Out-of-Network $12,700 $25,400 Out-of-Pocket Max - Individual - Family

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1 MEDICAL Medica Plan Name Medica Choice Passport HSA Medica Choice Passport HSA Calendar Year Deductible - Individual - Family In Network $3,000 $6,000 Out-of-Network $6,000 $12,000 In Network $6,350 $12,700 Out-of-Network $12,700 $25,400 Out-of-Pocket Max - Individual - Family $6,500 $13,000 $26,000 $52,000 $6,350 $12,700 $25,400 $50,800 Coinsurance - Preventive Care - Primary Care (injury or illness) - Specialist No Charge 2 2 No Charge Prescription Drug Coinsurance - Generic Drugs / Preventive - Preferred Brand Drugs / Preventive - Non-preferred Brand Drugs - Specialty Drugs Preferred / Non-Preferred 2 / No Charge 2 / No Charge 4 2 / 4 Not Covered / No Charge / No Charge Not Covered Monthly Employee Deductions Employee Only $ $ Employee + Spouse $1, $1, Employee + Child(ren) $ $ Family $1, $1, A list of providers can be found at: under the Find a physician or facility link

2 DENTAL The Standard Plan pays 10 8 Plan Benefit Type 1 Routine Exams (2 in ) Bitewing X-rays (1 in ) Full Mouth/Panoramic X-rays (1 in 5 years) Periapical X-rays Cleanings (2 in ) Sealants (age 13 and under) Space Maintainers Fluoride (age 13 and under, 2 in ) Type 2 Restorative Amalgams Restorative Composites Endodontics (surgical/nonsurgical) Periodontics (surgical/nonsurgical) Simple/Complex Extractions Anesthesia Type 3* Onlays Crowns (1 in 5 years per tooth) Crown Repair Denture Repair Implants Prosthodontics (1 in 5 years) Allowance 90 th Usual and Customary** Annual Deductible Waived for Type 1 Type 2 &3: $50 ($150 per Family) per calendar year Annual Maximum $1,000 per person per calendar year Monthly Employee Deductions Employee Only Employee + Spouse Employee + Child(ren) Family $9.22 $37.42 $52.57 $80.96 * 12 month waiting period on Type 3 dental services for all new enrollees effective 4/1/2019. ** Usual and Customary (U&C) describes dental charges that have been determined to be the usual and customary charge for a given dental procedure within a particular ZIP code. U&C amounts are reviewed and updated on an annual basis. A list of providers can be found at: and click on "Find a Dentist."

3 VISION Vision Service Plan (VSP) Through The Standard Benefits In-Network Out-of-Network Exam $10 copay Up to $45 Frame Allowance $150 Up to $70 Lenses Single Vision Bifocal Standard Progressives $10 copay $10 copay Patient is responsible for the difference between the base lens and progressive lens charge Up to $30 Up to $50 Up to Lined Bifocal allowance Contacts (when chosen in lieu of lenses) Up to $150 Up to $120 Frequency Exam Lenses/Contact Lenses Frame 24 months 24 months Monthly Employee Deductions Employee Only Family $5.43 $6.43 A list of providers can be found at: Enter your City/County, State, or Zip.

4 LIFE & AD&D The Standard NHS provides full-time employees with the option to purchase group life and accidental death and dismemberment (AD&D) insurance. If the employee elects coverage, they may also elect coverage for a spouse or child(ren), through age 25. Employee maximum benefit: $300,000 (may not exceed 6 times your annual earnings) Employee minimum benefit: $10,000 Can purchase additional coverage in $10,000 increments Guaranteed Issue: $150,000 (amount of coverage you can elect without requiring an evidence of insurability form to be completed) AD&D Benefit matches life benefit Conversion and Portability are included Employee age reduction schedule: Reduces to 65% at age 65 Reduces to at age 70 Reduces to 35% at age 75 For additional information on the available features and benefits of Life and AD&D Insurance from The Standard, go to: SHORT TERM DISABILITY Allstate NHS provides full-time employees with the option to purchase Short Term Disability coverage for 6 or. Disability insurance can help replace your lost income and help ensure your finances are not depleted. You will receive cash benefits to use as you see fit. 6-month Plan Details: Elimination period for accident 7 days Elimination period for sickness 7 days (Elimination period is a period of continuous total disability which must be satisfied before you are eligible to receive benefits) Monthly Benefit - $5,000* Benefit Period Maximum benefit period is 6 months 12-month Plan Details: Elimination period for accident 14 days Elimination period for sickness 14 days (Elimination period is a period of continuous total disability which must be satisfied before you are eligible to receive benefits) Monthly Benefit - $5,000* Benefit Period Maximum benefit period is * The following process is used to calculate your monthly benefit: (1) Multiply monthly earnings by 6. (2) Subtract deductible sources of income from 1. (3) Determine the lesser of item 2 and the maximum monthly benefit amount issued to you. (4) pay the greater of item 3 or $100. For additional details on each of the plans listed above, refer to the Enrollment Guide or

5 GROUP WORKSITE Allstate NHS provides full-time employees with the option to purchase CRITICAL ILLNESS, CANCER, and ACCIDENT INSURANCE. If the employee elects coverage, they may also elect coverage for a spouse or child(ren) under age 26. Critical Illness: Helps provide financial support if you are diagnosed with a covered critical illness. You will receive a cash benefit based on the percentage payable for the condition. Cancer: The coverage pays you a cash benefit to help with the costs associates with treatments and to pay for daily living expenses. Accident: Most major medical insurance plans only pays a portion of your bills. Additional Accident insurance pays you cash benefits that correspond with hospital and intensive care confinement. LEGALSHIELD and IDSHIELD LegalShield NHS provides full-time employees with the option to purchase LegalShield or IDShield or both. LegalShield: LegalShield has made smart legal coverage simple, in the form of accessible, affordable, full-service coverage. They have a network of dedicated law firms made up of seasoned lawyers to help you with your legal issues. You know exactly what you are getting and how much you are paying for it. If you elect LegalShield coverage, the employee, spouse/domestic partner, and child(ren) under age 26 are all covered for one fee. IDShield: If your identity is stolen or compromised, IDShield and their team of licensed private investigators will do whatever it takes for as long as it takes to restore your identity to its pre-theft status. You have their $5 million service guarantee. You have two options for IDShield coverage. IDShield Family covers the employee, spouse/domestic partner and up to 8 dependents. IDShield Individual covers only the employee. Rates vary depending on which option you choose. For additional details on each of the plans listed above, refer to the Enrollment Guide or

6 CONSUMER ACCOUNTS Medica OneSource HSA (Health Savings Account) FSA* (Flexible Spending Account) LPFSA* (Limited Purpose Flexible Spending Account) An HSA is a tax-exempt account created for employees who are covered under a high-deductible health plan. Contributions can be made by the employer and/or employee. The contributions or funds can be used for qualified medical expenses. The account beneficiary owns the HSA and any unused amounts may be carried over from year to year. NHS matches $1 for $1 up to $55/month per employee The maximum contribution amounts for 2019 are: $3,500 per individual $7,000 per family $1,000 additional catch-up contributions are available to individuals age 55 and older. A medical FSA allows you make contributions to an account to pay for certain qualifying medical expenses that are not covered by insurance. The maximum contribution amount for 2019 is $2,700. There is no minimum annual amount. Examples of medical expenses that can be reimbursed through your FSA include: Hospital, Doctor, Dental, Drugs, and over-the-counter drugs that have been prescribed by a physician. However, premiums for health and/or dental insurance or long-term care insurance or any long-term care expenses cannot be reimbursed through the medical FSA. Unlike HSAs, FSA funds need to be used within the calendar year. You may carryover up to $500 of any unused amount in your medical FSA remaining at the end of the plan year to the following plan year. A limited medical FSA is an account that pays only certain medical expenses. The expenses covered will be for: Dental; and Vision, including eyeglasses, to the extent not covered under your health insurance. If you wish to fund an HSA and if you wish to be covered under a medical FSA, you must elect a limited medical FSA. If you are covered under a full medical FSA for any month, you are not eligible to contribute to an HSA that month. Unlike HSAs, LPFSA funds need to be used within the calendar year. You may carryover up to $500 of any unused amount in your medical LPFSA remaining at the end of the plan year to the following plan year. If you select reimbursement for medical expenses, your wages or salary will be reduced by the amount you have determined in your election to have withheld from your paycheck. *Contact Human Resources to complete election form, if eligible due to new hire or qualifying life event.

7 FLEXIBLE SPENDING ACCOUNTS Medica OneSource DCFSA or DCAP* (Dependent Care Flexible Spending Account or Dependent Care Assistance Program) A DCFSA or DCAP allows you to pay for expenses incurred for the care of either: Your dependent who is under the age of 13 years and with respect to whom you are entitled to an income tax exemption; or Your dependent or spouse who is physically or mentally incapable of caring for him or herself. Expenses must meet each of the following criteria: They must be incurred for the care of your dependent or for related household services; They must be paid to a dependent care service provider; and They must be incurred to enable you and your spouse to be gainfully employed for the period for which you have one or more qualifying dependents. In addition, you will have to supply the taxpayer identification number of your day care provider in order to receive reimbursement. The maximum amount that you can elect to have reimbursed to you under this plan in any plan year is the lesser of: Your earned income; Your spouse s earned income; or $5,000 ($2,500 if you are married and file separate tax returns). If your spouse is a full-time student at an educational institution or physically or mentally incapable of caring for him or herself and has the same principal place of abode as you for more than half the year, he or she is considered to have earned income of $250 per month if you have one dependent or $500 per month if you have two or more dependents. There is no minimum annual amount. If you select reimbursement for dependent care expenses, your wages or salary will be reduced by the amount you have determined in your election to have withheld from your paycheck. *Contact Human Resources to complete election form, if eligible due to new hire or qualifying life event.