CODAC 2025 Benefit Plan Summaries

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CODAC HEALTH, RECOVERY & WELLNESS, INC. Policy #: 010-34425 -LOW PLAN

FUSION combines dental and eye care benefits into one easy-to-administer plan. This plan combines the annual maximum between the dental and vision plans. For the maximum:

· The member can use up to $1,000 Non PPO - $1,500 PPO toward any covered dental expense.

· The member can use up to $100 toward any covered eye care expense. · Total benefits paid between the two coverages will not exceed $1,500.

Dental Plan Benefits subject to FUSION plan design listed above Networks: Classic In-Network

Out-of-Network

Type 1 Preventive No Waiting Period

100%

Routine Exam (1 per 6 months)

Bitewing X-rays (1 per 12 months)

Cleaning (1 per 6 months)

Type 2 Basic No Waiting Period

100%

50%

Restorative Amalgams

Restorative Composites

Simple Extractions

Type 3 Major No Waiting Period

60%

25%

Surgical Extractions

Endodontics (nonsurgical)

Periodontics (nonsurgical)

Crowns (1 in 10 years per tooth)

Endodontics (surgical)

Periodontics (surgical)

Implants

Prosthodontics (Bridges, Dentures) (1 in 10 years)

Deductible* Type 1

$100 per person, per calendar year $100 per person, per calendar year When 3 family members satisfy their Deductible Amounts for this Calendar Year, no additional Deductibles will apply to any family members for the rest of this Calendar Year.

$50 per person, per calendar year When 3 family members satisfy their Deductible Amounts for this Calendar Year, no additional Deductibles will apply to any family members for the rest of this Calendar Year.

Family Maximum

Benefit Year Maximum Type 1, 2, and 3 (per person, per calendar year)

$1,500

$1,000

Orthodontia Benefits (children under age 19) No waiting period Plan Benefit

50%

Lifetime Deductible

Lifetime Maximum (per person)

$1,500

Claims Allowance Type 1, 2 and 3

Discounted Fee

Maximum Allowable Benefit

1 of 3

Class 1

Created 7/24/2023

CODAC HEALTH, RECOVERY & WELLNESS, INC. Policy #: 010-34425 -LOW PLAN

Vision Plan Benefits subject to FUSION plan design listed above Allowances Exam Subject to Maximum Lenses (per pair) Single Subject to Maximum Bifocal Subject to Maximum Trifocal Subject to Maximum Lenticular Subject to Maximum Progressive Subject to Maximum Contacts Elective/Medically Necessary Subject to Maximum Frames Subject to Maximum Exam Lenses Frames

Frequencies Based on date of service**

None None None

Maximum

$100

Deductibles (Lifetime deductible)

*Deductible applies to the first service received **Please submit claims within 90 days of the date of service so that the plan can consider benefits (subject to State requirements).

Member Cost for Vision Discounts (may vary by prescription, option chosen and retail location)

Exam

$5 off routine exam $10 off contact lens exam

With dilation as necessary

The following lenses, frame and lens options discounts and fees apply only if a complete pair of glasses is purchased. Standard Plastic Lenses Single Vision

$50 $70 $105

Bifocal Trifocal

Frame

35% of retail price

Lens Options

Standard Progressive Premium Progressive Standard Polycarbonate Tint (solid or gradient) Scratch-Resistant Coating Anti-Reflective Coating Ultraviolet coating Other Add-ons

$65 plus standard plastic lens cost 20% discount

$40 $15 $15 $45 $15 20% discount

Contact Lenses

Conventional

15% off retail price (does not apply to fitting) After initial purchase, replacement contacts by mail are offered at substantial savings online through eyemedvisioncare.com. Average discount of 15% off retail price or 5% off promotional price at US Laser Network participating providers.

Lasik or PRK

Items Not included

See limitations and exclusions

Limitations and Exclusions Discounts are not available for the following procedures material or services. · Orthoptic or vision training, subnormal vision aids, and any associated supplemental testing. · Medical and/or surgical treatment of the eye, eyes, or supporting structures. · Corrective eye wear required by your employer as a condition of employment, includes safety eye wear unless specifically covered under your plan. · Worker's Compensation injury claims (or similar injury laws.) · Plano non-Prescription lenses and non-prescription sunglasses, but you receive 20% off retail for items purchased separately. · EyeMed provider professional services, or disposable contect lenses. · Two pairs of glasses in lieu of bifocals.

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CODAC HEALTH, RECOVERY & WELLNESS, INC. Policy #: 010-34425 -LOW PLAN

Open Enrollment If you do not elect to participate when initially eligible, you may elect to participate at the policyholder’s next enrollment period, which normally coincides with the policy anniversary date. Dental Rewards Your dental plan includes Dental Rewards as a way to grow your annual maximum benefit. Simply by visiting a dental provider each year and submitting a claim, you can increase your annual maximum benefit over time. After your initial benefit is used, accumulated rewards are there to help pay for more expensive procedures, such as root canals or crowns. Here's how it works. For each year, you submit at least one dental claim and your total dental benefits paid for the year are at or under $500 you qualify to carry over $250 in rewards to the following year. When your dental visit is to an Ameritas network provider, you earn an extra $100 PPO Bonus. You may accumulate rewards up to the maximum amount of $1000. Please note, if you do not submit a dental claim during the year, no rewards are earned and accumulated rewards are reset to zero. However, you can start qualifying for rewards again the very next year. Provider Flexibility and Network Savings Members aren't limited to one particular dentist, or a small group of providers, who may or may not be taking new patients. Each plan member is free to visit any provider they choose, including your current dentist, regardless if they are in- or out-of-network. And family members do not have to see the same dentist. When yo visit an in-network dentist there are no claim forms to complete. For a list of network dentists in your area, go to Find A Provider at Ameritas.com.

Late Entrant We strongly encourage you and/or your dependents to sign up for coverage when you are initially eligible. If you choose to enroll after initially declined, you and/or your eligible dependents will be considered a Late Entrant. Covered expenses will not include and benefits will not be payable in the first 12 months that a person is insured if the person is a Late Entrant; except for evaluations, prophylaxis (cleanings), and fluoride application. After 12 months, you will have access to all of the plan's benefits. Customer Service Customer Connections 800-487-5553 www.Ameritas.com Monday - Thursday 7am-12am CST, Friday 7am-6:30pm CST This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator.

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CODAC HEALTH, RECOVERY & WELLNESS, INC. Policy #: 010-34425 -HIGH PLAN

FUSION combines dental and eye care benefits into one easy-to-administer plan. This plan combines the annual maximum between the dental and vision plans. For the maximum:

· The member can use up to $2,000 Non PPO - $2,500 PPO toward any covered dental expense.

· The member can use up to $100 toward any covered eye care expense. · Total benefits paid between the two coverages will not exceed $2,500.

Dental Plan Benefits subject to FUSION plan design listed above Networks: Classic In-Network

Out-of-Network

Type 1 Preventive No Waiting Period

100%

Routine Exam (1 per 6 months)

Bitewing X-rays (1 per 12 months)

Cleaning (1 per 6 months)

Type 2 Basic No Waiting Period

100%

50%

Restorative Amalgams

Restorative Composites

Endodontics (nonsurgical)

Periodontics (nonsurgical)

Endodontics (surgical)

Periodontics (surgical)

Simple Extractions

Type 3 Major No Waiting Period

60%

25%

Surgical Extractions

Crowns (1 in 10 years per tooth)

Implants

Prosthodontics (Bridges, Dentures) (1 in 10 years)

Deductible* Type 1

Family Maximum

Benefit Year Maximum Type 1, 2, and 3 (per person, per calendar year)

$2,500

$2,000

Orthodontia Benefits (children under age 19) No waiting period Plan Benefit

50%

Lifetime Deductible

Lifetime Maximum (per person)

$2,500

Claims Allowance Type 1, 2 and 3

Discounted Fee

80th U&C

1 of 3

Class 2

Created 7/24/2023

CODAC HEALTH, RECOVERY & WELLNESS, INC. Policy #: 010-34425 -HIGH PLAN

Frequencies Based on date of service**

None None None

Maximum

$100

Deductibles (Lifetime deductible)

*Deductible applies to the first service received **Please submit claims within 90 days of the date of service so that the plan can consider benefits (subject to State requirements).

Member Cost for Vision Discounts (may vary by prescription, option chosen and retail location)

Exam

$5 off routine exam $10 off contact lens exam

With dilation as necessary

The following lenses, frame and lens options discounts and fees apply only if a complete pair of glasses is purchased. Standard Plastic Lenses Single Vision

$50 $70 $105

Bifocal Trifocal

Frame

35% of retail price

Lens Options

Standard Progressive Premium Progressive Standard Polycarbonate Tint (solid or gradient) Scratch-Resistant Coating Anti-Reflective Coating Ultraviolet coating Other Add-ons

$65 plus standard plastic lens cost 20% discount

$40 $15 $15 $45 $15 20% discount

Contact Lenses

Conventional

Lasik or PRK

Items Not included

See limitations and exclusions

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CODAC HEALTH, RECOVERY & WELLNESS, INC. Policy #: 010-34425 -HIGH PLAN

Open Enrollment If you do not elect to participate when initially eligible, you may elect to participate at the policyholder’s next enrollment period, which normally coincides with the policy anniversary date. Dental Rewards Your dental plan includes Dental Rewards as a way to grow your annual maximum benefit. Simply by visiting a dental provider each year and submitting a claim, you can increase your annual maximum benefit over time. After your initial benefit is used, accumulated rewards are there to help pay for more expensive procedures, such as root canals or crowns. Here's how it works. For each year, you submit at least one dental claim and your total dental benefits paid for the year are at or under $750 you qualify to carry over $400 in rewards to the following year. When your dental visit is to an Ameritas network provider, you earn an extra $200 PPO Bonus. You may accumulate rewards up to the maximum amount of $1200. Please note, if you do not submit a dental claim during the year, no rewards are earned and accumulated rewards are reset to zero. However, you can start qualifying for rewards again the very next year. Provider Flexibility and Network Savings Members aren't limited to one particular dentist, or a small group of providers, who may or may not be taking new patients. Each plan member is free to visit any provider they choose, including your current dentist, regardless if they are in- or out-of-network. And family members do not have to see the same dentist. When yo visit an in-network dentist there are no claim forms to complete. For a list of network dentists in your area, go to Find A Provider at Ameritas.com.

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CODAC HEALTH, RECOVERY & WELLNESS, INC. FUSION Highlight Sheet Policy # 34425

VISION BENEFITS CLAIM FORM PLEASE BE AS THOROUGH & ACCURATE AS POSSIBLE WHEN COMPLETING THIS FORM. ERRORS OR OMMISSIONS MAY DELAY CLAIM PAYMENTS. CLAIMS MUST BE SUBMITTED WITHIN 90 DAYS FROM SERVICE DATE.

TO BE COMPLETED BY THE CARDHOLDER

1. PATIENT’S NAME ( Last, First, Middle )

2. CARDHOLDER’S GROUP # 34425

3. CARDHOLDER’S ID#

4. PATIENT’S BIRTH DATE 5. PATIENT’S SEX  MALE  FEMALE

6. RELATIONSHIP TO CARDHOLDER  SELF

7. CARDHOLDER’S NAME ( Last, First, Middle)

 CHILD  OTHER

 SPOUSE

8. CARDHOLDER’S ADDRESS ( No., Street, City, State and Zip Code)

9. HOME NUMBER

WORK NUMBER

(

)

(

)

10. NAME OF INSURANCE CARRIER

11. NAME OF EMPLOYER CODAC Health, Recovery & Wellness, Inc.

12. CARDHOLDER’S STATUS  ACTIVE

13. CARDHOL DER’S BIRTH DATE

 RETIRED  SALARIED

Ameritas

 HOURLY

14. PATIENT IS COVERED FOR VISION CARE

15. NAME AND ADDRESS OF THE OTHER CARRIER

 YES

IF YES, PLEASE COMPLETE BOXES 15 THROUGH 16

BY ANOTHER PLAN

 NO

16. POLICY HOLDER’S N AME 17. RELATIONSHIP TO CARDHOLDER  SELF  CHILD  SPOUSE  OTHER

18. POLICY HOLDERS’ DATE OF BIRTH 19. 19. POLICYHOLDER’S S.S. #/GROUP #

SIGNATURE OF CARDHOLDER _________________________________________________________ DATE SIGNED _______________________

PLEASE CHECK ALL ITEMS BELOW THAT APPLY TO THE SERVICES RENDERED BY YOUR EYE CARE PROVIDER

DATE OF SERVICE ________________________________

EXAM



CONTACT LENS FITTING/EXAM



CONTACT LENSES



EYE GLASS LENSES



SINGLE VISION



BIFOCAL



TRIFOCAL



PROGRESSIVE (NO LINE BIFOCAL)



 OTHER _______________________________

 FRAME

PLEASE SUBMIT THIS FORM WITH YOUR ITEMIZED RECEIPT (S) TO THE FOLLOWING

$100 Flat Max

Send claims to: Ameritas Group Claim Office

P.O. Box 82520 Lincoln, NE 68501

 Check to send payment directly to provider.

Toll Free (800) 487-5553 www.ameritas.com

Member Signature _______________________

Term Life Insurance

We’ve Got You Covered As an active employee of CODAC Health, Recovery & Wellness, Inc, you have access to a life insurance policy from United of Omaha Life Insurance Company. It replaces the income you would have provided, and helps pay funeral costs, manage debt and cover ongoing expenses. How much insurance is enough? When determining how much life insurance you need, think about the expenses you may encounter now and through every stage of your life. Coverage guidelines and benefits are outlined in the chart below.

ELIGIBILITY - ALL ELIGIBLE EMPLOYEES Eligibility Requirement

You must be actively working a minimum of 30 hours per week to be eligible for coverage. The premiums for this insurance are paid in full by the policyholder. There is no cost to you for this insurance.

Premium Payment

45103

G000539J

BENEFITS Life Insurance Benefit Amount

For You: An amount equal to 1 times your annual salary, but in no event less than $0 or more than $300,000 In the event of death, the benefit paid will be equal to the benefit amount after any age reductions less any living care/accelerated death benefits previously paid under this plan. For You: The Principal Sum amount is equal to the amount of your life insurance benefit.

Accidental Death &

Dismemberment (AD&D) Benefit Amount FEATURES Living Care/ Accelerated Death Benefit

50% of the amount of the life insurance benefit is available to you if terminally ill, not to exceed $100,000. If it is determined that you are totally disabled, your life insurance benefit will continue without payment of premium, subject to certain conditions. In addition to basic AD&D benefits, you are protected by the following benefits: - Seat Belt - Airbag If your employment ends, you may apply for an individual life insurance policy from Mutual of Omaha without having to provide evidence of insurability (information about your health). You will be responsible for the premium for the coverage. The Travel Assistance program is an added benefit that provides assistance for your travels over 100 miles away from home or outside the country. The Hearing Discount Program provides you and your family discounted hearing products, including hearing aids and batteries. Call 1-888-534-1747 or visit www.amplifonusa.com/mutualofomaha to learn more. We work with Epoq, Inc. to offer employees online will prep tools. In just a few clicks you can complete a basic will or other documents to protect your family and property. To get started visit www.willprepservices.com.

Waiver of Premium

Additional AD&D Benefits

Conversion

SERVICES Travel Assistance

Hearing Discount Program Will Prep Services

AGE REDUCTIONS AND EXCLUSIONS Insurance benefits and guarantee issue amounts are subject to age reductions:

- At age 70, amounts reduce to 65% - At age 75, amounts reduce to 45% - At age 80, amounts reduce to 30% - At age 85, amounts reduce to 20% - At age 90, amounts reduce to 15% Information about the AD&D exclusions for this plan will be included in the summary of coverage, which you will receive after enrolling. Please contact your employer if you have questions prior to enrolling.

Who is eligible for this insurance? You must be actively working (performing all normal duties of your job) at least 30 hours per week. What is Guarantee Issue? The amount of insurance applied for without answering any health questions (or which does not require evidence of insurability). Coverage amounts over the Guarantee Issue Amount will require evidence of insurability. What is Evidence of Insurability? Evidence of Insurability or proof of good health – may be required if you are a late entrant and/or you request any additional coverage above your guarantee issue amount. Can I take this insurance with me if I change jobs/am no longer a member of this group? In the event this insurance ends due to a change in your employment/membership status with the group, or for certain other reasons, you may have the right to continue this insurance under the Conversion provision, subject to certain conditions. Are there any limitations, reductions or exclusions? The benefits payable are based on the following: · Insurance benefits and guarantee issue amounts are subject to age reductions: - At age 70, amounts reduce to 65% - At age 75, amounts reduce to 45% - At age 80, amounts reduce to 30% - At age 85, amounts reduce to 20% - At age 90, amounts reduce to 15% · Information about the AD&D exclusions for this plan will be included in the summary of coverage, which you will receive after enrolling. All exclusions may not be applicable, or may be adjusted, as required by state regulations.

This information describes some of the features of the benefits plan. Benefits may not be available in all states. Please refer to the certificate booklet for a full explanation of the plan's benefits, exclusions, limitations and reductions. Should there be any discrepancy between the certificate booklet and this outline, the certificate booklet will prevail. Life insurance and accidental death & dismemberment insurance are underwritten by United of Omaha Life Insurance Company, 3300 Mutual of Omaha Plaza, Omaha, NE 68175. Policy form number 7000GM-U-EZ 2010 or state equivalent (in NC: 7000GM-U-EZ 2010 NC). United of Omaha Life Insurance Company is licensed nationwide, except New York.

TERM LIFE INSURANCE

Employee Assistance Program

Available Services When You Need Help the Most

539J

Life isn’t always easy. Sometimes a personal or professional issue can affect your work, health and general well-being. During these tough times, it’s important to have someone to talk with to let you know you’re not alone.

We are here for you

With Mutual of Omaha’s Employee Assistance Program, you can get the help you need so you spend less time worrying about the challenges in your life and can get back to being the productive worker your employer counts on to get the job done. Learn more about the Employee Assistance Program services available to you. Enhanced EAP Services

Visit the Employee Assistance Program website to view timely articles and resources

on a variety of financial, well-being, behavioral and mental health topics. mutualofomaha.com/eap

Features

Value to Company and Employees

Employee Family Clinical Services

• An in-house team of Master’s level EAP professionals who are available 24/7/365 to provide individual assessments • Outstanding customer service from a team dedicated to ongoing training and education in employee assistance matters • Access to subject matter experts in the field of EAP service delivery Three sessions per year (per household) conducted by either face-to-face* counseling or video

Counseling Options •

Exclusive Provider Network

• National network of more than 10,000 licensed clinical providers • Network continually expanding to meet customer needs • Flexibility to meet individual client/member needs

*California Residents: Knox-Keene Statute limits no more than three face-to-face sessions in a six-month period per person.

Continued on back.

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Enhanced EAP Services (continued)

Features

Value to Company and Employees

Access

• 1-800 hotline with direct access to a Master’s level EAP professional • 24/7/365 services available

• Telephone support available in more than 120 languages • Online submission form available for EAP service requests • EAP professionals will help members develop a plan and identify resources to meet their individual needs • Valuable resources – legal libraries, tools and forms – available on EAP website • A counseling session may be substituted for one legal consultation (up to 30 minutes) with an attorney • 25% discount for ongoing legal services for same issue • Inclusive financial platform powered by Enrich that includes financial assessment tools, personalized courses, articles and resources, and ongoing progress reports to help members monitor their financial health • A counseling session may be substituted for one financial consultation (up to 30 minutes) with an attorney • 25% discount for ongoing financial services for same issue

Employee Family Legal Services

Employee Family Financial Services

Employee Family Work/Life Services

• Child care resources and referrals • Elder care resources and referrals

Online Services

• An inclusive website with resources and links for additional assistance, including: • Current events and resources • Family and relationships • Emotional well-being • Financial wellness • Substance abuse and addiction • Legal assistance • Physical well-being • Work and career • Bilingual article library

Employee Communication

• All materials available in English and Spanish

Eligibility

• Full-time employees and their immediate family members; including the employee, spouse and dependent children (unmarried and under 26) who reside with the employee • EAP professionals will coordinate services with treatment resources/providers within the employee’s health insurance network to provide counseling services covered by health insurance benefits, whenever possible

Coordination with Health Plan(s)

Insurance products and services are offered by Mutual of Omaha Insurance Company or one of its affiliates. Mutual of Omaha Insurance Company is licensed nationwide. United of Omaha Life Insurance Company is licensed nationwide, except in New York. Companion Life Insurance Company is licensed in New York. Each underwriting company is solely responsible for its own contractual and financial obligations. Some exclusions or limitations may apply.

Long-Term Disability Insurance

We’ve Got You Covered As an active employee of CODAC Health, Recovery & Wellness, Inc, you have access to a disability income insurance policy from United of Omaha Life Insurance Company. A lengthy disability can be devastating, and is more common than you might think. It may lead to a loss of income, independence and financial security. A disability income insurance policy can help provide security when you need it most. It pays you cash benefits when you’re sick or hurt and can’t work. Coverage guidelines and benefits are outlined in the chart below.

ELIGIBILITY - ALL ELIGIBLE EMPLOYEES Eligibility Requirement

You must be actively working a minimum of 30 hours per week to be eligible for coverage.

Premium Payment

The premiums for this insurance are paid in full by the policyholder. There is no cost to you for this insurance.

BENEFITS Elimination Period

Your benefits begin on the later of 180 calendar days after the onset of your disabling injury or illness or the date your short term disability ends. Your benefit is equivalent to 60% of your before-tax monthly earnings, not to exceed the plan’s maximum monthly benefit amount less other income sources. The premium for your long-term disability coverage is waived while you are receiving benefits.

Monthly Benefit

Maximum Monthly Benefit Minimum Monthly Benefit Maximum Benefit Period Partial Disability Benefits

$5,000

$50

If you become disabled prior to age 62, benefits are payable to age 65, your Social Security Normal Retirement Age or 3.5 years, whichever is longest. At age 62 (and older), the benefit period will be based on a reduced duration schedule. If you become disabled and can work part-time (but not full-time), you may be eligible for partial disability benefits.

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DEFINITIONS Own Occupation Own Occupation Earnings Test Definition of Monthly Earnings FEATURES Vocational Rehabilitation Benefit Survivor Benefit SERVICES Employee Assistance Program (EAP) Hearing Discount Program

2 Years

99%

Monthly earnings for salaried employees is the gross annual salary in effect immediately prior to the date disability begins, divided by 12. Monthly earnings for hourly employees is the hourly rate of pay multiplied by the average number of hours worked during the 12 month period immediately prior to the date disability begins. If employed for part of the prior 12 month period, monthly earnings is the hourly rate of pay multiplied by the average number of hours worked.

If you become disabled and participate in the vocational rehabilitation program, you will be eligible for a monthly benefit increase of 5%.

If you pass away while receiving disability benefits, a lump sum equal to 3 times your monthly benefit will be paid to your eligible survivor.

The EAP program provides you and your loved ones access to trained professionals and resources for assistance with personal and workplace issues.

The Hearing Discount Program provides you and your family discounted hearing products, including hearing aids and batteries. Call 1-888-534-1747 or visit www.amplifonusa.com/mutualofomaha to learn more.

Who is eligible for this insurance? You must be actively working (performing all normal duties of your job) at least 30 hours per week. How long will my benefits be paid? Benefits begin after the end of the elimination period and can be payable up to the maximum benefit period as long as you remain disabled. Will my benefits be reduced by other sources of income? Yes, depending on the type of income you receive. Your benefit amount may be reduced by other sources of income such as retirement/government plans, other group disability plans, salary continuance/sick leave, settlements on payments received and no-fault benefits. Does this plan cover me if I become disabled due to an injury at work? Yes, your LTD insurance provides benefits for both on-the-job and off-the-job coverage for disabilities due to injury or sickness. Are there any limitations or exclusions? The benefits payable are subject to the following: · Disabilities related to alcohol and drug abuse are only payable for up to 24 months while insured under the policy. · Disabilities related to mental disorders are only payable for up to 24 months while insured under the policy. · Your plan is subject to a pre-existing condition limitation. A pre-existing condition is one for which you have received medical treatment, consultation, care or services including diagnostic measures, or if you were prescribed or took prescription medications in the predetermined time frame prior to your effective date of coverage. The pre-existing condition under this plan is 3/12 which means any condition that you receive medical attention for in the 3 months prior to your effective date of coverage that results in a disability during the first 12 months of coverage, would not be covered. · Benefits are not payable for any disability or loss that: - Results from an act of declared or undeclared war or armed aggression - Results from participation in a riot or commission of or attempt to commit a felony - Results, whether the insured person is sane or insane, from an intentionally self-inflicted injury or illness, suicide, or attempted suicide - Results from alcohol and drug abuse and/or substance abuse, except as noted above - Results from a mental disorder, except as noted above - Is caused by alcohol and drug abuse and/or substance abuse, while not being actively supervised by and receiving continuing treatment from a rehabilitation center or designated institution approved for such treatment by an appropriate body in the governing jurisdiction - Occurs while incarcerated or imprisoned for any period exceeding 31 days

- Is solely a result of a loss of a professional license, occupation license or certification All exclusions may not be applicable, or may be adjusted, as required by state regulations.

This information describes some of the features of the benefits plan. Benefits may not be available in all states. Please refer to the certificate booklet for a full explanation of the plan’s benefits, exclusions, limitations and reductions. Should there be any discrepancy between the certificate booklet and this summary, the certificate booklet will prevail. Benefits availability is subject to final acceptance and approval of the group application by the underwriting company. Disability income insurance is underwritten by United of Omaha Life Insurance Company, 3300 Mutual of Omaha Plaza, Omaha, NE 68175, 1-800-769-7159. United of Omaha Life Insurance Company is licensed nationwide, except in New York. Policy form number 7000GM-U-EZ-2010.

LONG-TERM DISABILITY INSURANCE

Voluntary Short-Term Disability Insurance

We’ve Got You Covered As an active employee of CODAC Health, Recovery & Wellness, Inc, you have access to a disability income insurance policy from United of Omaha Life Insurance Company. A disability income insurance policy can help provide security when you need it, plus give you peace of mind so you can recover faster and get back on the job sooner. Coverage guidelines and benefits are outlined below.

ELIGIBILITY - ALL ELIGIBLE EMPLOYEES Eligibility Requirement

You must be actively working a minimum of 30 hours per week to be eligible for coverage.

Premium Payment

The premiums for this insurance are paid in full by you.

BENEFITS Elimination Period

If you become disabled, there is an elimination period before benefits are payable. Your benefits begin:

· On the 15th day of your disabling injury. · On the 15th day of your disabling illness.

Weekly Benefit

Your benefit is equivalent to 60% of your before-tax weekly earnings, not to exceed the plan’s maximum weekly benefit amount less other income sources.

The premium for your short-term disability coverage is waived while you are receiving benefits.

Maximum Benefit Period Maximum Weekly Benefit Minimum Weekly Benefit

Up to 26 weeks

$500

None

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Partial Disability Benefits

If you become disabled and can work part-time (but not full-time), you may be eligible for partial disability benefits, which will help supplement your income until you are able to return to work full time.

DEFINITIONS Definition of Disability

Disability and disabled mean that because of an injury or illness, a significant change in your mental or functional abilities has occurred, for which you are prevented from performing at least one of the material duties of your regular job and are unable to generate current earnings which exceed 99% of your weekly earnings from your regular job. You can be totally or partially disabled during the elimination period. Weekly earnings for salaried employees is the gross annual salary in effect immediately prior to the date disability begins, divided by 52. Weekly earnings for hourly employees is the hourly rate of pay multiplied by the average number of hours worked per week during the 12 month period immediately prior to the date disability begins. If employed for part of the prior 12 month period, weekly earnings is the hourly rate of pay multiplied by the average number of hours worked.

Definition of Weekly Earnings

FEATURES Vocational Rehabilitation Benefit

If you become disabled and participate in the vocational rehabilitation program, you will be eligible for a monthly benefit increase of 5%.

SERVICES Hearing Discount Program

VOLUNTARY SHORT-TERM DISABILITY PREMIUM CALCULATION Use the rates in the Age/Premium Factor Table to calculate your premium for voluntary short-term disability coverage in the worksheet below, using the example as a guide. AGE PREMIUM FACTOR BI-WEEKLY PREMIUM CALCULATION EXAMPLE < 30 0.0188308

(42-year-old employee earning $40,000 a year)

30 - 34

0.0171692

35 - 39

0.0160615

769.23

40 - 44

0.0155077

List your weekly earnings (Maximum is $833.33)

45 - 49

0.0163385

0.0155077

Multiply by the premium factor

50 - 54

0.0177231

11.93

Your Estimated Bi-Weekly Premium** $

55 - 59

0.0207692

60 - 64

0.0243692

65 - 69

0.0276923

**This is an estimate of premium cost. Actual deductions may vary slightly due to rounding and payroll frequency.

70+

0.0304615

Who is eligible for this insurance? You must be actively working (performing all normal duties of your job) at least 30 hours per week. How long will my benefits be paid? Benefits begin after the end of the elimination period and can be payable up to the maximum benefit period as long as you remain disabled. Will my benefits be reduced by other sources of income? Yes, depending on the type of income you receive. Your benefit amount may be reduced by other sources of income such as retirement/government plans, other group disability plans, paid family leave, salary continuance/sick leave, settlements on payments received and no-fault benefits. Does this plan cover me if I become disabled due to an injury at work? No, your STD insurance only provides benefits for off-the-job coverage for disabilities due to injury or sickness. Are there any limitations or exclusions? The benefits payable are subject to the following: · Your plan is subject to a pre-existing condition limitation. A pre-existing condition is one for which you have received medical treatment, consultation, care or services including diagnostic measures, or if you were prescribed or took prescription medications in the predetermined time frame prior to your effective date of coverage. The pre-existing condition under this plan is 12/12 which means any condition that you receive medical attention for in the 12 months prior to your effective date of coverage that results in a disability during the first 12 months of coverage, would not be covered. · Benefits are not payable for any disability or loss that: - Results from an act of declared or undeclared war or armed aggression - Results from participation in a riot or commission of or attempt to commit a felony - Arises out of or in the course of employment with the policyholder for benefits under any workers’ compensation or occupational disease law, or receives any settlement from the workers’ compensation carrier - Results, whether the insured person is sane or insane, from an intentionally self-inflicted injury or illness, suicide, or attempted suicide - Occurs while incarcerated or imprisoned for any period exceeding 31 days

- Is solely a result of a loss of a professional license, occupation license or certification All exclusions may not be applicable, or may be adjusted, as required by state regulations.

This information describes some of the features of the benefits plan. Benefits may not be available in all states. Please refer to the certificate booklet for a full explanation of the plan’s benefits, exclusions, limitations and reductions. Should there be any discrepancy between the certificate booklet and this summary, the certificate booklet will prevail. Benefits availability is subject to final acceptance and approval of the group application by the underwriting company. Disability income insurance is underwritten by United of Omaha Life Insurance Company, 3300 Mutual of Omaha Plaza, Omaha, NE 68175, 1-800-769-7159. United of Omaha Life Insurance Company is licensed nationwide, except in New York. Policy form number 7000GM-U-EZ-2010.

VOLUNTARY SHORT-TERM DISABILITY INSURANCE

Voluntary Term Life Insurance

ELIGIBILITY - ALL ELIGIBLE EMPLOYEES Eligibility Requirement

You must be actively working a minimum of 30 hours per week to be eligible for coverage. To be eligible for coverage, your dependents must be able to perform normal activities, and not be confined (at home, in a hospital, or in any other care facility), and any child(ren) must be under age 26. In order for your spouse and/or children to be eligible for coverage, you must elect coverage for yourself. The premiums for this insurance are paid in full by you.

Dependent Eligibility Requirement

Premium Payment

COVERAGE GUIDELINES

Minimum

Guarantee Issue

Maximum

$10,000

7 times annual salary, up to $100,000

$350,000, in increments of $10,000, but no more than 7 times annual salary

For You

45103

G000539J

$5,000

100% of employee’s benefit, up to $30,000

50% of employee’s benefit, up to $100,000

Spouse

$2,000

100% of employee’s benefit 50% of employee’s benefit, up to $10,000

Children

Subject to any reductions shown below. Guarantee Issue is available to new hires. Amounts over the Guarantee Issue will require a health application/evidence of insurability. For late entrants, all amounts will require a health application/evidence of insurability. BENEFITS

Within the coverage guidelines defined above, you select the amount of life insurance coverage you want. This plan includes the option to select coverage for your spouse and dependent children. Children include those, up to age 26. In the event of death, the benefit paid will be equal to the benefit amount after any age reductions less any living care/accelerated death benefits previously paid under this plan. For you, your spouse and your dependent child(ren): The Principal Sum amount is equal to the amount of the life insurance benefit. AD&D coverage is available if you or your dependents are injured or die as a result of an accident, and the injury or death is independent of sickness and all other causes. The benefit amount depends on the type of loss incurred, and is either all or a portion of the Principal Sum. 50% of the amount of the life insurance benefit is available to you and your spouse if terminally ill, not to exceed $100,000. If it is determined that you are totally disabled, your life insurance benefit will continue without payment of premium, subject to certain conditions. If you enroll for even the minimum amount of coverage during your initial enrollment, you have the ability to enroll for additional coverage at your next enrollment by up to $10,000, provided the total amount of insurance does not exceed your maximum benefit amount. This feature allows you to secure additional life insurance protection in the event your needs change (ex. you get married or have a child). Amounts over the Guarantee Issue will require evidence of insurability (proof of good health). In addition to basic AD&D benefits, you are protected by the following benefits: - Seat Belt - Airbag Allows you to continue this insurance program for yourself and your dependents should you leave your employer for any reason, without having to provide evidence of insurability (information about your health). You will be responsible for the premium for the coverage. If your employment ends, you may apply for an individual life insurance policy from Mutual of Omaha without having to provide evidence of insurability (information about your health). You will be responsible for the premium for the coverage. The Hearing Discount Program provides you and your family discounted hearing products, including hearing aids and batteries. Call 1-888-534-1747 or visit www.amplifonusa.com/mutualofomaha to learn more. We work with Epoq, Inc. to offer employees online will prep tools. In just a few clicks you can complete a basic will or other documents to protect your family and property. To get started visit www.willprepservices.com.

Life Insurance Benefit Amount

Accidental Death &

Dismemberment (AD&D) Benefit Amount

FEATURES Living Care/ Accelerated Death Benefit

Waiver of Premium

Annual Benefit Amount Increase

Additional AD&D Benefits

Portability

Conversion

SERVICES Hearing Discount Program

Will Prep Services

AGE REDUCTIONS AND EXCLUSIONS Insurance benefits and guarantee issue amounts are subject to age reductions:

- At age 70, amounts reduce to 65% - At age 75, amounts reduce to 45% - At age 80, amounts reduce to 30% - At age 85, amounts reduce to 20% - At age 90, amounts reduce to 15% Spouse coverage terminates at age 70.

Life insurance benefits will not be paid if the insured’s death is the result of suicide within two years from the date coverage begins. If this occurs, the sum of the premiums paid will be returned to the beneficiary. The same applies for any future increases in coverage under this plan. Information about the AD&D exclusions for this plan will be included in the summary of coverage, which you will receive after enrolling. Please contact your employer if you have questions prior to enrolling.

Voluntary Term Life and AD&D Coverage Selection and Premium Calculation Please note that the premium amounts presented below may vary slightly from the amounts provided on your enrollment form, due to rounding. To select your benefit amount and calculate your premium, do the following: 3) Your premium amount is found in the box where the row (your age) and the column (benefit amount) intersect. 4) Enter the benefit and premium amounts into their respective areas in the Voluntary Life and AD&D section of your enrollment form. If the benefit amount you want to select is greater than any

1) Locate the benefit amount you want from the top row of the employee premium table. Your benefit amount must be in an increment of $10,000. Refer to the Coverage Guidelines section for minimums and maximums, if needed. 2) Find your age bracket in the far left column.

amount in the table below, select the benefit amount from the top row that when multiplied by another number results in the benefit amount you want. For example, if you want $150,000 in coverage, you obtain your premium amount by multiplying the rate for $50,000 times 3.

EMPLOYEE PREMIUM TABLE (26 PAYROLL DEDUCTIONS PER YEAR) Age $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 0 - 34 $0.39 $0.78 $1.18 $1.57 $1.96 $2.35 $2.75 $3.14 $3.53 $3.92 35 - 39 $0.53 $1.06 $1.59 $2.12 $2.65 $3.18 $3.72 $4.25 $4.78 $5.31 40 - 44 $0.76 $1.52 $2.28 $3.05 $3.81 $4.57 $5.33 $6.09 $6.85 $7.62 45 - 49 $1.22 $2.45 $3.67 $4.89 $6.12 $7.34 $8.56 $9.78 $11.01 $12.23 50 - 54 $1.73 $3.46 $5.19 $6.92 $8.65 $10.38 $12.12 $13.85 $15.58 $17.31 55 - 59 $2.52 $5.03 $7.55 $10.06 $12.58 $15.09 $17.61 $20.12 $22.64 $25.15 60 - 64 $4.08 $8.17 $12.25 $16.34 $20.42 $24.51 $28.59 $32.68 $36.76 $40.85 65 - 69 $7.32 $14.63 $21.95 $29.26 $36.58 $43.89 $51.21 $58.52 $65.84 $73.15 70 - 74 $10.27 $20.54 $30.81 $41.08 $51.35 $61.62 $71.88 $82.15 $92.42 $102.69 75+ $22.04 $44.08 $66.12 $88.15 $110.19 $132.23 $154.27 $176.31 $198.35 $220.38 Follow the method described above to select a benefit amount and calculate premiums for optional dependent spouse and/or child(ren) coverage. Your spouse’s rate is based on your spouse's age, so find your spouse's age bracket in the far left column of the Spouse Premium Table. Your spouse’s premium amount is found in the box where the row (the age) and the column (benefit amount) intersect. Your spouse’s benefit amount must be in an increment of $5,000. Refer to the Coverage Guidelines section for minimums and maximums, if needed. SPOUSE PREMIUM TABLE (26 PAYROLL DEDUCTIONS PER YEAR) Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 0 - 34 $0.20 $0.39 $0.59 $0.78 $0.98 $1.18 $1.38 $1.57 $1.77 $1.96 35 - 39 $0.27 $0.53 $0.80 $1.06 $1.33 $1.59 $1.86 $2.12 $2.39 $2.65 40 - 44 $0.38 $0.76 $1.14 $1.52 $1.91 $2.28 $2.67 $3.05 $3.43 $3.81 45 - 49 $0.61 $1.22 $1.84 $2.45 $3.06 $3.67 $4.28 $4.89 $5.51 $6.12 50 - 54 $0.87 $1.73 $2.60 $3.46 $4.33 $5.19 $6.06 $6.92 $7.79 $8.65 55 - 59 $1.26 $2.52 $3.78 $5.03 $6.29 $7.55 $8.81 $10.06 $11.32 $12.58 60 - 64 $2.04 $4.08 $6.13 $8.17 $10.21 $12.25 $14.30 $16.34 $18.38 $20.42 65 - 69 $3.66 $7.32 $10.98 $14.63 $18.29 $21.95 $25.61 $29.26 $32.92 $36.58

ALL CHILDREN PREMIUM TABLE (26 PAYROLL DEDUCTIONS PER YEAR)*

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000 $10,000

$0.18

$0.28

$0.37

$0.46

$0.55

$0.65

$0.74

$0.83

$0.92

*Regardless of how many children you have, they are included in the "All Children" premium amounts listed in the table above.

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