OPEN ENROLLMENT 2016/17 Principle Solutions Group June 1, 2016 – May 31, 2017 Next

Medical Options Option 3: $2,500 Deductible Point of Service Plan Option 1: $4,000 Deductible (Health Savings Account H.S.A.) Option 2: $5,000 Deductible Point of Service Plan Deductible: (In-Network) Single: $4,000 Family $8,000 Family $10,000 Family $10,000 Insurance Carrier: United Health Care Policy Number: Single: $5,000 Family $5,000 Single : $2,500 Deductible: (In-Network) Previous Next Option 2 Option 3 Dental Vision Life Ins Disability Option 1 Use the Menu to navigate, or click “Next” to go to the next slide. Rates Reflect Employee Biweekly Deductions

Coinsurance: In Network: 80% / Out of Network: 60% In-Network Deductible: Single $4,000/Family: $8,000 In Network Out of Pocket Max: Single: $6,400/ Family: $12,800 Employee pays 100% of medical cost up to deductible, with the option to pay any out of pocket medical, dental or vision cost, with tax free dollars, up to annual limits. (See next slide for more details.) Option 1 Next Previous Insurance Carrier: United Health Care Policy Number: Rates Reflect Employee Biweekly Deductions

What is an HSA? Watch Video Previous Next What is an HSA? Frequently Asked Questions Retirement H.S.A Comparison Additional Resources What is an HSA? Frequently Asked Questions Retirement H.S.A Comparison Additional Resources 1 Option

Health Savings Account (HSA) Advantages:  Tax-deductible Contributions to the HSA are 100% deductible (up to the legal limit) — just like an IRA  Tax-free Withdrawals to pay qualified medical expenses, including dental and vision, are never taxed.  Tax-deferred Interest earnings accumulate tax-deferred, and if used to pay qualified medical expenses, are tax-free.  HSA money is yours to keep Unlike a flexible spending account (FSA), unused money in your HSA isn’t forfeited at the end of the year; it continues to grow tax-deferred. HSA holders can choose to save up to $3,350 for an individual and $6,750 for a family (HSA holders 55 and older get to save an extra $1,000 which means $4,350 for an individual and $7,750 for a family) - and these contributions are 100% tax deductible from gross income. Minimum annual deductibles are $1,300 for self-only coverage or $2,600 for family coverage. Annual out-of-pocket expenses (deductibles, copayments, and other amounts, but not premiums) cannot exceed $6,450 for self-only coverage and $12,900 for family coverage. HSA holders can choose to save up to $3,350 for an individual and $6,750 for a family (HSA holders 55 and older get to save an extra $1,000 which means $4,350 for an individual and $7,750 for a family) - and these contributions are 100% tax deductible from gross income. Minimum annual deductibles are $1,300 for self-only coverage or $2,600 for family coverage. Annual out-of-pocket expenses (deductibles, copayments, and other amounts, but not premiums) cannot exceed $6,450 for self-only coverage and $12,900 for family coverage. Previous Maximum Annual Contribution Next Option 1

Option 2: $5,000 deductible Dr. Visit: Co-Pay- $30 Specialist: Co-pay-$60 Urgent Care: Co-pay-$60 Emergency Room: Co-pay-$500 (Waived if admitted) Brand Name and Generic RX coverage, with tiered co-pays. $15/$45/$85/$125 Co-insurance: In Network: 70%/ Out of Network 60% In-Network Deductible: Single $5,000/Family: $10,000 In Network Out of Pocket Max: Single: $6,600/ Family: $13,200 No RX Deductible Insurance Carrier: United Health Care Policy Number: Previous Rates Reflect Employee Biweekly Deductions EE Only$94.32 Next EE+ Spouse$ EE+Child(ren) $ EE+Family$ Option 1 Option 3 Dental Vision Life Ins Disability Option 2

.. Option 3: 2500 deductible Previous Dr. Co-Pay- $25 Specialist Co-pay-$50 Urgent Care Co-pay- $60 Prescription drugs (Tier based co-pays) Emergency Room Co-pay-$ 500 (Waived if admitted) Brand Name and Generic RX coverage, with tiered co-pays. $15/$45/$85/$125 Co-insurance: In Network: 80% / Out of Network 60% In-Network Deductible: Single $2,500/Family: $5,000 In Network Out of Pocket Max: Single: $4,000/ Family: $8,000 No RX Deductible Rates Reflect Employee Biweekly Deductions Next Insurance Carrier: United Health Care Policy Number: Option 1 Dental Vision Life Ins Disability Option 2 Option 3

Teladoc is a, that gives all participants of a PSG medical plan access to a Doctor through your phone or video consults. 27/7/365 access to a licensed Doctor with over 15 years experience. They can even call in a prescription for you or your dependents!  Talk to a doctor anytime, anywhere you happen to be.  Receive quality care via phone or online video.  Prompt treatment, average call back in 16 min.  A network of doctors that can treat children of any age.  Secure personal and portable electronic health record.  No limits on consults, so take your time! Next Previous FREE 100% employer paid service

Dental Coverage Insurance Carrier: MetLife Deductible: Single $50/ Family $150 Max plan will pay per year per member: $2,000 Preventative: 100% Covered Deductible Waived: Cleanings (1 per 6 months) Space maintainers (Under Age 15) X-Rays- Bitewings & Full Mouth Sealants – Under Age 16 Deductible Applies: 80% Co- Insurance Fillings Simple Extractions Oral Surgery Periodontics Endodontics Deductible Applies: 50% Co-Insurance Crowns Bridges Dentures Implants Previous Next Rates Reflect Employee Biweekly Deductions Option 1 Option 2 Option 2 Option 3 Vision Life Ins Disability

Vision Insurance Carrier: MetLife (Once Every 12 months) Eye Exams: InNetwork $10 Copay/ OutNetwork $45 Copay Frames: InNetwork $130 allowance/OutNetwork $70 allowance Lenses: (Once every 12 months) Single: In Network $20 copay/Out of Network $30 allowance Lined Bifocal:$20 copay/Out of Network $50 allowance Lined Trifocal: $20 copay/Out of Network $65 allowance Contact Lenses (Instead of Frames or Lenses/Once every 12 months ) In Network: $130 allowance OutNetwork: $105 allowance Previous Next Option 1 Option 1 Option 2 Option 3 Life Ins Disability Dental No Changes! Rates Reflect Employee Biweekly Deductions

Voluntary Life Insurance Employee Optional group term life insurance You may purchase coverage in an amount of $10,000 to $500,000 in increments of $10,000. Your family or beneficiary will get this additional benefit amount if you pass away. If you choose an optional life benefit amount more than $120, you will need to have an EOI (Evidence of Insurability) approved by Mutual of Omaha. An EOI form will be sent to you within 48 hours of your election. Previous Next Insurance Carrier: Mutual of Omaha Option 1 Option 1 Option 2 Option 3 Dental Life Ins Disability No Changes!

Spousal and Child Life Insurance Optional Life Coverage for your family You may also choose additional life coverage for your spouse and your children. If you choose Optional Life coverage for your Spouse of more than $30, you will need to have an EOI (Evidence of insurability ) approved by Mutual of Omaha. Within 48 hours of your election, the EOI form will be sent to you via . *Dependents coverage may not exceed 50% of the employee’s own elected Life insurance amount. Child Optional group term life rates- Monthly Rate per $1000 of coverage: $0.20 Previous Next Insurance Carrier: Mutual of Omaha No Changes!

Long Term Disability(LTD) Help Protect Your Loved Ones- And your Income with Long Term Disability Long term disability will pay you 60% of your annual gross income until retirement age in the event of injury or illness which would prevent you from working. Your monthly LTD benefit will be 60% of your monthly pre-disability earnings, up to the maximum of $10,000, less deductible sources of income. **No medical questions asked if you enroll at your time of hire. Should you chose to elect LTD during open enrollment and it is not also your time of hire, you will be subject to EOI (Evidence of Insurability) and will have to wait for carrier approval prior to paying premiums. (an regarding EOI will be sent to when applicable) How to Calculate Your Total LTD biweekly cost: Previous Next Insurance Carrier: Mutual of Omaha No Changes!