Welcome to the Sandia Retiree Health Benefits Program! This kit is a confirmation of your Sandia health care coverage and premium billing if applicable. Enclosed is information about your new health benefits program.

Confirmation Statement – The confirmation statement shows what plan(s) will bein effect and who are covered under you.

Premium Billing – Extend Health is partnering with Mercer Health & BenefitsAdministration LLC to manage the premium billing process. Your first premiumbilling notice is enclosed if payment is due. Mercer will be sending out a billingstatement 30 days in advance for each monthly effective date of coveragethereafter if payment is due.

You can always call Extend Health about any billing questions you may have.

Electronic Payment Form – You have the option to electronically submit yourpremium payments to Mercer. As of January 1, 2011, pension deduction forpremium payments is no longer available. If you have a checking account, youcan set up electronic payment for your premium(s). Advantages are cost savingsand convenience for you.

If you have any questions concerning the Sandia Retiree Health Benefits Program, please contact the Extend Health, the Benefits Administrator for Sandia National Labs at 1-888-598-7809, Monday – Friday, 7:00 a.m. – 7:00 p.m., Mountain Time.

Sincerely,

Extend Health, the Benefits Administrator for Sandia National Labs

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ardPAY®

Safe Guard your coverage Safe Guard your personal information Safe Guard your family's future

SAFEguardPAY® provides you peace of mind in knowing your coverage will be there when your family needs it.

Avoid a coverage cancellation for late or missed payments by letting SAFEguardPAY® automatically—and safely—make your premium payment when it's due.

SAFE & SECURE. . You can rely on this trusted service to safely and confidently guard your personal information. You can rest assured your payments will be safe and secure each time an electronic transaction is made.

AUTOMATIC PAYMENT ..SAFEguardPAY® safely makes your premium payment for you automatically from your bank account. No hassles of writing checks, mailing payments or missing a payment.

SAVES YOU MONEY .. No more stamps-no more checks! With frequent increases in postage, and financial institutions charging more for checks, you'll save money. While it may not be that much each payment, over time the money saved will add up to extra cash in your wallet.

IT'S CONVENIENT .. With SAFEguardPAY® your payment will be made safely, conveniently and on time. Payments are withdrawn the scheduled day ofthe month they are due. If needed, SAFEguardPAY® will try again at a later date- while your coverage is still within its grace period.

FREE SERVICE* TO YOU.. Because you're a preferred participant in your insurance plan, your Plan Administrator does not charge a fee for SAFEguardPAY® services. This is a service you've earned, thanks to your continued participation. *Financial institution fees may apply.

IT'S EASY TO START ..To start your SAFEguardPAY® transactions, simply sign and date the Authorization form below. Then detach and return it along with your current premium payment.

↓ Complete, detach and return with your premium payment ↓

SAFEguardPAY® Authorization Name: Address: _

City: State: Zip:

Your Certificate Number:

Select Your Premium/Billing Cycle:

� YES! Please start my SAFEguardPAY® payments for the coverage indicated.Bank Account Information:

Routing# Account#

I authorize Mercer Health & Benefits Administration LLC to establish automatic bill payments to pay my insurance premiums when they come due. I also authorize my financial institution to charge my account accordingly. I understand if my premium changes, I will be notified and my SAFEguardPAY® deduction will be adjusted accordingly. I agree to notify Mercer Health & Benefits Administration LLC should my account information change.

x � Monthly � Quarterly Member's Signature Date (mm/dd/yyyy)

� Semiannually � Annually Please return with your current premium payment. You will be notified when your SAFEguardPAY® begins. In the meantime, please continue to pay any premium notices you receive. Premium payments are indicated on your bank statement as "Mercer Health & Benefits Administration LLC Premium".

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