$4,800.00/ individual. $9,600.00/family

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1 Medical Plans Please note, this brochure provides an overview of certain health care plan provisions under the Adobe Systems Incorporated Group Welfare Plan. It is not intended to be a complete description of these benefits. For more complete details, refer to the Adobe Systems Incorporated Group Welfare Plan Summary Plan Description ( SPD ) and the plan documents on Appendix A of the SPD. If there is any conflict between the information presented here and the official plan documents, the plan documents will govern. The medical plans may require precertification for certain procedures, treatments and hospital stays. If you use in network providers, this process is handled automatically. Otherwise, if you are enrolled in a plan that has an out of network option and you obtain the services from an out of network provider, it is your responsibility to ensure you complete this process when required. Aetna Medical Plans Percentages shown represent the amount the plan pays after you meet the deductible (unless otherwise noted) you pay the remaining percentage (your coinsurance); flat dollar amounts represent the amount you pay (your co-payment), while the plan pays the remainder. When evaluating the medical option that is right for you, it s important to also consider the plan cost (your per-pay-period contribution). All out-of-network benefits are paid up to the UCR maximum. The Aetna Out-of-Area HealthSave Plan is offered to those employees who do not live within the Aetna Choice POS II network. All medical care is provided by the plan including, Prescription Drug, Mental Health Care and Substance Abuse Treatment. Qualifying for an HSA: To be an eligible and qualify for an HSA, you must meet certain IRS requirements. In terms of using an HSA account for dependent expenses, you should know that the IRS has specific rules and definitions related to spouses and children. Go to benefits.adobe.com to learn more and contact HealthEquity at with your personal HSA eligibility questions. General Provisions Provider Choice Annual Deductible (Applies to all expenses except as noted) Account Funding/ Account Balance Cap *Refer to proration schedule on the next page Bridge Out-of-pocket Maximum (OOPM) (Includes deductible and copays) Lifetime Maximum You may use any licensed provider $1,250.00/ (single coverage) $2,500.00/family (family coverage) If you cover any dependents, your deductible is the FULL family deductible regardless of which member of the family incurs expenses Adobe provides the following HSA funding: $750.00/ $1,500.00/family Deposited if you activate your account with HealthEquity. No balance cap $500.00/ $1,000.00/family You may use any licensed provider; however, you ll receive a higher level of benefits by using network providers $500.00/ $1,000.00/family If you cover any dependents, your OOPM is the FULL family OOPM regardless of which member of the family incurs expenses $1,800.00/employee $2,700.00/employee + 1 $3,600.00/employee + 2 Adobe provides the following HRA funding: $750.00/employee $1,125.00/employee + 1 $1,500.00/employee + 2 or more dependents The fund cap is the following: employee $4,200.00/employee + 1 $5,600.00/employee + 2 $1,050.00/employee $1,575.00/employee+1 $2,100.00/employee+2 employee $4,200.00/ employee +1 $5,600.00/ employee + 2 or more Unlimited (Excluding certain services) employee $7,200.00/ employee + 1 $9,600.00/ employee + 2 or more $1,500.00/ $3,000.00/family $1,500.00/ $3,000.00/family Not applicable $3,000.00/ $3,000.00/ Routine Care: Doctor s office visits includes specialist visits and second surgical opinions, though certain limitations may apply; well child care includes immunizations; routine physical exam includes OB/GYN exams, mammograms and prostate exams well care services all provided in accordance with age frequency guidelines Doctor s Office Visit Well Baby/ Child Care Routine Physical Exam/ Preventive Care Plan pays 80% after $15.00 (PCP) or $30.00 (specialist) co-pay Deductible is waived if in-network Deductible is waived if in-network 1

2 Aetna Medical Plans continued Hospital Care, Urgent Care and Surgery Precertification Semi-private Room and Board Emergency Room and Ambulance inpatient stays procedures: a $ (inpatient) automatically by network providers procedures: a $ (inpatient) automatically by network providers procedures: a $ (inpatient) automatically by network providers procedures: a $ (inpatient) Plan pays 80% Different benefit payment provisions apply for care provided in a skilled nursing facility Plan pays 80% Under all of the plans, non-emergency use of an emergency room or ambulance service is covered at 50% usage determined by Aetna Urgent Care Plan pays 80% Surgery (Outpatient/Inpatient) Maternity and Family Planning Prenatal Visits During Pregnancy Hospital Care / Birthing Center Infertility (Separate calendar year max. may apply) Fertility Treatment Drugs Contraceptive Drugs and Devices Plan pays 80% Plan pays 80% Coverage for preventive prenatal care with no cost share to the member is limited to pregnancy-related in-network physician office visits including the initial and subsequent history and physical exams of the pregnant woman (maternal weight, blood pressure and fetal heart rate check). Items not considered preventive include (but are not limited to) inpatient admissions, high risk specialist visits, ultrasounds, amniocentesis, fetal stress tests, certain pregnancy diagnostic lab tests, and delivery including anesthesia Plan pays 80% Plan pays 80% IVF and GIFT limited to three attempts/lifetime; for both Artificial Insemination (AI) services and Ovulation Induction (OI) procedures, benefits limited to six attempts/lifetime Plan pays up to $15,000.00/lifetime. After you meet the deductible, you pay a co-pay/prescription. Co-pays count towards the plan s Out-of-Pocket Maximum Office visit co-pay: You pay $15.00 (PCP) or $30.00 (specialist) Other facility: Plan pays up to $15,000.00/lifetime. A co-pay/prescription applies. Co-pays count towards the plan s Out-of-Pocket Maximum Generic formulary contraceptives will be covered at no member cost share when filled at an in-network pharmacy *Proration schedule Aetna HealthSave Medical Plan Below is the proration Adobe applies to the annual HSA contribution when you join the Aetna HealthSave. Your unused HSA funds roll over each year (with no balance cap) so you can watch your account grow. The HSA is administered by HealthEquity and applied/used at your discretion. Based on your effective date in the plan: % of Annual Fund amount provided January 1 January % February 1 February % March 1 March % April 1 April % May 1 May % June 1 June % July 1 July % August 1 August % September 1 September % October 1 October % November 1 November % December 1 December % Aetna HealthFund Medical Plan Below is the proration Adobe applies to the Annual Fund when you join the HealthFund. At the end of the year, any unused Fund dollars roll over automatically to the next year s Fund balance up to the fund cap. The Fund is administered by Aetna and applied/used automatically. Based on your effective date in the plan: % of Annual Fund amount provided January 1 January % January 16 February % February 16 March % March 16 April % April 16 May % May 16 June % June 16 July % July 16 August % August 16 September % September 16 October % October 16 November % November 16 December % December 16 December % 2

3 Aetna Medical Plans continued Mental Health Care and Substance Abuse Treatment: Benefits provided through Aetna; routine outpatient services do not require precertification. Inpatient treatment must be pre authorized. Applied Behavioral Analysis (ABA) coverage up to age 18 requires precertification and is subject to medical necessity/utilization reviews Outpatient Plan pays 80% Office visit: You pay $15.00 Plan pays 80% Inpatient Different benefit payment provisions apply for care provided in a skilled nursing facility Prescription Drug Benefits: Provided through Aetna. You pay as indicated below when filling at participating pharmacies. Reduced benefits if drugs obtained at a non-participating pharmacy. Copays count towards plan s out of pocket maximums due to the Affordable Care Act (ACA) Retail: 30-day supply Mail Order: 90-day supply Other Medical Care After deductible: $15.00 generic, $45.00 brand name drugs on the Aetna Performance Drug List, $65.00 other brand name drugs (Preventive care medications for certain conditions are not subject to the deductible) After deductible: $30.00 generic, $90.00 brand name drugs on the Aetna Performance Drug List, $ other brand name drugs (Preventive care medications for certain conditions are not subject to the deductible) $15.00 for generics $45.00 for brand-name drugs on the Aetna Performance Drug List $65.00 for other brand name drugs $30.00 for generics $90.00 for brand-name drugs on the Aetna Performance Drug List $ for other brand name drugs Acupuncture Plan pays 80% Allergy Testing and Treatment (Injections) Plan pays 80% Plan pays 80% Plan pays 80% Limited to 45 visits per calendar year Limited to 45 visits per calendar year Limited to 45 visits per calendar year Plan pays 80% (100% after office co-pay for testing) Diagnostic Lab and X-ray services Plan pays 80% Durable Medical Equipment Hearing Aid Physical, Occupational, and Speech Therapy Spinal Subluxation (Chiropractic Care) Plan pays 80% Plan pays 80% Plan pays 80% Plan pays 80% Plan pays 80% Hearing aid exams covered as any other office visit; devices limited to two every 24 months Plan pays 80% Benefits limited to 60 visits per calendar year. Non-restorative speech therapy is covered for Autism and developmental delay when provided under the supervision of a doctor as medically necessary, subject to evaluation Plan pays 80% Limited to 45 visits per calendar year after $30.00 co-pay 3

4 Kaiser and Blue Cross Blue Shield of MA Medical Plans Kaiser Permanente (Kaiser) is available to Northern California employees. Blue Cross Blue Shield POS (BCBS of MA POS) is available only to Massachusetts employees who enrolled with an effective date prior to December 31, No new enrollment in BCBSMA is permitted for KAISER HMO BLUE CROSS BLUE SHIELD OF MA POS (No new entrants allowed) In-Network Out-of-Network General Provisions Provider Choice Annual Deductible Co-payment/ Out-of-Pocket Maximum (Includes deductible and medical copays) You must use Kaiser doctors and facilities Individuals may use any licensed doctor, but benefits are higher when a member of the HMO Blue network is used out-of-network benefits will apply for all care not referred by your primary care physician (PCP) The HMOs will provide benefits for emergency services provided outside the HMO s service area/provider network if access to HMO facilities/network is not available None $3,000.00/ $800.00/ $1,600.00/family Lifetime Maximum Unlimited Unlimited (excluding certain services) $1,600.00/ $3,200.00/family Routine Care: Well child care includes immunizations; routine physical exam includes OB/GYN exams, mammograms and prostate exams provided in accordance with age frequency guidelines Doctor s Office Visit Well Baby/ Child Care Routine Physical Exam/ Preventive Care Hospital Care & Surgery Precertification Semi-private Room and Board You pay $20.00 co-pay after $15.00 (PCP) or $30.00 (specialist) co-pay ; Deductible waived ; Deductible waived automatically automatically by network providers and certain surgical procedures: a $ (inpatient) not obtained You pay $ per admission Urgent Care You pay $20.00 You pay $30.00 Emergency Room and Ambulance Surgery (Outpatient/Inpatient) Maternity and Family Planning Prenatal Visits During Pregnancy Hospital Care / Birthing Center Infertility You pay $ (waived if admitted); ambulance $50.00 per trip ; outpatient you pay $20.00 After confirmation of pregnancy, the normal series of regularly scheduled preventive prenatal care exams and the first postpartum follow-up consultation and exam are covered at no charge Office visit: You pay $15.00 (PCP) or $30.00 (specialist) co-pay Surgical facility: ; Deductible waived Limited to in-network pregnancy-related physician office visits including the initial and subsequent history and physical exams of the pregnant woman (maternal weight, blood pressure and fetal heart rate check) You pay $ per admission Plan pays 50% for covered services related to the diagnosis and treatment of infertility Office visit: You pay $15.00 (PCP) or $30.00 (specialist) co-pay. Other facility: Limited to $25, per lifetime Fertility Treatment Drugs Contraceptive Drugs and Devices Plan pays 50% Prescribed, FDA-approved, contraceptive devices and contraceptive drugs are covered at no cost to comply with women s preventive service requirements Plan pays $15,000.00/lifetime: a $45.00 co-pay/prescription applies Generic formulary contraceptives will be covered at no member cost share when filled at an in-network pharmacy 4

5 Kaiser and Blue Cross Blue Shield of MA Medical Plans continued KAISER HMO BLUE CROSS BLUE SHIELD OF MA POS (No new entrants allowed) In-Network Out-of-Network Mental Health Care and Substance Abuse Treatment Outpatient You pay $20.00 ($10.00 for group therapy; $5.00 for group for substance disorder) after $15.00 co-pay Inpatient You pay $ per admission; substance abuse treatment limited to detoxification Prescription Drug Benefits: Prescription co-pays do not count towards the plan out of pocket maximums Retail Mail Order Other Medical Care Acupuncture Allergy Testing and Treatment (Injections) Diagnostic Lab and X-ray services Durable Medical Equipment Hearing Aid Spinal Subluxation (Chiropractic care) Generic: $15.00 up to 30-day supply, $30.00 up to 60-day supply, $45.00 up to 100-day supply Brand: $30.00 up to 30-day supply, $60.00 up to 60-day supply, $90.00 up to 100-day supply Generic: $15.00 up to 30-day supply, $30.00 up to 100-day supply Brand: $30.00 up to 30-day supply, $60.00 up to 100-day supply Covered at $20.00 co-pay if deemed medically necessary by Plan physician You pay $20.00/visit; for injection Per 30-day supply: You pay $15.00 for generics, $45.00 for brand-name formulary drugs, $65.00 for other brand name drugs; reduced benefits paid if drugs obtained at a non-participating pharmacy 2 co-pays as outlined above per 90-day supply Plan pays 80%; limited to 45 visits per calendar year (100% after office co-pay for testing) Office visit: You pay $15.00 (PCP) or $30.00 (specialist) co-pay Other facility: Plan pays 80% Plan pays 80% You pay $20.00/exam; Plan pays up to $1, every 36 months for devices You pay $15.00/visit; benefits limited to 30 visits/year Plan pays 80%; exams covered as any other office visit; devices limited to two every 24 months after $30.00 co-pay Limited to 45 visits per calendar year 5