SEIU Local 2015 Member Benefits

SEIU Local 2015 Member Benefits MetLife Dental and Vision Reliance Standard Life/AD&D and Accident All plan information is available at: www.seiu2015benefits.org

Benefits Information Eligibility for Member Benefits SEIU Local 2015 dues-paying members with a signed union card on file and in good standing How to Enroll Visit the SEIU Local 2015 benefits website www.seiu2015benefits.org and register to enroll online Request enrollment information by calling the SEIU Local 2015 Benefits Center at 1.877.421.0177 Coverage will be effective the 1st of the following month if enrollment is processed by the 15th of the current month Once enrolled, you must stay on the plan for a minimum of six (6) months SEIU Local 2015 Benefits Center SEIU Local 2015 offers a dedicated benefits center to help members and their families with their benefits needs. You can contact the Benefits Center at 1.877.421.0177, Monday through Friday, 8:30AM-5:30 PM for assistance with: Enrollment Updating personal contact information Enrolling qualified dependents Understanding claims and doctor estimates Filing Life and AD&D and Accident claims Eligibility confirmation Locating a dental and vision provider The SEIU Local 2015 Benefits Center offers assistance in: - English - Spanish - Armenian - Korean - Mandarin - Cantonese - Vietnamese - Russian SEIU Local 2015 Website Visit the SEIU Local 2015 benefits website at www.seiu2015benefits.org to: Enroll in all benefits Update personal contact information Enroll qualified dependents Access plan information Access claim forms Cancel or change your benefits enrollment

Online Enrollment Guide Step 1: Visit www.seiu2015benefits.org and click on Register to create a User Name and Password. Step 2: Enter your SSN and DOB on the registration page. Please note that the Company Key is seiu2015 (lower-case). Step 3: From the Home Page, you can enroll in benefits by clicking Start Here. Step 4: You can update your personal information, your dependent information or enroll in benefits by clicking on one of the options provided. Step 5: Update your personal information, dependent information, and begin your benefit elections. Step 6: To select your coverage, click on I Want Coverage. Click on Waive Coverage if you do not wish to enroll. Step 7: Once you have made your benefit elections, click on Approve. Step 8: Continue to click Approve until you receive your Confirmation Number. Your enrollment is now complete!

MetLife HMO Dental The SEIU Local 2015 HMO Dental plan helps support you in maintaining and improving your oral health by providing coverage for over 400 procedures. The SEIU Local 2015 HMO Dental Plan has a $5 copay for office visits and is supported by one of the largest dental provider networks in California, with over 10,700 dentists. HMO Dental Benefits* Preventive services White fillings on front teeth Porcelain crowns Adult and child orthodontics Root canals (per tooth) Extractions (non-surgical) Partial & Complete Dentures Implants BENEFIT COPAY $ 0 $ 0 $ 185-$410 $ 1,945 $ 80-$200 $ 0 $ 210-$365 Varies widely by individual MetLife HMO Dental Monthly Rates Coverage Monthly Rate Member Only $19.54 Member Plus 1 $37.12 Member Plus 2 or more $51.79 *This is a summary only. Please refer to the Schedule of Benefits for a full list of covered services and the plan s limitations and exclusions at www.seiu2015benefits.org. What s the Difference Between HMO and PPO Dental Benefits? Dental HMO plans require members to select a preferred in-network primary care dentist from MetLife. All care must be coordinated through that dentist; out-of-network dental care will not be covered under the HMO Plan. Dental HMOs have a set copay amount that the insured pays for each procedure. Dental PPO plans allow members to see any preferred dentist in-network and will also provide partial benefits if the insured seeks care from a dentist who is out-of-network. Dental PPO plans have a deductible and an annual benefit maximum, and cover a percentage of each dental procedure.

MetLife PPO Scheduled Reimbursement Dental The SEIU Local 2015 PPO Scheduled Reimbursement Dental plan allows you to visit any licensed dentist, in or out-ofnetwork. Although the PPO Scheduled Reimbursement dental plan costs more than the HMO dental plan, it is offered for members who do not have access to an in-network HMO dentist. The PPO Scheduled Reimbursement dental benefits are based on a maximum that MetLife has agreed to cover. The benefits listed below indicate the amount for services that MetLife has agreed to cover up to a maximum for each covered benefit. We encourage you to contact your dentist and ask them if they re contracted and in-network with MetLife to ensure that you receive the best benefit. MetLife does not have control over the amounts that out-of-network dentists charge for services. Although the MetLife PPO Scheduled Reimbursement dental plan allows access to a much larger network of dentists than the HMO dental plan, the out-of-pocket costs to members to obtain services is much higher than the HMO dental plan. PPO Scheduled Reimbursement Dental Benefits* BENEFIT In-Network Out-of-Network Preventive services Basic Major Calendar year deductible: Individual Family Calendar year maximum 75% 50% 30% $50 $150 $1,000 75% 50% 30% $50 $150 $1,000 PPO Scheduled Reimbursement Monthly Rates Coverage Monthly Rate Member Only $35.86 Member Plus 1 $68.12 Member Plus 2 or more $95.02 Orthodontia Not Covered Not Covered Sample MetLife Reimbursements* Treatment Maximum Benefit Paid by MetLife* Limited oral evaluation $37 Crown $247 Protective restoration (fillings) $25 *This is a summary only. Please refer to the benefit summary for maximum amounts MetLife will cover for each benefit. Benefit summary and plan limitations and exclusions can be found at www.seiu2015benefits.org.

MetLife Vision SEIU Local 2015 members can save up to 60% on vision wear and services. You can choose from thousands of participating ophthalmologists, optometrists and opticians at private practices or at popular retail locations, like Costco Optical and Visionworks. MetLife Vision Benefits* Service Routine Eye Exam Exam, Lens and Contacts Frequency Frame Frequency Benefit $15 copay 12 months 24 months Single, Bifocal, Trifocal Lenses $25 copay Frames Contact Lenses (Necessary) $130 allowance, 20% additional Covered in full MetLife Vision Monthly Rates Coverage Monthly Rate Member Only $6.13 Member Plus 1 $11.67 Member Plus 2 or more $18.42 *This is a summary only. Please refer to the Schedule of Benefits for a full list of covered services and the plan s limitations and exclusions at www.seiu2015benefits.org.

Finding a Provider MetLife HMO Dental 1: Go to www.metlife.com 2: I want to find a MetLife: Click on blue box indicating Dentist Input Zip Code For Network Type: Click Dental HMO/Management Care Click on submit 3: Make sure Network type is indicating Dental DHMO/Managed Care For Plan Name: Click on MET185A You can search by dentist, or dental practice name, or mile radius based on zip code entered Click Search to obtain results 4: The facility ID number listed under the dental provider name will be required to complete the member benefit enrollment form MetLife PPO Scheduled Reimbursement Dental 1. Go to www.metlife.com 2. I want to find a MetLife: Click on blue box indicating Dentist Input your Zip Code For Network Type: Click on PDP Plus 3. Click submit to obtain results Vision 1. Go to www.metlife.com 2. I want to find a MetLife: Click on blue box indicating Dentist Input your Zip Code For Network Type: MetLife Vision PPO 3. Click submit to obtain results

Reliance Standard Life and AD&D SEIU Local 2015 members now have access to Life and Accidental Death and Dismemberment (AD&D) insurance for themselves and their eligible dependents through Reliance Standard. These benefits offer protection for families in the event of a death. The SEIU Local 2015 plan offers life and AD&D benefits for all members at the same cost, regardless of your age. If you have been denied for life insurance in the past, you are still eligible for this plan at the benefit and monthly cost below. AD&D offers an additional benefit amount for deaths due to an accident and for dismemberment due to an accident such as loss of a limb, loss of eyesight, etc. You will not be required to submit any health information to sign up for this plan! Reliance Standard Member Supplement Life and AD&D Monthly Rates Coverage Monthly Rate $5,000 $4.00 $10,000 $5.95 $20,000 $10.90 Reliance Standard Dependent Supplement Life and AD&D Monthly Rates Dependent Coverage Monthly Rate Spouse $5,000 $3.75 Child(ren) $1,000 $1.25 Additional Benefits and Plan Information* All members are eligible for this benefit regardless of age, gender, and health condition. There is no medical exam or medical information required to enroll! Benefits reduce to $2,500 at age 70. For example, if you are enrolled in the $10,000 insurance policy, your benefit will reduce to $2,500, at $4.00 per month, when you turn age 70. Members must be enrolled in Life/AD&D coverage for themselves in order to enroll their spouse/domestic partner and/or child(ren) Spouse/domestic partner coverage terminates when they turn age 70 Child coverage terminates when your child turns age 26, unless mentally and/or physically disabled. Bereavement counseling and travel assistance is available for members and their families. *For further explanation and details of your benefits, please contact the SEIU Local 2015 Benefits Center and review the Plan Documents on www.seiu2015benefits.org.

Reliance Standard Accident SEIU Local 2015 members now have access to Accident coverage for themselves and eligible dependents through Reliance Standard. Whether it s an automobile accident, sports injury, or a slip and fall, an accident can bring expenses that are devastating to your family s finances. Accident coverage offers protection for members and their eligible dependents in the event of an accident by providing a cash benefit for every covered expense, including AD&D coverage - from x-rays to ambulance services - regardless of what is covered by your medical insurance. Here s an example of how SEIU Local 2015 s Accident plan can help * Ricky is on a walk with his dogs when a cat passes by and causes both of his dogs to wrap their leash around his legs trying to chase after the cat. Ricky falls and hurts his arm. He is taken to the hospital in an ambulance and given an MRI to check for injuries. The MRI confirms a concussion and he stays the night in the hospital for observation. Below is a breakdown of what SEIU Local 2015 s Accident plan covers: PROCEDURE BENEFIT Ambulance Ride $150 Emergency Room Visit $200 Hospital Admission $1,000 MRI $200 Concussion $150 Follow-up doctor visit $75 Total Benefit $1,775 Coverage Monthly Rate Member Only $9.47 Member Plus Spouse $17.22 Member Plus Child(ren) $20.18 Family $23.45 Additional Benefits and Plan Information* Member and spouse must be under the age of 70 to enroll. Coverage is NOT available to members and dependents covered by Medicare Part A and Part B. Child coverage terminates when child reaches age 26, unless mentally and/or physically disabled. Age reduction for AD&D benefit applies *This is a summary only. Please refer to the Schedule of Benefits for a full list of covered services and the plan s limitations and exclusions at www.seiu2015benefits.org.