Peace Medical Center 2014 Employee Benefits

Welcome The details of various 2014 Benefit Plans offered, are detailed below to assist you to select the plans that are appropriate for you and your family. The effective date of the Health Plan is December 1,2013 and for all other plans it is January 1,2014. Please contact the Purnima at / to add, remove or make changes to your benefits.

Benefits Summary Health Insurance 1. BCBS PPO – Premier Saver Plan 2. BCBS HDHP – HSA Plan Life /AD & D - BCBS Dental Insurance – Delta Dental Vision insurance - Alwayscare AFLAC -Short Term Disability Insurance/Life Insurance

Blue Cross Blue Shield PPO / Premium Saver Plan Benefit BCBS of South Carolina PPO / Premium Saver Plan Deductible with BCBS / Calendar Year EE $7,500Family $15,000 Lifestyle Deductible With Premium Saver Plan EE $2,000, Family $4,000 Covera gePremiumMonthlyPer PayCOBRA Coinsurance70% Single $ $248.23$ $ Office Visit$20 Co-pay EE + SP$ $ $ $ Specialist$40 Co-pay EE + CH $983.80$ $292.52$ VisionNo Coverage Family$ $ $ $ Preventive100% Urgent Care$40 Co-pay NOTEThe monthly premium includes Prescription Drugs$8, $30, $60 $2.4 towards Life / AD & D coverage Emergency Room Deductible, Then 100% Out of Pocket Maximum EE $1,500, Family $3,000

Explanation of Medical Benefits Including Premium Saver Premium Saver is a secondary insurance to the medical PPO. Employees will receive a separate ID card from Premium Saver that will need to be presented at the time of service. The Premium Saver Plan lowers the BCBS deductible from $7,500 Individual and $15,000 Family to $2,000/4,000 and OOP of $1,500/$3,000. Total OOP for an Individual is $3,500. There are no limitations on inpatient or outpatient expenses. Claims are not automatically transferred from BCBS to Premium Saver so both cards need to be presented at time of service for Inpatient and Outpatient treatment.

Blue Cross Blue Shield HSA Plan Benefit BCBS of South Carolina, HSA PLAN Deductible with BCBS / Calendar Year EE $1,500 Family $3,000 Lifestyle Deductible With Premium Saver Plan N/A Coinsurance100% CoverageHDHPMonthlyPer PayCOBRA Office Visit Deductible, Then 100% Single$ $ $ $ Specialist Deductible, Then 100% EE + SP $ $ $ $ VisionN/A EE + CH$999.91$ $ $ Preventive100% Family $ $ $ $ Urgent Care Deductible, Then 100% Prescription Drugs Deductible, Then 100% NOTE The monthly premium includes Emergency Room Deductible, Then 100% $2.4 towards Life / AD & D coverage Out of Pocket Maximum$0

Explanation of HSA Employees that elect the HSA option can set up a separate bank account. All contributions into the HSA account are 100% tax deductible. Money that is spent on qualified medical expenses comes out of the account tax free. Single employees can contribute up to $3300 in 2014 to the account and Employees with dependent coverage can contribute up to $6,550 in HSA catch-up contributions is $ for account holder age 55 or older. All unused money remains in the account and rolls to the next year. At age 65 employees can take the money out for non-medical expenses and the account is taxed just like an IRA.

Life/ AD & D Insurance BCBS Plan $20, 000 Benefit Basic Life / AD & D Required for BCBS Health (Included in rates on those slides) All Eligible F/T employees may be covered if they do not waive coverage. Coverage Level Monthly Rate Bi Weekly Rate Employee$2.40$1.11

Dental Benefits BenefitDelta Dental PPO Deductible$50 Individual / $150 Family Waived for Preventive Preventive Services100% Basic Services80% Major Services50% Annual Maximum$1,000 OrthodonticsNot Covered This Coverage is Voluntary and sponsored by the employee Employee Cost Per Pay Period Customer Service : Delta Dental Employee12.46 Emp/Spouse24.79 Emp/Children24.60 Family39.53

AlwaysCare Vision Insurance

Vision – Always Care Plan A Co Pays: In Network Out Of Network Exam $10 Up to $35 Materials $10 Std Plastic Lenses : Single Vision Co Pay Up to $25 Bifocal Co Pay Up to $40 Trifocal Co Pay Up to $50 Lenticular $ 80 Allowance Up to $50 Progressive $ 70 Allowance Up to $ 40 Frames At Provider $120 Allowance Up to $50 WM, Sams, Costco $ 94 Allowance Up to $50 Contact Lenses : Elective Up to $120 Up to $100 Medical Nec. Up to $210 Up to $210 Coverage Level Monthly RateBi Weekly Rate Employee$7.38$3.41 Employee + Spouse$14.74$6.80 Employee + Children$15.60$7.20 Employee + Family$24.50$11.31

Life and AD&D You are provided with a flat $20,000 Term Life insurance coverage. The Life can be purchased as a stand alone benefit. Payable by the employee per pay period deduction. The life Benefit is automatically added if an employee elects any tier of Medical Coverage with BCBS Coverage Level Monthly Rate Bi weekly Rate Employee $ 2.40 $1.11

401K Maximum Allowable Contributions The maximum amounts individuals are permitted to contribute to their retirement plans for the year 2014 are as under: Annual employee contribution limit for 401(k) - $17,500. Annual catch-up contribution limit for 401(k), if employee is age 50 or over - $5,500 Please advise the HR if you want to make changes to your 401(k) contributions.

Contact Information Gibson & Associates is ready to assist you in any way possible. For any questions regarding any part of your Health plan or benefits please call You may also submit your inquiry at Peace Medical Center service representatives will be Jennifer Nelson and Allison Hunt Aflac contact – Michele Jain –