Heartland Benefit Guide

2020 | Benefit Guide THE TOOLS FOR A HEALTHY WORKFORCE

Heartland Automotive

Welcome to Your Benefits!

Making the right choice is important. This Benefit Guide will help you understand the benefit choices you can make before your enrollment deadline.

We want our team and their families to be happy and healthy. Whether that means keeping fit, eating right, knowing your health risks or changing lifestyle behaviors, your well-being is important to you, your family, your coworkers, and Heartland Automotive.

At Heartland Automotive, we are committed to a comprehensive employee benefit program that helps our employees stay healthy, feel secure, and maintain a work/life balance.

Whether staff members are already enrolled in Heartland Automotive benefits, learning more about benefits makes it easier for you to use them. This Benefit Summary will help you understand your benefits as you consider your choices.

The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Summary was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies, or errors are always possible. In case of discrepancy between the Benefits Summary and the actual plan documents the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about this summary, contact Human Resources.

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Table of Contents

Section 1 | Health Benefits

Section 2 | Financial Protection Benefits

Medical Plan

5

Life and AD&D

15

Apta Health

6

Disability / 401(k)

16

Importance of Preventive Care

7

Allstate Voluntary Benefits

17

Virtual Visits | OC24health

10

Where to Find Care

11

Dental

12

Vision

13

Contacts - 23 • • • • •

Apta Health VSP Symetra Allstate Human Resources

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Section 1 | Health Benefits

Medical Plan Cost Per Week Employee

$5.00

Employee + Family

$20.00

Plan Feature

In-Network

Out-of-Network

Annual Deductible

Individual: $750 Family: $1,500

Individual: $1,500 Family: $3,000

80% after deductible

60% after deductible

Individual: $2,750 Family: $5,500

Individual: $5,500 Family: $11,000

Coinsurance Out-of-Pocket Max (this does not include prescriptions) Out-of-Pocket Max for Prescription Drugs Preventive Care Services OC24health Physician’s Office Visits • Primary Care Physician • Specialist

Individual: $2,000 Family: $4,000 Covered at 100% (no copay, no deductible)

Not Covered

$0 copay

NA

$25 copay $35 copay with referral, $70 copay without referral

Urgent Care Services Emergency Room Services

60% after deductible

$25 copay $250 copay, then deductible and coinsurance

Prescription Drugs - Retail (up to a 34-day supply) • Generic • Preferred Brand • Non-Preferred Brand

$10 20% ($30 maximum) 30% ($50 maximum)

Prescription Drugs- Retail (3591 day supply) • Generic • Preferred Brand • Non-Preferred Brand

$20 20% ($60 maximum) 30% ($100 maximum)

Search for UnitedHealthcare Choice Plus Providers on HEARTLAND.MYAPTAHEALTH.COM Note: Any employee with a spouse that has other coverage available through their place of employment, is not eligible to be covered on the Heartland Medical Plan. If you are covering a spouse, please complete the spousal affidavit.

Please see plan document for full details.

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HEALTHCARE

JUST GOT A LOT EASIER I AM YOUR HEALTHCARE COORDINATOR

MEET YOUR APTA CARE COORDINATORS Care Coordinators are an expert team of nurses, patient services representatives and benefits specialists who are ready to help you before, during and after any health event. Think of Care Coordinators as your personal healthcare team. They fight hard to help you save money and make sure you get the best possible care for you and your family. You can contact them via the website, toll-free number listed on your ID card, or through the myQHealth app.

CARE COORDINATORS CAN HELP WITH: • • • • • •

Ordering ID Cards Claims, billing and benefit questions Finding in-network providers Nurse coaching to help you stay or get healthy Reducing out-of-pocket costs Anything that can make the healthcare process easier for you

ACCESS YOUR APTA HEALTH WEBSITE: HEARTLAND.MYAPTAHEALTH.COM CONTACT YOUR CARE COORDINATORS BY CALLING: 1-877-610-8817 DOWNLOAD THE MYQHEALTH APP TO HAVE HEALTHCARE SUPPORT ON THE GO. 6

Apta Health | FAQs

What is Apta Health

Apta Health is an independent, healthcare concierge model, that engages health plan members at the time they need to make a healthcare decision. Their main objective is to inform a member of their options, and then connect them to the best resources in the next steps of their health care journey. The key to the exceptional experience provided is the Apta Care Coordinator, better known as your Healthcare Coordinator. Their Coordinators have effectively served plan members for nearly two decades.

What does a Healthcare Coordinator do?

The primary job of a Healthcare Coordinator is to help a plan member maximize their benefits and understand their options. Whether it’s a health plan decision, finding prescription drug savings, discussing a complex health condition with their clinical specialist, or even sorting out a bill from a medical provider, the Healthcare Coordinator is there to help. Additionally, the independence of the Apta platform means that they are not tied to the insurance company, so you can trust that they are there to fight for you!

Can I contact my Healthcare Coordinator with questions or issues I am having with benefits other than the health plan?

Will there be changes to the health plans?

2.1.20 - There is a Specialist Referral Copay

Get help...

• Finding in-network providers • Identifying the highest quality providers or best value for services within the network • Claims and billing questions • Personalized nurse/clinical support for healthcare conditions • Ordering ID cards • Caregiver Support – advocacy and support for employees or spouses who need assistance caring for a sick plan member • Anything that will make your healthcare journey easier

There will be minimal changes to the health plan options beginning 2/1/2020.

However, there will be a Specialist Referral Copay Incentive for the PPO plan as well as an expanded pre-certification list.

The Specialist Referral Copay Incentive is simply a plan change that provides a lower copay to members on the PPO plan who utilize a primary care physician (PCP) for initial services, and then obtain a referral to Apta Health for a subsequent specialist visit (if needed). Any plan member who receives a referral for a specialist visit will pay a lower copay on the PPO plan. A plan member can still choose to go directly to a specialist without a referral but would be subject to a higher copay.

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Apta Health | FAQs No problem. Plan members can keep your current relationship with their specialist, although you will definitely want to check that the provider is within network. In order to pay the lower copay structure on the PPO plan after 2/1/20, a plan member will need to:

What if I am already seeing a specialist

1.) Contact their PCP and have them call their referral into Apta (the PCP can make multiple referrals at one time in the event a member is seeing multiple specialists) 2.) Contact a Healthcare Coordinator and have them connect with the PCP to see if they can obtain the referral for the specialist 3.) Visit their PCP and have them call-in the referral to Apta The cost and quality of specialist’s visits and care can vary dramatically, so this may also be a good time to connect with a healthcare Coordinator and the Apta clinical team to independently review the options that are best for you or a member of your family.

The following services will need to be pre-certified beginning 2/1/20:

What services need to be pre-certified moving forward?

•MRI, MRA, & Pet Scan •Durable Medical Equipment over $500 •Dialysis •Genetic Testing •Home Health Care & Services •Hospice Care

•Inpatient Hospitalizations •Oncology Care & Services •Outpatient Surgeries •Skilled Nursing Facilities •Transplants – Organ & Bone Marrow

Providers call: 1-877-813-9240 Members call: 1-877-610-8817

What happens if I have a procedure Apta Health is going to open their pre-certification and Healthcare Coordinator services scheduled (or it is beginning February 1st. already pre-certified) or need to utilize Apta Health Care Coordinators 1-877-610-8817 Mon-Fri 8:30 am-10:00 pm EST healthcare services in February?

Will there be No. Heartland Automotive will continue to partner with TrueScripts as our Pharmacy changes to the Benefit Manager (PBM). Plan members should receive the same great benefits and prescription drug services they have experienced in the past. benefits?

TrueScripts partners with an extensive network of both local and national pharmacies

Will my pharmacy be (i.e. Walgreens, CVS, Walmart, Target, etc.) to provide unmatched access for prescription in network? drug fills. Heartland Automotive plan members will continue to have access to the same, existing network.

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Importance of Preventive Care Did you know that if you are covered under one of the medical plans, your in-network preventive care is covered at 100%?

out of your pocket*

That’s right! That means $0 out of your pocket for your annual physicals and preventive exams and screenings. These exams and screenings help identify health risks early on, and in turn keep those N out-of-pocket medical expenses in check.

TIO N VE

H

g ER kin involve running a complete panel of blood work. When m oexams t s I N TMany it igh

qu w e last was time you had your blood pressure checked? Your glucose levels? Knowing these ethe hy n alt los sio he s t e critical pr s e is the most important part of the visit. If you don’t know them, then it’s time to e a numbers de lu fy ho i t o n ana l cappointment! make lly ide ua e re d

x uc se tted i oid av ansm ses tr isea d

INTERVENTION

If you have additional questions about preventive care services, talk to your doctor or call Apta. quit smoking lose weight

H

CANCER CANCER

eat healthy

identify depression

ES

INTERVENTION

reduce alcohol use

SCREENINGS

MAMMOGRAMS AND COLONOSCOPIES

TESTS BLOOD PRESSURE DIABETES CHOLESTEROL

E PR AR ALTHY

EG

C R HE FO

N NA

CIE

S O N LES,

H

eat healthy identify depression reduce alcohol use avoid sexually transmitted diseases

SCREENINGS

MAMMOGRAMS AND COLONOSCOPIES

D

LLANSMITTED IONS

lose weight

S

TSL-CHILD I S VI WEL

R BY, AN A NINGS BA

quit smoking

avoid sexually transmitted diseases

CARE

REGULAR VISITS

FOR HEALTHY PREGNANCIES

WELL-WOMAN, WELL-BABY, AND WELL-CHILD

SCREENINGS

VA C C I N AT I O N S S AS ME EASE SEXUALLY S I FLU, TRANSMITTED PNEUMONIA, MEASLES, RD INFECTIONS POLIO, MENINGITIS AND OTHER DISEASES

REGULAR VISITS WELL-WOMAN, WELL-BABY, AND WELL-CHILD

VA C C I N AT I O N S FLU, PNEUMONIA, MEASLES, POLIO, MENINGITIS AND OTHER DISEASES

9

CARE FOR HEALTHY PREGNANCIES

Virtual Visits | OC24health

Talk to a local doctor

anytime OC24health gives you 24/7/365 access to U.S. board-certified doctors through the convenience of phone, video or mobile app visits.

It’s an affordable option for quality medical care.

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3

2

GET THE CARE YOU NEED Our doctors can treat many medical conditions, including: Receive quality care via phone, video or mobile app.

Talk to an Indiana-based, board-certified doctor.*

4

Prescriptions are sent to pharmacy of choice if medically necessary.

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5

OC24health is less expensive than the ER or urgent care.

Physicians are able to refer to high quality and lower cost specialist if needed.

You can be assigned a Primary Care Physician (PCP) if you don’t already have one.

•

Cold and flu symptoms

•

Allergies

•

Pink eye

•

Ear infection

•

Respiratory infection

•

Sinus problems

•

Skin problems

•

And more!

With your consent, we’re happy to provide information about your visit to your primary care physician.

Speak with a doctor now!

OC24health.com | 855.617.2116 © 2017 Teladoc, Inc. All rights reserved.

Complete disclaimer at Teladoc.com/disclaimers.

Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc.

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* Does not apply during select times, and for those living outside Indiana and Ohio, virtual visits are with Teladoc® doctors

Where to Find Care

Consider the information in the chart below when you need care. Still not sure where to go?

Cost & Wait

Type of Care

When to Go

Visit HEARTLAND.MYAPTAHEALTH.COM for more information.

Doctor’s Office

Urgent Care

Emergency Room

$

$$

$$$

Quick care that is not an emergency when your regular doctor is not available. They’re for nonlife-threatening injuries or illness and are staffed with qualified doctors.

For when you need immediate treatment of a very serious, critical or life-threatening condition.

Usually the best choice for preventive exams or treatment for a current health issue. Your doctor typically knows you best and has your medical records.

Your doctor can also refer you to a specialist.

• • • •

Routine checkups Immunizations Preventive services General health management

• • • • •

Sprains Strains Minor broken bones Minor infections Minor burns

•

Requires copays unless your visit is for preventive care Normally requires an appointment Usually little wait time with scheduled appointments

•

Requires copay, but much smaller copay than an Emergency Room Walk-in patients are welcome but are usually treated by severity

• •

•

• • • • • • • • • • •

•

•

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Heavy bleeding Large open wounds Sudden change in vision Chest pain Sudden weakness or trouble talking Major burns Spinal injuries Severe head injury Difficulty breathing Major broken bones The cost is much higher than a doctor’s office or urgent care In and out-of-network copayments are the same.

In-network out-of-pocket costs are lower Open 24/7

Dental

Plan Feature

In-Network / Out-of-Network

Annual Deductible

Individual: $25 Family: $75

Annual Plan Max

$1,000/person

Preventive Care

100%, no deductible

Basic Care

80% after deductible

Major Care

50% after deductible

Orthodontic Care

Not Covered

Cost Per Week Employee

$0.00

Employee + Family

$1.44

Please see Plan Document for full details.

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Vision

Plan Feature Examination (once every 12 months) Lenses (once every 12 months) • Single • Bifocal • Trifocal Contact Lenses (once every 12 months in lieu of frames and lenses) Frames (once every 24 months)

In-Network / Out-of-Network $10 copay, then covered 100%

$25 copay, then covered 100%

$10 copay, then covered up to $45 $25 copay, then covered up to: $30 $50 $65

Covered up to $130

Covered up to $105

$25 copay, then covered up to $130

$25 copay, then covered up to $70

Cost Per Week Employee

$1.67

Employee + Spouse

$2.82

Employee + Child(ren)

$2.88

Employee + Family

$4.64

Search for Vision Providers at www.vsp.com and search under the VSP Choice network Please see Plan Document for full details.

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Section 2 | Financial Protection Benefits

Life and AD&D Insurance Basic Life and AD&D Heartland Automotive provides Basic Life and Accidental Death and Dismemberment (AD&D) Insurance that equals one times your annual salary, not to exceed $150,000. This comes at no cost to you. This benefit will terminate when your employment ends or upon retirement.

If you wish to elect additional coverage...

Voluntary Life and AD&D This is a voluntary plan that provides you the option to purchase coverage beyond the Basic Term Life Insurance provided by Heartland Automotive. You may also apply for life insurance coverage on your spouse and dependents for the amounts listed below. The weekly premiums increase with age and coverage level and are paid by you via payroll deduction.

Plan Feature Benefit Amount Guarantee Issue Amount (only if you are applying when initially eligible) Overall Maximum Benefit Reductions

Employee

Spouse

Increments of $10,000

Increments of $5,000

If under age 60: $100,000

If under age 60: $25,000

Lesser of 50% of employee Max of $500,000 or 5x salary life amount or $250,000 Age 70: 67% Age 75: 50%

Coverage terminates at age 70

15

Child(ren) $500 (14 days - 6 months) $10,000 (6 months - 19 years)

N/A

Disability Insurance

Short-Term Disability To assist our employees during illness or injury, Heartland provides short-term disability benefits, administered by Symetra.

• Begins: 8th day of disability due to accident or sickness • Benefit Percentage: Salaried employees get 70% of earnings to a maximum of $1,500 per week. Hourly employees get $150 per week • Max Benefit Duration: Up to 26 weeks Long-Term Disability Long-Term Disability is provided to salaried employees only, and is administered by Symetra.

• Begins: After 180 days • Benefit: 60% of earnings up to a max of $4,000 per month • Max Benefit Duration: To Social Security Normal Retirement Age To claim disability benefits, you must first complete Symetra’s claim form according to Symetra’s requirements. You may request the claim form from Symetra by calling (877) 3776773 or from Heartland Human Resources.

401(k) Plan To help you prepare for the future, Heartland Automotive sponsors a 401(k) plan as part of its benefits package.

What Benefits Does a 401(k) Plan Provide?

If you sign up and contribute a percentage of your earnings to a 401(k), Heartland Automotive will match up to the first 3%. You may enroll at the start of your 7th month of employment.

Please see HR if you wish to sign up for this benefit.

Please see Plan Document for full details.

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Allstate Voluntary Benefits

Heartland Automotive employees have the option of purchasing a variety of different coverage lines through Allstate. These include Accident, Critical Illness, Hospital Indemnity, and Short-Term Disability.

These plans pay you varying amounts based on the coverage you purchase and the type of claim you incur. Below is a summary of these benefits. For more information, please contact HR.

Enrollment • New Hires - There will be an opportunity to enroll once per quarter. Please see HR for specific timing. New hires will not have to answer any medical questions, and there are no pre-existing limitations. • All Other Employees - If you did not enroll when you were initially eligible, you will have to wait until the next annual enrollment. If you choose to elect Critical Illness or Short-Term Disability, you will have to answer medical questions before your enrollment can be finalized.

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Allstate Accident Insurance Accident Insurance

Today, active lifestyles in or out of the home may result in bumps, bruises and sometimes breaks. Getting the right treatment can be vital to recovery, but it can also be expensive. And if an accident keeps you away from work during recovery, the financial worries can grow quickly.

Here’s How It Works

Our coverage pays you cash benefits that correspond with hospital and intensive care confinement. Your plan may also include coverage for a variety of occurrences, such as: dismemberment; dislocation or fracture; ambulance services; physical therapy and more. The cash benefits can be used to help pay for deductibles, treatment, rent and more.

Meeting Your Needs • • • • • •

Guaranteed Issue, meaning no medical questions to answer Benefits are paid directly to you unless otherwise assigned Pays in addition to other insurance coverage Coverage also available for your dependents (children’s coverage ends on their 26th birthday) Premiums are affordable and can be conveniently payroll deducted Coverage may be continued; refer to your certificate for more details

Outpatient Physician’s Benefit Rider - $50 once per day, not to exceed 2 days per covered person per year (maximum of 4 days per calendar year if dependents are covered). Treated by a physician outside of a hospital due from any cause.

Benefit Enhancement Rider In addition to the basic policy benefits, there are items covered such as lacerations, skin graft, paralysis, medicine, and prosthesis.

Accident Plan

Plan 1

Plan 2

Initial Hospital Confinement (per year)

$1,000

$1,500

Daily Hospital Confinement (per day)

$200

$300

Ambulance (Ground / Air)

$200 / $600

$300 / $900

Dislocations or Fractures

$4,000

$6,000

Burns (15%+)

$1,000

General Anesthesia

$200

Plan 1

Employee

Employee + Spouse

Employee + Children

Family

WEEKLY

$2.78

$4.31

$6.51

$8.16

Plan 2

Employee

Employee + Spouse

Employee + Children

Family

WEEKLY

$3.83

$6.01

$9.07

$11.36

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Allstate Critical Illness Insurance Critical Illness Insurance

The treatment to recovery is vital, but it can also be expensive. Critical Illness coverage helps provide financial support if you are diagnosed with a covered critical illness.

Here’s How It Works

You choose benefits to protect yourself and any family members if diagnosed with a critical illness. Then, if diagnosed with a covered critical illness, you will receive a cash benefit based on the percentage payable for the condition.

Meeting Your Needs • • • •

Guaranteed Issue, meaning no medical questions to answer at initial enrollment.

Coverage available for individual and child(ren) or family.

Covered dependents receive 50% of your Basic-Benefit Amount.

Benefits paid regardless of any other medical or disability plan coverage.

Fixed Wellness Rider - $50 once per person per year; if the member receives certain services, screenings, or tests that are listed within the policy.

Lifestyle Enhancement Rider - $25 once per year for employee and twice per year for family; for members upon

program completion of tobacco or alcohol cessation, weight or stress management, walking challenge, run/row/cycle/swim events, or registration and completion of health assessment.

Critical Illness Plan

Plan 1

Plan 2

Heart Attack / Stroke / Major Organ Transplant / End Stage Renal Failure

Employee: $10,000 Covered Dependents: $5,000

Employee: $20,000 Covered Dependents: $10,000

Coronary Artery Bypass

Employee: $2,500 Covered Dependents: $1,250

Employee: $5,000 Covered Dependents: $2,500

Plan 1 Age

Non-Tobacco EE / EE + Child(ren)

Tobacco

EE + Spouse / Family

EE / EE + Child(ren)

EE + Spouse / Family

18-29

$1.30

$2.25

$1.61

$2.72

30-39

$2.27

$3.75

$3.07

$4.95

40-49

$4.09

$6.56

$6.08

$9.54

50-59

$6.85

$10.82

$10.56

$16.39

60-64

$9.10

$14.27

$14.17

$21.87

65+

$14.34

$22.24

$22.13

$33.93

Plan 2

Non-Tobacco

Tobacco

Age

EE / EE + Child(ren)

EE + Spouse / Family

EE / EE + Child(ren)

EE + Spouse / Family

18-29

$1.99

$3.28

$2.61

$4.22

30-39

$3.84

$6.10

$5.44

$8.50

40-49

$7.30

$11.37

$11.27

$17.33

50-59

$12.60

$19.44

$20.03

$30.58

60-64

$16.94

$26.03

$27.07

$41.23

65+

$27.20

$41.52

$42.78

$64.91

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Allstate Hospital Indemnity Insurance Hospital Indemnity Insurance Life is unpredictable. Without any warning, an illness or injury can lead to a hospital confinement, medical procedures and/or visits, which may mean costly out-of-pocket expenses.

Expenses associated with a hospital stay can be financially difficult if money is tight and you are not prepared. But having the right coverage in place before you experience a sickness or injury can help eliminate your financial concerns and provide support at a time when it is needed most.

Here’s How It Works

Our Hospital Indemnity insurance pays a cash benefit for hospital confinement. This benefit is payable directly to you and can keep you from withdrawing money from your personal bank account for hospital-related expenses.

Meeting Your Needs • • • •

Guaranteed Issue, meaning no medical questions to answer at initial enrollment.

Coverage is available for your dependents.

Premiums are affordable and conveniently payroll deducted.

Coverage may be continued; refer to your certificate for more details.

Hospital Indemnity Plan

Benefit

First Day Hospital Confinement

$1,000

Daily Hospital Confinement (30-day max)

$200 per day

Hospital Intensive Care (30-day max)

WEEKLY

Employee

Employee + Spouse

Employee + Child(ren)

Family

$5.37

$14.13

$9.30

$15.36

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Allstate Disability Insurance Disability Insurance An injury or sickness may slow you down, but it won’t slow down your monthly bills. Disability insurance can help replace your lost income and help ensure your finances are not depleted.

Here’s How It Works

You choose the maximum monthly benefit level that meets your needs. Then, if you are faced with a period of unexpected sickness or off-the-job injury, you will receive cash benefits to use as you see fit. This could include medical treatments, daily living expenses and more.

Meeting Your Needs • • •

You choose the monthly maximum benefit level that meets your needs.

Benefits start the first day after the waiting period, when you are totally disabled and cannot work.

Premiums are affordable and conveniently payroll deducted.

Disability Plan Monthly Benefit

Benefit 60% of monthly earnings up to a monthly maximum of $5,000

Maximum Benefit Period

6 months

Elimination Period

14 days for accident or sickness

Please see next page for the rates.

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Allstate Disability Insurance Disability Plan Weekly Premiums

Issue Age

Monthly Benefit

18-49

50-59

60-64

65-69

70+

$400.00

$2.73

$3.64

$4.89

$5.26

$5.78

$500.00

$3.41

$4.55

$6.11

$6.57

$7.23

$600.00

$4.09

$5.46

$7.33

$7.88

$8.67 $10.12

$700.00

$4.77

$6.37

$8.55

$9.20

$800.00

$5.45

$7.28

$9.77

$10.51

$11.56

$900.00

$6.13

$8.19

$10.99

$11.82

$13.01

$1,000.00

$6.81

$9.10

$12.21

$13.13

$14.45

$1,100.00

$7.49

$10.01

$13.43

$14.45

$15.89

$1,200.00

$8.17

$10.91

$14.65

$15.76

$17.34

$1,300.00

$8.85

$11.82

$15.87

$17.07

$18.78

$1,400.00

$9.53

$12.73

$17.09

$18.39

$20.23

$1,500.00

$10.22

$13.64

$18.32

$19.70

$21.67

$1,600.00

$10.90

$14.55

$19.54

$21.01

$23.12

$1,700.00

$11.58

$15.46

$20.76

$22.33

$24.56

$1,800.00

$12.26

$16.37

$21.98

$23.64

$26.01

$1,900.00

$12.94

$17.28

$23.20

$24.95

$27.45

$2,000.00

$13.62

$18.19

$24.42

$26.27

$28.90

$2,100.00

$14.30

$19.10

$25.64

$27.58

$30.34

$2,200.00

$14.98

$20.01

$26.86

$28.89

$31.79

$2,300.00

$15.66

$20.92

$28.08

$30.20

$33.23

$2,400.00

$16.34

$21.83

$29.30

$31.52

$34.67

$2,500.00

$17.02

$22.73

$30.52

$32.83

$36.12

$2,600.00

$17.70

$23.64

$31.74

$34.14

$37.56

$2,700.00

$18.38

$24.55

$32.96

$35.46

$39.01

$2,800.00

$19.07

$25.46

$34.19

$36.77

$40.45

$2,900.00

$19.75

$26.37

$35.41

$38.08

$41.90

$3,000.00

$20.43

$27.28

$36.63

$39.40

$43.34

$3,100.00

$21.11

$28.19

$37.85

$40.71

$44.79

$3,200.00

$21.79

$29.10

$39.07

$42.02

$46.23

$3,300.00

$22.47

$30.01

$40.29

$43.34

$47.68

$3,400.00

$23.15

$30.92

$41.51

$44.65

$49.12

$3,500.00

$23.83

$31.83

$42.73

$45.96

$50.57

$3,600.00

$24.51

$32.74

$43.95

$47.27

$52.01

$3,700.00

$25.19

$33.65

$45.17

$48.59

$53.45

$3,800.00

$25.87

$34.55

$46.39

$49.90

$54.90

$3,900.00

$26.55

$35.46

$47.61

$51.21

$56.34

$4,000.00

$27.23

$36.37

$48.83

$52.53

$57.79

$4,100.00

$27.92

$37.28

$50.06

$53.84

$59.23

$4,200.00

$28.60

$38.19

$51.28

$55.15

$60.68

$4,300.00

$29.28

$39.10

$52.50

$56.47

$62.12

$4,400.00

$29.96

$40.01

$53.72

$57.78

$63.57

$4,500.00

$30.64

$40.92

$54.94

$59.09

$65.01

$4,600.00

$31.32

$41.83

$56.16

$60.41

$66.46

$4,700.00

$32.00

$42.74

$57.38

$61.72

$67.90

$4,800.00

$32.68

$43.65

$58.60

$63.03

$69.35

$4,900.00

$33.36

$44.56

$59.82

$64.34

$70.79

$5,000.00

$34.04

$45.47

$61.04

$65.66

$72.23

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Benefit Contacts

• Medical Insurance • Prescriptions • Dental

(877) 610-8817 heartland.myaptahealth.com And download the MyQHealth app for free!

• Vision

www.vsp.com (800) 877-7195

• Life and AD&D • Voluntary Life

www.symetra.com (800) 796-3872

• Voluntary Plans

www.allstatebenefits.com/ mybenefits (800) 521-3535

• Human Resources

Linda Johnson (765) 848-1774

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