20 E M P L O Y E E B E N E F I 18 T S

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1 EMPLOYEE BENEFITS 2018

2 2 advantel employee benefits 2018

3 Medical Insurance AdvantTel Networks is proud to offer medical benefits available to all eligible employees through United Healthcare (UHC) and Kaiser. A detailed benefit description is provided below. UHC PPO - Select Plus (largest Network) or Core PPO network, PPO plans give members access to two of the largest provider networks in California and nationwide. PPO plans give members the ability to self-direct their care and, if they choose to see any doctor (including specialists) without a referral. HMO - (for California employees only) HMO members receive comprehensive benefits from an integrated network of participating doctors and hospitals. Members must choose a Primary Care Physician (PCP) who oversees their total health care. Medical Insurance Kaiser United HealthCare HMO 9991 HMO 30/40/500 PPO Plans HSA Plans Individual Deductible (Calendar Year) Family Deductible (Calendar Year) In Network Only In Network-Signature Value In Network-Select Plus or Core/Out of Network In Network-Select Plus or Core/Out of Network None None $250 / $500 $3,000 None None $500 / $1,000 $6,000 Individual Out of Pocket Max. $2,500 $2,500 $2,250/$4,500 $5,000/$10,000 Family Out of Pocket Max. $5,000 $5,000 $4,500/$9,000 $10,000/$20,000 Office Visit PCP / Specialist $30 $30/$40 $20/40% 20%/40% Preventive Care Covered in full Covered in full Covered in full Covered in full Well Baby Covered in full Covered in full Covered in full Covered in full Annual Exams Covered in full Covered in full Covered in full Covered in full Diagnostic Lab/X-Ray/ Advance Imaging $10 No Charge 20%/40% 20%/40% Inpatient Hospital $500 Per Adm. $500 Per Adm. 20%/40% 20%/40% Outpatient Hospital $250 $250 20%/40% 20%/40% Emergency $100 $100 $100 copay + 20% Rx tier 1 $15 $15 $10 $10 Rx tier 2/3 $35 $30/$50 $30/$50 $35/$60 Group No.: % 3

4 Dental Insurance United Healthcare United HealthCare dental insurance is making it easier to keep up with regular visits to the dentist and lead a healthier life. UHC dental allows you to visit any dentist of your choice and there are no waiting period for checkups. Dental In Network-National Options PPO 30 Out of Network Preventive Services 100% 100% Deductible $50 per person, 3 individuals per family $50 per person, 3 individuals per family Basic Services 80% 80% Major Services 50% 50% Annual Maximum $1,500 each eligible family member $1,500 each eligible family member Orthodontic - Child 50% to $1,500 lifetime max 50% to $1,500 lifetime max Group No.: Vision Insurance VSP Advantel Networks employees are offered vision benefits through Vision Service Provider (VSP). VSP has a network of 23,000 doctors, located in rural and metropolitan areas throughout the nation. VSP doctors provide both eye exams and eyewear, making for a convenient one-stop means of obtaining eye-care benefits. Benefit Office Visit Examination Copay (1x every 12 months) Choice Network $10 copay Lens Replacement (1x every 12 months): $25 Single Vision 100% Bifocal 100% Trifocal 100% Frame Replacement (1x every 24 months) Contact Lenses (in lieu of glasses, 1x every 12 months) $ % off over allowance $ % allowance + contact lens exam Group No.:

5 Life and Disability Insurance Unimerica Advantel Networks offers Life and AD&D, and Long Term Disability (LTD) for all eligible employees. Life and AD&D (Employer Premium Paid) Life and AD&D benefit is a flat $50,000 Long Term Disability (Employer Premium Paid) 60% of monthly salary to a maximum of 5,000 per month 90 day elimination period Maximum benefit duration is to age 65 Group No.: Health Savings Account Optum Bank An HSA, or Health Savings Account, is a unique tax-advantaged account that can be used to pay for current or future healthcare expenses. When combined with a high-deductible health plan, it offers savings and tax advantages that a traditional health plan can t duplicate. The maximum amount that you can contribute to a HSA in 2018 is $3,450 for individual coverage and $6,850 for family coverage. If you are 55 or older you may make an additional catch-up contribution of $1,000. Authorized Signers who are 55 or older must have their 5

6 own HSA in order to make the catch-up contribution Employee Contribution Per Month Medical Plans Employee Only Employee + Spouse Employee + Children Family Kaiser HMO $ $ $ $ UHC HMO $ $ $ $ UHC Core PPO $ $ $ $ UHC Select Plus PPO $ $ $ $ UHC Core HSA $ $ $ UHC Select Plus HSA $90.55 $ $ $ UHC Dental $8.55 $28.38 $33.33 $61.22 VSP Vision 1.46 $4.08 $4.21 $8.12 Eligibility Requirements Benefits begin the first of the month following your hire date. Regular full-time employees (those employees who work 30+ hours/week) are eligible. Eligible dependents are: Spouse or domestic partner, and dependent children, including children of domestic partners. Your dependents may be permitted to remain on your medical plan up to age 26,regardless of marital or student status. Advantel s Open Enrollment is held every year in the month of December for a January 1st effective date. At this time, you can make changes to your benefit plan elections such as adding or deleting spouses and dependents and changing health plans. However, Qualifying Events (Marriage, Divorce, Birth or Adoption, Death and Loss of Coverage), allow you to make changes outside of the Open Enrollment period. If you experience a Qualifying Event after Open Enrollment, you must notify Human Resources within 30 days, otherwise you will be required to wait until the next Open Enrollment to make any changes to your benefit plan elections. If you have questions or unresolved issues after contacting member services at one of our insurance providers, you are welcome to contact your Filice Insurance Agency Account Manager. They will answer any questions you may have concerning your employee benefits, claim problems and administrative issues. 6

7 Filice Account Manager: Tom Jindrich Phone: Cell: Visit your benefits website for further detailed information at This summary is not intended to provide a complete plan description. If there is an actual or apparent conflict between this benefit summary or the Evidence of Coverage (EOC) booklet and the official plan documents, the provisions of the EOC prevail. IMPORTANT: All official documents relating to the Advantel Networks Employee Benefits Program, including the Evidence of Coverage (EOC) booklets, HIPAA Privacy Notice, Initial COBRA Notice, Medicare Part D Notice and any other relevant Plan Documents or Notices, are available electronically through the Advantel Networks benefits website. You may also receive a paper copy of any of the documents by contacting HR. Created by Filice Insurance, License No

8 Revised March 8, :41 AM