OPEN ENROLLMENT 2016 CONTRIBUTION RATES

OPEN ENROLLMENT 2016 CONTRIBUTION RATES UHC MEDICAL COVERAGE 2016 FULL-TIME WITH BASE SALARY $35,000 EE $15.00 $444.95 $6.92 $205.36 $20.00 $593.27 EE+SP/DP $84.00 $881.90 $38.77 $407.03 $112.00 $1,175.87 EE+ Child(ren) $63.00 $787.91 $29.08 $363.65 $84.00 $1,050.55 Family $142.00 $1,283.85 $65.54 $592.55 $189.33 $1,711.80 EE $36.00 $445.81 $16.62 $205.76 $48.00 $594.41 EE+SP/DP $231.00 $780.80 $106.62 $360.37 $308.00 $1,041.07 EE+ Child(ren) $194.00 $697.34 $89.54 $321.85 $258.67 $929.79 Family $370.00 $1,123.60 $170.77 $518.58 $493.33 $1,498.13 EE $114.00 $399.55 $52.62 $184.41 $152.00 $532.73 EE+SP/DP $358.00 $720.46 $165.23 $332.52 $477.33 $960.61 EE+ Child(ren) $295.00 $655.07 $136.15 $302.34 $393.33 $873.43 Family $552.00 $1,040.01 $254.77 $480.00 $736.00 $1,386.68 EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 1 CONTRIBUTION RATES

2016 FULL-TIME WITH BASE SALARY $35,000.01 $60,000 EE $60.00 $399.95 $27.69 $184.59 $80.00 $533.27 EE+SP/DP $174.00 $791.90 $80.31 $365.49 $232.00 $1,055.87 EE+ Child(ren) $153.00 $697.91 $70.62 $322.11 $204.00 $930.55 Family $258.00 $1,167.85 $119.08 $539.01 $344.00 $1,557.13 EE $106.00 $375.81 $48.92 $173.45 $141.33 $501.08 EE+SP/DP $321.00 $690.80 $148.15 $318.83 $428.00 $921.07 EE+ Child(ren) $284.00 $607.34 $131.08 $280.31 $378.67 $809.79 Family $486.00 $1,007.60 $224.31 $465.05 $648.00 $1,343.47 EE $159.00 $354.55 $73.38 $163.64 $212.00 $472.73 EE+SP/DP $448.00 $630.46 $206.77 $290.98 $597.33 $840.61 EE+ Child(ren) $385.00 $565.07 $177.69 $260.80 $513.33 $753.43 Family $667.00 $925.01 $307.85 $426.93 $889.33 $1,233.35 EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 2 CONTRIBUTION RATES

2016 FULL-TIME WITH BASE SALARY $60,000.01 $120,000 EE $60.00 $399.95 $27.69 $184.59 $80.00 $533.27 EE+SP/DP $174.00 $791.90 $80.31 $365.49 $232.00 $1,055.87 EE+ Child(ren) $153.00 $697.91 $70.62 $322.11 $204.00 $930.55 Family $258.00 $1,167.85 $119.08 $539.01 $344.00 $1,557.13 EE $106.00 $375.81 $48.92 $173.45 $141.33 $501.08 EE+SP/DP $321.00 $690.80 $148.15 $318.83 $428.00 $921.07 EE+ Child(ren) $284.00 $607.34 $131.08 $280.31 $378.67 $809.79 Family $486.00 $1,007.60 $224.31 $465.05 $648.00 $1,343.47 EE $159.00 $354.55 $73.38 $163.64 $212.00 $472.73 EE+SP/DP $448.00 $630.46 $206.77 $290.98 $597.33 $840.61 EE+ Child(ren) $385.00 $565.07 $177.69 $260.80 $513.33 $753.43 Family $667.00 $925.01 $307.85 $426.93 $889.33 $1,233.35 EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 3 CONTRIBUTION RATES

2016 FULL-TIME WITH BASE SALARY $120,000.01 $180,000 EE $67.00 $392.95 $30.92 $181.36 $89.33 $523.93 EE+SP/DP $194.00 $771.90 $89.54 $356.26 $258.67 $1,029.20 EE+ Child(ren) $171.00 $679.91 $78.92 $313.80 $228.00 $906.55 Family $288.00 $1,137.85 $132.92 $525.16 $384.00 $1,517.13 EE $118.00 $363.81 $54.46 $167.91 $157.33 $485.08 EE+SP/DP $359.00 $652.80 $165.69 $301.29 $478.67 $870.40 EE+ Child(ren) $317.00 $574.34 $146.31 $265.08 $422.67 $765.79 Family $543.00 $950.60 $250.62 $438.74 $724.00 $1,267.47 EE $177.00 $336.55 $81.69 $155.33 $236.00 $448.73 EE+SP/DP $500.00 $578.46 $230.77 $266.98 $666.67 $771.28 EE+ Child(ren) $430.00 $520.07 $198.46 $240.03 $573.33 $693.43 Family $745.00 $847.01 $343.85 $390.93 $993.33 $1,129.35 EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 4 CONTRIBUTION RATES

2016 FULL-TIME WITH BASE SALARY $180,000.01 $240,000 EE $70.00 $389.95 $32.31 $179.98 $93.33 $519.93 EE+SP/DP $203.00 $762.90 $93.69 $352.11 $270.67 $1,017.20 EE+ Child(ren) $179.00 $671.91 $82.62 $310.11 $238.67 $895.88 Family $300.00 $1,125.85 $138.46 $519.62 $400.00 $1,501.13 EE $124.00 $357.81 $57.23 $165.14 $165.33 $477.08 EE+SP/DP $374.00 $637.80 $172.62 $294.37 $498.67 $850.40 EE+ Child(ren) $331.00 $560.34 $152.77 $258.62 $441.33 $747.12 Family $566.00 $927.60 $261.23 $428.12 $754.67 $1,236.80 EE $185.00 $328.55 $85.38 $151.64 $246.67 $438.07 EE+SP/DP $522.00 $556.46 $240.92 $256.83 $696.00 $741.95 EE+ Child(ren) $449.00 $501.07 $207.23 $231.26 $598.67 $668.09 Family $778.00 $814.01 $359.08 $375.70 $1,037.33 $1,085.35 EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 5 CONTRIBUTION RATES

2016 FULL-TIME WITH BASE SALARY >$240,000 EE $73.00 $386.95 $33.69 $178.59 $97.33 $515.93 EE+SP/DP $211.00 $754.90 $97.38 $348.42 $281.33 $1,006.53 EE+ Child(ren) $186.00 $664.91 $85.85 $306.88 $248.00 $886.55 Family $313.00 $1,112.85 $144.46 $513.62 $417.33 $1,483.80 EE $129.00 $352.81 $59.54 $162.84 $172.00 $470.41 EE+SP/DP $390.00 $621.80 $180.00 $286.98 $520.00 $829.07 EE+ Child(ren) $345.00 $546.34 $159.23 $252.16 $460.00 $728.45 Family $590.00 $903.60 $272.31 $417.05 $786.67 $1,204.80 EE $193.00 $320.55 $89.08 $147.95 $257.33 $427.40 EE+SP/DP $544.00 $534.46 $251.08 $246.67 $725.33 $712.61 EE+ Child(ren) $468.00 $482.07 $216.00 $222.49 $624.00 $642.76 Family $810.00 $782.01 $373.85 $360.93 $1,080.00 $1,042.68 EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 6 CONTRIBUTION RATES

2016 PART-TIME PART TIME EE $93.00 $366.95 $42.92 $169.36 $124.00 $489.27 EE+SP/DP $497.00 $468.90 $229.38 $216.42 $662.67 $625.20 EE+ Child(ren) $438.00 $412.91 $202.15 $190.57 $584.00 $550.55 Family $734.00 $691.85 $338.77 $319.32 $978.67 $922.47 EE $212.00 $269.81 $97.85 $124.53 $282.67 $359.75 EE+SP/DP $532.00 $479.80 $245.54 $221.45 $709.33 $639.73 EE+ Child(ren) $469.00 $422.34 $216.46 $194.93 $625.33 $563.12 Family $785.00 $708.60 $362.31 $327.05 $1,046.67 $944.80 EE $286.00 $227.55 $132.00 $105.02 $381.33 $303.40 EE+SP/DP $719.00 $359.46 $331.85 $165.90 $958.67 $479.28 EE+ Child(ren) $633.00 $317.07 $292.15 $146.34 $844.00 $422.76 Family $1,060.00 $532.01 $489.23 $245.54 $1,413.33 $709.35 EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 7 CONTRIBUTION RATES

DENTAL COVERAGE FULL-TIME AND PART-TIME COVERAGE CATEGORIES MONTHLY (PAID OVER 12 MONTHS) BIWEEKLY PAID OVER 9 MONTHS DMO Only $21.64 $9.99 $28.85 + One $49.45 $22.82 $65.93 + Family $59.84 $27.62 $79.79 HIGH PPO Only $52.01 $24.00 $69.35 + One Dependent $112.78 $52.05 $150.37 + Family $136.47 $62.99 $181.96 LOW PPO Only $31.12 $14.36 $41.49 + One Dependent $66.12 $30.52 $88.16 + Family $80.04 $36.94 $106.72 9-Month s, please note: There are no employee or contributions during June, July, or August. 8 CONTRIBUTION RATES

UHC VISION COVERAGE FULL-TIME AND PART-TIME MONTHLY (PAID OVER 12 MONTHS) BIWEEKLY PAID OVER 9 MONTHS BASIC Only $4.99 $2.30 $6.65 + One $9.24 $4.26 $12.32 + Family $14.73 $6.80 $19.64 ENHANCED Only $7.24 $3.34 $9.65 + One $13.40 $6.18 $17.87 + Family $21.36 $9.86 $28.48 9-Month s, please note: There are no employee or contributions during June, July, or August. 9 CONTRIBUTION RATES

2016 LIFE AND AD&D RATES ADDITIONAL CHILD LIFE MONTHLY RATE PER $1,000 OF COVERAGE Flat Rate* $0.103 ADDITIONAL EMPLOYEE AND SPOUSE LIFE** MONTHLY RATE PER $1,000 OF COVERAGE age 19 and younger $0.05 ages 20 24 $0.05 ages 25 29 $0.06 ages 30 34 $0.08 ages 35 39 $0.09 ages 40 44 $0.12 ages 45 49 $0.22 ages 50 54 $0.39 ages 55 59 $0.66 ages 60 64 $0.90 ages 65 69 $1.62 ages 70 74 $2.15 age 75 and older $2.44 ADDITIONAL EMPLOYEE AD&D MONTHLY RATE PER $1,000 OF COVERAGE $0.035 ADDITIONAL SPOUSE AD&D MONTHLY RATE PER $1,000 OF COVERAGE $0.035 ADDITIONAL CHILD AD&D MONTHLY RATE PER $1,000 OF COVERAGE $0.035 * The premium paid for child coverage is based on the cost of coverage for one child, regardless of how many children you have. ** NOTE: For additional life, the rate will increase as the covered participant ages and moves to the next age band. This will occur on January 1st following the covered participant s birthdate. 10 CONTRIBUTION RATES

2016 LONG-TERM DISABILITY AND SHORT-TERM DISABILITY RATES* SHORT-TERM VOLUNTARY DISABILITY (EMPLOYEE PAID) RATES ages 15-24 $0.0204 ages 25-29 $0.0246 ages 30-34 $0.0204 ages 35-39 $0.0183 ages 40-44 $0.0190 ages 45-49 $0.0211 ages 50-54 $0.0261 ages 55-59 $0.0324 ages 60-64 $0.0387 ages 65-69 $0.0408 age 70 and over $0.0408 * NOTE: For short-term voluntary disability, the rate will increase as the covered participant ages and moves to the next age band. This will occur on January 1st following the covered participant s birthdate. CALCULATE YOUR MONTHLY COST: 1. Determine your weekly benefit if disabled: Annual benefits salary 52 x.60 2. Take your weekly benefit times your age band rate. (If Weekly Benefit is over $3,000, use $3,000.) SAMPLE CALCULATION FOR 35 YEAR OLD EARNING $40,000 A YEAR: 1. $40,000 x.60 = $461.54 52 2. $461.54 x.0183 = $8.45 LONG-TERM DISABILITY RATE Buy-Up Benefit 0.057% TO CALCULATE YOUR MONTHLY COST: 1. Determine your monthly covered payroll: Annual benefits salary 12 2. Take your monthly covered payroll times 0.00066. (If Monthly Payroll is over $18,000, use $18,000.) SAMPLE CALCULATION FOR SOMEONE EARNING $45,000 A YEAR: 1. $45,000 = $3,750.00 12 2. $3,750.00 x 0.00066 = $2.48 Note: Your rate will increase as you age and move to the next age band. This will occur on January 1st following your birthdate. 11 CONTRIBUTION RATES