Enrollment New vendor, Chard Snyder, will handle enrollment and premium collection Online: www.Chard-Snyder.com Phone: 800-982-7715 Coverage does not rollover, so every retiree must enroll Open Enrollment is October 29th -November 18th

2019 HEALTH ASSESSMENT CHANGES New DEDUCTIBLE CREDIT To qualify for the deductible credit, employees and their covered dependents should receive a preventative wellness exam with their primary care physician in 2018. Once complete, the credit will automatically apply to the 2019 deductible.

Plan Changes 2019 Telemedicine Bariatric Surgery Mental Health Copays All 6 medical plans will offer telemedicine Plans 1-4 will have access to a Primary Care Physician Plans 5 & 6 will have access to Primary Care Physician and Mental Health Specialists Bariatric Surgery No longer covered under any medical plan or The Zero Card Mental Health Copays Access to mental health professionals will be available for a copayment, if applicable by plan, rather than subject to deductible and coinsurance Emergency Room Copays Visits to the ER now come with an additional deductible of $250 unless admitted

RX Changes 2019 $0 Drug List 90 Day Supply Weight Loss Prescriptions Preferred generics available on plans 1-4 at any in-network pharmacy Replaces RXnGo benefit through Zero Card 90 Day Supply Cost is 2.5 co-pays mail order or 3 co-pays in retail pharmacy Weight Loss Prescriptions Covered after pre-authorization Fertility Prescriptions Coverage now includes initial diagnosis and injections

Preventative Coverage Recommended routine gender and age-specific care and screenings Health Counseling Weight loss, depression, tobacco cessation Immunizations Flu, HPV, shingles, Tdap, Pneumoccocal, Heptatitus A and B Cancer Screenings Mammogram, colonoscopy, PSA, pap smear Preventative RX Folic acid, single agent statins, aspirin

Benefits Value Advisor Only Available on Plans 5 and 6 Concierge-style customer service from Blue Cross and Blue Shield BVA offers the following services: Education about coverage options Appointment scheduling Price comparison and shopping assistance This service empowers members to make more cost- effective, high quality choices

2019 Zero Card Changes

BCBS Plan 1 Blue Choice PPO; Zero Card Eligible; Not Eligible for HSA Benefit In-Network Payment Level Individual/ Family Deductible $2,000/$6,000 Individual/ Family Out-of-Pocket Max (Includes deductible, copays and RX) $5,600/$13,500 Office Visit Co-pay Primary Care- $35; Specialist- $50; Telemedicine- $15 Emergency Room Copay $250 Coinsurance 80% RX Deductible $150 Individual/ $450 Family Preferred Generics $0 Non-Preferred Generic $40 Preferred Brand $75 Non-Preferred Brand $125 Specialty $200

BCBS Plan 1 Blue Choice PPO; Zero Card Eligible; Not Eligible for HSA Plan 1 PPO, Blue Choice 2019 Monthly Retiree Cost Retiree Only $110.00 Retiree + Spouse $810.00 Retiree + Child $400.00 Retiree + Children $660.00 Retiree + Family $1,330.00 Plan 1 PPO, Blue Choice 2019 Monthly Cost WITHOUT UCO Contribution Retiree Only $578.02 Spouse Only Child Only Children Only $860.45 Family Only $1,142.89

BCBS Plan 2 Blue Preferred PPO; Zero Card Eligible; Not Eligible for HSA Benefit In-Network Payment Level Individual/ Family Deductible $1,250/$3,750 Individual/ Family Out-of-Pocket Max (Includes deductible, copays and RX) $3,500/$10,500 Office Visit Co-pay Primary Care- $25; Specialist- $50; Telemedicine- $15 Emergency Room Copay $250 Coinsurance 80% RX Deductible $150 Individual/ $450 Family Preferred Generics $0 Non-Preferred Generic $40 Preferred Brand $75 Non-Preferred Brand $125 Specialty $200

BCBS Plan 2 Blue Preferred PPO; Zero Card Eligible; Not Eligible for HSA Plan 2 PPO, Blue Preferred 2019 Monthly Retiree Cost Retiree Only $40.00 Retiree + Spouse $670.00 Retiree + Child $300.00 Retiree + Children $530.00 Retiree + Family $1,150.00 Plan 2 PPO, Blue Preferred 2019 Monthly Cost WITHOUT UCO Contribution Retiree Only $576.08 Spouse Only Child Only Children Only $857.56 Family Only $1,139.05

BCBS Plan 3 Blue Preferred PPO; Zero Card Eligible; Not Eligible for HSA; No RX Deductible Benefit In-Network Payment Level First Dollar Coverage $500 per person Individual/ Family Deductible $500/$1000 Individual/ Family Out-of-Pocket Max (Includes deductible, copays and RX) $5,500/$11,000 Office Visit Co-pay No co-pays. Office visits including telemedicine are subject to first dollar coverage, then deductible and coinsurance Emergency Room Copay $250 Coinsurance 50% Preferred Generics $0 Non-Preferred Generic $25 Preferred Brand $50 Non-Preferred Brand $100 Specialty $150

BCBS Plan 3 Blue Preferred PPO; Zero Card Eligible; Not Eligible for HSA; No RX Deductible Plan 3 PPO, Blue Preferred 2019 Monthly Retiree Cost Retiree Only $0.00 Retiree + Spouse $490.00 Retiree + Child $200.00 Retiree + Children $360.00 Retiree + Family $890.00 Plan 3 PPO, Blue Preferred 2019 Monthly Cost WITHOUT UCO Contribution Retiree Only $554.08 Spouse Only Child Only Children Only $824.40 Family Only $1,094.99

Primary Care- $35; Specialist- $60; Telemedicine- $15 BCBS Plan 4 Blue Preferred PPO; Zero Card Eligible; Not Eligible for HSA; No RX Deductible Benefit In-Network Payment Level Individual/ Family Deductible $5,000/$10,000 Individual/ Family Out-of-Pocket Max (Includes deductible, copays and RX) $7,900/15,800 Office Visit Co-pay Primary Care- $35; Specialist- $60; Telemedicine- $15 Emergency Room Copay $250 Coinsurance 80% Preferred Generics $0 Non-Preferred Generic $25 Preferred Brand $50 Non-Preferred Brand $100 Specialty $150

BCBS Plan 4 Blue Preferred PPO; Zero Card Eligible; Not Eligible for HSA; No RX Deductible Plan 4 PPO, Blue Preferred 2019 Monthly Retiree Cost Retiree Only $0.00 Retiree + Spouse $430.00 Retiree + Child $160.00 Retiree + Children $310.00 Retiree + Family $660.00 Plan 4 PPO, Blue Preferred 2019 Monthly Cost WITHOUT UCO Contribution Retiree Only $513.47 Spouse Only Child Only Children Only $764.34 Family Only $1,015.21

BCBS Plan 5 Blue Choice PPO; HSA Eligible; Not Eligible for Zero Card Benefit In-Network Payment Level Individual/ Family Deductible $4,000/$12,000 Individual/ Family Out-of-Pocket Max (Includes deductible, copays and RX) $6,500/$13,000 Coinsurance 80% Office Visit Co-pay No co-pays. Office visits including telemedicine are subject to deductible and coinsurance Telemedicine Primary care physicians and mental health specialists are available through telemedicine for substantially less than traditional office visits All RX No co-pays, RX subject to deductible and coinsurance

BCBS Plan 5 Blue Choice PPO; HSA Eligible; Not Eligible for Zero Card Plan 5 PPO, Blue Choice UCO HSA Contribution 2019 Monthly Retiree Cost Retiree Only $75.00 $0.00 Retiree + Spouse $410.00 Retiree + Child $130.00 Retiree + Children $90.00 $280.00 Retiree + Family $630.00 Plan 5 PPO, Blue Choice No HSA Contribution 2019 Monthly Cost WITHOUT UCO Contribution Retiree Only $456.54 Spouse Only Child Only Children Only $678.31 Family Only $900.08

BCBS Plan 6 Blue Preferred PPO; HSA Eligible; Not Eligible for Zero Card Benefit In-Network Payment Level Individual/ Family Deductible $3,000/$9,000 Individual/ Family Out-of-Pocket Max (Includes deductible, copays and RX) $5,000/$10,000 Coinsurance 80% Office Visit Co-pay No co-pays. Office visits including telemedicine are subject to deductible and coinsurance Telemedicine Primary care physicians and mental health specialists are available through telemedicine for substantially less than traditional office visits All RX No co-pays, RX subject to deductible and coinsurance

BCBS Plan 6 Blue Preferred PPO; HSA Eligible; Not Eligible for Zero Card Plan 6 PPO, Blue Preferred UCO HSA Contribution 2019 Monthly Retiree Cost Retiree Only $100.00 $0.00 Retiree + Spouse $400.00 Retiree + Child $120.00 Retiree + Children $115.00 $270.00 Retiree + Family $620.00 Plan 6 PPO, Blue Preferred No HSA Contribution 2019 Monthly Cost WITHOUT UCO Contribution Retiree Only $459.29 Spouse Only Child Only Children Only $682.40 Family Only $905.52

Dental Plan Changes 2019 New vendor, Blue Cross and Blue Shield of Oklahoma Dental plans in 2018 paid 146% of premiums collected, meaning rates were set to increase by almost 60% To curb the increase, UCO is self-funding claims through BCBS and the plans have new coverage amounts Two Plans with Orthodontia New lifetime max on orthodontia services No Joint Networks Providers are either in-network or out of network

BCBS Plan 1 Benefit In-Network Payment Level $100/$300 100% 80% 50% No Deductible for Preventative Care Individual/Family Deductible $100/$300 Preventative Services Routine cleanings and x-rays 100% Basic Services Cavities and fillings 80% Major Services Crowns, dentures and implants 50% Orthodontic Services Orthodontic Lifetime Max $2,000 Annual Maximum Per Person Preventative services do not reduce annual maximum $1,500 Plan 1 2019 Monthly Cost Retiree Only $54.00 Retiree + Spouse $104.00 Retiree + Child $80.00 Retiree + Children $106.00 Retiree + Family $154.00

BCBS Plan 2 Benefit In-Network Payment Level $75/$225 100% 75% 50% No Deductible for Preventative Care Individual/Family Deductible $75/$225 Preventative Services Routine cleanings and x-rays 100% Basic Services Cavities and fillings 75% Major Services Crowns, dentures and implants 50% Orthodontic Services Orthodontic Lifetime Max $1,000 Annual Maximum Per Person Preventative services do not reduce annual maximum Plan 2 2019 Monthly Cost Retiree Only $42.00 Retiree + Spouse $80.00 Retiree + Child $62.00 Retiree + Children $82.00 Retiree + Family $118.00

BCBS Plan 3 Benefit In-Network Payment Level $50/$150 100% 80% N/A No Deductible for Preventative Care Individual/Family Deductible $50/$150 Preventative Services Routine cleanings and x-rays 100% Basic Services Cavities and fillings 80% Major Services Crowns, dentures and implants N/A Orthodontic Services Annual Maximum Per Person Preventative services do not reduce annual maximum $750 Plan 3 2019 Monthly Cost Retiree Only $19.00 Retiree + Spouse $38.00 Retiree + Child $31.00 Retiree + Children $40.00 Retiree + Family $61.00

Vision Plan Changes 2019 Same vendor (VSP), new plans Two plans Plan 2 offers the ability for contacts and prescriptions lenses in the same year No ID Cards Use SSN to verify eligibility 2019 is the last year to elect vision and keep it. If vision is not elected this year, you will not be able to enroll in vision benefits in the future This rule will apply every year from now on

VSP Vision Plan 1 Benefit In-Network Payment Level Well Vision Exam $10 Frame Allowance Allowance on contacts OR frames $150 or $170 for featured brands Lenses $25 copay for single vision, lined bifocal/trifocal Contacts Allowance on contacts OR frames $150 per year Plan 1 2019 Monthly Cost Retiree Only $7.54 Retiree + Spouse $15.06 Retiree + Child $14.74 Retiree + Children $16.10 Retiree + Family $25.72 VSP does not issue ID cards, use your SSN to verify eligibility

VSP Vision Plan 2 Benefit In-Network Payment Level Well Vision Exam $10 Frame Allowance $150 or $170 for featured brands Lenses $25 copay for single vision, lined bifocal/trifocal Contacts $150 per year Allowance Limit Allows for purchase of frames and contacts in the same year, or double frame/contact benefit Plan 2 2019 Monthly Cost Retiree Only $12.30 Retiree + Spouse $24.64 Retiree + Child $24.10 Retiree + Children $26.34 Retiree + Family $42.04 VSP does not issue ID cards, use your SSN to verify eligibility