HealthSelectSM of Texas Plan

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1 HealthSelectSM of Texas Plan HealthSelect SM of Texas is self-funded, which means you and your dependents' health care claims are paid with funds provided by the State of Texas and through any contributions you might pay, like dependent premiums and copayments. Blue Cross and Blue Shield of Texas (BCBSTX) is the third-party administrator (TPA) for HealthSelect SM of Texas medical benefits. This means that the ERS sets the benefits and pays the claims, while Blue Cross and Blue Shield of Texas (BCBSTX) manages the provider network, processes claims and provides customer service. HealthSelect SM of Texas is a point-of-service plan, which means a primary care physician (PCP) will direct your care to specialists when necessary. You will also need a referral from your PCP to receive in-network benefits. With the point-of-service plan, there are three levels of benefits: Network, non-network and out-of-area benefits. You may visit the HealthSelect of TexasSM website for more information. KelseyCare powered by Community Health Choice A Health Maintenance Organization (HMO) provides health coverage and prescription drug benefits to HMO participants and their eligible dependents in limited Texas counties. Coverage is provided through a network of doctors, specialists and pharmacies in the KelseyCare powered by Community Health Choice service areas. Counties served by KelseyCare are Brazoria, Fort Bend, Galveston, Harris and Montgomery. Employees can go to any network provider without a referral. You do not have to select a primary care physician (PCP) under this plan. You may visit the KelseyCare website for more information. Consumer Directed HealthSelectSM The consumer-directed health plan (CDHP) includes a high-deductible health plan (HDHP) and a health savings account (HSA). The CDHP is offered through Blue Cross and Blue Shield of Texas (BCBSTX). The provider network is the same as HealthSelect SM of Texas. Participants do not need to name a primary care physician (PCP) and do not need referrals to see specialists. Note: Participants will be responsible for much more out-of-pocket expenses and will have to satisfy a large deductible before the plan begins to pay for any health or prescription benefits, except preventive care.

2 The HSA helps participants save money so they are prepared for out-of-pocket healthcare expenses. Participants can also save money on income taxes. The HSA is an important part of the plan. A participant in Consumer Directed HealthSelect SM can and should open an HSA as soon as possible. The state will contribute pre-tax money into the account each month, and the participant also can contribute money up to a certain amount every year. Optum Bank is the administrator of the HSA program. HSA participants cannot participate in a traditional health care flexible spending account (FSA). You may visit the HealthSelect of TexasSM website for more information. New employees have a 60-day waiting period before the State's health plan takes effect. The health plan, which includes $5,000 of life insurance, is provided to the full-time employee at no cost. Health coverage must be selected during the first 31 days of employment. Coverage will not become effective until the first day of the month following the 60-day waiting period. Eligible dependents include the employee's spouse and unmarried children under age 26.

3 Health Plan Comparison

4 COBRA On April 7, 1986, a federal law was enacted (Public Law , commonly called "COBRA"). This law required the State of Texas to offer employee and dependent covered under the Texas Employee Group Benefits Program (GBP) the opportunity to temporarily extend their health and/or dental coverage at the group rates. Continuation is available only when certain qualifying events cause the coverage under the GBP to end. Coverage under COBRA is limited to the health and/or dental coverage in effect at the time of the qualifying event. After an employee leaves employment, ERS will send the employee a COBRA notification, election form and instructions for premium payments. Prescriptions OptumRx is the prescription drug benefit administrator for participants in HealthSelect SM of Texas and in Consumer Directed HealthSelect SM. OptumRx pharmacy network includes access to thousands of retail locations, including national chains, and many community pharmacies. You may visit HealthSelectRx for more information. KelseyCare powered by Community Health Choice is the prescription drug benefit manager for participants in the HMO plan. It's important to note that KelseyCare by Community covers only those drugs listed in their formulary, which is basically an approved list of drugs. Their formulary is created and approved by a committee of physicians and pharmacists based on the latest research available. While there are often many drugs that treat the same condition, they've chosen the drugs that research shows are the most effective. Generic drugs are also included on their list and are generally available at a lower copay than brand name drugs. You may visit the KelseyCare website for more information.

5 Rates SM MONTHLY RATES FOR FULL-TIME EMPLOYEES MEMBER ONLY $ $ $0.00 $1, $ $ CHILD $1, $ $ FAMILY $1, $1, $ * Employees working at least 30 hours a week will be considered full time. SM MONTHLY RATES FOR PART-TIME EMPLOYEES MEMBER ONLY $ $ $ $1, $ $ CHILD $1, $ $ FAMILY $1, $ $1,203.30

6 KELSEYCARE MONTHLY RATES FOR FULL-TIME EMPLOYEES MEMBER ONLY $ $ $0.00 $1, $ $ CHILD $ $ $ FAMILY $1, $ $ KELSEYCARE MONTHLY RATES FOR PART-TIME EMPLOYEES MEMBER ONLY $ $ $ $1, $ $ CHILD $ $ $ FAMILY $1, $ $935.74

7 CONSUMER DIRECTED HEALTHSELECT FULL-TIME EMPLOYEES MEMBER ONLY $ $ $0.00 $1, $ $ CHILD $1, $ $ FAMILY $1, $1, $ CONSUMER DIRECTED HEALTHSELECT PART-TIME EMPLOYEES MEMBER ONLY $ $ $ $1, $ $ CHILD $ $ $ FAMILY $1, $ $1,143.80

8 STATE OF TEXAS VISION PLAN FULL-TIME & PART-TIME EMPLOYEES MEMBERSHIP LEVEL PREMIUM MEMBER ONLY $6.69 $13.38 CHILD $14.38 FAMILY $21.07 DENTAL PLAN MONTHLY RATES FOR FULL-TIME & PART-TIME EMPLOYEES MEMBER ONLY CHILD FAMILY HUMANA MAINTENANCE PLAN (DHMO) HUMANA TEXAS DENTAL CHOICE PLAN (PPO) DENTAL DISCOUNT PLAN $9.59 $19.17 $23.01 $32.59 $27.41 $54.82 $65.78 $93.19 $2.25 $4.50 $5.40 $7.65

9 OPTIONAL TERM LIFE RATES PER $1,000 OF ANNUAL SALARY Age E I E II E II E IV Age E I E II E III E IV $0.05 $0.10 $0.15 $0.20 $0.05 $0.10 $0.15 $0.20 $0.05 $0.10 $0.15 $0.20 $0.06 $0.12 $0.18 $0.24 $0.06 $0.12 $0.18 $0.24 $0.08 $0.16 $0.24 $0.32 $0.12 $0.24 $0.36 $ $0.33 $0.66 $0.99 $1.32 $0.57 $1.14 $1.71 $2.28 $0.93 $1.86 $2.79 $3.72 $1.48 $2.96 $4.44 $5.92 $2.41 $4.82 $7.23 $9.64 $3.92 $7.84 $11.76 $15.68 $6.79 $13.58 $20.37 $27.16 $0.19 $0.38 $0.57 $ $10.57 $21.14 $31.71 $42.28 Beginning at age 70, Optional Term Life coverage is reduced to a percentage of your annual salary according to the following table: Age % % % % % DEPENDENT TERM LIFE RATES $1.38 (includes $5,000 term life with AD&D coverage per dependent)

10 VOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) RATES Employee Only Employee & Family $0.02/$1, of coverage $0.04/$1, of coverage TEXAS INCOME PROTECTION PLAN (TIPP) Short-Term Disability Long-Term Disability $0.30/$ of monthly salary $0.63/$ of monthly salary

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