Services PPO with HSA EPO Kaiser Permanente HMO. $2,500/employee only coverage $5,000/employee + one or more covered dependents

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1 Benefits At-A-Glance Health Care Coverage Staff and UHW (SEIU) Your benefits go into effect the first day of the month following your hire date. You have a choice of MEDICAL PLANS, so be sure to review your choices carefully and choose what s right for you. Stanford Hospital & Clinics pays most of the premium costs (and in some cases all of the premium costs); you pay the rest through payroll deductions. All medical plans provide 100% for preventive care from in-network providers, with no deductibles or copays. When you enroll, you can also choose for your spouse or eligible domestic partner and/or your children. Services PPO with HSA EPO Kaiser Permanente HMO In-Network Out-of-Network* Annual Deductible applies to medical and mental health/substance abuse $1,250/employee only $2,500/employee + $2,500/employee only $5,000/employee + $400/per person $1,000/family limit $400/per person $1,000/family limit Annual Out-of-Pocket Maximum includes deductible (applies to medical and mental health/substance abuse) $2,500/employee only $5,000/employee + $5,000/employee only $10,000/employee + $1,800/per person $3,600/family Copayments do not apply to this maximum $1,800/individual $3,600/family Maximum Lifetime Benefit Unlimited Unlimited Unlimited Unlimited Choice of Physicians You must use UnitedHealthcare Options PPO network providers for in-network benefits You may use any licensed provider You must use UnitedHealthcare Options PPO network providers; you do not need to select a Primary Care Physician (PCP) You must use Kaiser facilities; all care and covered services must be approved by a Kaiser physician Hospital Care Room and Board, Surgeon, Physician Visit and Anesthesiologist 80% of charges, after deductible; precertification required 60% ; precertification required or $300/ admission penalty applies (waived if emergency admission) 90% ; precertification required 90% Office Care Physician Visit 80% of charges after deductible $20/visit $20/visit Routine Physical Adult Preventive Services Child Preventive Services Specialist Visit 80% Immunizations Infertility Diagnosis 80% $35/visit $35/visit for counseling and consultation; 50% covered expenses for infertility studies and tests (does not apply to out-of-pocket maximum $35/visit 50% for all services related to covered infertility treatment Prescription Drugs Prescription Drugs provided through Express Scripts Prescription Drugs provided through Express Scripts Prescription Drugs provided through Express Scripts Prescription Drugs provided through Kaiser Permanente * Usual Customary and Reasonable (UCR) charges are the fees normally charged for medical services or supplies in a particular geographic location.

2 Services PPO with HSA EPO Kaiser Permanente HMO In-Network Out-of-Network* Preventive Non-preventive Retail 30-day Supply Generic and Formulary Brands: 100%; no deductible Non-formulary brand: $50/prescription; no deductible Mail-order: Generic and formulary brands: 100%; no deductible Non-formulary brand: $100/prescription; no deductible 80% Retail Mail-order Not covered Retail 30-day supply Generic: $10/prescription Formulary brand: $25/prescription Non-formulary brand: $50/prescription Mail-order 90-day Supply Generic: $20/prescription Formulary brand: $50/prescription Non-formulary brand: $100/ prescription Retail 30-day Supply Generic: $10/prescription Brand: $25/prescription when prescribed by a plan physician Mail-order 100-day supply Generic: $20/prescription Brand: $50/ prescription Women s Contraceptives Provided through Express Scripts Provided through Express Scripts Provided through Express Scripts Provided through Kaiser Permanente Pharmacy Contraceptives examples include: oral, patch, emergency See medical plan for additional details Retail & Mail-order 100%, no deductible for generic and formulary Non-formulary brand: $50/ prescription (retail); $100/ prescription (mail-order); deductible waived Retail: 60% of UCR charges Mail-order: Not covered Retail & Mail-order 100%, no deductible for generic and formulary Non-formulary brand: $50/ prescription (retail); $100/ prescription (mail-order) (see plan for details) Women s Contraceptives covered under the Medical Plan Contraceptive injections, and contraceptive devices such as, IUDs, implants, (including the insertion and removal) See medical plan for additional details Services through UMR Services through UMR Services through UMR Services through Kaiser HMO No Charge No Charge No Charge * Usual Customary and Reasonable (UCR) charges are the fees normally charged for medical services or supplies in a particular geographic location. 2

3 2013 Employee Contributions PPO If your hourly rate is $28.50 or less: Employee only $0 $ Employee + child(ren) $0 $1, Employee + spouse $0 $1, Employee + family $0 $1, If your hourly rate is more than $28.50 an hour but less than $50.00 an hour: Employee only $0 $ Employee + child(ren) $0 $1, Employee + spouse $79.20 $1, Employee + family $79.20 $1, If your hourly rate is $50.00 or more: Employee only $0 $ Employee + child(ren) $0 $1, Employee + spouse $ $1, Employee + family $ $1, EPO Employee only $99.54 $ Employee + child(ren) $ $1, Employee + spouse $ $1, Employee + family $ $2, Kaiser HMO* If your hourly rate is $28.51 or more: Employee only $67.12 $ Employee + child(ren) $ $ Employee + spouse $ $1, Family $ $1, *If your hourly rate is $28.50 or less, you are eligible for free at all tiers under the Kaiser plan. NOTE: Imputed income will be assessed if you are covering an eligible domestic partner and/or domestic partner s child(ren) under your health benefits. Important! If you cover your spouse/eligible domestic partner on your medical plan, you will be charged a $50 monthly access fee unless you certify your spouse/eligible domestic partner is enrolled in their employer-sponsored medical plan. 3

4 Vision When you enroll in a medical plan, you automatically receive vision through Vision Service Plan. When you use a VSP provider, you receive an eye exam and eyewear with low copayments. Dental Delta Dental PPO Employee premiums required for spouse/eligible domestic partner and family You can visit any dental care provider you wish When you use a provider in the PPO network, you typically pay less because network providers have agreed to provide dental care to members at lower, negotiated rates After you pay an annual deductible, you pay a percentage of the bill, called coinsurance, for most dental services Diagnostic and preventive care are covered at 100% and are not subject to the deductible. DeltaCare USA No employee premiums You may choose a primary care dentist from the DeltaCare network You may select up to three different primary care dentists for your family Most preventive, diagnostic and basic services are covered at 100% You pay a copayment for major and restorative services. Monthly Coverage Cost for: Employee Monthly Contribution LPCH Monthly Cost Sharing Employee Monthly Contribution LPCH Monthly Cost Sharing Employee only $0 $56 $0 $16 Employee + spouse/eligible DP Employee + child(ren) $26 $77 $0 $30 $0 $106 $0 $28 Employee + Family $26 $128 $0 $43 NOTE: Imputed income will be assessed if you are covering an eligible domestic partner and/or domestic partner s child(ren) under your dental benefits. Health Savings Account A Health Savings Account (HSA) is an employee-owned, tax-advantaged savings and investment account to help you pay for health care expenses both now and into retirement. Your account is 100% yours, meaning if you leave or retire from SHC, you can take your funds with you. The HSA is only available if you enroll in the PPO medical plan. For 2013, IRS regulations allow for HSA savings up to $3,250 (individual), $6,450 (family), and an additional $1,000 catch-up contribution for those who are 55 and older as of December 31, Flexible Spending Accounts Flexible Spending Accounts (FSAs) allow you to set aside pre-tax money each year to pay for certain eligible health care and dependent daycare expenses. Your contributions are automatically deducted from your paycheck before taxes are withheld, which means your taxable income will be lower Flexible Spending Account Maximum Contribution Limits Health Care FSA $2,500 Dependent Care FSA $5,000 4

5 Backup Care Bright Horizons provides backup care 24 hours a day, 365 days a year, for your loved ones of any age, whether healthy or mildly ill. Employees may utilize up to 80 hours of care per calendar year when they need to be at work and their regular child or adult/elder care is unavailable. The cost is $2 per hour for center based care and $4 per hour for in-home care. Rewarding a Healthy You Our wellness incentive program, Rewarding a Healthy You, is designed to encourage employees to focus on improving their health and well-being. By participating in approved wellness activities, you will earn wellness incentive points, which are then converted to dollars, based on your achieved wellness level. These contributions will be deposited into your Health Savings Account or Health Incentive Account to pay for eligible medical costs. You can earn up to $500 for employee only and up to $1,000 for employees who have enrolled in their SHC medical plan. Paid Time Off You can use your paid time off (PTO) for vacation, illness, holidays, family emergencies, religious observances and other reasons. As a full-time employee, you earn the following number of paid days off: Paid Time Off Employment Type Exempt employees: Non-exempt employees: Years of Service or more or more PTO Days Earned PTO Time Accrued Per Hour Worked Extended Sick Leave (ESL) If you are unable to work due to your own serious health condition, as of the fourth consecutive day of absence, or from the first day if you are hospitalized on that day, you will receive an Extended Sick Leave benefit that is at no additional cost to you. All regular or fixed-term employees begin accumulating ESL hours at the rate of.0116 hours per hour worked (equivalent of 24 hours per year for a full time employee). There is no limit on the accumulation of ESL. Retirement Plan You have a great retirement plan! After you ve been with us for one year, SHC automatically contributes 5% of your base pay to your retirement plan. To support your retirement savings goals, SHC also matches your personal contribution to the Plan, increasing your savings. The match you are eligible to receive depends on your years of service as follows: Your Service SHC Retirement Plan Match 1 9 years 100% of your contribution, up to 4% of your pay years 100% of your contribution, up to 5% of your pay 15+ years 100% of your contribution, up to 6% of your pay For example, if you have been with SHC for five years and elect to save 4%, you receive: 5% automatic SHC contribution + 4% your savings + 4% SHC match 13% of your base pay Even better, SHC contributions are immediately yours there s no waiting period. So, even if you leave before retirement, you keep all the money in your account! Life and Accident Insurance Free up to $50,000 Life Insurance for yourself. You can buy extra for yourself, your spouse and your children at competitive group rates plus, you can take the with you when you leave. Disability Short-Term Disability (STD) You can purchase to supplement California SDI, for a maximum benefit of 60% of your base pay, up to $1,846 per week. Long-Term Disability (LTD) You receive hospital-paid LTD that pays a benefit of 50% of your base pay up to $8,000 per month. You can buy additional, for a total benefit of 662 3% of your base pay, up to $8,000 per month. 5

6 Educational Assistance As a full-time employee who has completed the trial period, you are eligible for tuition reimbursement up to $1,000 per fiscal year for approved courses. Voluntary Benefits Group Legal Plan You can receive access to legal advice and professional legal representation at an affordable price, through a voluntary, after-tax payroll deduction. Single : $15.79 per month. Family : $19.99 per month. Pet Insurance Purchase pet insurance to help you manage the cost of medical care for your pet. Coverage is available for dogs, cats, birds and other exotic pets. Costs vary based on the level of elected. Identity Theft Protection Receive comprehensive identity theft safeguards and restoration services. Membership includes a credit report at no additional charge, personal credit score and analysis, continuous credit monitoring, access to the services of risk management experts and more through a voluntary, after-tax payroll deduction. Single : $7.95 per month. Spouse/Domestic Partner : Additional $3.95 per month. This document contains benefit highlights only and is subject to change. The specific terms of, exclusions and limitations are contained in the plan documents. If there is any conflict between this summary and the plan documents, the plan documents will govern. This summary does not imply a contract of employment. SHC reserves the right to review, change or end any benefit for any reason. March 2013 Staff and UHW (SEIU)