IVY LANE CORPORATION EMPLOYEE BENEFIT GUIDE 2017

DISCLAIMER The intent of this summary is to briefly highlight your benefits and NOT to replace your insurance contracts or booklets. The information has been compiled into summary form to outline the benefits offered by your company. If this benefit summary does not address your specific benefit questions, please refer to the Customer Service Contact page of this booklet. This page will provide you with the information you need to contact the specific insurance carriers and/or your Human Resources Department for additional assistance. The information provided in this summary is for comparative purposes only. Actual claims paid are subject to the specific terms and conditions of each contract. This benefit summary does not constitute a contract. The information in this booklet is proprietary. Please do not copy or distribute to others.

Contained within this document is your annual Medicare Part D notice as required by the Centers for Medicare & Medicaid. Please see the table of contents for page number.

TABLE OF CONTENTS Customer Service Contact Information Holmes Murphy Contacts Eligibility 2017 Premiums Medical Insurance – UHC JYV $750 Deductible Medical Insurance – UHC JYR $1,500 Deductible Medical Insurance – UHC JY3 $2,000 Deductible Medical Insurance – UHC KX8 $5,000 Deductible with Copays Medical Insurance – UHC GPM $5,000 Deductible Rally My Nurseline Virtual Visits Health Savings Account (HSA) Administration Dental Insurance Dental Mobile App Vision Insurance Flexible Spending Accounts Basic Life / Accidental Death & Dismemberment Short Term Disability Insurance Long Term Disability Insurance MetLife Critical Illness MetLife Accident LifeLock Identity Protection Medicare Part D Notice – Creditable Coverage HIPAA Special Enrollment Notice Women’s Health & Cancer Rights Act of 1998 EPIC Hearing Enrollment Forms

1 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 21 22 23 25 27 29 31 31 32 33

CUSTOMER SERVICE CONTACT INFORMATION Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources. MEDICAL: United Healthcare (800) 669-1830 www.uhc.com DENTAL: MetLife (800) 942-0854 www.metlife.com VISION: Avesis (800) 828-9341 www.avesis.com FLEXIBLE SPENDING ACCOUNTS (FSA): Kabel Business Services (515) 224-9400 www.kabelbiz.com LIFE/AD&D / SHORT-TERM DISABILITY / LONG-TERM DISABILITY: MetLife (800) 858-6506 www.metlife.com For additional assistance, please contact: HOLMES MURPHY & ASSOCIATES: Alesha Carroll (800) 247-7756, ext. 2360 [email protected] MEDICARE: Eric Kiser (515) 223-7033 [email protected]

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ACTION ITEMS FOR OPEN ENROLLMENT Medical  There have been NO changes to medical plan designs or offerings for 2017.  2017 medical rates have increased from 2016.  If you are not making any changes, NO action is necessary.  If you would like to make a change, add, or drop a dependent, please complete the UHC application on page 37. Dental    

There have been NO changes to the dental plan for 2017. 2017 dental rates have increased from 2016. If you are not making any changes, NO action is necessary. If you would like to make a change, add, or drop a dependent, please complete the MetLife application on page 41.

Vision  There have been NO changes to the vision plan or rates for 2017.  If you are not making any changes, NO action is necessary.  If you would like to make a change, add, or drop a dependent, please complete the Avesis application on page 51. Flexible Spending Accounts  Flexible Spending Accounts will now be administered through Kabel Business Services.  If you wish to enroll in the FSA, you MUST complete the enrollment form on page 52.  Elections from last year WILL NOT roll over to this year. Critical Illness/Accident Policies  The Company will no longer be paying for Aflac premiums through payroll deductions.  If you are enrolled in any Aflac Critical Illness or Accident policies, you must port those with Aflac or enroll in the company sponsored MetLife Critical Illness and Accident policies.  If you are currently enrolled and are not making any changes, NO action is necessary.  If you wish to enroll, you must complete the MetLife application on page 45 or 48.

*All employees must complete the ERISA Electronic Disclosure Consent Form on page 33 of this packet.*

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WHO IS ELIGIBLE? If you are a full-time employee (working 30 or more hours per week) you are eligible to enroll in the benefits described in this guide. The waiting period for new hires is the first of the month following 60 days of employment. You will need to elect your benefits during this 60 day time period for them to be effective.

HOW TO ENROLL The first step is to review your current benefit elections. Verify your personal information and make any changes if necessary. Make your benefit elections. Once you have made your elections, you will not be able to change them until the next open enrollment period unless you have a qualified change in status. Please make your elections by completing the enrollment forms found in the back of this booklet and returning them to Human Resources.

WHEN TO ENROLL The open enrollment period runs January 6, 2017 through January 13, 2017. The benefits you elect during open enrollment will be effective from February 1, 2017 through January 31, 2018.

HOW TO MAKE CHANGES Unless you have a qualified change in status, you cannot make changes to the benefits you elect until the next open enrollment period. Qualified changes in status include: marriage, divorce, legal separation, domestic partnership status change, birth or adoption of a child, change in child’s dependent status, death of spouse, child or other qualified dependent, change in residence due to an employment transfer for you, your spouse or domestic partner, commencement or termination of adoption proceedings, or change in spouse’s or domestic partners benefits or employment status, reduction in hours, or marketplace open enrollment. See HIPAA Special Enrollment Rights later in this packet for notification requirements

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2017 SEMI-MONTHLY (24) PREMIUMS Coverage

Semi-Monthly Deduction

Medical UHC JYV - $750 Deductible Single:

$93.71

Employee/Spouse:

$323.27

Employee/Child(ren):

$240.77

Family:

$478.33

UHC JYR - $1,500 Deductible Single:

$74.71

Employee/Spouse:

$282.38

Employee/Child(ren):

$207.49

Family:

$423.15

UHC JY3 - $2,000 Deductible Single:

$57.18

Employee/Spouse:

$244.66

Employee/Child(ren):

$176.78

Family:

$372.25

UHC KX8 - $5,000 Deductible with Copays Single:

$49.29

Employee/Spouse:

$227.68

Employee/Child(ren):

$162.95 $349.34

Family: UHC GPM - $5,000 Deductible Single:

Family:

$25.41 $176.29 $121.12 $279.99

Single:

$16.43

Employee/Spouse:

$34.37

Employee/Child(ren):

$38.63

Family:

$60.69

Single:

$3.44

Employee/Spouse:

$6.64

Employee/Child(ren):

$6.64

Family:

$9.72

Voluntary Life & STD

100%

Employee/Spouse: Employee/Child(ren): Dental

Vision

Basic Life & LTD

Company Paid

Flexible Spending Account

100%

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MEDICAL INSURANCE United Healthcare Medical Plan JYV with RX Plan G4 - $750 Deductible This chart gives a side-by-side look at the amounts you pay when you use in-network and out-of-network providers. For a complete listing of providers, visit www.uhc.com/find-a-physician, and enter the desired search criteria.

In-Network

Out-of-Network(1,2)

$750 single

$1,000 single

$1,500 family

$2,000 family

20%

40%

$2,250 single

$3,000 single

$4,500 family

$6,000 family

Office Visit

$20 copayment

Deductible, 40% coinsurance

Specialist Visit

$40 copayment

Deductible, 40% coinsurance

Copayment waived, covered at 100%

Not Covered

Urgent Care

$50 copayment

Deductible, 40% coinsurance

Emergency Room

$100 copayment

$100 copayment

Facility Services

Deductible, 20% coinsurance

Deductible, 40% coinsurance

Outpatient Services

Deductible, 20% coinsurance

Deductible, 40% coinsurance

Deductible, 20% coinsurance

Deductible, 40% coinsurance

$20 copayment

Deductible, 40% coinsurance

Plan Feature Deductible – Embedded

(3)

Coinsurance Out-of-Pocket Maximum

Preventive Care Services

Mental Health & Substance Abuse Services Inpatient / Outpatient Office Visit Retail Prescription Drug Coverage

(4,5)

$100 Single/$300 Family Deductible (waived for Tier 1) $10 Tier 1 / $30 Tier 2 / $50 Tier 3

(Up to 31-day supply)

EMPLOYEE COST

Semi-Monthly (24/year)

Employee

$93.71

Employee/Spouse

$323.27

Employee/Child(ren)

$240.77

Family

$478.33

(1) (2) (3) (4) (5)

For out-of-network providers, the member may incur some charges above usual, customary and reasonable, which are the responsibility of the member and do not apply to the out-of-pocket maximum. In and out-of-network deductibles and out-of-pocket maximums do not apply to each other. Member has benefits when single deductible is met. Entire family has benefits when family deductible is met. When members purchase Tier 2 and Tier 3 drugs when there is a Tier 1 drug available, they will pay the Tier 2 or Tier 3 copayment plus the difference between the Tier 1 and the Tier 2 or Tier 3 drug. When members purchase prescriptions from a non-participating pharmacy, he/she may be required to manually file the claim with the carrier; plus he/she may incur additional costs above the maximum allowed amount.

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MEDICAL INSURANCE United Healthcare Medical Plan JYR with RX Plan G4 - $1,500 Deductible This chart gives a side-by-side look at the amounts you pay when you use in-network and out-of-network providers. For a complete listing of providers, visit www.uhc.com/find-a-physician, and enter the desired search criteria.

In-Network

Out-of-Network(1,2)

$1,500 single

$2,000 single

$3,000 family

$4,000 family

20%

30%

$3,000 single

$4,000 single

$6,000 family

$8,000 family

Office Visit

$20 copayment

Deductible, 30% coinsurance

Specialist Visit

$50 copayment

Deductible, 30% coinsurance

Copayment waived, covered at 100%

Not Covered

Urgent Care

$50 copayment

Deductible, 30% coinsurance

Emergency Room

$200 copayment

$200 copayment

Facility Services

Deductible, 20% coinsurance

Deductible, 30% coinsurance

Outpatient Services

Deductible, 20% coinsurance

Deductible, 30% coinsurance

Deductible, 20% coinsurance

Deductible, 30% coinsurance

$20 copayment

Deductible, 30% coinsurance

Plan Feature Deductible – Embedded

(3)

Coinsurance Out-of-Pocket Maximum

Preventive Care Services

Mental Health & Substance Abuse Services Inpatient / Outpatient Office Visit Retail Prescription Drug Coverage

(4,5)

$100 Single/$300 Family Deductible (waived for Tier 1) $10 Tier 1 / $30 Tier 2 / $50 Tier 3

(Up to 31-day supply)

EMPLOYEE COST

Semi-Monthly (24/year)

Employee

$74.71

Employee/Spouse

$282.38

Employee/Child(ren)

$207.49

Family

$423.15

(1) (2) (3) (4) (5)

For out-of-network providers, the member may incur some charges above usual, customary and reasonable, which are the responsibility of the member and do not apply to the out-of-pocket maximum. In and out-of-network deductibles and out-of-pocket maximums do not apply to each other. Member has benefits when single deductible is met. Entire family has benefits when family deductible is met. When members purchase Tier 2 and Tier 3 drugs when there is a Tier 1 drug available, they will pay the Tier 2 or Tier 3 copayment plus the difference between the Tier 1 and the Tier 2 or Tier 3 drug. When members purchase prescriptions from a non-participating pharmacy, he/she may be required to manually file the claim with the carrier; plus he/she may incur additional costs above the maximum allowed amount.

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MEDICAL INSURANCE United Healthcare Medical Plan JY3 with RX Plan G4 - $2,000 Deductible This chart gives a side-by-side look at the amounts you pay when you use in-network and out-of-network providers. For a complete listing of providers, visit www.uhc.com/find-a-physician, and enter the desired search criteria.

In-Network

Out-of-Network(1,2)

$2,000 single

$2,500 single

$4,000 family

$5,000 family

20%

30%

$6,000 single

$6,000 single

$12,000 family

$12,000 family

Office Visit

$30 copayment

Deductible, 30% coinsurance

Specialist Visit

$50 copayment

Deductible, 30% coinsurance

Copayment waived, covered at 100%

Not Covered

Urgent Care

$75 copayment

Deductible, 30% coinsurance

Emergency Room

$200 copayment

$200 copayment

Facility Services

Deductible, 20% coinsurance

Deductible, 30% coinsurance

Outpatient Services

Deductible, 20% coinsurance

Deductible, 30% coinsurance

Deductible, 20% coinsurance

Deductible, 30% coinsurance

$30 copayment

Deductible, 30% coinsurance

Plan Feature Deductible – Embedded

(3)

Coinsurance Out-of-Pocket Maximum

Preventive Care Services

Mental Health & Substance Abuse Services Inpatient / Outpatient Office Visit Retail Prescription Drug Coverage

(4,5)

$100 Single/$300 Family Deductible (waived for Tier 1) $10 Tier 1 / $30 Tier 2 / $50 Tier 3

(Up to 31-day supply)

EMPLOYEE COST

Semi-Monthly (24/year)

Employee

$57.18

Employee/Spouse

$244.66

Employee/Child(ren)

$176.78

Family

$372.25

(1) (2) (3) (4) (5)

For out-of-network providers, the member may incur some charges above usual, customary and reasonable, which are the responsibility of the member and do not apply to the out-of-pocket maximum. In and out-of-network deductibles and out-of-pocket maximums do not apply to each other. Member has benefits when single deductible is met. Entire family has benefits when family deductible is met. When members purchase Tier 2 and Tier 3 drugs when there is a Tier 1 drug available, they will pay the Tier 2 or Tier 3 copayment plus the difference between the Tier 1 and the Tier 2 or Tier 3 drug. When members purchase prescriptions from a non-participating pharmacy, he/she may be required to manually file the claim with the carrier; plus he/she may incur additional costs above the maximum allowed amount.

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MEDICAL INSURANCE United Healthcare Medical Plan KX8 with RX Plan G4 - $5,000 Deductible with Copays This chart gives a side-by-side look at the amounts you pay when you use in-network and out-of-network providers. For a complete listing of providers, visit www.uhc.com/find-a-physician, and enter the desired search criteria.

In-Network

Out-of-Network(1,2)

$5,000 single

$6,000 single

$10,000 family

$12,000 family

0%

30%

$5,000 single

$10,000 single

$10,000 family

$20,000 family

Office Visit

$25 copayment

Deductible, 30% coinsurance

Specialist Visit

$50 copayment

Deductible, 30% coinsurance

Copayment waived, covered at 100%

Not Covered

Urgent Care

$50 copayment

Deductible, 30% coinsurance

Emergency Room

$175 copayment

$175 copayment

Facility Services

Deductible, 0% coinsurance

Deductible, 30% coinsurance

Outpatient Services

Deductible, 0% coinsurance

Deductible, 30% coinsurance

Deductible, 0% coinsurance

Deductible, 30% coinsurance

$25 copayment

Deductible, 30% coinsurance

Plan Feature Deductible – Embedded

(3)

Coinsurance Out-of-Pocket Maximum

Preventive Care Services

Mental Health & Substance Abuse Services Inpatient / Outpatient Office Visit Retail Prescription Drug Coverage

$100 Single/$300 Family Deductible (waived for Tier 1)

(4,5)

$10 Tier 1 / $30 Tier 2 / $50 Tier 3

(Up to 31-day supply)

EMPLOYEE COST

Semi-Monthly (24/year)

Employee

$49.29

Employee/Spouse

$227.68

Employee/Child(ren)

$162.95

Family

$349.34

(1) (2) (3) (4) (5)

For out-of-network providers, the member may incur some charges above usual, customary and reasonable, which are the responsibility of the member and do not apply to the out-of-pocket maximum. In and out-of-network deductibles and out-of-pocket maximums do not apply to each other. Member has benefits when single deductible is met. Entire family has benefits when family deductible is met. When members purchase Tier 2 and Tier 3 drugs when there is a Tier 1 drug available, they will pay the Tier 2 or Tier 3 copayment plus the difference between the Tier 1 and the Tier 2 or Tier 3 drug. When members purchase prescriptions from a non-participating pharmacy, he/she may be required to manually file the claim with the carrier; plus he/she may incur additional costs above the maximum allowed amount.

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MEDICAL INSURANCE United Healthcare Medical Plan HSA GPM with RX Plan MM - $5,000 Deductible This chart gives a side-by-side look at the amounts you pay when you use in-network and out-of-network providers. For a complete listing of providers, visit www.uhc.com/find-a-physician, and enter the desired search criteria.

In-Network

Out-of-Network(1,2)

$5,000 single

$5,000 single

$10,000 family

$10,000 family

0%

30%

$5,000 single

$10,000 single

$10,000 family

$20,000 family

Office Visit

Deductible, 0% coinsurance

Deductible, 30% coinsurance

Specialist Visit

Deductible, 0% coinsurance

Deductible, 30% coinsurance

Copayment waived, covered at 100%

Not Covered

Urgent Care

Deductible, 0% coinsurance

Deductible, 30% coinsurance

Emergency Room

Deductible, 0% coinsurance

Deductible, 0% coinsurance

Facility Services

Deductible, 0% coinsurance

Deductible, 30% coinsurance

Outpatient Services

Deductible, 0% coinsurance

Deductible, 30% coinsurance

Inpatient / Outpatient

Deductible, 0% coinsurance

Deductible, 30% coinsurance

Office Visit

Deductible, 0% coinsurance

Deductible, 30% coinsurance

Plan Feature Deductible – Embedded

(3)

Coinsurance Out-of-Pocket Maximum

Preventive Care Services

Mental Health & Substance Abuse Services

Retail Prescription Drug Coverage

(4)

Deductible, 0% coinsurance

(Up to 31-day supply)

EMPLOYEE COST

Semi-Monthly (24/year)

Employee

$25.41

Employee/Spouse

$176.29

Employee/Child(ren)

$121.12

Family

$279.99

(1) (2) (3) (4)

For out-of-network providers, the member may incur some charges above usual, customary and reasonable, which are the responsibility of the member and do not apply to the out-of-pocket maximum. In and out-of-network deductibles and out-of-pocket maximums do not apply to each other. Member has benefits when single deductible is met. Entire family has benefits when family deductible is met. When members purchase prescriptions from a non-participating pharmacy, he/she may be required to manually file the claim with the carrier; plus he/she may incur additional costs above the maximum allowed amount.

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Build Better Habits

Rally is available at no additional cost to you, as part of your health plan benefits.

FIND YOUR MISSION TODAY. Register today at myuhc.com®.

Win Cool Stuff

Rally Health provides health and well-being information and support as part of your health plan. It does not provide medical advice or other health services, and is not a substitute for your doctor’s care. If you have specific health care needs, consult an appropriate health care professional. Participation in the health survey is voluntary. Your responses will be kept confidential in accordance with the law and will only be used to provide health and wellness recommendations or conduct other plan activities. Your Health Age is based on self-disclosed information, including any applicable biometric screening data. All trademarks are the property of their respective owners. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. © 2015 United HealthCare Services, Inc. All rights reserved. 48355-062015

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myNurseLine

SM

When you have a health concern, it can be difficult and time-consuming to find the information you need. myNurseLine can help you make informed health care decisions with telephone and online access to experienced registered nurses.

Your health advocate One toll-free number connects you with a registered nurse who will take the time to understand what is going on with your health and provide personalized information just for you. And this is all available 24 hours a day, seven days a week, at no additional cost to you as part of your benefits. myNurseLine also gives you access to an audio health information library. Choose from more than 1,100 health and well-being topics, with 600 messages available in Spanish. Services are available to translate 140 languages and for callers with hearing impairments.

Experience you can rely on myNurseLine nurses have an average of 15 years clinical nursing experience. They are an excellent resource when you need help choosing care, managing a chronic condition, understanding treatment options and more.

Your one-stop source Whether you have a baby with a 102 temperature at midnight or need help managing your diabetes, myNurseLine is the one source to help you with the answers you need.

Not sure if you need a doctor, urgent care clinic or just some good health advice? One call to myNurseLine may help you get information about the care and services you need. So, think of myNurseLine as your one-stop resource to help you make informed health care decisions every day. To talk with a myNurseLine nurse, call the Customer Care number on the back of your health plan ID card, or visit myuhc.com®.

My health, my questions, myNurseLine. myNurseLine is here to help you:  Chat with a nurse live on myuhc.com  Understand your symptoms  Decide where to go for care  Learn more about a diagnosis  Explore treatment options  Understand medications  Find a doctor, hospital, or specialist and check if a doctor is in your network and is accepting new patients.

The myNurseLineSM, Care Coordination Nurse, and Cancer Nurse Advocate services are for informational purposes only, and should not be used for emergency or urgent care situations. In an emergency, call 911 or go to the nearest emergency room. Nurses cannot diagnose problems or recommend specific treatment and are not a substitute for your doctor’s care. These services are not an insurance program and may be discontinued at any time. They are included as part of your health plan. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. 100-3501 2/13 Consumer

© 2013 United HealthCare Services, Inc.

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Virtual Visits Get access to care online. Any where. Any time.

When you don’t feel well, or your child is sick, the last thing you want to do is leave the comfort of home to sit in a waiting room. Now, you don’t have to. A virtual visit lets you see and talk to a doctor from your mobile device or computer without an appointment. Most visits take about 10-15 minutes and doctors can write a prescription*, if needed, that you can pick up at your local pharmacy. And, it’s part of your health benefits.

Conditions commonly treated through a virtual visit Doctors can diagnose and treat a wide range of non-emergency medical conditions, including: • Bladder infection/ Urinary tract infection • Bronchitis • Cold/flu

• Diarrhea • Fever • Migraine/headaches • Pink eye

• Rash • Sinus problems • Sore throat • Stomach ache

Access virtual visits Log in to myuhc.com® and choose from provider sites where you can register for a virtual visit. After registering and requesting a visit you will pay your portion of the service costs according to your medical plan, and then you will enter a virtual waiting room. During your visit you will be able to talk to a doctor about your health concerns, symptoms and treatment options.

To learn more, login to myuhc.com

* Prescription services may not be available in all states. Access to virtual visits and prescription services may not be available in all states or for all groups. Go to myuhc. com for more information about availability of virtual visits and prescription services. Always refer to your plan documents for your specific coverage. Virtual visits are not an insurance product, health care provider or a health plan. Virtual visits are an internet based service provided by contracted UnitedHealthcare providers that allow members to select and interact with independent physicians and other health care providers. It is the member’s responsibility to select health care professionals. Care decisions are between the consumer and physician. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times or in all locations. Members have cost share responsibility and all claims are adjudicated according to the terms of the member’s benefit plan. Payment for virtual visit services does not cover pharmacy charges; members must pay for prescriptions (if any) separately. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. MT-1027900.0 6/16 © 2016 United HealthCare Services, Inc. 16-2211 100-16667

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Use virtual visits when: • Your doctor is not available • You become ill while traveling • You are considering visiting a hospital emergency room for a non-emergency health condition

Not good for: • Anything requiring an exam or test • Complex or chronic conditions • Injuries requiring bandaging or sprains/ broken bones

HEALTH SAVINGS ACCOUNT (HSA) ADMINISTRATION HSA Overview Who is eligible? 1) Anyone covered under a qualified High Deductible Health Plan (HDHP) on the first day of the month, but not covered under any other medical plan. 2) Anyone not enrolled in Medicare. Note: an actively at-work employee who is older than 65 may not enroll in an HSA unless he/she has waived Medicare. 3) When enrolled in an HSA, member and spouse (if applicable) may only participate in a “limitedpurpose” flexible spending account. 4) Anyone not claimed as a dependent on another person’s tax return. Is there a limit on the amount that can be contributed per year? $3,400 for an individual plan, $6,750 for a family plan for 2017. These numbers are indexed annually by the Treasury Department. In addition, there is a $1,000 catch-up contribution allowed for individuals 55 and older. What are the advantages of enrolling in a HSA? 1) Monies go in tax-free. 2) Monies grow tax-free. 3) Monies come out tax-free if spent on qualified medical expenses. 4) Unspent monies roll over year to year, grow, and earn interest. 5) The account owner decides whether to use the HSA dollars for current expenses, or to save them for future expenses. 6) The account is portable. What expenses are eligible for reimbursement? Internal Revenue Code Section 213(d) medical expenses for the employee and qualified dependents (even if the dependents are not on the employee’s HDHP); COBRA premiums; qualified long-term care expenses; retiree medical premiums to employer-sponsored medical coverage (if age 65 or older); Medicare Parts B & D premiums, but not Medicare supplement premiums. What if funds are used for non-qualified expenses? Distributions for an account owner under age 65 are subject to income tax plus a 20% penalty. Distributions for an account owner 65 and older are subject to income tax only. For more details: Check out www.irs.gov for more details.

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DENTAL INSURANCE MetLife

This chart gives a side-by-side look at the amounts you pay when you use in-network and out-of-network providers.

In-Network

Out-of-Network(1)

$50 single

$50 single

$150 family

$150 family

Diagnostic & Preventive Services

Deductible waived, covered at 100%

Deductible waived, covered at 100%

Routine & Restorative Services

Deductible, 20% coinsurance

Deductible, 20% coinsurance

Major Services

Deductible, 50% coinsurance

Deductible, 50% coinsurance

Deductible, 50% coinsurance

Deductible, 50% coinsurance

Type of Service Deductible

Orthodontia (Covers children up to age 19)

$2,000 per calendar year for Diagnostic & Preventive, Routine & Restorative, and Major Services Plan Maximum



Per insured person

$1,000 per lifetime for Orthodontia 

EMPLOYEE COST

Per dependent child

Semi-Monthly (24/year)

Employee

$16.43

Employee/Spouse

$34.37

Employee/Child(ren)

$38.63

Family

$60.69

(1) Out-of-Network benefits are reimbursed based on Reasonable & Customary charge. Reasonable & Customary is based on the lowest the dentist’s actual charge or charge of most dentists in the area for the same or similar services.

ID CARD INFORMATION

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Group Dental

Dental information available through the MetLife Mobile App

Viewing your dental plan just got easier with the MetLife Mobile App.1 You can:  Find a dentist  View your plan summary and claims  View your ID card

It’s easy! Search “MetLife” at iTunes App Store or Google Play to download the App. Search our network of thousands of dentists and specialists to find a provider near you. Or log-in to MyBenefits to access your plan information.1 It’s available 24 hours a day, seven days a week.

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Certain features of the MetLife Mobile App are not available for all MetLife Dental plans. Before using the MetLife Mobile App, you must register at www.metlife.com/mybenefits from a computer. Registration cannot be done from your mobile device. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact MetLife or your plan administrator for complete details. L0216456127[exp0417][All States][DC,GU,MP,PR,VI] © 2016 METLIFE, INC. PEANUTS © 2016 Peanuts Worldwide

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VISION INSURANCE Avesis This chart gives a side-by-side look at the amounts you pay when you use in-network and out-of-network providers.

Type of Service

In-Network

Out-of-Network

Vision Exam

$10 copayment

Reimbursed up to $45

Standard Single Vision

$10 copayment

Reimbursed up to $30

Standard Bifocal

$10 copayment

Reimbursed up to $50

Standard Trifocal

$10 copayment

Reimbursed up to $65

Standard Lenticular

$10 copayment

Reimbursed up to $80

$50 Wholesale Allowance

Reimbursed up to $70

Reimbursed up to $130

Reimbursed up to $105

$10 copayment

Reimbursed up to $210

Lenses

Frames Contact Lenses

(1)

Elective Medically Necessary

Vision Exam every 12 months Spectacle Lenses every 12 months

Benefit Frequency

Frames every 24 months Contact Lenses every 12 months

EMPLOYEE COST

(1)

Semi-Monthly (24/year)

Employee

$3.44

Employee/Spouse

$6.64

Employee/Child(ren)

$6.64

Family

$9.72

Contacts are in lieu of frames or spectacles.

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FLEXIBLE SPENDING ACCOUNTS (FSA) Kabel Business Services FSAs provide you with an important tax advantage that can help you pay health care and dependent care expenses on a pre-tax basis. By anticipating your family’s health care and dependent care costs for the next year, you can actually lower your taxable income.

Plan Overview Pre-Tax Premium Benefits This plan allows you to fund several of your premium contributions with pre-tax dollars and to fund either a Health Care Reimbursement Account and/or Dependent Care Reimbursement Account. Your contributions are deducted from your gross wages before FICA, Federal and State taxes are deducted. You save money because you are taxed at a reduced income level. Your taxes are calculated after your premiums and reimbursement account monies are deducted from your gross wages. Health Care Reimbursement Accounts This plan allows you to defer pre-tax dollars into a Health Care Reimbursement Account to pay for certain IRS-approved medical care expenses not covered by your insurance plan with pre-tax dollars. Some examples include:  Deductible, coinsurance and copayments  Over the counter medications – with prescription  Dental services and orthodontia  Vision services, including contact lenses, contact lens solution, eye exams and eyeglasses  Hearing services, including hearing aids and batteries Medical Care Maximum:

$2,600

Dependent Care Reimbursement Accounts This plan allows you to defer pre-tax dollars into a Dependent Care Reimbursement Account. You may request reimbursement as you incur expenses to provide day care for qualified dependents: children under age 13, or an older disabled dependent child, or a disabled adult. Dependent Care Maximums:

$5,000 if married filing jointly or head of household; $2,500 if married filing single.

Plan Provisions Please Note: Your election in the Arona Corporation Section 125 Flexible Benefit Plan is irrevocable for st st the entire plan year (February 1 through January 31 ) without a qualifying change in status (i.e. birth, adoption, divorce, job status change, etc.) Please be advised that any unused FSA monies will be forfeited back to the Plan at the end of the plan year. Extension Your flex plan has a 2.5 month extension of time (at the end of the 12 month flex plan year), in which you may incur eligible flex expenses. Claim Submission Claims may be filed by mailing, faxing, or online. Please be aware that your plan has a 90 day run out period, after the end of the plan, where you may still file claims. Remember that the expense, however, must have been incurred during the plan year. Claim Processing Claims are processed on a daily basis. Reimbursements may be automatically deposited into your checking account or mailed to you in the form of a check.

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FLEXIBLE SPENDING ACCOUNTS How do Flexible Spending Accounts Work? Flexible Spending Accounts (FSAs) are like personal bank accounts. They allow you to set aside money for healthcare and/or dependent care expenses on a pre-tax basis. You can enroll in a Healthcare FSA and/or a Dependent Day Care FSA. Your election will cover you from your enrollment date through the end of the plan year unless you have a change in family status. You can elect to have a portion of your salary withheld on a pre-tax basis for health or dependent care expenses you incur during the plan year. The funds will be placed into an account to be used during the year. If you contribute to both FSAs, you cannot use amounts contributed to one account to pay expenses eligible for payment from another account. For example, you cannot pay medical expenses from your Dependent Day Care FSA. Health Care FSA During annual enrollment you may elect to contribute monies into the Health Care FSA during the coming plan year. The amount you elect to set aside will be deducted from your paycheck in equal installments during the plan year. Eligible health care expenses include copayments, deductibles, coinsurance, certain orthodontic procedures and other health-related expenses incurred by you or a family member. In addition, over-the-counter medicines are eligible for reimbursement with a prescription. Dependent Care FSA You can contribute up to $5,000 each year to the Dependent Day Care FSA to pay for dependent care expenses. The amount you elect to set aside will be deducted from your paycheck in equal installments during the coming year. Eligible expenses are only those incurred for the care of a child under 13 years of age (or a disabled child older than age 13) who qualifies as your dependent for tax purposes; or, anyone you can claim as a dependent, such as an elderly parent or disabled spouse. Use It Or Lose It It is very important that you estimate accurately when determining how much to contribute to either FSA. FSAs can provide significant tax advantages for employees when the contributions are made on a pre-tax basis. For this reason the IRS requires that you use all of the money in your account(s) during the plan year. Any money remaining in your account(s) at the end of the plan year will be forfeited.

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BASIC LIFE / ACCIDENTAL DEATH & DISMEMBERMENT MetLife Your employer provides full-time employees with Basic Life/Accidental Death and Dismemberment coverage, and pays the full cost of this benefit. Contact your Human Resources department to update your beneficiary information.

Plan Overview Basic Life Benefit Amount $15,000 Accidental Death Benefit Amount is the same as the Basic Life amount. Waiver of Premium Life insurance continues for totally disabled employees without payment of premium if:  Disability begins while the employee is insured;  Disability begins prior to age 60 and terminates at age 65;  Proof of disability is given to Carrier, prior to the end of the Disability Elimination Period;  Proof of continued disability is verified periodically, according to the terms of the contract. Living Care Benefits If you have a qualifying medical condition, you may apply for an accelerated benefit to receive a portion of your life insurance once during your lifetime. Conversion Must apply for conversion within 31 days of termination of policy. Age Reduction Benefit reduces by 35% at Age 65; Benefit reduces by 50% at Age 70.

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VOLUNTARY TERM LIFE INSURANCE MetLife Employees who want to supplement their group life insurance benefits may purchase additional coverage. When you enroll yourself, you may also elect coverage on your dependents in this benefit. You pay the full cost through payroll deductions.

Voluntary Coverage Amounts Employee may elect up to 5 times his/her annual salary Minimum: $10,000 Maximum: $500,000 Multiples of: $10,000 Spouse

Child(ren)

Minimum: Maximum: Multiples of: Minimum: Maximum: Increments:

$5,000 $100,000 $5,000 $1,000 $10,000 $1,000, $2,000, $4,000, $5,000, $10,000 (1)

Guarantee Issue Amounts Employee: $100,000 Spouse: $25,000 Child(ren): All amounts Accidental Death Benefit Amount is the same as the Voluntary Coverage Amount for employee only. Waiver of Premium Life insurance continues for totally disabled employees without payment of premium if:  Disability begins while the employee is insured;  Disability begins prior to age 60 and terminates at age 65;  Proof of disability is given to Carrier, prior to the end of the Disability Elimination Period;  Proof of continued disability is verified periodically, according to the terms of the contract. Portability Apply for within 31 days of termination. Age Reduction Schedule At age: 70 75 80 85 90 (1)

Benefits reduce to: 65% 45% 30% 20% 15%

The levels of Guarantee Issue (GI) coverage are available for employees & family members when the employee is initially eligible. At later annual enrollment periods, all applications for coverage are subject to approval by the carrier.

Monthly Cost for Each $1,000 of Employee & Spouse Life/AD&D Insurance Coverage Age Life Children