Davidson College Plan Comparison PPO Plan Single Family HSA Plan Deductible In - $750 Out - $2,250 In -$2,250 Out - $6,750 In -$2,700 Out - $8,100 In - $5,400 Out - $16,200 Out of Pocket Maximum In - $3,000 Out – Unlimited *Includes Deductibles and copays In - $6,000 In - $5,500 In - $11,000 Copays In-Network Only PCP - $30 Specialist - $50 Not Applicable Coinsurance In – 80% Out – 60% HSA Contribution Employee - $750 EE+SP $1,500 EE + Child(ren) $1,500 Family $1,500

Davidson College Pharmacy Plan Comparison – In-Network Only PPO Plan Retail (30 day) Mail Order (90 day) HSA Plan Deductible $100 per individual Does not apply Combined Medical/RX ded Out of Pocket Maximum Included in Medical OOP Maximum Combined Medical/RX OOP Generic $15 after Rx Ded $38 20% after combined Ded Preferred Brand $30 after Rx Ded $75 30% after combined Ded Non-Preferred Brand $60 after Rx Ded $150 40% after combined Ded 40% after Combined Ded Specialty $150 after Rx Ded $150 after Rx Ded (30 day supply) 50% after combined Ded 50% after combined Ded (30 day supply)

Davidson College Premiums PPO Plan Monthly Bi-Weekly HSA Plan Employee Only $214.43 $98.97 $55.00 $25.38 Employee & Spouse/Domestic Partner $849.13 $391.91 $307.32 $141.84 Employee & Child(ren) $675.45 $311.74 $244.46 $112.83 Family $1,235.10 $570.04 $483.29 $223.06

Davidson College Premium Differences Coverage Tier PPO Plan HSA Plan Difference Employee Only $2,573.16 $660 $1,913.16 Employee & Spouse/Domestic Partner $10,189.56 $3,687.84 $6,501.72 Employee & Child(ren) $8,105.40 $2,933.52 $5,171.88 Family $14,821.20 $5,799.48 $9,021.72

Employee Only – Normal Utilization Coverage Tier Total Annual Charge PPO (Member Pays) HSA RX – 1 Generic 1 Pref Brand $924 $640 PCP – 2 Visits $200 $60 Specialist – 1 Visit $250 $50 Outpatient Service - 1 $1,500 $900 $1,361 Annual Premiums $,2573.16 $660 HSA Contribution $750 Total Expense $4,223 $2,645 ($1,578 Est. Savings)

Employee & Spouse/Domestic Partner – Normal Utilization Coverage Tier Total Annual Charge PPO (Member Pays) HSA RX – 1 Generic 1 Pref Brand 1 Non-Pref Brand $1,884 $1,360 PCP – 4 Visits $400 $120 Specialist – 2 Visit $500 $100 Outpatient Services - 2 $3,000 $2,400 $2,693 Annual Premiums $10,189.56 $3,687.84 HSA Contribution Not Applicable $1,500 Total Expense $14,270 $7,665 ($6,605 Est. Savings)

Employee & Child(ren) – Normal Utilization Coverage Tier Total Annual Charge PPO (Member Pays) HSA RX – 1 Generic $144 PCP – 6 Visits $600 $180 Specialist – 1 Visit $250 $50 Outpatient Services - 2 $3,000 $2,400 Annual Premiums $8,105.40 $2,933.52 HSA Contribution Not Applicable $1,500 Total Expense $10,879 $5,428 ($5,452 Est. Savings)

Family – Normal Utilization Coverage Tier Total Annual Charge PPO (Member Pays) HSA RX – 1 Generic 1 Pref Brand 1 Non-Pref Brand $1,884 $1,560 PCP – 6 Visits $600 $180 Specialist – 2 Visit $500 $100 Outpatient Services - 3 $4,500 $2,700 $2,833 Annual Premiums $14,821.70 $5,799.48 HSA Contribution Not Applicable $1,500 Total Expense $19,361 $10,116 ($9,245 Est. Savings)

Employee Only – High Utilization Coverage Tier Total Annual Charge PPO (Member Pays) HSA In-Patient Hospital - 1 $60,000 $3,000 $5,500 PCP – 10 Visits $1,000 $0 Specialist – 8 Visit $2,000 RX – 2 Generic 2 Pref Brand 2 Non-Pref Brand $3,768 Annual Premiums $2,573.16 $660 HSA Contribution $750 Total Expense $5,573 $5,410 ($163 Est. Savings)

Employee & Spouse/Domestic Partner – High Utilization Coverage Tier Total Annual Charge PPO (Member Pays) HSA In-Patient Hospital - 2 $120,000 $6,000 $11,000 PCP – 15 Visits $1,500 $0 Specialist – 12 Visit $3,000 RX – 2 Generic 4 Pref Brand 2 Non-Pref Brand $5,328 Annual Premiums $10,189.56 $3,687.84 HSA Contribution Total Expense $16,190 $13,188 ($3,002 Est. Savings)

Employee & Child(ren) – High Utilization Coverage Tier Total Annual Charge PPO (Member Pays) HSA In-Patient Hospital - 2 $120,000 $6,000 $11,000 PCP – 10 Visits $1,000 $0 Specialist – 10 Visit $2,500 RX – 2 Generic 2 Pref Brand 2 Non-Pref Brand $3,768 Annual Premiums $8,105.40 $2,933.52 HSA Contribution $1,500 Total Expense $14,105 $12,434 ($1,672 Est. Savings)

Employee & Family – High Utilization Coverage Tier Total Annual Charge PPO (Member Pays) HSA In-Patient Hospital - 2 $120,000 $6,000 $11,000 PCP – 20 Visits $2,000 $0 Specialist – 15 Visit $3,750 RX – 3 Generic 2 Pref Brand 3 Non-Pref Brand $4,872 Annual Premiums $14,821.20 $5,799.48 HSA Contribution $1,500 Total Expense $20,821 $15,299 ($5,522 Est. Savings)