20 23 BENEFITS

SUMMARY FOR EMPLOYEES

For active employee use only.

02 TA B L E O F CO NT ENTS 2023 FTI BENEFITS

TABLE OF CONTENTS
Answers to your most common questions can be found in the following pages.

MEDICAL COVERAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
PRESCRIPTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
VISION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
DENTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

HEALTH SAVINGS ACCOUNT [HSA] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

FLEXIBLE SPENDING ACCOUNTS [FSA] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

LIFE, ACCIDENTAL DEATH & DISMEMBERMENT, SHORT TERM AND LONG TERM DISABILITY . . . . . . . . . . . . . . 16

VOLUNTARY LIFE, VOLUNTARY AD&D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

VOLUNTARY ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

401[K] AND 401[A] PLANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

FAMILY-FRIENDLY BENEFITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
EMPLOYEE ASSISTANCE PROGRAM [EAP] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

WELLNESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

ADDITIONAL RESOURCES | MISCELLANEOUS INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Faith Technologies Incorporated medical and dental plans are self-funded, which means FTI and employee premiums
cover the cost of claims. Being self-funded helps us reduce our costs because we don’t pay more to a carrier; however,
it also means that we take on a lot of risk in the process. We all play a part in keeping costs down by taking advantage
of preventive care benefits, which are typically no cost for you: participating in the biometric screenings, staying current
on medications and treatment plans, and actively participating in the FTI Wellness programs. Taking action to reduce
the severity of preventable health issues plays a big part in keeping our claims costs down and we’re able to transfer
that savings to you in the form of lower premiums.

For active employee use only.

 2023 FTI BENEFITS BE N E F ITS OVE RVIEW 03

BENEFITS OVERVIEW
We are pleased to offer full-time employees [working on average 30+ hours per week] a comprehensive benefits package with
cost-effective options to fit your lifestyle as part of your total rewards package. FTI offers a $300 reimbursement per family each
calendar year for various healthy lifestyle choices as part of the Healthy Lifestyle Reimbursement Program. The table below provides
a brief description of your benefits, with more detailed information provided in the pages that follow or as referenced below. The
Benefit Counselors at Prepare Benefits will provide all FTI employees with a clear understanding of the benefit programs we offer and
will assist you with the enrollment process. Schedule a one-on-one meeting with a Benefit Counselor, ask questions and get enrolled.

BENEFIT DESCRIPTION
Medical
We partner with United Healthcare and Alliance to offer medical insurance. There are three plans to choose
from based on personal wellness and health care usage.

Teladoc®
Access to U.S. board-certified doctors, pediatricians, dermatologists, psychiatrists, psychologists, licensed
clinical social workers, counselors or therapists by phone, online video or mobile app.

Prescription Drug
Included with your Medical insurance coverage, the company provides Prescription Drug [Rx] coverage
through OptumRx.
Vision We partner with United Healthcare to offer vision insurance.
Dental We partner with Delta Dental of Wisconsin to offer dental insurance.
An HSA is a personal health care bank account that you can use to pay out-of-pocket medical, dental and
Health Savings Account [HSA] vision expenses, vision expenses on a pre-tax basis when you are enrolled in the qualified High Deductible
Health Plan [HDHP].
These accounts allow you to set aside pre-tax dollars from your paycheck to cover qualified out-of-pocket
Flexible Spending Account [FSA] expenses. The company partners with WEX to offer three FSA options: [1] Healthcare FSA, [2] Limited-Purpose
FSA, [3] Dependent Care FSA.
Company-provided benefit [at no cost to you]. Depending on your position with the company, coverage
Life | AD&D Insurance
amounts range from 1-2 times your annual income [with a cap].
Company-provided benefit that is 100% paid by the company. After a 13-week waiting period, the LTD plan
Short Term & Long Term Disability
will pay 60% of your normal earnings up to a maximum of $10,000 per month.
Accident, Critical Illness and
Voluntary insurance coverage avaliable to you as a supplement to your other health care insurance coverage.
Hospital Indemnity Insurance

Voluntary Life and AD&D You may purchase additional life and AD&D insurance for yourself, spouse and/or dependents.

FTI’s matching contribution will be in accordance with our Plan through Empower, formerly Prudential
401[k] Retirement Plan Retirement. [The current discretionary match is 50% of the first 6% of your individual contribution to your 40[k]
retirement plan, regardless of whether your contributions are pre-tax, Roth, or a combination of both].
Discretionary contributions may be made to your 401[a] Profit Sharing Plan by FTI, based on company growth
and financial performance. The funds contributed under this plan are subject to a three-year cliff vesting
401[a] Profit Sharing Plan schedule, meaning that employees will not have access to these funds until they have completed three
years of employment with FTI from either the initial date of the plan [August 1, 2019] or their initial date of
employment, whichever is later.
We partner with ERS EAP, an AllOne Health Company, to offer 24/7/365-day confidential support to all
employees and their household members. The EAP provides mental health counseling services along with life
Employee Assistance Program [EAP]
coaching, medical advocacy, work/life resources, personal assistant and legal/financial services at no cost
to you. [100% paid by the company].
This benefit is designed to extend time off to each employee to focus on their total well-being - mind, body
Time to Recharge and soul. Each full, part-time and seasonal team member receives two hours of paid time off every month to
use toward self-care, training, and/or professional health services.

Talent Development
Internal course and curriculum available in the following categories: apprenticeship, employee development,
high potential, leadership, safety and trade.
Reimbursement: 100% for A, B, or A/B grade; 50% for C grade; no reimbursement for grades lower than a C.
Tuition Reimbursement Prior approval required.
Paid time off eligibility is based on your years of service with FTI
Paid Time Off [PTO]
90 days: 1 week 5 years: 4 weeks 10 years: 4 weeks + 3 days 20 years: 6 weeks
1 year: 2 weeks 8 years: 4 weeks +1 day 11 years: 4 weeks + 4 days Holiday Pay:
2 years: 3 weeks 9 years: 4 weeks + 2 days 15 years: 5 weeks 7 paid holidays

Safety Shoes: Reimbursement up to 30% of cost; maximum of $30 per year. Prescription Safety Glasses:
Safety Reimbursement Plan
Reimbursement up to $100 per year.
Adoption Assistance Up to $5,000 per calendar year, after 1 year of service.
Paid Parental Leave 1 week of paid parental leave per rolling 12 months for births and adoptions, after 1 year of service.
Up to $5,000 per calendar year [$10,000 lifetime maximum] for eligible services within medical insurance
Fertility Benefits
coverage.
04 ME D I CAL P LAN CO M PAR I SO N 2023 FTI BENEFITS

MEDICAL | PLAN COMPARISON

For additional plan details, visit the 2023 Open Enrollment Portal Site. [https://faithtechnologies.sharepoint.com/sites/
BenefitsCW/SitePages/2023-Open-Enrollment.aspx; log in with your Office 365 credentials.]
HIGH DEDUCTIBLE
PREMIER PPO VALUE PPO HEALTH PLAN
In Network Non-Network In Network Non-Network In Network Non-Network
DEDUCTIBLE

PER PERSON $1,000 $2,000 $2,000 $4,000 $2,800 $5,200

PER FAMILY $3,000 $6,000 $6,000 $12,000 $5,600 $10,400
OUT-OF-POCKET MAX

PER PERSON $2,000 $4,000 $4,000 $8,000 $2,800 $10,400

PER FAMILY $6,000 $12,000 $12,000 $24,000 $5,600 $20,800
PHYSICIAN VISITS
Premium Care Primary Care $20 $20
[UHC Choice Plus Only) Ded + 40% Ded + 40% Deductible Ded + 40%
Premium Care Specialist $40 $40
(UHC Choice Plus Only)

Primary Care $25 $35

Ded + 40% Ded + 40% Deductible Ded + 40%
Specialist | Urgent Care $50 $50
Preventive Wellness Care Covered 100% Not Covered Covered 100% Not Covered Covered 100% Not Covered
Mammograms, colonoscopies
Covered 100% Ded + 40% Covered 100% Ded + 40% Covered 100% Ded + 40%
& routine hearing
HOSPITAL SERVICES

Inpatient & Outpatient Ded + 10% Ded + 40% Ded + 20% Ded + 40% Deductible Ded + 40%
Hospitalization
$150 copay + $150 copay + $150 copay + $150 copay + In-Network
True Emergency Room Visit Deductible
Ded + 10% Ded + 10% Ded + 20% Ded + 20% Deductible
PRESCRIPTION CO-PAYMENTS

Retail Generic | Formulary | Non-Formulary $15 | $30 | $50 $15 | $35 | $60 Deductible
Mail Order (90-Day Supply) 2X Retail 2X Retail Deductible
EMPLOYER CONTRIBUTION - HSA
Employee Only $0 $0 $200
Family $0 $0 $600

Monthly Premium with Wellness Incentive PREMIER PPO VALUE PPO HIGH DEDUCTIBLE
MONTHLY PREMIUM MONTHLY PREMIUM MONTHLY PREMIUM
WHOLE HALF WHOLE HALF WHOLE HALF
Wellness Incentive Wellness Incentive Wellness Incentive Wellness Incentive Wellness Incentive Wellness Incentive

Employee Only $118 N/A $60 N/A $84 N/A

Employee + Spouse $358 $483 $235 $358 $280 $398
Employee + Child(ren) $269 N/A $171 N/A $205 N/A
Family $409 $534 $263 $386 $313 $431
Monthly Premium without Wellness Incentive MONTHLY PREMIUM MONTHLY PREMIUM MONTHLY PREMIUM

Employee Only $243 $183 $202

Employee + Spouse $608 $480 $516
Employee + Child(ren) $394 $293 $323
Family $659 $509 $549
COBRA MONTHLY PREMIUM MONTHLY PREMIUM MONTHLY PREMIUM

Employee Only $704 $640 $670

Employee + Spouse $1,668 $1,516 $1,587
Employee + Child(ren) $1,337 $1,216 $1,273
Family $1,971 $1,791 $1,876
NOTE: The whole wellness incentive premium amount reflects the premium when both the employee and spouse [if applicable] complete the Premium Incentive
Program. The half wellness incentive premium amount reflects the premium when either the employee or the spouse complete the Premium Incentive Program.
COBRA continuation coverage can become available to you and other members of your family who are covered under the Plan when you or they would otherwise
lose group health coverage. As a COBRA participant, please be aware that you are responsible for paying the entire cost of the medical coverage, plus an
administrative charge of 2%.
 2023 FTI BENEFITS UM R PRO GRAMS 05

UNITED HEALTH PREMIUM DESIGNATION PROGRAM

To help you make more informed choices about your health care, United Healthcare created the United Health
Premium Designation program. The Premium program, offered through UMR, recognizes doctors who meet
standards for quality and cost efficiency. Members who choose to see a Premium Care Physician may pay lower
co-payments for services than for a non-Premium Care Physician.

How to Find a Premium Care Physician To find a Premium Care Physician or facility in your area
The United Health Premium Care Physician symbol is used to Visit www.umr.com and search for a provider
identify physicians who have been recognized for providing
Call the toll-free number on the back of your health plan ID
exceptional value.
card to speak with a customer care professional.

Premium Care Physicians are only available on the United Healthcare Choice Plus network and may not be available in all
locations.

UMR HEALTH MANGEMENT PROGRAMS

FTI has teamed up with UMR to provide company-paid health management programs for medical plan members.

Chronic Back and Neck Pain Management Program NurseLine

This program supports members diagnosed with chronic back The UMR NurseLine service is a 24/7 health information line
or neck pain. Individuals may voluntarily self-enroll, or UMR that assists individuals with medical-related questions and
coaches may reach out to individuals diagnosed with chronic concerns. NurseLine gives members access to highly trained
back or neck pain to invite them to participate in a series of registered nurses so they may receive guidance and support
when making decisions about their health and/or the health
one-on-one calls with a health coach. This program offers
of their dependents. The service is offered via a partnership
expert resources and one-on-one support to help avoid costly
with Optum. The NurseLine registered nurses educate callers
ER or doctor visits, to help control pain and to improve quality
on specific conditions as well as treatment options. The
of life. To sign up to work with a health coach, call nurses help members determine the right care by assisting
866.575.2540 or log in to your UMR account, go to the Health with decisions on when and where to seek care.
Center and select "Having back or neck pain?"
NurseLine is available in English, Spanish and 140+
Disease Management Program additional languages through the use of a Language Line
UMR’s nurse coaches will help members bring their chronic service 877.950.5083.
medical conditions under control [some examples include
asthma, hypertension, heart disease, diabetes]. The coaches NurseChat [included with NurseLine program]
can motivate and guide you in making informed decisions to NurseChat is a convenient and trusted online source of health
control your symptoms, improve your health, set goals, and and wellness information that is available 24 hours a day,
discuss strategies for success. Most importantly, coaches can seven days a week. Members have one-on-one secure, real-
arm you with the confidence to take charge of your health time access to registered nurses through the Health Center on
and welcome the rewards that follow. To sign up to work umr.com. These nurses provide information on a variety of
with a health coach, call 866.575.2540 or log in to your UMR health and wellness topics, including fitness, nutrition,
account, go to the Health Center and select “Get a Health common illnesses and conditions, and prevention tips.
Coach.” Please note, triage is not part of the NurseChat experience.
However, if a member needs triage assistance, NurseChat will
Maternity Management Program refer the member to NurseLine.
Whether you are considering having a baby or are already
expecting, this program can teach you how to reduce your Nicotine Cessation Program [prescription drug program]
risk of complications and prepare you for a successful, Available to all enrolled employees and dependents
full-term pregnancy and a healthy baby. Experienced through the FTI prescription drug coverage.
OB/GYN nurses will help you understand your personal health All nicotine cessation products (brand name, generic,
risks, provide prenatal education and refer you to case prescription and over-the-counter [OTC] products are
management if a serious condition arises. To enroll, call covered 100% at a retail pharmacy. A prescription from
888.438.8105 or log in to your UMR account, go to the Health your provider is required.
Center and select “Expecting a Baby?” Up to 180 days per person per calendar year benefit.

For active employee use only.

06 M E D I CAL | TELADO C 2023 FTI BENEFITS

MEDICAL | TELADOC ®

®
TELADOC
Teladoc provides you and your eligible dependents with 24/7/365 access to U.S. board-certified doctors, pediatricians,
dermatologists, psychiatrists, psychologists, licensed clinical social workers, counselors or therapists by phone, online video or
mobile app visit for many medical issues.

Behavioral Health services

Behavioral Health services are now available through Teladoc! Schedule an appointment through Teladoc's website
or mobile platform to see a psychiatrist for medication management, or a counselor or psychologist for counseling.
Behavioral health services are not available 24/7 and you must schedule an appointment. Teladoc Behavioral Health
provides treatment for issues such as stress/anxiety, depression, substance abuse, domestic abuse and grief counseling.

Resolve many of your medical issues

Teladoc can diagnose, recommend treatment and prescribe medication, when appropriate, for many of your medical
issues, including: sinusitis, cold and flu, sore throat, ear infections, allergies, rashes, hives, poison ivy, eczema, acne, anxiety,
depression, panic disorder, pediatric care, non-emergency medical issues, and more.

Speak with U.S. board-certified doctors

Our national network includes the highest quality, state-licensed doctors who will call you back in less than 30 minutes, on
average.

Save money
Teladoc costs you much less than urgent care or ER visits.

NOTE
All charges apply toward your out-of-pocket maximum.
You must complete your medical history disclosure before requesting a consultation and update your medical history each year.

TELADOC SERVICES PREMIER PLAN VALUE PLAN HIGH-DEDUCTIBLE PLAN

General Medicine $5 $5 $49
Psychiatrist [initial visit] $5 $5 $220
Psychiatrist [ongoing] $5 $5 $100
Psychologist, Licensed Clinical Social $5 $5 $90
Worker, Counselor or Therapist

BENEFIT INFO General Benefits Email Benefits Hotline

Headquarters Contact Information
Reach out to your FTI team 201 Main Street | P.O. Box 260 | Menasha, WI 54952-0260
[email protected] 920.225.6772
for benefit-specific questions. (800) 677.1506 | FAX: 920.722.7201

For active employee use only.

 2023 FTI BENEFITS PRE S CRIP TION 07

PRESCRIPTION BENEFITS

PLAN INFORMATION
Claims Administrator: OptumRx
Plan Name: Faith Technologies Incorporated
Group Number: 01961037
Member ID: Same as Medical ID
Eligibility: First of the month following 30 days of employment
NOTE: Monthly premium is included with the medical insurance premium

CUSTOMER SERVICE
OptumRx: 877.559.2955
www.optumrx.com
P.O. Box 29044 • Hot Springs, AR 71903
OptumRx | Mail Order: P.O. Box 2975 • Mission, KS 66201-1375

SCHEDULE OF BENEFITS | PRESCRIPTION

HIGH-DEDUCTIBLE
PHARMACY BENEFIT PLAN DESIGN PREMIER PLAN VALUE PLAN PLAN

Retail NOTE: Monthly refill limited to a 34-day

supply. A 90-day refill is available at a
Tier 1: Generic retail pharmacy at three times the $15 $15 Network Deductible
Tier 2: Brand Name monthly copay. $30 $35 Network Deductible
Tier 3: Non-Formulary $50 $60 Network Deductible

Mail Order NOTE: Limited to a 90-day supply

Tier 1: Generic $30 $30 Network Deductible
Tier 2: Brand Name $60 $70 Network Deductible
Tier 3: Non-Formulary $100 $120 Network Deductible

Smoking Deterrents
NOTE: Limited to 180 days per
Brand Name, Generic, calendar year by the plan
$0, 100% Covered $0, 100% Covered $0, 100% Covered
Prescription and
Over-the-Counter
(OTC) Products

NOTE: All copays apply toward the medical out-of-pocket maximum.

BENEFIT INFO General Benefits Email Benefits Hotline

Headquarters Contact Information
Reach out to your FTI team 201 Main Street | P.O. Box 260 | Menasha, WI 54952-0260
[email protected] 920.225.6772
for benefit-specific questions. 800.677.1506 | FAX 920.722.7201

For active employee use only.

08 PRESCRIPTION 2023 FTI BENEFITS

PRESCRIPTION BENEFITS

3 Tier Benefit Design Nicotine Cessation Program

The Nicotine Cessation Program is available to all covered
Tier 1
employees and spouses through the Prescription Drug
The lowest tier or the lowest cost level contains generic
Coverage. The first office visit per year to discuss nicotine
drugs. A generic drug contains the same active ingredient,
cessation with your primary care provider is covered at 100%,
has the same strength, dosage form, route of
no copay, through the Preventive Care Wellness benefit (any
administration, and works the same way in the body as
additional office visits regarding nicotine cessation are
the brand name product but may cost 50% to 75% less.
subject to an office visit copay, or deductible and/or
Tier 2 coinsurance, depending on the plan selected). All nicotine
The middle tier contains formulary brand-name drugs. cessation products utilized are covered up to 180 days per
Formulary brand-name drugs result in a slightly higher cost calendar year. This includes brand, generic, prescription, or
because they cost more than generic drugs. over-the-counter [OTC] products. It is important that you
show your insurance card for any of these purchases so it
Tier 3
processes through the Prescription Drug Coverage properly.
The highest tier contains non-formulary drugs and results in
the highest cost. Non-formulary drugs may not offer any Quantity Limitations
additional value compared to lower-tiered drugs. Usually, a PBM’s clinical pharmacists have identified several non-
similar drug that is on the formulary is available as a maintenance, high-cost medications that are not used daily,
generic or a brand-name drug at lower tiers. but instead are used on an as-needed basis. The Quantity
Limitations Program will adjust and manage the quantity of
Dosage Optimization
medication that a Member can receive in a given time period,
The Dosage Optimization Program identifies medications that
pursuant to FDA guidelines.
are sometimes prescribed in multiple daily doses but are also
approved by the manufacturer and FDA in a single dose to be Specialty Pharmacy
just as effective. The goal is to simplify the daily medication The Specialty Pharmacy program is designed to target high
schedule and improve the likelihood of following the doctor’s cost, injectable or medications requiring special handling for
recommendation. For example, if 20 mg of Lipitor® is a specific category of conditions. An in-depth clinical review
prescribed to manage high cholesterol, you should take one is done on a case-by-case basis by the on-staff pharmacists.
20 mg tablet daily, instead of two-10 mg tablets daily. By The selected pharmacy then establishes a care team to
managing the number of medications that can and should be monitor and support each individual and their needs.
taken once daily, FTI Members will receive the most benefit
from the medication. Step Therapy
The Step Therapy program establishes a recommended
Mail-Order Maintenance Medications order of medications used within a selected therapy class.
The Standard Maintenance list is a comprehensive This program ensures members are receiving clinically
recommendation of medications utilized on a long-term or appropriate, yet cost-effective medication based on
lifelong basis. This list reflects the guidelines established by individual prescription history. An over-the-counter drug may
the Food and Drug Administration and drug manufacturers, be the first step in a trial period to monitor the effectiveness
and promotes appropriate utilization using therapeutic of lower-cost alternatives. Any covered OTC products will be
effectiveness and safety as its main proponents. Drugs that considered Tier 1.
are not considered Maintenance Medications are not eligible
for mail order. Specialty Injectables Prior Authorization
Specialty medications are vital for people who have rare,
complex or hard-to-treat conditions. However, since these
medications are also generally expensive, they are subject to
prior authorization clinical reviews. Please reach out to
OptumRx to determine if your medication is on the specialty
injectables list. If it is, you or your doctor will need to call UMR
for a prior authorization.

For active employee use only.

 2023 FTI BENEFITS VISION 09

SCHEDULE OF BENEFITS | VISION

BENEFIT MEMBER RESPONSIBILITY

In Network Non-Network
Comprehensive Exam | Every 12 months
Present your medical insurance card at the time of service $10 copay Up to $40 reimbursement
and the exam will be covered 100% in or out of network.

Frames | Covered every 24 months $25 copay Up to $45 reimbursement

up to $150 frame allowance

Lenses | Covered every 12 months $25 copay

Clear glass or plastic; includes standard scratch-resistant coating unless purchasing frames
Covered every 12 months:
Single Vision Lenses 100% Covered Up to $40 reimbursement
Bifocal Lenses | Lined 100% Covered Up to $60 reimbursement
Trifocal Lenses | Lined 100% Covered Up to $80 reimbursement
Lenticular Lenses 100% Covered Up to $80 reimbursement
Polycarbonate Lenses 100% Covered Above reimbursements apply
Progressive Lenses, Anti-Reflective Coatings and Other Upgrades Discounts may apply Discounts may apply

Contact Lenses | Covered every 12 months

In lieu of eye glasses
Covered every 12 months:
[e.g. diagnostic, fitting and evaluation services]

Elective, Covered-in-Full | See Formulary List for covered contacts $25 copay Up to $150 reimbursement
up to 6 boxes & fittings for materials only
Elective, Not Covered-in-Full $150 allowance Up to $150 reimbursement
[toric, gas permeable, bifocal contact lenses, includes fitting & evaluation fees
and others not found on the Formulary List]
for materials only

Medically Necessary Paid in full Up to $210 reimbursement

for materials only
NOTE: Coverage for Covered Contact Lenses at Costco, Walmart or Sam’s
Club locations will be up to $150 reimbursement for contact lenses and
fitting/evaluation fee.

United Healthcare Vision has partnered with QualSight to provide our members with access to the largest network of credentialed and experienced LASIK
surgeons nationwide. These surgeons use only FDA-approved technologies and have collectively performed over 7 million procedures. For more information,
call 855.239.2020 or visit www.myuhcvision.com.

VISION COVERAGE LEVEL MONTHLY EMPLOYEE COST

Vision Plan: MONTHLY Employee Costs [Pre-tax amounts]

Employee Only $5.80
Employee + Spouse $11.73
Employee + Child[ren] $11.91
Employee + Family $22.62

COBRA Insurance: MONTHLY Employee Costs

Employee Only $5.92
Employee + Spouse $11.98
Employee + Child[ren] $12.16
Employee + Family $23.10

COBRA continuation coverage can become available to you and to other members of your family who are covered under the Plan when you or they would otherwise
lose group health coverage. As a COBRA participant, please be aware that you are responsible for paying the entire cost of the vision coverage, plus an administrative
charge of 2%.

For active employee use only.

10 D E N TAL 2023 FTI BENEFITS

SCHEDULE OF BENEFITS | DENTAL

BENEFIT MEMBER RESPONSIBILITY

Annual Maximum | Total amount paid by the plan per calendar year. Plan pays $2,000 per covered person

Deductibles
Individual $50
Family $150
NOTE | Once three family members have met their deductibles, the family maximum
of $150 will apply and no deductible will be charged for any other family members.

Diagnostic & Preventive Services | Covered 100% regardless of annual maximum

Exams 100% Covered
Cleanings 100% Covered
Fluoride Treatments | Dependents to age 14 100% Covered
X-rays 100% Covered
Sealants | Dependents to age 19 100% Covered
Space Maintainers | Dependents to age 16 100% Covered
Evidence Based Dentistry Guidelines | Contact Delta Dental to register
NOTE: Additional coverage for individuals with diabetes, pregnancy, serious See Summary Plan Description
periodontal conditions, high-risk cardiac conditions, suppressed immune systems for coverage levels
conditions, kidney failure or dialysis conditions, and cancer-related chemotherapy
and/or radiation.

Basic & Major Services [deductible applies; subject to annual maximum]

Emergency Treatment to Relieve Pain 20%
Fillings 20%
Endodontics [surgical/nonsurgical] 20%
Periodontics [surgical/nonsurgical] 20%
Extractions [surgical/nonsurgical/other oral surgery] *excluding wisdom teeth 20%
Crowns, Inlays, On-Lays 20%
Bridges and Dentures 20%
Repairs and Adjustments to Bridges and Dentures 20%
NOTE | Verify medical or dental coverage of all oral surgery procedures before scheduling.

Orthodontic Services
Coverage copayment 50%
Individual lifetime maximum paid by the plan $2,000
Dependents eligible to age 26
Adult orthodontics Yes

DENTAL COVERAGE LEVEL MONTHLY EMPLOYEE COST

Dental Plan: MONTHLY Employee Costs [Pretax amounts]
Employee Only $13.00
Employee + Spouse $25.60
Employee + Child(ren) $34.45
Employee + Family $47.45

COBRA Insurance | MONTHLY Employee Costs

Employee Only $33.00
Employee + Spouse $65.00
Employee + Child[ren] $88.00
Employee + Family $121.00

COBRA continuation coverage can become available to you and to other members of your family who are covered under the Plan when
you or they would otherwise lose group health coverage. As a COBRA participant, please be aware that you are responsible for paying
the entire cost of the dental coverage, plus an administrative charge of 2%.

For active employee use only.

 2023 FTI BENEFITS H EALTH SAVIN GS ACCOUN T [HSA] 11

HEALTH SAVINGS ACCOUNT [HSA]

A Health Savings Account is available for all employees enrolled in the High Deductible Health Plan [HDHP].
An HSA is a personal healthcare bank account that you can use to pay out-of-pocket medical, dental and
vision expenses. You own and administer your healthcare savings account. You determine how much
pre-tax income you will contribute to your account, when to use your money to pay for qualified medical
expenses, and when to reimburse yourself. HSAs allow you to save and “roll over” money if you do not spend
it in the calendar year. This is a bank account; you must have money in the account before you can spend
it. The money in this account is always yours. If you change health plans or jobs, the money in the account
is yours to keep.

You are eligible to open and fund an HSA if:

You are covered by an HSA-eligible High Deductible Health Plan.
You are not covered by your spouse’s health plan [unless it is a qualified HDHP], Healthcare Flexible Spending Account [FSA],
or Health Reimbursement Arrangement [HRA].
You are not enrolled in the Healthcare FSA*.
You are not eligible to be claimed as a dependent on someone else’s tax return.
You are not enrolled in Medicare, TRICARE, or TRICARE for Life.
You have not received Veterans Administration Benefits in the past three months.

You can use HSA money to pay for qualified medical, dental, or vision expenses now or in the future. Your HSA can be used for
your expenses and those of your spouse and dependents, even if they are not covered by the HDHP. FTI has partnered with Wex
to administer the HSAs opened by employees participating in the HDHP.

HSA Eligibility | Spouses: In the case of married individuals, Distributions: HSA distributions are tax-free if they are used
each spouse who is an eligible individual who wants to have an to pay for qualified medical, dental, and vision expenses not
HSA must open a separate HSA. Married couples cannot have a covered by insurance. In general, payments for insurance are not
joint HSA, even if they are covered by the same HDHP; however, qualified medical expenses for HSA purposes; however, there
distributions can be used to cover the qualified expenses of the are exceptions for:
other spouse.
Qualified long-term care services and long-term care
If you are covered by your spouse’s plan that is not a HDHP, then insurance.
you are not eligible for an HSA.
Continuation of coverage required by federal law [i.e., COBRA].
Health insurance for the unemployed.
Medicare expenses [but not Medigap].
Retiree health expenses for individuals age 65 or older.
Distributions made for any other purpose are subject to
income tax and a 20 percent penalty. The 20 percent penalty
is waived in the case of death or disability. The 20 percent
penalty is also waived for distributions made by individuals
age 65 or older.
12 FL EX I B L E S P END I NG ACCO UNT [ F SA ] 2023 FTI BENEFITS

FLEXIBLE SPENDING ACOUNT [FSA]

A Flexible Spending Account is designed to help you pay for health care expenses and/or dependent day
care expenses on a pre-tax basis. You can set aside funds through regular payroll deductions based on your
anticipated expenses. The following page provides a worksheet to help you determine an appropriate amount
to set aside.

PLAN INFORMATION
Claims Administrator: WEX

Eligibility: First of the month following 30 days of employment

Plan Year: January 1, 2023 - December 31, 2023

Grace Periods: January 1, 2023 - March 15, 2024

NOTE | Window to incur claims for the 2022 plan year.

January 1, 2023 - June 15, 2024

NOTE | Window to submit forms and receipts for the 2022 plan year.

Reimbursement Options: Auto Reimbursement, Debit Card, Manual

Forfeiture Date: June 16, 2024

CUSTOMER SERVICE 866.451.3399

www.wexinc.com

The biggest advantage of participating in a flexible spending account is tax savings. Every dollar you set aside in your
account reduces your income taxes, and you can be reimbursed for qualified expenses that you are already paying for!
Carefully review your estimated expenses before making the decision to participate. Expenses must be incurred by March
15, 2024, and claims for eligible expenses must be submitted by June 15, 2024, in order to ensure your flexible spending
account contributions aren't forfeited.

BENEFIT INFO General Benefits Email Benefits Hotline

Headquarters Contact Information
Reach out to your FTI team 201 Main Street | P.O. Box 260 | Menasha, WI 54952-0260
[email protected] 920.225.6772
for benefit-specific questions. 800.677.1506 | FAX 920.722.7201

For active employee use only.

 2023 FTI BENEFITS F L EXIBL E S PE N D IN G ACCO UN T [ FSA] 13

FLEXIBLE SPENDING ACCOUNT [FSA]

Dependent Care Flexible Spending Account [DC FSA] Health Care Flexible Spending Account [HC FSA]
This account reimburses you for day care expenses A Health care FSA allows you to set aside pre-tax dollars from
for eligible children and adults. Qualified expenses for your paycheck to cover qualified medical, dental and vision
reimbursement include: adult and child day care centers, expenses. The funds you elect to contribute are available in
preschool, before/after school care. Through regular payroll full on the first day of the plan year. The maximum
deductions, you can set aside part of your income to pay contribution amount is determined by the IRS.
for these expenses on a tax-free basis. The annual family
NOTE: IRS rules prohibit an employee from having a Healthcare FSA
maximum contribution is $5,000 [subject to change per IRS and HSA at the same time.
regulations]. Funds you contribute to the Dependent Care FSA
need to be accumulated before you can use them. Limited-purpose Flexible Spending Account [LP FSA]
If you enroll in the Health Savings Account, you may
To qualify, your dependents must be participate in the Limited Purpose FSA, which allows for
A child under the age of 13. reimbursement of eligible dental and/or vision expenses.
The IRS determines the maximum contribution limit each year.
A child, spouse or other dependent who is physically or
mentally incapable of self-care and spends at least eight NOTE: You must participate in the HDHP in order to have a LP FSA.
hours a day in your household.

Determining Your Reimbursable Expenses

By completing the following information, you can calculate your annual reimbursable expenses. Take into consideration the
services to be provided during the upcoming plan year for you and your dependents.

Health Care Expenses

Medical Qualifying Health Care Items
Deductibles $ ____________________ Prescriptions $ ____________________
You can use your health care flexible spending account to pay
Copayments $ ____________________ Other $ ____________________ for a variety of health care products and services for you,
Coinsurance $ ____________________ Eligible OTC Items $ ____________________ your spouse, and your dependents. The IRS determines which
expenses are eligible for reimbursement. See the list below
Dental of potentially eligible expenses and over-the-counter [OTC]
Deductibles $ ____________________ Other $ ____________________ products.
Fillings/Crowns $ ____________________ Eligible OTC Items $ ____________________
Acne Products* Nasal Sprays & Strips*
Orthodontics $
Acupuncture Orthotics
Vision Over-the-Counter [OTC]
Allergy Medications*
Eye Surgery $ ____________________ Other $ ____________________ Medications
Blood Pressure Monitor
Lenses/Frames $ ____________________ Eligible OTC Items $ ____________________ Pregnancy Test
Cold & Flu Prevention*
Contacts $ ____________________ Reading Glasses
Feminine Hygiene Products
Sleep Aid & Sedatives*
Total Reimbursable Health care Expense Fertility Monitor
Smoking Cessation |
First Aid Kits
$ ____________________ Programs, Supplies*
Hearing Aids | Batteries
The annual individual maximum contribution is TBD by Sterilization
IRS regulations Humidifier | Supplies*
Sunscreen Products*
Infertility Treatment
Wart Removal
Dependent Day Care Expenses
Lice Treatment* Treatments*
Children $ ____________________ Medicines* Wound Care
Adults $ ____________________
Motion Sickness Medications*
Total Reimbursable Dependent Care Expenses *Some expenses may require a valid prescription or that you submit a
$ ____________________ letter of medical necessity signed by your doctor for them to be eligible.
For more information and/or a complete list of eligible items, refer to
The annual individual maximum contribution is $5,000 your plan document or IRS resources for more information.
[subject to change per IRS regulations]
NOTE: You must re-enroll each year to participate in flexible spending
account plans.

For active employee use only.

14 S P E N D I N G ACCO UNT | SI D E- BY - SI D E CO M PA RIS O N 2023 FTI BENEFITS

SPENDING ACCOUNTS | SIDE-BY-SIDE COMPARISON

For additional plan details, visit the 2023 Open Enrollment Portal Site: https://faithtechnologies.
sharepoint.com/sites/BenefitsCW/SitePages/2023-Open-Enrollment.aspx. Log in with your Office 365 credentials.

HEALTH CARE FLEXIBLE DEPENDENT CARE FSA HEALTH SAVINGS LIMITED-PURPOSE FSA
SPENDING ACCOUNT ACCOUNT
[DC FSA] [LP FSA]
[HC FSA] [HSA]

PURPOSE Allows you to set aside pre-tax Allows you to set aside pre-tax Allows you to set aside pre-tax Allows you to set aside pre-tax
dollars from your paycheck to dollars from your paycheck to use dollars from your paycheck to dollars from your paycheck to
OF ACCOUNT
pay for qualified out-of-pocket toward qualified dependent care pay for qualified out-of-pocket pay for qualified out-of-pocket
health care expenses (Medical, Rx, expenses. health care expenses [Medical, Rx, dental or vision expenses.
Dental, Vision). Dental, Vision]. Funds in your HSA
can also be saved for future
emergencies or retirement and
invested. Your contribution
amounts can be changed at any
time. Or you can choose to not
contribute to the HSA and just
receive the employer contribution.

ELIGIBILITY TO
USE ACCOUNT PPO Plan N/A High-Deductible Health High-Deductible Health
You must be enrolled in
the following Medical Plan
[Value or Premier] no requirement Plan [HDHP] Plan [HDHP]
offered by the company in
order to participate:

Common eligible expenses: Common eligible expenses: Common eligible expenses:

ELIGIBLE Similar to the HC FSA except you
EXPENSES Doctor visits Day Care Doctor visits are initially limited to spending
[deductibles, copays, coinsurance] [deductibles, copays, coinsurance] your pretax dollars on eligible
Before/After-School Care
Prescription drugs Prescription drugs DENTAL and VISION expenses.
Summer Camp
Over-the-counter Over-the-counter
(OTC) medications Elder Care (OTC) medications
Orthopedic goods Orthopedic goods
Acupuncture Acupuncture
Hearing aids Hearing aids
Physical therapy Physical therapy
Vaccinations Vaccinations
Counseling/therapy Counseling/therapy
DENTAL expenses DENTAL expenses
[exams / cleanings, orthodontics] [exams / cleanings, orthodontics]
VISION expenses VISION expenses
[exams, glasses/contacts] [exams, glasses/contacts]

IRS ANNUAL YEAR LIMIT COVERAGE LEVEL LIMIT YEAR LIMIT

CONTRIBUTION $5,000
2022 $2,850 Employee Only $3,850 2022 $2,850
LIMITS
2023 TBD Family $7,750 2023 TBD

NOTE | HSA catch-up

contributions age 55 and
older: $1,000

EMPLOYER N/A N/A Employee Only $200 N/A

CONTRIBUTION Family $600

An eligible dependent is a tax-dependent child under age 13 or a tax-dependent spouse, parent or child unable to care for themselves.

These are the 2023 maximum annual contribution amounts [the sum of contributions you AND your employer make to your HSA during the
year] that apply to you UNLESS you are age 55 or older, in which case you are able to contribute an additional $1,000 on top of these amounts.

For individuals who become eligible to receive HSA contributions from the company during the year, contribution amounts are pro-rated.

For active employee use only.

 2023 FTI BENEFITS D E PE N D E N T VE RIF ICATION 15

DEPENDENT ELIGIBILITY VERIFICATION

We are pleased to offer our employees a very robust benefit plan. We work hard to control healthcare costs so we can
preserve the benefits we offer to you and your dependents under our healthcare plan[s]. In order to continue to do this,
all spouses and dependents added to benefits are included in the dependent eligibility verification program.

The purpose of this program is to ensure each dependent enrolled is accurately listed and eligible for coverage. We are
confident that this process will ensure that we are covering eligible dependents in a fair and consistent manner.

If you enroll one or more dependents, you will be asked to submit evidence of eligibility. It’s important for you to know
that documents will be used solely to verify dependent eligibility so we can ensure that only those who are eligible for
coverage under the terms of our plan are receiving those benefits.

Please make sure that you submit any proof of eligibility for your dependents in a timely manner.
If you fail to provide the information requested, your dependent[s] will not be added to the elected coverage.

ELIGIBLE DEPENDENTS PROVIDE ALL DOCUMENTS NOTED

Adoption or Legal
Marriage Certificate Birth Certificate Social Security
Guardianship papers
or most recent 1040 or most recent 1040 Disability letter
or most recent 1040

LEGAL SPOUSE

CHILD | BIOLOGICAL

CHILD | STEPCHILD
Two documents required

CHILD | ADOPTED/
PLACED FOR ADOPTION/
LEGAL GUARDIANSHIP

CHILD | DISABLED
OVER THE AGE OF 26
Two documents required
16 L I FE AN D AD& D, ST D & LT D 2023 FTI BENEFITS

LIFE & AD&D, STD & LTD INSURANCE

Lincoln Financial Group has been selected as our new Life, AD&D [Accidental Death and Dismemberment] and
Disability administrator! This new partnership allows our employees to now purchase additional life insurance for
themselves, up to an amount of $500,000. You will also now have the opportunity to enroll in Hospital Indemnity
Insurance for the first time. Please see detailed information below.

PLAN INFORMATION
Administrator: Lincoln Financial Group
Plan Name: Faith Technologies Incorporated
Eligibility: First of the month following 30 days of employment
NOTE: These are company-provided benefits wherein the company pays the entire premium for
coverage.

CUSTOMER SERVICE
Leave & Disability: 888.438.4542 or www.MyLincolnPortal.com
First-time registration code: FAITH

Life And Accidental Death & Dismemberment Benefit Amount

Insurance [AD&D] 60% of your normal weekly earnings, up to a maximum of
Life and Accidental Death & Dismemberment insurance $2,000 per week.
benefit amounts range from one to two times your annual
income [rounded to the next higher $1,000 if not already a Maximum Benefit Period
multiple of $1,000] with a cap of $150,000 [unless otherwise 13 weeks for any period of disability.
specified]. The percentage of AD&D payout varies based on
Long-term Disability Insurance [LTD]
loss of life or the severity of the accidental bodily injury
Long-term disability benefits partially replace your income if
sustained.
you become totally or partially disabled while insured.
Short-term Disability Insurance [STD]
Elimination Period
Short-term disability benefits partially replace your income if
13 weeks [benefits begin when short-term disability benefits
you become totally or partially disabled while insured. Please
end].
contact the Benefits department to file a claim at
[email protected] or 920.225.6772. Benefit Amount
60% of your normal monthly earnings, up to a maximum of
Elimination Period
$10,000 per month.
No waiting period for an injury. Seven-day waiting period for
a sickness. Maximum Benefit Period
Varies based on age at time of disability.

BENEFIT INFO General Benefits Email Benefits Hotline

Headquarters Contact Information
Reach out to your FTI team 201 Main Street | P.O. Box 260 | Menasha, WI 54952-0260
[email protected] 920.225.6772
for benefit-specific questions. 800.677.1506 | FAX 920.722.7201
 2023 FTI BENEFITS VOLUN TA RY L IF E & AD&D 17

VOLUNTARY LIFE AND AD&D

PLAN INFORMATION
Carrier: Lincoln Financial Group
Plan Name: Faith Technologies Incorporated

Eligibility: First of the month following 30 days of employment

NOTE: These are voluntary insurance plans offered at a lower group rate, wherein YOU are
responsible for paying all of the cost.

Voluntary Life And Accidental Death & Dismemberment [AD&D] Insurance

The people you love and support could face financial challenges if you were no longer around. Voluntary life and accidental
death and dismemberment [AD&D] insurance provides your loved ones with money they can use for household expenses,
tuition, mortgage payments and more, and is in addition to the group life and AD&D coverage provided and paid for by FTI.
Voluntary life and AD&D premiums are paid after-tax and are based on age and the benefit amount that you elect.

You may purchase additional voluntary life and AD&D insurance for yourself, spouse and/or dependents. Evidence of
Insurability may be required for certain coverage amounts.

Employees may elect up to $200,000 for themselves without having to provide evidence of good health. However, if you
would like to purchase an amount over $200,000 [up to $500,000], you will be required to provide evidence of good health to
Lincoln Financial.

BENEFIT DESCRIPTION
EE Increments of $10,000, not to exceed $200,000 [as guarantee issue]

Voluntary Spouse Option 1: $10,000 Option 2: $25,000 Option 3: $50,000

Voluntary Child Flat $10,000

Will equal the amount of voluntary life coverage elected for employee, spouse and child.
Voluntary AD&D Coverage
Increments of $10,000, not to exceed $200,000 | Option 1: $10,000 Option 2: $25,000 Option 3: $50,000

Voluntary AD&D Child Flat $10,000

BENEFIT INFO General Benefits Email Benefits Hotline

Headquarters Contact Information
Reach out to your FTI team 201 Main Street | P.O. Box 260 | Menasha, WI 54952-0260
[email protected] 920.225.6772
for benefit-specific questions. 800.677.1506 | FAX 920.722.7201

For active employee use only.

 18 ACC I D E N TAL , C R I T I CAL I L LNESS I NSURAN CE & H OS PITAL IN D E M N ITY 2023 FTI BENEFITS

ACCIDENT, CRITICAL ILLNESS INSURANCE & HOSPITAL INDEMNITY

PLAN INFORMATION
Carrier: Lincoln Financial Group
Plan Name: Faith Technologies Incorporated

Eligibility: First of the month following 30 days of employment

NOTE: These are voluntary insurance plans offered at a lower group rate, wherein YOU are
responsible for paying all of the cost.

Accident Insurance
Accident insurance helps give you peace of mind by minimizing the financial impact that results if a covered individual [you, your
spouse or your child] is involved in an accident that results in injury or medical treatment. Accident insurance isn't a substitute
for other coverages; however, it can supplement other coverages as a financial safety net by paying you cash for covered
accidents and treatment. You can use the money to pay for out-of-pocket medical costs or everyday expenses. Premiums for
this coverage are paid after-tax.

Critical Illness Insurance

An illness can lead to unexpected costs not covered by your health care plan. In the case of a serious illness, you may experience
income loss that's only partially replaced by disability insurance. In addition to your medical bills, you still have to pay for
insurance premiums, rent or mortgage, vehicle payments, credit card bills, taxes, grocery bills, utilities, and general household
needs, and if you’re ever diagnosed with a critical illness, don’t forget about travel costs to see specialists.

Critical illness insurance helps protect employees and their families from financial loss by providing a lump-sum benefit upon
diagnosis of a covered medical condition [see the Critical Illness highlight for covered illnesses]. This coverage provides cash at
a time when you need it most. Premiums for critical illness coverage are paid after-tax and are dependent on your age, nicotine
use and the benefit amount that you elect.

Hospital Indemnity Insurance

Hospital Indemnity insurance is designed to help provide financial protection for covered individuals by paying a benefit due to
hospitalization. Employees can use the benefit to meet the out-of-pocket expenses and extra bills that can occur. Indemnity
lump-sum benefits are paid directly to the employee.

BENEFIT INFO General Benefits Email Benefits Hotline

Headquarters Contact Information
Reach out to your FTI team 201 Main Street | P.O. Box 260 | Menasha, WI 54952-0260
[email protected] 920.225.6772
for benefit-specific questions. 800.677.1506 | FAX 920.722.7201

For active employee use only.

 2023 FTI BENEFITS 401 [K] & 401 [A ] PLANS 19

401[K] & 401[A] PLANS

PLAN INFORMATION
Administrator: Empower Retirement
Plan Name: Faith Technologies Incorporated
Group Number: 401[k]: 767201; 401[a]: 768290
Account Number: Social Security number
Eligibility: All employees are immediately eligible to participate

CUSTOMER SERVICE
Prudential Retirement: 877.778.2100
www.prudential.com/online/retirement

401[k] Beneficiary Designations

Prudential Retirement, acquired by Empower, manages 401[k] beneficiary records. You can make or update your
beneficiary designations by logging into your account at http://prudential.com/online/retirement, or by calling
Prudential Retirement at 877.778.2100 [M-F 7 a.m. to 8 p.m. CST].

Contact Prudential Retirement to:

Change your contribution deferral on your Pre-Tax, Start a loan from your Pretax balance,
Roth, and/or After-Tax Emergency Savings or your After-Tax Emergency Savings
Change your investment funds [allocations] View account balances
Make a withdrawal from your After-Tax View statements
Emergency Savings Educate yourself on retirement saving
Roll over an eligible 401[k] from a previous
employer's plan

BENEFIT INFO General Benefits Email Benefits Hotline

Headquarters Contact Information
Reach out to your FTI team 201 Main Street | P.O. Box 260 | Menasha, WI 54952-0260
[email protected] 920.225.6772
for benefit-specific questions. 800.677.1506 | FAX 920.722.7201

For active employee use only.

20 401 [ K ] & 401 [ A] P L ANS 2023 FTI BENEFITS

401[K] RETIREMENT PLAN FEATURES

FTI’s 401[k] Retirement Plan through Empower, formerly Prudential Retirement, is a solution to provide you with a
future savings option.
Automatic Deferral Feature Goalmaker
New participants will be automatically enrolled in FTI’s 401[k] Goalmaker is a simplified investment feature that allows you
plan at a 6% deferral rate. [Participants can opt out in the first to select your investment style [conservative, moderate or
30 days]. You can adjust the deferral rate of your 401[k] aggressive] and your expected retirement age, and you’ll be
contributions within your Empower account at any time. invested in a portfolio made up of the Plan’s investment
In order to maximize the discretionary company match, you options suited to your investment style at no additional cost.
would need to defer at least 6% to your 401[k]. If you elect GoalMaker, you may be on your way to a more
secure retirement because it offers you the following benefits
Automatic Escalation
Periodically rebalances your account to keep your
This feature automatically increases your elective deferral
investments on track.
amount in small increments each year. New participants are
enrolled in Automatic Escalation where your deferral rate will Automatically adjusts your portfolio as you get closer to
increase by 2% on your anniversary date, until you reach a 12% retirement.
deferral rate. [Participants can customize this to escalate
Roth Option
either 1, 2, or 3%, or opt out of this feature at any time, and can
Participants may set aside after tax money via Roth to
choose auto escalation on pretax or Roth 401[k]],
save on future taxes of retirement distributions and income.
Catch-up Contribution Original contributions and earnings grow tax free.
If you are 50 years or older, you may also set aside a
After-tax Emergency Savings
catch-up contribution of $6,500 per year [may be increased
Participants may defer up to 80% of their after-tax earnings
by the IRS].
to help build a safety net for unexpected expenses. Original
Company Match contributions are tax free upon withdrawal, but earnings are
As its targeted discretionary match for 2023, FTI will match subject to tax and may be subject to an early withdrawal
50% of the first 6% of your individual contribution to your 401[k] penalty if withdrawn before age 59 1/2. A Roth conversion
retirement plan. An additional discretionary company match option is also available [taxes are due on earnings at the time
may be made based on the company’s performance in 2022. of Roth conversion].

Deferral Percentages Financial Wellness

FTI’s plan allows you to set aside between 1% and 80% of your Empower Financial includes access to financial life education,
pretax salary, up to a maximum of $20,500 may be increased tools and assessments to manage a variety of financial
by the IRS. challenges and goals.

Vesting Schedule
You are always 100% vested in all of your plan accounts.
401[A] PROFIT-SHARING PLAN FEATURES
FTI’s 401[a] Profit-Sharing Plan is in addition to FTI’s 401[k] plan and is a solution to offer you with an additional saving
option for your future.
Eligibility | All regular employees are eligible. Part-time employees will receive a prorated contribution based on hours worked.
Contributions | The 401[a] is a non-contributory plan - only the company deposits money. The amount contributed to the 401[a]
is pre-tax and will be based on company growth and financials.
Investment Options | You have full control of how your money is invested. Visit Prudential's Retirement site at any time to
update your investment fund allocation.
Safety Incentive Program Contribution | For every 30 days the organization works without a recordable incident,
eligible team members will receive a contribution to their 401[a] accounts. Each payout increases by $50 for each
30-day milestone worked incident-free.
Vesting Schedule | Vesting is a three-year cliff vesting period, regardless of the amount of time you have been with FTI. An
exception to the three-year vesting rule is for participants age 55 or above. A participant attaining the age of 55 while Active at
FTI will be fully vested after his/her 55th birthday. If an Active participant is already 55 and older, s/he is automatically vested in
the 401[a]. Distributions from the 401[a] follow the same rules as distributions from the 401[k], except loans are not allowed. The
difference is that the 401[a] funds are not available for distribution until fully vested [3 years] whereas, our 401[k] funds vest
immediately and are not subject to a time requirement. Also, the 401[a] can only be contributed to by FTI; the employee cannot
add funds to their 401[a] account. All funds in the 401[a], vested and unvested, can be directed into investment options by the team
member, but they cannot withdraw or take a distribution until vested. Assuming the funds are fully vested, an in-service distribution
[team member elects to withdraw money from the account] is allowed if the team member has reached the age of 59 ½. If you
have any further questions regarding this benefit, please reach out to [email protected]. 29
For active employee use only.
 2023 FTI BENEFITS FAM ILY - F RIE N D LY BE NEFITS 21

FAMILY-FRIENDLY BENEFITS

PAID PARENTAL TIME-OFF BENEFIT

Regular, full-time employees employed at least 12 months and who have at least 1,250 hours of work are eligible
to apply for one week of paid parental time off [40 hours-hourly employees, one week-salary employees].
Paid Parental Leave | It is the policy of FTI to grant paid parental time off for any of the following reasons:
Birth of your child
Adoption of your child
Pre-adoptive foster care and foster placement of your child
Parental Leave Entitlements | Eligible employees who have experienced one of the events listed above within the two
months immediately preceding the date of the request are eligible for a maximum of one week of paid parental time off
[does not need to be consecutive] per rolling 12-month period. During this time, the employee will remain responsible for all
normal deductions and premiums to be deducted from their paycheck. If paid parental time off is requested, the employee
must contact the Benefits Department in advance and follow the necessary steps in Workday. Benefit-eligible employees
who satisfactorily meet or exceed all eligibility protocols and are not currently on a performance improvement plan are
eligible to receive payment.

The employee must also apply for family medical leave, as paid parental time will run concurrent with family medical leave.
Paid parental time off will be applied to the one-week elimination period before disability benefits begin for maternity
disability claims.

Disqualification for Leave | In the case of any granted leave, including paid parental leave, the leave will be canceled and
an employee will be subject to disciplinary action, up to and including termination of employment, if the leave was based on
false statements or if an employee engages in any gainful employment while on leave without specific permission from FTI.

ADOPTION BENEFIT POLICY

Regular, full-time employees employed at least 12 months are eligible to apply for an adoption benefit up to
$5,000 once per calendar year to help offset the costs of adopting a child.
Adoption Benefit | It is the policy of FTI to grant an adoption benefit up to $5,000 to eligible employees following the
adoption of your child. In order to request the adoption benefit, you must contact the Benefits Department within 90 days of
the date the adoption is made final and complete and return the necessary form in addition to providing a copy of the final
legal adoption papers. FTI reserves the right to request documentation of adoption expenses prior to issuing payment.

Disqualification for Payment | If payment was based on false statements, this shall be grounds for disciplinary actions and
the employee may be required to reimburse the amount received to FTI.

OTHER FAMILY-FRIENDLY BENEFITS

Parenting & Caregiving Solutions | RethinkCare, available through the Virgin Pulse wellness program, allows access
to various courses to help build resilience with Rethink's mental health experts while learning to manage the challenges
of modern-day parenting. Additional mindfulness and resilience courses are available for young adults geared toward
practices that will help overcome challenges with stress management, focus, sports, bullying, personal growth and more.

Work/Life Balance Solutions | Creating a perfect work/life balance is a struggle for many. There are situations that come
up in everyday life that sometimes require additional assistance. Work/life resources and referrals, available through the ERS
Employee Assistance Program [EAP] are designed to provide employees and members of their household with consultations
regarding items such as child care, pet care, housing services, education, elder/adult care, and more.

BENEFIT INFO General Benefits Email Benefits Hotline

Headquarters Contact Information
Reach out to your FTI team 201 Main Street | P.O. Box 260 | Menasha, WI 54952-0260
[email protected] 920.225.6772
for benefit-specific questions. (800) 677.1506 | FAX: (920) 722.7201

For active employee use only.

22 E M P LOY E E ASSI STANC E P RO GRAM [ EAP] 2023 FTI BENEFITS

EMPLOYEE ASSISTANCE PROGRAM [EAP]

PLAN INFORMATION
Administrator: ERS, an AllOne Health Company
Plan Name: Faith Technologies Incorporated
Eligibility: All employees and their families
NOTE: This is a company-provided benefit; services are provided at no cost to all employees and
their families.

CUSTOMER SERVICE
EAP: 800.292.2780
mylifeexpert.com

Company Code: eapnow

EMPLOYEE ASSISTANCE PROGRAM FEATURES

This is a no-cost, company-sponsored benefit available to you and your dependents that offers confidential,
24/7 support and resources that encourage you to maintain healthy and positive lifestyles - while supporting
you with proven, effective strategies through life's challenges.

Mental health coaching Medical advocacy Critical Incident Response

Life coaching Legal/financial resources Student Assistance Program
Work/life resources Organizational development & training

CONSULTATION AND SUPPORT

The AllOne Health total well-being model provides employees and their immediate family members with
on-demand access to support and resources via telephone, mobile app, web portal, video counseling and chat
functionality. You and the members of your household are entitled up to eight consultations with a licensed
clinician per incident, per individual, per calendar year.

BENEFIT INFO General Benefits Email Benefits Hotline

Headquarters Contact Information
Reach out to your FTI team 201 Main Street | P.O. Box 260 | Menasha, WI 54952-0260
[email protected] 920.225.6772
for benefit-specific questions. 800.677.1506 | FAX 920.722.7201

For active employee use only.

 2023 FTI BENEFITS WE L L N E S S PRO GRAM 23

WELLNESS PROGRAM

CUSTOMER SERVICE
Faith Technologies Alyssa Kwasny • Wellness Program Manager
Incorporated: 201 Main Street • P.O. Box 260 • Menasha, WI 54952-0260
800.677.1506, extension 9815
920.751.9815 | 920.722.7201 [fax]
[email protected]

Virgin Pulse Member Support: 888.671.99395 [email protected]

Quest Diagnostics Participant Service Center: 855.623.9355 [email protected]

EMPOWERYOU WELLNESS PROGRAM

The stronger the body, the sharper the mind. FTI's award-winning wellness program focuses on the physical and
mental well-being of team members and their families. By providing opportunities to incorporate Mind, Body and
Soul into our day-to-day lives, we can improve our health, wellbeing, and confidence.
Virgin Pulse Partnership
Virgin Pulse offers a total well-being platform and mobile app that helps you build healthy habits across all areas of well-being
to achieve long-term health. They get to know your interests, discover your goals and can then design a personalized
experience to support those goals.

The platform provides new health content daily and their award-winning mobile app allows you to engage with the platform
when it's most convenient for you. Create your customized profile today by visiting join.virginpulse.com to track progress,
achieve personal goals and earn rewards!

Reward programs | Live healthy and get rewarded! Mental Wellness

Good mental health is fundamental to the health and
Premium Incentive Program
well-being of every person and our communities as a whole.
If you elect FTI’s medical insurance, you have the
We want all people to understand how to protect and
opportunity to earn an additional company contribution
improve their mental health and know when to seek help for
toward your medical insurance premium. If you'd like to
themselves or someone close to them.
participate in this voluntary program, employees and
spouses must earn enough points to reach at least Level 3 Employee Assistance Program Services include mental
in the program by November 15. Participating in this health counseling, work/life resources, legal/financial
program allows each employee and spouse to save resources, and support for substance abuse issues, stress,
between $1,400 and $3,000 in health insurance premiums, grief, family/marital counseling and more.
depending on plan chosen.
RethinkCare, offered through Virgin Pulse, offers daily
Cash Rewards sessions and science-based courses focused on
Through the Virgin Pulse program, employees and spouses meditation, reducing stress and anxiety, building emotional
can complete a variety of activities to reach certain levels intelligence, improving relationships, thriving at work,
on the wellness platform to earn up to $100 Pulse Cash. sleeping better, parenting and so much more!
Pulse Cash is currency that can be redeemed at any time
during the calendar year in the Virgin Pulse online store, Mental Health Training is available for all employees,
toward a gift card or donated to a charity. as well as leaders, to understand common mental health
conditions, how to actively work to reduce the stigma
Financial Wellness surrounding mental health, and learn how to spot warning
FTI offers various financial wellness tools and education signs for mental health concerns.
through Empower Financial, Virgin Pulse and the Employee
Assistance Program, including various assessment tools,
budget calculators, financial education courses and financial
coaching.

For active employee use only.

24 WE L L N E S S P RO GRAM 2023 FTI BENEFITS

WELLNESS PROGRAM CONT.

Physical Wellness Social Wellness

Virgin Pulse's Nutrition Guide helps participants pick Virgin Pulse Personal & Team Challenges allows you to
their nutrition profile and serve up healthy tips and great engage in some friendly competition with coworkers,
recipes. friends and family. Turn up your activity level and develop
new healthy habits by focusing on one specific topic at a
Virgin Pulse's Sleep Guide allows participants to pick a time.
sleep profile, get customized tips, and see all your sleep
data in once place! Virgin Pulse Social Groups | Social networks are a
foundational part of your wellbeing journey! Friends can
Get active and earn points! Through Virgin Pulse, track prompt each other to adopt healthy habits, celebrate
your steps and activity to earn points towards rewards. success, and encourage engagement. Create groups
Create personal fitness challenges and build healthy habits around common interests like biking, recipe sharing,
toward your physical activity goals. parenting, and more!
Biometric Screenings provide vital information about Friends & Family | Build up your support network in Virgin
your overall health, including cholesterol, triglycerides, Pulse by adding work friends, as well as friends and family
cardiac risk, glucose, blood pressure, height, weight, BMI outside of the organization!
and waist measurement.

Health Coaches through Virgin Pulse helps individuals

achieve their health and wellness goals. Telephonic
coaching is available at the touch of a button and at times
that are convenient for you. Select from topics such as
managing weight, being tobacco-free, getting active,
eating healthy, reducing stress and sleeping well.

Virgin Pulse Journeys helps participants get on the path

to better health with self-guided digital courses that give
you daily support in the areas you want to focus on. Select
from topics such as reducing stress, finding emotional
balance, getting active, eating healthy, sleeping well, being
tobacco-free, navigating health situations, managing
finances, and embracing diversity.

Take the Virgin Pulse Health Check Assessment to assess

your health across various factors from mental health to
fitness. You'll get a personalized report and actions to take!

Nicotine Cessation Program | Through our nicotine

cessation program, class reimbursement, health coaching
and Employee Assistance Program, we're here to support
you on your journey towards a nicotine free lifestyle.

Healthy Lifestyle Reimbursement Program | FTI offers a

$300 per family per calendar year reimbursement for
various healthy lifestyle choices. Examples include
run/walk/bike events, gym memberships, weight
management programs, exercise equipment, wearable
fitness devices and more!

For active employee use only.

 2023 FTI BENEFITS M IS CE L L AN EO US IN FORMATION 25

ADDITIONAL RESOURCES | EMPLOYEE PORTAL

Easy access to information about our benefit programs can be found
online, 24/7, from your PC, mobile device or tablet. Simply visit
https://faithtechnologies.sharepoint.com/sites/BenefitsCW/SitePages/2023-Open-Enrollment.aspx
and log in with your Office 365 credentials to find:
Benefit plan information, including premiums
Links to access provider networks
Important plan documents and forms
Contact information for additional help
A link to make changes to your benefit elections
Wellness program information

MISCELLANEOUS INFORMATION
Qualifying Events
You must have a qualifying event occur in order to change your elections outside of Open Enrollment. If a qualifying event occurs and
you need to change your elections, you must notify the Benefits Department and follow the necessary steps in Workday. Qualifying
events include, but are not limited to, the following:

Birth or adoption of a child

Marriage/divorce/legal separation
Death of a spouse or dependent
Dependent child reaches age 26
Change in employment status or benefit eligibility of a dependent
Losing or gaining coverage elsewhere [e.g. spouse or parent's benefits plan]

You will also be required to submit proper documentation validating your qualifying life event. Please refer to the grid below for
examples:

EVENT ELIGIBLE CHANGE DOCUMENT[S] NEEDED

Enroll in Coverage Cancel Coverage Add a Dependent Remove a Dependent

ADOPTION Adoption Papers

BIRTH Birth Certificate

DEATH OF DEPENDENT Death Certificate

DIVORCE Divorce Decree

NOW ELIGIBLE FOR Proof of other coverage
OTHER COVERAGE
LOSS OF OTHER
Proof of loss of other coverage
COVERAGE
LEGAL GUARDIANSHIP Guardianship or Custody paperwork

LEGAL SEPARATION Legal separation paperwork

MARRIAGE Marriage certificate

If you are submitting a copy of your most recent Federal Income Tax return, please black out any financial information, as well as
the first five digits of any Social Security numbers. The entire tax return is not required, only the page that lists filing status and
exemptions.

For active employee use only.

26 M I S C E L L AN EO US I NFO R MAT I O N 2023 FTI BENEFITS

MISCELLANEOUS INFORMATION
Dual Coverage
Married employees whose spouse works outside the home may have two health insurance plans available to them: FTI’s plan and their
spouse’s plan. However, having two plans available doesn't mean that they should elect both plans [dual coverage]. For the great
majority of people with dual coverage, they would be better off financially if they selected one plan. The reasons for this include:

Coordination Of Benefits
In the past, it wasn’t uncommon for families to have dual coverage because when the two insurance plans coordinated benefits, the
secondary health plan picked up the employee's out-of-pocket expense, leaving little to no payment for the employee. Coordination
of Benefits provisions have changed. Most health insurance plans, if they are secondary coverage, will no longer pick up the employee's
out-of-pocket expenses.

Premium Contribution
If you have dual coverage, you and your spouse are more than likely making a contribution to health insurance premiums for both plans.
For most people, they pay more in premium than what they receive in benefits from having dual coverage and it would be a better
deal to save the premium and take only one health plan.

Health Insurance Portability And Accountability Act [HIPAA]

Some families have dual coverage because they are concerned a spouse could lose their job and thus health insurance. Loss of a
spouse’s job is considered a qualifying event, and HIPAA allows a family to pick up health insurance from their employer if the spouse
who carried the health insurance loses their job. Should this happen, the employed spouse can request health insurance from their
employer as long as they do so within the required timeframe of the qualifying event [e.g., loss of job].

DEFINITIONS
Preferred Provider Organization [PPO] | A PPO offers Specialist | A provider who falls outside of the primary care
access to physicians and hospitals that participate in a definition.
network plan. You are then able to access health care
services at a discounted rate each time you use an in- Urgent Care | Services received for a sudden, serious or
network provider. unexpected illness, injury or condition. Urgent care is not
considered a medical emergency. Care is needed right
In-network | A health care provider or facility that our plan away to relieve pain, find out what is wrong or treat a health
has contracted with to provide services to plan members problem that is not life-threatening. Examples of urgent care
for specific pre-negotiated rates. include strep throat, sprains, strains, cramps, rashes or
earaches.
Out-of-network | A health care provider or facility that is
not contracted with the plan. Generic Drug | A generic drug is identical [or bioequivalent]
to a brand-name drug in dosage form, safety, strength,
Copay | A co-pay is a flat dollar amount you pay for the route of administration, quality, performance characteristics
network physician office visits. After the co-pay, the plan and intended use. A generic drug can be produced when the
pays 100% thereafter. Co-pays do not apply toward the patent on a brand-name drug has expired.
deductible.
Brand-name Drug | A brand-name drug is a medicine
NOTE | Co-pays are not applicable on the HDHP. that’s discovered, developed and marketed by a
Deductible | A deductible is the initial portion of the annual pharmaceutical company.
medical expenses that plan participants may be required to Non-formulary Drug | A drug that is not included in the list
pay before benefits are paid by the insurance plan. of preferred medications that a committee of pharmacists
Coinsurance | Coinsurance is the percentage you pay for and doctors deem to be the safest, most effective and most
medical care once your deductible has been satisfied. economical.

Out-of-pocket Maximum | An out-of-pocket maximum Maintenance Drug | A drug is considered a maintenance

is the maximum dollar amount that you will have to medication when it is being taken to treat chronic condition
pay for medical benefits [includes copays, deductibles and for an extended amount of time.
coinsurance]. Explanation Of Benefits [EOB] | An explanation of
Primary Care Doctor | The plan defines “primary care” as benefits comes from the third-party administrator after a
physicians who are classified as: family practice, internal claim has been filed and shows payment information for
medicine, pediatricians, OB/GYNs and chiropractors. each service or supply covered by the plan.

For active employee use only.

This packet provides information on various FTI benefit plans, including changes that take effect as of
January 1, 2023. It is intended to provide a brief overview and cannot present all of the details of the Plan
provisions. While every attempt has been made to ensure accuracy, if any conflict or discrepancy exists
between the information contained herein and the official plan documents or policies, the official plan
documents or policies will govern.

The benefits descriptions contained herein are not guarantees of current or future employment or benefits.
FTI reserves the absolute and unconditional right to change, suspend, or discontinue any of its benefits
programs or policies at any time.

This information is being provided for informational purposes only and should not be considered legal,
financial, or other professional advice. If you need assistance in these areas, please consult with the
appropriate professional.

Published | October 2022

FAI T H T EC H I N C . CO M

For active employee use only.