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AUTONATION MEDICAL BENEFITS PLAN

2019 Summary Plan Description for Retail BlueCross BlueShield Self-Insured Plan Options

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AUTONATION MEDICAL BENEFITS PLAN

This booklet constitutes the written instrument under which the AutoNation Medical Benefits Plan (the “Plan”) is established and maintained (i.e., Plan Document) for purposes of ERISA section 402(a), and the Summary Plan Description (“SPD”) for the Retail Associates under the Plan.

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TABLE OF CONTENTS

Plan Overview 6 Eligibility and Enrollment 6

Who Is Eligible 6 If You Transfer From One AutoNation Location to Another AutoNation Location 6 If You Were Previously Part-Time and Become Full-Time 6 If You Were Previously Full-Time and Become Part-Time 7 If You Were Previously a Benefit Eligible Corporate Associate and Transferred into a benefit Eligible Retail Associate Position

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If You Are Rehired After Terminating Employment 7 If Your Company or Location is Acquired by AutoNation 7 If You Work for More Than One AutoNation Location 7 If You and Your Spouse Work for AutoNation 7 If You and Your Dependent Child Work for AutoNation 7 Eligible Dependents 7

Who Is Not Eligible 8 When Coverage Begins 8 Leave of Absence 8 How to Enroll 9

Medical Score Risk Predictor (MSRP) 9 MSRP Screening Deadline 9 Your MSRP Deadline If Your Company or Location Is Acquired by AutoNation 9 Your MSRP Deadline If You Experience a Qualifying Life Event (QLE) 9 MSRP Credits and Screening Results 9 If You Do Not Get Screened by the Deadline 10 MSRP Biometric Credit 10 Non-Tobacco Healthy Credit 10 Deadline to Complete Alternative Requirements to Qualify for the Healthy Credits 11 Deadline to Complete Alternative Requirements to Qualify for the Healthy Credits If Your Company or Location is Acquired by AutoNation

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Initial Enrollment 11 Annual Enrollment 12 Enrollment Change Due to a Qualifying Life Event 12

HIPAA Special Enrollment Events 13 Your Cost for Coverage 13 Working Spouse Surcharge 14

How the Plan Works 16 Your Coverage Options and Levels of Coverage 16

What the Medical Options Cover 16 Your Out-of-Pocket Costs for Medical Expenses 16

Your Annual Deductible 16 Your Copayments 17 Your Coinsurance 17 Your Out-of-Pocket Maximum 17 Medical Benefits Summary 17

Allowance 17 Other Important Factors That Affect Your Medical Benefits 18

CMS Reporting Requirements 18 Women’s Health and Cancer Rights Act 18 Newborns’ and Mothers’ Health Protection Act 18 Nonduplication of Benefits

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TABLE OF CONTENTS (CONTINUED)

If You Are Covered by Another Group Medical Plan 21 If You Recover Medical Payments From Another Party 21 Uncashed Checks 21

Medical Options 21 EPO Options 21 Locating Network Providers 22

Emergency Care 22 Emergency Admissions 22 Hospital Pre-Certification 22 Pre-Notification/Pre-Authorization Requirements 22 Specialist Care 23

HSA 23 What is an HSA 23

Tax Advantages of an HSA 23 Paying Qualified Medical Expenses through an HSA 23 HSA Eligibility 24 Opening your Health Savings Account 24 AutoNation Contribution to your HSA 25 Associate Contributions to the HSA 25 Changing your Contribution Amount 26 HSA Fees 26

Filing Your Income Tax Return 26 Investing your HSA 26 If You Terminate Employment with AutoNation or Are No Longer Enrolling in the HSA Plan 26 BlueCross BlueShield EPO Options Medical Benefits Summary 27 PPO Options 38 In-Network Benefits 38

Locating Network Providers 38 Out-of-Network Benefits 38 Emergency Care 38 Emergency Admissions 38 Hospital Pre-Certification 39 Pre-Notification/Pre-Authorization Requirements 39 Specialist Care 39 BlueCross BlueShield PPO Options Medical Benefits Summary 40

Transplantation Benefits 53 Bariatric Surgery Benefits 53 Transition of Care Under the Medical Options 53 Exclusions Under the Medical Options 54 Prescription Drug Benefits 57

Prescription Drug Plan Practices 57 Formulary Drugs 57

Generic Drugs 57 Specialty Drugs 57 Quantity Level Limits 58 How to Use the In-Network Retail Pharmacy Program 58 How to Use the Mail Service Program 58 How to Contact the Prescription Drug Network Manager 58 Out-of-Network Retail Pharmacies 58

Prescription Drug Program 58 Utilization Management Programs 59 Exclusions Under Prescription Drug Benefits 59

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Prescription Drug Program Benefits Summary 60 Claims Procedure 61 No Assignment of Health Benefits 61

Claim-Filing Deadline 61 Explanation of Benefits 61 Initial Claim 62

Urgent Claims 62 Pre-Service Claims 62 Post-Service Claims 62 Concurrent Care Claims 62 Notice of Determination 62

How to Appeal a Denied Claim 64 Eligibility Appeals 64

Dependent Verification Appeals 64 Medical Benefit Appeals 64 Prescription Drug Benefit Appeals 64

Internal Appeal Process Under The Plan 64 Urgent Claims 64 Pre-Service Claims 64 Post-Service Claims 64 Notice of Appeals Determination 65

Second Internal Review of a Denied Claim or Eligibility Appeal 65 External Review 66 Legal Action 66

When Coverage Ends 67 If You Are Granted a Leave of Absence 67

If You Terminate 67 At Other Times 67

COBRA Continuation Coverage 68 COBRA Qualifying Events and Length of Coverage 68 COBRA and Medicare 68

If You Are on Military Leave 68 If You or Your Dependent is Disabled 68

Electing COBRA 69 Your Cost for COBRA 69

COBRA Continuation Coverage Payments 70 When COBRA Continuation Coverage Ends 70 Other Important Information 71 No Guarantee of Employment 71

Future of the Plan 71 Statements Made by AutoNation 71 Plan Administrator 71 HIPAA Compliance 71 Network Manager Quality Assessment 74 Security Measures 74 Right to Recover Overpayment 74 Subrogation & Reimbursement 74 BlueCard Program 75 Summary of Benefits and Coverage (SBC) 76 Important Definitions 77

Your Rights Under ERISA 82 Notice Regarding Wellness Program 83 Protections from Disclosure of Medical Information 84 Authorization for Release of Information 85 Administrative Information 87

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PLAN OVERVIEW

ELIGIBILITY AND ENROLLMENT

The AutoNation Medical Benefits Plan (‘the Plan”) is a major component of your benefits package that offers you and your family valuable coverage and provides certain preventive care benefits to help keep you well. You have a choice of several medical coverage options, depending on the local area in which you reside. The options cover a wide range of benefits including benefits for covered medical services, certain preventive care, mental health and substance abuse treatment, and prescription drugs.

AutoNation pays a major portion of the cost of your medical coverage. Your cost for coverage and your total out-of-pocket costs differ depending on the option you elect.

If you enroll for medical coverage under the plan, you may also elect coverage for your Eligible Dependents, as defined in the Plan, under the same medical option as you elect for yourself. Refer to “Your Coverage Options and Levels of Coverage.”

Who is Eligible

You are eligible to participate in the Plan if you are a regular, Full-Time, Retail Benefits Eligible Associate of AutoNation who is regularly scheduled to work at least 30 hours each week. See “When Coverage Begins.”

If you work under the provisions of a collective bargaining agreement, you are eligible to participate only if your agreement specifically provides for benefits under the AutoNation policies and plans.

If You Transfer From One AutoNation Location to Another AutoNation Location

If you transfer from one AutoNation location another, your eligibility status transfers with you to your new location.

If you were enrolled in benefits at your previous location, you maintain the coverage you had in effect when you transfer as long as the medical option is available in the new location. If the option you were enrolled in at your previous location is not available in the new location, you will be automatically enrolled in the designated default option and you have will have 31 days from the date on the confirmation statement to change to another option.

If you are eligible after the transfer, but were not previously eligible for benefits, the time you were employed Full-Time at your previous location will be counted toward the benefit eligibility (waiting) period at your new location.

If You Were Previously Part-Time and Become Full-Time

If you were previously a Part-Time, contract, or temporary Associate and you become a Full-Time Associate, your prior service will not be credited to your benefit eligibility (waiting) period. You will have to satisfy the new hire waiting period for benefits.

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ELIGIBILITY AND ENROLLMENT (CONTINUED)

If You Were Previously Full-Time and Become Part-Time

If you were previously Full-Time and become Part-Time, you will no longer be eligible for benefits as of the date you become Part-Time.

If You Were Previously a Benefit Eligible Corporate Associate and Transferred into a Benefit Eligible Retail Associate Position

If you transfer from a benefit eligible Corporate position to a Retail Benefit Eligible position and previously met the waiting period under the Corporate Plan, your Effective Date of coverage under the Retail Plan will be the date of your transfer. If you had not met the waiting period under the Corporate Plan, your Effective Date of coverage will be determined under the Retail Plan’s eligibility provisions. You will receive credit for any hours worked as a Full-Time Associate under the Corporate Plan.

If You Are Rehired After Terminating Employment

Rehired within 13 weeks: If you are rehired after terminating employment at an AutoNation location you will be reinstated in the same medical benefits that you were enrolled in and had in effect before your termination – if available – unless you are rehired by a location with different benefit options. If you terminate your employment at an AutoNation location prior to your benefit Effective Date and are rehired, your benefit Effective Date will be your original benefit Effective Date or your rehire date, whichever is later. If you terminate and are hired in a subsequent plan year, you will be given an opportunity to enroll in a medical Plan upon rehire.

Rehired after 13 weeks: If your rehire occurs more than 13 weeks after your termination, you will be required to satisfy the new hire eligibility (waiting) period before you are eligible for benefits. See “When Coverage Begins.”

If Your Company or Location is Acquired by AutoNation

If your company or location is acquired by AutoNation, you will be eligible for AutoNation benefits on the date established for the transition to the AutoNation Plan (AutoNation will notify you of your benefit Effective Date).

If You Work for More Than One AutoNation Location

If you work for more than one AutoNation location and you meet the eligibility requirements, you may enroll for benefits only at one location.

If you work Full-Time at one location and Part-Time at another location, you can be covered only by the benefits provided by your Full-Time location.

If you work Part-Time at more than one AutoNation location, the hours from your two Part-Time jobs will be combined to meet the Full-Time eligibility requirements for benefits. You will be offered the benefit Plan of the location that first hired you. It is your responsibility to notify the location that first hired you of your combined Part-Time hours, so that your benefit eligibility status can be updated.

If You and Your Spouse Work for AutoNation

If you and your spouse are eligible for the Plan and AutoNation employs both of you, either or both of you may enroll as Associates, or one of you may be covered as a dependent of the other. If both of you enroll as an Associate, one of you may enroll your children, provided they satisfy the definition of “Eligible Dependents.” You cannot be enrolled as an Associate and a spouse at the same time.

If You and Your Dependent Child Work for AutoNation

If you and your dependent child work for AutoNation, your dependent child cannot be enrolled as an Associate and as a dependent at the same time.

Eligible Dependents

Your Eligible Dependents for coverage include your spouse and children who meet the definition of “Eligible Dependents” in “Important Definitions.”

You must provide the appropriate supporting documentation by the deadline before coverage for any Eligible Dependent will become effective.

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It is your responsibility to certify that each of your enrolled dependents continues to meet all of the eligibility requirements to participate in the Plan as described in “Eligible Dependents” in “Important Definitions.”

Further, it is your responsibility to recertify your dependent(s) if they are selected for a random dependent audit. You must notify The Benefit Connection of any changes in the status of a dependent prior to or by the change date.

You must also certify that you understand that any fraudulent statement, falsification, or material omission of information made in connection with your dependent enrollment under the Plan would violate AutoNation’s ethical code and will be considered an act of fraud or intentional misrepresentation of material fact, as prohibited by the terms of this Plan. The Plan may retroactively rescind coverage as a result. The Plan reserves the right to conduct random claims audits paid on behalf of ineligible dependents or otherwise paid due to fraudulent acts or omissions on your part.

Who Is Not Eligible

You are not eligible for benefits if any of the following applies to you:

An Associate covered under the Corporate or Non-Retail group

A Part-Time Associate, classified as such upon hire, and regularly scheduled to work less than 30 hours each week

An Associate subject to collective bargaining, unless the Plan is specifically included in the bargaining agreement

A temporary or seasonal Associate, unless you work enough hours to become benefits eligible

A leased Associate

A contract Associate

An Associate employed by a location that does not participate in the Plan

An Associate who is a nonresident alien receiving no earned income from sources within the United States

When Coverage Begins

If you are a new Associate, provided you enroll yourself and your Eligible Dependents when you are first eligible to participate in the Plan, your coverage under the Plan is effective the first day of the fourth month after the month in which you were hired. However, if you are hired on the first day of a month, your coverage under the Plan is effective the first day of the third month after the month in which you were hired.

Coverage for your Eligible Dependents is effective when your coverage begins if you enroll your dependents and certify them with The Benefit Connection by the deadline. Otherwise, your dependents will be covered when they first become eligible or on the Qualifying Life Event date if you enroll them timely and submit proper documentation in support of the life event. See “Enrollment Change Due to a Qualifying Life Event.”

Leave of Absence

If you are on an approved Leave of Absence during your benefit eligibility (waiting) period, coverage begins on the date you would have become eligible had you been an active Associate during your eligibility (waiting) period. If you do not enroll, you will be assigned to “no coverage."

If you are enrolled in benefits and then go out on an approved Leave of Absence, you will be direct billed at the home address that is on file for you at The Benefit Connection. You will be billed on an after-tax basis the same amount that you would have paid as a contribution from your paycheck if you were an active Associate. If you do not make any after tax payments while you are on leave, your benefits will be terminated retroactive to your Leave of Absence start date. If you fail to continue to make timely after-tax payments via direct bill, your benefits will be terminated retroactive to the last date you paid in full. For the period you are on leave you must pay your required contributions in full by the due date specified on the direct bill (partial payments are not accepted). Loss of coverage due to nonpayment is not considered a qualifying event under the federal law, known as COBRA (the Consolidated Omnibus Budget Reconciliation Act).

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When you return to work from an approved leave, your coverage will be reinstated, as of your return to work date, even if you lost coverage due to nonpayment. Payments for benefits for the dates you were on leave will not be automatically deducted from your paycheck upon your return to work.

After you have been on an approved Leave of Absence for six months and if you had coverage immediately prior to and/or during your leave, COBRA continuation coverage will be offered to you. If you return to work on your scheduled return to work date, your COBRA coverage will end, and your coverage that was in place prior to your Leave of Absence, if available, will be reinstated effective the day you return to work.

How to Enroll

You may enroll in benefits at the following times:

Initial enrollment, which occurs when you are hired and first become eligible for benefits

Annual Enrollment, an enrollment period held once a year as determined by AutoNation

An enrollment change permitted within 31 days of a Qualifying Life Event (within 60 days if you become eligible for Medicare/Medicaid/CHIP and 90 days for divorce)

Or HIPAA Special Enrollment Event

Medical Score Risk Predictor (MSRP)

You will have an opportunity to complete the MSRP biometric screening administered by Quest Diagnostics, Inc. The MSRP screening is an assessment of 5 biometric factors* that affect your health and predict your risk for certain conditions.

MSRP Screening Deadline

The deadline to be screened is the end of the month in which your benefits become effective. The same screening period applies for your spouse if you are covering your spouse on your medical coverage.

Example: If you were hired on January 3, your benefits would be effective on May 1. You MSRP Screening deadline is May 31.

*Your spouse’s MSRP Biometric screening will include a cotinine (nicotine) screening.

Your MSRP Deadline If Your Company or Location Is Acquired by AutoNation

You will have 60 days from the date your AutoNation benefits become effective to be screened unless a different number of days is established for the transition. The same screening period applies for your spouse if you are covering your spouse on your medical coverage.

During the 60-day period, you will receive the MSRP healthy credit discount if you enroll in medical and/or additional life or spouse life insurance. If you are not screened within this 60-day period, your credit will not apply going forward.

Your MSRP Deadline if You Experience a Qualified Life Event (QLE)

If you experience a QLE, and you and/or your spouse were not previously enrolled in medical benefits under the Plan prior to the QLE, you and/or your spouse will have 60 days following your QLE date to be screened and complete the alternative requirements (if applicable). See “Deadline to Complete Alternative Requirements to Qualify for the Healthy Credits” for additional information on alternative requirements.

MSRP Credit and Screening Results

Your MSRP screening results are confidential. By registering for and participating in the MSRP screening, your individual test results will be shared with certain contracted third parties, including, but not limited to, insurance carriers and AutoNation Benefit Plan consultants.

Your data will be transferred securely and confidentially to contracted third parties for the purpose of processing your screening results, compiling aggregate statistics, and determining if healthy credits apply to you and/or your spouse. In order to be eligible for healthy credits, you must fully participate in all required screening components and testing procedures. AutoNation will not receive any individual data from Quest Diagnostics, Inc.

You and/or your spouse will receive an email notification from Quest Diagnostics, Inc. with a link to view the lab results online. The Pass/Fail indicator will be provided to The Benefit Connection within two weeks of you receiving your results from Quest Diagnostics.

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If you do not get screened by the deadline:

You will not receive the MSRP healthy credits (25% off the Associate portion of the premium for you biometric screening and 15% off the spouse portion of the premium for your covered spouse’s biometric screening).

Additionally, your spouse will not be eligible for the Non-Tobacco Healthy Credit (10% off the spouse portion of the medical premium)

MSRP Biometric Credit

The MSRP biometric screening measures:

Blood Pressure

HDL Cholesterol

Triglycerides

Glucose 3

Body Mass Index (BMI)

If, based on your MSRP biometric screening results, you pass 3 out of 5 screening components you will receive the 25% biometric healthy credit off the Associate portion of the medical cost of coverage. If your covered spouse passes 3 out of 5 screening components you will receive the 15% biometric healthy credit off the spouse portion of the medical cost of coverage.

If you do not pass the MSRP screening, you can receive the same healthy credit by calling the MSRP Health Advisor and discussing your results. Visit www.KnowYourBenefits.org for more information.

The same process applies for your covered spouse if your spouse did not pass the MSRP biometric screening.

Non-Tobacco Healthy Credit

During your online enrollment, you will have the option to indicate whether or not you use Tobacco Products. You may also select “Prefer Not to Answer.”

If you do not use tobacco, you will receive the 20% non-tobacco healthy credit off the Associate portion of the medical cost of coverage. Your spouse’s MSRP biometric screening will include a screening for cotinine (nicotine). If your covered spouse’s cotinine screening results are negative you will also receive the 10% non-tobacco healthy credit off the medical cost of coverage for your spouse.

If you and/or your covered spouse are a tobacco user, you and/or your covered spouse may still receive the non-tobacco healthy credit by completing a free tobacco cessation course online through AutoNation. Go to www.KnowYourBenefits.org for instructions on how to access the course. You must go through all modules and print your certificate of completion. You must send your certificate of completion together with the Tobacco Cessation Affidavit form by the deadline stated on the form. You can access this form by going to

www.KnowYourBenefits.org.

The same process applies for your covered spouse if your spouse is a tobacco user.

During your enrollment you will be asked to agree to consent language online including, but not limited to certifying that all information you provide is correct and that you understand that misstatements, misrepresentations, or omissions may be considered an intentional misrepresentation of material fact and may result in retroactive removal of non-tobacco credits (and recoupment of said amounts from you) or your coverage being canceled as of its effective date. Additionally, the consent language will state that you understand that providing false information may subject you to disciplinary action, up to and including termination and that you understand that any person who knowingly provides false, incomplete or misleading facts or information to any insurer may be found guilty of insurance fraud, which is a crime, and may be subject to both civil and criminal penalties.

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Additionally, the consent indicates that AutoNation may gather information from other sources including, but not limited to, workers’ compensation, FMLA or disability intake to validate your responses, and such data may be used to initiate an investigation into your responses and may result in imposition of the penalties set forth above.

By accepting consent, you agree that by registering for and participating in the AutoNation MSRP biometric screening program, and responding to the tobacco question online you understand and agree that your individual test results and responses to the online tobacco question will be shared with certain contracted third parties, as permitted by HIPAA and other applicable law, including, but not limited to, insurance carriers and AutoNation Benefit Plan (“Plan”) consultants. You also agree that you are providing consent to the secure and confidential transfer of your test results and tobacco response, as permitted by HIPAA and other applicable law, to contracted third parties for the purpose of enhancing patient care services, assisting with Plan communications and/or Plan administration and management and processing your screening results and determining which healthy incentive credits apply to you.

PLEASE NOTE: If you did not actively re-enroll and instead defaulted into coverage for any subsequent plan year, all of the above consents and acknowledgments will be deemed to apply to your default re-enrollment.

Deadline to Complete Alternative Requirements to Qualify for the Healthy Credits

If you and/or your covered spouse did not pass the MSRP biometric screening and/or either of you is a tobacco user, you and/or your covered spouse have until the end of the month in which your benefits become effective to complete your alternative requirements.

Deadline to Complete Alternative Requirements to Qualify for the Healthy Credits if Your Company or Location is Acquired by AutoNation*

If you and/or your covered spouse did not pass the MSRP biometric screening, each of you will have 30 days, following the initial 60 days you had to be screened, to complete the MSRP Health Advisor call unless a different number of days is established for the acquisition transition. If you do not complete the alternative requirements, the MSRP biometric healthy credit that you were automatically given during the initial 60-day period, will cease. If you’re a tobacco user, you will have 30 days from your benefit Effective Date to submit documentation that you have completed your alternative requirements. If your covered spouse is a tobacco user (based on the results of the cotinine screening), your spouse will have 30 days, following the initial 60 days they had to be screened, to submit documentation that they completed the alternative requirement. These timeframes may change if a different number of days is established for the acquisition transition. If you and/or your covered spouse complete the alternative requirement(s) by the deadline, the healthy credits will be retroactively applied.

*The timing specified in this section will control unless different timing is communicated as part of the transition.

Initial Enrollment

Prior to becoming eligible for benefits, you will receive notification that you can enroll online at www.KnowYourBenefits.org. You must enroll online before the deadline indicated on the enrollment site. Contact The Benefit Connection at 1-877-550-BENE (2363) if you have questions concerning your online enrollment.

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The elections you make will be effective the first day of the fourth month after the month in which you were hired. However, if you are hired on the first day of a month, your coverage under the Plan is effective on the first day of the third month after the month in which you were hired.

If you don’t enroll by the deadline indicated on The Benefit Connection website, your next opportunity to enroll will be during the next Annual Enrollment period, unless you experience a Qualifying Life Event during the Plan Year.

Annual Enrollment

Each year during Annual Enrollment, you may add, drop or change your current coverage option for the next Plan Year.

Before the Annual Enrollment period, you will be notified to log on to the benefit website at www.KnowYourBenefits.org.

To change your benefit elections, you must enroll online before the announced deadline. Contact The Benefit Connection at 1-877-550-BENE (2363) if you have any questions concerning your online enrollment. The elections you make during the Annual Enrollment period will be effective for the following Plan Year, beginning January 1. If you do not actively enroll, your coverage will be defaulted according to the default rules for that Plan Year.

Prior to Annual Enrollment, the MSRP Screening deadline requirements will be communicated to you.

Enrollment Change Due to a Qualifying Life Event

If you are covered under the Plan, you may change your medical coverage if you experience certain Qualifying Life Events. If you are eligible and not currently enrolled, you may enroll in medical coverage if you experience one of these Qualifying Life Events, Contact The Benefit Connection if you have any questions regarding your Qualifying Life Event.

Because you can pay for coverage on a pre-tax basis, certain federal income tax advantages apply to you. As a result, the Internal Revenue Service (IRS) sets certain restrictions on when you can make or change your pre-tax elections. Specifically, the elections you make during your initial or Annual Enrollment period must remain in effect for the entire Plan Year following the date you become eligible for coverage under the Plan.

If you experience a change in certain family or employment circumstances, you may enroll or change your benefits to fit your new situation without waiting for the next Annual Enrollment period. Any request to change your benefits must be consistent with the Qualifying Life Event. The following are Qualifying Life Events:

Marriage

Divorce, legal separation or annulment

Birth, adoption or placement for adoption of a child

Death of your spouse or a dependent

Change in eligibility status of a dependent

Loss or gain of your spouse or dependent’s employment

Change in your spouse or your dependent’s employment status, which includes a switch between Part-Time and Full-Time employment, a strike or lockout

Significant change in the coverage provided to you, your spouse or your dependent

A change in your place of residence or work, or that of your spouse or a dependent that affects your coverage

You first become eligible for Medicare/Medicaid/CHIP coverage

You, your spouse, or your dependents originally decline coverage under this Plan due to coverage under another group health plan, and you, your spouse, or your dependents lose that coverage due to exhaustion of COBRA, loss of eligibility (for example, due to a divorce or a dependent reaching age 26), or because Employer contributions toward that coverage were terminated

A HIPAA Special Enrollment Event

You may be required to cover a dependent if you are subject to a Qualified Medical Child Support Order (QMCSO). If a QMCSO applies to you, you will be notified.

In some cases (e.g., your child becomes ineligible or you divorce), you, your spouse, or your child, may need to arrange for COBRA continuation coverage, if it applies. See “COBRA Continuation Coverage” for details.

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You must notify the Benefit Connection within 31 days of the life event (within 60 days if you become entitled to Medicare/Medicaid/CHIP and 90 days for a divorce) and submit proper documentation in support of it to change your current coverage during the Plan Year. If you do not notify the Benefit Connection within 31 days (within 60 days if you become entitled to Medicare/Medicaid/CHIP and 90 days for a divorce), you will have to wait until the next Annual Enrollment period to make a change for the next Plan Year. In addition, you may be required to provide documentation, by the deadline, regarding the date of your status change. Intentionally providing false information may be considered grounds for termination of employment or other legal action.

Note that in case of legal separation, divorce, death or loss of dependent status, the Plan reserves the right to terminate coverage for the ineligible individual at any time on a retroactive basis, to the extent permitted by law. Different time periods may apply for HIPAA Special Enrollment events.

Any change request must be consistent with your life event. As a result of a Qualifying Life Event, you may elect to add, drop, or change your current coverage, or change your current coverage option under the Plan.

Your coverage change request, including any change in payroll deductions, will be effective on the date of the Qualifying Life Event (e.g., the date of your marriage or the date of your child’s birth) provided The Benefit Connection approves your request. You will be responsible for any retroactive benefit premiums owed if you added coverage or had an increase in coverage.

By requesting this change, you certify that the information provided is true and correct. Any fraudulent statement, falsification or material omission of information may you to discipline up to and including termination of employment.

HIPAA Special Enrollment Events

Under the Health Insurance Portability and Accountability Act (HIPAA), you may also have a right to a special enrollment in medical coverage under the Plan (e.g., if you lose other coverage or acquire a dependent). These events include:

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this Plan if you or your dependents lose eligibility for that coverage (or if the Employer stops contributing toward your or your dependents’ other coverage). You must request enrollment within 31 days of the loss of eligibility for that coverage.

If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself, your spouse, and/or your new Eligible Dependent. You must request enrollment within 31 days of the acquisition of the new dependent.

If you or a dependent are no longer eligible for coverage under Title XIX of the Social Security Act (Medicaid) or a state children’s health plan under Title XXI of the Social Security Act, or if you or a dependent become eligible for assistance for plan coverage under Medicaid or a state children’s health insurance plan, you may be able to enroll yourself or your dependent. You must request enrollment within 60 days of the prior coverage terminating or becoming eligible for assistance. Such coverage will be effective upon the date you enroll in the Plan.

See the Qualifying Life Events section above for more information.

Your Cost for Coverage

AutoNation pays a major portion of the cost of your medical benefits coverage.

The cost for medical benefits coverage is set each year based on the following factors, among others:

Competitive market

Copayments, Coinsurance, Annual Deductibles, and Out-of-Pocket Maximums

Number of individuals covered

Utilization and medical claims experience of the Plan

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Annual premium credit for passing the MSRP biometric screening or completing the alternative by the deadline

Annual premium credit for not using Tobacco Products or completing the tobacco cessation course and submitting the course completion certificate and affidavit by the deadline

Your cost for coverage under the Plan also depends on the level of coverage and the medical option you elect. Refer to the benefit website at www.KnowYourBenefits.org for the required contributions. *

You pay your portion of the cost for coverage with Pre-Tax contributions. The cost may increase or decrease at the beginning of the any Plan Year, January 1, as determined by AutoNation.

AutoNation provides a competitive subsidy for Associates’ medical benefits. The amount of the AutoNation subsidy for medical coverage varies between Plan options and medical markets. In some situations where an Associate (and their covered spouse, if applicable) does not take full advantage of all the healthy credit incentives or is subject to the Working Spouse Surcharge, the Associate cost for coverage may exceed the actual or projected cost of the coverage for that specific Plan choice.

Pre-Tax contributions are deducted from your pay each pay period before federal, Social Security, and most state and local taxes are withheld. This reduces your taxable income and your net cost. Your Social Security benefit at retirement could be slightly reduced as a result. However, the tax savings usually offset the reduction.

During the Plan Year, your cost for coverage will be increased or decreased if either of the following events occur:

You transfer to another location with required contributions that differ

* If you complete the MSRP Screening but do not enroll in AutoNation medical coverage, you will not receive the annual credit. No cash will be given in lieu of the premium credit.

You have Qualifying Life Event or HIPAA Special Enrollment Event and experience a change in the level of coverage. For example, if you are married during the Plan Year and add your spouse to coverage, the required contribution will change to the “You Plus Spouse” level instead of the “You Only” level of coverage.

If you are enrolled in benefits and then go out on an approved Leave of Absence, your will be direct billed at the home address that is on file for you at The Benefit Connection. You will be billed on an after-tax basis the same amount that you paid as a contribution from your paycheck if you were an Active Associate. If you do not make any after tax payments while you are on leave, your benefits will be terminated retroactive to your Leave of Absence start date. If you fail to continue to make timely after-tax payments via direct bill, your benefits will be terminated retroactive to the last date you paid in full. For the period you are on leave you must pay your required contributions in full by the due date specified on the direct bill (partial payments are not accepted). When you return from an approved leave, your coverage will be reinstated as of your return to work date, even if your loss of coverage was due to nonpayment. Payments for benefits for the dates you were on leave will not be automatically deducted from your paycheck upon your return to work.

Working Spouse Surcharge

If you enroll your spouse in the Plan, during your initial Enrollment, Annual Enrollment or as a result of a Qualified Life Event during the year, you will be required to select the appropriate response to the Working Spouse Surcharge question in the online enrollment system. Failure to respond will result in your being automatically charged the Working Spouse Surcharge if you enroll your spouse under the Plan.

A premium surcharge will be charged for a spouse covered under the AutoNation medical Plan if the spouse is eligible for coverage under their employer’s medical benefits coverage. The premium surcharge will not apply if you indicate during your online enrollment:

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Your spouse is self-employed Your spouse is an AutoNation employee Your spouse is not employed Your spouse’s employer completes the Working Spouse

Surcharge form verifying the spouse is not eligible for their employer’s medical benefits coverage and the form is returned and approved by The Benefit Connection on or before the deadline.

If, after being enrolled, your spouse becomes eligible under their employer’s medical coverage you must notify the Benefit Connection within 31 days of your spouse becoming eligible. The Working Spouse Surcharge will be applied to your spouse’s medical premium if you continue to cover your spouse under the AutoNation Plan.

If, after being enrolled, your spouse loses eligibility under their employer’s medical coverage you have 31 days after the loss of eligibility to notify The Benefit Connection for the Working Spouse Surcharge to be removed. If you do not notify The Benefit Connection within 31 days, the Working Spouse Surcharge will remain in effect for the remainder of the Plan Year.

If your spouse is selected for a random dependent audit and it is determined that your spouse is eligible for coverage under their employer’s medical plan which was not previously disclosed to The Benefit Connection, the Working Spouse Surcharge will be applied retroactively, as permitted by law, back to the date your spouse became eligible for their employer’s coverage or the first day of the current Plan Year, whichever is earlier.

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HOW THE PLAN WORKS

Your Coverage Options and Levels of Coverage

When you first become eligible and/or experience a Qualifying Life Event and once each year during Annual Enrollment, you will be given the opportunity to choose one of the many AutoNation options. You will be able to elect from:

PPO or EPO options; or

No medical coverage through AutoNation

If you enroll for medical coverage when you become eligible or experience a Qualifying Life Event, you may also elect to cover your Eligible Dependents. There are ten levels of coverage from which to choose:

You Only

You plus Spouse

You plus Spouse and 1 Child

You plus Spouse and 2 Children

You plus Spouse and 3 Children

You plus Spouse and 4 or more Children

You plus 1 Child

You plus 2 Children

You plus 3 Children

You plus 4 or more Children

What the Medical Options Cover

The medical options each cover a wide range of benefits including all of the following:

Benefits for Medically Necessary services, as defined by the Plan, Covered Medical Expenses and certain preventive care services even if not Medically Necessary

Mental health and substance abuse treatment

Prescription drug benefits

The Plan will pay benefits only for medical conditions that meet all of the following requirements:

Medically Necessary except as provided for certain preventive care services

Not job-related

Treated or prescribed by a licensed or certified provider acting under applicable State Law

Not specifically excluded by the Plan

Covered services for the medical options are described in detail in “Medical Options.”

Covered services for prescription drug options are described in detail in “Prescription Drug Benefits.”

Your Out-of-Pocket Costs for Medical Expenses

Your cost for medical coverage and your Out-of-Pocket Covered Medical Expenses – Annual Deductible, Copayments, and Coinsurance amounts – are different under many of the options. Refer to the “Medical Benefits Summary” charts for details.

The prescription drug program has a separate Annual Deductible in 2 of the options- the Blue Cross 80% with Copays and the Blue Cross 90% with Copays. Prescription Drug Out-of-Pocket amounts apply to your Medical Out-of-Pocket Maximum as described in “Prescription Drug Benefits.” The Annual Deductible in the Blue Cross 70% with HSA option is combined with the overall medical Annual Deductible.

Your Annual Deductible

Your Annual Deductible, if required by your option, is the amount you must spend for Covered Medical Expenses each Plan Year, January 1 – December 31 (or your coverage period, if shorter), before the Plan pays benefits. After the individual Annual Deductible is met, the Plan pays a certain percentage of Covered Medical Expenses incurred by that individual.

Associates who have enrolled themselves and one or more Eligible Dependents in the Plan will not pay more than the “family” Annual Deductible before benefits are payable under the Plan for Covered Medical Expenses for family members. In order to meet the family Annual Deductible, two or more covered family members must each contribute to meeting the family Annual Deductible during the Plan Year. If that occurs, any other covered family members will not have to satisfy an Annual Deductible for the rest of the Plan year for Covered Medical Expenses before the Plan pays benefits.

The Annual Deductible contributed by any one family member toward the total family Annual Deductible will not exceed the “individual” Annual Deductible amount.

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HOW THE PLAN WORKS (CONTINUED)

The Annual Deductible amounts are combined for both in-network and out-of-network covered medical services under the PPO option.

Prescription drug out-of-pocket expenses that you may pay will not apply to your individual or family medical Annual Deductible in the Blue Cross 80% or 90% options. In the Blue Cross 80% and 90% options, there is a separate prescription drug deductible. Prescription drug out-of-pocket expenses that you may pay will apply to your individual or family medical Annual Deductible in the Blue Cross 70% option.

Your Copayments

Your Copayments, if required by your option, are the flat dollar amounts you must pay to the provider at the time services are received, for example, for certain in-network doctor’s office visits. For medical, the Copayment applies regardless of whether you have met your Annual Deductible. For prescription drugs, the Copayment applies after your Annual Deductible or prescription drug deductible is met. The Copayment varies based on the type of Covered Medical Expense and/or place of service.

Your Coinsurance

Your Coinsurance, if required by your option, is the specific percent of the Allowance that you must pay for certain Covered Medical Expenses after your Annual Deductible, if applicable, has been met.

Your Out-of-Pocket Maximum

The Out-of-Pocket Maximum is the most you will spend of your own money on Covered Medical and Prescription Drug Expenses in a Plan Year. Your Out-of-Pocket Maximum is based on the medical option you choose. Refer to the Out-of-Pocket Maximum in the “Medical Benefits Summary” charts.

The individual Out-of-Pocket Maximum is the most that will apply to any one family member. After you or any covered Eligible Dependents reach the individual Out-of-Pocket Maximum, the Plan pays 100 percent of that person’s Covered Medical and Prescription Drug Expenses for the rest of the Plan Year. After your family Out-of-Pocket Maximum is reached (by two or more individuals), the Plan pays 100 percent of Covered Medical and Prescription Drug Expenses for the rest of the Plan Year for you and your covered Eligible Dependents.

The Out-of-Pocket Maximum amounts are combined for both in-network and out-of-network services under the PPO medical options.

Example:

Bill goes Out-of-Network for an eligible service and the total charge by the doctor is $1,000. The Allowance reported on the claim is $200. The $200 Allowance is credited to the Out-of-network deductible and to the In-network deductible. This logic is also applied to the Out-of-Pocket on the plan.

Any cost sharing amount incurred for a Covered Medical and Prescription Drug Expense counts toward your Out-of-Pocket Maximum.

Regardless of which medical option you elect, the Out-of-Pocket Maximum does not include any of the following:

Amounts above what is determined to be Medically Necessary

Amounts above the Allowance as determined by the

Claims Administrator

Amounts above the specific limits of the Plan

Any cost difference between brand name and generic drugs that apply to prescription drug benefits

Expenses for medical services, treatment and/or supplies that are not covered under the Plan

Medical Benefits Summary

The “Medical Benefits Summary” chart for each of the medical options includes the Plan Year individual and family Annual Deductibles (if applicable), Out-of-Pocket Maximums, and the required Copayments and/or Coinsurance amounts that you pay in addition to what the Plan pays for Covered Medical Expenses. The Plan does not provide benefits for services that are not Medically Necessary (except for certain preventive care services), Experimental or Investigational, or performed for cosmetics purposes, or that provide custodial or domiciliary care. Not all Medically Necessary Services are covered. Refer to “Exclusions Under the Medical Options” for more information.

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Allowance

The Claims Administrator determines an Allowance or limit on a charge for Covered Medical Expenses, based on medical practices in your region. Benefits under the Plan are based on the amount charged up to the Allowance for a particular medical service that is performed.

Other Important Factors That Affect Your Medical Benefits

CMS Reporting Requirements

The Centers for Medicare & Medicaid Services (CMS) is the federal agency that oversees the Medicare program. Many Medicare beneficiaries have other private group health plan (GHP) coverage in addition to their Medicare benefits. There are federal rules that determine whether Medicare or the other GHP coverage pays first.

Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), a federal law that became effective January 2009, requires that group health insurance plans, certain claims processing third-party administrators, and certain Employer self-funded/self-administered plans report specific information about covered individuals who may be eligible for Medicare.

This reporting is to assist CMS and other health insurance plans to properly coordinate payment of benefits among plans so that your claims are paid promptly and correctly.

CMS requires plans to report data that includes Social Security Numbers (SSN) effective January 1, 2010. If Plans do not comply they will be fined $1,000/day for each individual not reported as required by law.

You and your covered Eligible Dependents must have a SSN on file with The Benefit Connection to be enrolled in medical coverage. If your dependent does not have a SSN you can complete the CMS form available through The Benefit Connection.

If you are adding a child to your AutoNation medical coverage, who is 120 days old or less on the date you are adding them to coverage, the system will let you add the child without having to enter his/her SSN. An annual solicitation will be performed to solicit any missing dependent SSNs. If you do not provide the SSN or complete the CMS form within the time frame outlined in the letter and emails you receive, your dependent will be

dropped from coverage effective October 1st of that year.

Women’s Health and Cancer Rights Act

The Plan covers certain breast reconstruction benefits in connection with a mastectomy. If you elect breast reconstruction in connection with a mastectomy, coverage is available in a manner determined in consultation with you and your Physician for any of the following:

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

Prosthesis and treatment of physical complications during all stages of the mastectomy including lymphedemas

Coverage for breast reconstruction is subject to the same Annual Deductibles, Copayments, and Coinsurance that apply to other covered medical and surgical services provided under the medical options.

Newborns’ and Mothers’ Health Protection Act

The Plan does 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 normal vaginal delivery or less than 96 hours following a cesarean section. However, the newborn’s attending provider, after consulting with the mother, may discharge the mother or newborn earlier than 48 hours (or 96 hours as applicable).

In addition, the Plan will not require that a provider obtain authorization from the Plan or MyQHeatlh for a length of stay of less than the above time frames. In order to ensure benefit coverage under the Plan for the newborn’s services, notify The Benefit Connection of the Qualified Life Event and provide supporting dependent certification documentation to enroll your newborn within 31 days of your child’s date of birth.

Nonduplication of Benefits

The Plan may pay benefits if you, your spouse, or your covered dependent children are eligible for benefits under more than one plan. This is called “Nonduplication of Benefits.” Your AutoNation medical benefits are coordinated with benefits from any of the following:

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Other employers’ plans Government plans

Motor vehicle plans required by law, including no-fault plans

Benefits under the Plan when combined with benefits from other plans will not exceed what the Plan would pay by itself.

When an individual is covered by two plans, one plan pays benefits first (the “primary plan”), while the other (the “secondary plan”) considers what the primary plan paid and pays benefits as the secondary plan if any are payable. Benefits from the secondary plan are coordinated so that payments from all plans do not exceed what the Plan would pay in the absence of other coverage. If the Plan is the secondary plan, this is accomplished by first calculating the benefits payable from the Plan as if no other plan were involved and then subtracting the amount payable from the primary plan. The excess, if any, then is paid by the Plan. If you are covered by motor vehicle plans, the other plan is always the primary plan, and this Plan is always the secondary plan where permitted by law.

Example of How Nonduplication of Benefits Works

You are enrolled under the Blue Cross 80% with Copays option for “Associate plus Spouse” level of coverage. Your spouse is also covered by another group medical plan through his or her employer. The other group medical plan is primary for your spouse and pays 75 percent of a covered expense. For that same expense, the Blue Cross 80% with Copays option pays 80 percent. To calculate your payment from the Blue Cross 80% with Copays option, take the Plan benefit of 80 percent less the other plan’s benefit of 75 percent.

See Column A below.

In this example, the Blue Cross 80% with Copays option would pay 5 percent. This brings your total payment up to 80 percent, which is what the Blue Cross 80% with Copays option would have paid by itself.

If the other plan paid 85 percent or more of the expense, the Blue Cross 80% with Copays option would not pay any benefit. See Column B below.

A B Medical Expenses total $1,500 $1,500 PPO option would pay $1,200 $1,200 Other plan actually pays -$1,125 -$1,275 Blue Cross 80% option then will pay1 $75 $0 1 After any annual Deductibles, Copayments or Coinsurance

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How to Determine Which Medical Plan Pays First

Medical expense is for: AutoNation Plan is: Spouse’s/Child’s plan is: You Primary Secondary Your Spouse Secondary Primary Your children1 Primary if your birthday (month/day

only) occurs earlier in the year than that of your spouse

Secondary if your spouse’s birthday (month/day only) is later in the year than yours

Your children if covered by your and your spouse’s plan1

Secondary if your birthday (month/day only) is later in the year than that of your spouse

Primary if your spouse’s birthday (month/day only) occurs earlier in the year than yours

Your children if covered under their own plan

Secondary Primary

1 If your birthday and your spouse’s birthday occur on the same day, the plan covering the children for the longer period of time is the primary plan.

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If You Are Covered by Another Group Medical Plan

If the other plan does not have a coordination of benefits or Nonduplication of Benefits provision, that plan is always the primary plan. Benefits paid or payable by the other group plan will be taken into account to determine if any benefits will be paid under the Plan. If the other plan has a coordination of benefits or Nonduplication of Benefits provision, there are several guidelines for determining the primary plan.

When you and your spouse are legally separated or divorced, the following order applies:

1. If the parent with custody of the child has not remarried, the plan of the parent with custody pays first; the other parent’s plan is secondary

2. When a divorced parent with custody has remarried, the plan of the parent with custody pays first; then, the stepparent’s plan pays before the plan of the parent who does not have custody

3. Regardless of which parent has custody, whenever a court decree specifies the parent who is financially responsible for the child’s medical expenses, the plan of that parent pays first. The plan of the other natural parent is secondary, and the plan of the stepparent, if any, pays third

When none of the above circumstances apply, the individual’s coverage under the plan in effect for the longest period of time pays first provided that:

The plan has a provision regarding laid-off or retired employees. If so, the coverage of that plan covering the employee or a dependent of the employee is primary before the benefits of the plan covering a laid-off or retired employee, or a dependent of such person.

If the other plan does not have a provision regarding laid-off or retired employees, and, as a result, the benefits of each plan are determined after the other, then the preceding provision does not apply

Under the Nonduplication of Benefits provision, if the Plan pays more than it should have as a result of benefits coordination, you are expected to repay any overpaid amount to the Plan. Benefits will also be coordinated with Medicare, Medicaid, and Tricare, as permitted by law.

If You Recover Medical Payments from Another Party If you receive benefits as a result of an illness or injury for which

you have asserted or will assert any claim or right of recovery against a third party or parties, Plan benefits will be paid to you with the understanding that you will reimburse the Plan when you receive the recoverable amount from the third party or parties.

Only the amount recovered from a third party or parties in a settlement or judgment will be subject to this provision, up to a maximum of the total medical benefits paid by the Plan for the illness or injury, regardless of whether or not you are made whole, or you or any other party admits liability.

When this provision applies to your medical benefit claim under the Plan, you must comply with the following:

You assign your right of recovery to the Plan

You repay to the Plan the recovery received from the third party or parties, or the third party’s insurance company, or any of your own motor vehicle insurance coverages.

You execute and deliver any instruments and papers requested by the Plan when a right of recovery exists and do whatever is necessary to fully execute and protect the Plan’s rights. In addition, you must not prejudice the Plan’s right of recover to such reimbursement.

For additional information concerning this provision, refer to “Subrogation & Reimbursement.”

Uncashed Checks

If a check to a Participant, for benefits under the Plan, remains uncashed beyond the void date listed on the check, or, if no void date is listed, for 180 days after issue, amounts attributable to such check shall be forfeited to the Plan. In such event, the Participant shall have no further claim to such amount for any reason.

Medical Options

Exclusive Provider Organization (EPO) Options

The Network Manager has contracted with Physicians, hospitals, and other facilities, and other health care professionals to provide medical services and treatment to you and your covered Eligible Dependents at negotiated rates. You do not have to select a Primary Care Physician. You may self-refer to any provider in the Network. You must reside or work within the EPO Network service area in order to enroll for coverage under these options of the Plan.

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Except for certain Emergency situations, you must use Physicians and hospitals in the EPO Network or no benefits will be paid under the Plan. It is ultimately your responsibility to determine that a provider is in the Network.

Locating Network Providers

To locate Network providers, you can access the Network Manager’s online directory of Network providers or call MyQHealth. The website address and the telephone number for MyQHealth are on your identification card. You can also find this contact information in “Administrative Information.”

Emergency Care

If you have an Emergency, go to the nearest emergency room even if it is not a Network facility. You, your Physician or a family member must contact MyQHealth within 48 hours after the Emergency to make certain that benefits will be approved. If you use the emergency room for non-Emergency care, not benefits will be payable under the EPO options. Refer to “Important Definitions” for a description of Emergency services.

Emergency Admissions

If you are admitted to the hospital directly from the emergency room, you or a family member must contact MyQHealth within 48 hours of the admission to make certain that benefits will be approved. Call the telephone number on your identification card to report the Emergency admission. Failure to call may result in reduced benefits or denial of your claim for benefits.

Hospital Pre-Certification

Hospital pre-certification helps ensure that you receive the most medically appropriate treatment for your condition. All hospital admissions must be pre-certified (including for mental health and substance abuse). You or your Physician must contact MyQHealth prior to an inpatient admission that is not an Emergency.

If you do not contact MyQHealth and it is determined that all or part of the admission was not Medically Necessary or appropriate, you will be responsible for payment of any expenses not covered by the Plan. However, if it is determined that the stay is not approved prospectively or retrospectively, and you choose to be admitted, you will be responsible

for payment of all expenses associated with the entire hospital stay.

If the admission is approved by MyQHealth, you will be notified of the specific number of days you may stay in the hospital and receive benefits under the Plan. If your Physician recommends extending your hospital stay beyond the approved period (including maternity admissions exceeding 48 hours for a vaginal delivery or 96 hours for a cesarean delivery), your Physician must contact MyQHealth for a continued stay review. If MyQHealth is not contacted or if your extended stay is not approved, you will be responsible for the full cost of the unapproved portion of your stay.

Pre-Notification/Pre-Certification Requirements

In addition to the hospital pre-certification requirements, you and your Physician are required to notify MyQHealth and receive pre-certification prior to receiving any of the following services:

Bariatric Surgery Computerized Axial Tomography (CAT scans),

Magnetic Resonance Angiography (MRA scans), Magnetic Resonance Imaging (MRI scans), and Position Emission Tomography (PET scans) as long as they are not performed in an emergency room, on weekends or holidays*

Durable Medical Equipment (DME) when the purchase is $500 or more on an aggregate or individual claim basis and all rentals

Dental Services due to an accidental injury to natural teeth

Dialysis

Home health care

Hospice care

Hospitalizations to include in-patient acute care, skilled nursing, skilled rehabilitation, and behavioral health/substance abuse

Mastectomy and breast cancer reconstruction

Organ transplants (transplants are covered only when performed in a Network facility; refer to “Transplantation Benefits”)

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Oncology services (chemotherapy and radiation) Outpatient surgery

Partial hospitalization and intensive outpatient for mental health/substance abuse

Private Duty Nursing

Prosthetic devices (including wigs for hair loss following chemotherapy)

Orthotics

Reconstructive surgical procedures

Skilled nursing care

Sleep studies

Therapies (physical, occupational, speech, behavioral, vision)

Transplants

If you fail to pre-certify these services when required, the services will be reviewed on appeal upon your request. If it is deemed to be medically appropriate, benefits may be payable as provided under the Plan. If a service is not approved and you choose to receive the service, you will be responsible for the entire cost, that is denied by the Plan.

Refer to the pre-certification phone numbers on your medical identification card.

Specialist Care

Under the EPO options, if you need to have treatment provided by a specialist, you may self-refer to any in-network specialist. However, no benefits will be payable under the Plan if you see a specialist who is not a participating in-network provider.

Blue Cross 70% with Health Savings Account (HSA) Option

If you enroll in the Blue Cross 70% with HSA Option you have the option to open an HSA. Bank of America is the HSA administrator/custodian.

*Pre-certification for CAT, MRI, MRAs, and PET scans handled by MyQHealth

What is an HSA?

A Health Savings Account (HSA) allows you to save money for out-of-pocket medical expenses like doctor visits, dental and vision care and prescriptions. You own the HSA, the money in your account belongs to you and rolls over year over year and never expires. Additionally, it offers tax advantages that allow you to keep more of your money, plus you can use it now or save it to cover health care costs in the future.

Tax Advantages of an HSA

Contributions to your HSA within certain limits are exempt from federal income taxes, and from some state income taxes, too. When you contribute through pre-tax payroll deductions, dollars flow into your HSA tax-free to build your savings faster.

Interest and investment income your HSA earns accumulates tax-free, so your HSA balance grows faster, even at modest rates of return.

Withdrawals from your HSA, for qualified expenses, also are tax-free.

Some states, however, tax HSA contributions and earnings.

Paying Qualified Medical Expenses Through an HSA While the funds in your HSA belong to you, any money distributed that is not used for qualified medical expenses will be subject to federal income tax as well as a 20% penalty if you are under the age of 65. You will be required to report the distribution and any applicable penalty on your federal tax return and possibly your state tax return. Qualified medical expenses must be incurred by you, your spouse or your children who meet certain requirements. Expenses incurred by any other individual (e.g., your domestic partner) are not considered qualified medical expenses, unless your partner qualifies as your tax dependent. Please visit myhealth.bankofamerica.com if you have questions about qualified medical expenses or taxes/penalties associated with distributions from an HSA.

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HSA Eligibility

You are eligible to contribute to an HSA, as long as you participate in a qualified High-Deductible Health Plan (HDHP). The Blue Cross 70% option is a qualified HDHP.

Even if you participate in the Blue Cross 70% option, you may not be eligible to contribute to an HSA if you:

• Are covered under any other health plan that is not a qualified high-deductible health plan, including a health care flexible spending account (exceptions include some disease-specific coverage; dental, vision, long-term care and disability coverage; accident policies such as critical illness insurance and accident insurance; and others)

• Are enrolled in Medicare

• Are enrolled in Medicaid

• Are covered under TRICARE®

• Have received medical benefits from the U.S. Department of Veterans Affairs during the preceding three months, other than benefits for preventive care or a service-connected disability, as defined by applicable law (mere eligibility for Veterans Affairs benefits does not disqualify you from contributing to a Health Savings Account), or

• Are claimed as a dependent on another person’s tax return.

Opening your Health Savings Account

When you enroll online in the Blue Cross 70% with HSA option, you will be asked to agree to the terms and conditions of the HSA. If you do not agree to the terms and conditions you will not be allowed to open an HSA. If you agree to the terms and conditions, you will choose the amount you want to contribute to your account through payroll deductions. You may change your contribution amount at any time during the year. You are not required to contribute any of your own money to the HSA to enroll in the Blue Cross 70% with HSA option.

Upon your enrollment, you’ll receive a welcome kit at your address on file directly from Bank of America.

Your debit card will be included with the welcome kit along with instructions on how to activate it.

You can also call Bank of America at 1-877-744-4015 if you have additional questions about your account.

No payroll withholding or employer contributions will be deposited to your Health Savings Account until it is open. Your account will not be considered “open” until you have successfully passed the customer identification process required to open an HSA. If additional documentation is required to complete this process, Bank of America will contact you directly.

In the event that any payroll withholding or employer contribution is made prior to your account being opened, the contribution will be deposited into your Health Savings Account and held in a “pending” state until your account is opened. If your account is not opened within a reasonable amount of time, as determined by Bank of America, the funds withheld from your check will be refunded to you through your payroll check (less any applicable income and payroll tax) and reported as wages on your Form W-2, and the employer contribution, if any, will be returned to AutoNation.

For questions about your account status or fulfillment (welcome kit or debit card), you may call Bank of America at 1-877-744-4015.

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AutoNation Contribution to your HSA

AutoNation will contribute to your HSA if you enroll in the Blue Cross 70% with HSA Option. You must agree to the terms and conditions of the HSA in order to receive the AutoNation contribution.

AutoNation contribution amounts are prorated based on the following events below.

Your date of hire,

QLE,

Annual Enrollment event, or

The date you agree to the terms and conditions of the HSA, if later than any of the events listed above.

Your account will be funded with the AutoNation contribution as follows:

Annual Enrollment election: In January of the next Plan year on a date established by AutoNation.

New Hires and QLE’s: At the beginning of the quarter following your benefit Effective Date/election date or the date your agreed to the terms and conditions of the HSA.

The schedule of prorated contributions is included below:

Effective date of coverage

Associate Only

Associate +Spouse

Associate +Children

Associate +Family

1/1/19

$200 $400 $400 $400

Quarter 1 $200 $400 $400 $400

Quarter 2 $150 $300 $300 $300

Quarter 3 $100 $200 $200 $200

Quarter 4* N/A N/A N/A N/A

*AutoNation will not contribute to your account if your effective date of coverage is in the 4th Quarter.

If you experience a QLE and switch from associate-only coverage to family coverage under the Blue Cross 70% with HSA option during the year, AutoNation will increase its matching contribution to correspond with the matching contribution limit for family coverage.

If you experience a status change event and switch from family coverage to associate-only coverage during the year, the matching contributions that AutoNation made prior to the change will not be reduced. In the event this results in you having contributions in your account above the annual maximum contribution allowed under IRS guidelines, the excess contributions will need to be withdrawn by your tax-filing deadline to avoid additional taxes. You are responsible for any actions needed as a result of your excess contributions.

Associate Contributions to the HSA

By law, the maximum annual contribution that can be made to your account in 2019, including both the AutoNation’s contributions and your contributions (pretax and after-tax), is:

$3,500 for individual coverage; or

$7,000 for family coverage.

The annual maximum contribution is the total contribution from all sources (payroll contributions by the Associate and/or the AutoNation and personal contributions).

These amounts are indexed annually by the federal government and are subject to change each year. Please contact Bank of America at 1-877-744-4015 for questions regarding the contribution limits.

YOUR CONTRIBUTIONS AND THE COMPANY’S CONTRIBUTIONS TO THE HSA

2019 Annual Maximum Contribution

AutoNation Contribution

Associate Contribution

$3,500

(associate-only coverage)

$200 $3,300

$7,000 (family coverage)

$400 $6,600

If you are age 55 or older, you can make additional contributions to your HSA. These are called catch-up contributions.

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This additional amount will also be taken out by payroll deductions just like your normal contribution. For 2019, the catch-up contribution limit is $1,000.

Under IRS guidelines, you must file an IRS Form 8889 with your federal tax return if you (or someone on your behalf, including AutoNation) made contributions to your HSA during the year. IRS Form 8889 must also be filed if you have an HSA balance or use HSA funds during the year, even if you do not make contributions to your HSA in that year. Please consult your tax advisor if you have questions regarding the tax forms mentioned above.

Changing Your Contribution Amount

You may change your contribution amount online at any time during the year. You can also choose to begin contributing to the HSA if you chose not to do so during your enrollment. Contact The Benefit Connection at 1-877-550-2363 for information on how to make this change.

HSA Fees

AutoNation will pay the monthly maintenance fees charged by Bank of America if you are an Active Associate enrolled in the Blue Cross 70% with HSA option.

AutoNation will not pay overdraft fees, excess contribution fees or lost card fees. If you are enrolled in COBRA, terminate employment with the company, otherwise become ineligible for coverage under the AutoNation Medical Plan or are no longer enrolled in the Blue Cross 70% with HSA option, all associated fees will become your responsibility. These fees will be deducted automatically from your HSA balance if any of these events occur. You may call Bank of America at 1-877-744-4015 to learn more about the fees. It is your responsibility to check your HSA balance prior to using funds to pay for services.

If you enroll in COBRA, you will not be billed by The Benefit Connection for your HSA contributions. If you want to continue to make contributions to your HSA, you can do so by sending the contributions directly to Bank of America. Contact Bank of America at 1-877-744-4015 for details.

Filing Your Income Tax Return

Each January, Bank of America will mail you tax forms to report distributions, contributions (your contributions and/or AutoNation’s), and the market value of your HSA for the previous calendar year. IRS Form 1099-SA reports the distributions from your HSA in the previous calendar year. IRS Form 5498-SA reports the contributions to your HSA either “in” or “for” the previous calendar year and the fair market value of your account as of December 31. Both forms are also viewable online at myhealth.bankofamerica.com. You should save all of your medical expense receipts for income tax purposes. You can scan and upload your receipts to your Bank of America account.

Investing your HSA

You have the option of investing your HSA funds. Once your account has reached a minimum balance of $1,000, any amount over that balance can be invested in the selected mutual funds offered by Bank of America.

You can review the funds and learn more online at myhealth.bankofamerica.com.

If You Terminate Employment with AutoNation or Are No Longer Enrolled in the HSA Plan

The funds in your HSA belong to you as the account holder, even if you enroll in COBRA, change plans (and are no longer enrolled in the Blue Cross 70% with HSA option), change jobs or leave the Company. In these events, all fees associated with the account will become your responsibility. Contact Bank of America for details.

Page 27 of 88

BlueCross BlueShield EPO Options Medical Benefits Summary The following summarizes the BlueCross BlueShield EPO options in all locations.

YOU HAVE THE CHOICE OF ONE OF THE FOLLOWING OPTIONS:

Annual Deductible (individual/family)

Plan Name

Out-of-Pocket Maximum (individual/family)

Prescription Drug Program

$3,000 / $6,000

Blue Cross 70% with HSA

$6,750 / $13,500

See Page 57

$1,750 / $3,500

Blue Cross 80% with Copays

$5,750 / $11,500

See Page 57

COVERED MEDICAL EXPENSES2 WHAT THE PLAN PAYS Based on Plan Option Elected

Physician Services

Blue Cross 70% with HSA Blue Cross 80% with Copays

Physician Office Visits (for injury/illness)

70% after Annual

Deductible*

100% after $35/visit

Copayment

Specialist Office Visits (for illness/injury)

70% after Annual

Deductible*


Copayment

Amwell Telemedicine- Urgent Care 70% after Annual

Deductible*


Copayment

Amwell Telemedicine-Behavioral Health

70% after Annual

Deductible*


Copayment

Allergy Shots by Physician in Conjunction with an Office Visit (Allergist/Specialist)

70% after Annual

Deductible*

80% after Annual

Deductible*

Allergy Shots not in conjunction with an Office Visit

70% after Annual

Deductible*

80% after Annual

Deductible*

Physician Inpatient Hospital Visits/Consultation

70% after Annual

Deductible*

80% after Annual

Deductible*

Chiropractic Treatment Including Spinal Manipulation3

70% after Annual

Deductible*

80% after Annual

Deductible*

Voluntary Second Surgical Option (provided the proposed surgery is covered)

70% after Annual

Deductible*

80% after Annual Deductible

1 The Out-of-Pocket Maximum includes Out-of-Pocket costs for prescription drugs. 2 Expenses over the Network Allowance limit are not covered under the Plan. 3 Limited to 20 visits per Plan Year unless additional visits are approved upon appeal for reasons of Medical Necessity. * If applicable.

Page 28 of 88


COVERED MEDICAL EXPENSES1 WHAT THE PLAN PAYS

Based on Plan Option Elected

Physician Services (continued)


Surgeon Inpatient3

70% after Annual

Deductible*

80% after Annual

Deductible*

Surgeon Outpatient3

70% after Annual

Deductible*

80% after Annual

Deductible*

Anesthesiologist Inpatient3

70% after Annual

Deductible*

80% after Annual

Deductible*

Anesthesiologist Outpatient3

70% after Annual

Deductible*

80% after Annual

Deductible*

Radiologist2 and Pathologist Inpatient

70% after Annual

Deductible*

80% after Annual

Deductible*

Radiologist2 and Pathologist Outpatient

70% after Annual

Deductible*

80% after Annual

Deductible*

Hospital and Other Facility Services (Pre-certification is required by

MyQHealth)


Inpatient Hospital – Room and board charges and other hospital services (as determined by MyQHealth) required for medical or surgical care, or treatment for:

Semiprivate room Private room (up to the semiprivate

room allowance) Intensive care unit (ICU)

70% after Annual

Deductible*

100% after $500 Copayment

Emergency Room (for emergency)

70% after Annual Deductible*;

True Emergencies only

80% after Annual Deductible*;

True Emergencies only

Emergency Room (for non-emergency)

Not Covered

Not Covered

Ambulance (for Emergency and Medically Necessary transportation to/from a medical facility; land, air and sea ambulance services each have Medical Necessity criteria)

70% after Annual

Deductible*

80% after Annual

Deductible*

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Pre-certification required for PET, CAT, MRAs and MRI scans. 3 Professional services for outpatient surgery and all inpatient stays and related procedures, require precertification. * If applicable.

Page 29 of 88


COVERED MEDICAL EXPENSES1

WHAT THE PLAN PAYS (Based on Plan Option Elected)

Hospital and Other Facility Services (Pre-certification is required by

MyQHealth)


Blood or Blood Plasma (including preservation of autologous blood products for up to eight weeks prior to scheduled surgery)

70% after Annual

Deductible*

80% after Annual Deductible* 100% after $35 copayment if performed in

physician’s office; 100% after $70 copay if performed at

specialist; 100%; deductible doesn’t apply if done

with outpatient surgical.

Ambulatory Surgical Center2

70% after Annual

Deductible*

80% after Annual

Deductible*

Outpatient Surgical Center2

70% after Annual

Deductible*

80% after Annual

Deductible* Urgent Care Center

70% after

Annual Deductible*

100% after $50 copayment

Bariatric Surgery 2, 4 70% after Annual

Deductible*

Facility: $500 copayment Physician: 80% after Annual Deductible*

Maternity Care


Obstetrician Office Visit (to determine pregnancy); lab fees billed separately (refer to “Diagnostic X-ray and Laboratory Procedures”) 3

70% after Annual

Deductible*

$70/visit Copayment for specialist*

Obstetrician Routine Prenatal and Postnatal Office Visits3

70% after Annual

Deductible*

Office visits included in above amount if global maternity; otherwise 100% after

$70 Specialist copayment/visit

Maternity Lab fees (refer to “Diagnostic X-ray and Laboratory Procedures”)

70% after Annual

Deductible*

80% after Annual

Deductible*

Medically Necessary services, such as amniocentesis to determine the existence of a sex-linked genetic disorder

70% after Annual

Deductible*

80% after Annual

Deductible*

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Pre-certification required. Contact MyQHealth. 3 Global maternity; when the provider files under one claim all prenatal, postnatal and delivery Charges. 4 Refer to “Bariatric Surgery Benefits” on page 53 for more details. * If applicable

Page 30 of 88




Maternity Care


Midwife (Medically Necessary care provided by a certified and licensed midwife when under the direct supervision of a Physician acting within the scope of his/her license for midwife charges for prenatal and postnatal visits and delivery only)

70% after Annual

Deductible*

80% after Annual

Deductible*

Hospital Inpatient2 – Room and board charges and other hospital services (as determined by MyQHealth) required for maternity care for:

Semiprivate room Private room (up to the semiprivate

room Allowance) Intensive care unit (ICU)

(Approval by MyQHealth is required for stays in excess of 48 hours for vaginal delivery or 96 hours for C-section)

70% after Annual

Deductible*

100% after $500 copayment (facility only)

Birthing Center2 (Approval by MyQHealth is required for stays in excess of 48 hours for vaginal delivery or 96 hours for C-section)

70% after Annual

Deductible*

100% after $500 copayment (facility only)

Home Delivery

Not Covered

Not Covered

Physician Inpatient Hospital Delivery Visits for Newborn (including circumcision – provided newborn is enrolled for coverage within 31 days of birth)

70% after Annual

Deductible*

80% after Annual

Deductible*

Diagnostic X-ray and Laboratory Procedures3


X-ray and Lab Services3

70% after Annual

Deductible*

80% after Annual

Deductible*

X-ray and Lab Services in Outpatient Facility and/or in a Lab Facility; including ultrasound and chest X-ray3

Note: Computerized Axial Tomography (CAT), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET) Scans must be pre-certified for benefits to be payable.

70% after Annual

Deductible*

80% after Annual

Deductible*

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Precertification required. Contact MyQHealth. 3 Labs, x-rays and imaging services covered at free standing facilities only, except during an inpatient stay, outpatient surgery or in an urgent or emergency situation. * If applicable.

Page 31 of 88




Preventive Care (in accordance with PPACA Guidelines)


Frequency follows recommendation from The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, the American Society January 2008 Colorectal Cancer Screening Guidelines and items/services required under the Patient Protection and Affordable Care Act of 2010 (PPACA). When covered preventive care services are performed during a Well Man, Well Woman or Well Child visit, the Plan pays at 100%. For additional details and a complete list of all preventive care services covered by the Plan, please contact MyQHealth at 1-888-979-7677.

Well Man Visit2 (Preventive care services performed in conjunction with an office visit may include but are not limited to: routine blood pressure check, cholesterol screening, testicular exam, stool blood test and diabetes screening)

100%

100%

Well Woman Visit2 (Preventive care services performed in conjunction with an office visit may include but are not limited to: routine blood pressure check, cholesterol screening, Chlamydia/STD testing, breast exam, stool blood test, diabetes screening and osteoporosis screening)

100%

100%

Pap Smear and Mammogram3

100%

100%

Well Child Visit (Preventive care services performed in conjunction with an office visit may include but are not limited to: routine physical exam, blood pressure check, cholesterol screening and immunizations)

100%

100%

Cancer Screenings (Preventive cancer screenings that are age and gender appropriate and performed in conjunction with an office visit may include but are not limited to: routine screenings normally covered during Well Man and Well Woman visits, sigmoidoscopy, colonoscopy and chest X-ray)

100%

100%

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Associate’s spouse receives these services at the same benefit level. 3 Mammograms covered at free-standing facilities only except during an inpatient stay, outpatient surgery or in an urgent or emergency situation.

Page 32 of 88




Family Planning4


Diaphragm – Device and/or Fitting

100% Covered2

100% Covered2

IUD – Device and/or Insertion3

100% Covered2

100% Covered2

D&C/Abortion (Therapeutic for Voluntary) – for Surgeon and Facility3

70% after

Annual Deductible*

80% after

Annual Deductible*

Tubal Ligation – for Surgeon and Facility3 (Surgical reversal is not covered)

100%

Covered2

100%

Covered2

Vasectomy – for Surgeon and Facility3 (Surgical reversal is not covered). Pays based on place of service filed

70% after Annual

Deductible*

80% after Annual

Deductible*

Diagnosis for identification of the underlying medical condition causing infertility (Procedures that may produce a pregnancy and procedures that correct the underlying cause of the infertility are not covered, such as, but not limited to, artificial insemination, in-vitro fertilization and drug therapy. Refer to “Exclusions Under the Medical Coverage Options.” (limited to $1,500 per lifetime)

70% after Annual

Deductible*

80% after Annual

Deductible*

Depo Provera Injections

100% Covered2

100% Covered2

Other Services


Acupuncture performed by a Physician or Chiropractor licensed in acupuncture (Pays based on place of service filed)

70% after Annual

Deductible*

80% after Annual

Deductible*

Cardiac Rehabilitation

70% after Annual

Deductible*

80% after Annual

Deductible*

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Contact MyQHealth for coverage details. 3 Pre-certification required. Contact MyQHealth. 4 Certain drugs and services may be covered at 100%. Check with MyQHealth for details. * If applicable.

Page 33 of 88




Other Services (continued)


Chemotherapy2

70% after Annual

Deductible*

80% after Annual

Deductible*

Clinical Trials (MyQHealth for details on what Deductibles, Coinsurance and/or Copays may apply)

Routine patient costs otherwise covered by the Plan that are associated with participation in Phases I-IV of approved clinical trials to treat cancer or other life-threatening conditions, as determined by the Plan and as required by law, subject to the Plans’ otherwise applicable Deductibles and limitations. Does not include cost of the investigational item, device, or service, items that are provided for data collection, or services that are clearly inconsistent with widely accepted and established standards for care for a particular diagnosis.

Consumable Medical Supplies2 (pre-certification is required. Contact MyQHealth when the purchase is $500 or more on an aggregate or individual claim basis and for all rentals)

Ostomy supplies Other

If supplies are used as part of authorized inpatient or outpatient facility services

If supplies are used as part of home care when used directly by an authorized, skilled professional

If authorized, supplies used in conjunction with authorized Durable Medical Equipment

Oxygen

70% after Annual

Deductible*

80% after Annual

Deductible*

Dental Services due to an accidental injury to natural teeth (limited to 12 months following accidental injury) pays based on place of service filed2

70% after Annual

Deductible*

80% after Annual

Deductible*

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Pre-certification required. Contact MyQHealth. * If applicable.

Page 34 of 88

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Precertification required. Contact MyQHealth. * If applicable.






Diabetes Nutrition Counseling Education Coverage is provided for the following when required in connection with the treatment of diabetes and when prescribed by a Physician legally authorized to prescribe such items under the law:

Equipment and supplies Diabetes Education Program

Note: For a specific list of covered items, contact MyQHealth

70% after Annual

Deductible*

80% after Annual

Deductible*

Dialysis2

70% after Annual

Deductible*

80% after Annual

Deductible*

Durable Medical Equipment including prosthetic devices2 (pre-certification is required. Contact MyQHealth when the purchase is $500 or more on an aggregate or individual claim basis and for all rentals)

70% after Annual

Deductible*

80% after Annual

Deductible*

Hearing Test and Treatment due to illness or injury (routine hearing services are not covered for adults 19 and above)

70% after Annual

Deductible*

80% after Annual

Deductible*

Home Health Care2 (Limited to 40 visits per Plan Year; additional visits allowed if deemed Medically Necessary by MyQHealth)

70% after Annual

Deductible*

80% after Annual

Deductible*

Hospice Care Inpatient Facility or Outpatient Setting including bereavement counseling2 (Pre-certification is required. Contact MyQHealth.)

70% after Annual

Deductible*

80% after Annual

Deductible*

IV Therapy

70% after Annual

Deductible*

80% after Annual

Deductible*

Page 35 of 88


COVERED MEDICAL1 EXPENSES




Nutrition Counseling – Nutrition counseling is a covered service for the prevention and treatment or an illness or condition when performed in an outpatient facility provider or a professional provider’s officer. Services include but are not limited to physical examinations, laboratory tests, diet modifications, and disease self-management skills training. 100% covered where considered preventive care, as required by law. For additional details, please call MyQHealth.

70% after Annual

Deductible*

80% after Annual

Deductible*

Organ Transplant2 – includes medically appropriate, nonexperimental transplants (pre-certification is required. Contact MyQHealth)

70% after Annual

Deductible*

100% after $500 copayment for facility; 80% after

Annual Deductible* for professional services

Physical Therapy and Occupational Therapy3

70% after Annual

Deductible*

80% after Annual

Deductible*

Podiatry (routine foot care is not covered). Pays based on place of service filed

70% after Annual

Deductible*

80% after Annual

Deductible*

Radiation Therapy3

70% after Annual

Deductible*

80% after Annual

Deductible*

Skilled Nursing Facility/Convalescent Inpatient Facility/Inpatient Rehabilitation Facility2 – up to a maximum of 60 days per Plan Year; additional days available if under Case Management. (Pre-certification is required. Contact MyQHealth.)

70% after Annual

Deductible*

80% after Annual

Deductible*

Sleep studies (pre-certification is required. Contact MyQHealth)

70% after Annual

Deductible*

80% after Annual

Deductible* 1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Residential care is not covered. Residential care is custodial care to assist with the activities of daily living. 3 Pre-certification required. Contact MyQHealth. * If applicable.

Page 36 of 88






Speech Therapy to restore speech lost or impaired due to an acute incident involving disease, trauma or surgery that requires such applicable therapeutic care and is expected to significantly improve speech. Speech may be lost or impaired due to any of the following:

Surgery, radiation therapy or other treatment that affects the vocal cords

Cerebral thrombosis Accidental injury

(Pre-certification is required. Contact MyQHealth.)

70% after Annual

Deductible*

80% after Annual

Deductible*

Developmental Speech Therapy

Not Covered

Not Covered

Treatment for Temporomandibular Joint Syndrome (TMJ). Limited benefit provided on a case-by-case basis; appliances, adjustments and orthodontic treatment are not covered. (Covered charges are payable for services that are Medically Necessary to treat TMJ or related disorders resulting from an accident, a congenital defect, degenerative joint disease, disease-infected tissue, or trauma). Pays based on place of service filed.

70% after Annual

Deductible*

80% after Annual

Deductible*

Vision Test and Treatment due to illness or injury (Routine vision services are not covered). (Limited to one pair of permanent, implanted contact lenses following cataract surgery).2 Pays based on place of service filed.

70% after Annual

Deductible*

80% after Annual

Deductible*

Wigs required due to hair loss resulting from chemical or radiation therapy due to a malignancy3

70% after Annual

Deductible* (limited to one wig per plan

year)

80% after Annual

Deductible* (limited to one wig per plan

year)

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 If not a candidate for permanent implanted lenses; eligible for one pair of eye glasses or one pair of contact lenses. 3 Precertification required. Contact MyQHealth. * If applicable.

Page 37 of 88




Mental Health Treatment2


Inpatient Confinement due to Mental Health conditions 2,3

(Precertification is required. Contact MyQHealth.)

70% after Annual

Deductible*

Facility- 100% after $500 copay for Inpatient hospitalizations.

Residential Treatment Facility- 100% after $500 copay Professional- 80% after deductible

Outpatient Treatment due to Mental Health conditions (pre-certification may be required. Contact MyQHealth for details).

70% after Annual

Deductible*

Facility- 80% after deductible

Professional- 100% after $35 copayment if performed in PCP office

Professional- 100% after $70 copay if performed in a specialist’s office

Substance Abuse Rehabilitation Treatment2


Inpatient Confinement due to Substance Abuse Rehabilitation 2,3

(Precertification is required. Contact MyQHealth.)

70% after Annual

Deductible*

Facility- 100% after $500 copay for Inpatient hospitalizations. Residential Treatment Facility- 100% after $500 copay

Professional- 80% after deductible*

Outpatient Treatment due to Substance Abuse Rehabilitation (pre-certification may be required. Contact MyQHealth for details).

70% after Annual

Deductible*

Facility- 80% after deductible* Professional- 100% after $35 copayment if performed in PCP office Professional- 100% after $70 copay if performed in a specialist’s office

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Residential care is not covered. Residential care is custodial care to assist with the activities of daily living. 3 Precertification required. Contact MyQHealth. * If applicable.

Page 38 of 88


Preferred Provider Organization (PPO) Options

The PPO options provide you with a broad Network of Participating Providers to choose from every time you need medical services. When you enroll you are not required to select a Primary Care Physician to coordinate your care or to obtain a referral to a specialist.

Each time you need medical services, you may choose to receive those services on an in-network or out-of-network basis. Your choice affects the benefits payable under the Plan and your out-of-pocket costs. If you use an in-network provider for your covered medical services, you may have an Annual Deductible to satisfy, and then the Plan pays a higher level of benefits for Covered Medical Expenses. Generally, claims will be filed for you if you use in-network providers for your covered medical services.

If you use an out-of-network provider for your covered medical services, you may have an Annual Deductible to satisfy, and then the Plan pays a lower level of benefits for Covered Medical Expenses. Certain services are not covered if you use an out-of-network provider. Refer to the “PPO Options Medical Benefits Summary” chart for details on what the PPO options cover. Generally, you will be responsible for filing claims if you use out-of-network providers for your covered medical services.

In-Network Benefits

When you receive care from a PPO in-network Physician or facility, benefits are paid at a higher percentage than if you receive care outside the Network. This means you pay less for your care. The Plan pays a percentage of the cost of Covered Medical Expenses, including surgery and hospital admissions, after you first meet the Annual Deductible, if any. When you receive in-network services, you will not have to file a claim. It is ultimately your responsibility to determine if a provider is in the Network.

Locating Network Providers

To locate Network providers, you can access MyQHealth’s online directory of BlueCross BlueShield Network providers or call MyQHealth. The website address and the telephone number for MyQHealth are on your identification card. You can also find this contact information in “Administrative Information.”

Out-of-Network Benefits

The PPO options offer you the flexibility to use medical providers outside the Network. When you do, the Plan pays a percentage of the cost of Covered Medical Expenses after you meet the Annual Deductible, if any. Benefits for out-of-network care are subject to an Allowable charge. The Reasonable and Customary (R&C) Allowances are based on the usual fees charged by health care providers in your geographic area who have similar training and experience. You are responsible for paying amounts that exceed the R&C Allowance. Amounts in excess of the R&C Allowance will not count toward the Annual Deductible or the Out-of-Pocket Maximum.

When you receive care on an out-of-network basis, you will be responsible for filing claims, and obtaining pre-certification of any hospital admissions an any pre-notification requirements, as described in “Pre-Notification/Pre-Certification Requirements” later in this section.

Emergency Care

If you have an Emergency, go to the nearest emergency room even if it is not a Network facility. You, your Physician, or a family member must contact MyQHealth within 48 hours after the Emergency. MyQHealth reviews and evaluates recommended treatment plans and, if it is determined that you used the emergency room for non-Emergency care, either in-network or out-of-network, no benefits will be payable under the PPO options. Refer to “Important Definitions” for a description of Emergency services.

Emergency Admissions

If you are admitted to the hospital from the emergency room, you or a family member must contact MyQHealth within 48 hours of the admission to make certain that benefits will be approved. Call the telephone number on your identification card to report the Emergency admission. Failure to call may result in reduced benefits or denial of your claim for benefits.

Page 39 of 88


Hospital Pre-Certification Hospital pre-certification helps ensure that you receive the most medically appropriate treatment for your condition. All hospital admissions must be pre-certified. You or your Physician must contact MyQHealth prior to an inpatient admission that is not an Emergency. If you are using a Network Physician and a Network hospital, your Physician will pre- certify the hospital admission for you. If you are using an out-of-network Physician or hospital, it is your responsibility to notify MyQHealth for pre-certification. If you do not contact MyQHealth and it is determined that part of the admission was not Medically Necessary or appropriate, you will be responsible for payment of any expenses not covered by the Plan. However, if it is determined that the stay is not approved prospectively or retrospectively and you choose to be admitted, you will be responsible for payment of all facility expenses associated with the entire hospital stay. If the admission is approved by MyQHealth, you will be notified of the specific number of days you may stay in the hospital and receive benefits under the Plan. If your Physician recommends extending your hospital stay beyond the approved period (including maternity admissions exceeding 48 hours for a vaginal delivery or 96 hours for a cesarean delivery), your Physician must contact MyQHealth for a continued stay review. If MyQHealth is not contacted or if your extended stay is not approved, you will be responsible for the full facility expenses of the unapproved portion of your stay. Pre-Notification/Pre-Certification Requirements In addition to the hospital pre-certification requirements, you or your Physician is required to notify MyQHealth prior to receiving any of the following services:

Bariatric Surgery Computerized Axial Tomography (CAT scans),

Magnetic Resonance Angiography (MRA scans), Magnetic Resonance Imaging (MRI scans), and Positron Emission Tomography (PET scans) as long as they are not performed in an emergency room, on weekends or holidays*

Dental Services due to an accidental injury Dialysis Durable Medical Equipment when the purchase is

$500 or more on an aggregate or individual claims basis and all rentals

Home health care

Hospice care

Hospitalizations to include in-patient acute care, skilled nursing, skilled rehabilitation, and behavioral health/substance abuse

Mastectomy and breast cancer reconstruction

Organ transplants (transplants are covered only when performed in a Network facility; refer to “Transplantation Benefits”)

Oncology services (chemotherapy and radiation)

Outpatient surgery

Partial hospitalization and intensive outpatient for mental health/substance abuse

Private Duty Nursing

Prosthetic devices (including wigs for hair loss following chemotherapy)

Orthotics

Reconstructive surgical procedures

Skilled nursing care

Sleep studies

Therapies (physical, occupational, speech, behavioral, vision)

Transplants

If you fail to pre-certify these services when required, the services will be reviewed on appeal upon your request. If it is deemed to be medically appropriate, benefits may be payable as provided under the Plan.

If a service is not approved and you choose to receive the service, you will be responsible for the entire cost that is denied by the Plan.

Refer to the pre-certification phone numbers on your medical identification card

Specialist Care

If you need to have treatment provided by a specialist, you are not required to obtain a referral. You may choose a specialist who participates in the PPO Network and receive In-Network Benefits for covered medical services. Or, you may go to a specialist out-of-network and receive Out-of-Network Benefits for your covered medical services.

*All Pre-certifications handled by MyQHealth.

Page 40 of 88

1 The medical Annual Deductible and Prescription Drug Annual Deductible are separate amounts. 2 The medical out-of-pocket costs include prescription drug out of pocket costs. 3 Expenses over the Network Allowance limit are not covered under the Plan. *If applicable

BlueCross BlueShield PPO Options Medical Benefits Summary The following summarizes the BlueCross BlueShield PPO options in all locations.

Blue Cross 90% with Copays Option:

In-Network or Out-of-Network

Annual Deductible1

(Individual or family) Coinsurance

Level

Out-of-Pocket Maximum2

(Individual/family)


In-Network $1,000 / $2,000 90% $4,750 / $9,500 See page 57 Out-of-Network $2,000 / $4,000 70% $9,500 / $19,000 Not Covered


WHAT THE PLAN PAYS

Physician Services

In-Network Benefits


Physician Office Visits (for illness/injury))

100% after $30/visit Copayment

70% after Annual Deductible*

Specialist Office Visits (for illness/injury)



Amwell Telemedicine- Urgent Care


No coverage

Amwell Telemedicine- Behavioral Health


No Coverage

Allergy Shots by Physician in conjunction with an Office Visit (Allergist/Specialist)



Allergy shots not in conjunction with an Office Visit



Physician Inpatient Hospital Visits/Consultation



Chiropractic Treatment including Spinal Manipulation (limited to 20 visits per Plan Year unless additional visits are approved upon appeal for reasons of Medical Necessity)



Page 41 of 88

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Pre-certification required for PET, CAT, MRA and MRI scans. *If applicable



WHAT THE PLAN PAYS

Physician Services (continued)

In-Network Benefits


Voluntary Second Surgical Opinion (provided the proposed surgery is covered under the Plan)



Surgeon Inpatient (pre-certification required)



Surgeon Outpatient (pre-certification required)



Anesthesiologist Inpatient (pre-certification required)



Anesthesiologist Outpatient (pre-certification required)



Radiologist2 and Pathologist Inpatient



Radiologist2 and Pathologist Outpatient



Page 42 of 88



WHAT THE PLAN PAYS

Hospital and Other Facility Services (pre-certification is required. Contact MyQHealth)

In-Network Benefits


Inpatient Hospital2 – Room and board charges and other hospital services (as determined by the Network Manager) required for medical or surgical care, or treatment for:

Semi-private room Private room (up to the semi-private room Allowance) Intensive care unit (ICU)



Emergency Room (for emergency)



Emergency Room (for non-emergency)

Not Covered

Not Covered

Ambulance (for emergency and Medically Necessary transportation to/from a medical facility; land, air and sea ambulance services each have Medical Necessity criteria)



Blood or Blood Plasma (including preservation of autologous blood products for up to eight weeks prior to scheduled surgery)

90% after deductible

100% after $30/visit Copayment (PCP)


Copayment (Specialist)

100% deductible doesn’t apply if done with

outpatient surgical.


Ambulatory Surgical Center2



Outpatient Surgical Center2



Urgent Care Center



Bariatric Surgery2,3


Not Covered

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Pre-certification required. Contact MyQHealth. 3 Refer to “Bariatric Surgery Benefits” on page 53 for more details *If applicable

Page 43 of 88



WHAT THE PLAN PAYS

Maternity Care

In-Network Benefits


Obstetrician Office Visit (to determine pregnancy); lab fees billed separately (Refer to “Diagnostic X-ray and Laboratory Procedures”)

100% after $60/visit Copayment (Specialist)


Obstetrician Routine Prenatal and Postnatal Office Visits2

Office visits included in above amount if filed as global maternity;

100% after $60 Copayment/visit


Maternity Lab Fees (Refer to “Diagnostic X-Ray and Laboratory Procedures”)



Medically Necessary services, such as amniocentesis, to determine the existence of a sex-linked genetic disorder



Midwife (Medically Necessary care provided by a certified and licensed midwife when under the direct supervision of a Physician acting within the scope of his/her license for midwife charges for prenatal and postnatal visits and delivery only)



Hospital inpatient3 – Room and board charges and other hospital services (as determined by MyQHealth) required for maternity care:

Semi-private room Private room (up to the semi-private room Allowance) Intensive care unit (ICU)

(Approval by MyQHealth is required for stays in excess of 48 hours for vaginal delivery or 96 hours for C-section)



1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Global maternity; when the provider files under one claim all prenatal, postnatal and delivery charges. 3 Pre-certification required. Contact MyQHealth. *If applicable

Page 44 of 88



WHAT THE PLAN PAYS

Maternity Care (continued)

In-Network Benefits


Birthing Center (Approval by MyQHealth is required for stays in excess of 48 hours for vaginal delivery or 96 hours for C-section)



Home Delivery

Not Covered

Not Covered

Physician Inpatient Hospital Delivery and Visits for Newborn (including circumcision) – provided newborn is enrolled for coverage within 31 days of birth



Diagnostic X-ray and Laboratory Procedures

In-Network Benefits


X-ray and Lab Services in Office Setting2

100% after $30/visit Copayment (PCP) or


Copayment (Specialist)


X-ray and Lab Services in Outpatient Facility and/or in a Lab Facility including ultrasound and chest X-ray2

Note: Computerized Axial Tomography (CAT), Magnetic Resonance Angiography (MRA), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET) Scans must be pre-certified for benefits to be payable



1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Labs, x-rays and imaging services covered at free standing facilities only, except during an inpatient stay, outpatient surgery or in an urgent or emergency situation. *If applicable

Page 45 of 88



WHAT THE PLAN PAYS

Preventive Care (in accordance with PPACA Guidelines)

In-Network Benefits


Frequency follows recommendation from The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, the American Society January 2008 Colorectal Cancer Screening Guidelines and items/services required under the Patient Protection and Affordable Care Act of 2010 (PPACA).

When covered preventive care services are performed during a Well Man, Well Woman or Well Child visit, the Plan pays at 100%. For additional details and a complete list of all preventive care services covered by the Plan, please contact MyQHealth at 1-888-979-7677.

Well Man Visit2 (Preventive care services performed in conjunction with an office visit may include but are not limited to: routine blood pressure check, cholesterol screening, testicular exam, prostate specific antigen [PSA] test, stool blood test and diabetes screening)

100%

Not Covered

Well Woman Visit2 (Preventive care services performed in conjunction with an office visit may include but are not limited to: routine blood pressure check, cholesterol screening, Chlamydia/STD testing, breast exam, stool blood test, diabetes screening and osteoporosis screening)

100%

Not Covered

Pap Smear and Mammogram3

100%

Not Covered

Well Child Visit up to age 19 (Preventive care services performed in conjunction with an office visit may include but are not limited to: physical exam, routine blood pressure check, cholesterol screening and immunizations)

100%

Not Covered

Cancer Screenings (Preventive cancer screenings that are age and gender appropriate and performed in conjunction with an office visit may include but are not limited to: routine screenings normally covered during Well Man and Well Woman visits, sigmoidoscopy, colonoscopy and chest X-ray)

100%

Not Covered

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Associate’s spouse receives these services at the same benefit level. 3 Mammograms covered at free-standing facilities only except during an inpatient stay, outpatient surgery or in an urgent or emergency situation. *If applicable

Page 46 of 88



WHAT THE PLAN PAYS

Family Planning4

In-Network Benefits


Diaphragm – Device and/or Fitting (Check with MyQHealth for details)

100% Covered2


IUD – Device and/or Insertion (Check with MyQHealth for details)

100% Covered2 70% after

Annual Deductible*

D&C/Abortion2 (Therapeutic or Voluntary) for Surgeon and Facility



Tubal Ligation – for Surgeon and Facility3 (Surgical reversal is not covered) (Check with MyQHealth for details)

100% Covered


Vasectomy – for Surgeon (Surgical reversal is not covered) Pays based on place on service filed



Diagnosis for identification of the underlying medical condition causing infertility (procedures that may produce a pregnancy and procedures that correct the underlying cause of the fertility are not covered, such as, but not limited to, artificial insemination, in vitro fertilization and drug therapy. Refer to “Exclusions Under the Medical Coverage Options”)

(limited to $1,500 per lifetime)



Depo Provera Injections (Check with MyQHealth for details)

100% Covered2


1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Contact MyQHealth for coverage details. 3 Pre-certification required. Contact MyQHealth. 4 Certain drugs and services may be covered at 100%. Check with MyQHealth for details. *If applicable

Page 47 of 88



WHAT THE PLAN PAYS

Other Services

In-Network Benefits


Acupuncture performed by a Physician or Chiropractor licensed in acupuncture (Pays based on place of service filed)

90% after Annual Deductible if not in conjunction with an

office visit


Cardiac Rehabilitation



Chemotherapy2



Clinical Trials (Check with MyQHealth for details on what Deductibles, Coinsurance and/or Copays may apply)

Routine patient costs otherwise covered by the Plan that are associated with participation in Phases I-IV of approved clinical trials to treat cancer or other life-threatening conditions, as determined by the Plan and as required by law, subject to the Plans’ otherwise applicable Deductibles and limitations. Does not include cost of the investigational item, device, or service items that are provided for data collection, or services that are clearly inconsistent with widely accepted and established standards of care for a particular diagnosis

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Pre-certification required. Contact MyQHealth. *If applicable

Page 48 of 88



WHAT THE PLAN PAYS

Other Services (covered)

In-Network Benefits


Consumable Medical Supplies (pre-certification is required by MyQHealth when the purchase is $500 or more on an aggregate or individual claim basis and all rentals)

Ostomy supplies Other

If supplies are used as part of authorized inpatient and outpatient facility services

If supplies are used as part of home care when used directly by an authorized, skilled professional

If authorized, supplies used in conjunction with authorized Durable Medical Equipment

Oxygen



Dental Services due to an accidental injury to natural teeth (limited to 12 months following accidental injury)2. Pays based on place on service filed.



Diabetes Nutrition Counseling & Education

Coverage is provided for the following when required in connection with the treatment of diabetes and when prescribed by a Physician legally authorized to prescribe such items under the law.

Equipment and supplies Diabetes Education Program

Note: For a specific list of covered items contact MyQHealth



Dialysis2



1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Pre-certification required. Contact MyQHealth. *If applicable

Page 49 of 88



WHAT THE PLAN PAYS


In-Network Benefits


Durable Medical Equipment including prosthetic devices (pre-certification is required by MyQHealth when the individual purchase is $500 or more on an aggregate or individual claim basis and all rentals)



Hearing Test and Treatment due to illness or injury (routine hearing services are not covered for adults 19 and older)



Home Health Care

(limited to 40 visits per Plan Year; additional visits allowed if deemed Medically Necessary by the Network Manager). (Pre-certification is required. Contact MyQHealth)



Hospice Care Inpatient Facility or Outpatient Setting including bereavement counseling (pre-certification is required. Contact MyQHealth)



IV Therapy



Nutrition Counseling – Nutrition counseling is a covered service for the prevention and treatment of an illness or condition when performed in an outpatient facility provider or a professional provider’s office. Services, include but are not limited to: physical examinations, laboratory tests, diet modifications, and disease self-management skills training. 100% covered in-network where considered preventive care, as required by law. For additional details, contact MyQHealth



1 Expenses over the Network Allowance limit are not covered under the Plan. *If applicable

Page 50 of 88



WHAT THE PLAN PAYS


In-Network Benefits


Organ Transplant2 – includes medically appropriate, nonexperimental transplants (pre-certification is required. Contact MyQHealth)


Not Covered

Physical and Occupational Therapy (pre-certification is required. Contact MyQHealth)



Podiatry (routine foot care is not provided). (Pays based on place of service filed)



Radiation Therapy (pre-certification is required. Contact MyQHealth)



Skilled Nursing Facility/Convalescent Inpatient Facility/Inpatient Rehabilitation Facility3 – up to a maximum of 60 days per Plan Year; additional days available if under Case Management (pre-certification is required. Contact MyQHealth)



Sleep studies (pre-certification is required. Contact MyQHealth)



1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Refer to “Transplantation Benefits on page 53 for more details. 3 Residential care is not covered. Residential care is custodial care to assist with the activities of daily living.

*If applicable

Page 51 of 88



WHAT THE PLAN PAYS


In-Network Benefits


Speech Therapy to restore speech lost or impaired due to an acute incident involving disease, trauma or surgery that requires such therapeutic care and is expected to significantly improve speech. Speech may be lost or impaired due to any of the following:

Surgery, radiation therapy or other treatment that affects the vocal cords

Cerebral thrombosis Accidental injury

(Pre-certification is required. Contact MyQHealth)



Developmental Speech Therapy

Not Covered

Not Covered

Treatment for Temporomandibular Joint Syndrome (TMJ). Limited benefit provided on a case-by-case basis; appliances, adjustments and orthodontic treatment are not covered. (Coverage charges are payable for services that are Medically Necessary to treat TMJ or related disorders resulting from and accident, a congenital defect, degenerative joint disease, a developmental defect, disease-infected tissue, or trauma)

Pays based on place of service filed.



Vision Test and Treatment due to illness or injury (routine vision services are not covered). (Limited to one pair of permanent, implanted contact lenses following cataract surgery)2

Pays based on place of service filed.


$30/visit Copayment for PCP

$60/visit Copayment for Specialist


Wigs required due to hair loss resulting from chemical or radiation therapy due to a malignancy (pre-certification is required. Contact MyQHealth)

90% after Annual Deductible* (limited to one wig

per Plan Year)

70% after Annual Deductible* (limited to one wig

per Plan Year)

1 Expenses over the Network Allowance limit are not covered under the Plan. 2 If not a candidate for permanent implanted lenses; eligible for one pair of eye glasses or one pair of contact lenses. *If applicable

Page 52 of 88



WHAT THE PLAN PAYS

Mental Health Treatment

In-Network Benefits


Inpatient Confinement due to Mental Health Conditions (pre-certification is required. Contact MyQHealth)



Outpatient Treatment due to Mental Health Conditions (pre-certification is required. Contact MyQHealth)



$60/visit Copayment for Specialists


Substance Abuse Rehabilitation Treatment2

In-Network Benefits


Inpatient Confinement due to Substance Abuse Rehabilitation (pre-certification is required. Contact MyQHealth)



Outpatient Treatment due to Substance Abuse Rehabilitation (pre-certification is required. Contact MyQHealth)



$60/visit Copayment for Specialists


1 Expenses over the Network Allowance limit are not covered under the Plan. 2 Residential care is not covered. Residential care is not covered. Residential care is custodial care to assist with the activities of daily living. *If applicable

Page 53 of 88

HOW THE PLAN WORKS

Transplantation Benefits The Plan provides transplantation benefits for those transplants that are performed only in a Network facility recognized as a Center of Excellence for certain transplants, ordered by a Participating Provider. All transplants must be coordinated and approved by MyQHealth. Transplants must not be Experimental, unproven, or for an Investigational service. Transplantation services are not covered when they are performed in an out-of-network facility.

Benefits are available for the following transplants:

Bone marrow/stem cell transplants (either from you or from a compatible donor), with or without high dose chemotherapy; not all bone marrow transplants meet the definition of a Covered Medical Expense

Corneal transplants

Heart transplants

Heart/lung transplants (single and double transplants)

Kidney transplants (single and double transplants)

Kidney/pancreas transplants (single and double transplants)

Liver segmental transplants

Liver transplants

Liver/small bowel transplants

Lung segmental transplants

Lung transplants (single and double transplants)

Pancreas transplants

Small bowel intestinal transplants

Transplant benefits are not available for removal of an organ or tissue from you for the purpose of transplanting to another person.

In addition to medical coverage, reimbursement for certain transportation expenses and lodging is provided when the transplantation is received in a Network facility, MyQHealth will assist the patient and family with travel and lodging arrangements. The covered expenses under the Plan when the transplant recipient resides more than 50 miles from the designated Network facility are as follows:

Transportation of the patient and one companion

who is traveling on the same day(s) when appropriate to and/or from the site of the transplant for the purposes of an evaluation, the transplant procedure or necessary post-discharge follow-up.

Eligible expenses for lodging for the patient (while not confined) and one companion. Benefits are paid at a daily rate of up to $50 for one person or up to $100 for two people per day. Meals can only be reimbursed at a hospital or similar institution.

If the patient is a covered Eligible Dependent and a minor child, transportation expenses of two companions, and lodging expenses reimbursed up to the daily rate of $100. Meals can only be reimbursed at a hospital or similar institution.

Covered transportation, lodging and meal expense reimbursements related to transplant benefits are limited to a $10,000 Lifetime Maximum for the recipient and companion/family combined.

Contact MyQHealth for additional information and specific guidelines about transplantation benefits.

Bariatric Surgery Benefits The Plan provides Bariatric Surgery benefits that are performed only in a Network facility recognized as a Center of Excellence, ordered by a Participating Provider, if those treatments are determined to be Medically Necessary. All Bariatric Surgeries must be coordinated and approved by MyQHealth. Bariatric surgeries are not covered when they are performed in an out-of-network facility.

There is a limit of one (1) Bariatric Surgery per Lifetime under the AutoNation Medical Plan.

In addition to the Bariatric Surgery, any complications that arise as a result of the covered Bariatric Surgery would be covered under the Plan if they are otherwise Covered Medical Expenses.

Contact MyQHealth for additional information and specific guidelines about Bariatric Surgery benefits.

Page 54 of 88


Transition of Care Under the Medical Options

If you are undergoing an active course of treatment when you first enroll in a new or different AutoNation medical option, you may be eligible for In-Network Benefits through your current provider until your active course of treatment ends, even if your provider does not participate in the Network.

This benefit is known as “transition of care.” The transition of care benefit may be appropriate when there are risks involved in the immediate transfer of care from your current provider to a new provider participating in the Network.

Several examples of the kinds of medical conditions that would invoke the transition of care benefit include any of the following:

Women in their third trimester of pregnancy or high-risk pregnancy

New participants active in certain rehabilitation programs

Terminal conditions as defined by a hospice

Acute conditions in active treatment at time of eligibility

Active chemotherapy

Fracture care

If you or your covered dependent is undergoing medical care when you first enroll in a new or different medical option, contact MyQHealth within 31 days of your Effective Date.

You will be notified in writing by MyQHealth of the approval or denial of your request. If your request is approved, the letter will explain that your current Physician has been approved to treat your or your covered dependent’s specific condition for a specific period of time at the in-network benefit level. Keep in mind that any services received from your current Physician not related to the specific condition will not be covered at the in-network benefit level. Once the approved time period ends or if any other condition requiring treatment occurs, you or your covered dependent must receive care from the Network provider to be eligible for In-Network Benefits under your new or different AutoNation medical option.

Exclusions Under the Medical Options

Although the medical options cover many Medically Necessary treatments, services and supplies, the Plan does not pay benefits for any of the following charges, treatments, services and supplies, among others:

Administrative fees, including Charges for missed appointments, completion of forms or photocopies of medical records

Amniocentesis, ultrasound or any other procedures requested solely for sex determination of a fetus, unless Medically Necessary to determine the existence of a sex-linked genetic disorder

Any service, treatment or supply (other than covered Substance Abuse Services), resulting from a Covered Member being intoxicated or under the influence of any: (i) drug (unless taken on the advice of a Physician), (ii) Alcohol, or (iii) other substance unless the result of a medical condition

Artificial aids for the convenience of the patient or patient care provider

Assistant surgeon’s Charges that are greater than 20 percent of the surgeon’s charge

Bariatric Surgeries performed in an out-of-network facility or any Bariatric services performed outside the benefits as stated

Cardiac rehabilitation services and supplies not considered Medically Necessary

Charges above the Allowance

Charges for expenses that are payable though a public program, other than Medicaid, Medicare, or TRICARE, subject to applicable law

Charges for services and supplies that are not Medically Necessary except as specifically provided under preventive care

Charges made by a hospital owned or operated by the U.S. government, or which provides services for the U.S. government, if such Charges are directly related to illness or injury incurred due to military service

Charges you are not legally required to pay and Charges that would not have been incurred if you did not have medical coverage

Page 55 of 88

Charges you are responsible to pay as a result of not

pre-certifying or receiving prior authorization from MyQHealth

Chromosome testing and genetic counseling that are not Medically Necessary to determine treatment plans

Cosmetic or reconstructive surgery except Medically Necessary reconstructive surgery to correct a congenital birth defect, or damage due to a covered injury or a mastectomy

Court-ordered physicals

Custodial Care or services, including services not intended primarily to treat a specific injury or sickness or any education or training

Dental implants and other dental expenses except for dental work due to injury of natural teeth within 12 months after the injury, and any related expenses for inpatient room and board and supplies

Educational, vocational, or training programs and materials, including related to autism or learning and educational disorders

Experimental and Investigational treatments not approved by the American Medical Association, the American Dental Association, or appropriate medical or dental specialty society

Experimental or Investigational procedures, medical treatments or devices, except routine patient costs related to certain clinical trials as required by law

Hearing aids or exams for prescribing or fitting them, and routine hearing exams for adults 19 and older

Home health care services after you or your covered dependent is no longer under a Physician’s care, or for care or treatment not listed in the home health care plan

Hospice care service after you or your covered dependent is no longer under a Physician’s care, or for care or treatment not listed in the hospice care plan and any curative life-prolonging procedures

Illness contracted, or injury sustained as a result of participating in a riot or insurrection

Immunizations required for travel

Injuries, illnesses or sickness covered under any workers’ compensation or similar law

Injuries resulting from, or in the course of, any employment for wage or profit

In vitro fertilization charges as well as charges for or

in connection with artificial insemination, Gamete (GIFT) and Zygote (ZIFT) intra-fallopian transfer procedures, or any other similar procedure or drug therapy that may result in producing a pregnancy and/or procedures that may correct an underlying cause of infertility

Marital counseling

Massage therapy Membership costs for health clubs, weight loss

clinics, and similar programs

Occupational therapy services that do not consist of traditional physical therapy modalities and are not part of an active multidisciplinary physical rehabilitation program designed to restore lost or impaired body function

Oral contraceptive drugs and contraceptive devices unless as specifically outlined in family planning or as covered in “Prescription Drug Benefits” and required to be covered by law

Orthopedic shoes that are a separate part of a covered brace; specifically ordered, custom-made or built-up shoes; cast shoes; shoe inserts designed to support the arch or affect changes in the foot or foot alignment; arch supports; elastic stockings and garter belts, except custom orthotics for the treatment of diabetes

Over-the-counter disposable/consumable supplies

Penile prostheses except for Medically Necessary implants

Personal convenience or comfort items, including, but not limited to, such items as televisions, telephones, air conditioners, saunas, hot tubs, exercise equipment, and first aid kits

Prescription drugs and medicines except as provided in “Prescription Drug Benefits”

Pulmonary rehabilitation services and supplies not considered Medically Necessary

Under BlueCross Radiology scans: Computerized Axial Tomography (CAT), Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), and Position Emission Tomography (PET) scans not precertified by MyQHealth. Except if performed on a weekend, holiday, or in the emergency room

Page 56 of 88

Replacement of external prostheses due to wear and

tear, loss, theft, or destruction, or for any biomechanical external prosthetic devices

Reports, evaluations, examinations, or hospitalizations not required for health reasons

Reversal of voluntary sterilization procedures

Routine eye exams, eyeglasses and contact lenses except permanent, implanted contact lenses following cataract surgery or if not a candidate for permanent implanted lenses, eligible for one pair of eye glasses or one pair of contact lenses

Routine foot care, including removal of calluses and corns, trimming of nails (unless Medically Necessary), or for tired, weak, or strained feet and services involving the foot and performed in the absence of localized illness, injury or symptoms

Routine physical exams not required for health reasons, such as for the purpose of obtaining employment or insurance

School or sports physicals

Services provided by a member of your family or covered dependent’s family, or someone who normally resides in your home

Special foods, food supplements (if other means of nutrition are available), liquid diets, diet plans or any related products, except where covered under Preventive Care, as required by law

Speech therapy provided for reasons other than to restore speech lost or impaired by any of the following: surgery, radiation therapy, or other treatment that affects the vocal cords, cerebral thrombosis, or accidental injury. Speech therapy exclusions include therapy used to improve speaking skills that have not been fully developed, therapy that can be considered custodial or educational, therapy intended to maintain speech communication, and therapy that continues beyond the date that maximum medical improvement has been achieved

Surgical treatment for correction of refractive errors, including, but not limited to, radial keratotomy and laser assisted in-situ keratomileusis (LASIK)

Therapy to improve general physical condition

Transplantations performed in an out-of-network facility or any transplantation benefit services performed outside the transplantation benefits as stated

Treatment for gender dysphoria

Treatment of an occupational sickness or injury sustained in the course of any employment (including self-employment), whether covered by workers’ compensation or similar laws

Treatment of myopia and other errors of refraction, including refractive surgery

Treatment of teeth/periodontia under the Plan including dental implants except for Emergency dental work to stabilize teeth due to injury to natural teeth or dental illness secondary to medical pathology

Treatment, services, and/or supplies not prescribed or performed by or under the direction of a Physician or other licensed provider

Treatment, services, and/or supplies not specifically defined as Covered Medical Expenses under the Plan

Treatment, services, and/or supplies provided before you became covered under the Plan or after your coverage ends

Treatment, services, and/or supplies provided for any illness or injury you suffer during your commission of a felony, if convicted, provided such illness or injury was not the result of a medical condition or an act of domestic violence

Treatment, services, and/or supplies provided for injuries sustained as a result of war, declared or undeclared, any act of war, or while on active or reserve duty in the armed forces or any country or international authority

Treatment, services, and/or supplies that are primarily to aid you or your covered dependent in daily living

Page 57 of 88

Vision care services, magnification vision aids, charges

for tinting, anti-reflective coatings, prescription sunglasses or light sensitive lenses, and safety glasses/lenses required for employment

X-rays, diagnostic lab tests, and imaging (such as MRIs) not performed in free-standing facilities (except during an inpatient stay, outpatient surgery, or in an urgent or emergency situation).

Any service or supply used to lose, gain, or maintain weight even if you have other health conditions that may be helped by such reduction, gain or maintenance weight, including but not limited to: any weight control, weight loss and exercise programs; any medications and/or diet supplements that result from diet programs, appetite control, weight control, and the treatment of obesity or morbid obesity; any equipment or memberships; or any other surgical procedures, except for bariatric surgery or where as required by PPACA

Any and all services, treatments, charges, counseling, exams, medications, and/or supplies that are related in any way to complications as a result of these exclusions are not covered Medical Expenses under the Plan

Prescription Drug Benefits

All of the medical options provided under the Plan include coverage for covered prescription drugs. You and your Eligible Dependents are covered automatically for prescription drug benefits when your medical coverage becomes effective.

Express Scripts is the Network Manager for the prescription drug Network. Under any of the medical coverage options provided under the Plan, you must purchase your prescriptions from an Express Scripts Network retail pharmacy or through Express Scripts mail service to receive benefits for covered prescription drugs.

Prescription Drug Plan Practices

The Plan provides for a drug formulary and a preference for generic drugs. Also, quantity level limits apply when covered drugs are dispensed. AutoNation and the Plan may establish other practices, procedures, and requirements as they deem necessary from time to time.

You can go online to www.express-scripts.com to obtain a list of participating pharmacies in the Network and the prescription drugs that are covered under the Plan. There is also an online drug price search tool to help you compare the cost of drugs before you have your prescriptions filled at a participating retail pharmacy or through mail service.

Formulary Drugs

The formulary is a list of medications covered by the Plan. The formulary was developed by an expert panel of pharmacists and Physicians who carefully reviewed the medications on the formulary for safety, quality, effectiveness, and cost. The formulary includes generic drugs. When appropriate, your Physician should use the formulary to prescribe drugs for you. If you are not able to take a formulary medication due to a reason of Medical Necessity, contact MyQHealth.

The formulary list is subject to change and will be reissued periodically when prescription drugs are added to or removed from the formulary. You can find the formulary list on the Express Scripts website at www.express-scripts.com.

Generic Drugs

All prescriptions that have a generic equivalent will be dispensed generically unless you or your Physician directs the pharmacist to fill the prescription with a brand name drug. This applies to drugs purchased at Network retail pharmacies and through mail service. If you are not able to take a generic medication due to a reason of Medical Necessity, contact MyQHealth (note that for preventive drugs, the Plan will always cover brand drugs, if your Physician has determined that the generic medication is not medically appropriate).

Specialty Drugs

Specialty Drugs are medications that typically require special handling, administration or monitoring. Examples of some conditions that may require specialty drugs include anemia, cancer, chronic renal disease, growth hormone deficiency, hemophilia, hepatitis C, multiple sclerosis, and rheumatoid arthritis.

All specialty drugs will be dispensed by Accredo Pharmacy, a specialty pharmacy owned by Express Scripts. Accredo will contact you and your Physician to explain the specialty drug refill process.

Page 58 of 88

Quantity Level Limits

The quantity level limit program encourages pharmacists and Physicians to adhere to recommended guidelines for how much medication should be dispensed with each prescription. The dosing guidelines provided by the Food and Drug Administration (FDA) and the specific manufacturer’s labeling insert will be followed even if the treating Physician prescribes a quantity or dose that is outside these guidelines.

How to Use the In-Network Retail Pharmacy Program

Express Scripts offers a nationwide Network of participating retail pharmacies. You can call MyQHealth at 1-888-979-7677 to locate the Network pharmacy closest to you.

You can purchase your covered prescription drugs, up to a 30-day supply, at a Network retail pharmacy (if you are filling a maintenance medication, you will only be allowed 2 fills at retail and all subsequent fills must go through mail order to be covered, unless you use a Walgreens pharmacy to fill your maintenance medications). You must show your member identification card to the pharmacist.

How to Use the Mail Service Program

Prescriptions for medication for treatment of arthritis, asthma, diabetes, high cholesterol, hypertension, or other conditions that require maintenance medication on a long-term or ongoing basis, must be filled through mail service or through a Walgreens pharmacy.

Your Physician may write your initial prescription and one refill to be filled by a Network retail pharmacy. Then all subsequent maintenance mediation refills must be filled through mail service or through a Walgreens pharmacy.

When your Physician writes your initial prescription, he, or she also should write you a prescription for a 90-day supply plus appropriate refills for up to one year that will be filled through mail service (except controlled substances as restricted by law) or at a Walgreens pharmacy.

You can have your Physician scan, fax or call-in your prescription for a maintenance drug by calling the number on the back of your ID card to fill through mail order (or if calling in a maintenance medication to a Walgreens pharmacy near you, calling the pharmacy directly). If you choose to use mail order for your maintenance drugs, your medication typically will be delivered within two weeks free of any shipping costs. Delays

in shipping your mail order may occur if the pharmacist needs to contact your Physician before filling the order. You can check the status of your order by going online at www.express-scripts.com or by calling MyQHealth at 1-888-979-7677. Medications are shipped in plain, weather-resistant pouches for protection. You may order your maintenance drug refills by telephone, through the mail, or via the internet at www.express-scripts.com after you register.

Filling prescriptions through mail service is convenient and saves you money.

How to Contact the Prescription Drug Network Manager

To locate the nearest Network retail pharmacy, find out whether a particular medication is included on the formulary or is covered under the Plan, order new prescriptions and refills or check on the status of your order, go online to www.express-scripts.com. You can also call MyQHealth at 1-888-979-7677.

Out-of-Network Retail Pharmacies.

If you choose to purchase your prescription drugs at an out-of -network retail pharmacy, you must pay the entire cost of the prescription.

The Plan does not cover prescription drugs purchased at nonparticipating pharmacies.


Once you satisfy your Annual Deductible, the Plan begins to pay toward the covered prescription drugs.

Once you meet the Out-of-Pocket Maximum, (which includes eligible out-of-pocket medical expenses) the Plan will pay 100% of covered prescription drug expenses for the rest of the Plan Year.

If you or your Physician request a brand name drug when an approved generic drug is available, you will be responsible for the difference between the cost of the brand name drug and the cost of the generic drug in addition to the Coinsurance amount required for the generic equivalent once you satisfy your Annual Deductible, except for preventive drugs when your Physician has determined that the generic drug is not medically appropriate.

Any non-covered prescription drug expense does not help satisfy the Out-of-Pocket Maximum.

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For example, if you choose a brand name drug when an approved generic drug is available, the difference between the cost of the generic drug and the brand name drug will be your responsibility. This amount will not count toward your Out-of-Pocket Maximum.

Utilization Management

There are certain programs that may affect your prescriptions. These programs, designed and administered by Express Scripts, target chronic disease states and specialty drugs while still providing comprehensive drug coverage. These programs include prior authorization and step therapy.

Express Scripts’ prior authorization program drives savings and patient safety by monitoring the dispensing of high-cost medications and those with the potential for misuse. The program ensures drug coverage is consistent with the intent for the prescription benefit.

The Step Therapy program manages prescription-drug waste within specific therapy classes by guiding patients to first-line medications before “stepping up” to more costly second-line medications. Within specific therapy classes, several clinically effective medications are often available to treat the same condition. Step Therapy directs a patient to a clinically effective, lower-cost medication and ensures patients receive cost-effective drug therapy that is clinically appropriate for their condition.

If your prescription is impacted by one of these programs, you will be notified by Express Scripts or your retail pharmacy. Contact Express Scripts for details.

Exclusions Under Prescription Drug Benefits

The Prescription Drug Benefits under the Plan do not pay for any of the following prescription drugs, supplies, or charges, among others:

Antineoplastic agents except oral dosages

Anti-obesity drugs

Any covered drug in excess of the quantity specified by the original prescription

Cosmetic agents for hair growth/hair loss

Devices or appliances or other nonmedical substances

Drugs dispensed while you are an inpatient

Drugs for which the ingredient cost plus the dispensing fee is either equal to or less than the Copayment amount

Drugs or medications that are dispensed for any illness or injury eligible for or covered by any federal, state, or local workers’ compensation or occupational disease laws

Drugs or medications to which you are entitled, with or without charge, under a plan or program of any government or governmental body, except as required by law

Drugs or medications used for unlabeled or unapproved indications by the Food and Drug Administration (FDA)

Drugs prescribed as part of a clinical trial, except where required by law

Drugs purchased at a nonparticipating retail pharmacy

Drugs requiring a prescription by state law but not federal law

Experimental medication

Fees for administering covered drugs

Fertility agents, including injectable and oral Injectable drugs except for Glucagon and insulin in

disposable syringes, unless approved in advance by Express Scripts

Maintenance prescriptions either at mail service or a Walgreens pharmacy for more than a 90-day supply

Medications furnished on an inpatient or outpatient basis covered under the medical portion on the Plan, or any other group coverage for prescription drugs or insulin

Over-the-counter medications unless specifically included

Retail pharmacy prescriptions for more than a 60-day supply (except for maintenance medications filled at a Walgreens pharmacy)

Syringes and needles, except for disposable insulin syringes, and needles

Vaccines administered to prevent infectious diseases

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2019 Prescription Drug Coverage for National BlueCross BlueShield Plan Members

Medical Plan

Blue Cross 70% with HSA (EPO)

Blue Cross 80% with Copays (EPO)

Blue Cross 90% with Copays (PPO)

Rx Deductible

Included with Medical1 $125 Individual; $250 Family;

Combined Retail/Mail and Specialty Drugs

$100 Individual; $200 Family; Combined Retail/Mail and

Specialty Drugs

Rx Out-of-Pocket Max

Included with medical out-of-pocket maximum

Retail Generic

$10 per script; 30-day supply; after overall deductible is

met1 $10 per script; 30-day supply; after Rx deductible is met

Retail Formulary Brand


met1

$70 per script; 30-day supply; after Rx deductible is met

$60 per script; 30-day supply; after Rx deductible is met

Retail Non-Formulary Brand

50% covered; 30-day supply; after overall deductible is

met1

60% covered; 30-day supply; after Rx deductible is met

70% covered; 30-day supply; after Rx deductible is met

Mail Generic*


met; mandatory after 2 retail fills1

$20 per script; 90-day supply; after Rx deductible is met; mandatory after 2 retail fills

Mail Formulary Brand*

$160 per script; 90-day supply; after overall

deductible is met; mandatory after 2 retail fills

$140 per script; 90-day supply; after Rx


$120 per script; 90-day supply; after Rx


Mail Non-Formulary Brand*

50% covered; 90-day supply; after overall


60% covered; 90-day supply; after Rx


70% covered; 90-day supply; after Rx


Specialty Drugs

Covered; subject to the lower of 50% coinsurance or $600 per script; pre-authorization may be required; no fills at retail pharmacy allowed for most specialty medications;

all fills must go through Accredo mail order





1If you enroll in the Blue Cross 70% with HSA option, there are many preventive medications that are not subject to the deductible. You will just pay the copay or coinsurance. However, note than ACA preventive medications are not subject to any cost-sharing. Check with Express Scripts for details.

*You can also fill your maintenance medication at Walgreens.

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CLAIMS PROCEDURES

Generally, your will not be required to file a claim if you receive covered medical services from a participating in-network provider.

If your receive services from an out-of-network provider, in most cases, you will be required to file a claim. Follow the steps below to ensure that your claim will be processed for payment consideration as efficiently as possible:

Know your Plan benefits to determine if the services you receive are eligible for medical coverage under the option you elected. Review this booklet to determine if the services you receive are eligible for coverage

Obtain an original, itemized bill that includes the following items (cancelled checks, cash register receipts or personal itemizations are not acceptable):

o Patient’s full name

o Amount charged

o Date of service

o Description of the service or supply

o Diagnosis or nature of illness or injury

o For private duty nursing, the nurse’s license number, and shift worked

o For Durable Medical Equipment, the Physician’s certification

o For ambulance services, total mileage

o Name, address, tax identification number, and signature of the medical service provider

If you have already paid for the services received, submit proof of the payment with your claim

Make a copy for your records

Call MyQHealth at the toll-free number on your identification card or log on to the KnowYourBenefits.org website to obtain a claim form. Complete the claim form, including your signature and date, attach for your itemized bills and mail to the address on the form.

No Assignment of Health Benefits

Except as required under state Medicaid law or in a Qualified Medical Child Support Order (QMCSO), you may not transfer or assign benefit or right under the Plan. This anti-assignment provision means that you may not assign benefits to your Physician or healthcare provider. All such assignments will be void.

Notwithstanding the foregoing, the Plan may choose to remit payments directly to providers with respect to covered services rendered to you, but only as a convenience to Participants. Healthcare providers are not and shall not be construed as, either Participants or beneficiaries under the Plan and shall have no right to receive benefits from the Plan under any circumstances.

Claim-Filing Deadline

All medical claims under the medical coverage options must be received by the Claims Administrator within 12 months after the end of the Plan Year in which the claim was incurred for payment consideration under the Plan. For example, if you incur Covered Medical Expenses on August 10, your claim must be submitted to the Claims Administrator or Network Manager by December 31 of the following year.

Claims filed after the claim-filing deadline will be denied even if the services otherwise would have been covered under the Plan.

Explanation of Benefits

When the claim is processed, you will receive an Explanation of Benefits statement from the Claims Administrator of the Network Manager.

This statement will include the provider’s charge, the allowable amount(s), any Annual Deductible, Copayment and/or Coinsurance amount(s), the total benefits payable under the option, and the total amount that you are required to pay.

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CLAIMS PROCEDURES (CONTINUED)

Initial Claims

Urgent Claims

An urgent claim is any claim for medical care or treatment where making a determination under the normal time frames could seriously jeopardize your life or health, or your ability to regain maximum function; or in the opinion of a Physician with knowledge of your medical condition, would subject you to severe pain that could not adequately be managed without the care or treatment that is the subject of the claim.

If your claim is determined to be an urgent claim, a notice will be sent as soon as possible taking into account the medical exigencies and in no case later than 72 hours after receipt of the claim or earlier, if required by law. You may receive notice orally, in which case, written notice will be provided within three days of the oral notice. If your urgent claim is determined to be incomplete, you will receive a notice to this effect within 24 hours of receipt of your claim, at which point you will have 48 hours to provide additional information.

If you request an extension of urgent care benefits beyond an initially determined period and make the request at least 24 hours prior to the expiration of the original determination, you will be notified within 24 hours of receipt of the request.

Pre-Service Claims

A pre-service claim is a claim for services that have not yet been rendered and for which the Plan requires prior certification.

If your pre-service claim is improperly filed or does not follow the procedures established in this “Claims Procedures” section, you will be sent notification within five days of receipt of the claim. If your pre-service claim is filed properly, a claims determination will be sent within a reasonable period of time appropriate to the medical circumstances, but no later than 15 days from the receipt of the claim. If Quantum Health or Express Scripts, as applicable, acting on behalf of the Plan Administrator (herein referred to as the “Plan”) determines that an extension is necessary due to matters beyond the control of the Plan, this time may be extended 15 days.

You will receive notice prior to the extension that indicates the circumstances requiring the extension and the date by which the Plan expects to render a determination. If the extension is necessary to request additional information, the extension notice will describe the required information,

and you will be given at least 45 days to submit the information. The Plan will then make its determination within 15 days from the date the Plan receives your information, or if earlier, the deadline to submit your information.

Post-Service Claims

A post-service claim is a claim for services that already have been rendered, or where the Plan does not require prior certification.

When you submit a post-service claim and your claim is denied, a notice will be sent within a reasonable time period but no later than 30 days from receipt of the claim. If Quantum Health or Express Scripts, as applicable, acting on behalf of the Plan Administrator (herein referred to as “the Plan”) determines that an extension is necessary due to matters beyond the control of the Plan, this time may be extended 15 days. You will receive notice prior to the extension that indicates the circumstances requiring the extension and the date by which the Plan expects to render a determination. If the extension is necessary to request additional information, the extension notice will describe the required information, and you will be given at least 45 days to submit the information. The Plan then will make its determination within 15 days from the date the Plan receives your information, or if earlier, the deadline to submit your information.

Concurrent Care Claims

A concurrent care claim is a claim that arises when there is a reduction or termination of ongoing care.

You will be notified if there is to be any reduction or termination in coverage for ongoing care sufficiently in advance of such reduction so that you will be able to appeal the decision before the coverage is reduced or terminated, unless such a reduction or termination is due to a Plan Amendment or the termination of the Plan.

Notice of Determination

If your claim is filed properly and your claim is denied, either in full or in part, you will receive notice of an adverse benefit determination that will:

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CLAIMS PROCEDURES (CONTINUED)

Identify the claim involved, including date of service, health care provider, and claim amount (if applicable)

State the specific reason or reasons for the adverse benefit determination, including the standard for denying the claim

Reference the specific Plan provisions on which the determination is based

Include the denial code and corresponding meaning and information about the availability, upon request, of the diagnosis code or treatment code and their corresponding meanings

Describe additional material or information, if any, needed to perfect the claim and the reasons such as material or information is necessary

Describe the Plan’s claim review procedures and the time limits applicable to such procedures, including a statement of your right to bring a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974, as amended (ERISA), following an adverse benefit determination on review

Disclose any internal rule, guidelines or protocol relied on in making the adverse determination (or state that such information is available free of charge upon request)

Explain the scientific or clinical judgment for the determination if the denial is based on a Medical Necessity, Experimental/Investigational treatment or similar limit (or state that such information is available free of charge upon request)

Describe the external review process, if applicable

Include a statement about the availability of, and contact information for, any applicable office of health insurance consumer assistance or ombudsman established under the health care reform laws to assist individuals with internal claims and appeals and external review process

If your claim is approved, you will receive notification if your claim is an urgent or pre-service claim. You will not receive an approval notice for post-service claims.

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HOW TO APPEAL A DENIED CLAIM

To initiate an appeal, you must submit a request within 180 days from the receipt of an adverse benefit determination.

Internal Appeal Process Under The Plan

Any request for an eligibility related appeal MUST be accompanied by a fully completed and executed Authorization for Release of Information form in this Summary Plan Description. Any request for an eligibility related appeal that does not include a fully completed and executed authorization form will be delayed in processing until such form is received.

You will have the opportunity to submit written comments, documents, or other information in support of your appeal, and you will have access to all documents that are relevant to your claim. Your appeal will be conducted by a person different from the person who made the initial decision. No deference will be afforded to the initial determination.

If your claim involves a medical judgement question, MyQHealth for medical claims and Express Scripts for prescription drug claims, will consult with an appropriately qualified health care practitioner with training and experience in the field of medicine involved.

If a health care professional was consulted for the initial determination, a different health care professional will be consulted upon appeal. Upon request, MyQHealth for medical claims and Express Scripts for prescription drug claims, will provide you with the identification of any medical expert whose advice was obtained on behalf of the Plan in connection with your appeal.

A final decision on the appeal will be made within the time periods specified below.

Eligibility Appeals

If your appeal concerns your eligibility to apply for enrollment under the Plan, write to:

AutoNation Benefit Connection Claims and Appeals Management P.O. Box 1407 Lincolnshire, IL 60069-1407

Or fax to: 1-847-554-1245

Dependent Verification Appeals

If your appeal concerns verification of your dependent(s) (i.e., your dependent’s verification documentation was not submitted timely), send your appeal letter to:

Claims and Appeals Management P.O. Box 1434 Lincolnshire, IL 60069-1434

Or fax it to 1-855-769-5781

Medical & Prescription Drug Appeals

Medical Benefit Appeals

If your appeal concerns medical benefits and/or benefit payments (including prescription drug benefits and/or benefit payments), write or call MyQHealth as provided in the Administrative Information section of this SPD.

Prescription Drug Benefit Appeals

If your appeal concerns prescription drug benefits and/or benefit payments, write or call Express Scripts as provided in the Administrative Information section of this SPD.

Urgent Claims

You may request an expedited review of any urgent claim. This request may be made orally, and the Plan will communicate with you by telephone, facsimile, or similarly rapid communication method. You will be notified of the determination as soon as possible, taking into account the medical exigencies, but no later than 72 hours after receipt of the claim.

Pre-Service Claims

When you request a review of a pre-service claim, you will be notified of the determination within a reasonable period of time taking into account the medical circumstances, but no later than 15 days from the date your request is received.

Post-Service Claims

When you request a review of a post-service claim, you will be notified of the determination within a reasonable period of time, but no later than 30 days from the date your request is received.

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HOW TO APPEAL A DENIED CLAIM (CONTINUED)

Notice of Appeals Determination for Eligibility, Medical & Prescription Drugs

If your claim is denied, either in full or in part, you will receive notice of an adverse benefit determination that will:

Identify the claim involved, including the date of service, health care provider, and claim amount (if applicable)

State the specific reason or reasons for the adverse benefit determination, including the standard for denying the claim

Reference the specific Plan provisions on which the determination is based

Include the denial code and corresponding meaning and information about the availability, upon request, of the diagnosis code or treatment code and their corresponding meanings

Describe any voluntary appeal procedures offered by the Plan and your right to bring a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974, as amended (ERISA), following an adverse benefit determination on review

Disclose any internal rule, guidelines, or protocol relied on in making the adverse determination (or state that such information is available free of charge upon request)

Explain the scientific or clinical judgment for the determination if the denial is based on a Medical necessity, Experimental/Investigational treatment or similar limit (or state that such information is available free of charge upon request)

State that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claim for benefits

Describe the external review process, if applicable

Include a statement about the availability of, and

contact information for, any applicable office of health insurance consumer assistance or ombudsman establishes under the health care reform laws to assist individuals with internal claims and appeals and external review processes. You will also receive a notice if your claim on appeal is approved.

You will also receive a notice if your claim on appeal is approved.

Second Internal Review of a Denied Medical or Prescription Drug Claim or Eligibility Appeal

If your initial appeal is not approved, you have the right to request a second level of appeal. All second appeals must be submitted within 60 days from the initial appeal decision.

As a result of the first-level review, you may appeal a partially or totally denied claim by following the same steps outlined in “How to Appeal a Denied Claim.” All second-level reviews will be conducted by the Plan Administrator or its designees. Send your second-level eligibility appeals directly to the Plan Administrator (AutoNation, Inc.), which can be found on page 87 of this Summary Plan Description. Send your second-level medical or prescription drug appeals to Quantum Health or Express Scripts, as applicable. The addresses can be found on page 87 of this Summary Plan Description.

You will be notified in writing of the Plan Administrator’s decision within the time frames stated in “How to Appeal a Denied Claim.” If the Plan Administrator denies your claim on review, you will receive written notice of the denial that will contain information on “Notice of Appeals Determination.” All decisions of the Plan Administrator are final and binding.

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HOW TO APPEAL A DENIED CLAIM (CONTINUED)

External Review

If your internal appeal under the Plan is denied, and your claim involved medical judgment or a rescission of coverage, you may have the right to further appeal your claim pursuant to a new independent external review process established under the Patient Protection and Affordable Care Act.

Your external appeal will be conducted by an independent review organization not affiliated with the Plan. This independent review organization may overturn the Plan’s decision, and the independent review organization’s decision will be binding on the Plan. Your internal appeal denial notice will include more information about your right to file a request for an external review and will include contact information. You must file your request for an external review within four months of receiving your final internal appeal determination. Filing a request for an external review will not affect your ability to bring a legal claim in court.

When filing a request for external review, you will be required to authorize the release of any medical records that may be required to be reviewed for the purpose of reaching a decision on the external review.

Legal Action

You may not bring a lawsuit to recover benefits under the Plan until you have exhausted the administrative process described in this section. No action may be brought at all unless brought no later than three years following a final decision on your claim for benefits under the Plan’s Internal Review procedure. The three-year statute of limitations on suits for all benefits shall apply in any forum where you may initiate such suit.

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WHEN COVERAGE ENDS

If You Are Granted a Leave of Absence

If AutoNation grants you a Leave of Absence, your personal and, if it applies, dependent coverage under the Plan continues for the period of your approved leave, not to exceed six months, provided that you continue to pay the required contributions on an after-tax basis for your personal coverage and, if it applies, dependent coverage. You will be billed directly by The Benefit Connection. The bills will be mailed to your address on file with Payroll. You will be billed on an after-tax basis the same amount you would have paid as a contribution from your paycheck if you were an active Associate. If you do not make any after-tax payments while you are on leave, your benefits will be terminated retroactive to your Leave of Absence start date.

If you fail to continue to make timely after-tax payments via direct bill, your benefits will be terminated retroactive to the last date you paid in full. For the period you are on leave you must pay your required contributions in full by the due date specified on the direct bill (partial payments are not accepted). Loss of coverage due to nonpayment is not considered a qualifying event under the federal law (known as COBRA). When you return from an approved leave, your coverage will be reinstated, as of your return to work date, even if you lost coverage due to nonpayment.

Payments for benefits for the dates you were on leave will not be automatically deducted from your paycheck upon your return to work.

After you have been on an approved leave for six months and if you had coverage immediately prior to or during your leave, COBRA continuation coverage will be offered to you.

Approved Leaves of Absence include the following:

Company, disability, leave under the Family and Medical Leave Act (FMLA), military service, personal, or workers’ compensation.

If You Terminate

If you terminate employment with AutoNation, your personal and, if it applies, dependent coverage under the Plan ends on your termination date unless you elect and pay for COBRA coverage. It is your responsibility to request a refund of any premiums paid beyond your termination date from your payroll representative.

At Other Times

Plan coverage including your personal coverage and, if it applies, dependent coverage will end when any of the following events occur:

You are no longer eligible for coverage, including going from Full-Time to Part-Time status.

You fail to make the required contributions for coverage.

You elect to waive coverage for the next Plan Year. Coverage will end on the last day of the current Plan Year.

You die.

The Plan is terminated.

The Plan Administrator determines that you have performed an act, practice, or omission that constitutes fraud, or you have made an intentional misrepresentation of material fact related to the Plan or Plan coverage, in which case your coverage may be rescinded retroactively to the date of the fraud or intentional misrepresentation.

In addition to the above, dependent coverage under the Plan will end if any of the following events occur:

Your dependents are selected for a random dependent audit, and you do not recertify them by the deadline noted.

If you do not recertify them, they will be dropped from coverage and offered COBRA. Dependents can be re-added to coverage during the next Annual Enrollment period provided they meet the definition of an Eligible Dependent at that time and you submit the Random Dependent Audit Form.

Your child is no longer an Eligible Dependent.

Your spouse no longer meets the definition of an Eligible Dependent due to divorce, legal separation or your marriage has been annulled.

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COBRA CONTINUATION COVERAGE

If you and your Eligible Dependent’s participation in the Plan ends due to certain events, you may be able to continue coverage under a federal law called the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) (such individuals are called “qualified beneficiaries”). Under COBRA, a qualified beneficiary may have the right to extend participation at their own expense for a period of time. If a qualified beneficiary chooses COBRA continuation coverage, AutoNation is required to offer him/her the same coverage that is offered at that time to similarly situated active employees.

Any qualified beneficiary may elect coverage for a newly acquired dependent (e.g., a spouse or a newborn child) under the Plan’s HIPAA special enrollment rules, described in the Qualifying Events section. The qualified beneficiary must notify the COBRA administrator to add coverage for a newly acquired dependent within 31 days of the event (e.g., marriage, birth, adoption, or placement for adoption) and submit proper documentation. In addition, a child who is born to or placed for adoption during a period of COBRA continuation coverage will be considered to be a COBRA qualified beneficiary and will be eligible to elect further continuation coverage if there is a second qualifying event.

The COBRA administrator is The Benefit Connection. Contact The Benefit Connection at 1-877-550-BENE (2363) or go online at www.KnowYourBenefits.org and click the Benefit Enrollment and Changes Section.

COBRA Qualifying Events and Length of Coverage

The length of COBRA coverage for a qualified beneficiary varies, depending on the qualifying event that occurs. The COBRA qualifying events and length of continuation coverage are shown in the chart on the following page.

If your dependent experiences a second qualifying event while receiving COBRA coverage, he or she may be entitled to extend COBRA to a maximum of 36 months. The dependent must notify the COBRA administrator as described in the chart.

COBRA and Medicare

The following explains how COBRA and Medicare impact coverage.

If a qualified beneficiary is on COBRA and then

becomes entitled to Medicare, his/her COBRA coverage will terminate.

Other covered qualified beneficiaries may continue coverage for the remainder of their COBRA period. Your Medicare entitlement is not a second qualifying event for your qualified dependent and will not extend his or her COBRA coverage.

If a COBRA qualifying event occurs, that is your termination of employment or reduction in hours, within 18 months after you become entitled to Medicare, you will be entitled to 18 months of COBRA from the date of the qualifying event. Your covered Eligible Dependents will be entitled to COBRA until the later of: (1) 18 months from your COBRA qualifying event, or

(2) 36 months from your date of Medicare entitlement.

If You Are on Military Leave

If you are on a military leave, you will be billed at the address on file for benefits for the first six months of your leave. After six months, you will be offered COBRA continuation coverage for an additional 18 months.

If You or Your Dependent is Disabled

If you or a covered dependent is determined by the Social Security Administration to have been disabled on the date of your qualifying event, that is a termination of employment or reduction in hours, or at any time during the first 60 days of COBRA continuation coverage, you or your qualified dependent may apply for an additional extension of 11 months to the 18-month period of COBRA continuation coverage. You must furnish a copy of the disability certification to the COBRA administrator within 60 days of the date of the certification and before the original 18-month continuation period ends.

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COBRA CONTINUATION COVERAGE

If the individual is no longer disabled, as determined by Social Security Administration, you must notify the COBRA administrator within 30 days of such determination. Nondisabled qualified beneficiaries may continue COBRA continuation coverage for the full 29 months even if the disabled person declines to do so.

Electing COBRA

The COBRA administrator will send you an election notice and information about COBRA continuation coverage and payment methods. You have 60 days to inform the COBRA administrator that you want to elect COBRA continuation coverage. Your notice will provide instructions on election procedures. The election period starts on the date you would otherwise lose coverage because of the qualifying event or when you were sent the election notice, whichever is later.

In order to protect your family’s COBRA rights, you should notify The Benefit Connection of any changes in the addresses of your family members.

Your Cost for COBRA

A qualified beneficiary must pay 100 percent of the cost of coverage, plus a 2 percent administrative fee. Full payment of the initial premium is required by the 45th day after the election. Payment must be made directly to the COBRA administrator and the contribution will be on an after-tax basis.

COBRA Qualifying Events and Length of Coverage

Qualifying Events (if cause loss of coverage)

Length of Coverage

Your employment ends for any reason except gross misconduct.1

You and/or your covered dependents lose eligibility because of a reduction in your working hours.1

18 months for you and/or your covered dependents

You die.1

Your child loses eligibility for any reason (e.g., age, marriage or change in student status).2

You become entitled to Medicare.2

You divorce or legally separate from your spouse.3

36 months for your covered dependents

1 AutoNation will notify the COBRA administrator of these qualifying events. 2 You and your dependent must contact The Benefit Connection by telephone at 1-877-550-BENE (2363) and ask to speak to a representative within 60 days of an initial or second qualifying event. You or your dependent also must notify The Benefit Connection to request a disability extension. 3 You or your spouse must contact The Benefit Connection by telephone at 1-877-550-BENE (2363) and ask to speak to a representative within 90 days of an initial or second qualifying event. Written notification will not be accepted by The Benefit Connection and will be returned as unsolicited mail. Failure to notify The Benefit Connection by telephone within the 90 day time period could result in legal action and recovery of benefits paid after the Qualifying Life Event.

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COBRA CONTINUATION COVERAGE (CONTINUED)

If approved for an 11-month disability extension, the disabled person and any other qualified beneficiaries will be charged 150 percent of the cost of coverage for the extension period.

If the disabled person declines COBRA coverage for the additional 11 months, the nondisabled qualified beneficiaries may still elect to continue COBRA coverage for the full 29-month period at a cost of 102 percent of the cost of coverage.

COBRA Continuation Coverage Payments The first COBRA premium payment is due no later than 45 days from the date COBRA coverage is elected. Although COBRA coverage is retroactive to the date of the initial qualifying event, no benefits will be paid until the full premium payment is received. The due date for each month’s premium is prior to the first day of the month of coverage. You are responsible for making timely payments.

COBRA premium payments should be mailed to the address indicated on your premium notice. If you do not receive your premium notice, visit www.autonationbenefits.com to access information about your COBRA coverage, check payment status and payment due date information, or contact the COBRA administrator. Do not contact your medical Network Manager as it does not administer COBRA nor bill you for COBRA coverage.

If you fail to make the first full payment within 45 days of your COBRA election or subsequent full payments within 30 days of the due date, COBRA continuation coverage will be permanently cancelled retroactive to the last date for which premiums were paid. Partial payments will not be accepted for coverage.

Other important information you need to know about the required COBRA continuation coverage payments is shown below:

COBRA continuation coverage cannot be reinstated once it is terminated.

COBRA premium payments that are returned by the bank for insufficient funds will result in termination of your COBRA continuation coverage if a replacement payment in the form of a cashier’s check, certified check, or money order is not made within the grace period.

COBRA premium payments should be mailed to the

address indicated on your premium notice. If you do not receive your premium notice, contact the COBRA administrator.

COBRA premiums paid for a month in which you gain other coverage will not be refunded.

You may be eligible for state and local assistance to pay the COBRA premium. For more information, contact your local Medicaid office or the office of your state insurance commissioner.

When Your COBRA Continuation Coverage Ends

A qualified beneficiary’s COBRA continuation coverage will end when any of the following occurs:

The premium for COBRA continuation coverage is not paid on a timely basis.

The maximum period for COBRA continuation coverage expires as it applies to the qualifying event.

The later of the end of the month you become covered under another group health plan, provided you paid for that month; or the end of the month you last paid in full.

A qualified beneficiary becomes entitled to Medicare. Refer to “COBRA and Medicare” for details.

AutoNation ceases to provide any group health plan for its employees.

You or your Eligible Dependents extended COBRA coverage to 29 months due to disability, but are no longer considered disabled.

No Guarantee of Employment

The Plan booklet and the benefits described in it do not create a contract of employment or a guarantee of employment between AutoNation and any Associate. Further, there is no guarantee that benefit levels will not be changed in the future or that the Plan will continue indefinitely.

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OTHER IMPORTANT INFORMATION

Future of the Plan

AutoNation reserves the unfettered and unrestricted right to change, amend, or terminate the Plan for any reason at any time. AutoNation, pursuant to written action of its Board of Directors, is empowered to amend the Plan or any benefit under the Plan. The Employee Benefit Committee (“the Committee”), which is established by the Board of Directors at AutoNation, is empowered to make amendments to the Plan or any benefit under the Plan at any time by a written resolution, so long as the amendment does not significantly increase or affect AutoNation’s liability. Any amendment which terminates the Plan or any portion of the Plan or the application of the Plan or to any class of Associates must be approved by written action of the Board of Directors at AutoNation. If the Plan is terminated, the rights of covered persons to benefits are limited to claims incurred up to the date of termination. The benefits under the Plan are not vested and shall not become vested as a result of any oral representations or statements or written document by an AutoNation representative or agent unless such written document is adopted pursuant to the amendment procedure set forth above.

Statements Made by AutoNation

Any oral representations or statements made to an Associate by an AutoNation representative or agent about benefits coverage under the Plan that conflict with Plan provisions will not be considered as representations or statements made by, or on behalf of AutoNation or the Plan, and will not bind AutoNation or the Plan for benefits under the Plan.

Plan Administrator

The Plan Administrator has overall responsibility for the operation of the Plan and controls the administration of the Plan. The Plan Administrator’s authority shall include (not by way of limitation) the authority to construe, in its discretion, all terms, provisions, conditions, and limitations of the Plan.

The Plan Administrator may delegate its authority and responsibility for certain parts of the Plan administration to other persons.

The Plan Administrator shall be deemed to have delegated its responsibilities for determining benefits and eligibility for benefits to a Claims Administrator where such person has been appointed to make such determinations. In such case, such other person shall have the duties and powers as the Plan Administrator, including the complete discretion to interpret and construe the provisions of the Plan.

You can receive additional information about the Plan and the Plan Administrator by contacting The Benefit Connection at 1-877-550-BENE (2363).

HIPAA Compliance

Disclosures to AutoNation

The Plan may disclose participant information to AutoNation, as permitted under the Standards for Privacy of Individually Identifiable Health Information, 45 CFR Parts 160 and 164 ("HIPAA Privacy Regulations"). In addition, the Plan may disclose protected health information to AutoNation as necessary to allow AutoNation to perform plan administration functions, within the meaning of the HIPAA Privacy Regulations.

Use of PHI

The Plan will not use or disclose PHI that is genetic information for underwriting purposes.

Access to Medical Information

The following employees or individuals under the control of AutoNation shall have access to the Plan's protected health information to be used solely for plan administration functions, as defined in the HIPAA Privacy Regulations:

The Plan Administrator;

Members of the benefits, legal, finance, information system, audit, accounting, and human resources departments of the AutoNation to the extent they perform functions with respect to the Plan; and

Such other individuals or classes of individuals identified by the Plan's Privacy Officer as necessary for the Plan's administration.

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AutoNation Agreement to Restrictions

The Plan will not disclose protected health information to AutoNation until AutoNation has certified to the Plan that it agrees to:

Not use or disclose protected health information other than as permitted or required by law or as specified above;

Not use or disclose the protected health information in any employment- related decisions or in connection with any other benefit or employee benefit plan of AutoNation;

Report to the Plan any use or disclosure of protected health information that is inconsistent with the uses and disclosures permitted by law or specified above of which AutoNation becomes aware;

Make protected health information accessible to the subject individual in accordance with the HIPAA Privacy Regulations;

Allow the subject individuals to amend or correct their protected health information and incorporate any amendments to protected health information in accordance with the HIPAA Privacy Regulations;

Make available the information to provide an accounting of its disclosures of protected health information in accordance with the HIPAA Privacy Regulations;

Make its internal practices, books and records relating to the use and disclosure of protected health information received from the Plan available to the Secretary of Health and Human Services for determining compliance;

Return or destroy the protected health information received, if feasible, after it is no longer needed for the original purpose and retain no copies of such information or if not feasible, restrict access and uses to those that make the return or destruction of the information infeasible as required by the HIPAA Privacy Regulations;

Ensure that any agents, including a subcontractor, of AutoNation to whom AutoNation provides protected health information shall also agree to these same restrictions;

Ensure that adequate separation between AutoNation and Plan is established as required under the HIPAA Privacy Regulations and restrict access to protected health information to those classes of employees or individuals identified in this section; and

Restrict the use of protected health information by those employees identified in this section for plan administration functions within the meaning of the HIPAA Privacy Regulations.

Permitted Disclosure to AutoNation

Notwithstanding the foregoing, the Plan (or a health insurance issuer or HMO with respect to the Plan) may disclose to the AutoNation the following types of information:

Summary health information may be disclosed to AutoNation if AutoNation requests the summary health information for the purpose of (1) obtaining premium bids from health plans for providing health insurance coverage under the Plan, or (2) modifying, amending, or terminating the Plan.

Information on whether an individual is participating in the Plan, or is enrolled in or has disenrolled from a health insurance issuer or HMO offered by the Plan.

Information provided pursuant to an authorization within the meaning of Section 164.508 of the HIPAA Privacy Regulations.

De-identified information, as defined under the HIPAA Privacy Regulations.

Noncompliance

In the event of noncompliance with the restrictions of this section by a designated employee or other individual receiving protected health information on behalf of AutoNation, the employee or other individual shall be subject to discipline in accordance with AutoNation's disciplinary procedures. Complaints or issues of noncompliance by such persons shall be filed with the Plan's Privacy Officer.

HIPAA Security Standards

Safeguards

AutoNation shall implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits on behalf of the Plan, as required under 45 CFR Part 160 and Subparts A and C of Part 164 (the “HIPAA Security Standards”).

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Agents

AutoNation shall ensure that any agent, including a subcontractor, to whom it provides electronic protected health information agrees to implement reasonable and appropriate safeguards to protect such information.

Security Incidents

AutoNation shall report to the Plan any security incident under the HIPAA Security Standards of which it becomes aware.

Adequate Separation

AutoNation shall establish reasonable and appropriate security measures to ensure adequate separation between the Plan and AutoNation, in support of the requirements described in this section.

Application

The provisions of this section shall only apply with respect to any health benefits subject to the HIPAA Privacy Regulations or HIPAA Security Standards.

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OTHER IMPORTANT INFORMATION (CONTINUED)

Network Manager Quality Assessment

Network Manager quality assessment is a critical component of a Network Manager’s evaluation process prior to and after a provider becomes a member of the Network. This includes, but is not limited to, reviewing medical records to make sure information is properly documented and billing is accurate.

Therefore, by enrolling for medical coverage under the Plan and designating dependent coverage, you and your dependents are giving your consent to medical providers to release your or your covered dependents' medical records and medical service-related information, as permitted by law, to the Network Manager for all of the following purposes:

Administering benefits

Managing quality assurance and member satisfaction procedures

Conducting bona fide medical research when required or authorized by law

When required or authorized by law

Security Measures

When AutoNation receives electronic protected health information from the Plan (beyond summary health information or enrollment information), it must comply with the HIPAA security terms in the Plan. The Plan document requires AutoNation to:

1. Implement administrative, physical and technical safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of electronic protected health information;

2. Ensure that the firewall required by the privacy rule is supported by reasonable and appropriate security measures;

3. Ensure that any agent or subcontractor to whom AutoNation provides electronic protected health information agrees to implement reasonable and appropriate security measures; and

4. Report to the Plan any security incident of which AutoNation becomes aware.

Right to Recover Overpayment

Payments are made in accordance with the provisions of the Plan. If it is determined that payment was made for benefits that are not covered by the Plan, for a participant who is not covered by the Plan, when other insurance is primary or other similar circumstances, the Plan has the right to recover the overpayment. The Plan will try to collect the overpayment from the party to whom the payment was made. However, the Plan reserves the right to seek overpayment from you and/or your covered dependents. Failure to comply with this request will entitle the Plan to withhold benefits due you and/or an outside collection agency if internal collection efforts are unsuccessful. The Plan may also bring a lawsuit to enforce its right to recover overpayments.

In addition, if the overpayment is made to a provider, the Plan may reduce or deny benefits, in the amount of the overpayment for otherwise covered services for current and/or future claims with the provider, on behalf of any Participant, beneficiary or dependent in the Plan. If the provider to whom the overpayment is made has patients who are participating in other health plans administered by the third-party administrator, the third-party administrator may reduce payments otherwise owed to the provider from such other health plan by the amount of the overpayment.

Subrogation & Reimbursement

When you and/or your covered dependents incur medical expenses which are payable under workers’ compensation, any statute, any insurance policy or other plan of benefits, or because legal action is brought against any third party or parties to recover damages for an illness or injury, you and/or your covered dependents must notify the Plan Administrator within 30 days and agree to subrogation.

The Plan is entitled to reimbursement for any payment which you/and your covered dependents may receive (or may be entitled to receive) from a third party or parties if the Plan has paid benefits. The Plan shall have a superior right in equity and first priority in any recovery to 100 percent reimbursement of the Plan’s outlay regardless of the manner in which the recovery is structured or worded (e.g., the recovery may seek to limit the Plan’s reimbursement by stating that amounts paid do not represent medical, dental, or vision expenses) and regardless of whether you and/or your covered dependents have been “made whole” by the

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settlement or fully compensated for your injury. The Plan is not subject to any state laws or equitable doctrine, including but not limited to the make whole or common fund doctrines, which would purport to require the Plan to reduce its recovery by any portion of a covered person’s attorney’s fees or costs. The Plan’s right of first priority shall not be reduced due to the covered person’s own negligence. The Plan requires all covered persons and their representatives to cooperate (including in any litigation) in order to guarantee reimbursement to the Plan from third-party benefits. Failure to comply with this request will entitle the Plan to withhold benefits due to you or your covered dependents under the Plan. The Plan’s reimbursement will not be reduced by any attorney’s fees incurred by you and/or your dependents or any person acting on your or their behalf.

By accepting benefits under this Plan, you and your covered dependent(s) agree to subrogate the Plan and acknowledge the Plan’s right to be reimbursed for expenses for which you and/or your covered dependent(s) are entitled to payment from a third party or parties. The Plan may pursue these subrogation rights independently of you or on your behalf, and you and/or your covered dependent(s) are obligated to cooperate, or if the Plan becomes aware that you and/or your covered dependents have received a third-party payment and not reported such payment, the Plan may suspend all further benefit payments on any account to you and/or your covered dependent(s) until the subrogated portion is returned to the Plan or offset against amounts which would otherwise be paid to you and/or your covered dependent(s).

The cost of legal representation of the Plan in matters related to subrogation shall be borne solely by the Plan. The costs of legal representation for you or your covered dependent(s) shall be borne solely by you or your covered dependents.

BlueCard Program

When you are a BlueCross and/or BlueShield covered member, you have access to doctors and hospitals nationally when you are traveling and need medical attention.

All BlueCross and/or BlueShield Plans participate in a national program called “The BlueCard Program.” This program benefits all BlueCross and/or BlueShield covered members who receive covered services in any participating BlueCross and/or

BlueShield service area. Your medical identification card is an important part of the BlueCard Program; be sure to carry it with you at all times.

When you obtain health care services through the BlueCard Program outside of the state in which you reside, the amount you pay for covered services is calculated on the lower of the:

Billed charges for your covered services, or

Negotiated price that the on-site BlueCross and/or BlueShield Plan (“host plan”) charges

Often, this “negotiated price” will consist of a simple discount, which reflects the actual price paid by the Plan, but sometimes it is an estimated price that factors into the actual price expected settlements, withholds, any other contingent payment arrangements and nonclaims transactions with your health care provider or with a specified group of providers. The negotiated price may also be billed Charges reduced to reflect an average expected savings with your health care provider or with a specified group of providers.

The price that reflects average savings may result in greater variation (more or less) from the actual price paid than will the estimated price. The negotiated price will also be prospectively adjusted in the future to correct for overestimation or underestimation of past prices. However, the amount you pay is considered a final price.

Statutes in a small number of states may require the host plan to use a basis for calculating the covered Plan Participant’s liability for covered services that does not reflect the entire savings realized or expected to be realized on a particular claim or to add a surcharge. Should any state statutes mandate liability calculation methods for the covered Plan Participant that differ from the usual BlueCard Program method previously stated or require a surcharge, BlueCross and/or BlueShield would then calculate your liability for any covered health care services in accordance with the applicable state statute in effect at the time you received your care.

BCBS Global Core provides BlueCross and/or BlueShield members with access to a Network of traditional inpatient, outpatient, and professional health care providers throughout the world.

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The program includes a broad range of medical assistance and claim support services for members traveling or living in countries outside their Plan service area.

For information on the BlueCard Program or BCBS Global Core, call the MyQHealth member service number on your medical/prescription drug identification card.

Summary of Benefits & Coverage (SBC)

The Summary of Benefits and Coverage (SBC) summarizes important information about the medical coverage options in a standard format. The SBC’s are intended to provide an easy way to compare medical options. A uniform glossary is also included with generic definitions of medical benefit terms. AutoNation Plan terms may differ from the general definitions provided in the uniform glossary. SBC’s can be found by accessing the benefit website at www.KnowYourBenefits.org. A paper copy can be requested free of charge, by calling The Benefit Connection toll free at 1-877-550-BENE (2363).

Written translation of the SBC is available upon request in certain non-English languages. Contact The Benefit Connection for additional information.

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Important Definitions

These words and phrases have special meaning when used to describe your benefits under the Plan.

Affiliate/Affiliated Employer Each subsidiary of AutoNation, Inc. that participates in the Plan. Allowance The limit on a charge for a covered service, which is determined by the Network Manager or Claims Administrator based on medical practices in your region. The benefits under the Plan are based on the amounts charged up to these Allowances. Amendment (Amend) A formal document signed by the representatives of AutoNation, Inc. The Amendment adds, deletes, or changes the provisions of the Plan and applies to all eligible participants, including those covered before the Amendment becomes effective, unless otherwise specified. Annual Deductible The amount, if required by your medical option, that you must pay in a Plan Year before the Plan starts sharing in the cost of your medical care. The Prescription Drug Program under the Blue Cross 80% with Copays option and Blue Cross 90% with Copays option have an Annual Deductible that is separate from any medical Annual Deductible. Annual Enrollment A designated period of time before the beginning of each Plan Year when you have an opportunity to enroll in benefits or change your benefit elections. Associate An employee of AutoNation, Inc. Charges The actual billed amount for services performed. Claims Administrator The companies that process medical, mental health and substance abuse, and prescription drug claims under the Plan. The Claims Administrators for the Plan are subject to change. In 2019, the Claims Administrator for medical claims is Highmark BlueCross BlueShield and Express Scripts for prescription drug claims.

COBRA The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), which provides that group medical, dental and vision plans must offer continuation of medical, dental and vision coverage to certain Associates and /or their covered dependents beyond the date that their coverage might otherwise terminate. Coinsurance The percentage of reasonable and customary charges you must pay for covered services after any applicable Annual Deductible has been satisfied. Company AutoNation, Inc. and certain of its Affiliates. Copayment A fixed-dollar amount (regardless of the total cost of the service) that you pay each time you receive certain covered medical services or prescription drugs that are payable under the Plan. For prescription drugs, the copayment applies after any applicable Annual Deductible or prescription deductible has been satisfied. For medical, the copayment applies regardless of whether any applicable Annual Deductible has been satisfied. Cosmetic Surgery A medically unnecessary surgical procedure performed primarily to preserve or improve appearance rather than to restore functions that are lost or impaired due to illness or injury. Covered Medical Expenses Charges for medical services, treatment and supplies that are eligible for reimbursement under the Plan. Custodial Care Care rendered to a patient who:

Is disabled mentally or physically, and such disability is expected to continue and be prolonged

Requires a protected, monitored and controlled environment whether in an institution or in the home

Requires assistance to support the essentials of daily living, such as eating, dressing, bathing, transferring and ambulating

Is not under active and specific medical/surgical or psychiatric treatment that will reduce the disability to the extend necessary to enable the patient to function outside the protected, monitored and controlled environment

Deductible (see Annual Deductible)

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Durable Medical Equipment Medical Equipment that meets all of the following requirements:

Is not disposable

Is used to serve a medical purpose with respect to treatment of an illness or injury and its symptoms

Is generally not useful to a person in the absence of an illness or injury and its symptoms

Is appropriate for use in the home Effective Date The date the Participant’s coverage begins under the Plan. Eligible Dependents Dependents eligible for coverage under the Plan include the following:

Your spouse, meaning an individual who is lawfully married to a Participant and not legally separated. An individual shall be considered lawfully married regardless of where the individual is domiciled if either of the following are true: (i) the individual is married in a state, possession or territory of the U.S. and the individual is recognized as lawfully married in that state, possession or territory of the U.S.; or (ii) the individual was married in a foreign jurisdiction and the laws of at least one state, possession or territory of the U.S. would recognize him/her as lawfully married. (A Common Law Spouse not covered or certified by the Plan prior to January 1, 2014, is excluded).

Your children up to the end of the month in which they turn age 26.

Your children of any age who were continuously covered under the Plan prior to the end of the month in which they turn age 26, who are physically or mentally disabled, and unable to work and are principally supported by you. (A disabled dependent certification is required). Eligibility will continue if you provide proof of the disability when the child reaches the age at which coverage otherwise would end; coverage then will remain in effect as long as the disability continues, the dependent continues to be principally supported by you and you maintain dependent coverage under the Plan.

For the purpose of the Plan, “children” include the following:

Your biological children

Legally adopted children (effective on the date of placement in your home)

Stepchildren of your current spouse as defined above

Any other child for whom you have legal custody or are the legal guardian, provided: 1) the child is related to you or is living in your household, and 2) you provide over half the child’s support

Dependents who are eligible as a result of a Qualified Medical Child Support Order (QMCSO)

Supporting documentation, such as a marriage license or birth certificate, must be submitted to and approved by The Benefit Connection within the required time frame before dependent coverage will become effective. No person may be covered both as an employee and a dependent, and no person may be covered as a dependent of more than one employee. Your dependents do not include any person, whether related to you or not, who resides outside of the United States and any person not previously specified. Eligible Expenses Charges for medical services, treatment and supplies that are eligible for reimbursement under the Plan. Emergency A sudden, serious medical condition for which failure to receive immediate medical care could cause permanent disability or loss of life. Some examples of an emergency are bleeding that will not respond to elevation or direct pressure, heart attack, poisoning, a serious wound, severe pain, shortness of breath or unconsciousness. Employer AutoNation, Inc. and its Affiliates.

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Exclusive Provider Organization (EPO) As a member of an EPO, you can use the doctors and hospitals within the EPO Network, but cannot go outside the Network for care. There are no Out-of-Network Benefits. Experimental/Investigational Expenses for medical, surgical, diagnostic, other medical care technologies, supplies, treatments, procedures, drug therapies or devices, MyQHealth for medical and Express Scripts for prescription drugs, as applicable, determine, in the exercise of its discretion, to be experimental or done primarily for research. Treatments, procedures, devices or drugs are excluded under the Plan at the time it makes a determination regarding coverage in a particular case unless: Approval of the U.S. Food and Drug Administration for

marketing the drug or device has been given at the time it is furnished, if such approval is required by law.

Reliable evidence shows that the treatment, procedure, device or drug is not the subject of ongoing Phase I, II or III clinical trials or under study to determine its maximum tolerated dose, its toxicity, its safety, its efficacy or its efficacy as compared with standard means of treatment or diagnoses.

Reliable evidence shows that the consensus of opinion among experts regarding the treatment, procedure, device or drug is that further studies or clinical trials are not necessary to determine its maximum tolerated dose, its toxicity, its safety or its efficacy as compared with the standard means of treatment or diagnoses. Reliable evidence includes anything determined to be such by MyQHealth for medical and Express Scripts for prescription drugs, as applicable, within the exercise of its discretion, and may include published reports and articles in the medical and scientific literature generally considered to be authorized by the national medical or dental professional community.

Full-Time An Associate who is regularly scheduled to work at least 30 hours each week. Incurred Expense The cost of medical service, treatment or supply when provided.

Injury Bodily damage other than sickness, including all related conditions and recurrent symptoms. Injury (Accidental) An unforeseen and unavoidable event cause by an externally violent force or occurrence resulting in bodily harm or damage, independent of an illness or sickness that is not the fault (as defined by the industry) of the Participant and requires initial necessary care provided by a Physician. In-Network Benefits Benefits under the Plan for Covered Medical Expenses provided by a Physician or other medical provider who is a participating Network provider. Leave of Absence Approved period of time away from work. Types of leaves are limited to the following: Company, disability, leave under the Family and Medical Leave Act (FMLA), military service, personal, or workers’ compensation. Maximum Allowed Charges The maximum amount Participating Providers have agreed to accept as payment in full for services provided. Medical Score Risk Predictor (MSRP) The MSRP screening is an assessment of 5 biometric factors that affects your health and predicts your risk for certain conditions. Medically Necessary (Medical Necessity) Services or supplies that MyQHealth for medical and Express Scripts for prescription drugs, as applicable, determine, in the exercise of its discretion, are generally accepted by the national medical professional community as being safe and effective in treating a covered illness or injury, consistent with the symptoms or diagnoses, furnished at the most appropriate medical level and not primarily for the convenience of the patient, a health care provider or anyone else. The Plan has the right to exclude certain procedures, within the bounds of applicable laws, even if they are Medically Necessary. Because a provider has prescribed, ordered or recommended a service or supply does not, in itself, mean that it is Medically Necessary as defined above.

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MyQHealth The company that handles all pre-certification of medical services/procedures as applicable under the Plan. MyQHealth is responsible for conducting utilization and concurrent reviews, case and chronic condition management and medical appeals review. MyQHealth also handles the MSRP Health Advisor calls. Network Manager The organization that credentials, evaluates and contracts with medical providers and/or pharmacies to establish a Network of participating medical providers, participating medical facilities and/or participating pharmacies. The Network Managers, listed in “Administrative Information,” are subject to change. In 2019, the Network Manager for medical claims is Highmark BlueCross BlueShield and Express Scripts for prescription drugs. Nonduplication of Benefits If you or any covered dependents are also covered under another medical plan, your benefits under the Plan and the other plan will be coordinated to determine how much the Plan pays toward your expenses. In 2019, the Network Manager for medical claims is Highmark BlueCross BlueShield and Express Scripts for prescription drugs. Not Job-Related Sickness or injury for which you are not entitled to benefits under workers’ compensation or occupational disease laws or similar laws. Out-of-Network Benefits Benefits under the Plan for Covered Medical Expenses provided by a Physician or other medical provider who is not a participating Network provider. Out-of-Pocket Maximum The most you will spend of your own money for your Annual Deductible, Coinsurance and Copay amounts for Covered Medical and prescription drug Expenses during the Plan Year before additional Covered Medical and prescription drug Expenses are paid by the Plan at 100 percent. Part-Time An Associate who is regularly scheduled to work less than 30 hours each week.

Participant An Associate or an Associate’s Eligible Dependent who is enrolled in the Plan and whose contribution for coverage is current. Participating Provider A Physician or other medical provider who has been selected by the Network Manager for inclusion in the EPO and PPO options provided under the Plan. Physician A licensed medical practitioner who is practicing within the scope of his or her license and who is licensed to prescribe and administer drugs or perform surgery. The term includes any other licensed practitioner operating within the scope of his or her license and performing a covered service, and whose services are required by law in the locality where the service is rendered. Plan The AutoNation Medical Benefits Plan. Plan Administrator The entity described in the section “Plan Administrator” on page 71. Plan Sponsor AutoNation, Inc. Plan Year The 12-consecutive-month period beginning January 1 and ending December 31. All Annual Deductibles and benefit maximums accumulate during the Plan Year. Preferred Provider Organization (PPO) As a member of a PPO, you can use the doctors and hospitals in or out of the PPO Network.

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Pretax Contributions Contributions that are deducted from your pay before federal, state (in most cases) and Social Security taxes are calculated. Because your taxable pay is reduced, you pay less in taxes. Primary Care Physician (PCP) A Physician who has contracted with the Network Manager and who is legally licensed to practice one of the following branches of medicine:

Family or general practice

Internal medicine

Pediatrics Qualified Medical Support Order (QMSCO) Any court order, judgment or decree (including a judicially approved settlement) that: (1) provides for child support with respect to a Plan Participant’s child or directs the Participant to provide coverage under a health benefits plan under a state domestic relations law; or (2) enforces a law described in the Social Security Act, Section 1908, with respect to a group plan. You will be notified if you are subject to a QMCSO. Participants and beneficiaries can obtain, without charge, a copy of the Plan’s QMCSO procedures from the Plan Administrator. Qualifying Life Event A change in your family, work or life status that can have an impact on your benefits as described in the “Enrollment Change Due to a Qualifying Event” section of this document. Reasonable and Customary (R&C) Allowance The maximum amount determined by the Network Manager or the Claims Administrator to be eligible for consideration of payment for a particular covered service, supply or procedure. The amount is determined from the range of the charges most frequently made in the same or similar medical service area for the service, supply or procedure as billed by other Physicians. Retail Benefits Eligible An Associate who has been designated in the payroll system to receive benefits designated by the Plan for retail associates.

Tobacco Products E-cigarettes, cigarettes, pipe tobacco, smokeless tobacco, chewing tobacco and cigars.

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YOUR RIGHTS UNDER ERISA

As a Participant in the AutoNation Medical benefits Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974, as amended (ERISA). ERISA provides that you, as a Plan Participant, are entitled to the following:

Examine all documents governing the Plan, including insurance contracts and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor, without charge at either the Plan Administrator’s office or at other specified locations.

Obtain copies of all documents governing the operation of the Plan, including insurance contracts and a copy of the latest annual report (Form 5500 Series) and an updated summary Plan description upon written request to the Plan Administrator. The Plan Administrator may make a reasonable charge for the copies.

Receive a summary of the Plan’s annual financial report. By law, the Plan Administrator must furnish each Participant with a copy of this summary annual report.

Continue health care coverage for yourself, spouse, or dependents if there is a loss of coverage under the Plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this summary Plan description and the documents governing the Plan on the rules governing your COBRA continuation coverage rights.

In addition to creating rights for Plan Participants, ERISA imposes duties on the people who are responsible for operating this Plan. The people who operate our Plan, called “fiduciaries,” have a duty to do so prudently and in your interest and that of other Plan Participants and beneficiaries. No one, including your Employer or any other person, may fire you, or otherwise discriminate against you in any way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA.

If your claim for a welfare benefit is denied or ignored in whole or in part, you must receive a written explanation of the reason for the denial and you have the right to obtain copies of

documents relating to the decision without charge within certain time schedules. You have the right to have the Plan Administrator review and reconsider your claim within certain time schedules. Under ERISA, there are steps you can take to enforce these rights. For instance, if you request a copy of Plan documents or the latest annual report from the Plan Administrator and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the Plan Administrator’s control. If you have a claim for benefits that is denied or ignored, in whole or in part, you may file suit in a state or federal court. In addition, if you disagree with the Plan Administrator’s decision or lack thereof concerning the qualified status of a medical child support order, you may file suit in federal court.

If the Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suite in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees – for example, if it finds your claim is frivolous.

If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Decision of Technical Assistance and Inquiries, Employee benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue NW, Washington, DC 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration at 1-866-444-3272.

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NOTICE REGARDING WELLNESS PROGRAM

The AutoNation MSRP Biometric Screening Program is a voluntary wellness program available to all employees and their covered spouses who are eligible to enroll in the AutoNation Medical Benefits Plan. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you or your spouse choose to participate in the wellness program you and/or your spouse will be asked to complete a biometric screening, which will measure your height and weight as well as your and/or your spouse’s blood pressure. The screening also includes a blood test that tests for HDL cholesterol, triglycerides, and glucose. Spouses will also be screened for cotinine, which measures nicotine levels in the blood. You will be asked a tobacco use question during your online enrollment. You (and your covered spouse) are not required to participate in the program.

However, Associates (and their covered spouses) who choose to participate in the wellness program will receive the following incentives:

The employee will receive:

25% off the Associate portion of the medical premium for completing and passing the biometric screening (or completing the alternative requirement),

20% off the Associate portion of the medical premium if they answer they are a non-tobacco user (or are a tobacco user and complete the alternative requirement).

Spouses will receive an incentive of:

15% off the spouse portion of the medical premium for completing and passing the biometric screening (or completing the alternative requirement),

10% off the spouse portion of the medical premium if

they pass the cotinine screening (or are a tobacco user and complete the alternative requirement).

Although you are not required to participate in the AutoNation MSRP Biometric Screening program, only Associates and spouses who do so will be eligible to receive the credits.

The results from your biometric screening will be used to provide you with information to help you understand your potential health risks and may also be used to offer you services through the wellness program, such as access to online wellness courses (i.e. nutrition, exercise, etc.) and health coaches. You also are encouraged to share your results or concerns with your own doctor.

Your health Plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all employees enrolled in the Plan. If you think you might be unable to meet a standard for a reward under this wellness program you have an opportunity to earn a reward through the alternative requirement.

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PROTECTIONS FROM DISCLOSURE OF MEDICAL INFORMATION

AutoNation is required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and AutoNation, Inc. may use aggregate information it collects to design a program based on identified health risks in the workplace, the MSRP Biometric Screening Program will never disclose any of your personal information either publicly or to AutoNation, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment. Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. The only individual(s) who will receive your personally identifiable health information are certain contracted third parties including, but not limited to, insurance carriers and AutoNation Benefit Plan consultants in order to provide you with services under the wellness program. In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records. Information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, you will be notified immediately. You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate. If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please complete a Benefit Inquiry and HIPAA form which can be found on KnowYouBenefits.org under the Benefits Information section.

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Administrative Information The following is important identification and administration information about the AutoNation Medical Benefits Plan of which the AutoNation Medical Benefits Plan for Retail Associates is a part. The Plan number identifies the Plan with the Internal Revenue Service and the U.S. Department of Labor.

Official Plan Name AutoNation Medical Benefits Plan Plan Type This Plan is a “welfare plan” as defined in Section 3(1) of the

Employee Retirement Income Security Act of 1974, as amended. It provides medical coverage including certain medical, preventive care, and prescription drug benefits.

Plan Number

510

Plan Sponsor, Administrator and Agent for Service of Legal Process

AutoNation, Inc. c/o AutoNation Benefits Company 200 Southwest First Avenue, 14th Floor Fort Lauderdale, FL 33301 954-769-6000 The Plan is administered by the Employee Benefits Committee (the “Plan Administrator”). The Plan Administrator makes all determinations as to the eligibility of any person under the Plan and determines all questions arising out of the administration and interpretation of the Plan. The Plan Administrator is the agent for service of legal process.

Controlling Law The laws of the state of Florida shall be the controlling state law in all matters relating to the Plan and shall apply to the extent not preempted by the laws of the United States of America.

Employer Identification Number 73-1105145 Plan Year January 1 – December 31 Network Managers, Claims Administrators, Quantum Health (MyQHealth)

Medical and prescription drug benefits for the following Network Managers and Claims Administrators are self-insured. BlueCross BlueShield administers all medical claims under the Plan, and Express Scripts administers all prescription drug claims. Quantum Health (MyQHealth) administers all medical/disease management aspects of the Plan (i.e. utilization and concurrent review, case management, etc.) as well as all pre-certification reviews and clinical appeals review and provides customer service for members.

Quantum Health (MyQHealth) Telephone Number 1-888-979-7677 (customer service, claim inquiries, all precertification and any questions regarding your medical and prescription plan benefits) Medical Appeals (pre-service and post-service) Quantum Health Inc. c/o Appeals 7450 Huntington Park Drive – Suite 100 Columbus, OH 43235

Express Scripts PRESCRIPTION DRUG NETWORK MANAGER AND PRESCRIPTION DRUG ADMINISTRATOR APPEALS (Pre-service and Post-service) Express Scripts, Inc. Clinical Appeal – QAL BW 1041 6301 Cecelia Circle Bloomington, MN 55439 Telephone Number: 1-888-979-7677 Website: www.express-scripts.com

Type of Financing General assets of AutoNation, Inc. and Associate contributions, as determined by AutoNation, Inc. in its

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discretion. Company AutoNation, Inc. and certain of its Affiliates.

You can obtain a copy of the complete listing of companies or divisions participating in the Plan by writing to the Plan Administrator. The list is available for examination by Participants and beneficiaries.

Retail 2019

Documents

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