IT IS UNDERSTOOD AND AGREED THAT THE FOLLOWING MODIFICATIONS SHALL BE MADE:

1. The following benefit will be added to the SCHEDULE OF MEDICAL BENEFITS – BLACK PLAN section of the Plan document:

NOTES:

1. In accordance with federal law, the Plan will provide coverage for the testing of and preventive mitigation efforts for COVID-19 without any cost-sharing provisions such as Deductibles or co-payments for claims incurred beginning on March 1, 2020 and ending upon the expiration of the applicable emergency period as outlined in the Families First Coronavirus Response Act (FFCRA), as amended by the Coronavirus Aid, Relief and Economic Security (CARES) Act, as well as any later laws that amend either of those Acts directly or indirectly, in whole or in part.

2. Eligible charges for treatment of COVID-19 or any related complications caused by or related to the virus are not eligible for coverage under this benefit. Instead, when eligible for Plan coverage, such charges will be paid the same as any other Illness. Cost-sharing provisions such as Deductibles, Coinsurance, or co-payments may apply depending upon the type of service rendered.

2. The following benefit will be added to the SCHEDULE OF MEDICAL BENEFITS – ORANGE PLAN section of the Plan document:

NOTES:

1. In accordance with federal law, the Plan will provide coverage for the testing of and preventive mitigation efforts for COVID-19 without any cost-sharing provisions such as Deductibles or co-payments for claims incurred beginning on March 1, 2020 and ending upon the expiration of the applicable emergency period as outlined in the Families First Coronavirus Response Act (FFCRA), as amended by the Coronavirus Aid, Relief and Economic Security (CARES) Act, as well as any later laws that amend either of those Acts directly or indirectly, in whole or in part.

2. Eligible charges for treatment of COVID-19 or any related complications caused by or related to the virus are not eligible for coverage under this benefit. Instead, when eligible for Plan coverage, such charges will be paid the same as any other Illness. Cost-sharing provisions such as Deductibles, Coinsurance, or co-payments may apply depending upon the type of service rendered.

3. The following benefit will be added to the list of COVERED CHARGES in the
COMPREHENSIVE MEDICAL EXPENSE BENEFIT section of the Plan document:

COVID-19 Testing and Preventive Mitigation Services

In accordance with the FFCRA, as amended by the CARES Act (as well as any later laws that amend either of those Acts directly or indirectly, in whole or in part), charges for the testing of and preventive mitigation efforts for COVID-19 as follows:

1. An in vitro diagnostic test for the detection of SARS-CoV-2 virus or for the
diagnosis of COVID-19, as well as the administration of such a test if the test meets one of the following requirements:
a. The test is approved, cleared, or authorized under the Federal Food, Drug, and Cosmetic Act (FFDCA).
b. The developer of the test has requested or intends to request emergency use authorization under the FFDCA.
c. The test is developed in and authorized by a state that has notified the U.S. Department of Health and Human Services (HHS) of its intention to review tests intended to diagnose COVID-19.
d. The test has been determined by HHS to be appropriate in guidance (e.g.,
serology testing to detect antibodies against the virus that causes COVID-
19).

2. Items and services such as influenza tests and blood tests, as well as the Physician’s exam fee (when applicable) furnished during an immediate care visit, an emergency room visit, or an Outpatient provider visit (including charges for an in-person office visit, a drive-through screening and testing site, or a Telemedicine e-visit) if the visit results in an order for or administration of an in vitro diagnostic test as described above, but only to the extent the items and services relate to the furnishing or administration of the diagnostic test or to the evaluation of the individual for purposes of determining the need of the individual for such a test.

3. Other services intended to mitigate or prevent the disease (including vaccinations, when available).

4. In the MISCELLANEOUS section of the Plan document, the following paragraph will be added to the CONFORMITY WITH LAW provision:

In accordance with guidance issued by the U.S. Department of Labor and the U.S. Department of Treasury (Joint Notice and Disaster Relief Notice 2020-01), applicable deadlines mandated by the Plan will be extended in response to the current COVID-19 pandemic from March 1, 2020 until 60 days after the announced end of the National Emergency Period (Outbreak Period). Specifically, the Plan shall disregard the Outbreak Period when calculating these deadlines.

5. In the EXTENSIONS OF PARTICIPATION section of the Plan document, the FAMILY AND MEDICAL LEAVE ACT OF 1993 (FMLA) subsection will be revised to read as follows:

FAMILY AND MEDICAL LEAVE ACT OF 1993 (FMLA)

The FMLA provisions of the Plan apply during any Calendar Year when the Employer is subject to FMLA, which generally means the Employer employs 50 or more Employees (including part-time Employees) each working day during 20 or more calendar weeks in the current or preceding Calendar Year. Further, the FMLA provisions apply only to eligible Participants (i.e., generally Participants who have been employed by the Employer for at least 12 months and who have worked at least 1,250 hours in the 12-month period immediately preceding the taking of the FMLA leave; however, if applicable to the Employer and to the limited extent required by the Emergency Family Medical Leave
Expansion Act [EFMLEA], as amended by the CARES Act [as well as any later laws that amend either of those Acts directly or indirectly, in whole or in part], the definition of an eligible Participant will be extended to include a Participant that has been employed by the Employer for at least 30 calendar days if the Participant has a “qualifying need related to a public health emergency” as defined by the EFMLEA and an eligible EFMLEA leave
begins on April 1, 2020 and ends as of the expiration date specified in the FFCRA). A Participant on leave under the FMLA may continue coverage during the leave on the same basis and at the same Participant contribution as if the Participant had continued in Active Employment continuously for the duration of the leave. The maximum period of an FMLA leave is generally 12 workweeks per 12-month period (as that 12-month period is defined by the Employer). However, if a Participant takes leave under the FMLA to care for a spouse, parent, child, or next of kin injured in the line of active military duty, the maximum
period of FMLA leave is 26 workweeks per 12-month period. Other provisions regarding an FMLA leave are set forth in the FMLA and the Employer’s policy regarding the FMLA. If the Participant fails to return from the FMLA leave for any reason other than the continuation, recurrence, or onset of a “serious health condition” as defined in the FMLA or other circumstance considered by the Plan Administrator as beyond the control of the Participant, the Employer may recover any Employer contribution paid to maintain coverage for the Participant during the leave. If a Participant fails to pay any required contribution for coverage during the FMLA leave within 30 days of the due date for the
contribution, coverage shall be suspended upon 15 days advance written notification of the non-payment, subject to the right to reinstatement of coverage upon return to work from FMLA leave with no waiting period or other limitation normally applicable to a new Participant in the Plan.

6. In the DEFINITIONS section of the Plan document, the ACTIVELY AT WORK definition will be revised to read as follows:

ACTIVELY AT WORK

The term “Actively at Work” means the active expenditure of time and energy in the service of the Employer. A Participant shall be deemed Actively at Work on each day of a regular paid vacation, to the limited extent required by the FFCRA for each day of paid sick leave (beginning April 1, 2020, and only to the extent that HIPAA requires the Plan to consider the Participant to be Actively at Work), and on a regular non-working day on which the Participant is not Totally Disabled, if the Participant was Actively at Work on the last preceding regular working day.

All other provisions of the Plan shall remain in effect and unchanged.

IN WITNESS WHEREOF, the undersigned has caused this amendment to be duly adopted and effective as of March 1, 2020, unless specifically stated otherwise above.

Signature on file in Human Resources