2017 Open Enrollments by AHLearning

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Employee Health & Welfare Benefits Plan Year: 01/01/2017 â&#x20AC;&#x201C; 12/31/2017 Aspen Heights provides an extensive benefits package to help you and your covered dependents. Following is a general summary of the benefits, including contact information and where you can find additional information. Fulltime employees are eligible for benefits on the first of the month following date of hire. Blue Cross Blue Shield of Texas (Group # 111459) Network Deductible

Individual Family

Coinsurance Out-of-Pocket (OOP) Maximum Surgery Office Visits

Individual Family

Primary Care Specialist Preventive Care Urgent Care Emergency Room Pharmacy Copays (Retail) Pharmacy Copays (Mail Order)

Traditional Co-Pay Plan (PPO MM09) Blue Choice $1,000 $3,000 80% $4,000 ($1,000 Rx) $10,200 ($3,000 Rx) 80% after deductible $25 Copay $25 Copay $0 Copay $50 Copay 80% after $100 Copay $20 / $35 / $50 $60/ $105 / $150

High Deductible Health Plan (HDHP MMH3) Blue Choice $5,000 $10,000 100% $5,000 $10,000 100% after deductible 100% after deductible 100% after deductible 100% (no deductible) 100% after deductible 100% after deductible 100% after deductible 100% after deductible

Account-Based Plans

Health Savings Account (HSA) 2017 Annual Maximum2 Company Annual Contribution Employee Only $3,400 $1,000 Employee +Spouse/Domestic Partner1 $6,750 $1,500 Employee + Child(ren) $6,750 $1,500 Employee + Family $6,750 $2,000 Requires enrollment in High Deductible Health Plan (HDHP MMH3) 1Please see IRS guidelines regarding HSA distributions for domestic partners 2Employees age 55 and older are allowed and optional $1,000 additional annual contribution. ADP Flexible Spending Account (FSA) Medical Dependent Care (usually paired with Traditional Co-Pay Plan) $2,600 Annual Contribution Maximum $5,000 Annual Contribution Maximum MetLife (Group # 5932994) Dental Network

Network Deductible

Individual Family Coinsurance Levels by Preventive Care Service Type Basic Care Major Care Orthodontia Care Maximum Benefit Annual Orthodontia Lifetime Out-of-Network Reimbursement

Dental Plans MetLife PDP Plus Dental Plan 1 Best if using In-Network Providers $50 $150 100% (deductible waived) 100% after deductible 60% after deductible 50% (Adult & Child) $1,750 $1,500 Negotiated Fee

Dental Plan 2 Best if using Out-of-Network Providers $50 $150 100% (deductible waived) 80% after deductible 50% after deductible 50% (Adult & Child) $1,750 $1,500 90th R&C

MetLife (Group # 5932994) Vision Plan Vision Network VSP Network Copays Exam $10 copay Materials $25 copay Frequency Exam 12 Months Lenses 12 Months / 100% Contact Lenses* 12 Months / 100% (medically necessary) / $130 (elective) Frames 24 Months / Covered up to $130 allowance, then 20% discount off balance *Contacts are in lieu of glasses MetLife (Group # 5932994) Basic Life AD&D Plan Benefit 1x Salary Maximum Benefit $50,000 Guarantee Issue $50,000 All health benefits (medical, dental and vision) offer out-of-network benefits. However, as a participant you will incur significantly greater costs because of increased deductibles and out-of-pocket maximums, decreased allowances and/or balance billing. Please confirm your doctor or physician is a network provider before receiving services in order to maximize your benefit. Please note that this summary highlights some of the main features of your benefit programs, but does not include all plan rules, features, limitations or exclusions. The terms of your benefit plans are governed by legal documents including insurance contracts. Should there be any inconsistencies between this summary and the legal plan documents, the plan documents are the final authority.

Employee Health & Welfare Benefits Plan Year: 01/01/2017 – 12/31/2017 MetLife (Group # 5932994) Benefit

Guarantee Issue Evidence of Insurability

Employee Units of $10,000 up to the lesser of 5x salary or $500,000 maximum

Voluntary Life AD&D Plan* Spouse Units of $5,000 up to $250,000, not to exceed 50% of employee’s election

$100,000

$50,000

Child Units of $1,000, $2,000, $4,000, $5,000 or $10,000, not to exceed the spouse’s election N/A

Health Statement May Be Required

MetLife (Group # 5932994) Coverage Amount Maximum Benefit Maximum Duration Benefits Begin Pre-Existing Condition Evidence of Insurability MetLife (Group # 5932994) Coverage Amount Maximum Benefit Maximum Duration Benefits Begin Pre-Existing Condition Evidence of Insurability

N/A

Voluntary Short Term Disability Plan 60% of Weekly Earnings $1,500 Per Week 12 Weeks Day 8 3 / 12 Health Statement May Be Required Voluntary Long Term Disability Plan 60% of Monthly Earnings $7,500 Per Month SSNRA Day 91 12 / 12 Health Statement May Be Required

Deductions Per Paycheck (Semi-Monthly) Medical Traditional Co-Pay Plan (PPO MM09) $100.00 $234.84 $184.36 $324.68

High Deductible Health Plan (HDHP MMH3) $15.00 $30.00 $20.00 $40.00 Basic Life AD&D Plan 100% Employer Paid Voluntary Life AD&D Plan Please see rate sheet. Voluntary Short Term Disability Please see rate sheet Voluntary Long Term Disability Please see rate sheet.

Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Dental (Plan 1 & Plan2)

Vision

$5.00 $14.50 $15.00 $25.00

$1.00 $3.00 $3.00 $5.50

MetLife Employee Assistance Program (EAP) MetLife’s E4 Health’s Employee Assistance Program (EAP) is accessible to help with the everyday challenges of life. MetLife Will Prep Services with Basic Life AD&D WillsCenter.com is a secure, on-line will document generation service with the ability to create current, state-compliant documents including a will, living will, power of attorney and HIPAA authorization form. MetLife Will Prep Services with Voluntary Life AD&D Hyatt Legal Plans’ is a network of more than 13,400 participating attorneys for preparing and updating power of attorney and living wills. Carrier/Vendor Blue Cross Blue Shield of Texas MetLife MetLife MetLife / WillsCenter MetlIfe / Hyatt Legal Plans Tango / Optum ADP ADP / LifeCare

Benefit Covered Medical Dental, Vision, Life & Disability Employee Assistance Program Will Prep Services w/ Life AD&D Will Prep Services w/ Voluntary Life AD&D HSA Administration / HSA FSA Employee Assistance Program

Website www.bcbstx.com www.metlife.com/mybenefits www.metlifeeap.com www.willscenter.com N/A http://hsa.tangohealth.com www.spendingaccounts.info http://member.lifecare.com

Customer Service (800) 521-2227 (800) 275-4638 (844) 7-METLIFE N/A (800) 821-6400 (866) 384-8549 (800) 228-5762 (800) 697-7315

For additional support or questions regarding your health and welfare benefits, please contact: 84

(855) 889-3713 support@clspartners.com Monday – Thursday 8:00 am – 5:30 pm CST / Friday 8:00 am – 5:00 pm CST Please note that this summary highlights some of the main features of your benefit programs, but does not include all plan rules, features, limitations or exclusions. The terms of your benefit plans are governed by legal documents including insurance contracts. Should there be any inconsistencies between this summary and the legal plan documents, the plan documents are the final authority.

2017 Open Enrollment: How To’s and FAQs How to Print Out Your Current Benefit Summary: -

You don’t need to do this but some people like to have it when choosing their new enrollments In ADP (https://workforcenow.adp.com) go to Myself > Benefits > Enrollments Click the “VIEW/PRINT BENEFITS STATEMENT” link in the upper right area of the screen (it is in tiny blue font)

How to Enroll: -

In ADP (https://workforcenow.adp.com), the Open Enrollment wizard should pop up for you. o If you’ve forgotten your password, click Forgot password at the above link to reset it yourself. Click “Start This Enrollment”. o If you previously clicked “Don’t Show This Again” and the Open Enrollment wizard isn’t popping up for you at login go to Myself > Benefits > Benefit Enrollments

Review your dependents (if necessary. See instructions in How to Add a Dependent) Leave the radio dial next to “Walk Me Through My Benefit Options” selected and click “Continue” at the bottom.

Review the Welcome Message, then click into EACH category all the way down the left hand vertical menu.

As you click through the sections, a green check mark will appear. Once you’ve clicked through all of them, you can click “Review & Complete” on the upper right.

The system will ask you to waive any benefit that you did not choose to enroll in. Pick whichever reason you feel best applies and when finished, click “Complete Enrollment”

You’re done when you see the below message! Congratulations!!

How to Add a Dependent: -

If you are adding dependents (spouse/domestic partner and/or children) to your plan you will first need to add them as a Dependent in ADP:

Myself > Personal Information > Dependents & Beneficiaries

Click on the little green

button and choose Dependent / Beneficiary.

NOTE: If you enter them as Beneficiary Only you will not have the option to add them to your Medical/Dental/Vision coverage. ***You will need to wait for the new Dependent to be approved at ADP. Once approved, you’ll get an email from ADP, then you need to go back in to complete your enrollment. If you don’t go back in you will NOT have added the dependent to the plans.**

How to Enroll in the Flexible Spending Account for Medical (FSA Medical) or the Health Savings Account (HSA): -

If you enroll in the High Deductible Health Plan, HR will be creating your HSA Account in Tango. Once created HR will email you with instructions on how to activate it and set up your payroll deduction. Keep watch for an email with the subject line “ACTION ITEM: Activate Your HSA Account TODAY!” o HSA funds are NOT use-it-or-lose-it o See the Tango HSA FAQs for all things HSA related If you enrolled in the Traditional Co-Pay Medical Plan, HR will contact you to see if you want a Flexible Spending Account for Medical. o FSA Medical funds ARE use-it-or-lose-it. If you did not enroll in either of our Medical plans but would like to enroll in a Flexible Spending Account for Medical, please email Sarah Weiner (sweiner@myaspenheights.com) in HR during the Open Enrollment period to enroll.

How to Enroll in the Flexible Spending Account for Dependent Care (FSA Dependent Care): -

Regardless of if you enrolled in our Medical or which plan you chose, you can enroll in the FSA Dependent Care in the Open Enrollment Wizard in ADP. Funds are use-it-or-lose-it based on the calendar year (January 1-December 31) and must be used to pay licensed child care or other dependent care providers.

How to Find a BlueCross BlueShield of Texas Doctor: Yes, you still have BCBS of Texas coverage if you live outside Texas - we have great nationwide access to providers! It is important to make sure your doctor, lab, pharmacy, and any other service provider are in your Blue Cross network of providers before you go to receive care. To find an in-network provider: You can go to http://www.bcbstx.com/ Click on “Find a Doctor or Hospital” Click “Search Now” on the left vertical banner Toggle the “I’m looking for a doctor or hospital and I live in” field to North Carolina, click Start Search

Choose the Blue Choice PPO [BCA] Plan Network Scroll down and enter your criteria (zip code or doctor or facility name, etc.)

Additionally you can call Blue Cross at 800-521-2227 (Group #111544, Blue Cross Blue Choice PPO Network) as sometimes labs or practices don’t show up in these listings.

How to Find a MetLife In-Network Dentist: -

Go to https://www.metlife.com/individual/dental-insurance-center/index.html In the right hand column under Find a Dentist, enter your Zip code and select the PDP Plus Plan and hit “Go”

Reminder: If you are going to use all In-Network providers, you want to choose the In-Network plan. If you want to keep going to a dentist that is not in our network, you may want to choose the Out-of-Network plan because it will pick up more of your cost than the In-Network plan, but not as much as if you went to an In-Network provider with the In-Network plan.

How to Find a MetLife In-Network Vision Provider: - Go to www.metlife.com/mybenefits (Company Name “Brg Management”) - Log in (create an account if this is your first time) - Scroll down to Vision Benefits and enter your desired zip code in the Find a Provider field

Other FAQ’s: What’s changing? Do I need to log in if I have 2016 benefits? - Nothing in the Medical, Dental, or Vision is changing. These will “roll over” to 2017 with whatever selections you have now, unless you make changes during Open Enrollment. - ALL EMPLOYEES will need to ENROLL in the below plans if you want to have them for 2017 (they will NOT “roll over” from 2016): o MetLife Voluntary Life with AD&D o MetLife Short Term Disability o MetLife Long Term Disability When do these changes take effect? - Changes made during Open Enrollment will take effect January 1, 2017. When is my next opportunity to change/add/remove my benefits? - Your next chance to change your selection will be next year’s Annual Enrollment which will occur in November with changes taking effect January 1, 2018 (unless you have a Qualifying Event before then – see What is a Qualifying Event for more information). - NOTE: Short Term Disability and Long Term Disability are only available during your New Hire enrollment window and during Open Enrollment. It cannot be added later after a Life Event.

I am covered by someone else’s medical insurance (parents, spouse, etc). Should I enroll in Aspen Heights’ medical insurance also?  You will want to check to see if our coverage is more comprehensive and/or less expensive than keeping you on the other plan. If you enroll in our plan and you are also covered by another plan, your medical insurance through Aspen Heights will be your primary insurance (the one charged first) so there aren’t many scenarios where it makes sense to have a second insurance provider and it isn’t something generally recommended. If you have questions about your specific scenario, please contact CLS Partners to discuss (see contact information at the end of this email). I’m on my parents’ insurance and I’m getting close to turning 26 – what do I need to know?  Have your parents check with their insurance company and confirm that you will have coverage through the end of the month in which you turn 26.  You will have 30 days from the date you turn 26 to enroll in our benefits.  Email me once we get close to your birthday so I am aware of your status. I’m going to get married or have a baby in the next year – anything I need to know?  Email me once you know what your marriage month will be so I am aware of your status.  Email me once you/your partner know the month of the scheduled due date of your baby so I can be aware of your status.  You have 30 days from the date of the marriage or the baby’s birth to make changes to your benefits enrollments. You do NOT want to leave this until the last minute as there are multiple steps that need to be completed in a short amount of time. When will I get my insurance cards?  You should receive your Blue Cross insurance card within 2 weeks of your benefits effective date.  MetLife does not provide plastic Dental and Vision Cards therefore you will not receive any in the mail. You don’t technically need a card, just your group number (5932994) and your social security number. You can check your coverage by either dialing 1-800275-4638 (Dental) and 1-855-638-3931 (Vision) or you can access your profile within the MyBenefits site at www.metlife.com/mybenefits (Company Name “Brg Management Inc Dba Aspen Heights”) where you have the ability to view your coverage, find a provider, and print out an ID card similar to the ones attached. I am switching between plans or adding a new plan. When should I schedule my first appointment? - If you are already enrolled in the plan you should have no change in service. - If you are adding/changing between plans, I recommend waiting to schedule your first appointments until 1/15/17. It takes a while to get the coverage up and running and into all the appropriate databases. What if I need to go to the doctor or dentist but my provider says they can’t verify my benefits with the insurance company? - Sometimes this happens due to database errors between ADP and the carriers - Email Sarah Weiner in HR (sweiner@mysapenheights.com) and let her know the type of provider you are using (medical vs. dental, etc), when your appointment is, the contact information for the provider’s office, and who we should talk to. We will try to verbally verify your benefits for the provider.

What is our benefit plan year? - Our benefit plan year is January 1 – December 31st so your medical deductible will reset to zero on January 1st. What is a Qualifying Life Event? - A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.

Thank you! Warm Regards, Sarah Weiner | Payroll & Benefits Specialist Aspen Heights | Austin Office: 512.369.3030 x111 | Mobile: 310.717.3144 Direct: 512.910.3266 | Fax: 512-879-1179

Tango Health Savings Account (HSA) FAQs & How To’s If you are unfamiliar with how a Health Savings Account works, watch this short video: http://www.tangohealth.com/health-savings-account-101/ I have included the answers to Frequently Asked Questions below. If you have further questions, please contact the really awesome Customer Support Team at Tango: - Call toll-free at (866) 384-8549 - E-mail a question to support@tangohealth.com - Submit a ticket or search our forums at https://support.tangohealth.com NOTE: You can set up deductions from your paycheck in Tango (not in ADP). Any changes to payroll deductions in Tango will need to be made at least 6 business days before the payroll check date to take effect during the same pay period. You should receive your HSA debit card by mail at your mailing address within 12 business days of when you log in to activate your account. Please let me know if you have any questions or if you don't receive your card. To set up your HSA payroll deduction in Tango’s HSA Management Website: 1. Log in to Tango at https://hsa.tangohealth.com/t/a/login/launch 2. Click “Update Payroll Deduction” in the middle box To upload receipts for your HSA purchases in Tango’s HSA Management Website: 1. Log in to Tango at https://hsa.tangohealth.com/t/a/login/launch 2. Click “ Record & Review Expenses” in the middle box 3. You need to upload itemized receipts for all qualifying medical expenses, both those paid with your HSA Debit Card AND those paid for with cash/check/credit card. If you are ever audited you need to be able to show that these funds were only used on eligible expenses. To Reimburse Yourself for Medical Expenses NOT Paid For With Your HSA Debit Card: 1. Log in to Tango at https://hsa.tangohealth.com/t/a/login/launch 2. Click “Pay Yourself Back” in the middle box 3. Don’t forget to still upload your receipts To see what expenses qualify as HSA Eligible Expenses, click here: https://support.tangohealth.com/hc/en-us/articles/203441644-Eligible-Expenses Your HSA card is a debit card so you can only spend what you have in the account. You will use the same debit card for the life of your account – don’t throw it away just because you’ve used all the current funds. To check your balance, create an account at Optum Bank (if it is your first time click Register Now): https://secure.optumhealthfinancial.com/CAP/Portlets/login.jsf?OFSP_login=consumer

To request a new Optum Bank HSA Debit Card: Contact Optum Bank at 866-234-8913. ** To set up your 2017 elections while weâ&#x20AC;&#x2122;re still in 2016: 1) Log in to Tango at hsa.tangohealth.com 2) Click "Update payroll Deduction" in the center of the screen 3) Click "Change Payroll Deduction" on the right part of the screen 4) At the very top left it will say "Calculate for" and then have a radio button for 2016 or 2017. Click on the one next to 2017. 5) Enter the per paycheck (AKA per pay period) amount that you want deducted (we have 24 pay periods per year). Example: if you want to contribute $2000 over the year, take $2000 divided by 24 pay periods = $83.34 per pay period. 6) Click "Next" at the bottom 7) Make sure it says "$xxx desired 01/01/2017" at the top of the page so you make sure you are changing it for 2017. 8) Click "Confirm Change Request" Warm Regards, Sarah Weiner | Payroll & Benefits Specialist Aspen Heights | Austin Office: 512.369.3030 x111 | Mobile: 310.717.3144 Direct: 512.910.3266 | Fax: 512-879-1179

BlueChoice BlueEdge HSA MMH3

Summary of Benefits and Coverage: What this Plan Covers & What it Costs

Coverage Period: 01/01/2017 - 12/31/2017 Coverage for: Individual/Family |Plan Type: HSA

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbstx.com/member/policy-forms/2017 or by calling 1-800-521-2227. Important Questions

What is the overall deductible?

Are there other deductibles for specific services?

Answers Network: $5,000 Individual/$10,000 Family. Out-of-Network: $10,000 Individual/$20,000 Family. Doesn't apply to In-Network preventive care. No.

Why this Matters: You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Check your policy or plan document to see when the deductible starts over (usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible. You don’t have to meet deductibles for specific services, but see the chart starting on page 2 for other costs for services this plan covers.

Yes. Network: $5,000 The out-of-pocket limit is the most you could pay during a coverage period (usually one Individual/$10,000 Family. Is there an out-of-pocket year) for your share of the cost of covered services. This limit helps you plan for health care limit on my expenses? Out-of-Network: $20,000 expenses. Individual/$40,000 Family. Preauthorization penalties, What is not included in premiums, balance-billed charges, Even though you pay these expenses, they don’t count toward the out-of-pocket limit. and health care this plan doesn't the out-of-pocket limit? cover. If you use an in-network doctor or other health care provider, this plan will pay some or all Yes. See www.bcbstx.com or of the costs of covered services. Be aware, your in-network doctor or hospital may use an Does this plan use a call 1-800-810-2583 for a list of out-of-network provider for some services. Plans use the term in-network, preferred, or network of providers? Network Providers. participating for providers in their network. See the chart starting on page 2 for how this plan pays different kinds of providers. Do I need a referral to see a No. You don't need a referral to You can see the specialist you choose without permission from this plan. see a specialist. specialist? Are there services this plan Some of the services this plan doesn’t cover are listed on page 5. See your policy or plan Yes. document for additional information about excluded services. doesn't cover?

Questions: Call 1-800-521-2227 or visit us at www.bcbstx.com/coverage If you aren’t clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary at www.dol.gov/ebsa/pdf/SBCUniformGlossary.pdf or call 1-855-756-4448 to request a copy.

Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

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타 Copayments are fixed dollar amounts (for example, $15) you pay for covered health care, usually when you receive the service. 타 Coinsurance is your share of the costs of a covered service, calculated as a percent of the allowed amount for the service. For example, if the health plan's allowed amount for an overnight hospital stay is $1,000, your coinsurance payment of 20% would be $200. This may change if you haven't met your deductible. 타 The amount the plan pays for covered services is based on the allowed amount. If an out-of-network provider charges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowed amount is $1,000, you may have to pay the $500 difference. (This is called balance billing.) 타 The plan may encourage you to use Network providers by charging you lower deductibles, copayments, and coinsurance amounts.

Common Medical Event Services You May Need Primary care visit to treat an injury or illness If you visit a health care Specialist visit provider's office or clinic Other practitioner office visit

If you have a test

Your cost if you use a Network Provider

Your cost if you use an Out-of-Network Limitations & Exceptions Provider

No charge after deductible

30% coinsurance

No charge after deductible

30% coinsurance

No charge after deductible

30% coinsurance

Preventive No Charge care/screening/immunization

30% coinsurance

Diagnostic test (x-ray, blood work)

No charge after deductible

30% coinsurance

Imaging (CT/PET scans, MRIs)

No charge after deductible

30% coinsurance

---none---

There is No Charge for Out-of-Network immunizations from birth through the day of the 6th birthday. ---none---

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Common Medical Event Services You May Need

Your cost if you use a Network Provider

Your cost if you use an Out-of-Network Limitations & Exceptions Provider

No charge after deductible

If you need drugs to treat your illness or condition Non-preferred generic drugs

No charge after deductible

More information about Preferred brand drugs prescription drug coverage is available at www.bcbstx.com/memb Non-preferred brand drugs er/rx_drugs.html

No charge after deductible

Specialty drugs

No charge after deductible

Facility fee (e.g., ambulatory surgery center)

No charge after deductible

30% coinsurance

Physician/surgeon fees

No charge after deductible

30% coinsurance

Emergency room services

No charge after deductible

Emergency medical transportation

No charge after deductible

Urgent care

No charge after deductible

30% coinsurance

Facility fee (e.g., hospital room)

No charge after deductible

30% coinsurance

Physician/surgeon fee

No charge after deductible

30% coinsurance

Preferred generic drugs

If you have outpatient surgery

If you need immediate medical attention

If you have a hospital stay

Up to a 90-day supply for generic and brand drugs. Up to a 30-day supply for specialty drugs. Certain women's preventive services will be covered with no cost to the member.

---none---

Preauthorization required Out-of-Network; failure to preauthorize at least two business days prior to admission will result in $250 reduction in benefits. ---none---

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Common Medical Event Services You May Need Mental/behavioral health outpatient services

No charge after deductible

Mental/behavioral health inpatient services

No charge after deductible

If you have mental health, behavioral health, Substance use disorder or substance abuse outpatient services needs Substance use disorder inpatient services

If you are pregnant

Your cost if you use a Network Provider

No charge after deductible No charge after deductible

Your cost if you use an Out-of-Network Limitations & Exceptions Provider Outpatient: Preauthorization required for 30% coinsurance psychological testing, neuropsychological testing, electroconvulsive therapy, repetitive transcranial magnetic stimulation, and 30% coinsurance intensive outpatient treatment; failure to preauthorize at least two business days prior 30% coinsurance to service will result in 50% reduction in benefits (not to exceed $500). Inpatient: Preauthorization required Out-of-Network; 30% coinsurance failure to preauthorize at least two business days prior to admission will result in $250 reduction in benefits.

Prenatal and postnatal care

No charge after deductible

30% coinsurance

Delivery and all inpatient services

No charge after deductible

30% coinsurance

---none---

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No charge after deductible

Your cost if you use an Out-of-Network Limitations & Exceptions Provider 60 visit maximum per benefit period. 30% coinsurance Preauthorization required Out-of-Network; failure to preauthorize at least two business days prior to service will result in 50% reduction in benefits (not to exceed $500).

Rehabilitation services

No charge after deductible

30% coinsurance

Habilitation services

No charge after deductible

30% coinsurance

Skilled nursing care

No charge after deductible

30% coinsurance

Durable medical equipment

No charge after deductible

30% coinsurance

Hospice service

No charge after deductible

30% coinsurance

Eye exam

Not Covered

Glasses

Not Covered

Dental check-up

Not Covered

Common Medical Event Services You May Need Home health care If you need help recovering or have other special health needs

If your child needs dental or eye care

Your cost if you use a Network Provider

Limited to combined 35 visits per year, including Chiropractic. 25 day maximum per benefit period. Preauthorization required Out-of-Network; failure to preauthorize at least two business days prior to admission will result in $250 reduction in benefits. ---none--Preauthorization required Out-of-Network; failure to preauthorize at least two business days prior to admission will result in $250 reduction in benefits. ---none---

Excluded Services & Other Covered Services: Services Your Plan Does NOT Cover (This isn't a complete list. Check your policy or plan document for other excluded services.) Ÿ Ÿ Ÿ Ÿ

Abortions Acupuncture Bariatric surgery Cosmetic surgery

Ÿ Dental care (Adult) Ÿ Long term care Ÿ Most coverage provided outside the United States. See www.bcbstx.com

Ÿ Private duty nursing Ÿ Routine eye care (Adult and Child) Ÿ Weight loss programs

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Other Covered Services (This isn't a complete list. Check your policy or plan document for other covered services and your costs for these services.) Ÿ Chiropractic care Ÿ Hearing aids

Ÿ Infertility treatment (Invitro and artificial insemination are not covered unless shown in your plan document) Ÿ Non-emergency care when traveling outside the U.S.

Ÿ Routine foot care (Only covered in connection with diabetes, circulatory disorders of the lower extremities, peripheral vascular disease, peripheral neuropathy, or chronic arterial or venous insufficiency)

Your Rights to Continue Coverage: If you lose coverage under the plan, then, depending upon the circumstances, Federal and State laws may provide protections that allow you to keep health coverage. Any such rights may be limited in duration and will require you to pay a premium, which may be significantly higher than the premium you pay while covered under the plan. Other limitations on your rights to continue coverage may also apply. For more information on your rights to continue coverage, contact the plan at 1-800-521-2227. You may also contact your state insurance department, the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa, or the U.S. Department of Health and Human Services at 1-877-267-2323 x61565 or www.cciio.cms.gov.

Your Grievance and Appeals Rights: If you have a complaint or are dissatisfied with a denial of coverage for claims under your plan, you may be able to appeal or file a grievance. For questions about your rights, this notice, or assistance, you can contact Blue Cross and Blue Shield of Texas at 1-800-521-2227 or visit www.bcbstx.com, or contact U.S. Department of Labor's Employee Benefits Security Administration at 1-866-444-EBSA (3272) or visit www.dol.gov/ebsa/healthreform. Additionally, a consumer assistance program can help you file your appeal. Contact the Texas Department of Insurance's Consumer Health Assistance Program at 1-800-252-3439 or visit www.texashealthoptions.com.

Does this Coverage Provide Minimum Essential Coverage? The Affordable Care Act requires most people to have health care coverage that qualifies as “minimum essential coverage.” This plan or policy does provide minimum essential coverage.

Does this Coverage Meet the Minimum Value Standard? The Affordable Care Act establishes a minimum value standard of benefits of a health plan. The minimum value standard is 60% (actuarial value). This health coverage does meet the minimum value standard for the benefits it provides.

Language Access Services: Spanish (Español): Para obtener asistencia en Español, llame al 1-800-521-2227. Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 1-800-521-2227. 1-800-521-2227. Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 1-800-521-2227. To see examples of how this plan might cover costs for a sample medical situation, see the next page.

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About These Coverage Examples: These examples show how this plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under different plans.

This is not a cost estimator. Donâ&#x20AC;&#x2122;t use these examples to estimate your actual costs under the plan. The actual care you receive will be different from these examples, and the cost of that care also will be different. See the next page for important information about these examples.

Having a baby

Managing type 2 diabetes

(normal delivery)

(routine maintenance of a well-controlled condition)

n Amount owed to providers: $7,540 n Plan pays $2,340 n Patient pays $5,200 Sample care costs: Hospital charges (mother) Routine obstetric care Hospital charges (baby) Anesthesia Laboratory tests Prescriptions Radiology Vaccines, other preventive Total Patient pays: Deductibles Copays Coinsurance Limits or exclusions Total

n Amount owed to providers: $5,400 n Plan pays $320 n Patient pays $5,080 Sample care costs: Prescriptions Medical Equipment and Supplies Office Visits and Procedures Education Laboratory tests Vaccines, other preventive Total

$2,700 $2,100 $900 $900 $500 $200 $200 Patient pays: $40 Deductibles $7,540 Copays Coinsurance Limits or exclusions $5,000 Total $0 $0 $200 $5,200

$2,900 $1,300 $700 $300 $100 $100 $5,400 $5,000 $0 $0 $80 $5,080

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Questions and answers about Coverage Examples: What are some of the assumptions behind the Coverage Examples?

What does a Coverage Example show?

Can I use Coverage Examples to compare plans?

Ÿ Costs don’t include premiums. Ÿ Sample care costs are based on national averages supplied by the U.S. Department of Health and Human Services, and aren’t specific to a particular geographic area or health plan. Ÿ The patient’s condition was not an excluded or preexisting condition. Ÿ All services and treatments started and ended in the same coverage period. Ÿ There are no other medical expenses for any member covered under this plan. Ÿ Out-of-pocket expenses are based only on treating the condition in the example. Ÿ The patient received all care from in-network providers. If the patient had received care from out-of-network providers, costs would have been higher.

For each treatment situation, the Coverage Example helps you see how deductibles, copayments, and coinsurance can add up. It also helps you see what expenses might be left up to you to pay because the service or treatment isn’t covered or payment is limited.

üYes. When you look at the Summary of

Does the Coverage Example predict my own care needs?

Are there other costs I should consider when comparing plans?

ûNo. Treatments shown are just examples. The care you would receive for this condition could be different based on your doctor’s advice, your age, how serious your condition is, and many other factors.

Does the Coverage Example predict my future expenses?

ûNo. Coverage Examples are not cost

Benefits and Coverage for other plans, you’ll find the same Coverage Examples. When you compare plans, check the “Patient Pays” box in each example. The smaller that number, the more coverage the plan provides.

üYes. An important cost is the premium you pay. Generally, the lower your premium, the more you’ll pay in out-of-pocket costs, such as copayments, deductibles, and coinsurance. You should also consider contributions to accounts such as health savings accounts (HSAs), flexible spending arrangements (FSAs) or health reimbursement accounts (HRAs) that help you pay out-of-pocket expenses.

estimators. You can’t use the examples to estimate costs for an actual condition. They are for comparative purposes only. Your own costs will be different depending on the care you receive, the prices your providers charge, and the reimbursement your health plan allows.

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Blue Choice PPO MM09

Summary of Benefits and Coverage: What this Plan Covers & What it Costs

Coverage Period: 01/01/2017 - 12/31/2017 Coverage for: Individual/Family |Plan Type: PPO

What is the overall deductible?

Are there other deductibles for specific services?

Answers Why this Matters: Network: $1,000 Individual/$3,000 Family. Out-of-Network: $2,000 You must pay all the costs up to the deductible amount before this plan begins to pay for Individual/$6,000 Family. covered services you use. Check your policy or plan document to see when the deductible Doesn't apply to In-Network starts over (usually, but not always, January 1st). See the chart starting on page 3 for how preventive care, In-Network much you pay for covered services after you meet the deductible. office visits, or prescription drugs. Copays and prescription drug costs don't count toward the overall deductible. No.

You don’t have to meet deductibles for specific services, but see the chart starting on page 3 for other costs for services this plan covers.

Yes. For Network $4,000 Individual/$10,200 Family. For The out-of-pocket limit is the most you could pay during a coverage period (usually one Is there an out-of-pocket Out-of-Network $8,000 year) for your share of the cost of covered services. This limit helps you plan for health care limit on my expenses? Individual/$24,000 Family. Rx expenses. Out-of-Pocket expense limit: $1,000 Individual/$3,000 Family. Premiums, balance-billed charges, What is not included in and health care this plan doesn't Even though you pay these expenses, they don’t count toward the out-of-pocket limit. the out-of-pocket limit? cover. If you use an in-network doctor or other health care provider, this plan will pay some or all Yes. See www.bcbstx.com or of the costs of covered services. Be aware, your in-network doctor or hospital may use an Does this plan use a call 1-800-810-2583 for a list of out-of-network provider for some services. Plans use the term in-network, preferred, or network of providers? Network Providers. participating for providers in their network. See the chart starting on page 3 for how this plan pays different kinds of providers. Do I need a referral to see a No. You don't need a referral to You can see the specialist you choose without permission from this plan. see a specialist. specialist? Questions: Call 1-800-521-2227 or visit us at www.bcbstx.com/coverage If you aren’t clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary at www.dol.gov/ebsa/pdf/SBCUniformGlossary.pdf or call 1-855-756-4448 to request a copy.

Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

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Important Questions Answers Are there services this plan Yes. doesn't cover?

Why this Matters: Some of the services this plan doesnâ&#x20AC;&#x2122;t cover are listed on page 6. See your policy or plan document for additional information about excluded services.

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Common Medical Event Services You May Need Primary care visit to treat an injury or illness

If you visit a health care provider's office or clinic Specialist visit

Other practitioner office visit

If you have a test

Your cost if you use a Network Provider

Your cost if you use an Out-of-Network Limitations & Exceptions Provider

$25 copay/visit

30% coinsurance

$25 copay/visit

30% coinsurance

$25 copay/visit

30% coinsurance

Preventive No Charge care/screening/immunization

30% coinsurance

Diagnostic test (x-ray, blood work)

No Charge

30% coinsurance

Imaging (CT/PET scans, MRIs)

20% coinsurance

---none---

There is No Charge for Out-of-Network immunizations from birth through the day of the 6th birthday. ---none---

40% coinsurance

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Common Medical Event Services You May Need

Generic drugs

20% coinsurance plus copay

Preferred brand drugs

Retail - $35/$45 copay/prescription Mail - $105 copay/prescription

20% coinsurance plus copay

Retail - $50/$60 copay/prescription Mail - $150 copay/prescription

20% coinsurance plus copay

Specialty drugs

Retail - $20/$35/$50 copay/prescription

20% coinsurance plus copay

Facility fee (e.g., ambulatory surgery center)

20% coinsurance

40% coinsurance

Physician/surgeon fees

20% coinsurance

40% coinsurance

Emergency room services

20% coinsurance after $100 copay/visit

Emergency medical transportation

20% coinsurance

Urgent care

$50 copay/visit

30% coinsurance

Facility fee (e.g., hospital room)

20% coinsurance

40% coinsurance

Physician/surgeon fee

20% coinsurance

40% coinsurance

More information about prescription drug coverage is available at www.bcbstx.com/memb Non-preferred brand drugs er/rx_drugs.html

If you need immediate medical attention

If you have a hospital stay

Your cost if you use an Out-of-Network Limitations & Exceptions Provider

Retail - $20/$25 copay/prescription Mail - $60 copay/prescription

If you need drugs to treat your illness or condition

If you have outpatient surgery

Your cost if you use a Network Provider

Lower copay applies at preferred Participating pharmacies. One copay per 30-day supply - up to a 90-day supply for generic and brand drugs, up to a 30-day supply for specialty drugs. Payment of the difference between the cost of a brand name drug and a generic may also be required if a generic drug is available. Certain women's preventive services will be covered with no cost to the member. Rx Out-of-Pocket expense limit: $1,000 Individual/$3,000 Family.

---none---

Copay amount waived if admitted.

---none--Preauthorization required Out-of-Network; failure to preauthorize at least two business days prior to admission will result in $250 reduction in benefits. ---none---

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Common Medical Event Services You May Need Mental/behavioral health outpatient services Mental/behavioral health If you have mental health, behavioral health, inpatient services or substance abuse Substance use disorder needs outpatient services Substance use disorder inpatient services If you are pregnant

If you need help recovering or have other special health needs

Prenatal and postnatal care

Your cost if you use an Out-of-Network Limitations & Exceptions Provider Outpatient: Preauthorization required for $25 copay for office visits psychological testing, neuropsychological or 20% coinsurance for 40% coinsurance testing, electroconvulsive therapy, repetitive other outpatient services transcranial magnetic stimulation, and intensive outpatient treatment; failure to 20% coinsurance 40% coinsurance preauthorize at least two business days prior to service will result in 50% reduction in $25 copay for office visits benefits (not to exceed $500). Inpatient: or 20% coinsurance for 40% coinsurance Preauthorization required Out-of-Network; other outpatient services failure to preauthorize at least two business days prior to admission will result in $250 20% coinsurance 40% coinsurance reduction in benefits. Copay applies to first prenatal visit (per $25 copay/visit 30% coinsurance pregnancy). Your cost if you use a Network Provider

Delivery and all inpatient services

20% coinsurance

40% coinsurance

---none---

Home health care

No Charge

30% coinsurance

60 visit maximum per benefit period. Preauthorization required Out-of-Network; failure to preauthorize at least two business days prior to service will result in 50% reduction in benefits (not to exceed $500).

Rehabilitation services

20% coinsurance

40% coinsurance

Habilitation services

20% coinsurance

40% coinsurance

Limited to combined 35 visits per year, including Chiropractic.

Skilled nursing care

No Charge

30% coinsurance

Durable medical equipment

20% coinsurance

40% coinsurance

Hospice service

No Charge

30% coinsurance

25 day maximum per benefit period. Preauthorization required Out-of-Network; failure to preauthorize at least two business days prior to admission will result in $250 reduction in benefits. ---none--Preauthorization required Out-of-Network; failure to preauthorize at least two business days prior to admission will result in $250 reduction in benefits.

5 of 9

Common Medical Event Services You May Need

If your child needs dental or eye care

Your cost if you use a Network Provider

Your cost if you use an Out-of-Network Limitations & Exceptions Provider

Eye exam

Not Covered

Glasses

Not Covered

Dental check-up

Not Covered

---none---

Excluded Services & Other Covered Services: Services Your Plan Does NOT Cover (This isn't a complete list. Check your policy or plan document for other excluded services.) Ÿ Ÿ Ÿ Ÿ

Abortions Acupuncture Bariatric surgery Cosmetic surgery

Ÿ Dental care (Adult) Ÿ Long term care Ÿ Most coverage provided outside the United States. See www.bcbstx.com

Ÿ Private duty nursing Ÿ Routine eye care (Adult and Child) Ÿ Weight loss programs

Other Covered Services (This isn't a complete list. Check your policy or plan document for other covered services and your costs for these services.) Ÿ Chiropractic care Ÿ Hearing aids

Ÿ Infertility treatment (Invitro and artificial insemination are not covered unless shown in your plan document) Ÿ Non-emergency care when traveling outside the U.S.

7 of 9

Having a baby

Managing type 2 diabetes

(normal delivery)

(routine maintenance of a well-controlled condition)

n Amount owed to providers: $7,540 n Plan pays $5,390 n Patient pays $2,150 Sample care costs: Hospital charges (mother) Routine obstetric care Hospital charges (baby) Anesthesia Laboratory tests Prescriptions Radiology Vaccines, other preventive Total Patient pays: Deductibles Copays Coinsurance Limits or exclusions Total

n Amount owed to providers: $5,400 n Plan pays $3,220 n Patient pays $2,180 Sample care costs: Prescriptions Medical Equipment and Supplies Office Visits and Procedures Education Laboratory tests Vaccines, other preventive Total

$2,700 $2,100 $900 $900 $500 $200 $200 Patient pays: $40 Deductibles $7,540 Copays Coinsurance Limits or exclusions $1,000 Total $50 $900 $200 $2,150

$2,900 $1,300 $700 $300 $100 $100 $5,400 $1,000 $900 $200 $80 $2,180

8 of 9

Questions and answers about Coverage Examples: What are some of the assumptions behind the Coverage Examples?

What does a Coverage Example show?

Can I use Coverage Examples to compare plans?

üYes. When you look at the Summary of

Does the Coverage Example predict my own care needs?

Are there other costs I should consider when comparing plans?

Does the Coverage Example predict my future expenses?

ûNo. Coverage Examples are not cost

9 of 9

Dental

Plan Design for: Aspen Heights Original Plan Effective Date: January 1, 2016 Network: PDP Plus The Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs. You get benefits for a wide range of covered services â&#x20AC;&#x201D; both in and out of the network. The goal is to deliver affordable protection for a healthier smile and a healthier you.

Coverage Type: Type A - Preventive Type B - Basic Restorative Type C - Major Restorative Type D - Orthodontia

In-Network1 % of Negotiated 100% 100% 60% 50%

Fee2

Out-of-Network1 % of Negotiated Fee2 100% 100% 60% 50%

Deductible3 Individual Family

$50 $150

$1750

Annual Maximum Benefit: Per Individual Orthodontia Lifetime Maximum Ortho applies to Adult and Child Dependent Age:

Up to dependent age limit $1500 per Person $1500 per Person Eligible for benefits until the day that he or she turns 26.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ÂŠUnited Feature Syndicate, Inc.

L0714382252[exp0916][All States]

Understanding Your Dental Benefits Plan The Preferred Dentist Program is designed to provide the dental coverage you need with the features you want. Like the freedom to visit the dentist of your choice – in or out of the network. . If you receive in-network services, you will be responsible for any applicable cost sharing, negotiated charges after benefit maximums are met, and costs for non-covered services. If you receive out-of-network services, you will be responsible for any applicable cost sharing, charges in excess of the benefit maximum, charges in excess of the negotiated fee schedule amount, and charges for noncovered services.



Plan benefits are based on the percentage of the negotiated fee – the fee that participating dentists have agreed to accept as payment in full.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ©United Feature Syndicate, Inc.

L0714382252[exp0916][All States]

Selected Covered Services and Frequency Limitations* Type A - Preventive Y4

Oral Examinations Full Mouth X-rays Bitewing X-rays (Adult/Child) Prophylaxis - Cleanings Topical Fluoride Applications Sealants Space Maintainers Emergency Palliative Treatment Harmful Habits Appliances

How Many/How Often: 1 in 6 months 1 in 60 months 1 in 12 months 1 in 6 months 2 in 12 months - Children to age 14 1 in 36 months - Children to age 16 1 per lifetime per tooth area - Children up to age 16

Type B - Basic Restorative Amalgam and Composite Fillings Prefabricated Crowns Endodontics Root Canal Periodontal Surgery Periodontal Scaling & Root Planing Periodontal Maintenance Oral Surgery (Simple Extractions) Oral Surgery (Surgical Extractions) Other Oral Surgery General Anesthesia Consultations

How Many/How Often: 1 in 24 months. 1 per tooth in 24 months 1 per tooth per lifetime 1 in 36 months per quadrant 1 in 24 months per quadrant 2 in 1 year, includes 2 cleanings

1 in 12 months

Type C - Major Restorative Crowns/Inlays/Onlays Repairs Bridges Dentures Implant Services TMJ

How Many/How Often: 1 per tooth in 10 years 1 in 12 months 1 in 10 years 1 in 10 years 1 service per tooth in 10 years - 1 repair per 10 years Major Service as part of Annual Maximum.

Type D – Orthodontia   



Adult and Child Coverage. Dependent children up to age 26. Age limitations may vary by state. Please see your Plan description for complete details. In the event of a conflict with this summary, the terms of the certificate will govern. All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia. Benefits for the initial placement will not exceed 20% of the Lifetime Maximum Benefit Amount for Orthodontia. Periodic follow-up visits will be payable on a monthly basis during the scheduled course of the orthodontic treatment. Allowable expenses for the initial placement, periodic follow-up visits and procedures performed in connection with the orthodontic treatment, are all subject to the Orthodontia coinsurance level and Lifetime Maximum Benefit Amount as defined in the Plan Summary. Orthodontic benefits end at cancellation of coverage

*Alternate Benefits: Your dental plan provides that if there are two or more professionally acceptable dental treatment alternatives for a dental condition, your plan bases reimbursement, and the associated procedure charge, on the least costly treatment alternative. If you receive a more costly treatment alternative, your dentist may charge you or your dependent for the difference between the cost of the service that was performed and the least costly treatment alternative. The service categories and plan limitations shown above represent an overview of your Plan of Benefits. This document presents many services within each category, but is not a complete description of the Plan. Please see your Plan description for complete details. In the event of a conflict with this summary, the terms of the certificate will govern. Like most group dental insurance policies, MetLife group policies contain certain exclusions, limitations and waiting periods and terms for keeping them in force. The certificate of insurance sets forth all plan terms and provisions, including all exclusions and limitations.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ©United Feature Syndicate, Inc.

L0714382252[exp0916][All States]

We will not pay Dental Insurance benefits for charges incurred for: 1. 2. 3. 4. 5.

6. 7. 8. 9. 10. 11. 12. 13.

14.

15.

16.

17.

18. 19. 20. 21. 22. 23.

24.

25. 26. 27. 28. 29. 30. 31. 32. 33.

Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which We deem experimental in nature; Services for which You would not be required to pay in the absence of Dental Insurance; Services or supplies received by You or Your Dependent before the Dental Insurance starts for that person; Services which are primarily cosmetic (For residents of Texas, see notice page section in your certificate). Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for:  scaling and polishing of teeth; or  fluoride treatments. For NY Sitused Groups, this exclusion does not apply. Services or appliances which restore or alter occlusion or vertical dimension. Restoration of tooth structure damaged by attrition, abrasion or erosion. Restorations or appliances used for the purpose of periodontal splinting. Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco. Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss. Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work. Missed appointments. Services  covered under any workers’ compensation or occupational disease law;  covered under any employer liability law;  for which the employer of the person receiving such services is not required to pay; or  received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital. For North Carolina and Virginia Sitused Groups, this exclusion does not apply. Services paid under any worker’s compensation, occupational disease or employer liability law as follows:  for persons who are covered in North Carolina for the treatment of an Occupational Injury or Sickness which are paid under the North Carolina Workers’ Compensation Act only to the extent such services are the liability of the employee, employer or workers’ compensation insurance carrier according to a final adjudication under the North Carolina Workers’ Compensation Act or an order of the North Carolina Industrial Commission approving a settlement agreement under the North Carolina Workers’ compensation Act;  or for persons who are not covered in North Carolina, services paid or payable under any workers compensation or occupational disease law. This exclusion only applies for North Carolina Sitused Groups. Services:  for which the employer of the person receiving such services is not required to pay; or  received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital. This exclusion only applies for North Carolina Sitused Groups. Services covered under any workers' compensation, occupational disease or employer liability law for which the employee/or Dependent received benefits under that law. This exclusion only applies for Virginia Sitused Groups. Services:  for which the employer of the person receiving such services is not required to pay; or  received at a facility maintained by the policyholder, labor union, mutual benefit association, or VA hospital. This exclusion only applies for Virginia Sitused Groups. Services covered under other coverage provided by the Employer. Temporary or provisional restorations. Temporary or provisional appliances. Prescription drugs. Services for which the submitted documentation indicates a poor prognosis. The following when charged by the Dentist on a separate basis:  claim form completion;  infection control such as gloves, masks, and sterilization of supplies; or  local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide. Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food. For NY Sitused Groups, this exclusion does not apply. Caries susceptibility tests. Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth. Other fixed Denture prosthetic services not described elsewhere in this certificate. Precision attachments, except when the precision attachment is related to implant prosthetics. Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it. Repair or replacement of an orthodontic device.1 Duplicate prosthetic devices or appliances. Replacement of a lost or stolen appliance, Cast Restoration, or Denture. Intra and extraoral photographic images.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ©United Feature Syndicate, Inc.

L0714382252[exp0916][All States]

34. Services or supplies furnished as a result of a referral prohibited by Section 1-302 of the Maryland Health Occupations Article. A prohibited referral is one in which a Health Care Practitioner refers You to a Health Care Entity in which the Health Care Practitioner or Health Care Practitioner’s immediate family or both own a Beneficial Interest or have a Compensation Agreement. For the purposes of this exclusion, the terms “Referral”, “Health Care Practitioner” , “Health Care Entity”, “Beneficial Interest” and Compensation Agreement have the same meaning as provided in Section 1-301 of the Maryland Health Occupations Article. This exclusion only applies for Maryland Sitused Groups 1Some

of these exclusions may not apply. Please see your plan design and certificate for details.

Like most group dental insurance policies, MetLife group insurance policies contain certain exclusions, waiting periods, reductions and terms for keeping them in force. The certificate of insurance sets forth all plan terms and provisions, including all exclusions and limitations.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ©United Feature Syndicate, Inc.

L0714382252[exp0916][All States]

Common Questions … Important Answers Who is a participating dentist? A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for services provided to plan members. Negotiated fees typically range from 15-45% below the average fees charged in a dentist’s community for the same or substantially similar services.* * Based on internal analysis by MetLife. Savings from enrolling in a dental benefits plan will depend on various factors, including how often members visit participating dentists and the cost for services rendered. Negotiated fees are subject to change. Negotiated fees for non-covered services may not apply in all states.

How do I find a participating PDP dentist? There are thousands of general dentists and specialists to choose from nationwide --so you are sure to find one that meets your needs. You can receive a list of these participating PDP dentists online at www.metlife.com/dental or call 1-800-275-4638 to have a list faxed or mailed to you.

What services are covered by my plan? All services defined under your group dental benefits plan are covered. Please review the enclosed plan benefits to learn more.

Does the Preferred Dentist Program offer any discounts on non-covered services? Negotiated fees may extend to services not covered under your plan and services received after your plan maximum has been met, where permitted by applicable state law. If permitted, you may only be responsible for the negotiated fee. * Negotiated fees are subject to change. Negotiated fees for non-covered services may not apply in all states.

May I choose a non-participating dentist? Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. He or she hasn’t agreed to accept negotiated fees. So you may be responsible for any difference in cost between the dentist's fee and your plan's benefit payment.

Can my dentist apply for participation in the network? Yes. If your current dentist does not participate in the network and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.* The website and phone number are for use by dental professionals only. * Due to contractual requirements, MetLife is prevented from soliciting certain providers.

How are claims processed? Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive e-mail alerts when a claim has been processed. If you need a claim form, visit www.metlife.com/dental or request one by calling 1-800-275-4638.

Can I find out what my out-of-pocket expenses will be before receiving a service? Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. The estimate helps you prepare for the cost of dental services. We recommend that you request a pre-treatment estimate for services in excess of $300. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.

How can I learn about what dentists in my area charge for different procedures? If you have MyBenefits you can access the Dental Procedure Fee Tool. You can use the tool to look up average in- and out-ofnetwork fees for dental services in your area.* You'll find fees for services such as exams, cleanings, fillings, crowns, and more. Just log in at www.metlife.com/mybenefits. * The Dental Procedure Fee Tool application is provided by go2dental.com. Inc., an independent vendor. Network fee information is supplied to go2dental.com by MetLife and is not available for providers who participate with MetLife through a vendor. Out-of-network fee information is provided by go2dental.com. This tool does not provide the payment information used by MetLife when processing your claims. Prior to receiving services, pretreatment estimates through your dentist will provide the most accurate fee and payment information..

Can MetLife help me find a dentist outside of the U.S. if I am traveling? Yes. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (collect) when outside the U.S. to receive immediate care until you can see your dentist. Coverage will be considered under your out-of-network benefits.** Please remember to hold on to all receipts to submit a dental claim. *International Dental Travel Assistance services are administered by AXA Assistance USA, Inc. AXA Assistance is not affiliated with MetLife and any of its affiliates, and the services they provide are separate and apart from the benefits provided by MetLife. ** Refer to your dental benefits plan summary for your out-of-network dental coverage.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ©United Feature Syndicate, Inc.

L0714382252[exp0916][All States]

How does MetLife coordinate benefits with other insurance plans? Coordination of benefits provision in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. These rules determine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan.

Do I need an ID card? No, you do not need to present an ID card to confirm that you are eligible. You should notify your dentist that you are enrolled in MetLifeâ&#x20AC;&#x2122;s Preferred Dentist Program. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system.

Do my dependents have to visit the same dentist that I select? No, you and your dependents each have the freedom to choose any dentist.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ÂŠUnited Feature Syndicate, Inc.

L0714382252[exp0916][All States]

Dental

Plan Design for: Aspen Heights Original Plan Effective Date: January 1, 2016 Network: PDP Plus The Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs. You get benefits for a wide range of covered services — both in and out of the network. The goal is to deliver affordable protection for a healthier smile and a healthier you.

Coverage Type: Type A - Preventive Type B - Basic Restorative Type C - Major Restorative Type D - Orthodontia

In-Network1 % of Negotiated 100% 80% 50% 50%

Fee2

Out-of-Network1 % of R&C Fee4 100% 80% 50% 50%

Deductible3 Individual Family

$50 $150

$1750

Annual Maximum Benefit: Per Individual Orthodontia Lifetime Maximum Ortho applies to Adult and Child Dependent Age:

Up to dependent age limit $1500 per Person $1500 per Person Eligible for benefits until the day that he or she turns 26.

1. "In-Network Benefits" means benefits provided under this plan for covered dental services that are provided by a MetLife PDP dentist. "Out-of-Network Benefits" means benefits provided under this plan for covered dental services that are not provided by a MetLife PDP dentist. 2. PDP Fee refers to the fees that MetLife PDP dentists have agreed to accept as payment in full. 3. Applies to Type B and C services only. 4. Out-of-network benefits are payable for services rendered by a dentist who is not a participating provider. The Reasonable and Customary charge is based on the lowest of:  the dentist’s actual charge (the 'Actual Charge'),  the dentist’s usual charge for the same or similar services (the 'Usual Charge') or  the usual charge of most dentists in the same geographic area for the same or similar services as determined by MetLife (the 'Customary Charge'). For your plan, the Customary Charge is based on the 90th percentile. Services must be necessary in terms of generally accepted dental standards.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ©United Feature Syndicate, Inc.

L0714382252[exp0916][All States]

 Plan benefits for in-network services are based on the percentage of the negotiated fee – the fee that participating dentists have agreed to accept as payment in full.

 Plan benefits for out-of-network services are based on the percentage of the Reasonable and Customary (R&C) charges. If you choose a dentist who does not participate in the network, your out-of-pocket expenses may be more, since you will be responsible for paying any difference between the dentist's fee and your plan's payment for the approved service

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ©United Feature Syndicate, Inc.

L0714382252[exp0916][All States]

Selected Covered Services and Frequency Limitations* Type A - Preventive Y4

How Many/How Often: 1 in 24 months. 1 per tooth in 24 months 1 per tooth per lifetime 1 in 36 months per quadrant 1 in 24 months per quadrant 2 in 1 year, includes 2 cleanings

1 in 12 months

Type C - Major Restorative Crowns/Inlays/Onlays Repairs Bridges Dentures Implant Services TMJ

How Many/How Often: 1 per tooth in 10 years 1 in 12 months 1 in 10 years 1 in 10 years 1 service per tooth in 10 years - 1 repair per 10 years Major Service as part of Annual Maximum.

Type D – Orthodontia   



Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ©United Feature Syndicate, Inc.

L0714382252[exp0916][All States]

We will not pay Dental Insurance benefits for charges incurred for: 1. 2. 3. 4. 5.

6. 7. 8. 9. 10. 11. 12. 13.

14.

15.

16.

17.

18. 19. 20. 21. 22. 23.

24.

25. 26. 27. 28. 29. 30. 31. 32. 33.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ©United Feature Syndicate, Inc.

L0714382252[exp0916][All States]

of these exclusions may not apply. Please see your plan design and certificate for details.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ©United Feature Syndicate, Inc.

L0714382252[exp0916][All States]

What services are covered by my plan? All services defined under your group dental benefits plan are covered. Please review the enclosed plan benefits to learn more.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ©United Feature Syndicate, Inc.

L0714382252[exp0916][All States]

Do my dependents have to visit the same dentist that I select? No, you and your dependents each have the freedom to choose any dentist.

Metropolitan Life Insurance Company, New York, NY 10166 PEANUTS ÂŠUnited Feature Syndicate, Inc.

L0714382252[exp0916][All States]

In-network benefits There are no claims for you to file when you go to a participating vision specialist. Simply pay your copay and, if applicable, any amount over your allowance at the time of service. Frequency

With your Vision Preferred Once every 12 months Eye exam Provider Organization Plan,  Eye health exam, dilation, prescription and refraction for glasses: Covered in full after $10 you can: copay.  Retinal imaging:1 Up to a $39 copay on routine retinal screening when performed by a Go to any licensed vision specialist private practice provider. and receive coverage. Just remember your benefit dollars go further when Frame Once every 24 months you stay in network.  Allowance: $130 after $25 eyewear copay. Choose from a large network of ophthalmologists, optometrists and opticians, from private practices to retailers like Costco® Optical and Vision works.

 Costco: $70 allowance after $25 eyewear copay. You will receive an additional 20% savings on the amount that you pay over your allowance. This offer is available from all participating locations except Costco. 1

Take advantage of our service Once every 12 months Standard corrective lenses agreement with Walmart and Sam's Club—they check your eligibility and  Single vision, lined bifocal, lined trifocal, lenticular: Covered in full after $25 eyewear copay process claims even though they are out of network. Once every 12 months Standard lens enhancements1

In-network value added features:

 Polycarbonate (child up to age 18) and Ultraviolet (UV) coating: Covered in full after $25 eyewear copay.

Additional lens enhancements:1 Average 20-25% savings on all other  Progressive, Polycarbonate (adult), Photochromic, Anti-reflective, Scratch-resistant lens enhancements. coatings and Tints: Your cost will be limited to a copay that MetLife has negotiated for you. These copays can be viewed after enrollment at www.metlife.com/mybenefits. Savings on glasses and sunglasses: Once every 12 months Get 20% savings on additional pairs Contact lenses instead of eye of prescription glasses and nonglasses prescription sunglasses, including  Contact fitting and evaluation:1 Covered in full with a maximum copay of $60. lens enhancements. At times, other  Elective lenses: $130 allowance. promotional offers may also be  Necessary lenses: Covered in full after eyewear copay. available. Laser vision correction: 2 Savings averaging 15% off the regular price or 5% off a promotional offer for We’re here to help laser surgery including PRK, LASIK and Custom LASIK. This offer is only Find a participating vision specialist: available at www.metlife.com/mybenefits or call [1-855-MET-EYE1 (1-855-638-3931)] MetLife participating locations. Get a claim form: www.metlife.com/mybenefits General questions: www.metlife.com/mybenefits or call [1-855-MET-EYE1 (1-855-638-3931)]

Page 1 of 2

Out-of-network reimbursement You pay for services and then submit a claim for reimbursement. The same benefit frequencies for In-network benefits apply. Once you enroll, visit www.metlife.com/mybenefitsfor detailed out-of-network benefits information. 

Eye exam: up to $45



Single vision lenses: up to $30



Lined trifocal lenses: up to $65



Frames: up to $70



Lined bifocal lenses: up to $50



Progressive lenses: up to $50



Contact lenses:



Lenticular lenses: up to $100

- Elective up to $105 - Necessary up to $210

Exclusions and Limitations of Benefits This plan does not cover the following services, materials and treatments.

Services and Eyewear Services and/or materials not specifically included in the Vision Plan Benefits Overview (Schedule of Benefits).

committing or attempting to commit a felony. Contact lens insurance policies and Services and materials obtained while outside service agreements. the United States, except for emergency vision Refitting of contact lenses after the care. initial (90-day) fitting period. Services, procedures, or materials for which a Contact lens modification, polishing, charge would not have been made in the and cleaning. absence of insurance.

Treatments Services: (a) for which the employer of the Orthoptics or vision training and any person receiving such services is not required associated supplemental testing. to pay; or (b) received at a facility maintained Any portion of a charge above the Maximum Benefit Allowance or reimbursement indicated by the Employer, labor union, mutual benefit Medical and surgical treatment of association, or VA hospital. in the Schedule of Benefits. the eye(s). Services, to the extent such services, or Any eye examination or corrective eyewear benefits for such services, are available under required as a condition of employment. Medications a Government Plan. This exclusion will apply Prescription and non-prescription Services and supplies received by you or your whether or not the person receiving the medication Dependent before the Vision Insurance starts. services is enrolled for the Government Plan. Missed appointments. Services or materials resulting from or in the course of a Covered Person’s regular occupation for pay or profit for which the Covered Person is entitled to benefits under any Workers’ Compensation Law, Employer’s Liability Law or similar law. You must promptly claim and notify the Company of all such benefits.

We will not exclude payment of benefits for such services if the Government Plan requires that Vision Insurance under the Group Policy be paid first. Government Plan means any plan, program, or coverage which is established under the laws or regulations of any government. The term does not include any plan, program, or coverage provided by a government as an employer or Medicare.

Plano lenses (lenses with refractive correction Local, state and/or federal taxes, except where of less than ± .50 diopter). MetLife is required by law to pay. Two pairs of glasses instead of bifocals. Services or materials received as a result of disease, defect, or injury due to war or an act of Replacement of lenses, frames and/or contact lenses furnished under this Plan which are lost, war (declared or undeclared), taking part in a stolen, or damaged (within the 12 month riot or insurrection, or benefit period from date of purchase.) 1All

lens enhancements are available at participating private practices. Maximum copays and pricing are subject to change without notice. Please check with your provider for details and copays applicable to your lens choice. Please contact your local Costco to confirm the availability of lens enhancements and pricing prior to receiving services. Additional discounts may not be available in certain states. Custom LASIK coverage only available using wavefront technology with the microkeratome surgical device. Other LASIK procedures may be performed at an additional cost to the member. Additional savings on laser vision care is only available at participating locations. 2

Important: If you or your family members are covered by more than one health care plan, you may not be able to collect benefits from both plans. Each plan may require you to follow its rules or use specific doctors and hospitals, and it may be impossible to comply with both plans at the same time. Before you enroll in this plan, read all of the rules very carefully and compare them with the rules of any other plan that covers you or your family. M130D-10/25 Benefits are underwritten by Metropolitan Life Insurance Company, New York, NY. Certain claims and network administration services are provided through Vision Service Plan. In certain states, availability of MetLife’s group vision benefits is subject to regulatory approval. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details. Metropolitan Life Insurance Company, New York, NY 10166 © 2014 METLIFE, INC. L0415420066[exp0616][All States][DC,GU,MP,PR,VI]

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Basic Term Life / AD&D

Plan Design for: Aspen Heights Original Plan Effective Date: January 1, 2016 For All Active Full Time Employees working at least 30 hours per week

Accidental Death & Dismemberment

An amount equal to 1 times Your Basic Annual Earnings, rounded to the next higher $1,000. An amount equal to Your Basic Life Insurance.

Plan Maximum

$50,000

Non-Medical Maximum

$50,000

Age Reduction Formula

Other

Employee Contribution • Basic Life • AD&D

Basic Life

Term Life Features (1) • Continuation of Life insurance while totally disabled as defined by the Group Policy (2) • Accelerated Benefits Option (3) • Total Control Account (4) • Portability (5) AD&D Features (1) • Seat Belt Benefit (6) • Common Carrier Benefit • Air Bag Benefit • Total Control Account

L0615428011[exp0816][All States][DC,GU,MP,PR,VI] Metropolitan Life Insurance Company, 200 Park Ave., New York, NY 10166

What Is Not Covered? Like most insurance plans, this plan has exclusions. In addition, a reduction schedule may apply. Please see your benefits administrator or certificate for specific details. Accidental Death & Dismemberment insurance does not include payment for any loss which is caused by or contributed to by: physical or mental illness, diagnosis of or treatment of the illness; an infection, unless caused by an external wound accidentally sustained; suicide or attempted suicide; injuring oneself on purpose; the voluntary intake or use by any means of any drug, medication or sedative, unless taken as prescribed by a doctor or an over-the-counter drug taken as directed; voluntary intake of alcohol in combination with any drug, medication or sedative; war, whether declared or undeclared, or act of war, insurrection, rebellion or riot; committing or trying to commit a felony; any poison, fumes or gas, voluntarily taken, administered or absorbed; service in the armed forces of any country or international authority, except the United States National Guard; operating, learning to operate, or serving as a member of a crew of an aircraft; while in any aircraft for the purpose of descent from such aircraft while in flight (except for self preservation); or operating a vehicle or device while intoxicated as defined by the laws of the jurisdiction in which the accident occurs. Life and AD&D coverages are provided under a group insurance policy (Policy Form GPNP99 or G2130-S) issued to your employer by MetLife. Life and AD&D coverages under your employer’s plan terminates when your employment ceases when your Life and AD&D contributions cease, or upon termination of the group insurance policy. Should your life insurance coverage terminate for reasons other than non-payment of premium, you may convert it to a MetLife individual permanent policy without providing medical evidence of insurability. This summary provides an overview of your plan’s benefits. These benefits are subject to the terms and conditions of the contract between MetLife and your employer. Specific details regarding these provisions can be found in the certificate. If you have additional questions regarding the Life Insurance program underwritten by MetLife, please contact your benefits administrator or MetLife. Like most group life insurance policies, MetLife group policies contain exclusions, limitations, terms and conditions for keeping them in force. Please see your certificate for complete details.

(1) Features may vary depending on jurisdiction. (2) Total disability or totally disabled means your inability to do your job and any other job for which you may be fit by education, training or experience, due to injury or sickness. Please note that this benefit is only available after you have participated in the Basic/Supplemental Term Life Plan for 1 year and it is only available to the employee. (3) When life expectancy is certified by a physician to be 12 months or less. The Accelerated Benefits Option (ABO) is subject to state availability and regulation. The ABO benefits are intended to qualify for favorable federal tax treatment in which case the benefits will not be subject to federal taxation. This information was written as a supplement to the marketing of life insurance products. Tax laws relating to accelerated benefits are complex and limitations may apply. You are advised to consult with and rely on an independent tax advisor about your own particular circumstances. Receipt of ABO benefits may affect your eligibility, or that of your spouse or your family, for public assistance programs such as medical assistance (Medicaid), Temporary Assistance to Needy Families (TANF), Supplementary Social Security Income (SSI) and drug assistance programs. You are advised to consult with social service agencies concerning the effect that receipt of ABO benefits will have on public assistance eligibility for you, your spouse or your family. (4) The Total Control Account (TCA) is provided for all Life and AD&D benefits of $5,000 or more. The TCA is not insured by the Federal Deposit Insurance Corporation or any government agency. The assets backing TCAs are maintained in MetLife’s general account and are subject to MetLife’s creditors. MetLife bears the investment risk of the assets backing the TCAs, and expects to receive a profit. Regardless of the investment experience of such assets, the interest credited to TCAs will never fall below the guaranteed minimum rate. Guarantees are subject to the financial strength and claims paying ability of MetLife. (5) Subject to state availability. To take advantage of this benefit, coverage of at least $10,000 must be elected. (6) The Seat Belt Benefit is payable if an insured person dies as a result of injuries sustained in an accident while driving or riding in a private passenger car and wearing a properly fastened seat belt _or a child restraint if the insured is a child_. In such case, his or her benefit can be increased by 10 percent of the Full Amount — but not less than $1,000 or more than $25,000.

L0615428011[exp0816][All States][DC,GU,MP,PR,VI] Metropolitan Life Insurance Company, 200 Park Ave., New York, NY 10166

Supplemental Term Life

Plan Design for: Aspen Heights Original Plan Effective Date: January 1, 2016 For All Active Full Time Employees working at least 30 hours per week Build Your Benefit With MetLife's Supplemental Term Life insurance, your employer gives you the opportunity to buy valuable life insurance coverage for yourself, your spouse and your dependent children -- all at affordable group rates. Employee Spouse1

Child

Increments of $10,000

Increments of $5,000

Flat Amount: $1,000, $2,000, $4,000, $5,000, or $10,000

$100,000

$25,000

$10,000

The lesser of 5 times Your Basic Annual Earnings, or $500,000

$250,000

$10,000

Yes (benefit amount is same as Supplemental Term Life coverage)

Maximum amount is same as Supplemental Term Life coverage

100%

Life Coverage: provides a benefit in the event of death Schedules: Non Medical Maximum Overall Benefit Maximum AD&D Coverage: provides a benefit in the event of death or dismemberment resulting from a covered accident Schedules:

AD&D Maximum

Spouse & Child

Employee Contribution

Any purchase or increase in benefits, which does not take place within 31 days of employeeâ&#x20AC;&#x2122;s or dependent's eligibility effective date is subject to evidence of insurability. Coverage is subject to the approval of MetLife.

To request coverage: 1. Choose the amount of employee coverage that you want to buy. 2. Look up the premium costs for your age group for the coverage amount you are selecting on the chart below. 3. Choose the amount of coverage you want to buy for your spouse. Again, find the premium costs on the chart below. Note: Premiums are based on your age, not your spouseâ&#x20AC;&#x2122;s. 4. Choose the amount of coverage you want to buy for your dependent children. The premium costs for each coverage option are shown below. 5. Fill in the enrollment form with the amounts of coverage you are selecting. (To request coverage over the non-medical maximum, please see your Human Resources representative for a medical questionnaire that you will need to complete.) Remember, you must purchase coverage for yourself in order to purchase coverage for your spouse or children.

Employee Age Under 30 30-34

Employee & Spouse Coverage -- Monthly Premium For: $1,000 $0.09 $0.10

$10,000 $0.87 $0.97

$20,000 $1.74 $1.94

$40,000 $3.48 $3.88

$50,000 $4.35 $4.85

$100,000 $8.70 $9.70

Dependent Child Coverage2 Monthly Premium For: $1,000

$0.29

$2,000

$0.58

L0314365531[exp0316] [All States][DC,GU,MP,PR,VI] Metropolitan Life Insurance Company, 200 Park Ave., New York, NY 10166

35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

$0.12 $0.19 $0.29 $0.43 $0.68 $1.13 $1.80 $2.93

$1.22 $1.87 $2.87 $4.27 $6.77 $11.27 $17.97 $29.27

$2.44 $3.74 $5.74 $8.54 $13.54 $22.54 $35.94 $58.54

$4.88 $7.48 $11.48 $17.08 $27.08 $45.08 $71.88 $117.08

$6.10 $9.35 $14.35 $21.35 $33.85 $56.35 $89.85 $146.35

$12.20 $18.70 $28.70 $42.70 $67.70 $112.70 $179.70 $292.70

$4,000

$1.16

$5,000

$1.46

$10,000

$2.91

Due to rounding, your actual payroll deduction amount may vary slightly.

Features available with Supplemental Life Will Preparation Service† Like life insurance, a carefully prepared Will is important. With a Will, you can define your most important decisions such as who will care for your children or inherit your property. By enrolling for Supplemental Term Life coverage, you will have in person access to Hyatt Legal Plans' network of 11,500+ participating attorneys for preparing or updating a will, living will and power of attorney. When you enroll in this plan, you may take advantage of this benefit at no additional cost to you if you use a participating plan attorney. To obtain the legal plan's toll-free number and your company's group access number, contact your employer or your plan administrator for this information. MetLife Estate Resolution Services (ERS)† is a valuable service offered under the group policy. A Hyatt Legal Plan attorney will consult with your beneficiaries by telephone or in person regarding the probate process for your estate. The attorney will also handle the probate of your estate for your executor or administrator.. This can help alleviate the financial and administrative burden upon your loved ones in their time of need. Portability*: If your present employment ends, you can choose to continue your current life benefits.

What Is Not Covered? Like most insurance plans, this plan has exclusions. Supplemental and Dependent Life Insurance do not provide payment of benefits for death caused by suicide within the first two years (one year in North Dakota) of the effective date of the certificate, or payment of increased benefits for death caused by suicide within two years (one year in North Dakota or Colorado) of an increase in coverage. In addition, a reduction schedule may apply. Please see your benefits administrator or certificate for specific details. Accidental Death & Dismemberment insurance does not include payment for any loss which is caused by or contributed to by: physical or mental illness, diagnosis of or treatment of the illness; an infection, unless caused by an external wound accidentally sustained; suicide or attempted suicide; injuring oneself on purpose; the voluntary intake or use by any means of any drug, medication or sedative, unless taken as prescribed by a doctor or an over-the-counter drug taken as directed; voluntary intake of alcohol in combination with any drug, medication or sedative; war, whether declared or undeclared, or act of war, insurrection, rebellion or riot; committing or trying to commit a felony; any poison, fumes or gas, voluntarily taken, administered or absorbed; service in the armed forces of any country or international authority, except the United States National Guard; operating, learning to operate, or serving as a member of a crew of an aircraft; while in any aircraft for the purpose of descent from such aircraft while in flight (except for self preservation); or operating a vehicle or device while intoxicated as defined by the laws of the jurisdiction in which the accident occurs. Life and AD&D coverages are provided under a group insurance policy (Policy Form GPNP99 or G2130-S) issued to your employer by MetLife. Life and AD&D coverages under your employer’s plan terminates when your employment ceases, when your Life and AD&D contributions cease, or upon termination of the group insurance policy. Dependent Life coverage will terminate when a dependent no longer qualifies as a dependent. Should your life insurance coverage terminate for reasons other than non-payment of premium, you may convert it to a MetLife individual permanent policy without providing medical evidence of insurability. This summary provides an overview of your plan’s benefits. These benefits are subject to the terms and conditions of the contract between MetLife and your employer and are subject to each state’s laws and availability. Specific details regarding these provisions can be found in the certificate. If you have additional questions regarding the Life Insurance program underwritten by MetLife, please contact your benefits administrator or MetLife. Like most group life insurance policies, MetLife group policies contain exclusions, limitations, terms and conditions for keeping them in force. Please see your certificate for complete details. 1. Spouse amount cannot exceed 50% of the employee’s Supplemental Life benefit. 2. Child benefits for children under 6 months old are limited.

L0314365531[exp0316] [All States][DC,GU,MP,PR,VI] Metropolitan Life Insurance Company, 200 Park Ave., New York, NY 10166

â&#x20AC; Will Preparation and MetLife Estate Resolution Services are offered by Hyatt Legal Plans, Inc., Cleveland, Ohio. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and Affiliates, Warwick, Rhode Island. Will Preparation and Estate Resolution Services are subject to regulatory approval and currently available in all states. For New York sitused cases, the Will Preparation service is an expanded offering that includes office consultations and telephone advice for certain other legal matters beyond Will Preparation. *Subject to state availability. To take advantage of this benefit, coverage of at least $10,000 must be elected.

L0314365531[exp0316] [All States][DC,GU,MP,PR,VI] Metropolitan Life Insurance Company, 200 Park Ave., New York, NY 10166

Short Term Disability

BRG Management Inc. (dba Aspen Heights) Plan Benefits Original Plan Effective Date: January 1, 2017 Explore the coverage that helps you protect your income and your lifestyle. What is Short-Term Disability Insurance? Short-Term Disability insurance can help replace a portion of your income during the initial weeks of a disability to help you pay your bills and help maintain your current lifestyle. It helps by protecting you and your income if a sickness or accidental injury kept you from working. The plan is being made available to you through your employer and with the convenience of payroll deduction.

Why Should I Consider Short-Term Disability Insurance? While most people typically insure their lives and other material assets like homes or automobiles, many overlook the need to protect one of their most valuable assets – their ability to work and earn a living. When Disability strikes, your ability to earn an income becomes interrupted, however, your monthly bills continue. Would you be adequately prepared to cover present and future financial obligations if you were to fall sick or become disabled and not able to work for a short period?

Consider the Following,.,, 41% of employees surveyed by MetLife are very concerned about having enough money to make ends meet.1 40% of employees surveyed in MetLife’s 11th Annual Employee Benefits Trends Study say living paycheck to paycheck describes them perfectly.1 Just over 1 in 4 of today’s 20-year-olds will become disabled before reaching age 67.2

Eligibility Requirements All Active Full Time Employees working at least 30 hours per week are eligible to participate.

How is "Disability" defined under the Plan? Generally, you are considered disabled and eligible for short term benefits if, due to sickness, pregnancy or accidental injury, you are receiving appropriate care and treatment and are complying with the requirements of the treatment and you are unable to earn more than 80% of your predisability earnings at your own occupation. For a complete description of this and other requirements that must be met, refer to the Certificate of Insurance/Summary Plan Description provided by your Employer or contact your MetLife benefits administrator with any questions.

What is the benefit amount? If you enroll for coverage during your group’s initial open enrollment period, you select the amount of weekly benefit that is right for you. Choose any weekly benefit amount in increments of $50 per week, subject to a minimum of $100. The maximum benefit amount is 60% of your gross weekly earnings or $1,500, whichever is less, (rounded down to next $50 increment).

MetLife GCERT2000 Highlights L0716473190[exp0717][xCA,NY]

Metropolitan Life Insurance Company, NY, NY

If I do not enroll during my groupâ&#x20AC;&#x2122;s initial enrollment period can I still purchase coverage at a later date? Yes, employees who do not elect coverage during the initial 31-day open enrollment period may still elect coverage at future enrollments. If you choose coverage after the initial open enrollment, you will be limited to a $100 weekly benefit amount at the next annual enrollment. At subsequent annual enrollments you will be limited to increasing your weekly benefit coverage by $50.

When do benefits begin and how long do they continue? Short Term Disability: Benefits begin after the end of the elimination period. The elimination period begins on the day you become disabled and is the length of time you must wait, while disabled, before you are eligible to receive a benefit. The elimination period is as follows: For Injury: 7 days. For Sickness (includes pregnancy): 7 days. Benefits continue for as long as you are disabled up to a maximum duration of 12 weeks of Disability. Your planâ&#x20AC;&#x2122;s maximum benefit period and any specific limitations are described in the Certificate of Insurance/Summary Plan Description provided by your Employer or contact your MetLife benefits administrator with any questions.

MetLife GCERT2000 Highlights L0716473190[exp0717][xCA,NY]

Metropolitan Life Insurance Company, NY, NY

What is the monthly premium? To determine your premium, refer to the chart below that shows monthly premium for all ages and each amount. Premiums are based on your current age as of the effective date of coverage. At each policy anniversary, future costs will change as your age increases. Please note, the maximum benefit amount cannot exceed 60% of your gross weekly earnings or $1,500, whichever is less, (rounded down to next $50 increment). Monthly Premiums for STD Weekly Benefit

$100 $150 $200 $250 $300 $350 $400 $450 $500 $550 $600 $650 $700 $750 $800 $850 $900 $950 $1,000 $1,050 $1,100 $1,150 $1,200 $1,250 $1,300 $1,350 $1,400 $1,450 $1,500

Employeeâ&#x20AC;&#x2122;s Age <30

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

$4.80 $7.20 $9.60 $12.00 $14.40 $16.80 $19.20 $21.60 $24.00 $26.40 $28.80 $31.20 $33.60 $36.00 $38.40 $40.80 $43.20 $45.60 $48.00 $50.40 $52.80 $55.20 $57.60 $60.00 $62.40 $64.80 $67.20 $69.60 $72.00

$4.90 $7.35 $9.80 $12.25 $14.70 $17.15 $19.60 $22.05 $24.50 $26.95 $29.40 $31.85 $34.30 $36.75 $39.20 $41.65 $44.10 $46.55 $49.00 $51.45 $53.90 $56.35 $58.80 $61.25 $63.70 $66.15 $68.60 $71.05 $73.50

$5.86 $8.79 $11.72 $14.65 $17.58 $20.51 $23.44 $26.37 $29.30 $32.23 $35.16 $38.09 $41.02 $43.95 $46.88 $49.81 $52.74 $55.67 $58.60 $61.53 $64.46 $67.39 $70.32 $73.25 $76.18 $79.11 $82.04 $84.97 $87.90

$7.87 $11.80 $15.74 $19.68 $23.61 $27.54 $31.48 $35.42 $39.35 $43.28 $47.22 $51.16 $55.09 $59.02 $62.96 $66.90 $70.83 $74.76 $78.70 $82.64 $86.57 $90.50 $94.44 $98.38 $102.31 $106.24 $110.18 $114.12 $118.05

$8.93 $13.40 $17.86 $22.32 $26.79 $31.26 $35.72 $40.18 $44.65 $49.12 $53.58 $58.04 $62.51 $66.98 $71.44 $75.90 $80.37 $84.84 $89.30 $93.76 $98.23 $102.70 $107.16 $111.62 $116.09 $120.56 $125.02 $129.48 $133.95

$9.22 $13.83 $18.44 $23.05 $27.66 $32.27 $36.88 $41.49 $46.10 $50.71 $55.32 $59.93 $64.54 $69.15 $73.76 $78.37 $82.98 $87.59 $92.20 $96.81 $101.42 $106.03 $110.64 $115.25 $119.86 $124.47 $129.08 $133.69 $138.30

Answers to Some Important Questionsâ&#x20AC;Ś Q. Are my benefits taxable? A. If you pay your premium with after-tax dollars, your benefit in the event of disability would be tax free. Taxation of benefits can occur if all or a portion of the benefit is paid for with pre-tax contributions3. Q. Can I still receive benefits if I return to work part time? A. Yes. As long as you are disabled and meet the terms of your Disability plan, you may qualify for adjusted Disability benefits. Your plan offers financial and Rehabilitation incentives designed to help you to return to work when appropriate, even on a part-time basis when you participate in an approved Rehabilitation Program. While disabled, you may receive up to 100% of your predisability earnings when combining benefits, Rehabilitation Incentives and other income sources such as Social Security Disability Benefits and State Disability Benefits, and part-time earnings.

MetLife GCERT2000 Highlights L0716473190[exp0717][xCA,NY]

Metropolitan Life Insurance Company, NY, NY

With the Rehabilitation Incentive you can get a 10% increase in your weekly benefit. Following the 4th weekly benefit payment, the Family Care Incentive provides reimbursement up to $100 per week for eligible expenses, such as child care. You may be eligible for the Moving Expense Incentive if you incur expenses in order to move to a new residence recommended as part of the Rehabilitation Program. Expenses must be approved in advance. Q. Are there any exclusions for pre-existing conditions? A. Yes. Your plan may not cover a sickness or accidental injury that arose in the months prior to your participation in the plan. A complete description of the pre-existing condition exclusion is included in the Certificate of Insurance/Summary Plan Description provided by your Employer or contact your MetLife benefits administrator with any questions. Q. Does my benefit have any offsets? A. Yes. The STD benefit replaces a portion of your predisability earnings, less the income that was actually paid to you for the same Disability from other sources4 (e.g., state-mandated benefits, no-fault auto laws, sick pay, Workers’ Compensation, etc.) Q. Are there any exclusions to my coverage? A. Yes. Your plan does not cover any Disability which results from or is caused or contributed to by:  War, whether declared or undeclared, or act of war, insurrection, rebellion or terrorist act;  Active participation in a riot;  Intentionally self-inflicted injury or attempted suicide;  Commission of or attempt to commit a felony.  In addition, no payment will be made for any disability caused or contributed to by elective treatment or procedures, such as cosmetic surgery, sex-change surgery, reversal of sterilization, liposuction, visual correction surgery or in vitro fertilization, embryo transfer procedure, or artificial insemination. However, pregnancies and complications from any of these procedures will be treated as a sickness. Additionally, no payment will be made for a Disability caused or contributed to by any injury or sickness for which you are entitled to benefits under Workers’ Compensation or similar law. Other limitations or exclusions to your coverage may apply. Please review your Certificate of Insurance/Summary Plan Description for specific details or contact your MetLife benefits administrator with any questions. 1 11th Annual Employee Benefits Trends Study, 2013 2 Social Security Fact Sheet, July 2013 3 Pursuant to IRS Circular 230, MetLife is providing you with the following notification: The information contained in this document is not intended to (and cannot) be used by anyone to avoid IRS penalties. This document supports the promotion and marketing of insurance products. You should seek advice based on your particular circumstances from an independent tax advisor. 4 Under certain circumstances, MetLife may estimate the amount of income you may receive from other sources, where permitted to do so. The “Plan Benefits” provides only a brief overview of the STD plan. A more complete description of the benefits provisions, conditions, limitations, and exclusions will be included in the Certificate of Insurance/Summary Plan Description. If any discrepancies exist between this information and the legal plan documents, the legal plan documents will govern. Like most group insurance policies, MetLife group policies contain certain exclusions, elimination periods, reductions, limitations and terms for keeping them in force. State variations may apply. Please consult the certificate of insurance for details For policies issued in New York: MetLife Disability Income Insurance policies provide disability income insurance only. They do NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department. The expected benefit ratio for these policies is at least 50%. This ratio is the portion of future premiums that MetLife expects to return as benefits when averaged over all people with the applicable policy. MetLife, its agents, and representatives may not give legal or tax advice. Any discussion of taxes herein or related to this document is for general information purposes only and does not purport to be complete or cover every situation. Tax law is subject to interpretation and legislative change. Tax results and the appropriateness of any product for any specific taxpayer may vary depending on the facts and circumstances. You should consult with and rely on your own independent legal and tax advisers regarding your particular set of facts and circumstances.

MetLife GCERT2000 Highlights L0716473190[exp0717][xCA,NY]

Metropolitan Life Insurance Company, NY, NY

Long Term Disability

Aspen Heights Plan Benefits Original Plan Effective Date: January 1, 2016 Explore the coverage that helps you protect your income and your lifestyle. What is Long-Term Disability Insurance? Long-Term Disability (LTD) insurance can help replace a portion of your income if you are unable to work for an extended period of time due to a sickness or accidental injury. It helps to provide the day to day peace of mind that comes from knowing that, during the time you would be recovering from a significant event in your life, you may not have to shoulder the additional burden of wondering how you’re going to pay for the things that would still have to be paid for.

Why Should I Consider LTD Insurance? You may have already purchased home, auto and life insurance to protect yourself against the threat of loss. And, you may already have health insurance to protect you against the cost of medical bills. But, have you protected one of your most valuable assets – your ability to work and earn a living? Nobody ever thinks it will happen to them, but unfortunately, it can. The car accident, the illness, the slip on an icy sidewalk, the fall down steps or off a bike. And, sometimes these events can deprive you of one of your most important and valuable assets—your ability to earn an income. A disability absence from work can potentially last for several years. That’s a long time to survive without a steady income. While some people may be able to survive without working for a few months by tapping into their savings, what happens after that? Would you be able to meet your financial obligations if you became disabled and were unable to work for an extended period? Recent statistics have shown: ~60% of employees surveyed in MetLife’s 10th Annual Employee Benefits Trends Study indicated they are very concerned about having enough money to pay bills during a period of sudden income loss. 1 ~ Today’s 20 year olds have an approximately 1 in 4 chance of becoming disabled before reaching age 67.2 Your employer recognizes the need for you to protect your ability to earn an income and is offering you the opportunity to enroll in Long Term Disability insurance coverage from MetLife. The plan is being made available to you with the convenience of payroll deduction so you don’t have to worry about mailing monthly payments.

Eligibility Requirements Long Term Disability: All Active Full Time Employees working at least 30 hours per week are eligible to participate.

How is "Disability" defined under the Plan? Generally, you are considered disabled and eligible for long term benefits if, during your elimination period and the next 24 months you are unable to earn more than 80% of your predisability earnings at your own occupation for any employer in your local economy due to sickness, pregnancy or accidental injury, while you are receiving appropriate care and treatment and complying with the requirements of the treatment. Following the Own Occupation period, you are considered disabled if, due to sickness, pregnancy or accidental injury, you are receiving appropriate care and treatment and complying with the requirements of treatment and you are unable to earn 60%of your predisability earnings at any gainful occupation for which you are reasonably qualified taking into account your training, education and experience.

MetLife VLTD Highlights L0114357627[exp0715][xCA]

Metropolitan Life Insurance Company NY, NY

For a complete description of this and other requirements that must be met, refer to the Certificate of Insurance/Summary Plan Description provided by your Employer or contact your MetLife benefits administrator with any questions

What is the benefit amount? Long Term Disability: The Long Term Disability benefit replaces a portion of your predisability monthly earnings, less other income you may receive from other sources1 during the same Disability (e.g., Social Security, Workers’ Compensation, vacation pay etc.). The Benefit amount is 60% of your predisability monthly earnings.

What is the maximum monthly benefit? The amount of Long Term Disability benefit may not exceed the maximum monthly benefit established under the plan, regardless of your annual salary amount. The maximum under this plan is $7,500.

If I do not enroll during my group’s initial open enrollment period can I still purchase coverage at a later date? Yes, employees who do not elect coverage during the initial 31-day open enrollment period may still elect coverage at future enrollments. You may be required to submit a Statement of Health or meet certain pre-existing condition limitations.

When do benefits begin and how long do they continue? Benefits begin after the end of the elimination period. The elimination period begins on the day you become disabled and is the length of time you must wait while being disabled before you are eligible to receive a benefit. Your elimination period for Long Term Disability is 90 days. Your plan’s maximum benefit period and any specific limitations are described in the Certificate of Insurance/Summary Plan Description provided by your Employer , or contact your MetLife benefits administrator with any questions

Additional Disability Plan Benefits: Coverage with Your Best Interests in Mind… When you are ill or injured for a long time, MetLife® believes you need more than a supplement to your income. That’s why we offer return-to-work services and financial incentives and assistance in obtaining Social Security Disability Benefits to help you get the maximum benefits from your coverage.

Services to Help You Get Back to Work Can Include: Nurse Consultant or Case Manager Services: Specialists who personally contact you, your physician and your employer to coordinate an early return-towork plan when appropriate. Vocational Analysis: Help with identifying job requirements and determining how your skills can be applied to a new or modified job with your employer. Job Modifications/Accommodations: Adjustments (e.g., redesign of work station tools) that enable you to return to work. Retraining: Development programs to help you return to your previous job or educate you for a new one. Financial Incentives: Allow employees to receive Disability benefits or partial benefits while attempting to return to work. MetLife VLTD Highlights L0114357627[exp0715][xCA]

Metropolitan Life Insurance Company NY, NY

The Services of Social Security Specialists: Once you are approved for Disability benefits, Metlife can help you obtain Social Security Disability benefits. Our specialists can guide you through the initial application and appeals processes and may also help you access legal assistance from attorneys or vendors to pursue Social Security benefits.

What is the Monthly premium? 1. To determine your premium, refer to the chart below that shows the rates for all ages per $100 of covered salary 2. Select the age banded rate that applies to you

Monthly Benefit 60%

Under 30 0.225

Premiums Rates for LTD Employeeâ&#x20AC;&#x2122;s Age 35-39 40-44 45-49 50-54 0.351 0.531 0.882 1.269

55-59 1.431

60-64 0.981

65+ 0.981

3. Complete the following premium calculation worksheet Monthly Premium Calculation Worksheet: A. Annual Earnings = PLEASE NOTE: If your annual earnings exceed $150,000 the premium is based on $150,000 due to the maximum benefit cap. Use $150,000 in this calculation. B. monthly Earnings = (A divided by 12) C. Your monthly Earnings divided by 100 = (B divided by 100) D. Estimated monthly Premium you will pay = (C multiplied by the applicable age-banded rate)

$ $ $ $

Premiums are based on your current age as of the effective date of coverage. At each policy anniversary, future costs will change as your age increases. Due to rounding, your actual payroll deducted premium amount may vary slightly.

Answers to Some Important Questionsâ&#x20AC;Ś Q. A.

Are my benefits taxable? If you pay your premiums with after tax-dollars, your benefit in the event of disability would be tax free. Taxation of benefits can occur if all or a portion of the benefit is paid for with pre-tax contributions.3

Q. Can I return to work part-time and still receive a benefit? A. Yes. As long as you are disabled and meet the terms of your disability plan, you may qualify for adjusted disability benefits. Your plan offers financial incentives designed to help you to return to work when appropriate, even on a parttime basis. While disabled, you may receive up to 100% of your predisability earnings for 24 months when combining benefits, While disabled, you may receive up to 100% of your predisability earnings when combining benefits, Rehabilitation Incentives and other income sources such as Social Security Disability Benefits and state disability benefits, and part-time earnings. other income sources such as Social Security Disability Benefits and state disability benefits, and part-time earnings. With the Rehabilitation Incentive you can get a 10% increase in your monthly benefit. The Family Care Incentive provides reimbursement up to $400 per month for eligible expenses, such as child care, during the first 24 months of disability. You may be eligible for the Moving Expense Incentive if you incur expenses in order to move to a new residence recommended as part of the Rehabilitation Program. Expenses must be approved in advance. Q. Are there any exclusions for pre-existing conditions? A. Yes. Your plan may not cover a sickness or accidental injury that arose in the months prior to your participation in the plan. A complete description of the pre-existing condition exclusion is included in the Certificate of Insurance/Summary Plan Description provided by your Employer. MetLife VLTD Highlights L0114357627[exp0715][xCA]

Metropolitan Life Insurance Company NY, NY

Q. Can my benefits be reduced? A. Yes. Your monthly LTD benefit will be reduced by other income you receive or are eligible to receive, such as: • Workers Compensation benefits • Social Security Disability or Retirement benefits • State or public employee retirement or disability plan benefits • Third Party Liability payments (minus attorney fees) • Sick Leave • Salary Continuation, Personal Time Off and Annual Leave pay • Return to work earnings as outlined in your Certificate If the total of the other income you receive or are eligible to receive exceeds your LTD monthly benefits, you may still be eligible for a minimum benefit of $100. Please review your Certificate of Insurance/Summary Plan Description for specific details or contact your benefits administrator with any questions. Q. Are there any exclusions to my coverage? A. Yes. Your plan does not cover any Disability which results from or is caused or contributed to by:    

War, whether declared or undeclared, or act of war, insurrection, rebellion or terrorist act; Active participation in a riot; Intentionally self-inflicted injury or attempted suicide; Commission of or attempt to commit a felony.

For Long Term Disability, limited benefits apply for specific conditions, such as, mental or nervous disorders or diseases, alcohol, drug, or substance abuse or addiction, neuromuscular, musculoskeletal or soft tissue disorders and chronic fatigue syndrome and related conditions. Other limitations or exclusions to your coverage may apply. Please review your Certificate of Insurance provided by your Employer for specific details or contact your benefits administrator with any questions. 1 10th Annual Employee Benefits Trends Study, 2012 2 Social Security Basic Facts,April 2012. 3 Pursuant to IRS Circular 230, MetLife is providing you with the following notification: The information contained in this document is not intended to (and cannot) be used by anyone to avoid IRS penalties. This document supports the promotion and marketing of insurance products. You should seek advice based on your particular circumstances from an independent tax advisor. The “Plan Benefits” provides only a brief overview of the LTD plan. A more complete description of the benefits provisions, conditions, limitations, and exclusions will be included in the Certificate of Insurance. If any discrepancies exist between this information and the legal plan documents, the legal plan documents will govern. Long Term Disability (“LTD”) coverage is provided under a group insurance policy (Form GPNP99) issued to your employer by MetLife. This LTD coverage terminates when your employment ceases, when you cease to be an eligible employee, when your LTD contributions cease (if applicable) or upon termination of the group contract by your employer. Like most group insurance policies, MetLife group policies contain certain exclusions, elimination periods, reductions, limitations and terms for keeping them in force. State variations may apply. 1

Under certain circumstances, MetLife may estimate the amount of income you may receive from other sources.

MetLife VLTD Highlights L0114357627[exp0715][xCA]

Metropolitan Life Insurance Company NY, NY

The LifeCare web site

Voluntary and confidential

The LifeCare web site offers rich content, extensive search features, and a variety of interactive tools including LifeMart, an online Discount Center. Highlights include:

LifeCare’s services are voluntary and confidential. Over the years, employees have found our services to be an invaluable source of support and information. We hope that you, too, will benefit from LifeCare.

Online provider searches and matches Instantly access information on providers and resources (child care, adult care, schools, fitness centers, etc.) nationwide Request personalized matches from a specialist via our interactive forms Confidentially view and retrieve information and matches via your own Message Center Access a history of your requests and transactions via your Account Activity section Best-in-class content Read or download our extensive library of materials available in printable html, PDF, and hard copy, including: Parenting information from experts Extensive content for seniors and caregivers on aging issues State regulations on child care centers and family day care homes nationwide Health content including a A-Z index of health articles, a Drug Database, a Symptom Checker, a Diagnosis Lookup Consumer articles on everyday issues such as choosing cleaning services, personal safety and home improvement

Life is

Challenging

Access LifeCare Today! Call toll-free – 24 hours a day:  1-800-697-7315  For TDD/TTY service, call 1-800-873-1322 Access the LifeCare website via your employer’s ADP web portal:  Navigate to the “My Tools” page and select the LifeCare – Work/Life, EAP, Discounts link  Register by completing the simple, one-time process Once registered, two options are available to access LifeCare:  Visit the employer’s web portal OR visit directly via http://member.lifecare.com

Whatever life throws at you, can help. Child Care and Paren ting Senior Ca re and Ag ing Legal and Financial Health an

d Wellness

A final note Neither LifeCare specialists nor the LifeCare web site are intended to provide any user with specific authority, advice or recommendations. The information obtained through specialist assistance or the LifeCare web site is for informational purposes only. In all instances, users should verify all information received. All final decisions on the appropriateness of information, the quality of a product, or the qualifications of a service provider must be made by the user.

Interactive tools and features Medical animations that illustrate human anatomy, medical conditions and other scientific topics. Interactive quizzes on topics such as anger, anxiety, depression, lifestyle, patience, selfesteem and more Webinars, podcasts and audio tips

Discount vendors shown here and on our web site are subject to change without notice to you. We do not guarantee the inclusion of any particular discount or vendor on our site. We do not guarantee product availability or that the prices offered are the lowest available. LifeCare makes no warranties, express or implied, regarding the products or services offered through the discount center.

Access brand-name discounts too! Click the “LifeMart Discounts” tab on the LifeCare site to start saving today. Find deals on computers, theme parks, movie tickets, DVDs, fitness centers, travel, jewelry, apparel, and more!

2 Armstrong Road, Shelton, CT 06484 800-697-7315  www.lifecare.com ADP_CMBP_Flip_DC_09-031214 Copyright © 2014 ADP, Inc. ADP and the ADP logo are registered trademarks of ADP, Inc. In the business of your success is a registered service mark of ADP, Inc. LifeCare,® Inc. All rights reserved.

Employee Daily Nee

Assistance Progra

LifeMart ®

Need help managing work and life? Take advantage of LifeCare®— an employer-paid benefit designed to save you time and relieve stress!

How LifeCare can help you

Whether you access our services via telephone or the web, you will receive personalized information and matches 24 hours a day, seven days a week.

Child Care & Parenting Adoption

Child care (centers, in-home, family day care)

Mothers at Work®

Special needs

Parenting infants to teens

Temporary/back up care

Prenatal care

Work & family

In-home services

Respite care

Legal and financial issues

Senior health and safety

Trying to manage daily responsibilities and life events can be a real challenge at times. Fortunately, there’s LifeCare, provided by your employer.

Before- and after-school

Offering comprehensive work and life services, LifeCare gives you the valuable and timely information you need to manage your daily life— from prenatal information to adult care . . . from summer camps to child care services . . . from pet care to health and wellness . . . and much more.

Care options and living arrangements

Geriatric care management

Caregiver issues and concerns

Home meal delivery programs (e.g. Meals on Wheels)

Plus, LifeCare offers LifeMart®, an online Discount Center that gives you exclusive access to discounts of up to 40 percent on over four million products and services.

Credit & debt

Legal

Personal finance

Retirement planning

Insurance

Medicare/Medicaid

Real estate & loans

Social Security

Assistance around the clock Whenever you need assistance with a work and life issue—or a referral to a provider—LifeCare is always there for you, 24 hours a day, seven days a week. You can take advantage of LifeCare’s services by: Calling our toll-free phone number:

800-697-7315 or Visiting our web site:

Breastfeeding

Child development

Senior Care & Aging

Hospice services

Medicare, Medicaid and Social Security

Transportation services

Legal & Financial

Plus, you may be eligible to receive FREE consultations with attorneys and financial counselors!

Health & Wellness Children’s health

Fitness/exercise

Men’s health

Senior health

Diet & nutrition

General health

Safety

Women’s health

Emotional health

Emotional Health/Employee Assistance Program (EAP) Anxiety

Domestic violence

Mental health

Stress

Conflict at work

Family issues

Personal issues

Substance abuse

Depression

Grief

Relationship issues

Call today for 3 face-to-face counseling sessions per issue with unlimited issues per year.

Daily Needs Automotive services

Home improvement

Pet care

Consumer information

Moving/relocation

Travel

Computers and electronics

Flights, cruises, car rentals, and hotels

Books and DVDs

Theme parks

Gifts and retail shopping

Utilities/home services

www.lifecare.com

LifeMart® Child and elder care products and services

Movie tickets and video rentals

Frequently Asked Questions Q What is LifeCare? is a benefit, provided to you at no cost, that saves members time and A LifeCare money with quality matches to content, providers, products and services in parenting, senior care, legal and financial services, home services, wellness and EAP. LifeCare also operates LifeMart, one of the largest members-only online discounts shopping websites, with discounts of up to 40% on more than 4 million products and services.

Q How do I access LifeCare service? a LifeCare specialist call 800-697-7315 (or TDD/TTY 800-873-1322) or you A Tocanreach access LifeCare on the web by visiting your employer’s web portal Q What are LifeCare’s hours? experienced and helpful specialists are here to help with life’s most important A Our needs 24/7, 365 days a year. Q What can LifeCare do for me? services are designed to help you and all members of your household A LifeCare’s balance work, life and personal issues. • EAP services feature access to counseling by Master’s level clinicians and referrals to community services. • The Child Care and Parenting services feature support for you and your family with referrals to child care options; adoption resources; prenatal and breastfeeding programs; education and recreational programs and help when it comes to planning for your children’s education. • The Senior Care services feature support for you and your family with referrals to senior housing options; home care and home safety resources, retirement planning resources and help when it comes to addressing caregiver issues and concerns. • The Legal and Financial services feature support for you and your family with referrals to legal counsel; financial planners; financial counselors to assist with debit or credit management and resources to help with legal document preparation and estate planning. • The Home and Personal Service resources feature support for you and your family with referrals to contractors and home repair specialists; pet care resources; referrals to community resources and help when moving or relocating. • LifeMart is a private online marketplace made available to employees by their employers. LifeMart features millions of discounts on leading brands from national and local retailers, including everyday savings, and local and national discounts and limited time offers.

Frequently Asked Questions Q Who am I speaking to when I call LifeCare? A LifeCare employs Bachelor’s and Master’s level specialists and licensed Master’s level clinicians. Each specialist is educated and trained in one specialty area (child care, elder care, academics, etc.) so you receive guidance from experts in their fields. Our clinicians provide a range of confidential professional services to help resolve problems that can affect your personal and work life; there is no question or issue too small.

Q How often can I use LifeCare services? EAP you will have access to licensed, clinical staff for 3 sessions per year per issue; there is no limit on the number of issues that A For can be addressed per year. For your other life events such as child care options, educational resources, caregiving questions, and home improvement services you have unlimited access to a LifeCare specialist and to the LifeMart online marketplace.

Q Are LifeCare services confidential? LifeCare services are completely confidential. This means when you or a family member call the toll free number, neither your A Yes, employer nor anyone else will know you have used the services unless you choose to tell them. Q Can my family members use these LifeCare services too? your family members are eligible to take advantage of LifeCare services. You can invite family members to use the LifeCare A Yes, services and register for the website on line by visiting your employer’s web portal or by calling 800-697-7315 and asking your specialist about registering your family members to use LifeCare services. In addition, your household members and children up to the age of 26 are eligible for EAP services and have access to licensed, clinical staff for 3 sessions per year per issue; there is no limit on the number of issues that can be addressed per year.

Q Are LifeCare services available on the web? the LifeCare web site offers rich content, extensive search features, and a variety of interactive tools including LifeMart, an online A Yes, Discount Center. Highlights include; • Online provider searches and referrals: instantly access information on providers and resources (child care, adult care, schools, fitness centers, etc.) nationwide or request personalized referrals from a specialist via our interactive forms • Best-in-class content; read or download our extensive library of materials available in printable html, PDF, and hard copy, including: Parenting information from experts; Extensive content for seniors and caregivers; Health content including an A-Z index of health articles and consumer articles on everyday issues such as choosing cleaning services, personal safety and home improvement • Interactive tools and features Interactive quizzes on topics such as anger, anxiety, depression, lifestyle, patience, self-esteem and live virtual seminars and audio tips

Group Insurance

Employee Assistance Program Option 1

WE ALL NEED HELP EVERY NOW AND THEN

YOUR EAP CAN HELP YOU RESOLVE A BROAD RANGE OF ISSUES INCLUDING: • Marriage, Relationship and Family Problems • Problems at Work • Changes in Mood • Legal and Financial Issues • Stress and Anxiety • Alcohol and Drug Dependency • Identity Theft • Health and Wellness Concerns

Problems are just a part of everyday life. In addition to the benefits provided under your MetLife Group Insurance coverage, you and your household members now have access to E4 Health’s Employee Assistance Program (EAP) to help with the everyday challenges of life that may affect your health, family life and desire to excel at work. (EAP services provided through an agreement with E4 Health, Inc. E4 Health is not a subsidiary or affiliate of MetLife and the services provided are separate and apart from the insurance and services provided by MetLife.) CONSULTATION AND SUPPORT You and the members of your household are entitled to up to 3 consultations with a licensed clinician per incident, per individual, per calendar year. You have telephonic consultations for maximum convenience and anonymity. Please call 1-844-7-METLIFE anytime to speak with a clinician or schedule an appointment. WORK AND LIFE SERVICES Telephonic consultations are available in the following areas: Financial Services: Budgeting, credit and financial guidance (investment advice, loans and bill payments not included), retirement planning and assistance with tax issues. Childcare and Eldercare Assistance: Needs assessment plus referrals to childcare and eldercare providers. Identity Theft Recovery Services: Information on ID theft prevention, plus an ID theft emergency response kit and help from a fraud resolution specialist if you are victimized. Legal Services: Consultations for issues relating to civil, consumer, personal and family law, financial matters, business law, real estate, estate planning and more (excluding disputes or actions beween you and MetLife/E4 Health/your employer). Daily Living Services: Referrals to consultants and businesses that can help with event planning, transportation services, pet services and more (does not cover the cost nor guarantee delivery of vendors’ services). Online Member Services: E4 Health’s EAP member website features a wide range of tools and information to help you take charge of your well-being and simplify your life. Log on to metlifeeap.com, user name: MetLife1-3 and password: guest.

continued >

ANSWERS TO FREQUENTLY ASKED QUESTIONS Services are provided by E4 Health, one of the nation’s premier providers of EAP services, with a national network of more than 35,000 practitioners. E4 Health’s staff provides immediate crisis resolution, information and referrals to appropriate counseling and support services. Licensed staff clinicians with crisis intervention expertise, including bilingual Spanish-/ English-speaking staff, are available to handle emergency or urgent need cases.

Are EAP services confidential? Yes. E4 Health abides by state and federal mandates governing confidentiality, and your identity is protected by law. When should I seek help? The right time to seek help for a problem is as early as possible, before the problem becomes critical. EAP services can be accessed through a dedicated tollfree number 24 hours a day, 7 days a week. How do I get help? You can call E4 Health directly at 1-844-7-METLIFE to arrange for your EAP services. E4 Health will consider one of your consultations used if you fail to cancel an appointment at least 24 hours in advance, unless the appointment is missed because of an emergency or circumstances beyond your control. Will I have to pay for services? No! Your employer pays for EAP services. There are no co-payments, co-insurance or deductible payments, and you will not be liable to an E4 Health counselor for any fees covered by your EAP under any circumstances. If you decide you want services not included in the EAP program offered by your employer, you will have to arrange and pay for them separately. Do I have rights under the Consolidated Omnibus Budget Reconciliation Act (“COBRA”)? For information about COBRA rights, contact your Human Resources Department. Does E4 Health’s EAP have any limitations? E4 Health’s EAP services do not provide: • Inpatient or outpatient treatment for any medically treated illness • Prescription drugs • Treatment or services for mental retardation or autism • C ounseling services beyond the number of sessions covered • Services by counselors who are not E4 Health providers • C ounseling required by law or a court, or paid for by Workers’ Compensation, or • F ormal psychological evaluations and fitness-for-duty opinions

WE’RE HERE TO LEND A HAND: 1-844-7-METLIFE TDD CALLERS CAN CALL: 1-877-267-9903

Some restrictions may apply to all of the above-mentioned services. Please contact E4 Health for details. EAP services provided through an agreement with E4 Health, Inc. E4 Health is not a subsidiary or affiliate of MetLife and the services provided are separate and apart from the insurance and services provided by MetLife. Information disclosed directly to E4 Health is not disclosed to MetLife, and therefore is not subject to MetLife’s privacy policy.

L1114399435[exp1115][All States]

Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 www.metlife.com

Group Life

WillsCenter

WillsCenter.com is a great benefit if you do not have access to an attorney. We are pleased to announce that you have access to WillsCenter.com1, at no cost to you.

Having an up-to-date will is one of the most important things you can do for your family. Without a will, your assets may be distributed according to state law and not in accordance with your wishes. An up-to-date will establishes important decisions about the distribution of your assets. WillsCenter.com helps you ensure your family’s future if something happens to you.

What is WillsCenter? WillsCenter.com is a secure online will preparation document generation service available to you 24x7. Created exclusively for MetLife and provided by an outside vendor, SmartLegalForms, Inc., this service provides users and their spouses/domestic partners with the ability to create current state-compliant documents including a will, living will, power of attorney and HIPAA authorization form. Resources are available online to address any questions you may have about terminology or general estate planning concepts. Once you create your documents, you will be provided with instructions for witnessing/signing them in front of a Notary Public.

How do I access WillsCenter? • Go to www.willscenter.com and register as a new user. • Follow the simple instructions on the site to create your document. • Return at your convenience to complete or update documents you have stored on the site.

WillsCenter.com is a document service provided by SmartLegalForms, Inc., an affiliate of Epoq Group, Ltd. SmartLegalForms, Inc. is not affiliated with MetLife and the WillsCenter.com service is separate and apart from any insurance or service provided by MetLife. The WillsCenter.com service does not provide access to an attorney, does not provide legal advice, and may not be suitable for your specific needs. Please consult with your financial, legal, and tax advisors for advice with respect to such matters.

Group Life

Will Preparation Service

Supplemental Life Insurance and Will Preparation Service As an Aspen Heights employee you have the opportunity to enroll in MetLife’s Supplemental Life insurance1 that can provide additional financial protection to your loved ones should something happen to you. When you enroll for additional coverage you also have access to a valuable service — Will Preparation.2

Having an up-to-date will is one of the most important things you can do for your family. Only 26% of survivors, who lost a spouse prematurely, said their spouse had a will at the time of death. 3 MetLife’s Will Preparation Service includes preparation of a will, living wills and power of attorney. With a will, you can define your most important decisions such as who will care for your children or inherit your property. You will have access to Hyatt Legal Plans’ network of more than 14,000 participating attorneys for preparing or updating these documents at no additional cost to you if you use a Hyatt Legal Plans participating attorney.

It’s easy to use the Will Preparation Service. Once your Supplemental Life coverage becomes effective, you will receive information that will allow you to access the Will Preparation Service. Step 1: Call Hyatt Legal Plans’ toll-free number 1-800-821-6400, reference group number (enter MetLife customer number) and a Client Service Representative will assist you in locating a participating plan attorney in your area and provide a case number. Step 2: Call and make an appointment with a participating attorney — many plan attorneys even have evening and weekend appointments for your convenience. Step 3: That’s it! When you use a plan attorney, you do not need to submit any claim forms. You also have the flexibility of using a non-network attorney and being reimbursed for covered services according to a set fee schedule.4

Supplemental Life includes the Buy-Up portion of Core Buy-Up for Small Business.

Included with Supplemental Life Insurance. Will Preparation is offered by Hyatt Legal Plans, Inc., a MetLife company, Cleveland, Ohio. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and Affiliates, Warwick, Rhode Island. For New York sitused cases, the Will Preparation service is an expanded offering that includes office consultations and telephone advice for certain other legal matters beyond Will Preparation. Tax Planning and preparation of Living Trusts are not covered by the Will Preparation Service.

MetLife’s 2015 Study of the Financial Impact of Premature Death.

If you chose a non-network attorney, you will be responsible for any attorneys’ fees that exceed the reimbursed amount.

Metropolitan Life Insurance Company 200 Park Avenue, New York, NY 10166, www.metlife.com 1502-0374 L0316461333[exp0517][All States][DC,GU,MP,PR,VI] © 2016 METLIFE, INC. PEANUTS ©2016 Peanuts Worldwide LLC

Group Life

Grief Counseling

Resources for Comfort and Support Facing a loss is never easy, and how you cope and grieve is very personal. No matter the circumstances, whether it’s a death, an illness, a divorce, or even a child leaving home, there are resources that can help. Your MetLife Group Term Life coverage through your employer comes with Grief Counseling1 provided by Harris, Rothenberg International (HRI), Inc., for you, your dependents and your beneficiaries at no extra cost. It is valuable, confidential support that can provide the comfort and guidance you need at the most difficult of times.

We’re Here to Help – In a way that accommodates your needs Simply call a dedicated 24/7 toll-free number, 1-855-609-9989, to speak with a licensed professional counselor experienced in helping people who have suffered a loss. You, your dependents and your beneficiaries can have up to five confidential counseling sessions per event2. Sessions can either take place in-person, because meeting face-to-face may provide a personalized experience if you so desire, or by phone if you prefer. The choice is yours depending upon your preference. If further assistance is desired, the counselor will help you access services that are appropriate to your situation, preferences, finances and health insurance coverage. You might call to discuss any situation you perceive as a major loss, including: • • • •

Death of a loved one Divorce Receiving a serious medical diagnosis Losing a pet

You can also log on to https://griefcounseling.harrisrothenberg.net/default.aspx (username: MetLife; password: grief) to contact a counselor or access helpful grief-related information and resources.

More Services to Help Cope With Loss Additional assistance from research specialists is also available at the same toll-free number at no cost. These specialists can refer services and providers as well as offer additional information that you may find helpful. They can help you: • • • •

Locate local funeral homes and identify monument vendors Locate back-up care for children or older adults Find specific types of support groups, e.g., children who have lost parents, survivors of suicide, dealing with grief, etc. Find storage facilities, estate sale planners and charities that pick up donations

They can also provide information on important tasks such as notifying the Social Security Administration, banks and utilities.

Help Is Just a Phone Call Away With Grief Counseling and related services provided by HRI, you, your dependents and your beneficiaries will have access to resources that help cope with the grief and practical challenges that accompany a loss. That’s just one of the valuable services that come with your MetLife group life coverage.

Call 1-855-609-9989 or log on to https://griefcounseling.harrisrothenberg.net/default.aspx Username: MetLife Password: grief

1 S ubject to state regulatory approval. Grief Counseling services are provided through an agreement with Harris, Rothenberg International (HRI), Inc. HRI is not an affiliate of MetLife, and the services HRI provides are separate and apart from the insurance provided by MetLife. HRI has a nationwide network of 46,700 counselors. Counselors have masterâ&#x20AC;&#x2122;s or doctoral degrees and are licensed professionals with extensive experience working with people who have suffered a loss. 2 The Grief Counseling program does not provide support for issues such as: Domestic Issues, Parenting Issues, or Marital/ Relationship Issues. For such issues, members should inquire with Human Resources about their companyâ&#x20AC;&#x2122;s EAP program, or community resources. Support for events covered in this program are subject to a member who must have received a serious medical diagnosis or suffered a major loss that has occurred, meaning, the diagnosis or loss must have taken place. (death in the family, job loss, a finalized divorce or separation). Support for events that may result in a loss that has not occurred, such as relationship issues or job instability are not covered in this program.

Metropolitan Life Insurance Company 200 Park Avenue, New York, NY 10166, www.metlife.com 1403-0786

L0215412691[exp0516][All States]

ÂŠ 2014 METLIFE, INC.

Group Life

Estate Resolution Services

You and Your Loved Ones Have the Support You Need You now have the opportunity to enroll in MetLife’s Supplemental Life insurance to help financially ensure that your family and loved ones are adequately prepared without you. Enrolling in Supplemental Life insurance will also ensure that valuable legal assistance is available to estate representatives and beneficiaries through MetLife Estate Resolution ServicesSM 1 (ERS). Included with your life insurance coverage, ERS can be used for your estate as well as your spouse’s/domestic partner’s estate. ERS gives estate representatives access to Hyatt Legal Plans’ network of more than 13,500 participating attorneys for face-to-face or telephone consultation at no additional cost. Estate representatives can get the legal help they need with this great benefit that provides: • Face-to-face consultations: estate representatives can meet with an attorney to discuss matters relating to probating your and your spouse’s/domestic partner’s estates. • Preparation and representation: document preparation and representation needed at court proceedings is available to execute the transfer of probate assets from the deceased’s estate to the heirs. • Correspondence and tax filings: any correspondence needed to transfer non-probate assets may be completed by an attorney, as well as any associated filings. • Coverage for attorney fees: All participating plan attorney fees for included services are covered through the plan. Out of network option is available according to a set fee schedule.* Beneficiaries can also use the ERS benefit to consult an attorney to discuss general questions about the probate process.

Accessing the Estate Resolution Service is easy. Once your Supplemental Life Insurance becomes effective, the services will automatically be available. To access the services, estate representatives or beneficiaries simply: • Call Hyatt Legal Plans’ toll-free number 1-800-821-6400 • Provide the Client Service Representative with the employee’s company name, customer number [customer number] (if available) and the last 4 digits of the insured employee’s Social Security number. • The Client Service Representative will give the estate representative or beneficiary a case number, and help locate a Hyatt plan attorney who will handle all the paperwork.

MetLife Estate Resolution Services are offered by Hyatt Legal Plans, Inc., a MetLife company, Cleveland, Ohio. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and Affiliates, Warwick, Rhode Island. Certain services are not covered by Estate Resolution Services, including matters in which there is a conflict of interest between the executor and any beneficiary or heir and the estate; any disputes with the group policyholder, MetLife and/or any of its affiliates; any disputes involving statutory benefits; will contests or litigation outside probate court; appeals; court costs, filing fees, recording fees, transcripts, witness fees, expenses to a third party, judgments or fines; and frivolous or unethical matters.

* Individuals have the option to use the out-of-network reimbursement feature to retain an attorney who does not participate in Hyatt Legal Plans’ network of plan attorneys. If a non-network attorney is chosen, the individual will be responsible for any attorneys’ fees that exceed the reimbursed amount.

Annual Notices

Required Annual Employee Notices This documents contains required notices as you are eligible for or enrolled in certain health and welfare plans. It contains the following:        

Newborn’s Act Disclosure Women’s Health and Cancer Rights Act of 1998 (WHCRA) Michelle’s Law Premium assistance under Medicaid and Children’s Health Insurance Program HIPAA Notices Notice of Availability for HIPAA/Notice of Privacy Practices Notice of COBRA Continuation Coverage Rights Notice of Creditable Coverage Under Medicare Part D

Unless stated, if you have questions or concerns about any of these documents you can contact your plan administrator. Name of Entity/Sender Contact-Position/Office Address Phone Number

[ASPEN HEIGHTS] [HR Department] [1301 S. Capital of TX Hwy., B201, Austin, TX 78746] [512-369-3030]

We advise that you maintain a copy of these notices in a place where you can find them. They contain information regarding your health plans and other government programs that may impact the availability and cost of health care both now as an employee and in the future.

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden varies based on the information collected. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number.

Annual Notices Newborn’s Act Disclosure - Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Women’s Health and Cancer Rights Act of 1998 (WHCRA) - Do you know that your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema? If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:    

All stages of reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan.

ONLY APPLICABLE TO FULLY INSURED PLANS WITH EMPLOYEES IN NY, NJ OR FL Michelle’s Law - Michelle’s Law, passed in 2008, prohibits group health plans from terminating coverage for a dependent child who has lost student status as a result of a medically necessary leave of absence. Plans must continue to provide coverage for up to one year or until coverage would otherwise terminate under the plan. Plans are allowed to require physician certification of the medical necessity for the leave of absence.

If you would like more information, please contact your plan administrator. Name of Entity/Sender Contact-Position/Office Address Phone Number

[Aspen Heights] [HR Department] [1301 S. Capital of TX Hwy., B201, Austin, TX 78746] [512-369-3030]

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 are 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, you can 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 (877) KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask the 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 permit 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 electronically at www.askebsa.dol.gov or by calling toll-free (866) 444-EBSA (3272).

If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2014. You should contact your State for further information on eligibility. ALABAMA – Medicaid

ALASKA – Medicaid

http://www.medicaid.alabama.gov (855) 692-5447

http://health.hss.state.ak.us/dpa/programs/medicaid/ Anchorage: (907) 269-6529 Outside of Anchorage: (888) 318-8890

ARIZONA – CHIP

COLORADO – Medicaid

http://www.azahcccs.gov/applicants/ Maricopa County: (602) 417-5437 Outside of Maricopa County: (877) 764-5437

http://www.colorado.gov In state: (800) 866-3513 Out of state: (800) 221-3943

FLORIDA – Medicaid

GEORGIA – Medicaid

https://www.flmedicaidtplrecovery.com/ (877) 357-3268

http://dch.georgia.gov/ Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) (800) 869-1150 IDAHO – Medicaid

http://healthandwelfare.idaho.gov/Medical/Medicaid/PremiumAssistance/tabid/1510/Default.aspx (800) 926-2588 INDIANA – Medicaid

IOWA – Medicaid

http://www.in.gov/fssa (800) 889-9949

www.dhs.state.ia.us/hipp/ (888) 346-9562

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) KANSAS – Medicaid

KENTUCKY – Medicaid

http://www.kdheks.gov/hcf/ (800) 792-4884

http://chfs.ky.gov/dms/default.htm (800) 635-2570

LOUISIANA – Medicaid

MASSACHUSETTS – Medicaid and CHIP

http://www.lahipp.dhh.louisiana.gov (888) 695-2447

http://www.mass.gov/MassHealth (800) 462-1120 MAINE – Medicaid

http://www.maine.gov/dhhs/ofi/public-assistance/index.html (800) 977-6740 TTY (800) 977-6741 MONTANA – Medicaid http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml (800) 694-3084 MINNESOTA – Medicaid

MISSOURI – Medicaid

http://www.dhs.state.mn.us/ Click on Health Care, then Medical Assistance (800) 657-3629

http://www.dss.mo.gov/mhd/participants/pages/hipp.htm (573) 751-2005

NEBRASKA – Medicaid

NEVADA – Medicaid

www.ACCESSNebraska.ne.gov (800) 383-4278

http://dwss.nv.gov/ (800) 992-0900

NEW HAMPSHIRE – Medicaid

NEW YORK – Medicaid

http://www.dhhs.nh.gov/oii/documents/hippapp.pdf (603) 271-5218

http://www.nyhealth.gov/health_care/medicaid/ (800) 541-2831

NEW JERSEY – Medicaid and CHIP Medicaid: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ (609) 631-2392 CHIP: http://www.njfamilycare.org/index.html (800) 701-0710 NORTH CAROLINA – Medicaid

NORTH DAKOTA – Medicaid

http://www.ncdhhs.gov/dma (919) 855-4100

http://www.nd.gov/dhs/services/medicalserv/medicaid/ (800) 755-2604

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) OKLAHOMA – Medicaid and CHIP

OREGON – Medicaid

http://www.insureoklahoma.org (888) 365-3742

http://www.oregonhealthykids.gov http://www.hijossaludablesoregon.gov (800) 699-9075

PENNSYLVANIA – Medicaid

RHODE ISLAND – Medicaid

http://www.dpw.state.pa.us/hipp (800) 692-7462

www.ohhs.ri.gov (401) 462-5300

SOUTH CAROLINA – Medicaid

SOUTH DAKOTA - Medicaid

http://www.scdhhs.gov (888) 549-0820

http://dss.sd.gov (888) 828-0059

TEXAS – Medicaid

UTAH – Medicaid and CHIP

https://www.gethipptexas.com/ (800) 440-0493

http://health.utah.gov/upp (866) 435-7414

VERMONT– Medicaid

WEST VIRGINIA – Medicaid

http://www.greenmountaincare.org/ (800) 250-8427

www.dhhr.wv.gov/bms/ (877) 598-5820, HMS Third Party Liability

VIRGINIA – Medicaid and CHIP Medicaid http://www.dmas.virginia.gov/rcp-HIPP.htm (800) 432-5924

CHIP http://www.famis.org/ (866) 873-2647

WASHINGTON – Medicaid http://www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspx (800) 562-3022 ext. 15473 WISCONSIN – Medicaid

WYOMING – Medicaid

http://www.badgercareplus.org/pubs/p-10095.htm (800) 362-3002

http://health.wyo.gov/healthcarefin/equalitycare (307) 777-7531

To see if any more States have added a premium assistance program since January 31, 2014, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa (866) 444-EBSA (3272)

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

HIPAA Notices Special Enrollment - If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. Your group health plan will allow an employee or dependent who is eligible, but not enrolled, for coverage to enroll for coverage if either of the following events occurs: 1. TERMINATION OF MEDICAID OR CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) COVERAGE – If the employee or dependent is covered under a Medicaid plan or under a State child health plan and coverage of the employee or dependent under such a plan is terminated as a result of loss of eligibility. 2. ELIGIBILITY FOR EMPLOYMENT ASSISTANCE UNDER MEDICAID OR CHIP – If the employee or dependent becomes eligible for premium assistance under Medicaid or a State child health plan, including under any waiver or demonstration project conducted under or in relation to such a plan. This is usually a program where the state assists employed individuals with premium payment assistance for their employer’s group health plan rather than direct enrollment in a state Medicaid program. To be eligible for this special enrollment opportunity you must request coverage under the group health plan within 60 days after the date the employee or dependent becomes eligible for premium assistance under Medicaid or CHIP or the date your or your dependent’s Medicaid or state-sponsored CHIP coverage ends.

Prohibition against discrimination based on a health factor. Under HIPAA, a group health plan may not keep you (or your dependents) out of the plan based on anything related to your health. In addition, a group health plan may not charge you (or your dependents) more for coverage, based on health, than the amount charged a similarly situated individual.

The Genetic Information Nondiscrimination Act (GINA). The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits discrimination in group health plan coverage based on genetic information. It expands the genetic information protections included in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and prevents a plan or issuer from imposing a pre-existing condition exclusion provision based solely on genetic information, and prohibits discrimination in individual eligibility, benefits, or premiums based on any health factor (including genetic information). GINA also generally prohibits plans and issuers from requesting or requiring an individual to undergo a genetic test and from collecting genetic information (including family medical history) prior to or in connection with enrollment, or for underwriting purposes.

HIPAA Notices Right to individual health coverage. Under HIPAA, if you are an “eligible individual”, you have a right to buy certain individual health policies (or in some states, to buy coverage through a high-risk pool) without a pre-existing condition exclusion. To be an eligible individual, you must meet the following requirements:     

You have had coverage for at least 18 months without a break in coverage of 63 days or more; Your most recent coverage was under a group health plan; Your group coverage was not terminated because of fraud or nonpayment of premiums; You are not eligible for COBRA continuation coverage or you have exhausted your COBRA benefits (or continuation coverage under a similar state provision); and You are not eligible for another group health plan, Medicare, or Medicaid, and do not have any other health insurance coverage.

The right to buy individual coverage is the same whether you are laid off, fired, or quit your job. Therefore, if you are interested in obtaining individual coverage and you meet the other criteria to be an eligible individual, you should apply for this coverage as soon as possible to avoid losing your eligible individual status due to a 63-day break.

Special information for people on FMLA leave. If you are taking leave under the Family and Medical Leave Act (FMLA) and you drop health coverage during your leave, any days without health coverage while on FMLA leave will not count toward a 63-day break in coverage. In addition, if you do not return from leave, the 30-day period to request special enrollment in another plan will not start before your FMLA leave ends. Therefore, when you apply for other health coverage, you should tell your plan administrator or health insurer about any prior FMLA leave.

Notice of Availability for HIPAA/Notice of Privacy Practices. [Aspen Heights] would like to communicate the availability of its Notice of Privacy Practices. At any time, a copy of the current Notice of Privacy Practices may be obtained by contacting Human Resources at [512-369-3030].

For more information. If you have questions about your HIPAA rights, you may contact your state insurance department or the U.S. Department of Labor, Employee Benefits Security Administration (EBSA), toll-free at (866) 444-3272 (for free HIPAA publications ask for publications concerning changes in health care laws). You may also contact the CMS publication hotline at (800) 633-4227 (ask for Protecting Your Health Insurance Coverage). These publications and other useful information are also available on the Internet at: http://www.dol.gov/ebsa, the DOL’s interactive Web pages - Health Elaws, or http://www.cms.hhs.gov/healthinsreformforconsume/.

Notice of COBRA Continuation Coverage Rights **Continuation Coverage Rights Under COBRA** Introduction You are receiving this notice because you have recently gained coverage under a group health plan (the Plan). This notice contains 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 the right to receive 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. 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 known as 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 are an employee, you will 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 are the spouse of an employee, you will 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; The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).

Notice of COBRA Continuation Coverage Rights **Continuation Coverage Rights Under COBRA** For the 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. 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 continuation coverage If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total 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 continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 month 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 Questions Questions 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 the EBSA website at 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 changes To 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 information Name of Entity/Sender Name of Plan Contact-Position/Office Address Phone Number

[Aspen Heights] [Aspen Heights Health Plan] [HR Department] [1301 S. Capital of TX Hwy., B201, Austin, TX 78746] [512-369-3030]

Important Notice from [Aspen Heights] About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with [Aspen Heights] and about your options under Medicareâ&#x20AC;&#x2122;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 Medicareâ&#x20AC;&#x2122;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. [Aspen Heights] has determined that the prescription drug coverage offered by the [Blue Choice PPO Plan] is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 th to December 7th However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current [Aspen Heights] coverage may be affected. If you do decide to join a Medicare drug plan and drop your current [Aspen Heights] coverage, be aware that you and your dependents may or may not be able to get this coverage back.

Important Notice from [Aspen Heights] About Your Prescription Drug Coverage and Medicare When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with [Aspen Heights] and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through [Aspen Heights] changes. You also may request a copy of this notice at any time. For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage:   

Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help Call (800) MEDICARE/(800) 633-4227); TTY users should call (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 at www.socialsecurity.gov Call them at (800) 772-1213; TTY (800) 325-0778.

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Plan Administrator contact information Date Name of Entity/Sender Contact--Position/Office Address Phone Number

[01/01/2017] [Aspen Heights] [HR Department] [1301 S. Capital of TX Hwy., B201, Austin, TX 78746] [512-369-3030]

Metropolitan Life Insurance Company 200 Park Avenue, New York, New York 10166

CERTIFICATE OF INSURANCE Metropolitan Life Insurance Company ("MetLife"), a stock company, certifies that You and Your Dependents are insured for the benefits described in this certificate, subject to the provisions of this certificate. This certificate is issued to You under the Group Policy and it includes the terms and provisions of the Group Policy that describe Your insurance. PLEASE READ THIS CERTIFICATE CAREFULLY. This certificate is part of the Group Policy. The Group Policy is a contract between MetLife and the Employer and may be changed or ended without Your consent or notice to You. Employer:

BRG Management Inc dba Aspen Heights

Group Policy Number:

KM 05932994-G

Type of Insurance:

Vision Insurance

MetLife Toll Free Number(s): For Claim Information

1-855-METEYE1

THIS CERTIFICATE ONLY DESCRIBES VISION INSURANCE. FOR CALIFORNIA RESIDENTS: REVIEW THIS CERTIFICATE CAREFULLY. IF YOU ARE 65 OR OLDER ON YOUR EFFECTIVE DATE OF THIS CERTIFICATE, YOU MAY RETURN IT TO US WITHIN 30 DAYS FROM THE DATE YOU RECEIVE IT AND WE WILL REFUND ANY PREMIUM YOU PAID. IN THIS CASE, THIS CERTIFICATE WILL BE CONSIDERED TO NEVER HAVE BEEN ISSUED. THE BENEFITS OF THE POLICY PROVIDING YOUR COVERAGE ARE GOVERNED PRIMARILY BY THE LAW OF A STATE OTHER THAN FLORIDA. THE GROUP INSURANCE POLICY PROVIDING COVERAGE UNDER THIS CERTIFICATE WAS ISSUED IN A JURISDICTION OTHER THAN MARYLAND AND MAY NOT PROVIDE ALL THE BENEFITS REQUIRED BY MARYLAND LAW. WE ARE REQUIRED BY STATE LAW TO INCLUDE THE NOTICE(S) WHICH APPEAR ON THIS PAGE AND IN THE NOTICE(S) SECTION WHICH FOLLOWS THIS PAGE. PLEASE READ THE(SE) NOTICE(S) CAREFULLY.

GCERT2000 fp

All Active Full-Time Employees NB 01/12/2016

IMPORTANT NOTICE

AVISO IMPORTANTE

To obtain information or make a complaint:

Para obtener información o para presentar una queja:

You may call MetLife’s toll free telephone number for information or to make a complaint at:

Usted puede llamar al número de teléfono gratuito de MetLife para obtener información o para presentar una queja al:

1-855-METEYE1

You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at:

1-800-252-3439

1-855-METEYE1

Usted puede comunicarse con el Departmento de Seguros de Texas para obtener información sobre compañías, coberturas, derechos o quejas al:

1-800-252-3439

You may write the Texas Department of Insurance:

Usted puede escribir al Departmento de Seguros de Texas a:

P.O. Box 149104 Austin, TX 78714-9104 Fax # (512) 490-1007

Web: http://www.tdi.texas.gov

Sitio web: http://www.tdi.texas.gov

E-mail: consumerprotection@tdi.texas.gov

PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact MetLife first. If the dispute is not resolved, you may contact the Texas Department of Insurance.

DISPUTAS POR PRIMAS DE SEGUROS O RECLAMACIONES: Si tiene una disputa relacionada con su prima de seguro o con una reclamación, usted debe comunicarse con MetLife primero. Si la disputa no es resuelta, usted puede comunicarse con el Departmento de Seguros de Texas.

ATTACH THIS NOTICE TO YOUR CERTIFICATE: This notice is for information only and does not become a part or condition of the attached document.

ADJUNTE ESTE AVISO A SU CERTIFICADO: Este aviso es solamente para propósitos de informativos y no se convierte en parte or en condición del documento adjunto.

For Texas Residents notice/tx 02/15

NOTICE FOR RESIDENTS OF ALL STATES THE INSURANCE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM.

GCERT2000 notice/tx/wc

NOTICE FOR RESIDENTS OF ARKANSAS If You have a question concerning Your coverage or a claim, first contact the Employer or group account administrator. If, after doing so, You still have a concern, You may call the toll free telephone number shown on the Certificate Face Page. If You are still concerned after contacting both the Employer and MetLife, You should feel free to contact: Arkansas Insurance Department Consumer Services Division 1200 West Third Street Little Rock, Arkansas 72201 (501) 371-2640 or (800) 852-5494

GCERT2000 notice/ar

NOTICE FOR RESIDENTS OF CALIFORNIA IMPORTANT NOTICE TO OBTAIN ADDITIONAL INFORMATION, OR TO MAKE A COMPLAINT, CONTACT THE EMPLOYER OR THE METLIFE CLAIM OFFICE SHOWN ON THE EXPLANATION OF BENEFITS YOU RECEIVE AFTER FILING A CLAIM. IF, AFTER CONTACTING THE EMPLOYER AND/OR METLIFE, YOU FEEL THAT A SATISFACTORY SOLUTION HAS NOT BEEN REACHED, YOU MAY FILE A COMPLAINT WITH THE CALIFORNIA INSURANCE DEPARTMENT AT: DEPARTMENT OF INSURANCE 300 SOUTH SPRING STREET LOS ANGELES, CA 90013 1 (800) 927-4357

GCERT2000 notice/ca

NOTICE FOR RESIDENTS OF THE STATE OF CALIFORNIA California law provides that for vision insurance, domestic partners of California’s residents must be treated the same as spouses. If the certificate does not already have a definition of domestic partner, then the following definition applies: “Domestic Partner means each of two people, one of whom is an employee of the Employer, a resident of California and who have registered as domestic partners or members of a civil union with the California or another government recognized by California as having similar requirements. For purposes of determining who may become a Covered Person, the term does not include any person who: · ·

is in the military of any country or subdivision of a country; is insured under the Group Policy as an employee.”

If the certificate already has a definition of domestic partner, that definition will apply to California residents, as long as it recognizes as a domestic partner any person registered as the employee’s domestic partner with the California government or another government recognized by California as having similar requirements. Wherever the term Spouse appears, except in the definition of Spouse, it shall be replaced by Spouse or Domestic Partner. Wherever the term step-child appears, it is replaced by step-child or child of Your Domestic Partner.

GCERT2000 notice/dp/ca

NOTICE FOR RESIDENTS OF GEORGIA IMPORTANT NOTICE The laws of the state of Georgia prohibit insurers from unfairly discriminating against any person based upon his or her status as a victim of family violence.

GCERT2000 notice/ga

NOTICE FOR RESIDENTS OF IDAHO If You have a question concerning Your coverage or a claim, first contact the Employer. If, after doing so, You still have a concern, You may call the toll free telephone number shown on the Certificate Face Page. If You are still concerned after contacting both the Employer and MetLife, You should feel free to contact: Idaho Department of Insurance Consumer Affairs 700 West State Street, 3rd Floor PO Box 83720 Boise, Idaho 83720-0043 1-800-721-3272 (for calls placed within Idaho) or 208-334-4250 or www.DOI.Idaho.gov

GCERT2000 notice/id

NOTICE FOR RESIDENTS OF ILLINOIS IMPORTANT NOTICE To make a complaint to MetLife, You may write to: MetLife P.O. Box 997100 Sacramento, CA 95899-7100 The address of the Illinois Department of Insurance is: Illinois Department of Insurance Public Services Division Springfield, Illinois 62767

GCERT2000 notice/il

NOTICE FOR RESIDENTS OF INDIANA Questions regarding your policy or coverage should be directed to: Metropolitan Life Insurance Company 1-855-METEYE1 If you (a) need the assistance of the government agency that regulates insurance; or (b) have a complaint you have been unable to resolve with your insurer you may contact the Department of Insurance by mail, telephone or email: State of Indiana Department of Insurance Consumer Services Division 311 West Washington Street, Suite 300 Indianapolis, Indiana 46204 Consumer Hotline: (800) 622-4461; (317) 232-2395 Complaint can be filed electronically at www.in.gov/idoi

GCERT2000 notice/in

NOTICE FOR RESIDENTS OF MAINE You have the right to designate a third party to receive notice if Your insurance is in danger of lapsing due to a default on Your part, such as nonpayment of a contribution that is due. The intent is to allow reinstatements where the default is due to the insured personâ&#x20AC;&#x2122;s suffering from cognitive impairment or functional incapacity. You may make this designation by completing a "Third-Party Notice Request Form" and sending it to MetLife. Once You have made a designation, You may cancel or change it by filling out a new Third-Party Notice Request Form and sending it to MetLife. The designation will be effective as of the date MetLife receives the form. Call MetLife at the toll-free telephone number shown on the face page of this certificate to obtain a Third-Party Notice Request Form. Within 90 days after cancellation of coverage for nonpayment of premium, You, any person authorized to act on Your behalf, or any covered Dependent may request reinstatement of the certificate on the basis that You suffered from cognitive impairment or functional incapacity at the time of cancellation.

GCERT2000 notice/me

NOTICE FOR RESIDENTS OF MASSACHUSETTS CONTINUATION OF VISION INSURANCE 1. If Your Vision Insurance ends due to a Plant Closing or Covered Partial Closing, such insurance will be continued for 90 days after the date it ends. 2. If Your Vision Insurance ends because: · ·

You cease to be in an Eligible Class; or Your employment terminates;

for any reason other than a Plant Closing or Covered Partial Closing, such insurance will continue for 31 days after the date it ends. Continuation of Your Vision Insurance under the CONTINUATION WITH PREMIUM PAYMENT subsection will end before the end of continuation periods shown above if You become covered for similar benefits under another plan. Plant Closing and Covered Partial Closing have the meaning set forth in Massachusetts Annotated Laws, Chapter 151A, Section 71A. CONTINUATION OF VISION INSURANCE FOR YOUR FORMER SPOUSE If the judgment of divorce dissolving Your marriage provides for continuation of insurance for Your former Spouse when You remarry, Vision Insurance for Your former Spouse that would otherwise end may be continued. To continue Vision insurance under this provision: 1. You must make a written request to the employer to continue such insurance; 2. You must make any required premium to the employer for the cost of such insurance. The request form will be furnished by the Employer. Such insurance may be continued from the date Your marriage is dissolved until the earliest of the following: ·

the date Your former Spouse remarries;

the date of expiration of the period of time specified in the divorce judgment during which You are required to provide Vision Insurance for Your former Spouse;

the date coverage is provided under any other group health plan;

the date Your former Spouse becomes entitled to Medicare;

the date Vision Insurance under the policy ends for all active employees, or for the class of active employees to which You belonged before Your employment terminated;

the date of expiration of the last period for which the required premium payment was made; or

the date such insurance would otherwise terminate under the policy.

If Your former Spouse is eligible to continue Vision Insurance under this provision and any other provision of this Policy, all such continuation periods will be deemed to run concurrently with each other and shall not be deemed to run consecutively.

GCERT2000 notice/ma

NOTICE FOR NEW HAMPSHIRE RESIDENTS CONTINUATION OF YOUR VISION INSURANCE If You are a resident of New Hampshire, Your Vision Insurance may be continued if it ends because Your employment ends unless: ·

Your employment ends due to Your gross misconduct;

this Vision Insurance ends for all employees;

this Vision Insurance is changed to end Vision Insurance for the class of employees to which You belong;

You are entitled to enroll in Medicare; or

Your Vision Insurance ends because You failed to pay the required premium.

The Employer must give You written notice of: ·

Your right to continue Your Vision Insurance;

the amount of premium payment that is required to continue Your Vision Insurance;

the manner in which You must request to continue Your Vision Insurance and pay premiums; and

the date by which premium payments will be due.

The premium that You must pay for Your continued Vision Insurance may include: ·

any amount that You contributed for Your Vision Insurance before it ended;

any amount the Employer paid; and

an administrative charge which will not to exceed two percent of the rest of the premium.

To continue Your Vision Insurance, You must: ·

send a written request to continue Your Vision Insurance; and

pay the first premium within 30 days after the date Your employment ends.

The maximum continuation period will be the longest of: ·

36 months if Your employment ends because You retire, and within 12 months of retirement You have a substantial loss of coverage because the employer files for bankruptcy protection under Title 11 of the United States Code;

29 months if You become entitled to disability benefits under Social Security within 60 days of the date Your Employment ends; or 18 months.

Your continued Vision Insurance will end on the earliest of the following to occur: ·

the end of the maximum continuation period;

the date this Vision Insurance ends;

the date this Vision Insurance is changed to end Vision Insurance for the class of employees to which You belong;

the date You are entitled to enroll for Medicare;

if You do not pay the required premium to continue Your Vision Insurance; or

the date You become eligible for coverage under any other group vision coverage.

GCERT2000 notice/coi/nh

NOTICE FOR NEW HAMPSHIRE RESIDENTS (continued) CONTINUATION OF YOUR DEPENDENT’S VISION INSURANCE If You are a resident of New Hampshire, Your Vision Insurance for Your Dependents may be continued if it ends because Your employment ends, Your marriage ends in divorce or separation, or You die, unless: ·

Your employment ends due to Your gross misconduct;

this Vision Insurance ends for all Dependents;

this Vision Insurance is changed, for the class of employees to which You belong, to end Vision Insurance for Dependents;

the Dependent is entitled to enroll in Medicare; or

Your Vision Insurance for Your Dependents ends because You fail to pay a required premium.

If Vision Insurance for Your Dependents ends because Your marriage ends in divorce or separation, the party responsible under the divorce decree or separation agreement for payment of premium for continued Vision Insurance must notify the employer, in writing, within 30 days of the date of the divorce decree or separation agreement that the divorce or separation has occurred. If You and Your divorced or separated Spouse share responsibility for payment of the premium for continued Vision Insurance, both You and Your divorced or separated Spouse must provide the notification. The Employer must give You, or Your former Spouse if You have died or Your marriage has ended, written notice of: ·

Your right to continue Your Vision Insurance for Your Dependents;

the amount of premium payment that is required to continue Your Vision Insurance for Your Dependents;

the manner in which You or Your former Spouse must request to continue Your Vision Insurance for Your Dependents and pay premiums; and

the date by which premium payments will be due.

The premium that You or Your former Spouse must pay for continued Vision Insurance for Your Dependents may include: ·

any amount that You contributed for Your Vision Insurance before it ended; and

any amount the Employer paid.

To continue Vision Insurance for Your Dependents, You or Your former Spouse must: ·

send a written request to continue Vision Insurance for Your Dependents; and

must pay the first premium within 30 days of the date Vision Insurance for Your Dependents ends.

If You, and Your former Spouse, if applicable, fail to provide any required notification, or fail to request to continue Vision Insurance for Your Dependents and pay the first premium within the time limits stated in this section, Your right to continue Vision Insurance for Your Dependents will end.

GCERT2000 notice/coi/nh

NOTICE FOR NEW HAMPSHIRE RESIDENTS (continued) CONTINUATION OF YOUR DEPENDENT’S VISION INSURANCE (continued) The maximum continuation period will be the longest of the following that applies: ·

36 months if Vision Insurance for Your Dependents ends because Your marriage ends in divorce or separation, except that with respect to a Spouse who is age 55 or older when your marriage ends in divorce or separation the maximum continuation period will end when the divorced or separated Spouse becomes eligible for Medicare or eligible for participation in another employer’s group plan;

36 months if Vision Insurance for Your Dependents ends because You die, except that with respect to a Spouse who is age 55 or older when You die, the maximum continuation period will end when Your surviving Spouse becomes eligible for Medicare or eligible for participation in another employer’s group vision coverage;

36 months if Vision Insurance for Your Dependents ends because You become entitled to benefits under Title XVIII of Social Security, except that with respect to a Spouse who is age 55 or older when You become entitled to benefits under Title XVIII of Social Security, the maximum continuation period will end when the divorced or separated Spouse becomes eligible for Medicare or eligible for participation in another employer’s group vision coverage;

36 months if You become entitled to benefits under Title XVIII of Social Security while You are already receiving continued benefits under this section, except that with respect to a Spouse who is age 55 or older when You first become entitled to continue Your Vision Insurance the maximum continuation period will end when the divorced or separated Spouse becomes eligible for Medicare or eligible for participation in another employer’s group vision coverage;

36 months with respect to a Dependent Child if Vision Insurance ends because the Child ceases to be a Dependent Child;

29 months if Vision Insurance for Your Dependents ends because Your employment ends, and within 60 days of the date Your employment ends you become entitled to disability benefits under Social Security; or

18 months if Vision Insurance for Your Dependents ends because Your employment ends.

A Dependent's continued Vision Insurance will end on the earliest of the following to occur: ·

the end of the maximum continuation period;

the date this Vision Insurance ends;

the date this Vision Insurance is changed to end Vision Insurance for Dependents for the class of employees to which You belong;

the date the Dependent becomes entitled to enroll for Medicare;

if You do not pay a required premium to continue Vision Insurance for Your Dependents; or

the date the Dependent becomes eligible for coverage under any other group vision coverage.

GCERT2000 notice/coi/nh

NOTICE FOR RESIDENTS OF NORTH CAROLINA UNDER NORTH CAROLINA GENERAL STATUTE SECTION 58-50-40, NO PERSON, EMPLOYER, PRINCIPAL, AGENT, TRUSTEE, OR THIRD PARTY ADMINISTRATOR, WHO IS RESPONSIBLE FOR THE PAYMENT OF GROUP HEALTH OR LIFE INSURANCE OR GROUP HEALTH PLAN PREMIUMS, SHALL: (1) CAUSE THE CANCELLATION OR NONRENEWAL OF GROUP HEALTH OR LIFE INSURANCE, HOSPITAL, MEDICAL, OR DENTAL SERVICE CORPORATION PLAN, MULTIPLE EMPLOYER WELFARE ARRANGEMENT, OR GROUP HEALTH PLAN COVERAGES AND THE CONSEQUENTIAL LOSS OF THE COVERAGES OF THE PERSONS INSURED, BY WILLFULLY FAILING TO PAY THOSE PREMIUMS IN ACCORDANCE WITH THE TERMS OF THE INSURANCE OR PLAN CONTRACT, AND (2) WILLFULLY FAIL TO DELIVER, AT LEAST 45 DAYS BEFORE THE TERMINATION OF THOSE COVERAGES, TO ALL PERSONS COVERED BY THE GROUP POLICY A WRITTEN NOTICE OF THE PERSON'S INTENTION TO STOP PAYMENT OF PREMIUMS. THIS WRITTEN NOTICE MUST ALSO CONTAIN A NOTICE TO ALL PERSONS COVERED BY THE GROUP POLICY OF THEIR RIGHTS TO HEALTH INSURANCE CONVERSION POLICIES UNDER ARTICLE 53 OF CHAPTER 58 OF THE GENERAL STATUTES AND THEIR RIGHTS TO PURCHASE INDIVIDUAL POLICIES UNDER THE FEDERAL HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT AND UNDER ARTICLE 68 OF CHAPTER 58 OF THE GENERAL STATUTES. VIOLATION OF THIS LAW IS A FELONY. ANY PERSON VIOLATING THIS LAW IS ALSO SUBJECT TO A COURT ORDER REQUIRING THE PERSON TO COMPENSATE PERSONS INSURED FOR EXPENSES OR LOSSES INCURRED AS A RESULT OF THE TERMINATION OF THE INSURANCE.

GCERT2000 notice/nc

NOTICE FOR RESIDENTS OF PENNSYLVANIA Vision Insurance for a Dependent Child may be continued past the age limit if that Child is a full-time student and insurance ends due to the Child being ordered to active duty (other than active duty for training) for 30 or more consecutive days as a member of the Pennsylvania National Guard or a Reserve Component of the Armed Forces of the United States. Insurance will continue if such Child: · · · ·

re-enrolls as a full-time student at an accredited school, college or university that is licensed in the jurisdiction where it is located; re-enrolls for the first term or semester, beginning 60 or more days from the child’s release from active duty; continues to qualify as a Child, except for the age limit; and submits the required Proof of the child’s active duty in the National Guard or a Reserve Component of the United States Armed Forces.

Subject to the Date Insurance For Your Dependents Ends subsection of the section entitled ELIGIBILITY PROVISIONS: INSURANCE FOR YOUR DEPENDENTS, this continuation will continue until the earliest of the date: · ·

the insurance has been continued for a period of time equal to the duration of the child’s service on active duty; or the child is no longer a full-time student.

GCERT2000 notice/pa

NOTICE FOR RESIDENTS OF UTAH Notice of Protection Provided by Utah Life and Health Insurance Guaranty Association This notice provides a brief summary of the Utah Life and Health Insurance Guaranty Association ("the Association") and the protection it provides for policyholders. This safety net was created under Utah law, which determines who and what is covered and the amounts of coverage. The Association was established to provide protection in the unlikely event that your life, health, or annuity insurance company becomes financially unable to meet its obligations and is taken over by its insurance regulatory agency. If this should happen, the Association will typically arrange to continue coverage and pay claims, in accordance with Utah law, with funding from assessments paid by other insurance companies. The basic protections provided by the Association are: Âˇ Life Insurance o $500,000 in death benefits o $200,000 in cash surrender or withdrawal values Âˇ Health Insurance o $500,000 in hospital, medical and surgical insurance benefits o $500,000 in long-term care insurance benefits o $500,000 in disability income insurance benefits o $500,000 in other types of health insurance benefits Âˇ Annuities o $250,000 in withdrawal and cash values The maximum amount of protection for each individual, regardless of the number of policies or contracts, is $500,000. Special rules may apply with regard to hospital, medical and surgical insurance benefits. Note: Certain policies and contracts may not be covered or fully covered. For example, coverage does not extend to any portion of a policy or contract that the insurer does not guarantee, such as certain investment additions to the account value of a variable life insurance policy or a variable annuity contract. Coverage is conditioned on residency in this state and there are substantial limitations and exclusions. For a complete description of coverage, consult Utah Code, Title 3 lA, Chapter 28. Insurance companies and agents are prohibited by Utah law to use the existence of the Association or its coverage to encourage you to purchase insurance. When selecting an insurance company, you should not rely on Association coverage. If there is any inconsistency between Utah law and this notice, Utah law will control. To learn more about the above protections, as well as protections relating to group contracts or retirement plans, please visit the Association's website at www.utlifega.org or contact: Utah Life and Health Insurance Guaranty Assoc. 60 East South Temple, Suite 500 Salt Lake City UT 84111 (801) 320-9955

Utah Insurance Department 3110 State Office Building Salt Lake City UT 84114-6901 (801) 538-3800

A written complaint about misuse of this Notice or the improper use of the existence of the Association may be filed with the Utah Insurance Department at the above address.

GTY-NOTICE-UT-0710

NOTICE FOR RESIDENTS OF VIRGINIA IMPORTANT INFORMATION REGARDING YOUR INSURANCE In the event You need to contact someone about this insurance for any reason please contact Your agent. If no agent was involved in the sale of this insurance, or if You have additional questions You may contact the insurance company issuing this insurance at the following address and telephone number: MetLife P.O. Box 997100 Sacramento, CA 95899-7100 Attn: Corporate Consumer Relations Department To phone in a claim related question, You may call Claims Customer Service at: 1-855-METEYE1 If You have been unable to contact or obtain satisfaction from the company or the agent, You may contact the Virginia State Corporation Commission’s Bureau of Insurance at: The Office of the Managed Care Ombudsman Bureau of Insurance P.O. Box 1157 Richmond, VA 23209 1-877-310-6560 - toll-free 1-804-371-9944 - locally www.scc.virginia.gov - web address ombudsman@scc.virginia.gov - email Or: Office of Licensure and Certification Division of Acute Care Services Virginia Department of Health 9960 Mayland Drive Suite 401 Henrico, Virginia 23233-1463 Phone number: 1-800-955-1819/ local: 804-367-2106 Fax: (804) 527-4503 MCHIP@vdh.virginia.gov Written correspondence is preferable so that a record of Your inquiry is maintained. When contacting Your agent, company or the Bureau of Insurance, have Your policy number available. VISION INSURANCE: PROCEDURES FOR VISION CLAIMS Routine Questions on Vision Insurance Claims If there is any question about a claim payment, an explanation may be requested from MetLife by dialing 1855-METEYE1. Claim Denial Appeals If a claim is denied in whole or in part, under the terms of this certificate, a request may be submitted to Us by a Covered Person or a Covered Person’s authorized representative for a full review of the denial. A Covered Person may designate any person, including their provider, as their authorized representative. References in this section to “Covered Person” include the Covered Person’s authorized representative, where applicable.

GCERT2000 notice/va1

NOTICE FOR RESIDENTS OF VIRGINIA (continued) Initial Appeal. All requests for review must be made within one hundred eighty (180) calendar days following denial of a claim. A Covered Person may review, during normal business hours, any documents used by Us pertinent to the denial. A Covered Person may also submit Written comments or supporting documentation concerning the claim to assist in Our review. Our response to the initial appeal, including specific reasons for the decision, shall be communicated to the Covered Person within thirty (30) calendar days after receipt of the request for the appeal. Second Level Appeal. If a Covered Person disagrees with the response to the initial appeal of the denied claim, the Covered Person has the right to a second level appeal. A request for a second level appeal must be submitted to Us within sixty (60) calendar days after receipt of Our response to the initial appeal. We shall communicate Our final determination to the Covered Person within thirty (30) calendar days from receipt of the request, or as required by any applicable state or federal laws or regulations. Our communication to the Covered Person shall include the specific reasons for the determination. Other Remedies. When a Covered Person has completed the appeals stated herein, additional voluntary alternative dispute resolution options may be available, including mediation or arbitration. Additional information is available from the U.S. Department of Labor or the insurance regulatory agency for the Covered Personsâ&#x20AC;&#x2122; state of residency. Additionally, under the provisions of ERISA (Section 502(a)(1)(B) 29 U.S.C. 1132(a)(1)(B)), the Covered Person has the right to bring a civil action when all available levels of reviews, including the appeal process, have been completed. ERISA remedies may apply in those instances where the claims were not approved in whole or in part as the result of appeals under this Policy and the Covered Person disagrees with the outcome of such appeals. Time of Action. No action in law or in equity shall be brought to recover on this Policy prior to the Covered Person exhausting his/her rights under this Policy and/or prior to the expiration of sixty (60) calendar days after the claim and any applicable documentation has been filed with Us. No such action shall be brought after the expiration of any applicable statute of limitations, in accordance with the terms of this Policy. No such action shall be brought after the expiration of three (3) years from the last date that the claim and any applicable invoices were submitted to Us, and no such action shall be brought at all unless brought within three (3) years from the expiration of the time within which such materials are required to be submitted in accordance with the terms of this Policy. Insurance Fraud: Any Covered Person who intends to defraud, knowingly facilitates a fraud, submits a claim containing false or deceptive information, or who commits any other similar act as defined by applicable state or federal law, is guilty of insurance fraud. Such an act is grounds for immediate termination of the coverage under this Policy of the Covered Person committing such fraud.

GCERT2000 notice/va1

NOTICE FOR RESIDENTS OF WISCONSIN

KEEP THIS NOTICE WITH YOUR INSURANCE PAPERS

PROBLEMS WITH YOUR INSURANCE? - If you are having problems with your insurance company or agent, do not hesitate to contact the insurance company or agent to resolve your problem.

MetLife Attn: Corporate Consumer Relations Department P.O. Box 997100 Sacramento, CA 95899-7100 1-800-638-5433

You can also contact the OFFICE OF THE COMMISSIONER OF INSURANCE, a state agency which enforces Wisconsinâ&#x20AC;&#x2122;s insurance laws, and file a complaint. You can contact the OFFICE OF THE COMMISSIONER OF INSURANCE by contacting:

Office of the Commissioner of Insurance Complaints Department P.O. Box 7873 Madison, WI 53707-7873 1-800-236-8517 outside of Madison or 608-266-0103 in Madison.

GCERT2000 notice/wi

NOTICE FOR RESIDENTS OF LOUISIANA, MINNESOTA, MONTANA, NEW HAMPSHIRE, NEW MEXICO, UTAH AND WASHINGTON The Definition of Child In The Definitions Section Of This Certificate Is Modified For The Coverage Listed Below: For Louisiana Residents (Vision Insurance): The term also includes Your grandchildren residing with You. The age limit for children and grandchildren will not be less than 21, regardless of the child’s or grandchild’s student status or full-time employment status. In addition, the age limit for students will not be less than 24. Your natural child, adopted child, stepchild or grandchild under age 21 will not need to be supported by You to qualify as a Child under this insurance. For Minnesota Residents (Vision Insurance): The term also includes · · ·

Your grandchildren who are financially dependent upon You and reside with You continuously from birth; children for whom You or Your Spouse is the legally appointed guardian; and children for whom You have initiated for adoption.

The age limit for children and grandchildren will not be less than 25, regardless of the child’s or grandchild’s student status or full-time employment status. Your natural child, adopted child, stepchild, or children for whom You or Your Spouse is the legally appointed guardian under age 25 will not need to be supported by You to qualify as a Child under this insurance. For Montana Residents (Vision Insurance): The term also includes newborn infants of any person insured under this certificate. The age limit for children will not be less than 25, regardless of the child’s student status or full-time employment status. Your natural child, adopted child or stepchild under age 25 will not need to be supported by You to qualify as a child under this insurance. For New Hampshire Residents (Vision Insurance): The age limit for children will not be less than 26, regardless of the child’s marital, student status or full-time employment status. Your natural child, adopted child or stepchild under age 26 will not need to be supported by You to qualify as a child under this insurance. For New Mexico Residents (Vision Insurance): The age limit for children will not be less than 25, regardless of the child’s student status or full-time employment status. Your natural child, adopted child or stepchild will not be denied vision insurance coverage under this certificate because: · · ·

that child was born out of wedlock; that child is not claimed as Your dependent on Your federal income tax return; or that child does not reside with You.

For Utah Residents (Vision Insurance): The age limit for children will not be less than 26, regardless of the child’s student status or full-time employment status. Your natural child, adopted child or stepchild under age 26 will not need to be supported by You to qualify as a Child under this insurance. For Washington Residents (Vision Insurance): The age limit for children will not be less than 26, regardless of the child’s marital status, student status, or full-time employment status. Your natural child, adopted child or stepchild under age 26 will not need to be supported by You to qualify as a Child under this insurance.

GCERT2000 notice/childdef

NOTICE FOR RESIDENTS OF ALL STATES WHO ARE INSURED FOR VISION INSURANCE Notice Regarding Your Rights and Responsibilities Rights: ·

We will treat communications, financial records and records pertaining to your care in accordance with all applicable laws relating to privacy.

Decisions with respect to vision treatment are the responsibility of You and the Vision Provider. We neither require nor prohibit any specified treatment. However, only certain specified services are covered for benefits. Please see the Vision Insurance sections of this certificate for more details.

You may request a written response from MetLife to any written concern or complaint.

Responsibilities: ·

You are responsible for the prompt payment of any charges for services performed by the Vision Provider not fully covered by your Vision Insurance.

You should consult with the Vision Provider about treatment options, proposed and potential procedures, anticipated outcomes, potential risks, anticipated benefits and alternatives. You should share with the Vision Provider the most current, complete and accurate information about your medical and vision history and current conditions and medications.

You should follow the treatment plans and health care recommendations agreed upon by You and the Vision Provider.

GCERT2000 notice/visrights

TABLE OF CONTENTS Section

Page

CERTIFICATE FACE PAGE............................................................................................................................... 1 NOTICES............................................................................................................................................................ 2 SCHEDULE OF BENEFITS.............................................................................................................................. 26 DEFINITIONS.................................................................................................................................................... 29 ELIGIBILITY PROVISIONS: INSURANCE FOR YOU...................................................................................... 32 Eligible Classes........................................................................................................................................... 32 Date You Are Eligible For Insurance...........................................................................................................32 Enrollment Process For Vision Insurance................................................................................................... 32 Date Your Insurance Takes Effect.............................................................................................................. 32 Date Your Insurance Ends.......................................................................................................................... 33 ELIGIBILITY PROVISIONS: INSURANCE FOR YOUR DEPENDENTS.......................................................... 34 Eligible Classes For Dependent Insurance................................................................................................. 34 Date You Are Eligible For Dependent Insurance........................................................................................ 34 Enrollment Process For Dependent Vision Insurance................................................................................ 34 Date Your Insurance Takes Effect For Your Dependents...........................................................................34 Date Your Insurance For Your Dependents Ends...................................................................................... 35 CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT.................................................................... 36 For Mentally or Physically Handicapped Children...................................................................................... 36 For Family And Medical Leave................................................................................................................... 36 COBRA Continuation For Vision Insurance................................................................................................ 36 At The Employer's Option........................................................................................................................... 36 VISION INSURANCE........................................................................................................................................ 37 VISION INSURANCE: DESCRIPTION OF COVERED SERVICES AND MATERIALS................................... 39 VISION INSURANCE: EXCLUSIONS............................................................................................................... 40 GCERT2000 toc

TABLE OF CONTENTS VISION INSURANCE: COORDINATION OF BENEFITS................................................................................. 41 VISION INSURANCE: FILING A CLAIM........................................................................................................... 45 VISION INSURANCE: PROCEDURES FOR VISION CLAIMS........................................................................ 46 GENERAL PROVISIONS.................................................................................................................................. 47 Assignment................................................................................................................................................. 47 Vision Insurance: Who We Will Pay............................................................................................................ 47 Entire Contract............................................................................................................................................ 47 Incontestability: Statements Made By By You............................................................................................ 47 Conformity With Law................................................................................................................................... 47

GCERT2000 toc

SCHEDULE OF BENEFITS This schedule shows the benefits that are available under the Group Policy. You and Your Dependents will only be insured for the benefits: · · ·

for which You and Your Dependents become and remain eligible, and which You elect, if subject to election; and which are in effect.

BENEFIT

BENEFIT AMOUNT AND HIGHLIGHTS

Vision Insurance For You and Your Dependents For All Active Full-Time Employees Service Interval (months)

Exam 12 months

Lenses 12 months

Frame 24 months

Exam In-Network Co-Pay Co-payment shall not apply to Retinal Imaging

$10

Materials In-Network Co-Pay Co-payment shall not apply to Elective Contact Lenses

$25

In-Network Coverage (Using an In-Network Vision Provider)

EYE EXAMINATION

Contacts 12 months

Out-of-Network Coverage (Using an Out-of-Network Vision Provider)

Covered in full*

Covered up to $45 allowance

(one per frequency)

Comprehensive examination of visual functions and prescription of corrective eyewear.

RETINAL IMAGING

Covered in full with a copay not to exceed $39

Applied to the allowance for the eye examination

Coverage for retinal imaging is an enhancement to eye examination. Retinal imaging is not available at all provider locations – contact your InNetwork Vision Provider to see if this technology (or equipment or service) is available. STANDARD CORRECTIVE LENSES

GCERT2000 sch

Single Vision Covered in full*

Covered up to $30 allowance

Lined Bifocal Covered in full*

Covered up to $50 allowance

Lined Trifocal Covered in full*

Covered up to $65 allowance

Lenticular Covered in full*

Covered up to $100 allowance

SCHEDULE OF BENEFITS (continued) STANDARD LENS OPTIONS1

Ultra Violet Coating Covered in full*

Polycarbonate (child up to age 18) Covered in full*

Standard or Premium Progressive Available at a discount

Applied to the allowance for the applicable corrective lens

Applied to the allowance for the applicable corrective lens Standard Progressive $50 allowance; or Premium Progressive $50 allowance

Polycarbonate (adult) Available at a discount

Scratch Resistant Coating Available at a discount

Tints Available at a discount

Anti-Reflective Coating Available at a discount

Photochromic Available at a discount

FRAMES

Covered up to a $130 allowance

Applied to the allowance for the applicable corrective lens

Covered up to a $70 allowance

Frames are covered to the allowance of $70* at Costco locations. In-Network Vision Providers prescribe and/or order Covered Personâ&#x20AC;&#x2122;s lenses, verify the accuracy of finished lenses, and assist Covered Person with frame selection and adjustment. Frames are covered up to the allowance of $70* at Costco and $130* at other optical retail locations.

CONTACT LENSES

In-Network Coverage (Using an In-Network Vision Provider)

FITTING AND EVALUATION

Standard and Premium fit: Covered in full with a copay not to exceed $60

GCERT2000 sch

Out-of-Network Coverage (Using an Out-of-Network Vision Provider) Applied to the allowance for the contact lenses

SCHEDULE OF BENEFITS (continued) ELECTIVE

Covered up to $130 allowance Contact lenses are provided in place of lens and frame benefits available herein.

Covered up to $105 allowance Contact lenses are provided in place of lens and frame benefits available herein.

NECESSARY

Covered in full*

Covered up to $210 allowance

Necessary contact lenses are a Plan Benefit when specific criteria are satisfied and when prescribed by Covered Person’s In-Network Vision Provider.

Contact lenses are provided in place of lens and frame benefits available herein.

* Less any applicable Co-payment. 1

All lens options are available at participating private practice provider offices, and not to exceed copays and pricing are subject to change without notice. Please check with your provider for details and copays applicable to your lens choice. At this time, all lens options and “not to exceed” copays and pricing are not available at Costco. Please contact your local Costco to confirm the availability of lens options and pricing prior to receiving services.

Value-Added Features Available At In-Network Vision Providers (These features are not insurance.) LASER VISION CORRECTION Savings averaging 15% off the regular price, or 5% off a promotional offer, for laser surgery including PRK, LASIK, and Custom LASIK. ADDITIONAL SAVINGS ON 20% savings on additional pairs of prescription glasses and GLASSES AND SUNGLASSES nonprescription sunglasses, including lens enhancements.2 ADDITIONAL SAVINGS ON LENS Average 20-25% savings on all lens enhancements not otherwise ENHANCEMENTS covered under the MetLife Vision Insurance program. 2 2

These features may not be available in all states and with all In-Network Vision Providers. Please check with Your In-Network Vision Provider.

GCERT2000 sch

DEFINITIONS As used in this certificate, the terms listed below will have the meanings set forth below. When defined terms are used in this certificate, they will appear with initial capitalization. The plural use of a term defined in the singular will share the same meaning. Actively at Work or Active Work means that You are performing all of the usual and customary duties of Your job on a Full-Time basis. This must be done at: · · ·

the Employer's place of business; an alternate place approved by the Employer; or a location to which the Employer's business requires You to travel.

You will be deemed to be Actively at Work during weekends or Employer-approved vacations, holidays or business closures if You were Actively at Work on the last scheduled work day preceding such time off. Anisometropia means a condition of unequal refractive state of the two eyes, one eye requiring a different lens correction than the other. Child means the following: (for residents of Louisiana, Minnesota, Montana, New Hampshire, New Mexico, Utah and Washington, the Child Definition is modified as explained in the Notice pages of this certificate please consult the Notice) For Vision Insurance, Your natural or adopted child; Your stepchild (including the child of a Domestic Partner); or a child who resides with and is fully supported by You; and who, in each case, is under age 26. The term also includes Your grandchild who is under age 26, and who was able to be claimed by You as a Dependent for Federal Income Tax purposes at the time You applied for Vision Insurance. A child will be considered Your adopted child during the period You are party to a suit in which You are seeking the adoption of the child. If You provide Us notice, a Child also includes a child for whom You must provide Vision Insurance due to a Qualified Medical Child Support Order as defined in the United States Employee Retirement Income Security Act of 1974 as amended. For the purposes of determining who may become covered for insurance, the term does not include any person who: ·

is on active duty in the military of any country or international authority; however, active duty for this purpose does not include weekend or summer training for the reserve forces of the United States, including the National Guard; or is insured under the Group Policy as an employee.

Contributory Insurance means insurance for which the Employer requires You to pay any part of the premium. Contributory Insurance includes: Vision Insurance for You and Your Dependents. Co-Payment or Co-Pay means a fixed dollar amount for which We are not responsible, as shown in the Schedule of Benefits. You must pay Your Co-Payment at the time services are rendered or materials ordered. Covered Person(s) means an Employee and/or a Dependent covered under this Certificate. Covered Services and Materials means a vision service or materials used to treat Your or Your Dependent’s vision condition which is: · · ·

prescribed or performed by a Vision Provider while such person is insured for Vision Insurance; Necessary to treat the condition; and described in the SCHEDULE OF BENEFITS, VISION INSURANCE or VISION INSURANCE: DESCRIPTION OF COVERED SERVICES AND MATERIALS sections of this certificate.

Dependent(s) means Your Spouse and/or Child. GCERT2000 def as amended by GCR09-07 dp/tx

DEFINITIONS Domestic Partner means each of two people, one of whom is an employee of the Employer, who: ·

have registered as each other's domestic partner, civil union partner or reciprocal beneficiary with a government agency where such registration is available; or

are of the same or opposite sex and have a mutually dependent relationship so that each has an insurable interest in the life of the other. Each person must be: 1. 2. 3. 4. 5.

18 years of age or older; unmarried; the sole domestic partner of the other; sharing a primary residence with the other; and not related to the other in a manner that would bar their marriage in the jurisdiction in which they reside.

A Domestic Partner declaration attesting to the existence of an insurable interest in one another's lives must be completed and Signed by the employee. Full-Time means Active Work on the Employer's regular work schedule for the class of employees to which You belong. The work schedule must be at least 30 hours a week. Full-Time does not include temporary or seasonal employees. In-Network Vision Provider means an optometrist, therapeutic optometrist, ophthalmologist, or optician licensed and otherwise qualified to practice vision care and/or provide vision care materials who is contracted to provide Plan Benefits to Covered Persons of MetLife and accepts reimbursement at the negotiated rate. Keratoconus means a development or dystrophic deformity of the cornea in which it becomes cone shaped due to a thinning and stretching of the tissue in its central area. Maximum Benefit Allowance means the maximum amount We will allow for Covered Services and Materials provided by a Vision Provider. Necessary means Covered Services and Materials that are necessary and meet with professionally recognized standards of practice. The fact that a Vision Provider may prescribe, order, recommend or approve a service or material does not, in itself, make it medically necessary, or make it a Covered Service and Material even though it is listed in the Group Policy or the Benefit Schedule as Covered Service and Material. Noncontributory Insurance means insurance for which the Employer does not require You to pay any part of the premium. Out-of-Network Vision Provider/Non-Network Vision Provider means any optometrist, therapeutic optometrist, optician, ophthalmologist or other licensed and qualified vision care provider who has not contracted to provide vision care services and/or vision care materials to Covered Persons of MetLife. Plan or Plan Benefits means the vision care services and vision care materials which a Covered Person is entitled to receive by virtue of coverage under this Certificate. Progressive Lens means a multifocal lens that makes the transition from distance to near vision by a gradual, progressive addition of power. The result is a lens with a seamless appearance. Proof means Written evidence satisfactory to Us that a person has satisfied the conditions and requirements for any benefit described in this certificate. When a claim is made for any benefit described in this certificate, Proof must establish: · · ·

the nature and extent of the loss or condition; Our obligation to pay the claim; and the claimant’s right to receive payment.

GCERT2000 def as amended by GCR09-07 dp/tx

DEFINITIONS Proof must be provided at the claimant’s expense. Service Interval or Frequency means a period of consecutive months, as shown in the SCHEDULE OF BENEFITS, in which You or Your Dependent may receive Covered Services and Materials. This period starts on Your or Your Dependent’s effective date of coverage. A subsequent service interval starts after vision services or materials are received. Once Covered Services and Materials are received during any service interval, additional services are not covered during the same service interval and are subject to an additional charge. Signed means any symbol or method executed or adopted by a person with the present intention to authenticate a record, which is on or transmitted by paper or electronic media which is acceptable to Us and consistent with applicable law. Spouse means Your lawful Spouse. The term also includes Your Domestic Partner. For the purposes of determining who may become covered for insurance, the term does not include any person who: ·

is insured under the Group Policy as an employee.

Vision Provider means an eye care professional who is an optometrist, therapeutic optometrist, ophthalmologist, or registered dispensing optician, who: · ·

is licensed as such by the proper authorities in the jurisdiction where such services are performed; is acting within the scope of such license; and

The term does not include: · · ·

You; Your Spouse; or any member of Your immediate family including Your and/or Your Spouse’s: · parents; · children (natural, step or adopted); · siblings; · grandparents; or · grandchildren.

We, Us and Our mean MetLife. Written or Writing means a record which is on or transmitted by paper or electronic media which is acceptable to Us and consistent with applicable law. Year or Yearly means the 12 month period that begins January 1. You and Your mean an employee who is insured under the Group Policy for the insurance described in this certificate.

GCERT2000 def as amended by GCR09-07 dp/tx

ELIGIBILITY PROVISIONS: INSURANCE FOR YOU ELIGIBLE CLASS(ES) All Active Full-Time Employees DATE YOU ARE ELIGIBLE FOR INSURANCE You may only become eligible for the insurance available for Your class as shown in the SCHEDULE OF BENEFITS. For All Active Full-Time Employees If You are in an eligible class on January 1, 2016, You will be eligible for insurance on that date. If You enter an eligible class after January 1, 2016, You will be eligible for insurance on the first day of the month coincident with or next following the date You enter that class. Waiting Period means the period of continuous membership in an eligible class that You must wait before You become eligible for insurance. This period begins on the date You enter an eligible class and ends on the date You complete the period(s) specified. ENROLLMENT PROCESS FOR VISION INSURANCE If You are eligible for insurance, You may enroll for such insurance by completing the required form in Writing. If You enroll for Contributory Insurance, You must also give the Employer Written permission to deduct premiums from Your pay for such insurance. You will be notified by the Employer how much You will be required to contribute. The Vision Insurance has a regular enrollment period established by the Employer. Subject to the rules of the Group Policy, You may enroll for Vision Insurance only when You are first eligible or during an annual enrollment period or if You have a Qualifying Event. You should contact the Employer for more information regarding the annual enrollment period. DATE YOUR INSURANCE TAKES EFFECT Enrollment When First Eligible If You complete the enrollment process within 31 days of becoming eligible for insurance, such insurance will take effect on the date You become eligible, provided You are Actively at Work on that date. If You are not Actively at Work on the date the insurance would otherwise take effect, the benefit will take effect on the day You resume Active Work. If You Do Not Enroll When First Eligible If You do not complete the enrollment process within 31 days of becoming eligible, You will not be able to enroll for Vision Insurance until the next annual enrollment period, as determined by the Employer, following the date You first become eligible or if You have a Qualifying Event. At that time You will be able to enroll for insurance for which You are then eligible. Enrollment During An Annual Enrollment Period During any annual enrollment period as determined by the Employer, You may enroll for vision insurance for which You are eligible. The changes to Your insurance made during an annual enrollment period will take effect on the first day of the month following the enrollment period, if You are Actively at Work on that date. If You are not Actively at Work on the date insurance would otherwise take effect, insurance will take effect on the day You resume Active Work.

GCERT2000 e/ee

ELIGIBILITY PROVISIONS: INSURANCE FOR YOU Enrollment Due to a Qualifying Event You may enroll for insurance for which You are eligible between annual enrollment periods only if You have a Qualifying Event. If You have a Qualifying Event, You will have 31 days from the date of that change to make a request. This request must be consistent with the nature of the Qualifying Event. The insurance enrolled for or changes to Your insurance made as a result of a Qualifying Event will take effect on the first day of the month coincident with or next following the date of Your request, if You are Actively at Work on that date. If You are not Actively at Work on the date insurance would otherwise take effect, insurance will take effect on the day You resume Active Work. Qualifying Event includes: ·

marriage; or

the birth, adoption or placement for adoption of a dependent child; or

divorce, legal separation or annulment; or

the death of a dependent; or

You previously did not enroll for vision coverage for You or Your dependent because You had other group coverage, but that coverage has ceased due to loss of eligibility for the other group coverage; or

Your dependent's ceasing to qualify as a dependent under this insurance or under other group coverage.

DATE YOUR INSURANCE ENDS Your insurance will end on the earliest of: 1. the date the Group Policy ends; 2. the date insurance ends for Your class; 3. the end of the period for which the last premium has been paid for You; 4. the last day of the calendar month in which Your employment ends; Your employment will end if You cease to be Actively at Work in any eligible class, except as stated in the section entitled CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT; 5. the last day of the calendar month in which You retire in accordance with the Employer’s retirement plan. In certain cases insurance may be continued as stated in the section entitled CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT.

GCERT2000 e/ee

ELIGIBILITY PROVISIONS: INSURANCE FOR YOUR DEPENDENTS ELIGIBLE CLASS(ES) All Active Full-Time Employees DATE YOU ARE ELIGIBLE FOR DEPENDENT INSURANCE You may only become eligible for the Dependent insurance available for Your class as shown in the SCHEDULE OF BENEFITS. For All Active Full-Time Employees If You are in an eligible class on January 1, 2016, You will be eligible for Dependent insurance on that date. If You enter an eligible class after January 1, 2016, You will be eligible for Dependent insurance on the first day of the month coincident with or next following the date You enter that class. Waiting Period means the period of continuous membership in an eligible class that You must wait before You become eligible for Dependent insurance. This period begins on the date You enter an eligible class and ends on the date You complete the period(s) specified. No person may be insured as a Dependent of more than one employee. ENROLLMENT PROCESS FOR DEPENDENT VISION INSURANCE If You are eligible for Dependent insurance, You may enroll for such insurance by completing the required form in Writing. If You enroll for Contributory Insurance, You must also give the Employer Written permission to deduct premiums from Your pay for such insurance. You will be notified by the Employer how much You will be required to contribute. In order to enroll for Vision Insurance for Your Dependents, You must either (a) already be enrolled for Vision Insurance for You or (b) enroll at the same time for Vision Insurance for You. The Vision Insurance has a regular enrollment period established by the Employer. Subject to the rules of the Group Policy, You may enroll for Vision Insurance only when You are first eligible or during an annual enrollment period or if You have a Qualifying Event. You should contact the Employer for more information regarding the annual enrollment period. DATE YOUR INSURANCE TAKES EFFECT FOR YOUR DEPENDENTS Enrollment When First Eligible If You complete the enrollment process within 31 days of becoming eligible for Dependent Insurance, such insurance will take effect on the later of: Âˇ Âˇ

the date You become eligible for such insurance; and the date You enroll

provided You are Actively at Work on that date. If You are not Actively at Work on the date the insurance would otherwise take effect, the benefit will take effect on the day You resume Active Work. If You Do Not Enroll When First Eligible If You do not complete the enrollment process within 31 days of becoming eligible, You will not be able to enroll for Dependent Vision Insurance until the next annual enrollment period, as determined by the Employer, following the date You first become eligible or if You have a Qualifying Event. At that time You will be able to enroll for insurance for which You are then eligible. Enrollment During An Annual Enrollment Period

GCERT2000 e/dep

ELIGIBILITY PROVISIONS: INSURANCE FOR YOUR DEPENDENTS (continued) During any annual enrollment period as determined by the Employer, You may enroll for Dependent vision insurance for which You are eligible. The changes to Your Dependent insurance made during an annual enrollment period will take effect on the first day of the month following the enrollment period, if You are Actively at Work on that date. If You are not Actively at Work on the date insurance would otherwise take effect, insurance will take effect on the day You resume Active Work. Enrollment Due to a Qualifying Event You may enroll for Dependent insurance for which You are eligible between annual enrollment periods only if You have a Qualifying Event. If You have a Qualifying Event, You will have 31 days from the date of that change to make a request. This request must be consistent with the nature of the Qualifying Event. The insurance enrolled for or changes to Your insurance made as a result of a Qualifying Event will take effect on the first day of the month coincident with or next following the date of Your request, if You are Actively at Work on that date. If You are not Actively at Work on the date insurance would otherwise take effect, insurance will take effect on the day You resume Active Work. Qualifying Event includes: ·

marriage; or

the birth, adoption or placement for adoption of a dependent child; or

divorce, legal separation or annulment; or

the death of a dependent; or

Your dependent's ceasing to qualify as a dependent under this insurance or under other group coverage.

DATE YOUR INSURANCE FOR YOUR DEPENDENTS ENDS A Dependent's insurance will end on the earliest of: 1. the date Your Vision Insurance ends; 2. the date You die; 3. the date the Group Policy ends; 4. the date Insurance for Your Dependents ends under the Group Policy; 5. the date Insurance for Your Dependents ends for Your class; 6. the last day of the calendar month in which Your employment ends; Your employment will end if You cease to be Actively at Work in any eligible class, except as stated in the section entitled CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT. 7. the end of the period for which the last premium has been paid; 8. the date the person ceases to be a Dependent; 9. for Utah residents, the last day of the calendar month the person ceases to be a Dependent; 10. the last day of the calendar month in which You retire in accordance with the Employer's retirement plan. In certain cases insurance may be continued as stated in the section entitled CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT.

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CONTINUATION OF INSURANCE WITH PREMIUM PAYMENT FOR MENTALLY OR PHYSICALLY HANDICAPPED CHILDREN Insurance for a Dependent Child may be continued past the age limit if the child is incapable of self-sustaining employment because of a mental or physical handicap as defined by applicable law. Proof of such handicap must be sent to Us within 31 days after the date the Child attains the age limit and at reasonable intervals after such date, but not more frequently than once a year after the two-year period following the child’s attainment of the limiting age. Subject to the DATE INSURANCE FOR YOUR DEPENDENTS ENDS subsection of the section entitled ELIGIBILITY PROVISIONS: INSURANCE FOR YOUR DEPENDENTS, insurance will continue while such Child: ·

remains incapable of self-sustaining employment because of a mental or physical handicap; and

continues to qualify as a Child, except for the age limit.

FOR FAMILY AND MEDICAL LEAVE Certain leaves of absence may qualify for continuation of insurance under the Family and Medical Leave Act of 1993 (FMLA), or other legally mandated leave of absence or similar laws. Please contact the Employer for information regarding such legally mandated leave of absence laws. COBRA CONTINUATION FOR VISION INSURANCE The following applies to employers with 20 or more employees that are not church or government plans: If Vision Insurance for You or a Dependent ends, You or Your Dependent may qualify for continuation of such insurance under the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA). Please refer to the COBRA section of Your summary plan description or contact the Employer for information regarding continuation of insurance under COBRA. AT THE EMPLOYER’S OPTION The Employer has elected to continue insurance by paying premiums for employees who cease Active Work in an eligible class for any of the reasons specified below. If Your insurance is continued, insurance for Your Dependents may also be continued. You will be notified by the Employer how much You will be required to contribute. Insurance will continue for the following periods: 1. for the period You cease Active Work in an eligible class due to layoff up to 2 months. 2. for the period You cease Active Work in an eligible class due to injury or sickness up to 9 months. 3. for the period You cease Active Work in an eligible class due to any other Employer approved leave of absence up to 2 months. At the end of any of the continuation periods listed above, Your insurance will be affected as follows: ·

if You resume Active Work in an eligible class at this time, You will continue to be insured under the Group Policy;

if You do not resume Active Work in an eligible class at this time, Your employment will be considered to end and Your insurance will end in accordance with the DATE YOUR INSURANCE ENDS subsection of the section entitled ELIGIBILITY PROVISIONS: INSURANCE FOR YOU.

If Your insurance ends, Your Dependents’ insurance will also end in accordance with the DATE INSURANCE FOR YOUR DEPENDENTS ENDS subsection of the section entitled ELIGIBILITY PROVISIONS: INSURANCE FOR YOUR DEPENDENTS. GCERT2000 coi-eport

VISION INSURANCE Benefits are available for Covered Services and Materials provided by either In-Network Vision Providers or Out-of-Network Vision Providers. However, You may be able to reduce Your out-of-pocket costs by using InNetwork Vision Providers because Out-of-Network Vision Providers have not entered into an agreement to limit their charges. You are always free to receive services from any Vision Provider. You do not need any authorization from Us before seeing a Vision Provider. In-Network Vision Providers have agreed to provide Covered Services and Materials as listed in the SCHEDULE OF BENEFITS. If You or a Dependent incur a charge for Covered Services and Materials from an Out-of-Network Vision Provider, Proof of such service must be sent to Us. When We receive such Proof, We will review the claim and if We approve it, will pay the insurance in effect on the date that service was completed. The benefits available under this Vision Insurance are set forth on the SCHEDULE OF BENEFITS. In addition to the Co-Payment, if applicable, You may be responsible for: · ·

the cost of any services or materials that are not Covered Services and Materials; and the cost of any service or material that is in excess of the Maximum Benefit Allowance listed on the SCHEDULE OF BENEFITS.

We do not provide vision services. Whether or not benefits are available for a particular service does not mean You should or should not receive the service. You and Your Vision Provider have the right and are responsible at all times for choosing the course of treatment and services to be performed. When requesting Covered Services and Materials from an In-Network Vision Provider, We recommend that You confirm that the Vision Provider is currently an In-Network Vision Provider at the time that the Covered Services and Materials are provided. You can obtain a customized listing of MetLife’s In-Network Vision Providers either by calling 1-855METEYE1 or by visiting Our website at www.metlife.com/mybenefits. PLAN BENEFITS We will pay benefits for charges incurred by You or a Dependent for Covered Services and Materials as shown in the SCHEDULE OF BENEFITS, subject to the conditions set forth in this certificate. If You receive Covered Services and Materials from an In-Network Vision Provider, We will pay the provider directly for all covered benefits. If You or a Dependent receive Covered Services and Materials from an Out-of-Network Vision Provider, and You assign payment of Vision Insurance benefits to Your or Your Dependent's Vision Provider, We will pay benefits directly to the Vision Provider. Otherwise, We will pay Vision Insurance benefits to You. In-Network If Covered Services and Materials are provided by an In-Network Vision Provider, We will base the benefit on the Plan Benefits listed on the SCHEDULE OF BENEFITS. If an In-Network Vision Provider provides Covered Services and Materials, You will be responsible for paying: · ·

the Co-Payment, if applicable; and the cost of any service or material that is in excess of the Plan Benefits listed on the SCHEDULE OF BENEFITS.

Out-of-Network If Covered Services and Materials are provided by an Out-of-Network Vision Provider, We will base the benefit on the Plan Benefits listed on the SCHEDULE OF BENEFITS, subject to the Maximum Benefit Allowance. GCERT2000 vision

VISION INSURANCE (continued) Out-of-Network Vision Providers may charge You more than the Maximum Benefit Allowance. If an Out-ofNetwork Vision Provider provides Covered Services and Materials, You will be responsible for paying any amount in excess of the Maximum Benefit Allowance charged by the Out-of-Network Vision Provider. Necessary Contact Lenses Necessary contact lenses are a Plan Benefit when specific benefit criteria are satisfied and when prescribed by Covered Person’s In-Network Vision Provider. Generally, coverage will be authorized for the following reasons: · · · · · · · ·

Aphakia—379.31 or 743.35. Nystagmus—379.50 through 379.56, 386.11, 386.12 or 386.2. Keratoconus—371.60, 371.61, 371.62, 743.41, or 743.42. Corneal transplant—V42.5. Corneal dystrophies—371.50 through 371.58. Anisometropia greater than or equal to 2.00 diopters difference in any meridian based on the spectacle prescription. High ametropia greater than or equal to ±10.00 diopters in either eye in any meridian based on the spectacle prescription. Irregular astigmatism—367.22.

The codes listed above are from the International Classification of Diseases, Ninth Revision, Clinical Modification and are used to describe diseases, injuries, symptoms and conditions. If You have questions about the diagnoses listed above or the codes included with the diagnoses, please contact Your Vision Provider.

GCERT2000 vision

VISION INSURANCE: DESCRIPTION OF COVERED SERVICES AND MATERIALS Subject to the Service Intervals and Plan Benefits indicated in the SCHEDULE OF BENEFITS, the following will be Covered Services and Materials: 1. One complete visual examination, if indicated as a Covered Service on the SCHEDULE OF BENEFITS. Dilation is included as a Covered Service when provided by an In-Network Vision Provider. 2. Standard corrective lenses. We will cover a pair of standard single vision, lined bifocal, lined trifocal or lenticular lenses that are necessary to correct vision. Standard corrective lenses are as follows: · · · · · ·

eyesizes up to and including 60mm; multi-focal lenses in all segment widths; prism and slab off; base curves (regardless of curve); lenses with the combined power in any meridian is +/- .50 diopters or greater in at least one eye; plastic or glass lenses.

3. The following lens options described in the SCHEDULE OF BENEFITS: tint (solid and gradient), standard plastic scratch coating, standard polycarbonate (if you are less than 18 years of age), standard antireflective coating, plastic photochromic, polarized premium anti-reflective. 4. Contact lenses. · ·

A standard fitting and 1 follow-up visit by a Vision Provider; The following contact lenses options, as described in the SCHEDULE OF BENEFITS: conventional, disposable, and Necessary.

5. Necessary low vision aids. 6. We do not cover costs above the Maximum Benefit Allowance shown in the SCHEDULE OF BENEFITS for frames. If frames are selected that are more expensive than that amount, You will be charged the difference between the Maximum Benefit Allowance and the Vision Provider’s charge for the more expensive frame. 7. Necessary contact lenses in lieu of all benefits for vision materials.

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VISION INSURANCE: EXCLUSIONS We will not pay Vision Insurance benefits for charges incurred for: 1. Services and/or materials not specifically included in the SCHEDULE OF BENEFITS as covered Plan Benefits. 2. Any portion of a charge in excess of the Maximum Benefit Allowance or reimbursement indicated in the SCHEDULE OF BENEFITS. 3. Plano lenses (lenses with refractive correction of less than ± .50 diopter). 4. Two pairs of glasses instead of bifocals. 5. Replacement of lenses, frames and/or contact lenses furnished under this Plan which are lost, stolen or damaged, except at the normal intervals when Plan Benefits are otherwise available. 6. Orthoptics or vision training and any associated supplemental testing. 7. Medical or surgical treatment of the eye. 8. Prescription or non-prescription medications. 9. Contact lens insurance policies and service agreements. 10. Refitting of contact lenses after the initial (90-day) fitting period. 11. Contact lens modification, polishing and cleaning. 12. Any eye examination or any corrective eyewear required as a condition of employment. 13. Services or supplies received by You or Your Dependent before the Vision Insurance starts for that person. 14. Missed appointments. 15. Services or materials resulting from or in the course of a Covered Person’s regular occupation for pay or profit for which the Covered Person is entitled to benefits under any Workers’ Compensation Law, Employer’s Liability Law or similar law. You must promptly claim and notify the Company of all such benefits. 16. Local, state and/or federal taxes, except where MetLife is required by law to pay. 17. Services: · for which the employer of the person receiving such services is required to pay; or · received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital. 18. Services or materials received as a result of disease, defect, or injury due to war or an act of war (declared or undeclared), taking part in a riot or insurrection, or committing or attempting to commit a felony. 19. Services and materials obtained while outside the United States, except for emergency vision care. 20. Services, procedures, or materials for which a charge would not have been made in the absence of insurance.

GCERT2000 vis/exclusions

VISION INSURANCE: COORDINATION OF BENEFITS When You or a Dependent incur charges for Covered Services and Materials, there may be other Plans, as defined below, that also provide benefits for those same charges. In that case, We may reduce what We pay based on what the other Plans pay. This Coordination of Benefits section explains how and when We do this. DEFINITIONS In this section, the terms set forth below have the following meanings: Allowable Expense means a necessary vision expense for which both of the following are true: ·

a Covered Person must pay it, and

it is at least partly covered by one or more of the Plans that provide benefits to the Covered Person.

If a Plan provides fixed benefits for specified events or conditions (instead of benefits based on expenses incurred) such benefits are Allowable Expenses. If a Plan provides benefits in the form of services, We treat the reasonable cash value of each service performed as both an Allowable Expense and a benefit paid by that Plan. The term does not include: ·

expenses for services performed because of a Job-Related Injury or Sickness;

any amount of expenses in excess of the higher reasonable and customary fee for a service, if two or more Plans compute their benefit payments on the basis of reasonable and customary fees;

any amount of expenses in excess of the higher negotiated fee for a service, if two or more Plans compute their benefit payments on the basis of negotiated fees; and

any amount of benefits that a Primary Plan does not pay because the covered person fails to comply with the Primary Plan’s managed care or utilization review provisions, these include provisions requiring: · · · ·

second surgical opinions; pre-certification of services; use of providers in a Plan’s network of providers; or any other similar provisions.

If You or a Dependent are also covered under an HMO plan, We will not use this provision to refuse to pay benefits because an HMO member has elected to have vision services provided by a non-HMO provider and the HMO's contract does not require the HMO to pay for providing those services. Claim Determination Period means a calendar year or plan year. A Claim Determination Period for any Covered Person will not include periods of time during which that person is not covered under This Plan. Custodial Parent means a Parent awarded custody, other than joint custody, by a court decree. In the absence of a court decree, it means the Parent with whom the child resides more than half of the Year without regard to any temporary visitation. HMO means a Health Maintenance Organization or Vision Health Maintenance Organization. Job-Related Injury or Sickness means any injury or sickness: ·

for which You are entitled to benefits under a workers’ compensation or similar law, or any arrangement that provides for similar compensation; or

arising out of employment for wage or profit.

Parent means a person who covers a child as a dependent under a Plan.

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VISION INSURANCE: COORDINATION OF BENEFITS (continued) Plan means any of the following if it provides benefits or services for an Allowable Expense: ·

a group insurance plan;

an HMO;

a blanket plan;

uninsured arrangements of group or group type coverage;

a group practice plan;

a group service plan;

a group prepayment plan;

any other plan that covers people as a group;

any other coverage required or provided by any law or any governmental program, except Medicaid.

The term does not include any of the following: ·

individual or family insurance or subscriber contracts;

individual or family coverage through closed panel Plans or other prepayment, group practice or individual practice Plans;

hospital indemnity coverage;

a school blanket plan that only provides accident-type coverage on a 24 hour basis, or a "to and from school basis," to students in a grammar school, high school or college;

disability income protection coverage;

accident only coverage;

specified disease or specified accident coverage;

nursing home or long term care coverage; or

any government program or coverage if, by state or Federal law, its benefits are excess to those of any private insurance plan or other non-government plan.

The provisions of This Plan which limit benefits based on benefits or services provided under Plans which the employer, Policyholder (or an affiliate) contributes to or sponsors will not be affected by these Coordination of Benefits provisions. Each policy, contract or other arrangement for benefits is a separate Plan. If part of a Plan reserves the right to reduce what it pays based on benefits or services provided by other Plans, that part will be treated separately from any parts which do not. This Plan means the vision benefits described in this certificate, except for any provisions in this certificate that limit insurance based on benefits for services provided under plans which the Policyholder (or an affiliate) contributes to or sponsors. Primary Plan means a Plan that pays its benefits first under the “Rules to Decide Which Plan Is Primary” section. A Primary Plan pays benefits as if the Secondary Plans do not exist. Secondary Plan means a Plan that is not a Primary Plan. A Secondary Plan may reduce its benefits by amounts payable by the Primary Plan. If there are more than two Plans that provide coverage, a Plan may be Primary to some plans, and Secondary to others.

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VISION INSURANCE: COORDINATION OF BENEFITS (continued) RULES TO DECIDE WHICH PLAN IS PRIMARY When more than one Plan covers the person for whom Allowable Expenses were incurred, We determine which plan is primary by applying the rules in this section. When there is a basis for claim under This Plan and another Plan, This Plan is Secondary unless: ·

the other Plan has rules coordinating its benefits with those of This Plan; and

this Plan is primary under This Plan’s rules.

The first rule below which will allow Us to determine which Plan is Primary is the rule that We will use. Dependent or Non-Dependent: A Plan that covers a person other than as a dependent (for example, as an employee, member, subscriber, or retiree) is Primary and shall pay its benefits before a Plan that covers the person as a dependent; except that if the person is a Medicare beneficiary and, as a result of federal law or regulations, Medicare is: ·

Secondary to the Plan covering the person as a dependent; and

Primary to the Plan covering the person as other than a dependent (e.g., a retired employee),

then the order of benefits between the two Plans is reversed and the Plan that covers the person as a dependent is Primary. Child Covered Under More Than One Plan – Court Decree: When This Plan and another Plan cover the same Child as the Dependent of two or more Parents, and the specific terms of a court decree state that one of the Parents must provide health coverage or pay for the Child’s health care expenses, that Parent’s Plan is Primary if the Plan has actual knowledge of those terms. This rule applies to Claim Determination Periods that start after the Plan is given notice of the court decree. Child Covered Under More Than One Plan – The Birthday Rule: When This Plan and another Plan cover the same Child as the Dependent of two or more Parents, the Primary Plan is the Plan of the Parent whose birthday falls earlier in the Year if: ·

the Parents are married; or

the Parents are not separated (whether or not they have ever married); or

a court decree awards joint custody without specifying which Parent must provide health coverage.

If both Parents have the same birthday, the Plan that covered either of the Parents longer is the Primary Plan. However, if the other Plan does not have this rule, but instead has a rule based on the gender of the parent, and if as a result the Plans do not agree on the order of benefits, the rule in the other Plan will determine the order of benefits. Child Covered Under More than One Plan – Custodial Parent: When This Plan and another Plan cover the same Child as the Dependent of two or more Parents, if the Parents are not married, or are separated (whether or not they ever married), or are divorced, the Primary Plan is: ·

the Plan of the Custodial Parent; then

the Plan of the spouse of the Custodial Parent; then

the Plan of the non-custodial Parent; and then

the Plan of the spouse of the non-custodial Parent.

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VISION INSURANCE: COORDINATION OF BENEFITS (continued) Active or Inactive Employee: A Plan that covers a person as an employee who is neither laid off nor retired is Primary to a Plan that covers the person as a laid-off or retired employee (or as that person’s Dependent). If the other Plan does not have this rule and, if as a result, the Plans do not agree on the order of benefits, this rule is ignored. Continuation Coverage: The Plan that covers a person as an active employee, member or subscriber (or as that employee’s Dependent) is Primary to a Plan that covers that person under a right of continuation pursuant to federal law (e.g., COBRA) or state law. If the Plan that covers the person has not adopted this rule, and if, as a result, the Plans do not agree on the order of benefits, this rule shall not apply. Longer/Shorter Time Covered: If none of the above rules determine which Plan is Primary, the Plan that has covered the person for the longer time shall be Primary to a Plan that has covered the person for a shorter time. No Rules Apply: If none of the above rules determine which Plan is Primary, the Allowable Expenses shall be shared equally between all the Plans. In no event will This Plan pay more than it would if it were Primary. EFFECT ON BENEFITS OF THIS PLAN If This Plan is Secondary, when the total Allowable Expenses incurred by a covered person in any Claim Determination Period are less than the sum of: ·

the benefits that would be payable under This Plan without applying this Coordination of Benefits provision; and

the benefits that would be payable under all other Plans without applying Coordination of Benefits or similar provisions;

then We will reduce the benefits that would otherwise be payable under This Plan. The sum of these reduced benefits plus all benefits payable for such Allowable Expenses under all other Plans will not exceed the total of the Allowable Expenses. Benefits payable under all other Plans include all benefits that would be payable if the proper claims had been made on time. FACILITY OF PAYMENT A payment made under another Plan may include an amount which should have been paid under This Plan. If it does, We may pay that amount to the organization which made that payment. That amount will then be treated as though it were a benefit paid under This Plan. We will not have to pay that amount again. The term “payment made” includes benefits provided in the form of services, in which case We may pay the reasonable cash value of the benefits provided in the form of services. RIGHT OF RECOVERY If the amount We pay is more than We should have paid under this Coordination of Benefits provision, We may recover the excess from one or more of: ·

the person We have paid or for whom We have paid;

insurance companies; or

other organizations.

The amount of the payment includes the reasonable cash value of any benefits provided in the form of services.

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VISION INSURANCE: FILING A CLAIM CLAIMS FOR VISION INSURANCE If you select an In Network Vision Provider, You do not need to file a claim. If you select an Out-of-Network Vision Provider, You may provide full payment to the Out-of-Network Vision Provider at the time of service and submit the invoice including an itemized statement of charges with Your claim form, or You may be able to assign the claim to the Out-of-Network Vision Provider. If the Out-ofNetwork Vision Provider accepts the assignment, the provider will submit the claim on your behalf. You will be responsible for any charges not covered by the Plan. Out of network claim forms needed to file for benefits under the group insurance program can be obtained by calling MetLife at 1-855-METEYE1. Vision claim forms can also be downloaded from www.metlife.com/mybenefits. The instructions on the claim form should be followed carefully. This will expedite the processing of the claim. When We receive the claim form and Proof, Your claim will be paid subject to the terms and provisions of this certificate and the Group Policy. CLAIMS FOR VISION INSURANCE BENEFITS When a claimant files a claim for Vision Insurance benefits described in this certificate, both the notice of claim and the required Proof should be sent to Us within 180 days from the date of service. Claim and Proof may be given to Us by following the steps set forth below: Step 1 A claimant can request a claim form by downloading it from www.metlife.com/mybenefits. Step 2 Complete the claim form as instructed and return it with the invoice. Step 3 The claimant must give Us Proof not later than 180 days from the date of service.

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VISION INSURANCE: PROCEDURES FOR VISION CLAIMS Routine Questions on Vision Insurance Claims If there is any question about a claim payment, an explanation may be requested from MetLife by dialing 1855-METEYE1. Claim Denial Appeals If a claim is denied in whole or in part, under the terms of this certificate, a request may be submitted to Us by a Covered Person or a Covered Person’s authorized representative for a full review of the denial. A Covered Person may designate any person, including their provider, as their authorized representative. References in this section to “Covered Person” include the Covered Person’s authorized representative, where applicable. Initial Appeal. All requests for review must be made within one hundred eighty (180) calendar days following denial of a claim. A Covered Person may review, during normal business hours, any documents used by Us pertinent to the denial. A Covered Person may also submit Written comments or supporting documentation concerning the claim to assist in Our review. Our response to the initial appeal, including specific reasons for the decision, shall be communicated to the Covered Person within thirty (30) calendar days after receipt of the request for the appeal. Second Level Appeal. If a Covered Person disagrees with the response to the initial appeal of the denied claim, the Covered Person has the right to a second level appeal. A request for a second level appeal must be submitted to Us within sixty (60) calendar days after receipt of Our response to the initial appeal. We shall communicate Our final determination to the Covered Person within thirty (30) calendar days from receipt of the request, or as required by any applicable state or federal laws or regulations. Our communication to the Covered Person shall include the specific reasons for the determination. Other Remedies. When a Covered Person has completed the appeals stated herein, additional voluntary alternative dispute resolution options may be available, including mediation or arbitration. Additional information is available from the U.S. Department of Labor or the insurance regulatory agency for the Covered Persons’ state of residency. Additionally, under the provisions of ERISA (Section 502(a)(1)(B) 29 U.S.C. 1132(a)(1)(B)), the Covered Person has the right to bring a civil action when all available levels of reviews, including the appeal process, have been completed. ERISA remedies may apply in those instances where the claims were not approved in whole or in part as the result of appeals under this Policy and the Covered Person disagrees with the outcome of such appeals. Time of Action. No action in law or in equity shall be brought to recover on this Policy prior to the Covered Person exhausting his/her rights under this Policy and/or prior to the expiration of sixty (60) calendar days after the claim and any applicable documentation has been filed with Us. No such action shall be brought after the expiration of any applicable statute of limitations, in accordance with the terms of this Policy. No such action shall be brought after the expiration of three (3) years from the last date that the claim and any applicable invoices were submitted to Us, and no such action shall be brought at all unless brought within three (3) years from the expiration of the time within which such materials are required to be submitted in accordance with the terms of this Policy. Insurance Fraud: Any Covered Person who intends to defraud, knowingly facilitates a fraud, submits a claim containing false or deceptive information, or who commits any other similar act as defined by applicable state or federal law, may be guilty of insurance fraud. Such an act is grounds for immediate termination of the coverage under this Policy of the Covered Person committing such fraud.

GCERT2000 vis/claimrev

GENERAL PROVISIONS Assignment The rights and benefits under the Group Policy are not assignable prior to a claim for benefits, except as required by law. Upon receipt of a Covered Service, You may assign Vision Insurance benefits to the Vision Provider providing such service. Vision Insurance: Who We Will Pay If You assign payment of Vision Insurance benefits to Your or Your Dependentâ&#x20AC;&#x2122;s Vision Provider, We will pay benefits directly to the Vision Provider. Otherwise, We will pay Vision Insurance benefits to You. Entire Contract Your insurance is provided under a contract of group insurance with the Employer. The entire contract with the Employer is made up of the following: 1. the Group Policy and its Exhibits, which include the certificate(s); 2. the Employer's application; and 3. any amendments and/or endorsements to the Group Policy. Incontestability: Statements Made by You Any statement made by You will be considered a representation and not a warranty. Evidence of insurability will not be required nor will any statement made by You, which relates to insurability, be used: 1. to contest the validity of the insurance benefits; or 2. to reduce the insurance benefits. Conformity with Law If the terms and provisions of this certificate do not conform to any applicable law, this certificate shall be interpreted to so conform.

GCERT2000 gp 10/04

THE PRECEDING PAGE IS THE END OF THE CERTIFICATE. THE FOLLOWING IS ADDITIONAL INFORMATION.

ERISA INFORMATION THIS SUMMARY PLAN DESCRIPTION IS EXPRESSLY MADE PART OF THE PLAN AND IS LEGALLY ENFORCEABLE AS PART OF THE PLAN WITH RESPECT TO ITS TERMS AND CONDITIONS. IN THE EVENT THERE IS NO OTHER PLAN DOCUMENT, THIS DOCUMENT SHALL SERVE AS A SUMMARY PLAN DESCRIPTION AND SHALL ALSO CONSTITUTE THE PLAN. NAME OF THE PLAN BRG Management Inc dba Aspen Heights Welfare Benefit Plan ("Plan") NAME AND ADDRESS OF EMPLOYER BRG Management Inc dba Aspen Heights 1301 S Capital of Texas Hwy Austin, TX 787460 (512) 369-3030 EMPLOYER IDENTIFICATION NUMBER: 262458511 COVERAGE

PLAN NAME

Vision

BRG Management Inc dba Aspen Heights Welfare Benefit Plan

TYPE OF ADMINISTRATION The above listed benefits are insured by Metropolitan Life Insurance Company ("MetLife"). PLAN ADMINISTRATOR NAME, BUSINESS ADDRESS AND PHONE NUMBER BRG Management Inc dba Aspen Heights 1301 S Capital of Texas Hwy Austin, TX 787460 (512) 369-3030 AGENT FOR SERVICE OF LEGAL PROCESS For disputes arising under the Plan, service of legal process may be made upon the Plan Administrator at the above address. For disputes arising under those portions of the Plan insured by MetLife, service of legal process may be made upon MetLife at one of its local offices, or upon the supervisory official of the Insurance Department in the state in which you reside. ELIGIBILITY FOR PARTICIPATION; DESCRIPTION OR SUMMARY OF BENEFITS Your MetLife certificate describes the eligibility requirements for insurance provided by MetLife under the Plan. It also includes a detailed description of the insurance provided by MetLife under the Plan.

The following applies to employers with 20 or more employees that are not church or government plans: NOTICE OF YOUR RIGHT AND YOUR DEPENDENTS' RIGHT TO COBRA CONTINUATION COVERAGE COBRA is a federal law that requires most group health plans to give their employees and their dependents the opportunity to continue coverage when coverage is terminated due to certain specific events. If your employment terminates for any reason other than your gross misconduct, or if your hours worked are reduced so that your coverage terminates, you and your covered dependents may be able to continue coverage under This Plan for a period of up to 18 months. If it is determined under the terms of the Social Security Act that You or your covered dependent is disabled within the first 60 days of COBRA coverage, you and your covered dependents may be able to continue your vision coverage under This Plan for an additional 11 months after the expiration of the 18 month period. In addition, if you should die, become divorced or legally separated, or become eligible for Medicare, your covered dependents may be able to continue coverage under This Plan for up to 36 months. Also, your covered children may be able to continue coverage under This Plan for up to 36 months after they no longer qualify as covered dependents under the terms of This Plan. Group health plans for employers with fewer than 20 employees, church plans, and plans established and maintained by the federal government are not subject to COBRA continuation requirements. During the continuation period, a child of yours that is (1) born; (2) adopted by you; or (3) placed with you for adoption, will be treated as if the child were a covered dependent at the time coverage was lost due to an event described above. This continuation will terminate on the earliest of: a. the end of the 18, 29 or 36 month continuation period, as the case may be; b. the date of expiration of the last period for which the required payment was made; c.

the date, after you or your covered dependent elects to continue coverage, that you or your covered dependent first becomes covered under another group health plan as long as the new plan does not contain any exclusion or limitation with respect to your or your covered dependentâ&#x20AC;&#x2122;s preexisting condition;

d. the date your employer ceases to provide any group health plan for its employees. Notice will be given when you or your covered dependent becomes entitled to continue coverage under This Plan. You or your covered dependent will then have 60 days to elect to continue coverage. If you or your covered dependent do not notify your Employer within the 60-day election period, you will lose the option to elect continuation coverage. Each person who is eligible for COBRA coverage is entitled to make a separate election of COBRA coverage. Thus, a covered spouse (as defined by federal law) or dependent child (or parent on their behalf) is entitled to elect COBRA coverage even if the covered Employee does not make that election. However, covered Employees may elect COBRA coverage on behalf of their covered dependents. Any person who elects to continue coverage under This Plan must pay the full cost of that coverage (including both the share you now pay and the share your Employer now pays), plus any additional amounts permitted by law. Your payments for continued coverage must be made on the first day of each month in advance. If you do not elect COBRA coverage, your vision coverage will end. However, if you initially waive COBRA continuation coverage before the end of the 60-day election period, you may change your election by sending the completed election form to the Plan Administrator and postmarking it no later than the last day of the 60-day election period.

If You Elect Cobra If you choose COBRA coverage and pay the required premiums, you are entitled to coverage which, as of the time coverage is being provided, is identical to the coverage provided by the Employer to similarly situated active Employees, spouses or dependent children. This means that if the coverage for similarly situated Employees spouses or dependent children changes, coverage will change for those who elected COBRA coverage. Duration Of Cobra Coverage The law requires that you be given the opportunity to maintain COBRA coverage for 36 months from the date coverage ends as a result of the qualifying event unless you lost coverage because of the covered Employee's termination of employment or reduction in hours. In that case, the required COBRA coverage period is 18 months from the date you lose coverage as a result of the termination of employment or reduction in hours. However, the 18-month coverage period may be extended under the following circumstances: Disability. If any person entitled to COBRA coverage (the covered Employee, covered spouse or covered dependent child) is determined by the Social Security Administration to have been disabled at any time during the first 60 days of COBRA coverage period and the disability lasts at least until the end of the 18 month period of continuation coverage, then all such persons entitled to elect COBRA coverage may be able to continue coverage for up to 29 months, rather than 18 months. In order to be eligible for the additional 11 months of COBRA coverage, the covered Employee, covered spouse or covered dependent child must notify the Employer's COBRA Administrator within 60 days of the latest of: (1) the Social Security Administration’s determination of disability; (2) the date of the qualifying event; (3) the date on which the covered Employee’s coverage initially was or will be lost; or (4) the date a person entitled to COBRA coverage is informed of this obligation by being provided the initial COBRA notice for the applicable group health plan. Written notice to the COBRA Administrator must be received before the end of the initial 18-month coverage period. A copy of the Social Security Administration’s determination must be provided to the COBRA Administrator. If these procedures are not followed, there will be no disability extension of COBRA. During the additional 11 months of coverage, your cost for that coverage will be approximately 50% higher than it was during the preceding 18 months. The additional 11 months of coverage provided on account of a disability will end as of the earlier of: ·

The first day of the month beginning more than 30 days after a final determination by the Social Security Administration that the disability no longer exists; or

The last day of the 29th month of total coverage.

A person entitled to COBRA coverage must notify the COBRA Administrator within 30 days if the Social Security Administration determines that the disabled person is no longer disabled. This Plan reserves the right to retroactively cancel COBRA coverage, and will require reimbursement of all benefits paid for claims incurred after coverage terminates. Subsequent Qualifying Events. If, during the 18-month period of COBRA coverage (or within the 29month maximum coverage period in the case of a disability extension), the covered Employee and the spouse divorce, the covered Employee dies, the covered Employee becomes entitled to Medicare, or a dependent ceases to be an eligible dependent under the terms of This Plan, then the covered spouse and/or covered dependent child(ren) (as applicable) may be able to extend COBRA coverage for up to 36 months from the date of the termination of employment or reduction in hours.

A person entitled to COBRA coverage must notify the Employerâ&#x20AC;&#x2122;s COBRA Administrator of the subsequent event no later than 60 days after its occurrence. If such notification is not given, the covered spouse and/or covered dependent child will not be entitled to the additional COBRA coverage. Premiums For Cobra Coverage A person entitled to COBRA coverage is entirely responsible for paying the premiums for COBRA coverage. The required payment for each continuation coverage period for each option will be described in the notice that is sent when an individual experiences a qualifying event. Initial Premium Payment If continuation of coverage is elected, payment for continuation coverage must be made no later than 45 days after the date of such election. (This is the date the election notice is post-marked, if mailed.) If the first payment for continuation coverage is not made in full by the 45th day after the date of election, continuation coverage under This Plan will end. A person entitled to COBRA coverage is responsible for making sure that the amount of the first payment is correct. After the first payment for continuation coverage, the amount due for each coverage period for each qualified beneficiary will be provided when coverage is elected. PLAN TERMINATION OR CHANGES Written notice of termination must be given to the Employer at least 31 days prior to the date such insurance will be terminated. Premiums are due and payable on the first day of each month for which insurance coverage is to be provided. If a payment is not received within 31 days after the due date, coverage will terminate as follows: a. with respect to coverages other than Life Insurance and Accidental Death or Dismemberment Insurance - on the earlier of the 31st day following the due date and the date requested in writing by the Employer, provided such request is made before such 31st day; and b. with respect to Life Insurance and Accidental Death or Dismemberment Insurance -- on the later of the 31st day following the due date and the date MetLife's written notice of termination is received by the Employer. The Employer is liable to MetLife for payment of the pro-rata premium which accrues while any coverage remains in force. The group policy sets forth those situations in which the Employer and/or MetLife have the right to end the policy. The Employer reserves the right to change or terminate the Plan at any time. Therefore, there is no guarantee that you will be eligible for the benefits described herein for the duration of your employment. Any such action will be taken only after careful consideration. Your consent or the consent of your beneficiary is not required to terminate, modify, amend, or change the Plan. In the event Your coverage ends in accord with the Date Your Insurance Ends provision of Your certificate, you may still be eligible to receive benefits. The circumstances under which benefits are available are described in Your MetLife certificate.

CONTRIBUTIONS You must make a contribution to the cost of Personal and Dependent Vision Insurance. The total premium rate for insurance provided under the Plan by MetLife is set by MetLife. PLAN YEAR The Plan's fiscal records are kept on a Plan year basis beginning each January 1 and ending on the following December 31. Qualified Domestic Relations Orders/Qualified Medical Child Support Orders You and your beneficiaries can obtain, without charge, from the Plan Administrator a copy of any procedures governing Qualified Domestic Relations Orders (QDRO) and Qualified Medical Child Support Orders (QMCSO). Routine Questions on Vision Insurance Claims If there is any question about a claim payment, an explanation may be requested from MetLife by dialing 1-855-METEYE1. Claim Denial Appeals If a claim is denied in whole or in part, under the terms of this certificate, a request may be submitted to Us by a Covered Person or a Covered Person’s authorized representative for a full review of the denial. A Covered Person may designate any person, including their provider, as their authorized representative. References in this section to “Covered Person” include the Covered Person’s authorized representative, where applicable. Initial Appeal. All requests for review must be made within one hundred eighty (180) calendar days following denial of a claim. A Covered Person may review, during normal business hours, any documents used by Us pertinent to the denial. A Covered Person may also submit Written comments or supporting documentation concerning the claim to assist in Our review. Our response to the initial appeal, including specific reasons for the decision, shall be communicated to the Covered Person within thirty (30) calendar days after receipt of the request for the appeal. Second Level Appeal. If a Covered Person disagrees with the response to the initial appeal of the denied claim, the Covered Person has the right to a second level appeal. A request for a second level appeal must be submitted to Us within sixty (60) calendar days after receipt of Our response to the initial appeal. We shall communicate Our final determination to the Covered Person within thirty (30) calendar days from receipt of the request, or as required by any applicable state or federal laws or regulations. Our communication to the Covered Person shall include the specific reasons for the determination.

Other Remedies. When a Covered Person has completed the appeals stated herein, additional voluntary alternative dispute resolution options may be available, including mediation or arbitration. Additional information is available from the U.S. Department of Labor or the insurance regulatory agency for the Covered Personsâ&#x20AC;&#x2122; state of residency. Additionally, under the provisions of ERISA (Section 502(a)(1)(B) 29 U.S.C. 1132(a)(1)(B)), the Covered Person has the right to bring a civil action when all available levels of reviews, including the appeal process, have been completed. ERISA remedies may apply in those instances where the claims were not approved in whole or in part as the result of appeals under this Policy and the Covered Person disagrees with the outcome of such appeals. Time of Action. No action in law or in equity shall be brought to recover on this Policy prior to the Covered Person exhausting his/her rights under this Policy and/or prior to the expiration of sixty (60) calendar days after the claim and any applicable documentation has been filed with Us. No such action shall be brought after the expiration of any applicable statute of limitations, in accordance with the terms of this Policy. No such action shall be brought after the expiration of three (3) years from the last date that the claim and any applicable invoices were submitted to Us, and no such action shall be brought at all unless brought within three (3) years from the expiration of the time within which such materials are required to be submitted in accordance with the terms of this Policy. Insurance Fraud: Any Covered Person who intends to defraud, knowingly facilitates a fraud, submits a claim containing false or deceptive information, or who commits any other similar act as defined by applicable state or federal law, may be guilty of insurance fraud. Such an act is grounds for immediate termination of the coverage under this Policy of the Covered Person committing such fraud. Discretionary Authority of Plan Administrator and Other Plan Fiduciaries In carrying out their respective responsibilities under the Plan, the Plan administrator and other Plan fiduciaries shall have discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan. Any interpretation or determination made pursuant to such discretionary authority shall be given full force and effect, unless it can be shown that the interpretation or determination was arbitrary and capricious. STATEMENT OF ERISA RIGHTS The following statement is required by federal law and regulation. As a participant in the Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all participants shall be entitled to: Receive Information About Your Plan and Benefits Examine, without charge, at the Plan administrator's office and at other specified locations, all Plan documents governing the Plan, including insurance contracts and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefit Security Administration. Obtain, upon written request to the Plan administrator, copies of documents governing the operation of the Plan, including insurance contracts and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The administrator may make a reasonable charge for the copies. Receive a summary of the Plan's annual financial report. The Plan administrator is required by law to furnish each participant with a copy of this summary annual report.

Continue Group Vision Plan Insurance Continue vision insurance for yourself, spouse or dependents if there is a loss of coverage under the Plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this summary plan description and the documents governing the Plan on the rules governing your COBRA continuation coverage rights. Prudent Actions by Plan Fiduciaries In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit Plan. The people who operate your Plan, called "fiduciaries" of the Plan, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries. No one, including your employer or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA. Enforce Your Rights If your claim for a welfare benefit is denied or ignored in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Plan documents or the latest annual report from the Plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the Plan administrator to provide the materials and pay you up to $110.00 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. In addition, if you disagree with the Plan's decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support order, you may file suit in Federal court. If it should happen that Plan fiduciaries misuse the Plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees; for example, if it finds your claim is frivolous. Assistance with Your Questions If you have any questions about your Plan, you should contact the Plan administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan administrator, you should contact the nearest office of the Pension and Welfare Benefits Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Pension and Welfare Benefits Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Pension and Welfare Benefits Administration.

PLAN PRIVACY INFORMATION Notwithstanding any other Plan provision in this or other sections of the Plan, the Plan will operate in accordance with the HIPAA privacy laws and regulations as set forth in 45 CFR Parts 160 and 164, and as they may be amended ("HIPAA"), with respect to protected health information ("PHI") as that term is defined therein. The Plan Administrator and/or his or her designee retains full discretion in interpreting these rules and applying them to specific situations. All such decisions shall be given full deference unless the decision is determined to be arbitrary and capricious. The term “Plan Sponsor” means BRG Management Inc. The term “Plan Administrator” means the entity designated as Plan Administrator by the Plan documents pursuant to which the plan is operated. If a Plan Administrator is not designated by the plan documents, the Plan Sponsor shall be deemed to be the Plan Administrator.

I. Permitted Uses and Disclosures of PHI by the Plan and the Plan Sponsor The Plan and the Plan Sponsor are permitted to use and disclose PHI for the following purposes, to the extent they are not inconsistent with HIPAA: ·

For general plan administration, including policyholder service functions, enrollment and eligibility functions, reporting functions, auditing functions, financial and billing functions, to assist in the administration of a consumer dispute or inquiry, and any other authorized insurance or benefit function.

As required for computer programming, consulting or other work done in respect to the computer programs or systems utilized by the Plan.

Other uses relating to plan administration, which are approved in writing by the Plan Administrator.

At the request of an individual, to assist in resolving claims the individual may have with respect to benefits under the Plan.

II. Uses and Disclosures of PHI by the Plan and the Plan Sponsor for Required Purposes The Plan and Plan Sponsor may use or disclose PHI for the following required purposes: ·

Judicial and administrative proceedings, in response to lawfully executed process, such as a court order or subpoena.

For public health and health oversight activities, and other governmental activities accompanied by lawfully executed process.

As otherwise may be required by law.

III. Sharing of PHI With the Plan Sponsor As a condition of the Plan Sponsor receiving PHI from the Plan, the Plan Documents have been amended to incorporate the following provisions, under which the Plan Sponsor agrees to: ·

Not use or further disclose PHI other than as permitted or required by the plan documents in Sections I and II above;

Ensure that any agents to whom it provides PHI received from the Plan agree to the same restrictions and conditions that apply to the Plan Sponsor;

Not use or disclose PHI for employment-related actions or decisions or in connection with any other benefit or employee benefit plan of the Plan Sponsor;

Report to the Plan any use or disclosure of the information that is inconsistent with the permitted uses or disclosures of which it becomes aware;

Make PHI available to Plan participants for the purposes of the rights of access and inspection, amendment, and accounting of disclosures as required by HIPAA;

Make its internal practices, books and records relating to the use and disclosure of PHI received from the Plan available to the Secretary of the U.S. Department of Health and Human Services for purposes of determining compliance by the Plan with HIPAA;

If feasible, return or destroy all PHI received from the Plan that the sponsor still maintains in any form and retain no copies of such information when no longer needed for the purpose for which disclosure was made, except that, if such return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction of the information infeasible;

Ensure that adequate separation between the Plan and Plan Sponsor is established in accordance with the following requirements: (A) Employees to be Given Access to PHI: The following employees (or class of employees) of the Plan Sponsor are the only individuals that may access PHI provided by the Plan: Human Resource Director (B) Restriction to Plan Administration Functions: The access to and use of PHI by the employees of the Plan Sponsor designated above will be limited to plan administration functions that the Plan Sponsor performs for the Plan. (C) Mechanism for Resolving issues of Noncompliance: If the Plan Administrator determines that an employee of the Plan Sponsor designated above has acted in noncompliance with the plan document provisions outlined above, then the Plan Administrator shall take or seek to have taken appropriate disciplinary action with respect to that employee, up to and including termination of employment as appropriate. The Plan Administrator shall also document the facts of the violation, actions that have been taken to discipline the offending party and the steps taken to prevent future violations. Certify to the Plan, prior to the Plan permitting disclosure of PHI to the Plan Sponsor, that the Plan Documents have been amended to incorporate the provisions in this Section.

IV. Security As a condition of the Plan Sponsor receiving electronic PHI (“ePHI”) from the Plan, the Plan Documents have been amended to incorporate the following provisions, under which the Plan Sponsor agrees to: ·

Implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the ePHI that it creates, receives, maintains, or transmits on behalf of the Plan;

Ensure that the adequate separation between the Plan and the Plan Sponsor, which is required by the applicable section(s) of the Plan relating to the sharing of PHI with the Plan Sponsor, is supported by reasonable and appropriate security measures;

Ensure that any agent to whom it provides ePHI agrees to implement reasonable and appropriate security measures to protect the information; and

Report to the Plan any security incident of which it becomes aware. In this context, the term “security incident” means the attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in information systems such as hardware, software, information, data, applications, communications, and people. FUTURE OF THE PLAN

It is hoped that This Plan will be continued indefinitely, but BRG Management Inc dba Aspen Heights reserves the right to change or terminate the Plan in the future. Any such action would be taken only after careful consideration.

Our Privacy Notice We know that you buy our products and services because you trust us. This notice explains how we protect your privacy and treat your personal information. It applies to current and former customers. “Personal information” as used here means anything we know about you personally. Plan Sponsors and Group Insurance Contract Holders This privacy notice is for individuals who apply for or obtain our products and services under an employee benefit plan, or group insurance or annuity contract. In this notice, “you” refers to these individuals. Protecting Your Information We take important steps to protect your personal information. We treat it as confidential. We tell our employees to take care in handling it. We limit access to those who need it to perform their jobs. Our outside service providers must also protect it, and use it only to meet our business needs. We also take steps to protect our systems from unauthorized access. We comply with all laws that apply to us. Collecting Your Information We typically collect your name, address, age, and other relevant information. We may also collect information about any business you have with us, our affiliates, or other companies. Our affiliates include life, car, and home insurers. They also include a bank, a legal plans company, and securities broker-dealers. In the future, we may also have affiliates in other businesses. How We Get Your Information We get your personal information mostly from you. We may also use outside sources to help ensure our records are correct and complete. These sources may include consumer reporting agencies, employers, other financial institutions, adult relatives, and others. These sources may give us reports or share what they know with others. We don’t control the accuracy of information outside sources give us. If you want to make any changes to information we receive from others about you, you must contact those sources. Using Your Information We collect your personal information to help us decide if you’re eligible for our products or services. We may also need it to verify identities to help deter fraud, money laundering, or other crimes. How we use this information depends on what products and services you have or want from us. It also depends on what laws apply to those products and services. For example, we may also use your information to: · · · · · · ·

administer your products and services process claims and other transactions perform business research confirm or correct your information market new products to you help us run our business comply with applicable laws

Sharing Your Information With Others We may share your personal information without your consent if permitted or required by law. For example, we may share your information with businesses hired to carry out services for us. We may also share it with our affiliated or unaffiliated business partners through joint marketing agreements. In those situations, we share your information to jointly offer you products and services or have others offer you products and services we endorse or sponsor. Before sharing your information with any affiliate or joint marketing partner for their own marketing purposes, however, we will first notify you and give you an opportunity to opt out. Other reasons we may share your information include: doing what a court, law enforcement, or government agency requires us to do (for example, complying with search warrants or subpoenas) · telling another company what we know about you if we are selling or merging any part of our business · giving information to a governmental agency so it can decide if you are eligible for public benefits CPN-Group-Ann-2015 ·

· · · ·

giving your information to someone with a legal interest in your assets (for example, a creditor with a lien on your account) giving your information to your health care provider having a peer review organization evaluate your information, if you have health coverage with us those listed in our “Using Your Information” section above HIPAA

We will not share your health information with any other company – even one of our affiliates – for their own marketing purposes. The Health Insurance Portability and Accountability Act (“HIPAA”) protects your information if you request or purchase dental, vision, long-term care and/or medical insurance from us. HIPAA limits our ability to use and disclose the information that we obtain as a result of your request or purchase of insurance. Information about your rights under HIPAA will be provided to you with any dental, vision, long-term care or medical coverage issued to you. You may obtain a copy of our HIPAA Privacy Notice by visiting our website at www.MetLife.com. Select “Privacy Policy” at the bottom of the home page. For additional information about your rights under HIPAA; or to have a HIPAA Privacy Notice mailed to you, contact us at HIPAAprivacyAmericasUS@metlife.com, or call us at telephone number (212) 578-0299. Accessing and Correcting Your Information You may ask us for a copy of the personal information we have about you. Generally, we will provide it as long as it is reasonably retrievable and within our control. You must make your request in writing listing the account or policy numbers with the information you want to access. For legal reasons, we may not show you anything we learned as part of a claim or lawsuit, unless required by law. If you tell us that what we know about you is incorrect, we will review it. If we agree, we will update our records. Otherwise, you may dispute our findings in writing, and we will include your statement whenever we give your disputed information to anyone outside MetLife. Questions We want you to understand how we protect your privacy. If you have any questions about this notice, please contact us. When you write, include your name, address, and policy or account number. Send privacy questions to: MetLife Privacy Office P. O. Box 489 Warwick, RI 02887-9954 privacy@metlife.com We may revise this privacy notice. If we make any material changes, we will notify you as required by law. We provide this privacy notice to you on behalf of these MetLife companies: Metropolitan Life Insurance Company MetLife Insurance Company USA SafeGuard Health Plans, Inc.

CPN-Group-Ann-2015

MetLife Health Plans, Inc. General American Life Insurance Company SafeHealth Life Insurance Company

Uniformed Services Employment And Reemployment Rights Act This section describes the right that you may have to continue coverage for yourself and your covered dependents under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA). Continuation of Group Vision Insurance: If you take a leave from employment for “service in the uniformed services,” as that term is defined in USERRA, and as a consequence your vision insurance coverage under your employer’s group vision insurance policy ends, you may elect to continue vision insurance for yourself and your covered dependents, for a limited period of time, as described below. The law requires that your employer notify you of your rights, benefits and obligations under USERAA including instructions on how to elect to continue insurance, the amount and procedure for payment of premium. If permitted by USERRA, your employer may require that you elect to continue coverage within a period of time specified by your employer. You may be responsible for payment of the required premium to continue insurance. If your leave from employment for service in the uniformed services lasts less than 31 days, your required premium will be no more than the amount you were required to pay for vision insurance before the leave began; for a leave lasting 31 or more days, you may be required to pay up to 102% of the total Vision insurance premium, including any amount that your employer was paying before the leave began. You and your covered dependents insurance that is continued pursuant to USERRA will end on the earliest of the following: · ·

the end of 24 consecutive months from the date your leave from employment for service in the uniformed services begins; or the day after the date on which you fail to apply for, or return to employment, in accordance with USERRA.

You and your covered dependent may become entitled to continuation of coverage under the Consolidated Omnibus Budget Reconciliation Act (“COBRA”) while you have Vision insurance coverage under your employer’s group vision insurance policy pursuant to USERRA. Contact your employer for more information.

Your Retirement. Get there one step at a time.

Aspen Heights 401(K) Plan

Plan for what’s ahead Knowing your goals for retirement—and what it will take to reach them— is key to creating a strategy that works for you. Learn how the plan helps you save and stay on track to reach your goals.

Choose how you want to get there Understanding investments puts you on the right path to choosing options that best meet your goals and preferences. Get the basics to boost your knowledge and make smart investing decisions.

Start moving in the right direction Your plan makes it easy for you to start saving for your future ﬁnancial security. Take the ﬁrst step and enroll today.

Take the first step.

Enroll Today. The retirement years hold many possibilities. Do you have plans for this next phase in your life? Many of us do. Whether you see yourself working less, starting a new career, enjoying hobbies or traveling, chances are you’ll need to plan ahead and save.

Ready to enroll in the plan? Go to page 6 to find out how to get started saving now.

The future offers the potential for a longer life and the need for more income in retirement. You may need 70%-90% of your current annual income to replace your salary and live comfortably once you stop working or change your lifestyle in retirement. We all want the financial security to afford to spend retirement as we choose. And while Social Security may help, it probably won’t be enough. It’s up to you to make up the difference—and your plan can help. Aspen Heights 401(K) Plan can help you reach your future financial goals, and it’s easy to get started. The sooner you enroll, the sooner you can take advantage of these great benefits: ●

Employer contributions

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Tax-advantaged saving through pre-tax contributions and the Roth 401(k) option

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Convenient, automatic payroll deductions

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Investments that make saving easy

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Plan features that simplify planning

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An account you can take with you

This guide contains all the information you need to get started on your path to future financial security. Take a few moments to decide how much to save, how to choose the right investments for your needs and goals, and open your retirement account today.

04-3014-0516

Plan for what’s ahead.

Whatever you decide is ahead in retirement, you’ll want to be able to afford to live comfortably. The plan is a convenient way to get you started.

YOUR CONTRIBUTIONS How much you save will have a big impact on how much money you will have when you retire. You can contribute from 1% to 90% of your pre-tax salary to the plan each year. Your plan also allows you to contribute on an aftertax basis through Roth 401(k) contributions.

A SMART AND EASY WAY TO SAVE MORE Save Smart® is a plan feature that can help you save more for your future. It automatically increases your pretax plan contributions by 1, 2, or 3% annually on the date you choose—such as the month you expect to receive a raise. Saving more can make a big difference in how much money you have to live on in retirement. You can elect this feature on your plan website.

The IRS limit on your total annual contributions is $18,000 (2016). Those age fifty or over can save an additional $6,000 with catch-up contributions (2016). Try to save as much as you can to meet your retirement goals and take full advantage of the employer match and tax savings your plan offers.

YOUR EMPLOYER HELPS When you participate in the plan, your employer will match 50% up to the first 6% of your eligible compensation. You decide how to invest this contribution. See your Plan Information for details.

Starting Now

Starting now can pay off Start now Saveimportant for 10 years to save enough It’s $400,138 for your future, and it’s also Wait 10 years Saveas forsoon 30 years important to start as you can. The chart shows how $298,072 starting early puts compounding $376,138 $226,072 to work for you over time.

$24,000

$72,000

Earnings

Contributions

Start now* Contribute Start now for 10 years Save for 10 years $400,138

allows the account to grow an additional 10 years! Wait 10 years** Contribute for Wait 10 years 30 years Save for 30 years $298,072

$376,138

$226,072

$24,000

$72,000

Earnings

Contributions

Save $200 a month

This hypothetical illustration assumes pre-tax contributions made at the beginning of each month and an annual effective rate of return of 8% and reinvestment of earnings. * Start now assumes the contributions are invested for 40 years; ** Wait 10 years assumes contributions are invested for 30 years. Results are for illustrative purposes only and are not meant to represent the past or future performance of any specific investment vehicle. Investment return and principal value will fluctuate and, when redeemed, the investment may be worth more or less than its original cost. Taxes are due upon withdrawal. Withdrawals taken prior to age 59½ may be subject to a 10% tax penalty.

Reduce your income taxes today by saving pre-tax There are benefits to saving in the plan pre-tax. Saving pre-tax lowers your taxable income. It allows you to pay less in taxes now and take more income home. You can see the advantage of pre-tax saving in the chart: it costs less to contribute when you save pre-tax so you can afford to save more than you think.

» The out-of-pocket amount is less than the

amount contributed in the plan.

You are not required to pay taxes on your savings and earnings until you start making withdrawals. In retirement, you may be in a lower tax bracket because you are working part-time or not at all, so deferring taxes can be a benefit. It may also help your account compound faster by putting more money to work for you now with the money you may have paid in taxes.

Consider the Roth 401(k) option Your plan offers another tax-advantaged savings option: a Roth 401(k). With Roth, your contributions are taxed now—instead of when you retire. Your contributions and earnings grow tax-free, which means you pay no taxes when you make a withdrawal if certain conditions are met. A Roth 401(k) may be right for you if: •

Your federal income tax rate will be higher when you retire

•

You expect to invest for many years and reach a higher tax bracket when you retire

Pre-Tax Saving It costs less than you think to save for your retirement.

» »

Annual Salary: $30,000

Tax Bracket: 15%

Pre-tax Contribution Rate

Weekly Plan Contribution

$11.54

$23.08

$34.62

Weekly Tax Savings

$1.73

$3.46

$5.19

Weekly Out-of-Pocket Amount

$9.81

$19.62

$29.43

Annual Contribution

$600

$1200

$1800

$75,015

$150,030

$225,044

Account Balance After 30 Years

This chart is for illustrative purposes only. This example assumes contributions made at the beginning of the month and an 8% annual effective rate of return compounded monthly. Results are not meant to represent past or future performance of any specific investment vehicle. Investment return and principal value will fluctuate and when redeemed, the investment may be worth more or less than its original cost. Taxes are due upon withdrawal. Withdrawals taken prior to age 59½ may be subject to a 10% tax penalty.

You Decide: Roth or Traditional 401(k)

Traditional 401(k)

Roth 401(k)

Employee Contributions

Before-tax dollars

After-tax dollars

Account Growth (earnings)

Tax-deferred until distribution

Tax-free at distribution (if distribution is qualified)

Federal Tax

Reduces current taxable income by contribution amount

Contribution is taxable in current year

Taxes paid at withdrawal

No taxes due on qualified withdrawals*

Available at age 59½

Tax-free, provided you had the account at least five years and you are: - at least 59½, or are - disabled or deceased

You can also use the Roth 401(k) calculator on the plan web site to help you decide. Distributions

*Tax law requirements must be met.

Choose how you want to get there.

Investment options You control how your savings is invested. You have a variety of investment options in your plan to help you create the asset allocation that is right for your needs and goals. See the Performance Summary for a complete fund listing. Two ways to invest You decide which investment approach you prefer: Choose an asset allocation fund.* Your plan offers a solution for creating a diversified asset allocation for your account with just one investment option. Just choose either the fund with the date closest to your anticipated retirement date or the risk-based fund with the allocation that most closely reflects your investor type, whichever type your plan offers. It’s that easy! If you choose this approach, you can skip to page 6 to get started. Create your own asset allocation. You can create your own asset allocation from the investments offered in the plan. When you build your own mix, it’s important to spread your savings among different investments, which can help smooth the ups and downs of market cycles and reduce risk. Your account allocation is one of the most important decisions you can make in your retirement planning and can have a big impact on your investment results. To help you get yours right, complete the Investor Profiler on page 5.

Guidelines every investor should know: •• Put time on your side. Starting now can increase your chances of affording a comfortable retirement. It will give your account more time to benefit from compounding. With more time, you can consider investing more aggressively, which may provide greater growth potential. •• Understand risk. All investments carry some risk. Market risk, the change in value of your investment in response to stock market conditions, is usually the risk people think of. However, inflation risk, the risk your money will not maintain its purchasing power over time, is equally important. In general, the more risk an investment carries, the greater the potential for a higher return. Those with less risk offer lower potential return. •• Diversify. A diversified allocation can help manage risk. Spreading your money across different asset classes can help smooth out stock market fluctuations and reduce overall risk. •• Think long term. Once you’ve created a diversified investment mix for your age, years to retirement and risk tolerance, stick with it. You’ll want to review your strategy as life changes occur or you near retirement. •• Invest regularly. Making regular automatic contributions, like you do in the plan, is an easy way to invest. Each contribution buys shares in your investment funds—some at lower prices and some at higher prices. Over time, this process may lower the average purchase price of your investments.

NEED HELP CHOOSING INVESTMENTS? Visit www.mykplan.com to access calculators, tools and information to help with your planning.

* The underlying mutual funds in the portfolios of asset allocation funds are subject to stock market risk and invest in individual bonds whose yields and market values fluctuate, so that your investment may be worth more or less than its original cost. The target date of a target date mutual fund is the approximate date when an investor plans to begin withdrawing their money from the fund. The principal value of a target date fund is not guaranteed at any time, including at the target date. Ibbotson, Roger and Kaplan, Paul, “Does asset allocation policy explain 40 percent, 90 percent or 100 percent of performance?” Financial Analysts Journal, Jan./Feb. 2000. Diversification and dollar cost averaging does not guarantee a profit or protect against a loss in a declining market. There is no guarantee that your balance will increase over time. 4

Personal Investor Profile Answer the following questions to determine your investor profile score. Risk Tolerance Key A-D 1 - Strongly Disagree 2 - Disagree 3 - Neutral 4 - Agree 5 - Strongly Agree

Key E-F 1 - 0 - 4 Years 2 - 5 - 9 Years 3 - 10 - 14 Years 4 - 15 - 19 Years 5 - 20+ Years

Circle Score

I’m willing to risk short-term loss for a potentially higher long-term gain.

12345

Earning higher long-term returns to allow my money to outpace inflation is one of my most important investment objectives.

12345

I’m willing to tolerate sharp up and down swings in the value of my investments for a potentially higher return than I might expect from more stable investments.

12345

I do not expect to withdraw money from my retirement savings within the next five years.

12345

Time Horizon

Circle Score

Number of years until I expect to take distributions from my retirement plan.

12345

Number of years until I plan to retire.

12345 Your Score

Total the circled numbers for your score.

Investor Profile Score Match your investor profile score to one of the sample portfolios. Next, using the list of plan investments in the performance summary, choose investments that match the asset categories for the portfolio you selected. Score Range:

75% 18% 7%

LOW

Income Growth Aggressive Growth

6 - 13

14 - 22

60% 29% 11%

Income Growth Aggressive Growth

23 - 30

40% 43% 17%

Income Growth Aggressive Growth

RISK/REWARD POTENTIAL

5% 68% 27%

Income Growth Aggressive Growth

HIGH

04-3014-0516

Sample asset allocation models illustrative purposes only. They intended to be, construed investment advice. Sample asset allocation models are are for for illustrative purposes only. They are are notnot intended to be, nornor construed as, as, investment advice.

Start moving in the right direction.

ENROLL TODAY Here’s what you need to do to open your retirement account: ●

To help you reach your retirement goals, a voluntary elective contribution of 2% will be deducted pre-tax from your pay and deposited in your retirement account in the plan default fund for you. If you decide now is not the right time to start saving for your future, you can decline enrollment through the website or Voice-Response System. You can always change your mind and enroll later. See your welcome letter for more information, including important dates.

get information and elect them on www.mykplan.com. ●

Track your progress using the account resources available to help.

If you would like to make different elections, you can review the information in this guide and either complete any necessary forms or follow the instructions to open your retirement account. ●

Review the information in this guide and either complete any necessary forms or follow the instructions to open your retirement account.

●

Designate an account beneficiary. Submit your completed form to your employer or complete this step online.

●

Consider saving enough to get the full plan match. If you’re not saving enough, you could be missing out on money that could be yours.

●

Elect account features to help with planning like Save Smart® and automatic Account Rebalancing. You can

NAMING A BENEFICIARY FOR YOUR ACCOUNT IS IMPORTANT. In the event of your death, your account will be passed to the person(s) you name. If you are single, or married and want to name your spouse as your sole primary beneficiary, you can designate your beneficiary online. If you are married and want to designate someone other than your spouse, you must print the form available online and follow the instructions to complete it. Be sure to complete this important step in your retirement planning.

ENROLLMENT INSTRUCTIONS (Do Not Send to ADP) Follow these simple steps to enroll in your company retirement plan. I

DECIDE HOW MUCH TO SAVE

Deductions are subject to maximum deferral and contributions limits. Refer to your Summary Plan Description (SPD) or consult your Plan Administrator to review plan limits. Through your plan, you can make: l Before-tax contributions l Roth 401(k) contributions Your plan is an automatic enrollment plan. To help you save for your retirement, a portion of your pay will automatically be deducted and deposited into your retirement savings plan account for you, unless you actively enroll or decline enrollment. Refer to your welcome letter for information about important dates when you need to take action.

II CHOOSE YOUR INVESTMENTS

The list of your plan’s investments is on the following page(s).

III ENROLL l l

Enrolling with no prior account balance: Please use the password you received in the mail to enroll. Enrolling with an existing account balance: Use your current password to enroll if you have an account balance in your Plan due to a rollover/employer non-elective contribution.

Log on: www.mykplan.com (if available)

Call: 1-800-mykplan(1-800-695-7526)

Once you have accessed your account, follow the steps to choose your contribution amount and investments. You will receive confirmation of your enrollment.

! OTHER IMPORTA T NT CONSIDERAT A IONS Designate your beneficiary(ies): It’s an important step in managing your account because it provides a way for you to pass ownership of your account assets on to your beneficiary(ies) after your death. Either submit a completed Beneficiary Designation Form or designate your beneficiary online. Elect Save Smart: this feature lets you increase your pre-tax contributions by 1, 2, or 3% annually on the date you choose. It can help you meet your retirement savings goals by saving automatically over time. Elect automatic Account Rebalancing: It’s important to keep your asset allocation balanced. Once you’ve created your diversified allocation, this feature can keep it balanced for you.

EN_WKST 106 01-SHELL

7 227842_REENROLLWKSHTSM_09/01/16

ENROLLMENT INSTRUCTIONS II PLAN INVESTMENTS

Remember to review the fund prospectuses, which provide complete information about the funds, including fees and expenses, before choosing your investments. See the Web site or your Plan Administrator to obtain fund prospectuses. When you create your asset allocation, your investment election must total 100%. Asset allocation funds. These funds generally offer a diversification solution through just one fund. 7J

TE Vanguard Target Retirement 2040 Fund - Investor Class

Vanguard Target Retirement Income Fund - Investor Class Vanguard Target Retirement 2010 Fund - Investor Class

Vanguard Target Retirement 2015 Fund - Investor Class

S0 Vanguard Target Retirement 2050 Fund - Investor Class

Vanguard Target Retirement 2020 Fund - Investor Class

YX Vanguard Target Retirement 2055 Fund - Investor Class

Vanguard Target Retirement 2025 Fund - Investor Class

Vanguard Target Retirement 2030 Fund - Investor Class

73 Vanguard Wellesley Income Fund - Admiral Class

Vanguard Target Retirement 2035 Fund - Investor Class

YO Vanguard Target Retirement 2045 Fund - Investor Class

Columbia Balanced Fund - Class Y

Create your own asset allocation. MA Invesco Stable Asset Fund - ADPZ Class

5W Vanguard Extended Market Index Fund - Admiral Class

JPMorgan Core Plus Bond Fund - Class R6

Vanguard Intermediate Term Bond Index Fund Admiral Class BlackRock High Yield Bond Portfolio - Class K

AI Dreyfus/The Boston Company Small/Mid Cap Growth Fund - Class Y 97 Victory Integrity Small-Cap Value Fund - Class R6

PO BJ

DFA Inflation Protected Securities Portfolio Institutional Class Vanguard Target Retirement 2060 Fund - Investor Class

NV JPMorgan US Small Company Fund - Class R6

American Beacon Bridgeway Large Cap Value Fund Institutional Shares DFA US Core Equity 1 Portfolio - Institutional Class

8X American Beacon International Equity Fund - Institutional Class Shares AR DFA Large Cap International Portfolio - Institutional Class

Vanguard Dividend Growth Fund - Investor Class

PQ Oppenheimer International Growth Fund - Class I

Alger Spectra Fund - Class Z

PD Columbia Emerging Markets Fund - Class Y

American Beacon Mid Cap Value Fund - Institutional Class Shares

8R Vanguard REIT Index Fund - Admiral Class

NN C0

1C DFA US Small Cap Portfolio - Institutional Class

EN_WKST 106 01-SHELL

MC Janus Venture Fund - Class N

227842_REENROLLWKSHTSM_09/01/16

Aspen Heights 401(K) Plan

ROLLOVER FORM – 280

Social Security #:

Phone #:

Employee Name: Last, First, Middle

Address: Street

Apt. # / PO Box #

City

Birth Date: Month

Day

State

Hire Date: Year

Month

Zip Code

Day

Year

I ROLLOVER INSTRUCTIONS The Rollover Form is used to invest prior plan money in your Plan account. The rollover must be completed within 60 days of receipt of the distribution, come from another employer’s plan or an IRA and represent all or a portion of a lump sum distribution, or an installment distribution of less than ten years. In the context of a direct rollover, in which the funds are never actually made payable to you, the 60-day period for completing a rollover is inapplicable. Section II.A. Check (ü) the appropriate box to identify the source of this Rollover. Section II.B. Identify the total amount of the rollover. A certified or bank check must accompany this form for the stated dollar amount. Pre-printed checks are required. Handwritten checks will be returned to the Plan Administrator. Please include your Social Security Number and Plan Number on the check made payable to Reliance Trust Company. Section III. Read the acknowledgment, and then sign and date the form. Note: If you have not previously enrolled in the Plan, you must complete a Beneficiary Form and give it to your Plan Administrator. Do not send to ADP.

II ROLLOVER AMOUNT/SOURCE A. This rollover is a distribution from: o Individual Retirement Account o SIMPLE IRA (IRA must be in existence for at least 2 years) o §457 Plan o §403(b) Tax Sheltered Annuity o Qualified Plan of (check one): o an Unrelated Employer o a Related Employer Note: If you do not check a box, we will understand you have certified that the rollover is from an unrelated employer. B. Select rollover type: . o Before-Tax 401(k) $

TOTAL ROLLOVER AMOUNT o Roth 401(k)

. TOTAL ROLLOVER AMOUNT

Contributions

. Earnings

NOTE: Rollovers of Roth 401(k) monies may only be made via direct rollover and may not be rolled over from an IRA.

III ACKNOWLEDGMENT, ROLLOVER INVESTMENT DIRECTION AND SIGNATURE I have read and understand the Summary Plan Description and Participant Fee Disclosure Statement, have completed the Beneficiary Form if I have not previously enrolled in the plan, and agree to be bound by the provisions of the Plan. I have also reviewed a description of each of the funds, and understand the objectives, risks, expenses and charges associated with each. I certify that: l I received the distribution from the source indicated above within the last 60 days (60-day requirement not applicable in the case of a direct rollover). l The rollover is from the rollover source indicated above and has not been combined with any money that would disqualify the rollover. l No portion of this rollover contribution represents amounts received as a hardship distribution from an employer plan. I understand that if I do not have a plan account one will be established for my rollover contribution and invested in the plan default fund. Once my account has been established, I will be mailed my account access information and can make investment allocation changes through the plan website or Voice Response System. If I already have a plan account established, I direct that my rollover contribution be invested in accordance with my investment election on file.

In an effort to prevent short-term trading and market timing, many investment companies have established excessive trading and/or redemption fee policies for certain investments. ADP Retirement Services, whenever possible, implements the investment company’s market timing policy (please review the fund’s prospectus for information on a specific fund company’s policies). However, there are instances when ADP Retirement Services may need to implement its own market timing policy, which could differ from the investment company’s policy, in order to ensure compliance with the fund’s prospectus. Because investment options in your retirement savings plan may be subject to these policies, please refer to your Plan Participant Web site (or, if the Web site is not available to you, call a Client Services Representative) for additional information.

Signature of Employee/Participant

Date

FOR PLAN ADMINISTRATOR USE ONLY (MUST BE COMPLETED)

Company Code:

Date Received: __________________________

Plan Administrator Approval: _________________________________

Date Roth 401(k) contributions began: (If not provided, ADP will use date contribution is received)

_______ / _______ / 20_______

Recordkeeping Plan #:

280-126

2 2 7 8 4 2 !!!!!!

9 227842_ENROLLFORMSM_09/01/16

ADP Retirement Services Performance Summary

For the month ending July 31, 2016

Current performance may be lower or higher than the performance data quoted. For most recent performance, go to www.mykplan.com.

Fund Name/Inception

Morningstar Category

Ticker

Month

Average Annual Total Returns (NAV) QTR3 1 Yr 3 Yr 5 Yrs 10 Yrs4

Expense Ratio Net Gross

Income Invesco Stable Asset Fund - ADPZ Class (07/2014) JPMorgan Core Plus Bond Fund - Class R6 (02/2005) Vanguard Intermediate Term Bond Index Fund - Admiral Class (11/2001) BlackRock High Yield Bond Portfolio - Class K (11/1998) DFA Inflation Protected Securities Portfolio - Institutional Class (09/2006)

N/A Intermediate-Term Bond Intermediate-Term Bond High Yield Bond Inflation-Protected Bond

N/A JCPUX VBILX BRHYX DIPSX

0.14% 0.82% 0.71% 2.40% 0.57%

0.41% 2.80% 2.71% 4.03% 1.73%

1.57% 5.62% 7.47% 1.63% 4.86%

N/A 4.79% 5.16% 4.15% 2.33%

N/A 4.51% 4.62% 6.21% 2.04%

1.49%(I) 5.98% 6.30% 7.51% 4.83%(I)

0.46% 0.40% 0.09% 0.54% 0.12%

0.46% 0.43% 0.09% 0.54% 0.12%

Growth & Income Vanguard Target Retirement Income Fund - Investor Class (10/2003) Vanguard Target Retirement 2010 Fund - Investor Class (06/2006) Vanguard Target Retirement 2015 Fund - Investor Class (10/2003) Vanguard Target Retirement 2020 Fund - Investor Class (06/2006) Vanguard Target Retirement 2025 Fund - Investor Class (10/2003) Vanguard Target Retirement 2030 Fund - Investor Class (06/2006) Vanguard Target Retirement 2035 Fund - Investor Class (10/2003) Vanguard Target Retirement 2040 Fund - Investor Class (06/2006) Vanguard Target Retirement 2045 Fund - Investor Class (10/2003) Vanguard Target Retirement 2050 Fund - Investor Class (06/2006) Vanguard Target Retirement 2055 Fund - Investor Class (08/2010) Columbia Balanced Fund - Class Y (11/2012) Vanguard Wellesley Income Fund - Admiral Class (05/2001) Vanguard Target Retirement 2060 Fund - Investor Class (01/2012)

Target-Date Retirement VTINX Target-Date 2000-2010 VTENX Target-Date 2015 VTXVX Target-Date 2020 VTWNX Target-Date 2025 VTTVX Target-Date 2030 VTHRX Target-Date 2035 VTTHX Target-Date 2040 VFORX Target-Date 2045 VTIVX Target-Date 2050 VFIFX Target-Date 2055 VFFVX Allocation--50% to 70% EquityCBDYX Allocation--30% to 50% EquityVWIAX Target-Date 2060+ VTTSX

1.63% 1.65% 2.23% 2.66% 2.96% 3.21% 3.46% 3.73% 3.83% 3.79% 3.79% 2.72% 1.39% 3.79%

1.90% 1.92% 1.93% 1.99% 1.95% 1.92% 1.82% 1.81% 1.78% 1.81% 1.80% 1.86% 3.70% 1.78%

4.31% 3.91% 3.45% 3.28% 2.94% 2.50% 1.93% 1.47% 1.52% 1.49% 1.45% 4.94% 9.70% 1.47%

4.86% 5.30% 5.96% 6.53% 6.77% 6.97% 7.15% 7.20% 7.20% 7.20% 7.14% 8.60% 7.36% 7.16%

5.12% 5.53% 5.85% 5.52% 6.72% 5.79% 7.38% 5.94% 7.79% 5.98% 8.16% 5.98% 8.51% 6.07% 8.72% 6.19% 8.74% 6.19% 8.72% 6.19% 8.74% 10.50%(I) N/A 11.38%(I) 8.46% 7.54% N/A 10.05%(I)

0.14% 0.14% 0.14% 0.14% 0.15% 0.15% 0.15% 0.16% 0.16% 0.16% 0.16% 0.65% 0.16% 0.16%

Large Value

BRLVX

3.08%

2.58%

4.14%

10.70% 14.23%

7.91%

0.79%

0.75%

Large Blend Large Blend Large Growth Mid-Cap Value

DFEOX VDIGX ASPZX AACIX

4.08% 1.95% 1.79% 2.66% 5.10% -0.06% 4.68% N/A

3.16% 7.25% -1.13% -0.73%

9.49% 10.57% 12.37% 6.79%

12.47% 7.85% 13.32% 9.00% 12.90% 12.85%(I) 11.92% 7.86%

0.19% 0.33% 0.89% 0.86%

0.19% 0.33% 1.04% 0.86%

Mid-Cap Blend Mid-Cap Growth

VEXAX DBMYX

5.37% 5.72%

3.40% 4.65%

-0.15% -1.21%

7.91% 11.28% 7.94% N/A

8.37% 9.84%(I)

0.09% 0.68%

Small Value Small Blend Small Blend

MVSSX DFSTX JUSMX

4.84% 4.99% 5.77%

0.63% 1.69% 2.18%

0.34% 2.03% 0.88%

6.06% N/A 14.85%(I) 7.52% 11.57% 8.38% 7.78% N/A 15.91%(I)

1.01% 0.37% 0.74%

1.01% 0.37% 0.75%

Growth American Beacon Bridgeway Large Cap Value Fund - Institutional Shares (10/2003) DFA US Core Equity 1 Portfolio - Institutional Class (09/2005) Vanguard Dividend Growth Fund - Investor Class (05/1992) Alger Spectra Fund - Class Z (12/2010) American Beacon Mid Cap Value Fund - Institutional Class Shares (11/2005) Vanguard Extended Market Index Fund - Admiral Class (11/2000) Dreyfus/The Boston Company Small/Mid Cap Growth Fund - Class Y (07/2013) Aggressive Growth Victory Integrity Small-Cap Value Fund - Class R6 (06/2012) DFA US Small Cap Portfolio - Institutional Class (03/1992) JPMorgan US Small Company Fund - Class R6 (11/2011)

The 7-day yield more closely reflects the current earnings of the money market fund than the total return quotation. 2 Commingled Funds are not publicly traded mutual funds and are not listed in public stock market listings such as the Wall Street Journal. 3 Quarter-end returns are for the most recent quarter-end performance. (Quarter-end periods are 3/31, 6/30, 9/30 and 12/31.) 4 10 year or since inception of the fund.

Investment Returns and principal value of an investment will fluctuate so that when an investor's shares are redeemed, they may be worth more or less than the original cost. The returns represent past performance. Past performance is no guarantee of future results. An expense ratio is a fund's annual operating expenses expressed as a percentage of average net assets and includes management fees, administrative fees, and any marketing and distribution fees. Expense ratios directly reduce returns to investors. The expense ratio typically includes the following types of fees: accounting, administrator, advisor, auditor, board of directors, custodial, distribution (12b-1), legal, organizational, professional, registration, shareholder reporting, sub-advisor, and transfer agency. The expense ratio does not reflect the fundâ&#x20AC;&#x2122;s brokerage costs or any investor sales charges. For publicly traded mutual funds, the net prospectus expense ratio is collected from the fund's most recent prospectus and provided by Morningstar. This is the percentage of fund assets paid for operating expenses and management fees. In contrast to the net expense ratio, the gross expense ratio does not reflect any fee waivers in effect during the time period. Morningstar pulls the prospectus gross expense ratio from the fundâ&#x20AC;&#x2122;s most recent prospectus. Commingled Fund expense ratios are provided by the investment managers.

For complete information on the funds, please see the prospectus and consider the investment objective, risks, charges and expenses before investing. The prospectus contains this and other important information related to the funds and the investment company. Please read it carefully before investing. To obtain a prospectus, please see your plan sponsor or your plan administrator or go to www.mykplan.com. Investment options are available through ADP Broker-Dealer, Inc., an affiliate of ADP, LLC, One ADP Blvd, Roseland, NJ. Member FINRA.

ADP Retirement Services Performance Summary

For the month ending July 31, 2016

Current performance may be lower or higher than the performance data quoted. For most recent performance, go to www.mykplan.com.

Fund Name/Inception Aggressive Growth (continued) Janus Venture Fund - Class N (05/2012) American Beacon International Equity Fund - Institutional Class Shares (08/1991) DFA Large Cap International Portfolio - Institutional Class (07/1991) Oppenheimer International Growth Fund - Class I (03/2012) Columbia Emerging Markets Fund - Class Y (11/2012) Vanguard REIT Index Fund - Admiral Class (11/2001)

Morningstar Category

Ticker

Month

Small Growth Foreign Large Value

JVTNX AAIEX

5.77% 4.53% -1.53% 3.59% -1.67% -10.44%

10.48% 0.49%

Foreign Large Blend Foreign Large Growth Diversified Emerging Mkts Real Estate

DFALX OIGIX CEKYX VGSLX

4.19% -0.30% -6.75% 5.47% -3.44% -1.76% 4.72% 3.03% 0.70% 4.19% 6.79% 22.25%

1.56% 2.59% 3.51% N/A 1.53% N/A 14.65% 13.01%

Average Annual Total Returns (NAV) QTR3 1 Yr 3 Yr 5 Yrs 10 Yrs4 N/A 15.15%(I) 2.97% 2.15% 2.16% 7.31%(I) 1.07%(I) 7.66%

Expense Ratio Net Gross 0.67% 0.74%

0.67% 0.74%

0.29% 0.70% 1.15% 0.12%

Invesco Stable Asset Fund - ADPZ Class STRATEGY: The primary investment objective of the Fund will be to seek the preservation of principal and to provide interest income reasonably obtained under prevailing market conditions and rates, consistent with seeking to maintain required liquidity. The Fundâ&#x20AC;&#x2122;s returns are based on returns generated by an actively-managed, highly diversified portfolio of investment grade, fixed and floating rate securities. The Fund may invest in such securities directly or indirectly through commingled investment vehicles (the â&#x20AC;&#x153;building block strategyâ&#x20AC;?). This building block strategy may provide greater diversification than could be achieved by investing in individual bonds. This building block strategy also may reduce the unintended impact on portfolio characteristics created by participant cash flow. JPMorgan Core Plus Bond Fund - Class R6 STRATEGY: The investment seeks a high level of current income by investing primarily in a diversified portfolio of high-, medium- and lowgrade debt securities. The fund will normally invest at least 80% of its assets in bonds. Under normal conditions, at least 65% of the fund's total assets must be invested in securities that, at the time of purchase, are rated investment grade. It may invest up to 35% of its net assets in foreign securities, including securities denominated in foreign currencies. The fund's average weighted maturity will ordinarily range between five and twenty years. Vanguard Intermediate Term Bond Index Fund - Admiral Class STRATEGY: The investment seeks the performance of a market-weighted bond index with an intermediate-term dollar-weighted average maturity. The fund employs an indexing investment approach designed to track the performance of the Barclays U.S. 5-10 Year Government/Credit Float Adjusted Index. This Index includes all medium and larger issues of U.S. government, investment-grade corporate, and investment-grade international dollar-denominated bonds that have maturities between 5 and 10 years and are publicly issued. All of the fund's investments will be selected through the sampling process, and at least 80% of the fund's assets will be invested in bonds held in the index. BlackRock High Yield Bond Portfolio - Class K STRATEGY: The investment seeks to maximize total return, consistent with income generation and prudent investment management. The fund invests primarily in non-investment grade bonds with maturities of ten years or less. It normally invests at least 80% of its assets in high yield bonds. The fund may invest up to 30% of its assets in non-dollar denominated bonds of issuers located outside of the United States. Its investment in non-dollar denominated bonds may be on a currency hedged or unhedged basis. The fund may also invest in convertible and preferred securities.

DFA Inflation Protected Securities Portfolio - Institutional Class STRATEGY: The investment seeks to provide inflation protection and earn current income consistent with inflation-protected securities. As a non-fundamental policy, under normal circumstances, the Portfolio will invest at least 80% of its net assets in inflation-protected securities. Inflation-protected securities (also known as inflation-indexed securities) are securities whose principal and/or interest payments are adjusted for inflation, unlike conventional debt securities that make fixed principal and interest payments. Vanguard Target Retirement Income Fund - Investor Class STRATEGY: The investment seeks to provide current income and some capital appreciation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors currently in retirement. Its indirect bond holdings are a diversified mix of short-, intermediate-, and long-term U.S. government, U.S. agency, and investment-grade U.S. corporate bonds; inflation-protected public obligations issued by the U.S. Treasury; mortgage-backed and asset-backed securities; and government, agency, corporate, and securitized investment-grade foreign bonds issued in currencies other than the U.S. dollar. Vanguard Target Retirement 2010 Fund - Investor Class STRATEGY: The investment seeks to provide capital appreciation and current income consistent with its current asset allocation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors planning to retire and leave the workforce in or within a few years of 2010 (the target year). Its asset allocation will become more conservative over time, meaning that the percentage of assets allocated to stocks will decrease while the percentage of assets allocated to bonds and other fixed income investments will increase. Vanguard Target Retirement 2015 Fund - Investor Class STRATEGY: The investment seeks to provide capital appreciation and current income consistent with its current asset allocation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors planning to retire and leave the workforce in or within a few years of 2015 (the target year). The fund's asset allocation will become more conservative over time, meaning that the percentage of assets allocated to stocks will decrease while the percentage of assets allocated to bonds and other fixed income investments will increase. Vanguard Target Retirement 2020 Fund - Investor Class STRATEGY: The investment seeks to provide capital appreciation and current income consistent with its current asset allocation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors planning to retire and leave the workforce in or within a few years of 2020 (the target year). The fund's asset allocation will become more conservative over time, meaning that the percentage of assets allocated to stocks will decrease while the percentage of assets allocated to bonds and other fixed income investments will increase.

Vanguard Target Retirement 2025 Fund - Investor Class STRATEGY: The investment seeks to provide capital appreciation and current income consistent with its current asset allocation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors planning to retire and leave the workforce in or within a few years of 2025 (the target year). The fund's asset allocation will become more conservative over time, meaning that the percentage of assets allocated to stocks will decrease while the percentage of assets allocated to bonds and other fixed income investments will increase.

Vanguard Target Retirement 2050 Fund - Investor Class STRATEGY: The investment seeks to provide capital appreciation and current income consistent with its current asset allocation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors planning to retire and leave the workforce in or within a few years of 2050 (the target year). The fund's asset allocation will become more conservative over time, meaning that the percentage of assets allocated to stocks will decrease while the percentage of assets allocated to bonds and other fixed income investments will increase.

Vanguard Target Retirement 2030 Fund - Investor Class STRATEGY: The investment seeks to provide capital appreciation and current income consistent with its current asset allocation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors planning to retire and leave the workforce in or within a few years of 2030 (the target year). The fund's asset allocation will become more conservative over time, meaning that the percentage of assets allocated to stocks will decrease while the percentage of assets allocated to bonds and other fixed income investments will increase.

Vanguard Target Retirement 2055 Fund - Investor Class STRATEGY: The investment seeks to provide capital appreciation and current income consistent with its current asset allocation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors planning to retire and leave the workforce in or within a few years of 2055 (the target year). The fund's asset allocation will become more conservative over time, meaning that the percentage of assets allocated to stocks will decrease while the percentage of assets allocated to bonds and other fixed income investments will increase.

Vanguard Target Retirement 2035 Fund - Investor Class STRATEGY: The investment seeks to provide capital appreciation and current income consistent with its current asset allocation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors planning to retire and leave the workforce in or within a few years of 2035 (the target year). The fund's asset allocation will become more conservative over time, meaning that the percentage of assets allocated to stocks will decrease while the percentage of assets allocated to bonds and other fixed income investments will increase.

Columbia Balanced Fund - Class Y STRATEGY: The investment seeks high total return by investing in common stocks and debt securities. Under normal circumstances, the fund invests in a mix of equity and debt securities. Its assets are allocated among equity and debt securities (which include cash and cash equivalents) based on an assessment of the relative risks and returns of each asset class. The fund generally will invest between 35% and 65% of its net assets in each asset class, and in any event will invest at least 25% and no more than 75% of its net assets in each asset class under normal circumstances.

Vanguard Target Retirement 2040 Fund - Investor Class STRATEGY: The investment seeks to provide capital appreciation and current income consistent with its current asset allocation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors planning to retire and leave the workforce in or within a few years of 2040 (the target year). The fund's asset allocation will become more conservative over time, meaning that the percentage of assets allocated to stocks will decrease while the percentage of assets allocated to bonds and other fixed income investments will increase.

Vanguard Wellesley Income Fund - Admiral Class STRATEGY: The investment seeks to provide long-term growth of income and a high and sustainable level of current income, along with moderate long-term capital appreciation. The fund invests approximately 60% to 65% of its assets in investment-grade corporate, U.S. Treasury, and government agency bonds, as well as mortgage-backed securities. The remaining 35% to 40% of fund assets are invested in common stocks of companies that have a history of above-average dividends or expectations of increasing dividends.

Vanguard Target Retirement 2045 Fund - Investor Class STRATEGY: The investment seeks to provide capital appreciation and current income consistent with its current asset allocation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors planning to retire and leave the workforce in or within a few years of 2045 (the target year). The fund's asset allocation will become more conservative over time, meaning that the percentage of assets allocated to stocks will decrease while the percentage of assets allocated to bonds and other fixed income investments will increase.

Vanguard Target Retirement 2060 Fund - Investor Class STRATEGY: The investment seeks to provide capital appreciation and current income consistent with its current asset allocation. The fund invests in other Vanguard mutual funds according to an asset allocation strategy designed for investors planning to retire and leave the workforce in or within a few years of 2060 (the target year). The fund's asset allocation will become more conservative over time, meaning that the percentage of assets allocated to stocks will decrease while the percentage of assets allocated to bonds and other fixed income investments will increase.

American Beacon Bridgeway Large Cap Value Fund - Institutional Shares STRATEGY: The investment seeks to provide long-term total return on capital, primarily through capital appreciation and some income. The fund invests in a diversified portfolio of stocks of large capitalization companies that are listed on the New York Stock Exchange, NYSE MKT, and NASDAQ. Under normal market conditions, at least 80% of Fund net assets (plus borrowings for investment purposes) are invested in stocks from among those in the large-cap category at the time of purchase. DFA US Core Equity 1 Portfolio - Institutional Class STRATEGY: The investment seeks to achieve long-term capital appreciation. The fund purchases a broad and diverse group of securities of U.S. companies with a greater emphasis on small capitalization and value companies as compared to their representation in the U.S. Universe. The Advisor generally defines the U.S. Universe as a free float adjusted market capitalization weighted portfolio of U.S. operating companies listed on the New York Stock Exchange ("NYSE"), NYSE MKT LLC or Nasdaq Global Market or such other securities exchanges deemed appropriate by the Advisor. Vanguard Dividend Growth Fund - Investor Class STRATEGY: The investment seeks to provide, primarily, a growing stream of income over time and, secondarily, long-term capital appreciation and current income. The fund invests primarily in stocks that tend to offer current dividends. It focuses on high-quality companies that have prospects for long-term total returns as a result of their ability to grow earnings and their willingness to increase dividends over time. These stocks typically-but not always-will be large-cap, will be undervalued relative to the market, and will show potential for increasing dividends. The fund seeks to be diversified across industry sectors. Alger Spectra Fund - Class Z STRATEGY: The investment seeks long-term capital appreciation. The fund invests primarily in the equity securities of companies of any size that Fred Alger Management, Inc. believes demonstrate promising growth potential. It can leverage, that is, borrow money to purchase additional securities. The fund can invest in foreign securities. American Beacon Mid Cap Value Fund - Institutional Class Shares STRATEGY: The investment seeks long-term capital appreciation and current income. Under normal circumstances, at least 80% of the fund's net assets (plus the amount of any borrowings for investment purposes) are invested in equity securities of middle market capitalization U.S. companies. These companies have market capitalizations within the market capitalization range of the companies in the Russell Midcap Index at the time of investment.

Vanguard Extended Market Index Fund - Admiral Class STRATEGY: The investment seeks to track a benchmark index that measures the investment return of small- and mid-capitalization stocks. The fund employs an indexing investment approach designed to track the performance of S&P Completion Index, a broadly diversified index of stocks of small and mid-size U.S. companies. It invests by sampling the index, meaning that it holds a broadly diversified collection of securities that, in the aggregate, approximates the full index in terms of key characteristics. These characteristics include industry weightings and market capitalization, as well as certain financial measures, such as price/earnings ratio and dividend yield. Dreyfus/The Boston Company Small/Mid Cap Growth Fund - Class Y STRATEGY: The investment seeks long-term growth of capital. To pursue its goal, the fund normally invests at least 80% of its net assets, plus any borrowings for investment purposes, in equity securities of small-cap and mid-cap U.S. companies. The adviser currently considers small-cap and mid-cap companies to be those with total market capitalizations that are equal to or less than the total market capitalization of the largest company included in the Russell 2500 Growth Index (the index), the fund's benchmark index. The fund is non-diversified. Victory Integrity Small-Cap Value Fund - Class R6 STRATEGY: The investment seeks to provide long-term capital growth. The Adviser pursues long-term capital growth in the fund by investing, under normal circumstances, at least 80% of the fund's net assets in equity securities (i.e., common stocks, preferred stocks, convertible securities and rights and warrants) of small-capitalization companies. Small-capitalization companies mean those companies with market capitalizations within the range of companies included in the Russell 2000 Index ($38 million to $5.2 billion as of September 30, 2015). DFA US Small Cap Portfolio - Institutional Class STRATEGY: The investment seeks long-term capital appreciation. The fund, using a market capitalization weighted approach, purchases a broad and diverse group of readily marketable securities of U.S. small cap companies. A company's market capitalization is the number of its shares outstanding times its price per share. In general, the higher the relative market capitalization of the U.S. small cap company, the greater its representation in the Portfolio. JPMorgan US Small Company Fund - Class R6 STRATEGY: The investment seeks to provide high total return from a portfolio of small company stocks. Under normal circumstances, the fund invests at least 80% of its assets in equity securities of small cap U.S. companies. "Assets" means net assets, plus the amount of borrowings for investment purposes. Small cap companies are companies with market capitalizations similar to those within the universe of the Russell 2000 Index at the time of purchase.

Janus Venture Fund - Class N STRATEGY: The investment seeks capital appreciation. The fund pursues its investment objective by investing at least 50% of its equity assets in small-sized companies. It may also invest in larger companies with strong growth potential or relatively well-known and large companies with potential for capital appreciation. Small-sized companies are defined by the portfolio manager as those companies whose market capitalization falls within the range of companies in the Russell 2000 Growth Index at the time of purchase. The fund may also invest in foreign securities, which may include investments in emerging markets. American Beacon International Equity Fund - Institutional Class Shares STRATEGY: The investment seeks long-term capital appreciation. The fund normally invests at least 80% of its net assets (plus the amount of any borrowings for investment purposes) in common stocks and securities convertible into common stocks (collectively, "stocks") of issuers based in at least three different countries located outside the United States. It primarily invests in countries comprising the Morgan Stanley Capital International Europe Australasia and Far East Index ("MSCI EAFE Index"). The MSCI EAFE Index is comprised of equity securities of companies from various industrial sectors whose primary trading markets are located outside the United States. DFA Large Cap International Portfolio - Institutional Class STRATEGY: The investment seeks long-term capital appreciation. The fund will invest at least 80% of its net assets in securities of large cap companies in the particular markets in which the Portfolio invests. The Advisor determines the minimum market capitalization of a large company with respect to each country or region in which the Portfolio invests. It also may use derivatives, such as futures contracts and options on futures contracts for foreign or U.S. equity securities and indices, to adjust market exposure based on actual or expected cash inflows to or outflows from the Portfolio. Oppenheimer International Growth Fund - Class I STRATEGY: The investment seeks capital appreciation. The fund mainly invests in the common stock of growth companies that are domiciled or have their primary operations outside of the United States. It may invest 100% of its assets in securities of foreign companies. The fund may invest in emerging markets as well as in developed markets throughout the world. It normally will invest at least 65% of its total assets in common and preferred stocks of issuers in at least three different countries outside of the United States, and emphasize investments in common stocks of issuers that the portfolio managers consider to be "growth" companies.

Columbia Emerging Markets Fund - Class Y STRATEGY: The investment seeks long-term capital appreciation. The fund invests at least 80% of its net assets (including the amount of any borrowings for investment purposes) in equity securities (including, but not limited to, common stocks, preferred stocks and securities convertible into common or preferred stocks) of companies located in emerging market countries. Emerging market countries include those countries whose economies are considered to be developing or emerging from underdevelopment. It may invest in a variety of countries, industries and sectors and does not attempt to invest a specific percentage of its assets in any given country, industry or sector. Vanguard REIT Index Fund - Admiral Class STRATEGY: The investment seeks to provide a high level of income and moderate long-term capital appreciation by tracking the performance of a benchmark index that measures the performance of publicly traded equity REITs. The fund employs an indexing investment approach designed to track the performance of the MSCI US REIT Index. The index is composed of stocks of publicly traded equity real estate investment trusts (known as REITs). The adviser attempts to replicate the index by investing all, or substantially all, of its assets in the stocks that make up the index, holding each stock in approximately the same proportion as its weighting in the index. ADDITIONAL DISCLOSURES Investment options are available through ADP Broker-Dealer, Inc., a subsidiary of ADP, One ADP Blvd, Roseland, NJ. Member FINRA. ADP Broker-Dealer, Inc. is not an administrator as defined in Section 3(16)A of the Employee Retirement Income Security Act of 1974 (ERISA) and in Section 414(g) of the Internal Revenue Code as amended, nor is it a "fiduciary" within the meaning of ERISA Section 3(21). NAV (Net Asset Value) is determined by calculating the total assets, deducting total liabilities and dividing the result by the number of shares outstanding. Performance information for all publicly traded mutual funds, excluding Money Market funds, is provided by Morningstar®. Performance information for Money Market funds and certain other types of funds is provided by the respective fund manager. © 2003 Morningstar, Inc. All Rights Reserved. The information contained herein: (1) is proprietary to Morningstar and/or its content providers; (2) may not be copied or distributed; and (3) is not warranted to be accurate, complete or timely. Neither Morningstar, ADP, nor its content providers is responsible for any damages or losses arising from any use of this information. Expressed in percentage terms, Morningstar's calculation of total return is determined each month by taking the change in monthly net asset value, reinvesting all income and capital-gains distributions during that month, and dividing by the starting NAV. Reinvestments are made using the actual reinvestment NAV, and daily payoffs are reinvested monthly. The Investment Strategy is provided by Morningstar® for all publicly traded mutual funds. Investment Strategy information for Money Market funds and certain other types of funds are provided by the respective fund manager.

Investment Type Definitions: The investment types are four broad investment categories; each fund is categorized based on where the fund is listed in Morningstar, Inc.'s investment category. Income: Money Market, Stable Value, and Fixed Income investment funds. Growth and Income: Balanced and Lifestyle investment funds. Growth: Large and Mid Capitalization investment funds. Aggressive Growth: Small Capitalization, Specialty, Foreign Stock and World Stock investment funds. The Morningstar Category identifies funds based on their actual investment styles as measured by their underlying portfolio holdings (portfolio statistics and compositions over the past three years). If the fund is new and has no portfolio, we estimate where it will fall before assigning a more permanent category. When necessary, we may change a category assignment based on current information.

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Plan information

ACCOUNT ACCESS You can access your account anytime.* ● www.mykplan.com ● 1-800-695-7526 You may also speak with a Service Representative Monday through Friday 8 am– 9 pm ET on days when the New York Stock Exchange is open. PLAN ELIGIBILITY You can take advantage of this employee benefit as soon as you have met your plan’s age and service eligibility requirements: ● You must have completed 6 month(s) of service by the next plan entry date. CONTRIBUTIONS ● Pre-tax: 1% to 90% ● Roth 401k: 1% to 90% To help you reach your retirement goals, 2% will be deducted pre-tax from your pay and invested in your plan’s default fund for you, unless you elect otherwise. Refer to your welcome letter for dates when you need to take action. ● If you’re over 50, you may also make a catch-up contribution in excess of Internal Revenue Code or plan limits. You may save an additional $6,000 in your plan. EMPLOYER CONTRIBUTIONS ● Your company will match 50% of your salary deferrals up to the first 6% of your eligible compensation. ● There may be special requirements for you to receive your company contributions. VESTING Your contributions and any amounts you rolled into the plan, adjusted for gains and losses, are always 100% yours. Your company contribution account vests according to the following schedule: Years of service: Match % vested:

1 100%

PLAN INVESTMENTS You choose how to invest your savings. You may select from the following: ● The variety of investments listed in the Performance Summary. LOANS Your plan allows you to borrow from your savings. (A fee may apply.) ● Number of loans outstanding at any one time: 2 ● Minimum loan amount: $500 ● Maximum repayment period: Generally, 5 years, unless for the purchase of a primary residence. ● Interest rate: Prime + 2%

*Except during scheduled maintenance. Customer Service Representatives are employed by ADP Broker-Dealer, Inc., an affiliate of ADP, LLC, One ADP Boulevard, Roseland, NJ 07068, Member FINRA. Investment options available through ADP Broker-Dealer, Inc., an affiliate of ADP, LLC, One ADP Boulevard, Roseland, NJ 07068. Member FINRA. For more information on mutual funds, including fees and expenses, review the prospectus.

Plan information

WITHDRAWALS Types: ● Rollover ● Age 59½ ● Hardship Special rules: Special rules exist for each type of withdrawal. You may be subject to a 10% penalty in addition to federal and state taxes if you withdraw money before age 59½. See your Web site for more information.

DISTRIBUTIONS Vested savings may be eligible for distribution upon retirement, death, disability or termination of employment. ROLLOVERS Having all your savings in one place can make it easier to plan for retirement. Rollovers are accepted into the plan, even if you are not a participant yet. See the Rollover form for instructions for transferring money into your plan. ACCOUNT MANAGEMENT FEATURES You may elect this feature online at www.mykplan.com or by calling 1-800-695-7526. Save Smart® allows you to save gradually over time, as you can afford to, to help you meet your retirement savings goals. This feature lets you increase your pre-tax plan contribution by 1, 2, or 3% annually on the date you choose. Automatic Account Rebalancing can help you maintain the long-term investment strategy you decide is appropriate for meeting your savings goals. Once you have created your diversified asset allocation for your savings, automatic Account Rebalancing will rebalance your account as often as you choose: quarterly, semi-annually, or annually. Retirement Planning Assistance Personalized investment advisory services from GuidedChoice® GuidedSavingsSM is the investment advisory service from industry expert GuidedChoiceTM Asset Management. It can help you decide how much to save for your retirement goals and provide a clear, actionable strategy for your retirement assets tailored to your needs and plan choices. If you select a managed account, you’ll also get account rebalancing, annual reallocation based on current information and market conditions, and your annual report. Just access GuidedSavings at www.mykplan.com or call (800) 242-6182 to schedule an enrollment session. For information regarding eligibility, fees, investments, and risk, refer to the GuidedChoice-ADP Disclosure Document available within the GuidedSavings application or by contacting GuidedChoice (800) 242-6182 or help@guidedchoice.com.

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Take the ﬁrst step.

Enroll Today. ACCOUNT RESOURCES Once you set up your account, it’s easy to stay connected and get information. Online: www.mykplan.com The website provides instant access to your retirement account and the ability to make changes and perform transactions. You’ll also find tools and calculators to help with your investment planning decisions so you can make the most of your plan benefit:

If you were provided with access information at your enrollment meeting, you can enroll online now at https://www.mykplan.com/enroll You’ll need to enter the plan number and passcode you received at the enrollment meeting: Plan number: 227842

●

Research plan investments

Passcode: _______________

●

Transfer balances

This passcode expires on: _______________

●

Change your contribution amounts

●

Elect Save Smart® and automatic Account Rebalancing

●

Get prospectuses

Phone: 1-800-695-7526 The Voice Response System connects you to your plan account over the phone. Call 1-800-695-7526 to get account information and perform many of the transactions available on the website. You can also speak to a Customer Service Representative Monday – Friday, 8am – 9pm ET.

QUARTERLY ACCOUNT STATEMENT Stay informed about your progress. Your statement has details about your account, investment performance, and account activity for the period. Available on your plan website.

Customer Service Representatives are employed by ADP Broker-Dealer, Inc., an affiliate of ADP, LLC, One ADP Boulevard, Roseland, NJ 07068. Member FINRA.

AFTER YOU OPEN YOUR ACCOUNT AND YOUR PLAN IS LIVE, YOU CAN: ●

access the resources on the web and VoiceResponse System

●

speak to a representative

●

review your quarterly account statements (when available)

●

get help with your retirement planning from GuidedChoice

Use your User ID and Password to get your account information and access the site. Your Password will be mailed to you. If you lose your Password or want to change it, just call 1-800-695-7526 or go to www.mykplan.com and follow the prompts.

WANT TO LEARN MORE? Scan the code with your mobile device to enroll.

Get there one step at a time.

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ADP: A Global Leader Founded in 1949, Automatic Data Processing, Inc. (ADP) and its companies bring more than 60 years of unrivaled industry experience. ADP is a strong, stable partner you can rely on:

• Serving more than 620,000 businesses in more than 125 countries1 • Exceptionally strong Aa1 credit rating from Moody’s and AA from Standard & Poor’s2 • Pays approximately 24 million (1 in 6) workers in the U.S. and 10 million elsewhere1 • Top-ranked company in Financial Data Services in FORTUNE® magazine’s The World’s Most Admired Companies3 • Forbes magazine —100 Most Innovative Companies4

Source: Automatic Data Processing LLC, 2013 Annual Report. Source: Moody’s and Standard & Poor’s. 3 Source: FORTUNE® Magazine’s Most Admired Companies 2014. 4 Source: Forbes Magazine, August 2013. 1 2

GuidedSavingsSM is offered by GuidedChoiceTM Asset Management, Inc. GuidedSavingsSM is a service mark of GuidedChoice Asset Management, Inc. None of ADP Broker-Dealer, Inc. nor any of its affiliates is an affiliate of, nor do any of them endorse, the services or products of GuidedChoice®. Investment options are available through ADP Broker-Dealer, Inc., an affiliate of ADP, LLC, One ADP Blvd., Roseland, NJ 07068. Member FINRA. ADP, LLC and its affiliates do not offer investment, tax or legal advice and nothing contained in this communication is intended to be, nor should be construed as, advice or a recommendation for a particular investment option. Questions about how laws, regulations and guidance apply to a specific plan should be directed to your plan administrator or legal, tax or financial advisor. 1/2011-FN

ADP Broker-Dealer, Inc. One ADP Boulevard Roseland, NJ 07068 Member FINRA

For complete information about a particular fund or to obtain a fund prospectus (or information statement, in the case of commingled funds), go to www.mykplan.com or call the Voice-Response System. You should carefully consider an investment option’s objectives, risks, charges and expenses before investing. The prospectus (or information statement, as applicable) contains this and other important information about the investment option and investment company. Please read the prospectus/information statement carefully before you invest or send money. The ADP Logo is a registered trademark of ADP, LLC. IN THE BUSINESS OF YOUR SUCCESS is a registered trademark of ADP, LLC. Save Smart is a registered trademark of ADP, LLC. All other trademarks and service marks are the property of their respective owners.

This book was printed on 30% Post-Consumer recycled fiber. 04-3012-1215

Aspen Heights Parters: 401k Plan Information Here is information regarding our 401k program (both traditional and ROTH are available). You will be eligible to enroll on the first day of your 7th month with Aspen Heights. Important Information:  Aspen’s employer match for 401k is up to 50% of the first 6 % you put in. To get the full 3% employer match you need to elect at least 6% via payroll deduction. The election can be over any combination of a regular and/or Roth 401k but the employer match will be deposited into a regular 401k account (not a Roth account). Example: you can elect 5% to your Roth IRA and 1% to your regular IRA and that will total the needed 6% to get the full 3% match.  On your 1 year anniversary of starting with Aspen Heights you will be 50% vested in your employer match and on your 2nd anniversary of starting with Aspen Heights you will be 100% vested in your employer match. Being vested means that you can take that portion of the employer match with you if you were to leave our company. You are always 100% vested in the money you contribute, but you have to wait until your vesting dates to get that amount of the employer match. Here is more information on what “vesting” means http://money.cnn.com/retirement/guide/401k_basics.moneymag/index10.htm .  Employees will be auto-enrolled in the 401k at 2% contribution on the first day of their 7th month from date of hire. You will want to go into your account or contact the 401k help line (see number below) to make changes to your contribution rate and choose where you want that money invested. For assistance or to enroll you can call the 401k Participant Help Line at 800-695-7526 or you can go to www.mykplan.com and click “Register Now”, enter your Social Security Number, your Date of Birth, and your Zip code as it appears in ADP. If you are interested in rolling funds from a previous retirement program into ours you will need to wait until you become eligible in our plan and then: 1. Request a check for your funds from your old plan administrator (you will need to contact them to find out how to do that). Your Social Security Number and Plan Number should be printed on the check and it should be made payable to "State Street Bank & Trust Co". It must be a pre-printed (not handwritten) certified or bank check. This check should be sent to you (the employee). IMPORTANT: DO NOT HAVE THE CHECK WRITTEN OUT TO YOU (the employee) ONLY - but it is okay if it says "State Street Bank FBO _(your name) " or "State Street Bank For Benefit Of (your name) ". 2. Once you get the check from your former employer, fill out the attached form. Make sure that the total amount of funds listed on the form matches the total amount of the check. The check and completed form should be brought/sent to me at the following address: Aspen Heights, Attn: Sarah Weiner/Payroll, 1301 S. Capital of Texas HWY, Suite B-201, Austin, TX 78746. If you have any questions you can contact the below Support phone numbers: Rollovers In – 877.401.5725

Also make sure to enter your beneficiaries in your 401k account online. Unfortunately, the beneficiaries you enter in ADP for your life insurance do not transfer over to your 401k so you need to enter beneficiaries for your 401k plan. The beneficiaries you should enter are the people that you want your 401k to go to in the event of your death.

TO ADD BENEFICIARIES FOR YOUR 401K:  log in to the 401k website at www.mykplan.com  click My Account > Manage My Beneficiaries  click Add New Beneficiary  add your Primary Beneficiary (you can have more than one but the percentage needs to add to 100%)  add Secondary Beneficiaries (these would be who would get the money if your primary beneficiaries are no longer alive)  click SAVE after you have added your beneficiaries. If you don’t have someone’s social security information, at least enter their names and all other information you do have. Warm Regards,

Sarah Weiner | Payroll & Benefits Specialist Aspen Heights | Austin Office: 512.369.3030 x111 | Mobile: 310.717.3144 Direct: 512.910.3266 | Fax: 512-879-1179