Royal State National Insurance Company Co., Ltd. EUTF Benefits for Active Employees Presentation Title Month XX, Year Supplemental Health Plan Chiropractic Benefit Plan Welcome to this presentation on EUTF benefits for active employees. Supplemental Health Plan and Chiropractic Benefit Plan, administered by Royal State National Insurance Company. Royal State National Insurance Company Co., Ltd. Royal State National Insurance Company, Ltd. 1

Supplemental Health Plan WHO IS ELIGIBLE? Available only to Active EUTF participants who are covered under another Non-EUTF primary health plan. The Supplemental Health Plan is available only to active EUTF participants who are also covered under another non-EUTF primary health plan. 2

Supplemental Health Plan Reimbursement Information After your primary medical plan pays their portion, the Supplemental Health Plan: Reimburses you for eligible, out-of-pocket, co-payments on medical, hospital and surgical expenses Up to $3,500 per insured person, per plan year After your primary medical plan pays their portion, the Supplemental Health Plan reimburses you for eligible, out-of-pocket co-payments on medical, hospital and surgical expenses up to $3,500 per insured person per plan year.

Supplemental Health Plan Prescription Drug Benefits The Prescription Drug Benefit reimburses prescription drug co-payments up to: $20 per prescription (per 30-day supply) The prescription drug benefit reimburses prescription drug co-payments up to $20 per prescription. The maximum is $350 for Single/Self coverage $700 for Two-Party coverage – or - $1,000 for Family coverage per plan year Reimbursement for prescription drugs copayment count towards the plan year maximum benefit payable. The Prescription Drug Benefit reimburses prescription drug co-payments up to $20 per prescription. The maximum is $350 for single/self coverage, $700 for two-party coverage or $1,000 for family coverage per plan year.

Supplemental Health Plan Filing A Claim Complete the Claim Form Attach the Explanation of Benefits (EOB) or co-pay receipt(s) Mail or fax to Royal State National If you need to file a claim simply complete the claim form, attach the explanation of benefits or co-pay receipts then mail or fax the documents to Royal State National Insurance Company. Copies are acceptable and all reimbursement payments are payable to you. Copies are acceptable All reimbursement payments are payable to you

Supplemental Health Plan The Supplemental Health Plan also includes chiropractic benefits. Chiropractic Benefits Included

Chiropractic Benefit Plan   If you are enrolled in any of the EUTF or HSTA VB Medical or EUTF Supplemental plans, you will automatically be enrolled in the Chiropractic Benefit Plan. If you are enrolled in any of the EUTF or HSTA VB medical or EUTF supplemental plans you will automatically be enrolled in the Chiropractic Benefit Plan. We’re Specialists In You!

Chiropractic Benefit Plan Co-payments are $15 per visit for EUTF plans ($12 per visit for HSTA VB) A participating ChiroPlan Hawaii chiropractor must determine services are therapeutically necessary 20 visits per Calendar Year max Elective or maintenance care are not eligible Co-payments are $15 per visit for EUTF plans or $12 per visit for HSTA VB. A participating ChiroPlan Hawaii chiropractor must determine services are therapeutically necessary. You have 20 visits per calendar year as the maximum. But remember, elective or maintenance care are not eligible.

Chiropractic Benefit Plan Participating Providers Participating Provider List may be found at: www.chiroplanhawaii.com Inform the participating chiropractor that you are eligible under the EUTF plan and your coverage will be verified with the ChiroPlan Hawaii office I.D. cards will not be issued A participating provider list may be found at www.chiroplanhawaii.com. You do not need an I.D. card. Simply inform the participating chiropractor that you are eligible under the EUTF plan and your coverage will be verified with the ChiroPlan Hawaii office. Remember, I.D. cards will not be issued.

Royal State National Insurance Company, Ltd. Plan information for each plan is available at the Royal State website: www.royalstate.com Royal State National Insurance Company has been serving Hawaii for over 50 years. Plan information on what we have discussed can be found at the website www.royalstate.com. Our office is located at 819 South Beretania Street in Honolulu. And you can reach us via phone on Oahu at 539-1621 and on the Neighbor Islands toll free at 1-888-942-2447. Thank you very much for your time and we look forward to serving you in the future. 819 S. Beretania Street, Honolulu Phone: (808) 539-1621 Toll Free: 1 (888) 942-2447