2021 Caregivers and Healthcare Professionals Benefit Guide

2 02 1 B EN EF I TS G UI DE F OR CAR E GIV E R S
AN D HEALTHCAR E P ROF ES SI ON A L S
Welcome!
Dear Maxim Caregivers and Healthcare Professionals,
At Maxim, we strive to create success by leading and serving others. One way we recognize employees is by offering a comprehensive
benefits program. We realize that benefit needs vary from person to person, so we provide a range of plans that let you choose the level of
coverage and the combination of benefits that you want and need.
Your role is to make the right choices when you enroll during open enrollment or as a new associate, keep us updated if you experience a
life event, and to take advantage of the tools and resources we offer. This guide is intended to provide a summary of the benefits we offer
and to help you learn about the programs and resources that can help you protect the health and security of you and your family.
AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE

Your health is very important to us. A healthy lifestyle will help you feel your best and regular preventive care can help prevent costly
services down the road. Healthy employees tend to miss less time from work and usually require fewer and less expensive health services.
We encourage you to take advantage of the preventive services covered by our plans.
LET’S GET STARTED

Go ahead and explore your options. When you’re ready, enroll online at www.MaximHealthcareBenefits.com. See section on Enrollment
Instructions for detailed directions on how to enroll. If you have any questions during the process please contact us at 1-866-663-1107 or
benefitinquiries@maxhealth.com. Contact information for our providers can be found in the contact information section.
We look forward to working with you!
Sincerely,
The Benefits Team
What’s Inside
Benefits-At-A-Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Dental Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Vision Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Payroll Deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 401(k)–Allegis Group Retirement Savings Plan . . . . . . . . . 26
Changing Your Benefits During the Year . . . . . . . . . . . . 10 Short Term Disability . . . . . . . . . . . . . . . . . . . . . . . . 30
Beneficiaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Voluntary Group Life Insurance . . . . . . . . . . . . . . . . . 31
Medical Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Employee Discount Program . . . . . . . . . . . . . . . . . . . . 32
Prescription Drug Benefits . . . . . . . . . . . . . . . . . . . . 15 Transportation Benefits . . . . . . . . . . . . . . . . . . . . . . . 33
Hospital Bridge Insurance Plan . . . . . . . . . . . . . . . . . . . . . . 18 College Partnership Programs . . . . . . . . . . . . . . . . . 33
Hospital Expense Protection Plan . . . . . . . . . . . . . . 20 MetLife Home & Auto Insurance . . . . . . . . . . . . . . . . . 34
Supplemental Critical Illness Insurance . . . . . . . . . . . . . . . . 21 MetLife Pet Insurance . . . . . . . . . . . . . . . . . . . . . . . . . 34
Supplemental Accident Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Enrollment Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Employee Assistance Program (EAP) . . . . . . . . . . . . . . . . . . . . . 23 Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Health Advocacy Services . . . . . . . . . . . . . . . . . . 23 Appendix A . . . . . . . . . . . . . . . . . . . . . . Important Plan Notices
ALL SUMMARY OF BENEFITS COVERAGE (SBCS) CAN BE LOCATED ON

WWW.MAXIMHEALTHCAREBENEFITS.COM.
2 0 2 1 C A R E G I V E R S A N D H E A LT H C A R E P R O F E S S I O N A L S B E N E F I T G U I D E 2
Caregivers & Healthcare Professionals Benefits At-A-Glance
Maxim is committed to being your employer of choice, which is why in addition to healthcare benefits Maxim also offers an array of other benefits
that support a healthy work-life balance. This chart is your at-a-glance guide to the benefits Maxim offers, including healthcare, retirement planning,
MyTime, college partnerships, transportation benefits, employee discounts, and more!
HEALTH AND WELFARE

BlueCross BlueShield
• Four plans available: Basic Medical Plan, Silver Medical Plan, High Deductible Bronze Medical Plan, Standard Medical Plan (only for
existing participants)
• All plans feature national BlueCross BlueShield network
• All plans pay 100% with no deductible for most preventive care in-network
• All plans include prescription drug coverage through CVS/caremark
Medical/Prescription1
• Basic Medical Plan pays 100% of basic services, such as in-network office visits and in-network generic drugs (no coverage for major
services such as surgery, hospitalization, emergency room services, x-ray/diagnostic imaging [e.g., MRI], or Preferred and Non-Preferred
Specialty drugs)
• The Silver Medical Plan pays 70% for most other in-network services after calendar year deductible is met
• High Deductible Bronze Medical Plan pays 60% for most other in-network services after calendar year deductible is met
• Standard Medical Plan pays 80% for most other in-network services after calendar year deductible is met (only for existing participants)
MetLife
• Two plans available: Silver Plan and Gold Plan
• Both plans have in- and out-of-network benefits
Dental1 • Both plans pay 100% with no deductible for preventive services
• Silver Plan has a deductible of $75.00 per member per calendar year; then Plan pays 40% to 80% for most other services.
Calendar year annual maximum is $1,000
• Gold Plan has a deductible of $50.00 per member per calendar year; then Plan pays 50% to 80% for most other services.
Coverage includes orthodontia. Calendar year annual maximum is $1,500
Vision Service Plan (VSP)
Vision1 • In- and out-of-network option (eye exam every 12 months, lenses/frames/contacts every 24 months)
• Interim benefits for lenses and frames if prescription change meets interim benefit requirement
Health Advocate
• Access to a Personal Health Advocate, typically a Registered Nurse, supported by a team of physicians and administrative experts,
who will help in handling health care and insurance related issues
Health Advocacy
• You, your spouse/domestic partner, children, children of domestic partner, parents, and the parents of your spouse/domestic
partner are eligible to use this service
• Company paid, automatically enrolled when you enroll in a Medical Plan
Employee Assistance Health Advocate
Program (EAP) • Confidential counseling for emotional, legal, financial, and other personal issues
RETIREMENT AND FINANCIAL SECURITY
Wells Fargo
• Save up to $19,500 of your income for 2021
401(k) Plan3 • Traditional (pre-tax) and Roth (post-tax) contribution options
• Wide range of investment options
The Hartford
• Voluntary Short-Term Disability benefit protects you against loss of income if you cannot work due to a sickness or injury
Short Term Disability
• Plan pays 50% of your pre-disability weekly pay, up to $300 per week
• Disability begins on day 15 of disability, and may be paid for up to 11 weeks
The Hartford
• Employee Voluntary Life – up to $300,000 (for new hires, no evidence of insurability required for up to $75,000) – cost is based
on age and amount of coverage
Life Insurance2
• Spouse Voluntary Life – up to $150,000 (for new hires, no evidence of insurability required for amounts up to $25,000) – cost is
based on employee’s age and amount of coverage
• Child Voluntary Life – up to $10,000 – cost is based on level of coverage
RETIREMENT AND FINANCIAL SECURITY
Symetra Life Insurance Company
• Pays a daily benefit for medical services such as hospitalization, major diagnostic testing, emergency room visits, and more,
up to the annual maximum
Hospital Bridge
• Three options available, with different maximum benefits per covered person per year: Traditional – $25,000; Enhanced –
Insurance Plan1
$35,000; and Premium: $45,000
• Designed to be used in combination with Basic Medical Plan, or coverage can be purchased separately
• Not Minimum Essential Coverage under the ACA (designed to supplement comprehensive medical)
Hospital Expense • Provides direct payment to you for inpatient hospital stays including maternity care, substance abuse, and mental health
Protection Plan (HEPP)1 • Coverage can be purchased separately or in addition to a Medical plan
• Pays a fixed dollar amount if you or a covered family member is diagnosed for the first time with a serious illness or condition such
as invasive cancer, heart attack, stroke, end-stage renal failure, major organ transplant, paralysis, or coma
Critical Illness Insurance1 • Two options available, with different lump sum benefits: Option 1 – $10,000 or Option 2 – $20,000
• Benefits for the employee or spouse/domestic partner are 100% of the lump sum benefit you enrolled for; benefits for children are
25% of the adult benefit
• Covers any type of accidental injury not incurred at work (up to three accidents per calendar year per covered person) and pays
your actual billed expenses up to the maximum benefit for the option you purchased; can help you meet your deductible or pay
Accident Insurance1
other expenses that are not covered by a comprehensive medical plan
• Two options available, with different benefit levels: Option 1 – Up to $5,000 per accident or Option 2 – Up to $10,000 per accident
• Not Minimum Essential Coverage under the ACA (designed to supplement a comprehensive medical plan)
MetLife
• Eligible for discounts on voluntary insurance policies from MetLife Auto & Home
Home and Auto Insurance
• Policies available include: auto, home, landlord’s rental dwelling, condo, mobile home, renters, recreational vehicle, boat, and
personal excess liability policies
MetLife
Pet Insurance
• Discounts available on a variety of voluntary pet insurance policies
LIFESTYLE BENEFITS
• MyTime is an enhanced benefit that allows Maxim caregivers and healthcare professionals the opportunity to accrue up to 24
MyTime Program
hours of paid time off per year
College Universities
College Partnership
• Partnerships with universities and colleges where employees are eligible for tuition discounts
Programs
• Waivers for application fees, personalized coaching, and direct delayed billing may also apply for some programs
PerkSpot
Employee Discount • Comprehensive discount program that is a one-stop-shop for 1000’s of exclusive discounts and perks from a wide variety of
Programs national and local merchants
• Available to all employees, family members, and friends
Optum Bank
Transportation Benefits
• Allows you to use pre-tax payroll dollars to pay for qualified parking and transit expenses
LEAVE
Maxim
Leave of Absence
• Upon meeting eligibility requirements FMLA and Personal Leave options are available
1
You may elect or change these benefits during the annual open enrollment period or anytime during the year with a qualifying status change.
2
You may elect or change these benefits anytime during the year with medical underwriting requirements.
3
You may elect or change these benefits anytime during the year once you meet eligibility, without restriction.
Who’s Eligible?
Generally, Caregivers and Healthcare Professionals with Maxim Healthcare Group, Inc. or one of our subsidiaries who meet the eligibility
criteria detailed on the next page are eligible for the benefits described in this guide. The benefits available to Travel Employees are
described in a separate guide.
• A spouse: A spouse is an individual who is recognized as the Employee’s spouse under applicable state law, excluding, however, a
common law spouse unless the individual qualifies as the employee’s Domestic Partner.
• Domestic Partners: Same-sex and opposite-sex couples who have registered with any state or local government agency authorized by
state or local law to perform such registrations. In other words, you must have filed with the authorized agency and the agency must
maintain a record of your domestic partnership.
A civil union partner is neither a spouse nor a domestic partner, unless otherwise registered with any state or local government domestic
partnership registry.
Maxim may request documentation of relationships, including marriage certificates, domestic partner registry certificates, and birth
certificates. Any requirements for proof of relationship for domestic partnerships are also applied to marriages. For example, domestic
partner registry certificates are recognized as fully equivalent to marriage certificates.
• A child who:
• Is under the age of 26 or is permanently and totally disabled (and meets the eligibility requirements described below); and
• Is related to you in one of the following ways:
• You or your spouse’s or domestic partner’s child by birth or legal adoption;
• Under testamentary or court appointed guardianship, other than temporary guardianship of less than 12 months’
duration, and who resides with, and is the dependent of you or your spouse or domestic partner;
• A child who is the subject of a Medical Child Support Order or a Qualified Medical Support Order that creates or
recognizes the right of the child to receive benefits under a parent’s health insurance coverage;
• A grandchild who is in the court-ordered custody, and who resides with, and is the dependent of you or your spouse
or domestic partner.
Children whose relationship to you is not listed above, including, but not limited to grandchildren (except as provided above), foster
children or children whose only relationship is one of legal guardianship (except as provided above) are not eligible, even though the child
may live with you and be dependent upon you for support.
Employee contributions for health care coverage are generally taken on a pre-tax basis. However, according to federal law, employee
benefit contributions for domestic partners who are not tax dependents as defined by the Internal Revenue Code, and children of domestic
partners who are not tax dependents of the employee as defined by the Internal Revenue Code cannot be provided tax-free.
If you and your spouse both work for Maxim, each family member—you, your spouse, and your eligible children—can be covered only once
for medical, dental and vision. One of you can enroll in a plan and cover all eligible children, and the other can waive coverage, or you can
both enroll. Children cannot be covered by each parent separately.
Eligibility Requirements
TIERED ELIGIBILITY STRUCTURE – HIGH LEVEL OVERVIEW
To better accommodate our Caregivers and Healthcare Professionals, provide more options that meet the needs of you and your dependents,
and to continue to meet requirements under the Affordable Care Act, we have implemented a Tiered Benefit Eligibility Structure. This structure
will enable all employees that are actively employed and working at least 1 hour per calendar month look-back period, the opportunity to enroll
in medical benefits.
This page contains high level details on the Tiers. For detailed information and examples, refer to the following pages 7–8. The detailed
information will explain which Tier you are eligible for, as well as how to maintain eligibility, and when benefits will terminate.
When referencing the calendar month, we are calculating based off the hours that were worked within the look-back period. The look-back
period includes the Saturday week ending payroll dates that fall within the calendar month.
TIER 1 BENEFITS
All Caregivers and Healthcare Professionals that worked at least 1 hour, but less than 120 hours in the previous calendar month look-back
period, will be offered medical coverage under the High Deductible Bronze Plan. You must continue to work at least 1 hour per calendar month
look-back period to maintain coverage; otherwise your Medical Plan will terminate on the last day of the previous month that you worked less
than 1 hour. Example:
• Employee is enrolled in the Tier 1 Medical Plan and did not work in February.
• Hours for February would be reviewed in March.
• Benefits would terminate on February 28 due to zero hours worked in February.
• Employee would be offered continuation of coverage under COBRA.
TIER 2 BENEFITS
If Caregivers and Healthcare Professionals have worked at least 120 hours during the previous calendar month look-back period, they
will be considered full time and will be offered our full benefits package. In addition to medical, all other benefits (i.e. dental, vision, life
insurance, short term disability, hospital bridge plan, accident insurance, etc.) will be offered.
You must continue to work at least 120 hours per calendar month look-back period, otherwise your plans will terminate on the last day
of the month following the month in which you had less than 120 hours. You will be offered COBRA coverage for your Tier 2 benefits
accordingly. In addition, you will have the opportunity to enroll in the High Deductible Bronze Plan under Tier 1 if you worked at least one
hour in the previous calendar month look-back period. If you did not work one hour in the previous calendar month look-back period, then
you will not be offered Tier 1 coverage. Example:
• Employee is enrolled in Tier 2 benefits and worked 110 hours in February.
• Hours for February would be reviewed in March.
• Benefits would terminate on March 31.
• Employee would be offered continuation of coverage under COBRA, and also offered the option to elect Tier 1 coverage.
TIERED ELIGIBILITY STRUCTURE – HOW TO BECOME ELIGIBLE, REMAIN ELIGIBLE, AND WHEN BENEFITS
WILL TERMINATE
TIER 1 BENEFITS
If you have at least one hour of service, but less than 120 hours of service, during a look-back period (additional information following), you
will be offered medical coverage under the Bronze Plan. Maxim does not make an employer contribution towards this medical coverage.
This is known as “Tier 1 Coverage.”
TIER 2 BENEFITS
If you have at least 120 hours of service during a look-back period, you will be considered eligible for the full-time benefits package, and
will be eligible to enroll in that benefits package accordingly—not just medical coverage under the Bronze Plan, but also other medical
coverage options, dental and vision coverage, and all the other benefits described in this Guide. Maxim makes employer contributions
towards this medical coverage. This is known as “Tier 2 Coverage.”
HOW IS ELIGIBILITY FOR TIER 1 COVERAGE DETERMINED?

You are eligible for medical benefits from Maxim on the first Saturday (payroll week ending date) on or after your first hour of service with
Maxim, subject to a waiting period. Your first hour with Maxim includes the time you spend in your local office completing the necessary
onboarding paperwork and orientation. The waiting period runs from that first Saturday until the end of the next calendar month that follows.
If you elect medical coverage, your coverage will become effective the first of the month after the end of your waiting period. While you may
elect medical coverage in advance, in other words during your waiting period, you will also have 30 days from your coverage’s effective date to
enroll retroactively back to the effective date. Of course, if you retroactively enroll, any missed premium payments will be collected.
So, for example, let’s say you complete your first hour of service on January 21, 2021. The first Saturday thereafter (payroll week
ending date) is January 23, 2021. The end of the next calendar month is February 28, 2021. As such, the waiting period will run from
January 23, 2021 through February 28, 2021. If you elect coverage, it will become effective the first of the month after the end of your
waiting period, which is March 1, 2021. You will have until March 31, 2021 to enroll, with coverage effective as of March 1, 2021.
As another example, let’s say you complete your first hour of service on July 23, 2021. The first Saturday thereafter (payroll week ending
date) is July 24, 2021. The end of the next calendar month is August 31, 2021. As such, the waiting period will run from July 24, 2021
to August 31, 2021. If you elect coverage, it will become effective the first of the month after the end of your waiting period, which is
September 1, 2021. You will have until September 30, 2021 to enroll, with coverage effective as of September 1, 2021.
IF I ENROLL IN TIER 1 COVERAGE, HOW DO I MAINTAIN COVERAGE?

To maintain coverage, you must continue to have at least one hour of service with Maxim during each “look-back period.” Generally, we will
look back to the prior month. Specifically, every month, we will look back to the period that: (1) begins on the first day of the payroll period
that includes the first day of the prior calendar month, and (2) ends on the last Saturday of the prior calendar month (which may or may
not be the end of the calendar month) to see if you had an hour of service with Maxim.
So, for example, in April 2021, we will look back at March. The look-back period will begin on Sunday, February 28, 2021, because
this payroll period includes the first day of March. The look-back period will end on Saturday, March 27, 2021, because that is the
last Saturday in the month of March. If you continue to have at least one hour of service during that look-back period, you will be
eligible to continue medical benefits with Maxim.
In carrying the example forward, in October 2021, we will look back at September. The look-back period will begin on Sunday,
August 29, 2021, because this payroll period includes the first day of September. The look-back period will end on Saturday,
September 25, 2021, because that is the last Saturday in the month of September. If you continue to have at least one hour of
service during that look-back period, you will be eligible to continue medical benefits with Maxim.
HOW IS ELIGIBILITY FOR TIER 2 COVERAGE DETERMINED?
You are eligible for Tier 2 Coverage if you have at least 120 hours of service in a look-back period, subject to a waiting period. The waiting
period ends on the last day of the month that follows the look-back period. If elected, Tier 2 Coverage will be effective on the first day of
the next month.
So, for example, if you have been employed since 2015, but generally only working 100 or so hours per look-back month, you will
have been offered Tier 1 Coverage. Whether or not you elect Tier 1 Coverage, we will look at your hours during each look-back
period. In July, we will look at June’s hours using the look-back period from May 30, 2021 through June 26, 2021. If you have 120
hours during that look-back period, you will be offered Tier 2 Coverage. If you enroll, your Tier 2 Coverage will be effective as of
August 1, 2021.
Here is another example. Instead of working 120 hours in March, you continue to work only 100 or so hours per look-back month
into the summer. In September, we will look at August’s hours using the look-back period from August 1, 2021 through August 28,
2021. If you have 120 hours during that look-back period, you will be offered Tier 2 Coverage. If you enroll, your Tier 2 Coverage
will be effective as of October 1, 2021.
If you enrolled in Tier 1 Coverage (the Bronze Plan) and you do not make any elections when you are offered Tier 2 Coverage, we will keep you
enrolled in the Bronze Plan, and the premium for the Bronze Plan will be paid in part by Maxim as of the effective date of your Tier 2 Coverage.
In all other cases and for all other benefits and plans, you must make an affirmative election to enroll in and receive Tier 2 Coverage.
IF I ENROLL IN TIER 2 COVERAGE, HOW DO I MAINTAIN COVERAGE?

To maintain Tier 2 Coverage, you must continue to have at least 120 hours of service with Maxim during the look-back period.
WHEN TIER 1 COVERAGE TERMINATES

If you are enrolled in Tier 1 Coverage and you do not have at least one hour of service during a look-back period, your Tier 1 Coverage will
terminate on the last day of the month in which the look-back period ends. You will then be offered COBRA.
So, for example, in May we will look back at April hours. The look-back period for April will run from Sunday, March 28, 2021 to Saturday,
April 24, 2021. If you do not have at least one hour of service during that period, your coverage will terminate as of April 30, 2021.
WHEN TIER 2 COVERAGE TERMINATES

If you are enrolled in Tier 2 Coverage (medical, dental, and/or vision coverage, etc.) and you do not have at least 120 hours of service during
a look-back period, your Tier 2 Coverage will terminate on the last day of the calendar month that follows the look-back period. You will then
be offered COBRA.
So, for example, in May we will look back at April hours. The look-back period for April will run from Sunday, March 28, 2021 to Saturday,
April 24, 2021. If you do not have at least 120 hours of service during that period, your Tier 2 Coverage will terminate as of May 31, 2021.
If you had at least one hour of service during that look-back period, you will also be offered the opportunity to enroll in Tier 1 Coverage— that
is medical coverage under the Bronze Plan. If you had no hours of service during the look-back period, you will still be offered COBRA but will
not be offered Tier 1 Coverage under the Bronze Plan.
In either case, we will continue to monitor your hours monthly (per look-back period) to see if you re-qualify for either Tier 1 or Tier 2 Coverage.
*Note: On-Call hours are excluded from the eligibility review.
Leave of Absence (LOA)
BENEFITS DEPARTMENT LEAVE SPECIALIST: 1-866-492-0510 | LEAVEREQUESTS@MAXHEALTH.COM
If you are or will be out of work for more than 3 days due to your own serious medical condition or the serious medical condition of an
immediate family member, contact a Leave Specialist at leaverequests@maxhealth.com or 1-866-492-0510 to determine if you are eligible
to be placed on a leave of absence. For foreseeable leaves, you must provide us with 30 days advance notice. If the need for leave is not
foreseeable, you must notify us as soon as is practicable (typically within 3 days).
If you are placed on an approved leave of absence1, the eligibility calculation described on the prior page will be suspended until you return
from leave.
For additional information2 on Maxim’s Leave of Absence policies, contact a Leave Specialist.
1
We encourage you to provide as much notice of your leave as possible to prevent a disruption in your benefits. The benefit eligibility calculation will continue until your leave
is approved, which requires the submission and approval of appropriate paperwork.
2
Additional information and requirements will be provided to you with your LOA paperwork.
Payroll Deductions
All benefit premium deductions are taken weekly, with the exception of transportation benefits, which are deducted in one lump sum each
month. In the event that you miss a deduction, it will be automatically withheld from a future paycheck.
DEDUCTIONS IN ARREARS (DIA)

Deductions in Arrears (DIA) is an automated process that collects benefit plan premiums that were not withheld from a paycheck. This
occurs when an employee does not receive a paycheck for the week, does not have enough income to cover the cost of elected plans, or
has a retroactive qualifying event.
Under the DIA process, any missed premiums will be automatically placed into a make-up deduction “bucket” in the payroll system. When
a future paycheck is received, the make-up deduction will automatically pull from the paycheck on a pre-tax basis. This will be withheld in
addition to the regularly scheduled weekly benefit deduction. A maximum of $75 per week for medical, and a maximum of $50 a week per
plan for all other plans (i.e. dental, vision, life, etc.) will be deducted until the owed balance is paid in full.
PRE-TAX VS. POST-TAX: WHAT DOES IT MEAN FOR ME?

When you choose pre-tax benefits (such as medical, dental, and vision) you reduce your taxable income, thereby reducing the taxes you
owe. In exchange for allowing certain benefits to be deducted pre-tax, the IRS regulates when you can add, change, and cancel these
benefits. You can always make changes during the annual open enrollment period. You can also make certain changes if you experience a
Qualifying Status Change. Please see the ”Changing Your Benefits During the Year“ section of this guide for more information.
“Post-tax” means that the money you pay towards the cost of coverage (such as voluntary life insurance) comes out of your salary after
you pay taxes. Although you do not get any tax savings, you have the flexibility of dropping your coverage at any time. You may also enroll
any time during the year but you may have to provide Evidence of Insurability (EOI).
Note: Coverage for domestic partners (and their children if applicable) will be deducted pre-tax; however, if you fail to provide proof of
dependency, your income will be imputed.
Changing Your Benefits During the Year
In order to change or cancel a pre-tax benefit during the year, you must experience a qualifying status change. Except as otherwise
indicated below, you have 30 days from the date of the status change to contact us, complete a change form, and to provide proof of the
change, such as a birth or marriage certificate. Also, the requested changes must be consistent with your change in status. For example, if
you have a baby, you can change your medical plan coverage level and add dependent life insurance. Proof of relationship, such as a birth
or marriage certificate, will be required for dependents with a different last name from you.
QUALIFYING STATUS CHANGES AND EFFECTIVE DATES

Status Change Event What You May Change Effective Date
Add yourself, spouse, your domestic partner, child(ren),
Marriage Date of Event
children of domestic partners, and/or stepchild(ren)
Add yourself, spouse, your domestic partner, child(ren),
Birth, adoption or placement for adoption of a child(ren) Date of Event
children of domestic partners, and/or stepchild(ren)
Cancel coverage for your spouse/domestic partner if he/
Divorce/Legal Separation First of the month coinciding
she is enrolled in Maxim’s plan/Add coverage for yourself if
(only in states that recognize legal separation) with or following the event
enrolled in your spouse’s plan
You, spouse, domestic partner, or child(ren), or children Add yourself, spouse, domestic partner, and/or child(ren),
The day coverage ended
of domestic partners loses other group coverage1 children of domestic partners, who lost coverage
Cancel coverage for yourself, spouse, domestic
You, spouse, domestic partner or child(ren), or children First of the month coinciding
partner, child(ren), and/or children of domestic
of domestic partners gains other group coverage2 with or following the event
partners who gain coverage
You, spouse, domestic partner or child(ren) or children of Add yourself, spouse domestic partner, child(ren), and/or
Date of Event
domestic partners exhaust COBRA coverage3 children of domestic partners who were covered under COBRA
You, your spouse, domestic partner or child(ren), or Cancel coverage for yourself, spouse, domestic partner,
Date of Death
children of domestic partners die child(ren), children of domestic partners who die
First of the month coinciding
Change in dependent’s eligibility for benefits, such as age Cancel coverage for your dependent
with or following the event
1
Cancelling an individual health plan is not ordinarily considered a qualifying change and does not allow you to add coverage with Maxim.
2
Purchasing an individual health plan is not considered a qualifying change and does not allow you to cancel your coverage with Maxim.
3
COBRA period must be fully exhausted. Choosing to discontinue COBRA during your COBRA period does not allow you to add coverage with Maxim, except during the annual open enrollment period.
SPECIAL ENROLLMENT RIGHTS

Also note that you may be able to add coverage mid-year for yourself and/or your dependents (including your spouse/domestic partner) if
you decline enrollment for yourself or your dependents because of other health insurance or group health plan coverage, and if you or your
dependents subsequently lose eligibility for that other coverage (or if the employer stops contributing towards you, or your dependents’,
other coverage). However, you must request enrollment within 30 days after your, or your dependents’, other coverage ends (or after the
employer stops contributing toward the other coverage). In addition, 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. To request special enrollment or obtain more information, contact the
Benefit Service Center at 1-866-663-1107 or via e-mail at BenefitInquiries@maxhealth.com.
If you or your dependent become eligible for a state premium subsidy for Medicaid or through a state children’s health insurance program
with respect to coverage under this plan, you have 60 days from the date of such eligibility determination to enroll in the plan. If you or your
dependent decline to participate in the plan because you have Medicaid coverage or coverage under a state children’s health insurance
program and you later lose that coverage, you have 60 days from the date of such loss of coverage to enroll in the plan.
Additionally, you may be able to drop your medical coverage during the year if your position changes and you are no longer expected
to work at least 30 hours a week or you become eligible for an open enrollment or special enrollment on a government health insurance
exchange. You will be required to certify that you will be enrolling in other medical coverage. Please contact the Benefits Service Center
at 1-866-663-1107 for more information.
Beneficiaries
Many people overlook and underestimate the importance of designating a beneficiary. In many cases, people don’t designate a beneficiary
at all, and in other cases, the information is outdated. Taking the time to designate or update your beneficiaries today can eliminate many
challenges for your family in the event of your death.
WHAT IS A BENEFICIARY?
A beneficiary is a person or entity that you designate to receive the proceeds from your life insurance and/or 401(k) account. For each
account, you can name a single beneficiary or multiple beneficiaries. If you have multiple beneficiaries, you can also decide how the
proceeds will be split between them.
When naming beneficiaries, you should identify them as clearly as possible and include their social security numbers. This makes it easier
to find your beneficiary and also makes it less likely that disputes will arise.
You can also assign “primary” and “secondary” (also known as “contingent”) beneficiaries. A primary beneficiary receives the benefit if he or
she can be found after your death. A secondary beneficiary receives the benefit if the primary beneficiary predeceases you or cannot be found.
If neither your primary nor secondary beneficiaries can be found, or if you do not assign them, the benefit will be paid to your estate.
Probate proceedings are costly and will often delay distribution of the benefit; therefore, it’s best to specify how the benefits should be
handled if your beneficiaries have died or cannot be located.
Your choice of beneficiary may change as your life situation changes. Marriage, divorce, or the birth/adoption of a child are often events
that cause your beneficiary to change.
HOW TO DESIGNATE OR UPDATE YOUR BENEFICIARIES

Below is a list of the benefits that need a beneficiary as well as step-by-step instructions on how to check and update your beneficiaries.
VOLUNTARY LIFE INSURANCE

• Log on to www.MaximHealthcareBenefits.com.
• Click on the “My Benefits & Personal Information” tab at the top of the page.
• Under the “Benefits”. section on the left side of the page, click “Beneficiaries”.
401(K)
• Log on to www.wellsfargo.com.
• Click on “My Account”.
• Click on “My Profile”.
• Click on “Manage Beneficiary”.
Medical Benefits
CAREFIRST BLUECROSS BLUESHIELD: 1-877-691-5856 | WWW.BCBS.COM
Since everyone’s health care needs are different, we offer a variety of plans so you can customize your own coverage. By enrolling in a BlueCross
BlueShield Medical Plan, you can have medical and prescription coverage and access to BlueCross BlueShield’s national network of providers.
The various Medical Plans differ with copays, deductibles, coinsurance, and out-of-pocket limits. Review the Medical Plan Summary
Chart to compare the level of benefits to help you determine which plan best meets the needs of you and your dependents. To learn
more about how to personalize your medical coverage, contact a Benefits Customer Service Representative at 1-866-663-1107 or
BenefitInquiries@maxhealth.com. Representatives are available to assist you Monday through Friday, 8 a.m. to 6 p.m. (ET).
To locate a participating provider, visit www.MaximHealthcareBenefits.com for a direct link to the BlueCross BlueShield website, or go to
www.bcbs.com and select “Find a Doctor or Hospital”.
When you enroll in a Medical Plan you will also be enrolled in the prescription plan and Health Advocate at no extra cost!
Please note that only the High-Deductible Bronze Medical Plan is offered as a part of the Tier 1 benefits package.
Note: The Basic Medical Plan does not provide the minimum creditable coverage that adults who file taxes in Massachusetts need to have
in order to avoid penalties. Employees residing in Massachusetts who select the Basic Medical Plan may be subject to penalties.
Eligibility for the Standard Medical Plan is “frozen.” This means that Caregivers and Healthcare Professionals are not permitted to
enter the plan. Any Caregivers and Healthcare Professionals who have already elected the plan may continue participating in it at this
time. However, no new Caregivers and Healthcare Professionals will be allowed to enroll. In addition, if you are currently enrolled in the
Standard Medical Plan and cease to be enrolled for any reason, you will not be permitted to re-enroll.
WEEKLY PREMIUMS — MEDICAL/PRESCRIPTION PLAN

Basic Silver High Deductible Bronze Medical Plan Standard
Coverage Level
Medical Plan Medical Plan Tier 1 Tier 2 Medical Plan
Employee Only $34.13 $109.14 $139.59 $24.12 $169.43
Employee Plus Child $86.76 $253.15 $223.35 $223.35 $343.43
Employee Plus Spouse/Domestic Partner $99.83 $294.99 $251.26 $251.26 $383.08
Family $151.17 $453.51 $432.91 $432.91 $590.03
ID CARDS
Your medical ID cards will arrive at your home approximately 3 weeks after your enrollment is received at the insurance company.
If you need to see your provider prior to receiving your cards, you may print a Temporary Benefit Confirmation by logging on to
www.MaximHealthcareBenefits.com and selecting the “My Benefits & Personal Information” tab at the top of the Homepage. Click
Benefits, then select “Print Temporary Benefit Confirmation”. You will be able to retrieve your “Temporary Benefits Confirmation”
once your enrollment has been processed (typically within 1 week from the date you enrolled online).
BLUECROSS BLUESHIELD MEDICAL PLAN SUMMARY
Basic Silver
Benefit
In-Network In-Network Out-of-Network
Benefit Period Maximum
1 2
Unlimited Unlimited
Lifetime Maximum Unlimited Unlimited
$0 Individual $2,000 Individual $4,000 Individual
Benefit Period1 Deductible
$0 Family $4,000 Family $8,000 Family
Benefit Period1 Out-of-Pocket $0 Individual $5,500 Individual $9,000 Individual
Maximum3 $0 Family $10,000 Family $17,000 Family
Office Visits
$30 co-pay after deductible
PCP Visit Covered at 100% Covered at 50% after deductible
then plan pays 100%
Specialist Visit Covered at 100% Covered at 50% after deductible
then plan pays 100%
Maternity Services/Newborn Care
Maternity services and newborn Benefits are available to the same Benefits are available to the same
care except preventive prenatal Not Covered extent as benefits provided for other extent as benefits provided for other
services and birthing center illnesses illnesses
Benefits are available to the same
Covered at 100% of Covered at 100% of Allowed Benefit,
Preventive Prenatal Services extent as benefits provided for other
Allowed Benefit no deductible
illnesses
Lactation support and Benefits are available to the same
Covered at 100% of Covered at 100% of Allowed Benefit,
counseling; Breastfeeding extent as benefits provided for other
Allowed Benefit no deductible
supplies and equipment illnesses
Preventive Care5
Well Child Care (through age 17)
Immunizations (through age 17) Covered at 100%, Covered at 100%, Covered at 50% of Allowed Benefit
Annual Physicals no deductible no deductible after deductible
Routine GYN Exam
Mammography
Hospitalization Covered at 70% Covered at 50% of Allowed Benefit
Not covered
(Inpatient4 & Outpatient) after deductible after deductible
X-ray & diagnostic imaging: not cov-
Covered at 70% Covered at 50% of Allowed Benefit
X-Ray & Lab ered; Outpatient lab work: covered
after deductible after deductible
at 100%
Mental Health and Substance $30 co-pay after deductible Covered at 50% of Allowed Benefit
Not covered
Abuse (Office Visit) then plan pays 100% after deductible
Mental Health and Substance Covered at 70% Covered at 50% of Allowed Benefit
Not covered
Abuse (Inpatient4 & Outpatient) after deductible after deductible
Emergency Room Services/ Covered at 70% Covered at 70% of Allowed Benefit

Not covered
Emergency Medical Transportation after deductible after deductible
$50 copay after deductible, Covered at 50% of Allowed Benefit
Urgent Care Covered at 100%
then plan pays 100% after deductible
AB= Allowed Benefit

1
Benefit Period is 01/01/2021 through 12/31/2021
2
Per covered member for all medical services.
3
Includes deductible, coinsurance, and copayments.
4
Pre-authorization is required for these services.
5
As defined under the Affordable Care Act.
For a full description of covered services and exclusions, please see the detailed plan description provided on www.MaximHealthcareBenefits.com.
High Deductible Bronze Standard
Benefit
In-Network Out-of-Network In-Network
1 2
Unlimited Unlimited
Lifetime Maximum Unlimited Unlimited
$6,450 Individual $12,900 Individual $500 Individual
Benefit Period1 Deductible
$12,900 Family $25,800 Family $1,500 Family
Benefit Period1 Out-of-Pocket $6,550 Individual $13,100 Individual $5,500 Individual
Maximum3 $13,100 Family $26,200 Family $12,700 Family
Office Visits
PCP Visit $20 co-pay after deductible $30 co-pay, then plan pays 100%
Covered at 50% after deductible
Specialist Visit $40 co-pay after deductible $50 co-pay, then plan pays 100%
Maternity Services/Newborn Care

Maternity services and newborn Benefits are available to the same Benefits are available to the same Benefits are available to the same
care except preventive prenatal extent as benefits provided for extent as benefits provided for extent as benefits provided for
services and birthing center other illnesses other illnesses other illnesses
Benefits are available to the same
Covered at 100% of Allowed Benefit, Covered at 100% of Allowed Benefit,
Preventive Prenatal Services extent as benefits provided for
no deductible no deductible
other illnesses
Lactation support and Benefits are available to the same
Covered at 100% of Allowed Benefit, Covered at 100% of Allowed Benefit,
counseling; Breastfeeding extent as benefits provided for
no deductible no deductible
supplies and equipment other illnesses
Preventive Care5
Well Child Care (through age 17)
Immunizations (through age 17) Covered at 100%, Covered at 50% of Allowed Benefit Covered at 100%,
Annual Physicals no deductible after deductible no deductible
Routine GYN Exam
Mammography
Hospitalization Covered at 60% Covered at 50% of Allowed Benefit Covered at 80%
(Inpatient4 & Outpatient) after deductible after deductible after deductible
Covered at 60% Covered at 50% Covered at 80%

X-Ray & Lab
after deductible after deductible after deductible
Mental Health and Substance Covered at 50% of Allowed Benefit $30 co-pay,
Abuse (Office Visit) after deductible then plan pays 100%
Inpatient: Covered at 60%
Mental Health and Substance after deductible Covered at 50% of Allowed Benefit Covered at 80% of Allowed Benefit
Abuse (Inpatient4 & Outpatient) Outpatient: $20 co-pay after deductible after deductible
after deductible
Emergency Room Services/ Covered at 60% Covered at 60% Covered at 80%
Emergency Medical Transportation after deductible after deductible after deductible
Covered at 50%
Urgent Care $40 co-pay after deductible $50 co-pay after deductible
after deductible
AB= Allowed Benefit

1
Benefit Period is 01/01/2021 through 12/31/2021
2
Per covered member for all medical services.
3
Includes deductible, coinsurance, and copayments.
4
Pre-authorization is required for these services.
5
As defined under the Affordable Care Act.
Prescription Drug Benefits
CVS/CAREMARK: 1-800-241-3371 | WWW.CAREFIRST.COM
The following prescription drug benefits are included with all three BlueCross BlueShield Medical Plans. The plan administrator, CVS/caremark, has
a wide network of participating pharmacies throughout the country. For participating pharmacies, call 1-800-241-3371 or visit www.carefirst.com
for a direct link to the CVS/caremark website.
PRESCRIPTION BENEFITS SUMMARY

High Deductible Bronze
Coverage Level Basic Plan Silver Plan Standard Plan
Plan
Combined Medical/Prescription Combined Medical/Prescription
In-Network Deductible: In-Network Deductible:
$2,000 Individual $6,450 Individual
Deductible $0 $4,000 Family $12,900 Family $250
Out-of-Network Deductible: Out-of-Network Deductible:
$4,000 Individual $12,900 Individual
$8,000 Family $25,800 Family
Generic Co-pay $0 $10 $20 $10
Preferred Brand $0 $35 $40 $35

100% of the Average
Non-Preferred Brand $50 $70 $50
Wholesale Price of drug
Preferred Specialty Not Covered $150 $150 $150
Non-Preferred Specialty Not Covered $150 $150 $150

MANDATORY GENERIC REQUIREMENT

Your prescription benefit includes a mandatory generic drug requirement, which allows for substitution of brand-name drugs with generic drugs as
a way to help you manage the costs associated with prescription drugs.
WHAT YOU NEED TO KNOW ABOUT GENERIC DRUGS

Making informed choices about utilizing generic drugs, when available, can help save you money. Generic drugs are equally safe and effective as
brand-name drugs, but cost significantly less. The U.S. Food and Drug Administration defines a generic drug to be identical to a brand-name drug
in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.
WHAT YOU NEED TO KNOW ABOUT MANDATORY GENERIC DRUG SUBSTITUTION

If you receive a prescription for a brand-name drug, it will be substituted with a generic equivalent. If no generic equivalent exists, the brand-name
drug will be dispensed. In both cases, you are only responsible for the applicable copayment or coinsurance.
You or your physician may request a brand-name drug when a generic equivalent is available, but you will have to pay the applicable copayment or
coinsurance, plus the price difference between the brand-name drug and the generic drug, unless your physician proves medical necessity for the
brand-name drug.
If your physician writes “brand only” or “dispense as written” on a prescription, it does not qualify as medical necessity. In this case, the pharmacist
will be required to dispense the brand-name drug and you will still have to pay the cost differential when a generic equivalent is available.
We encourage you to talk to your provider to consider changing your prescription from a brand-name drug to a generic option.
If your provider indicates that there is a medical necessity for you to remain on the brand-name drug rather than an available generic, your provider
may submit a brand exception request. If the brand exception request is approved, you are only responsible for the applicable copayment or
coinsurance for the brand-name drug. To obtain the brand exception request form, log in to My Account at www.carefirst.com/myaccount and
click on Drug & Pharmacy Resources under Quick Links and then click on My Drug Forms or call CareFirst Pharmacy Services at 1-800-241-3371.
Please note that Preferred and Non-Preferred Specialty prescriptions are not covered under the Basic Medical Plan.
FILLING PRESCRIPTIONS
Maxim has a partnership with CVS/caremark and through that partnership is able to negotiate better rates on maintenance drugs for our
employees. This will require you to fill prescriptions for certain medications at a CVS pharmacy or by mail order, as explained below.
THROUGH A PARTICIPATING RETAIL PHARMACY

For non-maintenance drugs, you can choose to have your prescriptions filled at any in-network pharmacy. A non-maintenance drug is
a drug you do not take on a regular, ongoing basis (such as antibiotics). CVS/caremark, has a wide network of participating pharmacies
throughout the country. To locate participating pharmacies including CVS and other in-network pharmacies (such as Rite Aid or Walgreens),
visit MaximHealthcareBenefits.com for a direct link to the CVS/caremark website through CareFirst.com, or call 1-800-241-3371. If you fill
prescriptions of maintenance drugs at a pharmacy other than CVS (such as Rite Aid or Walgreens), our plan will not cover the cost, meaning
the prescription cost will not be at the discounted CVS price nor will the amount you pay count toward your deductible.
THROUGH MAIL ORDER

Non-Maintenance Medications – You can choose to have your non-maintenance prescriptions filled through the CVS mail order program.
Maintenance Medications – A maintenance medication is a medication that is prescribed for long-term conditions and are taken on a
regular, recurring basis. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma, and diabetes.
You must either fill your prescription for maintenance medications through a local retail CVS pharmacy or through the CVS mail order
program. If you fill prescriptions of maintenance drugs at a pharmacy other than CVS (such as Rite Aid or Walgreens), our plan will not
cover the cost, meaning the prescription cost will not be at the discounted CVS price nor will the amount you pay count toward your
deductible.
MEMBERS CAN SIGN UP FOR MAIL ORDER BY:

• Doctor Call-In: You can tell your doctor to either call CVS/caremark’s mail order program or e-fax them the prescription. If you need the medication
quickly, the doctor call-in is the fastest method. You should give your doctor this phone number: 1-800-378-5697 (then press Option 3).
• You should give your doctor this e-fax number: 1-800-378-0323
• By Phone: Call CVS Customer Care (this is also the toll-free number for Pharmacy on the back of your CareFirst member ID card)
1-800-241-3371. A CVS/caremark representative will walk you through the full process to set up your mail order prescriptions. Once you
provide the representative with the necessary information, CVS/caremark can contact your doctor directly regarding your prescription(s).
• Mail: If you already have a paper prescription from the doctor, you can mail it to CVS/caremark along with a completed Mail Service Order
Form. You can access Mail Order forms through My Account, under My Coverage, Drug and Pharmacy Resources, My Drug Home, Order
Prescriptions, then Forms for Print.
• Online: You can open an online account by going to www.CareFirst.com. Click on Register Now to create your account. Once registered,
go to My Coverage, Drug and Pharmacy Resources, My Drug Home. You will then be able to submit the new prescription online. You will
need the exact name of the medication, as well as your doctor’s name. CVS will then contact your doctor for you to fill the prescription
through mail order. If CVS is unable to reach your doctor after four attempts, they will reach out to you. To see all the steps for opening
an account online, please see the question below.
HOW DO I OPEN UP AN ONLINE ACCOUNT AND WHAT CAN I DO WITH IT?

To access and manage your prescription drugs:
• Go to www.carefirst.com and log in to “My Account”
• Click on My Coverage, Drug and Pharmacy Resources, My Drug Home. Once you open the online account, you will be able to view your
prescription information and manage your prescriptions through the mail order program.
• Once you have accessed your online account, the website will provide instructions regarding the various tools you have available to
manage your prescriptions.
How To Reduce Medication Costs
• Request generic prescriptions whenever available.
• Go to www.carefirst.com/myaccount. In the prescription drug section of this helpful website, you can look up medicines using the online
database. You can also use the price comparison tool to learn more about the costs associated with the medicines you may be taking.
• Talk with your doctor. Review the medicines you are taking with your physician and ask if there are more affordable alternatives
that may be right for you.
• Use a participating pharmacy. There are more than 59,000 participating pharmacies nationwide that accept your prescription drug
plan. Choose one that is convenient, but remember to shop around. Some pharmacies charge more than others.
• Be on the lookout for alternatives. New medicines become available often, so the price of your prescription may rise or fall as a result.
CVS/CAREMARK EXTRACARE HEALTH PROGRAM

SAVE 20% ON CVS-BRAND OVER THE COUNTER (OTC) PRODUCTS WITH CAREFIRST RX COVERAGE
In addition to the many benefits you will receive with a CareFirst pharmacy plan, you will also receive a digital savings card through the
CVS/Caremark* ExtraCare Health Program. This card provides great savings on the health-related items you and your family use most—
from cough and cold remedies to pain and allergy relief products. You will save 20% on regularly priced CVS-brand OTC health-related
products at any CVS retail store or online at www.cvs.com.**
With the ExtraCare Health digital savings card, you can:
• Benefit from a discount program—it’s easy to connect your digital ExtraCare Health card to your ExtraCare account.
• Stock up on cough and cold remedies, allergy medicines, pain relief, first aid, vitamins and many more health-related CVS brand products.
These items already priced 20-40 percent below national brands also contain the same high quality active ingredients.
Look for more information from CVS Caremark in your mail explaining more about the program and how you can start saving!
If you have any questions about the ExtraCare Health Program call CVS Caremark at 1-888-543-5938 and let them know you are a CareFirst
member.
* CVS/caremark is an independent company that provides pharmacy benefit management services.
** This free program offers plan members a 20 percent discount on health-related items valued at $1 or more. Exclusions include prescriptions, non-health related items and all sale items.
CAREFIRST 24-HOUR NURSE ADVICE LINE

FREE WHEN ENROLLED IN A CAREFIRST MEDICAL/PRESCRIPTION PLAN
When you have questions about your health, you may not be sure where to go. Instead of waiting and worrying, call the Nurse Advice Line
staffed by experienced nurses 24 hours a day, 7 days a week, 365 days a year.
The nurse will ask a few questions and give you information to help you decide what to do next. The Nurse Advice Line can help you:
• Decide when to visit your doctor or go to an Urgent Care or ER
• Understand your medications
• Find network doctors and prepare for an appointment
• Learn about preventive care
The nurse advice line provides support and guidance for any non-emergency situation. The service is personal, confidential, and available
at no cost.
Call 1-800-535-9700 anytime, day or night.
Hospital Bridge Insurance Plan
SYMETRA: 1-800-497-3699
Offered through Symetra, the Hospital Bridge Insurance Plan is designed to supplement the Basic Medical Plan, but can also be purchased
on a stand-alone basis or as a supplement to another medical plan. The Hospital Bridge Insurance Plan pays a fixed daily cash benefit
directly to you to help you offset the cost of medical services such as hospitalization, major diagnostic testing, emergency room visits,
outpatient surgical facility, mental healthcare room, and more, up to the annual maximum.
When you are admitted to the hospital, you may “assign” your benefits to the hospital or you may choose not to. This is your choice
regardless of any major medical or other coverage you may have, but if you do not have major medical coverage the hospital may require
you to assign your benefits as a condition of admittance. If you assign benefits, the hospital should file the claim and payment will be made
by Symetra directly to the hospital up to the amount the hospital shows due or up to the limit of the plan. Excess benefits, if any, will be
paid directly to you. If you do not assign your benefits, you will need to file the claim with Symetra yourself and benefits will be paid directly
to you. Paid benefits are not taxed.
Coverage is guaranteed issue, which means you cannot be denied coverage, regardless of current or prior personal or family health history,
and there are no pre-existing limitations.
You may choose from three plan options:
• Traditional: $25,000 maximum benefit per covered person per year
• Enhanced: $35,000 maximum benefit per covered person per year
• Premium: $45,000 maximum benefit per covered person per year
WEEKLY PREMIUMS – HOSPITAL BRIDGE INSURANCE PLAN
Coverage Level Traditional Enhanced Premium
Employee Only $27.70 $33.51 $41.35

Employee Plus Child $53.61 $65.04 $80.46
Employee Plus Spouse/Domestic Partner $53.61 $65.04 $80.46
Family $76.87 $93.35 $115.58
Due to state regulations, this plan is not available to employees who live in New Hampshire.
ID CARDS
Your Hospital Bridge Insurance Plan ID cards will arrive at your home approximately 3 weeks after your enrollment is received at Symetra.
HOW DO THE BASIC MEDICAL PLAN AND THE HOSPITAL BRIDGE INSURANCE PLAN WORK TOGETHER?
The Basic Medical Plan features low premiums and no deductible while providing you 100% coverage for unlimited sick and well visits
to doctors and covers generic and preferred brand name prescription drugs. However, the Basic Medical Plan does not cover surgery,
hospitalization, emergency room services, x-ray/diagnostic imaging or non-preferred brand name or specialty prescription drugs. Combining
the Basic Medical with a Hospital Bridge Plan allows you to expand your coverage and build a personalized program that suits your needs
and is budget friendly. Any one of the Hospital Bridge Plans can supplement the Basic Medical Plan or any other coverage you may have.
You can choose to further expand your coverage by choosing Critical Illness and/or Accident Insurance Plans.
BASIC MEDICAL PLAN + HOSPITAL BRIDGE INSURANCE PLAN = COMPREHENSIVE COVERAGE
In-Network Services Basic Medical Plan
Benefit Period Maximum, Lifetime Maximum Unlimited
Deductible, Out-of-Pocket Maximum, Coinsurance N/A
Office Visits Covered at 100% in-network
Preventive Care (annual physical, well-child care, routine GYN exam) Covered at 100% in-network
X-Ray & Diagnostic Imaging: Not Covered

X-Ray & Lab
Outpatient lab work (e.g., blood work with annual physical): Covered at 100%
Generic & preferred brand drugs: Covered at 100% in-network
Prescription Drugs
Non-preferred brand and specialty drugs: Not Covered
Hospitalization, Emergency Room Services Not covered
Hospital Bridge Insurance Plan | Three Options:

Benefit Period Maximum Traditional Enhanced Premium
$25,000/Covered Person/Year $35,000/Covered Person/Year $45,000/Covered Person/Year
Regular Hospital Room $1,200 per day $1,200 per day $1,500 per day
Intensive Care Unit Hospital Room $2,400 per day $2,400 per day $3,000 per day
Substance Abuse Room $1,200 per day $1,200 per day $1,500 per day
Mental Health Care Room $600 per day $600 per day $750 per day
Post-Hospital Nursing Facility $600 per day $600 per day $750 per day
Major Diagnostic Test $300 per day $400 per day $500 per day
Routine Diagnostic Test $30 per day $40 per day $50 per day
Emergency Room $150 per day $200 per day $200 per day
Outpatient Surgical Facility $300 per day $400 per day $500 per day
Hospital Expense Protection Plan (HEPP)
SYMETRA: 1-800-497-3699 | WWW.SYMETRA.COM
The Hospital Expense Protection Plan offers you the opportunity to buy additional inpatient hospitalization benefits for sickness, accident,
maternity care, substance abuse, and mental health care. It also provides benefits if you need nursing facility care following a hospital stay.
If you are hospitalized as an inpatient, the plan will pay a fixed dollar amount per day (at least 24 hours in a hospital) of confinement up to a maximum
number of days per calendar year. Benefits become payable on the first day of covered confinement (except for nursing facility). There are no pre-
existing condition limitations and you do not have to meet a deductible or pay a co-pay. Please see the chart on the following page for more details.
The HEPP does not issue restrictions on hospitals, meaning there is no requirement to use participating providers.
This plan can be purchased as a stand-alone plan or in addition to any of the Medical Plans. For claim filing instructions please visit
www.MaximHealthcareBenefits.com.
WEEKLY PREMIUMS - HOSPITAL EXPENSE PROTECTION PLAN

Coverage Level Option 1 Option 2
Employee Only $5.58 $8.99
Employee Plus Child $10.97 $17.69
Employee Plus Spouse/Domestic Partner $10.97 $17.69
Family $15.82 $25.50
ID CARDS
Your HEPP ID cards will arrive at your home approximately 3 weeks after your enrollment is received at Symetra.
HOSPITAL EXPENSE PROTECTION PLAN SUMMARY CHART

Benefit Option 1 Option 2
Deductible None None
Copay None None
Lifetime Maximum 500 days lifetime maximum for each benefit per person 500 days lifetime maximum for each benefit per person
(except for Mental Illness) (except for Mental Illness)
Inpatient Hospital Benefits outlined are payable when hospitalized Benefits outlined are payable when hospitalized
Benefit¹ for any covered illness or injury for any covered illness or injury
Daily Hospital Stays $500 per daily hospital stay $750 per daily hospital stay
(Includes Maternity Care) ²,³ (15 days maximum per calendar year) (15 days maximum per calendar year)
$1,000 per day, per person for stays in the $1,500 per day, per person for stays in the
Intensive Care Unit²
Intensive Care Unit (15 days maximum per calendar year) Intensive Care Unit (15 days maximum per calendar year)
$500 per day, per person for stays in a substance abuse $750 per day, per person for stays in a substance abuse
Substance Abuse²
facility (15 days maximum per calendar year) facility (15 days maximum per calendar year)
$250 per day, per person for stays in a mental health $375 per day, per person for stays in a mental health
Mental Health Facility²
facility (15 days maximum per calendar year; 180 days per lifetime) facility (15 days maximum per calendar year; 180 days per lifetime)
$250 per day, per person for stays in a nursing facility (only $375 per day, per person for stays in a nursing facility (only
Nursing Facility if following a covered hospital stay of at least 3 consecutive days and the if following a covered hospital stay of at least 3 consecutive days and the
person is less than age 65) (maximum 60 consecutive days per stay) person is less than age 65) (maximum 60 consecutive days per stay)
Emergency Room $50 per day $50 per day
Ambulance Ground Transport : $250 per day Ground Transport : $250 per day
Transportation Air Transport: $500 per day Air Transport: $500 per day
5 days combined calendar year maximum per person 5 days combined calendar year maximum per person
1
Coverage for inpatient hospital stays is provided and benefits are paid at a pre-selected fixed dollar amount per day of confinement up to a maximum number of days per calendar year.
2
Benefits become payable on the first day of coverage confinement.
3
Benefits will also be provided when a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital. Symetra will pay up to 4 days for the additional
hospitalization for the newborn.
The Inpatient Hospital Benefit is not a replacement for a major medical policy or other comprehensive policy. It is designed to cover benefits used on a routine basis at a preselected, fixed dollar amount. Coverage may be subject
to exclusions, limitations, reductions, and termination of benefit provisions. Exclusions, limitations, definitions, and benefits may vary by state. Please see the policy for details. Select Benefits is insured by Symetra Life Insurance
Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA, 98004. Symetra® is a registered service mark of Symetra Life Insurance Company.
Supplemental Critical Illness Insurance Plan
SYMETRA: 1-800-497-3699 | WWW.SYMETRA.COM
Critical Illness Protection, offered by Symetra, provides a lump sum payment upon the first diagnosis of a covered condition once coverage
takes effect for the individual. Covered conditions include cancer, heart attack and other critical illnesses due to disease. Covered critical
illness conditions are grouped into benefit categories. The benefit is payable once for a specific covered critical illness, up to 100% of the
benefit amount payable for each category of covered critical illness.
• Category 1: Invasive Cancer: 100%. Minor Cancer: 25%
• Category 2: Heart Attack and Stroke: 100%. Coronary Artery Disease needing surgery or angioplasty: 25%
• Category 3*: Coma due to accident, Occupational HIV infection, Loss of Sight, Loss of Speech, Loss of Hearing, Major Organ Failure, End-
Stage Renal Failure, Paralysis due to accident, Sever Burns: 100%
• Category 4: Multiple Sclerosis, Parkinson’s disease, advanced Alzheimer’s, ALS and similar motor neuron diseases.
You may elect $10,000 (Option 1) or $20,000 (Option 2) worth of coverage for yourself and your spouse/domestic partner, and the benefit
is always 100% of the lump sum benefit you enrolled for. Benefits for children are 25% of the adult benefit.
Critical Illness insurance is intended to supplement a comprehensive medical plan. It provides a lump sum cash benefit for expenses not
covered by a traditional medical plan.
The benefits of critical illness insurance include:
• Helps you have money for deductibles, co-pays, lost income, experimental treatment, etc.
• Benefits are paid directly to you in addition to the major medical insurance you may already have in place.
• With this policy, each category condition is independent. So, if you have a heart attack while covered and a year later you are diagnosed
with invasive cancer, then you may get paid the full benefit amount twice. Pre-existing conditions and other policy limitations apply.
• Paid benefits are not taxed.
*Category 3 benefits are limited for residents of Washington state and New Hampshire due to state regulations. Refer to the policy for more information.
WEEKLY PREMIUMS – SUPPLEMENTAL CRITICAL ILLNESS INSURANCE
Coverage Level Option 1 - $10,000 Option 2 - $20,000
Family $9.50 $18.99
Critical Illness Insurance can be purchased as a stand-alone plan or in addition to the Medical Plan, the Accident Insurance Plan, or the
Hospital Expense Protection Plan.
ID CARDS
Symetra does not issue ID cards for the Critical Illness Insurance Plan, however you will receive a policy certificate.
Supplemental Accident Insurance Plan
SYMETRA: 1-800-497-3699
Offered through Symetra, the Accident Insurance Plan covers any type of accidental injury not incurred at work (up to three accidents per
calendar year per covered person) and pays your actual billed expenses up to the maximum benefit for the option you purchased. As with
the other supplementary plans available, this plan can help you meet your deductible or pay other expenses that are not covered by a
comprehensive plan. Paid benefits are not taxed.
You can choose from two options:
• Option 1: Coverage of up to $5,000 per accident, or
• Option 2: Coverage of up to $10,000 per accident
Here are two examples of how benefits would be paid if Option 1 – Up to $5,000 was elected.
Example 1: Example 2:
Ambulance service $500 Urgent Care $310
Emergency room $1,525 Lab tests $235
Diagnostic testing (MRI) $750 X-rays $280
Physician fees $300 Physician fees $120
Physical therapy $500 Chiropractic services $390
Total expenses $3,575 Prescriptions (inpatient) $75
Benefits paid to insured = $3,575 Total expenses $1,410
Benefits paid to insured = $1,410
Coverage Level Option 1 – Up to $5,000 Option 2 – Up to $10,000

Up to $5,000 per occurrence, 3 occurrences per Up to $10,000 per occurrence, 3 occurrences
Group Accident Benefit
person, per calendar year maximum per person, per calendar year maximum
$300 per day, $600 per person, per calendar year $300 per day, $600 per person, per
Emergency Room Benefit
maximum calendar year maximum
Ground Transport: $500 per day;
Ground Transport: $500 per day;
Air Transport: $250 per day; 5 days
Ambulance Transportation Benefit Air Transport: $250 per day; 5 days combined
combined calendar year maximum per
calendar year maximum per person
person
WEEKLY PREMIUMS – SUPPLEMENTAL ACCIDENT INSURANCE

Coverage Level Option 1 – Up to $5,000 Option 2 – Up to $10,000
Employee $7.13 $8.51
Family $21.16 $25.26
Accident Insurance can be purchased as a stand-alone plan or in addition to the Medical Plan, the Critical Illness Insurance Plan, or the
Hospital Expense Protection Plan.
Due to state regulations, this plan is not available to employees who live in New Hampshire.
ID CARDS
Symetra does not issue ID cards for the Accident Insurance Plan, however you will receive a policy certificate.
Employee Assistance Program (EAP)
HEALTH ADVOCATE: 1-866-799-2728 | WWW.HEALTHADVOCATE.COM/MAXIMHEALTHCAREEXT
Maxim is pleased to offer the Employee Assistance Program (EAP) to all Caregivers and Healthcare Professionals working at least one hour
per calendar month. You will be automatically enrolled into this benefit at no cost to you. This benefit will be paid for by Maxim! The EAP
and Work/Life program, offered by Health Advocate is designed to help you lead a happier and more productive life at home and at work.
Balancing the needs of work, family, and personal responsibilities isn’t always easy. This program offers the right support at the right time.
All of us have experienced some type of personal problem, concern or emotional crisis at one time or another. Balancing the needs of work,
family, and personal responsibilities isn’t always easy. This program offers the right support at the right time.
The EAP and Licensed Professional Counselors will help define the problem clearly, assess the type of help needed, and either provide the
required help or make the most appropriate, cost-effective referral for you.
• Stress, depression, anxiety • Eldercare, childcare
• Family, parenting issues • Marital relationships
• Work conflicts • Legal, financial issues
• Anger, grief and loss • Time management
• Drug and alcohol abuse • Parenting and adoption
Call 1-866-799-2728 and talk to a counselor or visit www.HealthAdvocate.com/maximhealthcareext to access the EAP and Work/Life
services. The program is available 24/7.
For added support, log on to the EAP and Work/Life member website for information and to sign up for monthly webinars. You will also
receive newsletters covering a wide range of popular topics.
Health Advocacy Services

HEALTH ADVOCATE: 1-866-799-2728 | WWW.HEALTHADVOCATE.COM/MAXIMHEALTHCAREEXT
Health Advocate, the nation’s leading health advocacy company, provides confidential, personalized, one-on-one assistance to you and
eligible family members to help navigate many aspects of the healthcare world. You will have access to a Personal Health Advocate,
typically a registered nurse, supported by a team of physicians and administrative experts, who will help in handling healthcare and
insurance related issues. Eligible family members who can use Health Advocate include you, your spouse/domestic partner, your children,
your parents, and your spouse’s parents.
EXAMPLES OF HOW HEALTH ADVOCATE CAN ASSIST YOU:

• Finding the best doctors, hospitals, dentists, and other leading health care providers nationwide.
• Scheduling appointments with providers, including hard-to-reach specialists, and arranging for specialized treatments and tests.
• Resolving insurance claim questions, negotiating billing and payment arrangements, and other related administrative issues.
• Assisting with elder care issues.
• Assisting in the transfer of medical records, X-rays, and lab results.
• Locating and researching all current treatments for a medical condition.
• Answering questions and providing information and resources about medical terms, tests, medications, and treatments.
• Locating and making arrangements for members with special service’s needs (i.e. habilitation, private duty nursing, home-care equipment
following discharge from a hospital, etc.).
Employees who participate in our Medical Plan are eligible to use Health Advocate. To utilize the services offered by Health Advocate,
simply call 1-866-799-2728 or send an email to answers@HealthAdvocate.com. When you request service, you will be asked to complete
a Medical Information Release Form. Please be assured Health Advocate will keep all information strictly confidential and will protect your
privacy. For more information about the company and services, visit www.HealthAdvocate.com/maximhealthcareext.
Dental Benefits
METLIFE: 1-800-438-6388 | WWW.METLIFE.COM/MYBENEFITS* OR WWW.METLIFE.COM/DENTAL
Dental benefits are offered through MetLife. To locate a participating provider, visit www.metlife.com/dental and click on “PDP Plus Network”.
You can also call MetLife at 1-800-438-6388. When you make an appointment, indicate you are a MetLife member. The provider will obtain the
necessary approvals. If you use non-participating providers, you must pay for services and then submit a claim to MetLife for reimbursement.
WEEKLY PREMIUMS – DENTAL COVERAGE
Dental Coverage Level Silver Plan Gold Plan

Family $21.23 $22.50
METLIFE BENEFITS SUMMARY

Silver Plan Gold Plan
Benefit
In-Network Out-of-Network In-Network Out-of-Network
Benefit Period Deductible
1
$75.00 per member for basic & major services $50.00 per member for basic & major services
1
$1,000 per person $1,500 per person
Preventive Services: Oral Exams, Plan pays 100% of Plan pays 100% of Plan pays 100% of Plan pays 100% of
Cleanings, Sealants, Space Maintainers PDP Fee2 PDP Fee2 PDP Fee2 R&C Fee3
Basic Restorative4: X-rays, Fillings, Plan pays 80% of PDP Fee2 Plan pays 60% of PDP Fee2 Plan pays 80% of PDP Fee2 Plan pays 80% of R&C Fee3
Simple Tooth Extractions after deductible is met after deductible is met after deductible is met after deductible is met
Major Restorative4: Inlays, Onlays, Crowns,
Root Canal Treatment, Periodontal (gum Plan pays 50% of PDP Fee2 Plan pays 40% of PDP Fee2 Plan pays 50% of PDP Fee2 Plan pays 50% of R&C Fee3
work), General Anesthesia for covered after deductible is met after deductible is met after deductible is met after deductible is met
surgical procedures, Dentures
Orthodontia: (dependent children only/covered
Plan pays 50% of PDP Fee2 Plan pays 50% of R&C Fee3
until the end of the month of their 18th birthday) Not Covered
after deductible is met after deductible is met
$1,500 lifetime maximum per person
Benefit Period is 1/1/2021 through 12/31/2021. 2PDP Fee refers to the fees that participating dentists have agreed to accept as payment in full. 3Reasonable & Customary (R&C) charges are based on the research of dentist’s usual, actual and
1
community charge as determined by MetLife. 4For residents of Texas and Mississippi, the Silver Plan out-of-network benefits will be 100/80/50 and reimbursed at the PDP fee schedule.
ID CARDS
MetLife does not issue ID cards. You may print a Temporary Benefit Confirmation if you would like to have your dental information on hand when
you visit your provider. To print your Temporary Benefit Confirmation, log on to www.MaximHealthcareBenefits.com and select the “My Benefits
& Personal Information” tab at the top of the Homepage. Click Benefits, then select “Print Temporary Benefit Confirmation”. Select the benefits you
would like to print a temporary confirmation for and select “Retrieve Temporary Benefits Confirmation”.
*When you sign in to MyBenefits, you should enter “Maxim Healthcare Group” in the box where it says “Enter your company name”.
Vision Benefits
VISION SERVICE PLAN (VSP): 1-800-877-7195 | WWW.VSP.COM
Vision care benefits are provided through Vision Service Plan, or VSP. To find a VSP provider, visit www.vsp.com, click on “Members and
Consumers” and “Find a VSP Network Doctor.” You can also call VSP at 1-800-877-7195.
When you make an appointment, indicate you are a VSP member. The provider will obtain the necessary approvals. If you use non-
participating providers, you must pay for services and then submit a claim to VSP for reimbursement.
WEEKLY PREMIUMS – VISION COVERAGE
Vision Coverage Level Vision Plan
Employee Only $1.63

Employee Plus Child $3.25
Employee Plus Spouse/Domestic Partner $3.02
Family $4.18
VSP BENEFITS SUMMARY
Benefit Frequency1 In-Network Out-of-Network
Eye Exam Once every 12 months $15 copay, then plan pays 100% Plan pays up to $52
Contact Lens Exam $60 copay (maximum), then plan

Once every 24 months Plan pays up to $105
(Fitting & Evaluation) pays 100%
Plan pays 100% for selected frames
Frames Once every 24 months Plan pays up to $70
up to $120
Lenses Plan pays up to:
Single Vision Combined $15 co-pay for lenses and $55
Once every 24 months
Bifocal (lined) frames, then plan pays 100% $75
Trifocal (lined) $100
INTERIM BENEFITS for lenses (including contact lenses) and frames – If your lens prescription changes before you are eligible for new lenses and those
prescriptions meet at least one of the following criteria, lenses & frames will be replaced at a 12 month frequency; a) a new prescription differs from the
original by at least a .50 diopter sphere or cylinder; b) an axis change of 15 degrees or more; c) a .5 prism diopter change in at least one eye.
Visually necessary contact lenses Once every 24 months $15 copay, then covered at 100% Plan pays up to $210
Elective contact lenses Once every 24 months Plan pays up to $120 Plan pays up to $105
1 Frequency is based on your last date of service with ANY VSP plan. VSP will not cover eye exams more than once in a 12-month period, or contact lenses and eye glasses/frames in the same 24-month period.
ID CARDS
VSP does not issue ID cards. You may print a Temporary Benefit Confirmation if you would like to have your vision information on hand
when you visit your provider. To print your Temporary Benefit Confirmation, log on to www.MaximHealthcareBenefits.com and select the
“My Benefits & Personal Information” tab at the top of the Homepage. Click Benefits, then select “Print Temporary Benefit Confirmation”.
Select the benefits you would like to print a temporary confirmation for and select “Retrieve Temporary Benefits Confirmation”.
401(k) - Allegis Group Retirement Savings Plan
WELLS FARGO RETIREMENT SERVICE CENTER: 1-800-377-9188 | WWW.WELLSFARGO.COM
The Allegis Group Retirement Savings Plan offers a wide variety of investment options and services to help you plan for your retirement.
The plan allows both traditional (pre-tax) as well as Roth (post-tax) contributions. Please consult with your tax advisor to determine which
would be most advantageous for your situation.
ELIGIBILITY
All Maxim employees are eligible to participate on the first of the month coinciding with or following 30 days of employment.
HOW TO ENROLL
• Online at www.wellsfargo.com. Click on Account Access and select New User Login. You will be prompted to choose your contribution
rate and make investment selections.
• By calling Wells Fargo’s Participant Account Services (PAS) at 1-800-377-9188.
You can change your deferral percentage or investment selections at any time by using one of the methods listed above.
CONTRIBUTIONS
• You can contribute up to 100% of your eligible compensation up to the maximum permitted by the IRS. The limit for 2021 is $19,500.
• If you are over 50 years of age and contribute the full $19,500 in 2021 you are entitled to contribute an additional “catch-up”
contribution. The maximum catch-up contribution is $6,500 for 2021.
• You can start, change, or stop your contribution at any time.
VESTING
You are 100% vested in your contributions and any earnings they generate.
DISTRIBUTIONS
You can only receive distributions from your account in limited circumstances, including upon termination of employment. See the Summary
Plan Description for the 401(k) Plan for more information.
INVESTMENT OPTIONS
This plan offers a number of investment options for you to choose from. If you have not made an investment election, your contributions are invested
into the Vanguard Target Date funds. This fund has been selected for you based on your date of birth and an estimated retirement age of 65.
A target date fund is a practical, easy-to-understand choice for retirement investing. Each fund is diversified across stocks, bonds, and cash
equivalents, invested according to the fund’s target date. The target date represents the year you may be considering to begin withdrawing
your money. As the target date approaches, the fund slowly becomes more conservative, with less invested in stocks and more in bonds
and cash equivalents. While a target date fund offers a convenient investment solution, it’s important to remember that the principal value
of the fund is not guaranteed at any time, including at the target date.
For additional information regarding the default investment option, refer to the following page reference.
1
You may change your future contributions at any time but refunds are not available for any deductions that have already occurred. Additionally you should regularly review your paycheck to ensure
deductions are occurring as desired.
Fund Information
Target Date Funds
Vanguard Target Retirement Inc Trust I Asset Allocation

Expense Ratios (as of 06/30/2020): Gross: 0.07% | Net: 0.07%
(as of 06/30/2020)
48.7% U.S. Bond
Objective: Vanguard Target Retirement Income Trust uses an asset allocation strategy designed for 17.46% Non U.S. Bond
investors currently in retirement. The trust seeks to provide current income and some capital appreciation 17.17% U.S. Stock
by investing in a mix of the following five Vanguard funds: Total Bond Market II Index Fund, Total Stock 11.84% Non U.S. Stock
Market Index Fund, Total International Bond Index Fund, Short-Term Inflation-Protected Securities Index 4.45% Cash
Fund, and Total International Stock Index Fund. 0.38% Convertible
0.01% Other
92202V633
Vanguard Target Retirement 2015 Trust I Asset Allocation

(as of 06/30/2020)
44.4% U.S. Bond
Objective: Vanguard Target Retirement 2015 Trust uses an asset allocation strategy designed for 20.29% U.S. Stock
investors planning to retire between 2013 and 2017. The trust seeks to provide growth of capital and 16.66% Non U.S. Bond
current income consistent with its current target allocation by investing in a gradually more conservative 14.01% Non U.S. Stock
mix of the following Vanguard funds: Total Stock Market Index Fund, Total Bond Market II Index Fund, 4.27% Cash
Total International Bond Index Fund, Short-Term Inflation-Protected Securities Index Fund, and Total 0.36% Convertible
International Stock Index Fund. 0.01% Other
92202V617

(as of 06/30/2020)
33.53% U.S. Bond
Objective: Vanguard Target Retirement 2020 Trust Plus an asset allocation strategy designed for investors 28.87% U.S. Stock
planning to retire between 2018 and 2022. The trust seeks to provide growth of capital and current 19.63% Non U.S. Stock
income consistent with its current target allocation by investing in a gradually more conservative mix of 14.05% Non U.S. Bond
the following Vanguard funds: Total Stock Market Index Fund, Total Bond Market II Index Fund, Short-Term 3.61% Cash
Inflation-Protected Securities Index Fund, and Total International Stock Index Fund. 0.3% Convertible
0.01% Other
92202V591 0.01% Preferred

(as of 06/30/2020)
34.94% U.S. Stock
Objective: Vanguard Target Retirement 2025 Trust uses an asset allocation strategy designed for 24.88% U.S. Bond
investors planning to retire between 2023 and 2027. The trust seeks to provide growth of capital and 23.52% Non U.S. Stock
current income consistent with its current target allocation by investing in a gradually more conservative 13.06% Non U.S. Bond
Total International Bond Index Fund, and Total International Stock Index Fund. 0.29% Convertible
0.01% Other

(as of 06/30/2020)
39.69% U.S. Stock
Objective: Vanguard Target Retirement 2030 Trust uses an asset allocation strategy designed for 26.51% Non U.S. Stock
CFFS Vanguard Trust I - All |
investors planning to retire between 2028 and 2032. The trust seeks to provide growth of capital and 19.88% U.S. Bond
0.01% Other
Target Date Funds (continued)

(as of 06/30/2020)
44.27% U.S. Stock
Objective: Vanguard Target Retirement 2035 Trust Plus an asset allocation strategy designed for investors 29.47% Non U.S. Stock
planning to retire between 2033 and 2037. The trust seeks to provide growth of capital and current 15.02% U.S. Bond
income consistent with its current target allocation by investing in a gradually more conservative mix of 8.07% Non U.S. Bond
the following Vanguard funds: Total Stock Market Index Fund, Total Bond Market II Index Fund, Total 2.97% Cash
International Bond Index Fund, and Total International Stock Index Fund. 0.17% Convertible
0.02% Other

(as of 06/30/2020)
48.99% U.S. Stock
0.02% Other

(as of 06/30/2020)
53.28% U.S. Stock
0.02% Other

(as of 06/30/2020)
53.33% U.S. Stock
0.02% Other

(as of 06/30/2020)
52.71% U.S. Stock
0.02% Other

(as of 06/30/2020)
52.99% U.S. Stock
0.02% Other
Target Date Funds (continued)

(as of 06/30/2020)
53.67% U.S. Stock
0.02% Other
Investment and Risk Disclosures

The investment information listed in this guide is what was available at the time of publication. Additional investments, and more recent performance and fee
information, may be available online after signing onto your account.
The funds are assigned to an asset class, which may not match the asset class assigned by other data sources.
Before investing, please consider the investment objectives, risks, charges and expenses of the fund carefully. The prospectus, and if available, the
summary prospectus, contains this and other information and can be obtained by calling the fund company or your financial advisor. Read the
prospectus, and if available, the summary prospectus, carefully before you invest.
Performance data quoted represents past performance. Past performance is no guarantee of future results. The investment return and principal value of
an investment will fluctuate so that shares, when sold, may be worth more or less than their original cost. Current performance may be lower or higher
than the performance data quoted. For performance current to the most recent month-end, please review the prospectus or similar disclosure document
by visiting your retirement plan at wellsfargo.com or call your plan administrator.
Average Annual Total Returns are standardized total returns or cumulative total returns (only if the performance period is one year or less) as of the most recent
available period. They assume reinvestment of all distributions at net asset value (NAV). Returns shown at NAV do not include a sales charge, if applicable.
Asset Allocation is subject to change and may have changed since date specified. Morningstar calculates portfolio statistics on the short positions in each fund and
displays long, short, and net statistics as appropriate. Short positions produce negative exposure to the security that is being shorted. This means that when the
security rises in value, the short position will fall in value and vice versa. Individual short positions are displayed with negative percent weights in a complete holdings
list, and the short asset allocation for a fund will also be negative. These enhanced statistics allow investors to evaluate the long and short sides of a portfolio
separately and to estimate the fund’s overall net exposure.
Fund information contained herein (including performance information) is obtained from reliable sources including Morningstar, Inc. and/or mutual fund
companies, but is not guaranteed as to accuracy, completeness and timeliness. Provider shall not be liable for any errors in content or for any actions taken in
reliance thereon. An investor should consider the funds’ investment objectives, risks, charges and expenses carefully before investing or sending money.
© 2020 Morningstar, Inc. All Rights Reserved. The information contained herein: (1) is proprietary to Morningstar; (2) may not be copied or distributed; and (3) is not
warranted to be accurate, complete or timely. Neither Morningstar nor its content providers are responsible for any damages or losses arising from any use of this
information. Past performance is no guarantee of future results.
Investments in Retirement Plans:

Short Term Disability (STD) Benefits
THE HARTFORD: 1-800-538-8439
Maxim offers voluntary Short-Term Disability (STD) benefits through The Hartford that protect you against loss of income if you cannot
work due to a sickness or injury that is not work related. If you become totally disabled, benefits begin on day 15 of your disability and will
be paid for up to 11 weeks.
The plan will pay 50% of your pre-disability weekly pay (your benefit amount is determined at the time you become eligible for benefits and
will remain the same through the entire plan year) up to a maximum benefit of $300 per week. If you become disabled within the first 12
months after you enroll for STD coverage, benefits will not be paid for any medical condition for which you have been treated or diagnosed
within the six months prior to joining the STD plan (includes pregnancy).
If you enroll in the plan during your initial eligibility period (see page 7 for details), medical underwriting will not be required. If you enroll after
your initial eligibility period you will be required to complete the Personal Health Application and you will be subject to approval by The Hartford.
MONTHLY PREMIUMS – SHORT TERM DISABILITY

The cost of coverage is based on your age and weekly benefit amount, as shown in the following chart. When completing your enrollment
on www.MaximHealthcareBenefits.com, you will be able to automatically calculate your weekly STD premium.
Your Age Monthly STD Premium per $10 of Coverage

Under 25 $0.904
25-29 $0.840
30–34 $0.816
35–39 $0.632
40–44 $0.544
45–49 $0.592
50–54 $0.656
55–59 $0.720
60–64 $0.776
65+ $0.856
Cost of coverage is based on your age when you enroll in the plan. If your age band changes the cost of coverage will change at the next plan renewal.
Example: For an individual age 36 with $480 in weekly pay, the monthly cost is $18.96 per month ($480 x 50% = $240 / $10 = $24 x the monthly rate for age 36 of $0.79). The weekly cost is $4.38 per week ($18.96 x 12 months/52
weeks). If your weekly pay is $600 or more, use the following formula to calculate your monthly cost: $300/$10 = $30 x the monthly rate for your age, then multiply by 12 months and divide by 52 weeks to calculate your weekly cost.
FILING A SHORT TERM DISABILITY CLAIM

When filing a claim, you will be asked to provide:
• Your name and Social Security number • Nature of claim and whether it’s work-related
• Department and last day of active full-time work • Treating physician’s name, address and phone number
• Manager’s name and phone number
Ways to File a Claim
1. Online at www.TheHartfordAtWork.com.
2. By phone at 1-866-945-7781. Representatives are available Monday through Friday from 8:00am to 8:00pm ET.
3. Complete a paper form (available on www.MaximHealthcareBenefits.com).
Employees working in the following states/territories may be eligible for state mandated STD plans: California, Hawaii, New Jersey,
New York, Puerto Rico, Rhode Island, Washington. If so, any applicable state benefits will directly reduce your Hartford STD benefit.
Voluntary Group Life Insurance
THE HARTFORD: 1-800-563-1124
You may purchase Voluntary Group Life Insurance to protect you and your family from the financial impact of an unexpected loss of life.
You have the option to purchase coverage for yourself, your spouse/domestic partner, and your children up to the age of 26.
If you enroll during your initial eligibility period (see page 7 for details), you are eligible for the Guaranteed Issue Amount. If you want to
elect a higher amount of coverage, you will need to provide Evidence of Insurability (EOI). EOI will also be required if you enroll outside
of your initial eligibility period (regardless of how much coverage you elect) or if you want to increase your coverage level in the future.
The Hartford Personal Health Application (Evidence of Insurability form) can be found on www.MaximHealthcareBenefits.com.
Type Maximum Increments Guaranteed Issue Amount

Employee $300,000 $25,000 $75,000
Spouse/Domestic Partner1 $150,000 $25,000 $25,000
Child(ren)1,2 $10,000 $2,500 N/A
1
You must elect and be approved for employee coverage to be eligible for spouse/domestic partner and/or child coverage.
2
Coverage for newborn children begins at $1,000 at 15 days of age and takes effect at the elected amount at age 6 months.
DON’T FORGET TO ELECT A BENEFICIARY!
MONTHLY PREMIUMS – VOLUNTARY LIFE INSURANCE (EMPLOYEE/SPOUSE/DOMESTIC PARTNER)
Age Band Monthly Rate* per $1,000 of Coverage

< 30 $0.032
30-34 $0.048
35-39 $0.064
40-44 $0.104
45-49 $0.168
50-54 $0.280
55-59 $0.432
60-64 $0.584
65-69 $0.952
70-74 $1.704
75+ $3.032
Cost of coverage is based on your age and your spouse/domestic partner’s age when you enroll in the plan. If your age band or your spouse/domestic partner’s age band changes, the cost of coverage will increase at the next plan
renewal.
*Your weekly premium can be calculated by multiplying the monthly rate by 12 and dividing by 52. Rates are based on employee’s age.
MONTHLY PREMIUMS – VOLUNTARY LIFE INSURANCE (CHILDREN)
Coverage Amount Monthly Rate*

$2,500 $0.35
$5,000 $0.65
$7,500 $1.00
$10,000 $1.30
*Your weekly premium can be calculated by multiplying the monthly rate by 12 and dividing by 52.
Employee Discount Program
PERKSPOT: 1-866-606-6057 | WWW.MAXIMHEALTH.PERKSPOT.COM
Maxim is pleased to announce that we have partnered with PerkSpot to offer a comprehensive discount program that is a one-stop- shop for
1000’s of exclusive discounts and perks from a wide variety of national and local merchants. This program is available to all employees, family
members, and friends. Here’s how the program works.
GETTING STARTED
Sign up or log in at www.maximhealth.perkspot.com. Follow the quick and easy on-screen instructions to create an account with your personal
or work e-mail address. PerkSpot is optimized for use on any device: desktop, tablets, and phones.
If you have issues setting up an account, you can contact the PerkSpot Customer Service Team at 1-866-606-6057.
START SAVING
Once logged into PerkSpot, opt into PerkSpot’s weekly e-mail to receive a diverse selection of discounts. Each week’s e-mail features both new
and popular deals, as well as seasonal and thematic groupings of offers. The PerkSpot weekly e-mail is a particularly great resource for your
holiday shopping!
Browse your discounts in a number of ways. Peruse the “Everyday Savings” and “Popular Savings” sections for an array of in-demand deals
from across different categories.
Discover discounts in your neighborhood with PerkSpot’s streamlined Local Map. Filter your map results by categories like restaurants, health
and fitness, retail, and more!
REQUEST A MERCHANT
Don’t see the retailer or product you want? You can always request a merchant through your PerkSpot account, and our negotiating
experts will work diligently to get it for you!
STAY CONNECTED
Follow PerkSpot on Facebook, Twitter, and Instagram. Stay up to date on PerkSpot news, and find out about special promotions, contests and more!
Transportation Benefits
OPTUM BANK: 1-800-243-5543 | WWW.OPTUMBANK.COM
Maxim has partnered with Optum Bank to offer transportation benefits to you. Transportation benefits allow you to use pre-tax payroll
dollars to pay for qualified parking and transit expenses. You can enroll in this benefit at any time during the year.
HOW DOES IT WORK?

• You place your order by the tenth of the month. (Example: orders placed by March 10 are for vouchers that can be used in April)
• The amount of your purchase will be deducted from your paycheck shortly after you place your order. Currently, the IRS allows up
to $270 per month pre-tax for transportation benefits and parking costs.
• Your product is mailed to your home approximately two weeks after the order is placed.
PLACING YOUR ORDER IS EASY!

1. Log on to www.OptumBank.com.
2. From the Dashboard under “Accounts”, select Transportation Benefits.
3. Select your metropolitan area.
4. Select your transit and/or parking provider and the type of pass you want.
Additional information regarding transportation benefits, including eligible and ineligible expenses, can be found in IRS publication 15B.
College Partnership Programs

Maxim promotes the professional development of all its employees. We have formed partnerships with universities and colleges where
Maxim employees will be eligible for tuition discounts. Waivers for application fees, personalized coaching, and direct delayed billing may
also apply for some programs. All programs offer online coursework to allow students great work-life balance while enrolled.
For more information regarding the College Partnership Program, please visit www.MaximHealthcareBenefits.com, or contact the Benefits
Department at (410) 910-4966 or via email at BenefitsDepartment@maxhealth.com.
MetLife Home & Auto®
METLIFE AUTO AND HOME INSURANCE DISCOUNT PROGRAM
Maxim has partnered with MetLife Auto & Home to bring you a brand-new money saving benefit administered by MetLife.
You are now eligible for discounts on auto and home** insurance from MetLife Auto & Home. One phone call gets you a FREE, no obligation
quote. You are also eligible for extras like:
• Employee discount up to 15% • Multi-policy discount
• Extra Savings with automatic bank account deduction • Anti-theft discount
PROGRAM DESCRIPTION
MetLife Auto & Home is a voluntary group auto and home benefit program that provides you with access to insurance coverage for your
personal insurance needs. Policies available include: auto, home, landlord’s rental dwelling, condo, mobile home, renters, recreational vehicle,
boat, and personal excess liability policies.
BENEFITS
The program gives you access to special group discounts. You could also benefit from these program features:
• One easy-to-remember, toll-free number, 1-800-GET-MET-8, for all your insurance needs, such as receiving free insurance
quotes, making changes to your policy, or just asking questions
• 24-hour claim reporting
• Extended customer service hours, including weekday evenings and Saturdays
• Coverage you can take with you, should you retire or leave the company for another reason
• Enhanced product coverages that are built into every auto policy**
Visit www.myautohome.metlife.com for more information.
*Important Note: This program will be directly between you and MetLife. The application, approval, and billing process will not be administered by Maxim.
**Home insurance has limited availability in MA and is not part of MetLife Auto & Home’s benefit offering in FL.
Pet Insurance offered by MetLife1
Protect Your Furry Family Members with Pet Insurance offered by MetLife1.
Now more than ever, pets are playing a significant role in our lives and it is important to keep them safe and healthy. Help make sure your furry
family members are protected in case of an accident or illness with Pet Insurance offered by MetLife1.
WHY IS PET INSURANCE IMPORTANT?

• A small monthly payment can help you prepare for unexpected vet expenses down the road
• More than 6 in 10 pet owners said their pet has had an emergency medical expense2
• 24% of pet parents have credit card or personal loan debt to cover pet health and vet costs3
• Average annual cost for a routine vet visit is $212 for a dog and $160 for a cat; and average annual cost for a surgical vet visit is $426
for a dog and $214 for a cat4
• Pet insurance may not cover pre-existing conditions
WHAT’S COVERED5?
• Accidental Injuries • Surgeries • Hospital Stays
• Illnesses • Medications • X-Rays And Other
• Exam Fees • Ultrasounds Diagnostics
And our coverage also includes:

• Hip Dysplasia • Congenital Conditions • Alternative Therapies
• Hereditary Conditions • Chronic Conditions • And Much More!
To get a quote or enroll, call 1-800-GET-MET8 (1-800-438-6388) or visit mybenefits.metlife.com.
1. PetFirst Healthcare, LLC, a MetLife company, is the program administrator authorized to offer and administer pet health insurance policies underwritten by Independence
American Insurance Company, a Delaware insurance company, with its main office at 485 Madison Avenue, NY, NY 10022. For costs, complete details of coverage, and a
listing of approved states, please contact PetFirst Healthcare, LLC. Like most insurance policies, insurance policies offered by PetFirst Healthcare, LLC and underwritten by
Independence American Insurance Company, contain certain exclusions, exceptions, reductions, limitations, and terms for keeping them in force.
2. Delfino, Devon. “42% of Millennials Have Been in Debt for Their Pet,” lendingtree, https://www.lendingtree.com/personal/pet-financing/average-pet-debt/. Accessed 22
April 2020.
3. 2019 Employee Benefits Adviser “5 benefit perks to entice top millennial talent to your clients.”
4. 2019-2020 APPA National Pet Owners Survey.
5. Provided all terms of the policy are met. Like most insurance policies, insurance policies offered by PetFirst Healthcare, LLC and underwritten by Independence American
Insurance Company, contain certain exclusions, exceptions, reductions, limitations, and terms for keeping them in force.
Enrollment is Simple!
www.MaximHealthcareBenefits.com is an online benefits service that puts benefits information and enrollment at your fingertips 24
hours a day, 7 days a week. This site lets you look at your personal benefits record, current coverage, dependents, and costs. You can also
find details about all the available plans, claim forms, contact information, and much more. www.MaximHealthcareBenefits.com is private
and accessible from any computer, anywhere, anytime.
BEFORE YOU ENROLL

3 Review the benefits guide and plan documents thoroughly.
3 Decide which benefits are right for you.
3 Gather basic information on your dependents, such as: Legal Name, Address, Social Security Number, and Date of Birth
3 Decide who your beneficiary or beneficiaries will be if you are enrolling in a voluntary life plan.
3 Review the prices of the benefits you have selected and make sure they fit within your budget.
Except during the annual open enrollment period, you will not be able to make changes to your pre-tax benefits once you complete
your enrollment, unless you experience a qualifying status change.
HOW TO ENROLL
First Time www.MaximHealthcareBenefits.com Users
1. Go to www.MaximHealthcareBenefits.com. (We strongly recommend the most recent version of Internet Explorer or Firefox).
2. Click on the “Register Now” link located on the right-hand side of your screen.
3. When prompted, enter your Last Name, Date of Birth, and your Social Security Number. For security purposes you will also be asked
to type a randomly generated security code that will be presented when the page loads. Select Next.
4. Follow the directions provided on the site to complete your registration and setup your online account.
Returning www.MaximHealthcareBenefits.com Users
1. Log on to www.MaximHealthcareBenefits.com.
2. Read the information on the welcome page.
3. Click “Continue” to proceed to your online enrollment.
4. Follow the on screen instructions/prompts to complete your enrollment.
Please note: If you have forgotten your username and/or password, click on the “Login Help” link.
Tip: Make sure you print the confirmation at the end of your enrollment.
KTBSONLINE IS ALSO AVAILABLE AS AN APP! You can now enroll in your benefits online
or on your mobile device. Download the KTBSonline app (look for the lion icon) to access your benefits
on the go. With the app, you will have quick access to information and services, including:
• Benefits enrollment
• Plan details
• Employee/dependent information
• Ability to email proof of coverage directly from the app
• Ability to reach out to customer service for assistance
REMEMBER! If you do not enroll during your initial eligibility period (30 days from benefits effective date), you cannot enroll for any
pre-tax benefit until the next applicable open enrollment, unless you have a qualifying status change.
Contact Information
Benefit Provider Contact
1-866-663-1107
Enrollment, Eligibility, Administration, or COBRA Questions Benefits Service Center
BenefitInquiries@maxhealth.com
1-877-691-5856
Medical Benefits, Claim Questions, or Participating Providers BlueCross BlueShield www.bcbs.com
www.carefirst.com/myaccount
Prescription Drug Benefits, Claim Questions, 1-800-241-3371

CVS/caremark
or Participating Pharmacies www.carefirst.com
1-866-799-2728
Health Advocacy Services Health Advocate answers@HealthAdvocate.com
www.HealthAdvocate.com/maximhealthcareext
1-866-799-2728
Employee Assistance Program (EAP) Health Advocate answers@HealthAdvocate.com
www.HealthAdvocate.com/maximhealthcareext
Hospital Bridge Insurance Plan Symetra 1-800-497-3699
Hospital Expense Protection Plan (HEPP) Benefits

Symetra 1-800-497-3699
or Claim Questions
Supplemental Critical Illness Insurance Symetra 1-800-497-3699
Supplemental Accident Insurance Symetra 1-800-497-3699
1-800-438-6388
Dental Benefits, Claim Questions, or Participating Dentists MetLife www.metlife.com/mybenefits*
www.metlife.com/dental
Vision Benefits, Claim Questions, or Participating 1-800-877-7195

Vision Service Plan (VSP)
Eye Care Providers www.vsp.com
Short Term Disability Benefits or Claim Questions The Hartford 1-800-538-8439
Voluntary Life Insurance Benefits or Claim Questions The Hartford 1-800-563-1124
Wells Fargo Retirement 1-800-377-9188

401(k)
Services www.wellsfargo.com
1-866-606-6057
Employee Discounts and Perks Perkspot
www.MaximHealth.PerkSpot.com
1-800-243-5543
Transportation Benefits Optum Bank
www.OptumBank.com
1-866-492-0510
Leave of Absence Information Leave of Absence Specialist
LeaveRequests@maxhealth.com
MetLife Home & Auto MetLife 1-800-438-6388
MetLife Pet Insurance MetLife 1-800-438-6388
*When you sign in to MyBenefits, enter “Maxim Healthcare Group“ in the box where it says “Enter your company name“.
Appendix A: Important Plan Notices
WHAT YOU NEED TO KNOW ABOUT FORM 1095-C
In the beginning of 2016, you received your first 1095-C for the 2015 Plan Year. You will receive a 1095-C annually. Maxim is required to
report to the IRS on the health insurance it offers to full-time employees. The Form 1095-C includes information about the health insurance
coverage offered to you and, if applicable, your family. You may need to submit information from the form in 2022 as a part of your personal
tax filing for 2021.
Maxim is required to distribute your Form 1095-C by January 31st, 2022 covering information about Maxim health insurance for the 2021
calendar year.
WOMEN’S HEALTH AND CANCER RIGHTS ACT NOTICE

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. Please refer to your enrollment guide and/or Summary of Benefits and Coverage for more information on the deductibles
and coinsurance that apply under your plan. If you would like more information on WHCRA benefits, contact the Plan Sponsor.
NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT NOTICE

Under federal law, employer health plans and health insurance issuers offering group health insurance coverage generally may not 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 delivery by cesarean section. However, the Plan or issuer may pay for a shorter stay if the
attending provider (e.g., your physician, nurse midwife, or physician assistant), after consultation with the mother, discharges the mother
or newborn earlier.
Also, under federal law, plans and issuers may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour
(or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay.
In addition, a plan or issuer may not, under federal law, require that a physician or other health care provider obtain authorization for
prescribing a length of stay of up to 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-of-pocket
costs, you may be required to obtain pre-certification. For information on pre-certification, contact your Plan Sponsor.
NOTICE OF PRIVACY PRACTICES
For Self-Funded/Self-Insured Health Plans Sponsored by Maxim Healthcare Group, Inc. Effective: 9/1/2013
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The self-funded/self-insured medical plans (collectively “the Plan”), sponsored by Maxim Healthcare Group, Inc. (“Maxim”) for the benefit of
its employees, are required by law to secure and safeguard any protected health information provided to the Plan for managing employee
benefits. The Plan is further required to provide you with this notice explaining the Plan’s privacy practices with regard to your protected
health information. This Notice tells you how the Plan may use and disclose your health information and it outlines those instances where
your health information may be released without your authorization. You have certain rights regarding the privacy of your protected health
information and those rights are also described in this notice.
As used in this notice, Protected Health Information (PHI) includes both medical information regarding your care and treatment and individually
identifiable personal information such as your name, address, phone number, social security number or other personal information that you
provide in the course of applying for benefits and associated claims processing. This information may be in electronic, written and/or oral form.
PHI does not include health information contained in employment records held by Maxim in its role as an employer, including but not
limited to health information on disability, work-related illness/injury, sick leave, Family or Medical Leave (FMLA), life insurance, dependent
care flexible spending account, drug testing, etc. However, your PHI will be disclosed to certain employees of Maxim working in the
Benefits Department for plan administration purposes. These individuals may use your PHI for Plan administration functions including
those described below, provided they do not violate the provisions set forth herein.
Lastly, the Plan may not (and does not) use genetic information that is PHI for underwriting purposes.
USES OR DISCLOSURES OF PHI. Generally, the Plan may not use or disclose a person’s PHI without their permission and, once permission
has been obtained, the Plan must use or disclose PHI as provided for in the specific terms of that permission. A person may also decline the
release of information or restrict/revoke the release of information. Those rights are further outlined herein. Some specific instances where
authorization is required before the Plan may use or disclose health information include, without limitation:
• Most uses and disclosures of psychotherapy notes or other records including particularly sensitive health information including
substance abuse and sexually transmitted disease such as HIV/AIDS;
• Uses and Disclosures of PHI for marketing purposes; and
• Disclosures that constitute a sale of protected health information.
In certain instances, the Plan may use/disclose PHI without authorization. The following uses/disclosures DO NOT require authorization:
Treatment: PHI may be used or disclosed for the purposes of providing, coordinating or managing your healthcare or associated benefits.
This includes, but is not limited to, disclosures to doctors, nurses, technicians, staff and other healthcare professionals who become involved
in your care. For example: The Plan discloses to a treating specialist the name of your treating primary care physician so the two can confer
regarding your treatment plan.
Payment: PHI may be used or disclosed to receive payment for services or to obtain authorizations for proposed treatments. For example:
The Plan may need to review, or have a claims administrator or other entity review, information about treatment you received from a doctor
to determine whether, or how much, to pay the doctor or to reimburse you for the treatment. The Plan may also review information from a
doctor about a treatment you have received or you are going to receive to decide if the Plan will cover the treatment.
Healthcare Operations: PHI may be used or disclosed as needed to manage the Plan’s operations to ensure it runs soundly. Health care
operations includes but is not limited to quality assessment and improvement, patient safety activities, business planning and development,
reviewing competence or qualifications of health care professionals, underwriting, enrollment, premium rating and other insurance activities
relating to creating or renewing insurance contracts. It also includes disease management, case management, conducting or arranging for
medical review, legal services and auditing functions including fraud and abuse compliance programs and general administrative activities.
For example: The Plan uses information about your medical claims to refer you to a disease management program, to project future benefit
costs or to audit the accuracy of its claims processing functions.
Health-Related Benefits and Services: We may use and disclose PHI to tell you about other health-related benefits or services that may
be of interest to you.
To Maxim, the Plan Sponsor: The Plan may disclose PHI to Maxim for plan administrative purposes. Maxim needs your PHI to administer
benefits under the Plan. Maxim agrees not to use or disclose your PHI other than as permitted or required by the documents governing
the Plan and by law. Maxim cannot and will not use PHI obtained from the Plan for any employment-related actions. The Plan may also
disclose your PHI to Maxim, as the Plan Sponsor, to enable it, among other things, to perform enrollment and disenrollment functions and
make decisions about the structure of the Plan.
Individuals Involved In Your Care or Payment For Your Care: Unless you object, we may disclose PHI to a relative, friend or any person
identified by you, if these individuals need to know about or are involved in your care, or for payment for your care.
Workers Compensation: PHI may be disclosed in order to comply with laws relating to workers’ compensation or similar programs.
Public Health, Safety, Disaster Relief, Or to Divert a Threat to Health Or Safety; Victims of Abuse, Neglect, or Domestic Violence: PHI
may be used or disclosed to the extent necessary for public health activities and to avert a serious and imminent threat to your health or
safety or the health and safety of others. Information may also be disclosed to the appropriate authorities if we reasonably believe that you
are a possible victim of abuse, neglect, domestic violence or other crimes. Any disclosure would only be to someone able to help prevent
the threat or injury.
Health Oversight: PHI may be disclosed to a health oversight agency for activities authorized by law. This may include but is not limited
to The Joint Commission, ACHC, surveys, investigations, inspections, licensure or disciplinary actions.
Legal Proceedings and Law Enforcement: PHI is released when asked by a law enforcement officer and/or in response to a subpoena,
court or administrative order, warrant, discovery request or other lawful process.
Military and National Security: PHI is released when requested by authorized military command authorities or federal officials if you are
in the armed forces or are a veteran, or as required other national security activities.
Coroners, Medical Examiners and Funeral Directors: PHI may be disclosed to a coroner or medical examiner if necessary to identify a
deceased person or to determine a cause of death, or to a funeral director in connection with the performance of their duties.
Business Associates: The Plan may use vendor services as part of its operations to manage the Plan. In those instances, all business
associates are contractually obligated to safeguard your information through a Business Associate Agreement.
Research; Death; Organ Donation: PHI may be used for research purposes in limited circumstances. However, all such research projects
are subject to an approval process, and we will ask your permission if a researcher is to have access to your name, address, or other
information that identifies you. PHI may also be disclosed for the purpose of facilitating organ donation and transplantation.
Required By Law: The Plan will use or disclose PHI when required to do so by federal, state or local law.
YOUR RIGHTS REGARDING YOUR PERSONAL AND MEDICAL INFORMATION. The information contained in the records held by the Plan
belongs to you. Federal law gives you the rights described below regarding your medical information.
Revoke Authorizations. You may revoke any authorization for the release of information, at any time. Your request should be submitted
in writing to Maxim’s Privacy Officer. Upon receipt, we will no longer disclose health information for the reasons stated in your written
authorization. Disclosures made in reliance on the authorization prior to the revocation are not affected by the revocation.
Inspect and Copy. With certain exceptions, you have the right to inspect and copy your PHI maintained in the Plan’s “designated record
set.” To the extent your record is maintained electronically, you have the right to access your own electronic health record in an electronic
format. You may also direct Maxim to send the e-health record directly to a third party.
Amendments. If you feel that the PHI the Plan has about you is incorrect or incomplete, you may ask the Plan to amend the information.
All requests must be submitted to Maxim’s Privacy Officer in writing. Requests may be declined if the information (a) is not part of the PHI
kept by or for the Plan; (b) was not created by the Plan, unless the person or entity that created the information is no longer available to
make the amendment; (c) is not part of the information which you would be permitted to inspect and copy; or (d) is accurate and complete.
If your request is declined, we will provide you with a written denial stating the basis of the denial, your right to submit a written statement
disagreeing with the denial, and a description of how you may file a complaint with us or the Secretary of the U.S. Department of Health
and Human Services (“DHHS”).
Accounting of Disclosures. You may request a list of certain disclosures made of your medical information (“accounting of disclosures”). In
some instances, the accounting may be limited by time and may exclude disclosures made for treatment, payment or health care operations.
Request Restrictions. You may request a reasonable restriction on the uses or disclosures of your medical information. If you pay for your
services, in full, using your personal funds, you can ask that the information regarding the service not be disclosed to a third-party payer/
health plans/insurance company since no claim is being made against the third-party payer.
Request Alternate/Confidential Communications. You may request that we communicate with you about medical matters in a confidential
manner or at a specific location. For example, you may ask that we only contact you via mail to a post office box.
Paper Copy of This Notice. You may request a paper copy of this notice at any time by contacting the Benefits Department or Maxim’s
Privacy Officer. You may also obtain an electronic copy of this notice at our website, www.maximhealthcarebenefits.com
To exercise any of these rights you must: submit your request in writing to the Plan’s Benefits Department or Maxim’s Privacy Officer. Your
request should include a reason for your request and, if applicable, the action you want Maxim to take. We may charge a fee for the costs
of copying, mailing or other supplies associated with your request. We will notify you of the cost involved and you may choose to change
or take back your request at that time before any costs are incurred.
BREACH NOTIFICATION REQUIREMENTS: We are required to notify you if unsecured PHI is acquired, accessed, used and/or disclosed by
an unauthorized party. Under the Federal Rules, notification must occur without unreasonable delay and in no case later than 60 days of
the event. Some State regulations require shorter notification periods and Maxim shall comply with all such requirements.
CHANGES TO THIS NOTICE: We reserve the right to change this notice. We reserve the right to make the revised or changed notice
effective for medical information we already have about you as well as any information we receive in the future. The current notice is
available through the Benefits Department or Maxim’s Privacy Officer. If material changes are made to this notice, a revised notice will be
sent to all Plan members and the notice will contain an effective date for the revisions.
QUESTIONS/GRIEVANCES: If you want further information about matters covered by this notice, are concerned that your privacy rights
may have been violated, or disagree with a decision made about access to your personal and health information, you may contact Maxim’s
Privacy Officer by U.S. mail, fax, phone or email at: Maxim Healthcare Group, Inc., Attention: Privacy Officer, 7227 Lee Deforest Drive,
Columbia, MD 21046; Toll Free: 1.866.297.2295; Fax: 410.910.1675; e-mail: hipaa@maxhealth.com. You may also submit a grievance/
complaint to the U.S. Department of Health & Human Services, 200 Independence Ave., SW, Washington DC 20201, Phone: 202.619.0257,
Toll Free: 1.877.696.6775.
Maxim will not retaliate and you will not be penalized in any way if you choose to file a grievance complaint with us or with the U.S. Department
of Health and Human Services.
MEDICARE PART D NOTICE FOR BASIC, HIGH DEDUCTIBLE, SILVER, & STANDARD MEDICAL PLAN PARTICIPANTS
PLEASE NOTE: This Notice only applies to you if you are eligible for Medicare. If your covered spouse/domestic partner or dependent is
covered by Medicare, please share this notice with them.
IMPORTANT NOTICE FROM MAXIM HEALTHCARE GROUP, INC. 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 Maxim and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you
want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered
at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you
can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a
Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage.
All Medicare prescription 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. Maxim has determined that the prescription drug coverage offered under this 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 prescription 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 15th 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 ARE MY CHOICES?

If you decide to join a Medicare drug plan, your current prescription drug coverage with Maxim will not be affected.
Before choosing whether to enroll in a Medicare drug plan, you should compare your current coverage, including which drugs are covered and at
what cost, with the coverage and costs of the plans offering Medicare drug coverage in your area. You could choose to:
#1 Keep your medical and prescription drug coverage through Maxim, and not enroll in a Medicare prescription drug plan yet.
This choice is available to you because the prescription drug coverage that is offered to you as part of the overall package of medical benefits
provided by Maxim is “creditable” – meaning that, on average, it is at least as good as the standard Medicare prescription drug coverage.
#2 Keep your medical and prescription drug coverage through Maxim, but also enroll in a Medicare prescription drug plan now.
Under this choice, you will be paying premiums for both the Medicare prescription drug plan you select and for medical and prescription
drug coverage through Maxim. You will continue to receive medical and prescription drug benefits through Maxim. The benefits (if any)
that you receive from the Medicare prescription drug plan you select will depend on the cost and type of prescription drugs that you use,
the coverage of the plan that you choose, and the prescription drug coverage provided under Maxim’s plan. If you enroll in a Medicare
prescription drug plan, you must notify the Maxim Benefits Service Center so that your Maxim benefits can be coordinated with the
benefits you receive through the Medicare prescription drug plan.
#3 Enroll in a Medicare prescription drug plan now and drop your medical and prescription drug coverage though Maxim.
Under this choice, you will have prescription drug coverage only through the Medicare prescription drug plan that you have selected.
However, you will also be dropping ALL of your medical coverage through Maxim – not just the prescription drug coverage – and you may
not be able to re-enroll or otherwise get this coverage back.
Included in this benefit guide is a Prescription Drug Summary that you may use when comparing your current coverage with Medicare Part
D. It is always the member’s responsibility to verify coverage and eligibility with 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 Maxim 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 Maxim changes. You also may request a copy of this notice at any time.
FOR MORE INFORMATION ABOUT YOUR OPTIONS UNDER MEDICARE PRESCRIPTION DRUG COVERAGE…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy
of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about
Medicare prescription drug coverage: Visit www.medicare.gov.
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their
telephone number) for personalized help: Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra
help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice
when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a
higher premium (a penalty).
Date: October 2020
Name of Entity/Sender: Maxim Healthcare Group, Inc.,
Contact—Position/Office: Benefits Service Center
Address: 7227 Lee DeForest Drive, Columbia, MD 21046
Phone Number: 1-866-663-1107
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have
a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children
aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual
insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP
office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for
either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to
apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your
employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and
you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling
in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-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 July 31, 2020. Contact your State for more information on eligibility.
ALABAMA – Medicaid INDIANA – Medicaid

Website: http://myalhipp.com/ Phone: 1-855-692-5447 Healthy Indiana Plan for low-income adults 19-64
Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479
ALASKA – Medicaid All other Medicaid: www.indianamedicaid.com Phone 1-800-403-0864
The AK Health Insurance Premium Payment Program
Website: http://myakhipp.com/ Phone: 1-866-251-4861 IOWA – Medicaid and CHIP (Hawki)
Email: CustomerService@MyAKHIPP.com Medicaid Website: https://dhs.iowa.gov/ime/members
Medicaid Eligibility: dhss.alaska.gov/dpa/Pages/medicaid/default.aspx Medicaid Phone: 1-800-338-8366
Hawki Website: http://dhs.iowa.gov/Hawki Phone: 1-800-257-8563
ARKANSAS – Medicaid
Website: http://myarhipp.com/ KANSAS – Medicaid
Phone: 1-855-MyARHIPP (855-692-7447) Website: http://www.kdheks.gov/hcf/default.htm
Phone: 1-800-792-4884
CALIFORNIA – Medicaid
Website: www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx KENTUCKY – Medicaid
Phone: 916-440-5676 Kentucky Integrated Health Insurance Premium Payment Program
(KI-HIPP) Website:
COLORADO – Health First Colorado (Colorado’s Medicaid https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx
Program) & Child Health Plan Plus (CHP+) Phone: 1-855-459-6328
Health First Colorado Website: https://www.healthfirstcolorado.com/ Email: KIHIPP.PROGRAM@ky.gov
Health First Colorado: 1-800-221-3943/ State Relay 711 KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx
CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus Phone: 1-877-524-4718
CHP+ Customer Service: 1-800-359-1991/ State Relay 711 Kentucky Medicaid Website: https://chfs.ky.gov
Health Insurance Buy-In Program (HIBI): https://www.colorado.gov/
pacific/hcpf/health-insurance-buy-program LOUISIANA – Medicaid
HIBI Customer Service: 1-855-692-6442 Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp
Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)
FLORIDA – Medicaid
Website: https://www.flmedicaidtplrecovery.com/ MAINE – Medicaid
flmedicaidtplrecovery.com/hipp/index.html Enrollment Website: https://www.maine.gov/dhhs/ofi/applications-forms
Phone: 1-877-357-3268 Phone: 1-800-442-6003 TTY: Maine relay 711
Private Health Insurance Premium Webpage:
GEORGIA – Medicaid https://www.maine.gov/dhhs/ofi/applications-forms
Website: https://medicaid.georgia.gov/health-insurance-premium- Phone: -800-977-6740. TTY: Maine relay 711
payment-program-hipp
Phone: 678-564-1162 ext 2131 MASSACHUSETTS – Medicaid and CHIP
Website: http://www.mass.gov/eohhs/gov/departments/masshealth/
Phone: 1-800-862-4840
MINNESOTA – Medicaid PENNSYLVANIA – Medicaid
Website: http://mn.gov/dhs/people-we-serve/seniors/health-care/ Website: http://www.dhs.pa.gov/provider/medicalassistance/
health-care-programs/programs-and-services/medical-assistance.jsp healthinsurancepremiumpaymenthippprogram/index.htm
Phone: 1-800-657-3739 Phone: 1-800-692-7462
MISSOURI – Medicaid RHODE ISLAND – Medicaid and CHIP

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Website: http://www.eohhs.ri.gov/
Phone: 573-751-2005 Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)
MONTANA – Medicaid SOUTH CAROLINA – Medicaid

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Website: https://www.scdhhs.gov
Phone: 1-800-694-3084 Phone: 1-888-549-0820
NEBRASKA – Medicaid SOUTH DAKOTA - Medicaid

Website: http://www.ACCESSNebraska.ne.gov Phone: (855) 632-7633 Website: http://dss.sd.gov
Lincoln: (402) 473-7000 Omaha: (402) 595-1178 Phone: 1-888-828-0059
NEVADA – Medicaid TEXAS – Medicaid

Medicaid Website: https://dhcfp.nv.gov Website: http://gethipptexas.com/
Medicaid Phone: 1-800-992-0900 Phone: 1-800-440-0493
NEW HAMPSHIRE – Medicaid UTAH – Medicaid and CHIP
Website: https://www.dhhs.nh.gov/oii/hipp.htm Medicaid Website: https://medicaid.utah.gov/
Phone: 603-271-5218 CHIP Website: http://health.utah.gov/chip
Toll free number for the HIPP program: 1-800-852-3345, ext 5218 Phone: 1-877-543-7669
NEW JERSEY – Medicaid and CHIP VERMONT– Medicaid
Medicaid Website: www.state.nj.us/humanservices/dmahs/clients/medicaid/ Website: http://www.greenmountaincare.org/
Medicaid Phone: 609-631-2392 Phone: 1-800-250-8427
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710 VIRGINIA – Medicaid and CHIP
Website: https://www.coverva.org/hipp/
NEW YORK – Medicaid
Medicaid Phone: 1-800-432-5924
Website: https://www.health.ny.gov/health_care/medicaid/ CHIP Phone: 1-855-242-8282
Phone: 1-800-541-2831
WASHINGTON – Medicaid
NORTH CAROLINA – Medicaid
Website: https://www.hca.wa.gov/
Website: https://medicaid.ncdhhs.gov Phone: 1-800-562-3022
Phone: 919-855-4100
WEST VIRGINIA – Medicaid
NORTH DAKOTA – Medicaid
Website: http://mywvhipp.com/
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
Phone: 1-844-854-4825
WISCONSIN – Medicaid and CHIP
OKLAHOMA – Medicaid and CHIP
Website: www.dhs.wisconsin.gov/badgercareplus/p-10095.htm
Website: http://www.insureoklahoma.org Phone: 1-800-362-3002
Phone: 1-888-365-3742
WYOMING – Medicaid
OREGON – Medicaid
Website: https://health.wyo.gov/healthcarefin/medicaid/programs-
Website: http://healthcare.oregon.gov/Pages/index.aspx and-eligibility/
http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-251-1269
Phone: 1-800-699-9075
To see if any other states have added a premium assistance program since July 31, 2020, or for more information on special enrollment
rights, contact either:
U.S. Department of Labor U.S. Department of Health and Human Services
Employee Benefits Security Administration Centers for Medicare & Medicaid Services
www.dol.gov/agencies/ebsa | 1-866-444-EBSA www.cms.hhs.gov | 1-877-267-2323, Menu Option 4, Ext. 61565
NEW HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS & YOUR HEALTH COVERAGE
PART A: GENERAL INFORMATION
Key parts of the health care law took effect in 2014, creating a new way to buy health insurance: the Health Insurance Marketplace. To
assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and
employment based health coverage.
WHAT IS THE HEALTH INSURANCE MARKETPLACE?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-
stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your
monthly premium right away. For coverage starting in 2021, the Open Enrollment period is November 1, 2020 - December 15, 2020.
CAN I SAVE MONEY ON MY HEALTH INSURANCE PREMIUMS IN THE MARKETPLACE?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that
doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.
DOES EMPLOYER HEALTH COVERAGE AFFECT ELIGIBILITY FOR PREMIUM SAVINGS THROUGH THE MARKETPLACE?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through
the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly
premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets
certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5%
of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the
Affordable Care Act, you may be eligible for a tax credit.1
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose
the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution – as well as your employee contribution
to employer-offered coverage – is often excluded from income for Federal and State income tax purposes. Your payments for coverage
through the Marketplace are made on an after- tax basis.
HOW CAN I GET MORE INFORMATION?

For more information about your coverage offered by your employer, please check your summary plan description or contact the Maxim
Benefits Service Center at 1-866-663-1107 or send an e-mail to BenefitInquiries@maxhealth.com.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost.
Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a
Health Insurance Marketplace in your area.
1
An employer-sponsored health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.
PART B: INFORMATION ABOUT HEALTH COVERAGE OFFERED BY YOUR EMPLOYER
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage
in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
3. Employer name 4. Employer Identification Number (EIN)

Maxim Corporate Services, LLC 85-0518853
5. Employer address 6. Employer phone number
7227 Lee DeForest Drive 866-663-1107
7. City 8. State 9. ZIP code
Columbia MD 21046
10. Who can we contact about employee health coverage at this job?
The Maxim Benefits Service Center
11. Phone number (if different from above) 12. Email address
Benefitinquiries@maxhealth.com
Here is some basic information about health coverage offered by this employer:
• As your employer, we offer a health plan to:
All
employees.
;Some
employees. Eligible employees are: All Caregivers and Healthcare Professionals that work at least 1 hour, but less than
120 hours in the previous calendar month, and any other employees regularly scheduled to work 30 or more hours per week.
• With respect to dependents:
do offer coverage. Eligible dependents are: Legally recognized spouses, domestic partners (provided the employee and
;We
the domestic partner have registered their domestic partnership with a state or local domestic partnership registry), and
children through age 26 (or longer in certain circumstances if a child is permanently and totally disabled.)
We
do not offer coverage.
;If
checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based
on employee wages.
** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The
Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If,
for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly
employed mid-year, or if you have other income losses, you may still qualify for a premium discount.
If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the employer information
you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.
A Final Word
In this brochure, we describe your employee benefits in a clear, simple, and concise manner. Complete descriptions of the plans are
contained in the corresponding contracts or plan documents. If there is any disagreement between this brochure and the wording of
the corresponding contract or plan document, the contract or plan document will govern. Maxim reserves the right to modify, amend,
suspend, or terminate any plan, in whole or in part, at any time. This brochure does not constitute a guarantee of employment.
Maxim complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATTENTION: If you speak a different language other than English, assistance services, free of charge, are available to you. Call 1-888-808-9008.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-808-9008.
1-888-808-9008.
Designed & Prepared by:
A Division of Kelly & Associates Insurance Group, Inc. | www.kellyway.com
Kelly & Associates Insurance Group, Inc (KELLY) provides administrative services that include: billing, enrollment and call center service for insurance benefits. The administration of benefits by
KELLY does not guarantee coverage. Billing and collecting premiums or sending payroll deduction files, does not constitute coverage being bound. Please refer to specific insurance carrier contract for
rules requiring evidence of insurability (EOI) or other underwriting requirements regarding final insurance carrier approval. KELLY is not an insurer and is not responsible for paying insurance benefit
claims relative to KELLY's involvement with billing and collecting insurance premiums.
*This booklet summary is only intended as a brief summary of your benefits. Benefits are subject to the contractual terms, limitations and exclusions as set forth in the master contracts.
8746MAX
Benefits (Including Medical Coverage) Acknowledgement
Please initial each of the statements below to acknowledge the following:
✔
____ I understand that I have been given an offer of medical coverage by my employer. I have
received my Benefit Guide that explains the offer of this coverage and understand that I am
eligible to enroll in medical coverage now, with that coverage being effective after the
applicable waiting period.
✔ I acknowledge that if I choose to participate in the benefits for which I am eligible, including
____
medical coverage, I will need to visit www.MaximHealthcareBenefits.com or complete the
required paper enrollment forms to enroll.
✔ I have received the notice titled “New Health Insurance Marketplace Coverage Options and
____
Your Health Coverage.” I understand that this notice indicates that my employer is offering
me a medical plan that meets the requirements of Minimum Value (as defined in the
notice).
✔ I understand that, if my employer offers me Minimum Value coverage and that coverage is
____
affordable based on my wages, I am not eligible for a premium tax credit from any state or
federal healthcare marketplaces. If I receive a premium tax credit that I am not eligible for, I
will need to refund the government for the credits. For more information on eligibility for
premium tax credits, I can go to: https://www.irs.gov/Affordable-Care-Act/Individuals-and-
Families/The-Premium-Tax-Credit
✔ I have received the applicable Summary of Benefits and Coverage(s) describing the medical
____
benefits available to me.
✔ I acknowledge the Benefit Guide is only a summary of the benefits. Complete descriptions of
____
the plans are contained in the applicable plan documents. If there is any disagreement
between this acknowledgement and the wording of the applicable contract or plan
document, the contract or plan document will govern. Maxim Healthcare Services, Inc. and
its operating companies reserve the right to modify, amend, suspend, or terminate any plan
in whole or in part, at any time.
✔ I understand that I may access more information about the medical benefits available to me
____
at any time at www.MaximHealthcareBenefits.com, by calling 1-866-886-1107, or by
requesting a paper copy of relevant documents at any time free of charge.
✔ I understand that this document does not constitute a guarantee of employment.

____
Please Note: If you enroll in benefits after your Benefits’ Effective Date, you will be responsible for
all missed premiums.
Day Alcober
Printed Name of Employee:
Digitally signed by Day M. Alcober
Location: day.alcober@yahoo.com 01/12/2022
Signature of Employee: 01/12/2022 04:07:15 AM -08:00 Date:
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2 02 1 B EN EF I TS G UI DE F OR CAR E GIV E R S

AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE

LET’S GET STARTED

ALL SUMMARY OF BENEFITS COVERAGE (SBCS) CAN BE LOCATED ON

HEALTH AND WELFARE

HOW IS ELIGIBILITY FOR TIER 1 COVERAGE DETERMINED?

IF I ENROLL IN TIER 1 COVERAGE, HOW DO I MAINTAIN COVERAGE?

IF I ENROLL IN TIER 2 COVERAGE, HOW DO I MAINTAIN COVERAGE?

WHEN TIER 1 COVERAGE TERMINATES

WHEN TIER 2 COVERAGE TERMINATES

DEDUCTIONS IN ARREARS (DIA)

PRE-TAX VS. POST-TAX: WHAT DOES IT MEAN FOR ME?

QUALIFYING STATUS CHANGES AND EFFECTIVE DATES

SPECIAL ENROLLMENT RIGHTS

HOW TO DESIGNATE OR UPDATE YOUR BENEFICIARIES

VOLUNTARY LIFE INSURANCE

WEEKLY PREMIUMS — MEDICAL/PRESCRIPTION PLAN

Emergency Room Services/ Covered at 70% Covered at 70% of Allowed Benefit

AB= Allowed Benefit

Maternity Services/Newborn Care

Covered at 60% Covered at 50% Covered at 80%

AB= Allowed Benefit

PRESCRIPTION BENEFITS SUMMARY

Preferred Brand $0 $35 $40 $35

Non-Preferred Specialty Not Covered $150 $150 $150

MANDATORY GENERIC REQUIREMENT

WHAT YOU NEED TO KNOW ABOUT GENERIC DRUGS

WHAT YOU NEED TO KNOW ABOUT MANDATORY GENERIC DRUG SUBSTITUTION

THROUGH A PARTICIPATING RETAIL PHARMACY

THROUGH MAIL ORDER

MEMBERS CAN SIGN UP FOR MAIL ORDER BY:

HOW DO I OPEN UP AN ONLINE ACCOUNT AND WHAT CAN I DO WITH IT?

CVS/CAREMARK EXTRACARE HEALTH PROGRAM

CAREFIRST 24-HOUR NURSE ADVICE LINE

WEEKLY PREMIUMS – HOSPITAL BRIDGE INSURANCE PLAN

Coverage Level Traditional Enhanced Premium

Employee Only $27.70 $33.51 $41.35

In-Network Services Basic Medical Plan

Benefit Period Maximum, Lifetime Maximum Unlimited

Deductible, Out-of-Pocket Maximum, Coinsurance N/A

Office Visits Covered at 100% in-network

X-Ray & Diagnostic Imaging: Not Covered

Hospitalization, Emergency Room Services Not covered

Hospital Bridge Insurance Plan | Three Options:

WEEKLY PREMIUMS - HOSPITAL EXPENSE PROTECTION PLAN

HOSPITAL EXPENSE PROTECTION PLAN SUMMARY CHART

Emergency Room $50 per day $50 per day

WEEKLY PREMIUMS – SUPPLEMENTAL CRITICAL ILLNESS INSURANCE

Coverage Level Option 1 - $10,000 Option 2 - $20,000

Employee Only $4.07 $8.13

Employee Plus Child $5.43 $10.86

Employee Plus Spouse/Domestic Partner $8.13 $16.28

Family $9.50 $18.99

Coverage Level Option 1 – Up to $5,000 Option 2 – Up to $10,000

WEEKLY PREMIUMS – SUPPLEMENTAL ACCIDENT INSURANCE

Employee Plus Child $11.69 $13.95

Employee Plus Spouse/Domestic Partner $15.20 $18.14

Family $21.16 $25.26

Health Advocacy Services

EXAMPLES OF HOW HEALTH ADVOCATE CAN ASSIST YOU: