▪ Medical Benefits

M E D I C A L M E D I C A L / H S A / H R A I

K e y Te r m s t o R e m e m b e r

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EPO/PPO – A network of Management doctors, hospitals and other Account health care providers Marketing HMO – A network that Banking requires you to select a FinancePrimary Care Physician (PCP) who coordinates your health care POS – Combines aspects of a PPO and HMO to manage cost

HDHP – A plan that has higher cost sharing (e.g. deductible), but typically also lower monthly premiums.

Out-of-Pocket Maximum

This is the total amount you can pay out of pocket each calendar year before the plan pays 100 percent of covered expenses for the rest of the calendar year. Most expenses that meet provider network requirements count toward the annual out-of-pocket maximum, including expenses paid to the annual deductible*, copays and coinsurance. *Except for Grandfathered medical plans

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Annual Deductible

The amount you have to pay each year before the plan starts paying a portion of medical expenses. All family members’ expenses that count

toward a health plan deductible accumulate together in the aggregate; however, each person also has a limit on their own individual accumulated expenses (the amount varies by plan).

T h e Va l u e o f P r e v e n t i v e C a r e

W e l l n e s s a n d H e a l t h M a n a g e m e n t

Understanding the full value of covered benefits allows you to take responsibility for maintaining good health and incorporating healthy habits into your lifestyle. Some examples include getting regular physical examinations, mammograms and immunizations. Through the plans offered by Starkweather & Shepley , all covered individuals and family members are eligible to receive routine wellness services like these, at no cost.

Which Preventive Care Services Are Covered?

The US Preventive Services Task Force maintains a regular list of recommended services that all Affordable Care Act (i.e. Health Care Reform) compliant insurance plans should cover at 100% for in-network providers. Below is a list of common services that are included in the plans offered this year:

▪ Routine Physical Exam ▪ Well Baby and Child Care ▪ Well Woman Visits ▪ Immunizations ▪ Routine Bone Density Test ▪ Routine Breast Exam ▪ Routine Gynecological Exam ▪ Screening for Gestational Diabetes ▪ Obesity Screening and Counseling ▪ Routine Digital Rectal Exam ▪ Routine Colonoscopy ▪ Routine Colorectal Cancer Screening ▪ Routine Prostate Test ▪ Routine Lab Procedures ▪ Routine Mammograms ▪ Routine Pap Smear ▪ Smoking Cessation Programs ▪ Health Education/Counseling Services ▪ Health Counseling for STDs and HIV ▪ Testing for HPV and HIV ▪ Screening and Counseling for Domestic Violence

MEDICAL PLAN

Starkweather & Sheply Health Plan Comparison

Effective 01/01/2022 - 12/31/2022

Calendar Year Deductible Out of Pocket Maximum Primary Care Provider Necessary

In Network Services

HOSPITAL SERVICES: Inpatient Semi-private Room, Related Services & Supplies Outpatient Procedures & Surgery Emergency Room Services

URGENT CARE CENTERS:

Walk-In Treatment Centers

OFFICE VISITS:

Well Visits Primary Care Physician Specialty Physician

Acupunture Visits

Chiropractic / Spinal Manipulation Routine Eye Exam Physical / Speech / Occupational Therapy

INDEPENDENT LAB, X-RAY, CLINICS

Lab and X-Ray Services (Preventative) Lab and X-Ray Services (Diagnostic) Machine Tests (MRI,MRA'S,Pet Scans,CT Scans & Nuclear)

PHARMACY SERVICES:

Prescription Drugs (30 Day Supply) Tier 1 Prescription Drugs (30 Day Supply) Tier 2 Prescription Drugs (30 Day Supply) Tier 3 Prescription Drugs (30 Day Supply) Tier 4 Mail Order (90 Day Supply)

OUT OF NETWORK SERVICES:

Annual Deductible Copayment After Deductible Out of Pocket Limit

Blue Cross RI

BlueSolutions for H S A Plan 75

$6,350 / $12,700 $6,350/$12,700 No

$0 After Deductible $0 After Deductible $0 After Deductible

$0 After Deductible

$0 Co-payment $0 After Deductible $0 After Deductible

10 Visits Per Year

$0 After Deductible $0 After Deductible $0 After Deductible

$0 $0 After Deductible $0 After Deductible

$0 After Deductible $0 After Deductible $0 After Deductible $0 After Deductible $0 After Deductible

$12,700 / $25,400 40% $19,050 / $38,100

Coverage is effective the first of the month following hire date.

Your responsibility toward deductible: $ 1,400 for Individual Coverage or $ 2,800 for Family Coverage.