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YourBenefitsEffective January - December 2024

You must request a change to yourbenefits within 30 days of your life event(60 days for changes involving Medicaideligibility). Documentation may be required.Enroll NowYour benefit plans are in effect January 1 –December 31 each year. In general, there arethree times you can make benefit selections:Making Benefit SelectionsGetting startedEligibility Enrolling in CoverageYour benefits begin on the first day of themonth following 30 days of employment;this is your effective date. Be sure to submityour selections within your first 30 days ofbenefits eligibility.Your benefit selections will be in effectthrough December 31. When You're first eligible Open Enrollment is your one chance eachyear to review your coverage options andmake changes to your benefits.Your choices are in effect from January –December of the following year unless youhave a qualifying life event. At Open Enrollmentmarriage or divorce, birth or adoption, death of a covered dependent, and a change in eligibility throughMedicare, Medicaid, or a spouse orparent's coverage. Qualifying life events allow you to changeyour coverage during the year outside ofOpen Enrollment. These include: If you have a qualifying life eventThe benefit programs are availablefor all active full-time employeesworking 30 hours or more perweek and who have met theireligibility periodFor our medical, dental and visionplans, dependent children includethose through the end of the monththey turn age 26. There is nowaiting period for addingdependents during annualenrollment.

Balance BillingWhen you use an out-of-network medical or dentalprovider, they may bill you thedifference between what theycharge and the amount yourinsurance pays.Medical: balance billing is inaddition to – and does not counttowards – your out-of-pocketmaximum.CoinsuranceAfter you’ve met yourdeductible, you’re sometimesresponsible for a percentage ofthe cost of the medical care,dental care, or prescriptionmedication you received. Thispercentage is coinsurance.CopayA flat fee you pay each timeyou receive a copay-eligiblemedical, dental, or visionservice or prescriptionmedication. DeductibleThe amount you’re responsiblefor paying in care expensesbefore the medical or dentalplan starts paying deductible-eligible expenses.In-NetworkIn-network care is always yourlowest-cost option. Networksare groups of medical, dental,and vision providers,pharmacies, and facilities thatagree to discount the cost oftheir care or service.Out-of-Pocket MaximumThe most you’ll pay forcovered in-network medicalcare in a year. This includesyour deductible, anycoinsurance or copays, andprescription drugs. The out-of-pocket maximumdoes not include yourpremium (the amount you payfor coverage), non-coveredexpenses, or out-of-networkcare that’s been balance billed.Primary Care PhysicianA primary care physician (PCP)is your main medical doctor –usually a general practitioner(GP), family doctor, internist,OB/GYN, or pediatrician (forchildren).Referral/Pre-authorizationSome specialty medicalproviders and services requirea referral from a primarydoctor. These may include -but are not limited to -cardiology, psychiatry,orthopedic surgeons,rheumatology, surgery, andimaging (CT or MRI).Annual NoticesWe’re required to tell you aboutcertain rights and responsibilitiesyou have as an employee of FSI. Download NowHelpful Terms & ResourcesGetting started

Medical InsuranceUMR1-800-826-9781www.umr.comEmployee Assistance Program (EAP)H&H HealthAssociates 1-314-845-8302www.hhhealthassociates.comDental InsuranceVision InsuranceLife and AD&D InsuranceDisability InsuranceAccident and Critical Illness Mutual of Omaha 1-800-775-6000www.mutualofomaha.comHealth Savings Account (HSA)Flexible Spending Accounts (FSAs)Bank of America1-800-992-3200www.healthaccounts.bankofamerica.comRx RxBenefits 1-800-334-8134www.rxbenefits.comVirtual Health Care First Stop Health 1-888-691-7867fshealth.comIdentity Theft ProtectionNorton LifeLock1-800-607-9174Norton.com/PremPremierPlusOrthopedic SurgeryAlternativeRegenexx1-866-269-2871regene xxbenefits.com/foamsuppliesMedical Imaging Green Imaging1-844-968-4647greenimaging.netPet InsurancePet BenefitSolutions1-800-887-5708www.wishboneinsurance.com/fsiContact InformationGetting startedRefer to this list when you need to contact one of your benefitvendors. For general information, you can contact hr@fsi.co

PPO PlanUHC Choice Plus Network HDHP PlanUHC Choice Plus Network In-Network Non-Network In- Network Non-Network Annual Deductible Individual Family $2,000$4,000$5,000$10,000$3,200$6,400$9,000$18,000Annual Out- of PocketMaximum Individual Family $7,150$14,300$10,000$20,000$6,250$12,500$12,500$25,000Coinsurance (UHC'sCost Share)80%50%90%50%Office Visits Primary Care visit$15 copay 50% after deductible90% after deductible50% after deductibleSpecialist $75 copay 50% after deductible90% after deductible50% after deductible Preventative Services100%, no copay ordeductible 50% after deductible100%, no copay ordeductible50% after deductible Urgent Care$75 copay 50% after deductible 90% after deductible50% after deductible Emergency RoomServices Waived if Admitted$300 copay and 20% after deductible90% after deductiblePrescription Drugs (30 Day Supply) Tier 1Tier 2Tier 3Tier 4 $10 copay$35 copay$60 copay$200 copay Mail OrderPrescription Drugs PerTier (up to a 90 daysupply)$25/$87.50/$150/$500Not Covered2.5 x copayNot CoveredSee Plan DetailsSee Plan DetailsMedical InsuranceThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Select from two medical options through UMR.

Patient Advocacy ServicesNurse NavigationChronic Disease ManagementTobacco Cessation ProgramsNutrition EducationHealth Coaches Benefits that are completely free for you if you are on the medical plan:877-223-2350connectcare3.info

Telemedicine FlyerMental Health Flyer First Stop Health Use the FSH mobile app, online dashboard, or call 888-691-7867 to request your telemedicine or counselingvisitFREE to use; there are no copays or consultation fees to use this serviceVisits can be completed by phone or videoYour covered dependents are also eligible to use the serviceNo online registration is required to access a doctor, just call us!Prescriptions are available for telemedicine visits when appropriate, or a refill of a maintenance medication isneeded. Prescription copays apply.First Stop Health’s telemedicine and virtual counseling solutions makes everyday healthcare even easier for FSI’sbenefit-eligible employees and their covered dependents! 24/7 Virtual Access to U.S Based Physicans and Licensed Counselors Infections (e.g., urinary, ear, upperrespiratory, eye, etc.)Sinus or allergy- related problems;Sore throat & coughColds & fluSwelling and/or sorenessNausea and/or vomitingRashesOther minor illness & injuriesCommon ConditionsTreated via Telemedicine: StressAnxietyDepressionGriefMarital/relationship issuesDrug/alcohol misuseAnd moreReasons to speak with acounselor:

Green Imaging FSI has partnered with Green Imaging, a national network of independent imaging centers that provides you andyour dependents enrolled in the medical plan with free imaging services when you use one of their providers.The process couldn't be easier - when you need imaging, you will contact a Green Imaging Medical Conciergewho will personally walk you through the entire process.• Call, text or chat with a Green Imaging Medical Concierge • Easy scheduling • Convenient locations • High-quality imaging facilities$0 Out of Pocket cost if on the PPO PlanAdd Green Imaging to Your Contacts:

24/7/365 access tocare 1-800-832-8302Employee Assistance Program(EAP)Confidential. No one at FSI will ever know you called or whatwas discussed.Available 24/7/365. Life doesn't happen during office hours. TheEAP is here when you need them.Family care is included. Anyone living in your home is eligiblefor EAP services at no cost.Face-to-face visits. When needed, each person can receive face-to-face (or virtual) visits with a licensed counselor per issue peryear. At no cost. Additional visits - if needed - will go throughyour health insurance.EAP Features:The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.mental health concerns (including substance abuse or addiction),adoption, parenting, or caregiving needs,financial or legal support,familial relationships and friendships,coping with day-to-day challenges, andso much more.Our Employee Assistance Plan (EAP) is a confidential service with access toguidance and resources at no cost for: Essentially, if it's part of your life, our EAP is here for you.Access support online, through live chat, or over the phone. 24/7/365.Everyone needs support sometimes (even superheroes).Care for your mind – and your life – with supportthrough H&H Health Associates.Confidential care designed for all that life brings.

To speak with a FSI, INC. Regenexx Patient Liaison, call us at 866-269-2871 or visitregenexxbenefits.com/foamsupplies to learn more about Regenexx and how we canhelp you avoid surgery.

If you coveryourself onlyIf you coverdependentsFSIcontributes up to:$1,200$1,200You may alsocontribute:$2,950$7,1002024 IRS maximumcontribution $4,150$8,300Learn how HSAscan help you savefor today andtomorrow.The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Health Savings Account(HSA)55 or older? You can contribute an extra $1,000per year in catch-up contributions.FSI contributes to your Health Savings Account(HSA) when you elect the HDHP medical planand meet IRS eligibility requirements. You may also contribute tax-free funds to savefor current and future health expenses:Contributions HSA Funds Spend your HSA balance on health careexpenses (medical, prescription, dental, andvision) for you and your tax dependents, ORLet your balance grow for retirement.Using your moneyThe money in your HSA is always yours andavailable for qualified health care expenses -even if you change jobs or health plans. Beforeretirement, any funds used for non-healthcareexpenses are subject to tax penalties. Keep yourreceipts!Growing your money + tax savingsHSA dollars go in tax-free, grow tax-free, andcome out tax-free when you use them forqualified health expenses. You may also be ableto invest part of your balance once it meets acertain level.In retirementAt age 65, you can withdraw the funds in yourHSA for any use (not just health care!) withouttax penalties. Eligibilitybe enrolled in a qualified High DeductibleHealth Plan (HDHP),not be covered under any other non-HDHPhealth coverage, including a full health careFSA through your spouse,not be anyone else’s tax dependent, and not be eligible for or enrolled in Medicare Aor B, Tricare, or VA benefits.In order to make – or receive – contributionsto a Health Savings Account (HSA), you must:An HSA through Bank of America is paired with a HighDeductible Health Plan (HDHP).Save pre-tax money for health care expenses – or retirement!

Eligible Expenses2024 maximum contribution$5,000Married filing separately? You can contribute up to $2,500 per person.Flexible Spending Accounts(FSAs)2024 maximum contribution$3,200Pay for eligible child or disabled adultcare while you work or attend school.Dependent Care FSAThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Pay for eligible medical, prescription,dental, and vision expenses.Health Care FSAHealth and dependent care expenses can add up. Paying with tax-free funds can help. Enroll in one or more flexible spendingaccounts (FSAs) depending on your needs.Pay for qualifying expenses with tax-free money usingyour Flexible Spending Account through Bank ofAmerica.

Dental InsuranceStay in-network to avoid balance billing (the difference between what anout-of-network provider charges and the amount your insurance pays). In-NetworkOut-of-NetworkAnnual Deductible Individual Family Waived for Preventative$50$150Waived for Preventative$50$150Annual maximum benefit$1,000$1,000Type I Preventative Routine Exams/Cleanings Bitewing X-Rays Diagnostic X-Rays100%100%Type II Basic Services Fillings Oral Surgery- Simple & Complex80%80%Type III Major Services Periodontics Root Canals Crowns Bridges 50%50%OrthodontiaAdult/ChildLifetime Maximum 50%$1,00050%$1,000Your Cost for CoverageEmployee OnlyEmployee + SpouseEmployee + Child(ren)Employee + FamilyPer Pay Period $ 13.85$ 27.67$ 36.40$ 52.27See Plan DetailsThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Your dental coverage is through Mutual of Omaha.

Network name:EyeMedIn-NetworkOut-of-NetworkAnnual eye exam (every 12 months)$10 copayUp to $37Lenses (every 12 months)Single: $ 25 copayBifocal: $25 copayTrifocal: $25 copay Up to $20Up to $36Up to $64Frames(every 24 months)$150 allowance, plus 20% offamount over allowance Up to $66Elective Contact lenses(every 12 months)$150 allowance Up to $210Your Cost for CoverageEmployee OnlyEmployee + SpouseEmployee + Child(ren)Employee + FamilyPer Paycheck$ 5.88$ 13.50$ 14.95$ 22.83Vision InsuranceSee Plan DetailsThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Your vision coverage is throughMutual of Omaha.

Basic lifeBasic AD&DFSI Provides$50,000$50,000See Plan DetailsFor youFor your spouseFor yourchild(ren)CoverageIncrements$10,000$5,000$2,000CoverageMaximum$500,000Equal to your(employee)coverage amountup to $100,000$10,000See Plan DetailsMake sure to designate abeneficiary for your lifeinsurance coverage to ensureyour family is cared foraccording to your wishes.You may also purchase additional coverage for you, your spouse, andyour eligible child(ren). Additional Life and AD&D InsuranceLife insurance pays a benefit if you pass away while you're covered.Accidental Death and Dismemberment (AD&D) insurance offersadditional support if you pass away or are seriously injured due toan accident.Financial peace of mind through Mutual of Omaha .Life and AD&D InsuranceThe benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.Basic Life and AD&D InsuranceFSI provides life and AD&D insurance at no cost to you.

Benefits BeginAfter 90 days of inability to workCoverage Amount60% of your income up to $10,000 per monthPayments May ContinueIf you become disabled prior to age 62, benefits arepayable to age 65, your Social Security NormalRetirement Age or 3.5 years, whichever is longest. Atage 62 (and older), the benefit period will be based ona reduced duration schedule.See Plan DetailsLong-term disability coverage can provide lasting income protection if you remainunable to work. FSI provides this coverage at no cost to you.Long-term DisabilityDisability InsuranceThe benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.Protect your paycheck with disability insurance throughMutual of Omaha.Disability coverage insures your paycheck, replacing a portion ofyour income if you’re unable to work due to a covered illness orinjury.

See Plan DetailsMonthly Premium Rates Employee Only $10.42Employee + Spouse$17.31Employee + Child(ren)$22.95Family $31.44Age BandEmployee/Member Monthly Rates per $1,000< 30 $0.2430-39$0.4240-49$0.9650-59$2.1360-69$4.6070- 79$8.6180-99$11.69See Plan DetailsAdditional benefit plans are a great way to customizeyour benefits package.Additional Benefit OptionsThe benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.Accident coverage through Mutual of Omahapays you a cash benefit to help with yourexpenses –your deductible or copays,transportation, groceries and more – if you or acovered family member is injured due to anaccident. The money is yours to use as youchoose.Accident CoverageCritical illness coverage through Mutual ofOmaha pays you a cash benefit to helpwith your expenses– your deductible orcopays, transportation, groceries and more– if you or a covered family member isdiagnosed with a covered critical illness.The money is yours to use as you choose.Critical IllnessRates shown are monthly rates. There are 26 pay periods each year.To calculate the per pay period rate, multiply the monthly rate by 12and then divide by 26

See Plan DetailsAdditional benefit plans are a great way to customizeyour benefits package.Additional Benefit OptionsThe benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.Protect your furry best friend with Pet BenefitSolutions Pet Insurance. You'll get access to licensedveterinarians for routine care, emergencies, lab testsand wellness visits. Rates vary. Get a quote and enrollat www.wishboneinsurance.com/fsi. This benefit isnot payroll deducted. Pet insurance is a reduced planoffered through FSI. If you choose to enroll, you willdirectly pay through the Pet Benefit Solutions website. Pet Insurance See Plan DetailsIdentity theft protection through NortonLifeLock helps monitor your credit andpersonal information online. You can buycoverage for yourself, your spouse and/oryour child(ren).Identity Theft

2024 Benefits