401K Retirement Plan

South State Retirement Plan Services 2430 Mall Drive, Suite 360 Charleston, SC 294061-800-716-3742 (toll free)843-284-4225 (Jon Ahrens local)www.southstate401k.com

Medical Insurance

Contact for plan providers, correspondence, claims, & questions: BlueCross BlueShield of South Carolina – PPO PO Box 100300 Columbia, SC 29202Customer Service: 1-800-922-1185PPO Network Providers: 1-800-810-2583Essential Advocate: 1-855-638-5839Pre-Certification: Precertification: 1-800-334-7287Mental Health and Substance Abuse Precertification: 1-800-868-1032Your Network Provider must call Precertification: Preauthorization required for some outpatient procedures and all hospital inpatient admissions. Report all emergency admissions within 24 hours. MRI/MRA/PET/CT and radiation oncology therapy will require authorization to ensure benefit payment. Failure to do so may affect benefits. In an Emergency seek care immediately, then call your primary care doctor as soon as possible.

BCBS of SC website: www.SouthCarolinaBlues.com View plan providers View the status of your claim View the status of your deductible and out-of-pocket maximums Order I.D. cards View and electronic version of your summary plan description

BCBSSC Solution for accessing our MRFs: Transparency in Coverage | BlueCross BlueShield of South Carolina (southcarolinablues.com)

Shopping for Care is the Member Solution to access pricing for services: Find a Doctor | BlueCross BlueShield of South Carolina (southcarolinablues.com)

Contact for Prescriptions (correspondence, claims, & questions): Pharmacy Help Desk: 1-855-811-2218 Buy and Bill Drugs-Precertification: 1-877-440-0089 RxBIN: 021684 RxGRP: BXMN

Notice of Privacy Practices

Dental Insurance

Delta Dental of South Carolina Customer Care: 1-800-335-8266 Submit Claims To: Delta Dental of South Carolina – PPO PO BOX 8690 St. Louis, MO 63126 Electric Claims Payor ID 43090 PROVIDER SELECTION: You can generally reduce your out-of-pocket expenses if you use a network provider. To find a PPO network dental provider in your area, consult your directory, visit www.deltadentalSC.com, or call the toll-free number. See your benefits booklet for description of benefits, terms and conditions, limitations, and exclusions of coverage.

Vision Insurance

Sun Life Vision Insurance -VSP network Customer Service 1-800-247-6875 Sun Life website: www.sunlife.com/us Using your VSP Network Benefits: VSP Customer Service 1-800-877-7195 VSP website: www.vsp.com Choose a VSP Choice Network doctor online or by phone Make an appointment and let them know you are a VSP member

Voluntary Short Term/Long Term Disability & Life Insurance

Sun Life Short/Long Term Disability & Life Insurance Customer Service 1-800-247-6875 Sun Life website: www.sunlife.com/us



1670 Drydock Avenue
Building 236, Suite 200
North Charleston,
SC 29405-2121 USA

Phone: 843-308-8000
Fax:  843-308-8059
E-mail: drydock@detyens.com