WLISD EMPLOYEE ORIENTATION HEALTH PLANS TWO HEALTH PLANS AVAILABLE HCA M9203R BUY-UP MM02

WLISD HEALTH PLAN $500 DEDUCTIBLE $1,500 FAMILY HCA M9203R BUY-UP MM02 HCA M9203R $500 DEDUCTIBLE $1,500 FAMILY $1500 DEDUCTIBLE (*$750 HCA/$750) $3000 FAMILY (*$1500 HCA/$1500) *prorated for Sept.1st effective date

WLISD HEALTH PLAN BUY-UP MM02 HCA M9203R COINSURANCE AFTER DEDUCTIBLE SATISFIED $3000 EMPLOYEE $6000 MAX FOR FAMILY COINSURANCE AFTER DEDUCTIBLE SATISFIED $2500 EMPLOYEE $7500 MAX FOR FAMILY

WLISD HEALTH PLAN BUY-UP MM02 HCA M9203R 100% OF PREVENTATIVE CARE IS COVERED BY PLAN 100% OF PREVENTATIVE CARE IS COVERED BY PLAN

WLISD HEALTH PLAN BUY-UP MM02 HCA M9203R PRESCRIPTIONS PRESCRIPTIONS $15 GENERIC $30 BRAND FORMULARY $45 BRAND NON-FORMULARY MAIL: 3 TIMES RETAIL COPAY FOR 90 DAY SUPPLY BRAND $25 GENERIC COPAY PRESCRIPTIONS RETAIL: Plan pays 80% employee pays 20% OF ALLOWABLE AMOUNT AFTER CALENDAR YEAR DEDUCTIBLE MAIL:

WLISD HEALTH PLAN BUY-UP HCA PREMIUMS PREMIUMS EMPLOYEE ONLY $211.38 EMPLOYEE & CHILDREN $380.49 EMPLOYEE & SPOUSE $486.18 EMPLOYEE & FAMILY $655.28 PREMIUMS EMPLOYEE ONLY $0 EMPLOYEE & CHILDREN $250 EMPLOYEE & SPOUSE $250 EMPLOYEE & FAMILY $250 MARRIED BOTH WLISD $135

FLEXIBLE SAVINGS ACCOUNT WLISD HEALTH PLAN BUY-UP MM02 HCA M9203R FLEXIBLE SAVINGS ACCOUNT HEALTH CARE ACCOUNT

Employee Only BUY-UP $211.38 $2536.56 Monthly Annual Employee Only BUY-UP $211.38 $2536.56 Employee Only HCA $0 $0 ________________________________________ Deductible & Annual Premium Total Cost Coinsurance BUY-UP $2,500 $2,536.56 $5,036.56 HCA $4,500 -$750 HCA $0 $3,750.000

Employee & FAMILY BUY-UP $655.28 $7863.36 Monthly Annual Employee & FAMILY BUY-UP $655.28 $7863.36 FAMILY HCA $250.00 $3000.00 _____________________________________________ Deductible & Annual Premium Total Cost Coinsurance BUY-UP $9,000 $7863.36 $16,863.36 HCA $9,000 -$1500HCA $3000.00 $10,500.00

Monthly Annual. Employee & FAMILY BUY-UP $655. 28 $7863 Monthly Annual Employee & FAMILY BUY-UP $655.28 $7863.36 Married WLISD FAMILY HCA $135.00 $1620.00 Deductible & Annual Premium Total Cost Coinsurance BUY-UP $6,000 $7863.36 $13,863.36 HCA $6,000 -$1500HCA $1620.00 $6,120.00

SCENARIO Suzie, Jim, Katie, and Jake with HCA Family coverage. $1500 -$750 HCA Deductible ($3000 - $1500 HCA total for family) $1500 Coinsurance each, Max $3000 For Family. HCA $750 individual or $1500 Family. January 2016 Katie annual check-up – 100% covered, no cost Jake annual check-up – 100% covered, no cost March 2016 Jim gets flu - Doctor’s visit $100, Prescription $100 No out of pocket. Covered by HCA May 2016 Suzie – Annual exam – 100% covered, no cost June 2016 Jake gets sick - Doctor’s visit $100, Prescription $100 July 2016 Jim – Annual exam – 100% covered, no cost August 2016 Katie allergies – Doctor’s visit $150, shots $150 No out of pocket, $300 from HCA October 2016 Suzie sick – Doctor $85, Prescription $100 No out of pocket, $185 from HCA December 2016 Jim sick - Doctor $100, Prescription $100 No out of pocket. Covered by HCA TOTAL PAID FROM HCA ACCOUNT $1085 TOTAL $415 in HCA rolls to next year.