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BENEFITSfor Management EmployeesapRiNTED JaNUaRY 2013mEDica l OpTiONSIn-Network BENEFITS (Out-of-Network deductibles and coverage not shown)Meet Health Requirements 1Do NOT Meet Healthy Requirements1 Preferred CopayPreferred AccountCopayStandardHealthy RewardEmployee s contributions are lower than for CopayCompany funded HRA: Emp Only: $600 / year Emp + 1: $900 / year Family: $1,200 / year Lower Annual Out-of-Pocket MaxNot ApplicableNot ApplicableAnnual Deductible 2,3 Individual: $200 Family: $600 Individual: $1,200 Family: $2,400 Individual: $200 Family: $600 Individual: $1,200 Family: $2,400 Annual Out-of-Pocket Maximum 2,3 Individual: $2,500 Family: $5,000 Individual: $3,000 Family: $6,000 Individual: $2,500 Family: $5,000 Individual: $4,000 Family: $8,000No DeductibleAnnual Physical Exam, Routine Screenings, & Well Baby Care 4 Company pays 100%Company pays 100%Company pays 100%Company pays 100%Deductible AppliesInpatient Facility BENEFITS $100/day copay per confinement (up to $1,000), then Company pays 100% Company pays 80%$100/day copay per confinement (up to $1,000), then Company pays 100%Company pays 80%Inpatient Physician ServicesCompany pays 100%Company pays 100%Outpatient Primary Care Physician Services$15 copay then Company pays 100% $15 copay then Company pays 100%Outpatient Specialist Physician Services$40 copay then Company pays 100% $40 copay then Company pays 100%Outpatient Facility BENEFITS $100 copay then Company pays 10

BENEFITS for Management Employees a pRiNTED JaNUaRY 2013 mEDical OpTiONS In-Network Benefits (Out-of-Network deductibles and coverage not shown) Meet Health Requirements 1 Do NOT Meet Healthy Requirements1 Preferred Copay Preferred Account Copay Standard

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