Sherwin-Williams Medical, Prescription Drug and Dental Plans Plan Comparison Charts

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1 Sherwin-Williams Medical, Prescription Drug and Dental Plans Plan Comparison Charts You and Sherwin-Williams share the cost of certain benefits including medical and dental coverage and you have the opportunity to take advantage of group rates for others. You pay your share of the cost of medical, dental and vision coverage with pre-tax deductions from your paycheck. Sherwin-Williams Medical Plan Comparison See for HMO plan summaries Let s Get real about costs. Plan Features Gold PPO Silver HealthFund with HSA Bronze HealthFund with HSA Calendar Year Deductible Single (employee coverage only) $750 $1,500 $1,500 $3,000 $1,750 $3,500 Family (employee and spouse and/or dependent coverage) $1,500 $3,000* $3,000 $6,000* $3,500 $7,000* Out-of-Pocket Maximum (includes deductible) Single (employee coverage only) Family (employee and spouse and/or dependent coverage) $3,500 None $4,750 None $5,500 None $7,000 None $9,500 None $11,000 None Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited * The family deductible must be met before benefits are provided on two-person or family coverage. Once the family deductible is met, all family members will be considered as having met their deductible for the remainder of the year. If you enroll in the Silver HealthFund HSA at Open Enrollment, are a new hire, or change from part-time to full-time status on or before June 1, 2015, Sherwin Williams will contribute $400 to your health savings account if you have single coverage, or $800 to your account if you have family coverage. You will receive 50% of the Company contribution in your account in early January If you are an active employee still enrolled in the plan on June 30, 2015, you will receive the remaining 50% of the Company contribution in early July, Summary of and Coverage The Group Health Plan for The Sherwin-Williams Company (Plan) offers a variety of medical plan options. Choosing a medical plan option is an important decision, and to help you make an informed decision, your Plan makes available a Summary of and Coverage (SBC). The SBC summarizes important information about all of the medical plan options in a format that will assist you with making a comparison of the different medical plan options. The SBC is available online at A paper copy is also available by calling (800)

2 * ** * ** Physician Services Office Visits internists, pediatricians, family and general practitioners Specialist Office Visits $20 copay per office visit; no deductible; additional services subject to deductible and coinsurance $35 copay per visit; no deductible; additional services subject to deductible and coinsurance Physician In-Hospital Services Other Physician Services Preventive Care Services Routine Physicals/Immunizations (7 exams in the first 12 mos. of life; 3 exams in the second 12 mos. of life; 3 exams in the third 12 mos. of life; 1 exam per calendar year thereafter) Routine OB/GYN Exam (one routine exam per year; including Pap smear and related lab expenses) Routine Mammography (one baseline mammogram for females age 35 to 39; one routine mammogram per calendar year age 40 and over) Routine Digital Rectal Exam (DRE) and Prostate Antigen Test (PSA) (one per year for males age 40 and over) Nutritional Counseling (3 visits per calendar year) Obesity Screening and Counseling (To age 22: unlimited visits. Age 22 and older: up to 26 visits per 12 months, 10 of which can be for healthy diet counseling) Tobacco Cessation Counseling (up to 8 visits per 12 months) Dermatologist Screening Exam (one screening exam per calendar year) ** The out-of-network benefit is a percentage of the reasonable and customary (R&C) charge for a covered service or supply. Charges in excess of the R&C amount are the responsibility of the member. Please refer to the Summary Plan Description for additional information. 2

3 * ** * ** Alcohol/Drug Screening and Counseling (up to 5 visits per 12 months) Allergy Testing Allergy Injections Maternity Prenatal visits Hospital and related expenses 20% after deductible 40% after deductible 20% after deductible 40% after deductible Hospital Services Inpatient Coverage Outpatient Coverage Emergency Room 20% after deductible and $100 per-visit copay (copay waived if admitted) 20% after deductible and $100 per-visit copay (copay waived if admitted) 20% after deductible 20% after deductible Non-Emergency Use of the Emergency Room No coverage No coverage No coverage No coverage Walk-in Clinics Urgent Care $25 copay per visit; no deductible Urgent Care Provider $35 copay per visit; no deductible 20% after deductible Covered at 100% after deductible 20% after deductible Non-Urgent Use of Urgent Care Provider No coverage No coverage No coverage No coverage Surgical Services - Inpatient Surgical Services - Outpatient Diagnostic X-ray and Laboratory ** The out-of-network benefit is a percentage of the reasonable and customary (R&C) charge for a covered service or supply. Charges in excess of the R&C amount are the responsibility of the member. Please refer to the Summary Plan Description for additional information. $100 gift card upon enrollment in the Beginning Right SM Maternity Management Program during the first trimester of pregnancy. 3

4 * ** * ** Skilled Nursing Facility (up to 120 days per calendar year) Home Health Care (up to 100 visits per calendar year) Hospice Care Short-Term Rehabilitation (physical, occupational and speech therapy) Chiropractic Care (6 visits per calendar year) 50% after deductible 50% after deductible 50% after deductible 50% after deductible Durable Medical Equipment Oral Surgery Bariatric Surgery (covered expenses not subject to out-ofpocket maximum) Mental Health Care Inpatient Care Outpatient Office Visit $20 copay per visit Chemical Dependency Care Inpatient Care Outpatient Office Visit $20 copay per visit ** The out-of-network benefit is a percentage of the reasonable and customary (R&C) charge for a covered service or supply. Charges in excess of the R&C amount are the responsibility of the member. Please refer to the Summary Plan Description for additional information. 4

5 Sherwin-Williams Prescription Drug Coverage Comparison Administered by Caremark Prescription Drug Gold PPO Silver and Bronze HealthFund with HSAs* Generic Prescription Preferred Brand-Name Prescription Non-Preferred Brand-Name Prescription Caremark Other Prescription Out-of- Pocket Maximum $3,100 single $6,200 family Not applicable Retail Limited to 30-day supply You pay the first $10 for each prescription You pay the first 35% ($30 min/$125 max) for You pay the first 45% ($45 min/$150 max) for You pay 20% after meeting deductible Not covered Mail Order Limited to 90-day supply You pay the first $20 for each prescription You pay the first 25% ($60 min/$235 max) for You pay the first 35% ($75 min/$275 max) for You pay 20% after meeting deductible Not covered Preventive Drugs Subject to plan provisions listed above 100% no deductible Not covered Oral Contraceptives Oral contraceptives covered at 100% for generic and brand name if no generic available Note: Sherwin-Williams uses the Caremark formulary drug list. Refer to the medical Summary Plan Description for exclusions. Long-term maintenance medications must be filled in 90 day quantities through mail order at Caremark or at your local CVS pharmacy. * The cost of prescription drugs is applied toward satisfying the HealthFund plan deductible. The family deductible must be met before coinsurance is provided on a two-person or family coverage. Once the family deductible is met, all family members will be considered as having met their deductible for the remainder of the calendar year. If a brand-name drug is dispensed when a generic drug is available, you must pay the difference between the brand-name drug and the generic drug, plus the generic drug copayment. Does not apply towards prescription out-of-pocket maximum. Certain brand-name drugs are subject to the Step Therapy program; the program requires to fill for a generic drug before a brand-name drug can be filled. See My Sherwin for more information on the Step Therapy program. Sherwin-Williams PPO Dental Plan Comparison Plan Features * ** Calendar Year Deductible Applies to Preventive, Diagnostic, Basic and None $25 per individual, $75 per family Calendar Year Benefit Maximum Applies to Preventive, Diagnostic, Basic and $1,200 per individual $1,200 per individual Preventive and Diagnostic Services Covered at 100% with no deductible Covered at 100% of R&C after deductible Basic Restorative Services Employee Responsibility Employee Responsibility Orthodontia to age 19 or to age 25 if full-time student (dependents only) You pay 20% of discounted charges You pay 50% of discounted charges You pay 50% of discounted charges You pay 20% of R&C after deductible You pay 50% of R&C after deductible You pay 50% of R&C after deductible Lifetime Maximum for Orthodontia $1,200 per covered dependent child $1,200 per covered dependent child ** The out-of-network benefit is a percentage of the reasonable and customary (R&C) charge for a covered service or supply. Charges in excess of the R&C amount are the responsibility of the member. Please refer to the Summary Plan Description for additional information. 5

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