TERMINATION OF EMPLOYMENT

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TERMINATION OF EMPLOYMENT AND YOUR NCFLEX BENEFITS If your employment with the State of North Carolina (including State agencies, universities and select community colleges) terminates either voluntarily or involuntarily and you were a participant in the NCFlex Program on the date of termination, you will have the following continuation options: NCFlex Benefits Continuation Option Instructions After Aon receives a termination notice from your Benefit Representative or Benefits Department, Aon will mail the COBRA enrollment materials to your last known address. Please carefully follow the instructions in the package concerning the election process, deadlines, mailing address, and payment of premiums. You cannot continue this benefit. After the insurance vendor receives a termination notice from your Benefit Representative or Benefits Department, the COBRA administrator for the dental plan will send COBRA enrollment materials to your last known address. Please carefully follow the instructions in the package concerning the election process, deadlines, mailing address, and payment of premiums. It is your responsibility to contact the AD&D insurance vendor for an application. If you are under age 70, you may elect to port (continue coverage) all or any part of your or your dependent’s AD&D benefit. You must apply and pay the premiums within 31 days after your insurance coverage terminates. The AD&D portability enrollment form can be copied from the NCFlex website at www.ncflex.org and then click on NCFlex’s Flexible Benefits site or by contacting the vendor directly. After the insurance vendor receives a termination notice from your Benefit Representative or Benefits Department, the Vision Care Plan vendor will send COBRA enrollment materials to your last known address. Please carefully follow the instructions in the package concerning the election process, deadlines, mailing address, and payment of premiums. For questions, please contact Stephanie Kowerduck with Superior Vision Services at 1-800-923-6766, ext. 204. Health Care Flexible Spending Account COBRA Dependent Day Care Flexible Spending Account Dental Plan (High Option and Low Option) None COBRA Voluntary Accidental Death And Dismemberment Insurance (AD&D) Portability Vision Care Plan COBRA Supplemental Medical COBRA/Conversion After receiving the termination notice, the COBRA administrator for the Supplemental Medical benefit, will send COBRA enrollment materials to your last known address. Cost is 100% of your monthly premium plus 2% administration fee. You also have the right to convert the policy to an individual plan within 31 days after COBRA has been exhausted. Instructions on where and when to send the premiums will be included in the COBRA materials. After receiving the request to terminate your coverage on the Family/Employment Status Change Form, the COBRA administrator for the Cancer Insurance benefit (Benefits Outsource Group) will send COBRA enrollment materials to your last known address. Cost is 100% of your monthly premium. You will have the option to convert the benefit to an individual policy provided application and premium is received within 31 days of the termination date. Instructions on where and when to send the premiums will be included in the COBRA materials. For COBRA questions, please contact Jill Fletcher at the Benefits Outsource Group at (919) 573-6074. Her fax number is (919) 573-6081. You can contact the Term Life vendor for an application (and with any questions) or print the portability continuation form from the NCFlex website. If you are under age 70, you may elect to continue any or all of your Group Term Life benefit. If you are age 70 or above, you can only convert the benefit to a more expensive individual policy. You must submit an application and pay the premium within 31 days after the insurance terminates. The Term Life portability continuation enrollment form can be printed from the NCFlex website at www.ncflex.org and then click on Forms. Cancer Insurance COBRA/Conversion Voluntary Group Term Life Insurance Portability/Conversion Important Note: Whether you decide to continue or not to continue your NCFlex benefits, you still have the right to submit claims which were incurred (date of service) prior to your termination date.

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