Benefits

2012-2013

M di lMedical

Provider Network

• For a list of in-network providers go to www.humana.com

• Click on Find a Doctor

• Search by Coverage and Network and select Employer Group Plan (Non Medicare) as the type of Medical Coverage Enter yourPlan (Non Medicare) as the type of Medical Coverage. Enter your Zip Code.

• Select the National POS- Open Access

S h b dd t t d t Ch k th b t• Search by address or state and county. Check the box to agree to Humana’s Terms of Use.

• Search for a provider by type or by name.

Benefits Humana Buy Up PPO Humana Base PPO

Plan Design In-Network Out-of-Network In-Network Out-of-Network

Two Medical Plan Optionsg

Individual Deductible (Calendar Year) $1,000 $3,000 $1,500 $3,000

Family Deductible (Calendar Year) $3,000 $9,000 $3,000 $6,000

Co-insurance 80% 50% 80% 50%

OOP Max Individual (Deductible and copayments are not included) $3,000 $9,000 $4,000 $8,000

OOP Max Family (Deductible and copayments are not included) $9,000 $27,000 $8,000 $16,000

Inpatient Hospital 80%(After Deductible) 50% (After Deductible) 80%(After Deductible) 50% (After Deductible)

Outpatient Surgery 80% (After Deductible) 50% (After Deductible) 80%(After Deductible) 50% (After Deductible)

Physician Surgical Services 80% (After Deductible) 50% (After Deductible) 80%(After Deductible) 50% (After Deductible)

Lab and X-Ray in other outpatient facilities(excluding Advanced Imaging)

80% 50% (After Deductible) 80% 50% (After Deductible)(excluding Advanced Imaging)

Advanced Imaging Procedures:(PET, MRI, MRA, CAT, SPECT)

80% (After Deductible) 50% (After Deductible) 80% (After Deductible) 50% (After Deductible)

Preventive Care (Including Lab Work) 100% (co-pay waived) 50% (After Deductible) 100% (c-opay waived) 50% (After Deductible)

Office Visit Co-pay/Specialist Co-pay $35 50% (After Deductible) $35 50% (After Deductible)

Urgent Care Co-pay $75 50% (After Deductible) $75 50% (After Deductible)

Emergency Room Co-pay (excluding Advance Imaging)

Advanced Imaging Procedures:(PET, MRI, MRA, CAT, SPECT)

$150 (waived if admitted)

80% (After In-Network Deductible)

$150 (waived if admitted)

80% (After In-Network Deductible)(PET, MRI, MRA, CAT, SPECT)

Prescription DrugsLevel OneLevel TwoLevel Three

$15$30$50

70% of Allowable Amountminus Copayment

Amount

$15$30$50

70% of Allowable Amountminus Copayment

Amount

D t lDental

HumanaDental DHMO

Pl R i iPlan FeaturesFixed fee schedule

N d d tibl

Plan RestrictionsYou must designate a PCP

N t f t k b fitNo deductibles

No claim forms

No annual maximum

No out-of-network benefits

Specialty care is only given a discount, not co-pay. Member

No annual maximum

Lower premiums

No referrals for specialty care

pays discounted cost.

No referrals for specialty care

Find a provider at www humanadental comwww.humanadental.com

HumanaDental PPO

• Two PPO Plan options

Plan1 offers you the choice of going in or out of network, reimbursements are at 90% of usual and customary reimbursements.customary reimbursements.

Plan 2 offers you a higher level of benefit IF YOU STAY IN-NETWORK!

• $50 per person deductible; family deductible is $150

• Find a provider at www.humanadental.com

Dental Plan Comparison (Plan 1)

This plan is best-suited to members who knowto members who know

they will be utilizing non-contracted providers!

Dental Plan Comparison (Plan 2)

This plan is best-suited to members who know they will be

utilizing ONLY contracted gproviders! Non-network

services will result in substantial additional cost to the patient.

Dental Plan Comparison - DHMO

A full listing of covered services and theservices and the

associated patient charge is available in your benefit booklet.

Vi iVision

Vision

• Superior VisionSuperior Vision

• Out of network benefits set to specific reimbursementsreimbursements

• Network includes individual providers and some of the large chain store (Sam’s, EyeMasters,the large chain store (Sam s, EyeMasters, Walmart)

• www superiorvision com to find network providerswww.superiorvision.com to find network providers

Vision Plan

Benefits Network Non-Network

Co-pay $10 exam / $25 materials

Examination Interval 12 months

Lenses Interval 12 months

Frame Interval 24 months

Annual Vision Exam 100% 100% to $42

Frame 100% to $100 100% to $48

Single Vision Lenses 100% 100% to $32

Bifocal Lenses 100% 100% to $46

Trifocal Lenses 100% 100% to $61

Contact Lenses - Medical Necessity 100% 100% to $210

Contact Lenses - Elective 100% to $120 100% to $100

Non-Tobacco User Incentive

Non-Tobacco User IncentiveIn an effort to promote Health & Wellness for our employees, we will continue the Non-Tobacco User Discount Program for the gupcoming plan year December 1, 2012 – November 31, 2013. A discount will be given on the medical insurance premiums to an employee who is enrolled in one of our medical plans that does not smoke or use tobacco products.

The discount amount will be increased to $50.00 per month.

T i th di t ill b i d t l t NTo receive the discount, you will be required to complete a Non-Tobacco User affidavit.

Employees who do not return the affidavit in a timely manner will not receive the discount.

C t ib tiContributions

Employee/Employer Bi-Weekly Contributionsy

Base PPO Medical Rates Non-Tobacco User Di t d R t

Bi-Weekly Medical Contributions

Base PPO Medical Rates Discounted Rates

Employee Only: $77.71 $54.63

Employee + Spouse: $191.38 $168.30

Employee + Child(ren): $157.90 $134.82

Employee + Family: $254.79 $231.71

Non Tobacco UserBuy-Up PPO Medical Rates Non-Tobacco User Discounted Rates

Employee Only: $110.68 $87.60

Employee + Spouse: $258.12 $235.04

Employee + Child(ren): $218.09 $195.01

Employee + Family: $348.68 $325.60

Employee/Employer Bi-Weekly ContributionsyDental & Vision Contributions

Dental PPO Plans One and Two

Employee Only: $0.00Employee + Spouse: $9.23Employee + Child(ren): $11.54Employee + Family: $18.46Employee Family: $18.46

Dental DHMO Plan

Employee Only: $0.00Employee + Spouse: $2.26

Employee + Child(ren): $3.29

Employee + Family: $4.32

Vision Plan

Employee Only: $0.63Employee Only: $0.63

Employee + Spouse: $1.87

Employee + Child(ren): $1.63

Employee + Family: $2.74

E l P id T LifEmployer-Paid Term Life

Term Life/AD&DLife Benefit (Provided at no cost by Amplify): 2 x annual salary

Benefit Maximum: $450,000Benefit Maximum: $450,000

Guarantee Issue Amount: $400,000

Age Reductions: 35% at age 7050% at age 75

Age Reductions - The life benefit will be reduced by the respective percentage amounts shown above once an individual has attained the ages listed above.

Accidental Death & Dismemberment: 2 x annual salary

V l t LifVoluntary Life

Voluntary Life Employees/Spouses/Child(ren)p y p ( )

Coverage options to meet your family’s needsMaximum Benefit Lesser of 5 X Salary or $100,000

Minimum Benefit $25,000

Increments $25,000

Guarantee Issue Amount Employee $100,000

Spouse Coverage 100% to $50 000Spouse Coverage 100% to $50,000

Guarantee Issue Amount Spouse $50,000

Child(ren) Coverage $10,000

Age Reductions35% at age 6550% at age 70

Waiver of Premium Included

Portability Included Special Open

Note: The Voluntary Life Insurance is guaranteed at initial enrollment only. Enrollment at a future date will require evidence of insurability and co erage ma be declined At the time of each ann al open enrollment emplo ees ho are c rrentl enrolled ma increase their

Accelerated Benefit Included

AD&D Same as Voluntary Life

Special Open Enrollment Opportunity!

and coverage may be declined. At the time of each annual open enrollment, employees who are currently enrolled may increase their election up to the Guarantee Issue amount without Evidence of Insurability, unless you have been previously declined.

Sh t T Di bilitShort Term Disability

Short Term Disability (STD)

Offered through Unum 100% Employer paid

Weekly Benefit 66.67%

Weekly Maximum $2,500

Elimination Period 1st day accidentElimination Period 1st day accident

8th day illness

Benefit Duration Up to 13 weeks (as p (determined by your

physician)

L T Di bilitLong Term Disability

Long Term Disability (LTD)

Offered through Unum 100% Employer paid

Monthly Benefit 66.67%Monthly Maximum

Guarantee Issue

$13,500

$13 500Guarantee Issue $13,500Elimination Period 90 daysDuration SSNRAOwn Occupation 24 monthsMental/Nervous Limitation 24 monthsSubstance Abuse Limitation 24 monthsSS Integration Full FamilyPre-Existing Limitation 3/12Survivor Benefit 3 monthsSurvivor Benefit 3 months

S ti 125 A tSection 125 Accounts

Section 125 Accounts

• Designed to save you money

• Regulated by the IRS

• Premium deductions for Medical and Dental are pre-tax

• Direct deposit available

• Two types of accounts available:

– Flexible Spending Account (FSA)Flexible Spending Account (FSA)

• Debit card available

• File Claims by fax or mail

– Dependent Care Account (DCA)

Flexible Spending Account (FSA)

Flexible Spending Account• $2 500 annual maximum (new for 2013)• $2,500 annual maximum (new for 2013)

• Co-pays, co-insurance, over-the-counter products (i.e. bandages, saline solutions)

• Over-the-counter drugs require a prescription from your doctor. If your pharmacy runs the over-the-counter drug as a prescription you can use your debit card for the purchase.

• If your pharmacy does not run the over-the-counter drug through as a prescription, you cannot use your debit card to pay for the purchase, you will be required to file a manual claim form with a copy of your prescriptioncopy of your prescription.

• “Use it or Lose it” rule applies

• Dependent expenses are eligible even if they are not covered under AMPLIFY’ b fit l (U l th h H lth S i A t)AMPLIFY’s benefit plans (Unless they have a Health Savings Account)

Flexible Spending Account (FSA)

D d t C R i b t A tDependent Care Reimbursement Account• $5,000 Annual Max

• Before and after school care• Before and after school care

• Custodial care for qualified tax dependents

• Elder care including adult day care

• “Use it or Lose” it rule applies

Employee AssistanceEmployee Assistance Program

Employee Assistance Program(EAP)

• Telephone access to counselors 24 hours a day, seven days a week

• Up to 3 free in-person sessions with a local counselor

W b b d i f ti• Web-based information

• Dependent care services

• Financial consultation and referrals• Financial consultation and referrals

COMPLETELY CONFIDENTIAL!!COMPLETELY CONFIDENTIAL!!

Additi l B fitAdditional Benefits

Additional Benefits

• Allstate supplemental Insurance– Accident Policy– Heart Disease / Heart Attack / Stroke Policy– Heart Disease / Heart Attack / Stroke Policy– Cancer Policy

• Gold’s Gym Corporate Membership discount

• AMPLIFY Gym

• Weight Watchers @ WorkWeight Watchers @ Work

Gold’s Gym Corporate Discount

• No enrollment feesNo enrollment fees

• Can join at any time

M b hi d f id• Membership good for one year – no midyear cancellations

M lti l l ti th h t th it• Multiple locations throughout the city

Weight Watchers @ Work

• WW@W meetings are held everyWW@W meetings are held every Wednesday at Parmer at 12:15pm!

• 50% reimbursement of your fees based on50% reimbursement of your fees based on attendance.