Research Triangle Institute Research Triangle Institute is offering Medical, Dental, Vision, Pharmacy, Medical Evacuation and Repatriation, and Long Term Disability> benefits through Cigna Global Health Benefits to our employees. This comprehensive international healthcare program allows our employees and their families to access quality healthcare anywhere in the world. The following pages will provide a general overview of the plan designs for our employees on international assignment. International Medical Plan Lifetime Maximum Benefit Deductible Individual Family Out of Pocket Maximum - Excludes Deductible Individual Family Deductible/Out of Pocket Accumulation Coinsurance (Cigna Pays) Inpatient Hospital Services Facility Physician Outpatient Facility Services Hospital Emergency Room Infertility (Procedures directly related to diagnosis are covered. Treatment, prescription drugs, and/or other method to bypass, i.e. In-vitro, are not covered) Family Planning Women s Services -Inpatient hospital facility -Outpatient hospital facility -Surgical services such as tubal ligation are covered (excluding reversals) -Includes contraceptive devices as ed or prescribed by a physician Family Planning Men s Services -Inpatient hospital facility -Outpatient hospital facility -Surgical services such as vasectomy are covered (excluding reversals) International In-Network U.S. Out of Network U.S. $300 $600 $300 $600 Unlimited $1,200 $3,600 $1,200 $3,600 $1,200 $3,600 $9,000 $18,000 Cross applies between International, In network and Out of network U.S. 60% after 60% after 60% after 60% after 60% after 60% after (Office Visit 100% after $20 copay) 60% after 1
Research Triangle Institute International Medical Plan Maternity Care Services Lab & Radiology Facility Short Term Rehabilitation (60 day maximum per calendar year for all therapies combined) Includes Cardiac Rehab, Physical Therapy, Speech Therapy, Occupational Therapy, Pulmonary Rehab and Cognitive Therapy Physician Visit Prescription Mental Illness and Substance Abuse Inpatient Outpatient Skilled Nursing Facility (120 day maximum per calendar year) International In-Network U.S. Out of Network U.S. 60% after (Office Visit 100% after $20 copay) 60% after (Office Visit 100% after $35 copay) 60% after 100% after $20 copay 60% after Refer to the Prescription Drug Benefits Schedule Refer to the Prescription Drug Benefits Schedule 60% after 60% after 60% after Home Health Care (120 day Maximum per calendar year) Chiropractic Services (20 day maximum per calendar year) Hospice TMJ ($1000 maximum per lifetime) Diabetes Equipment & Supplies (Prescribed and recommended in writing by a physician. Equipment included are: insulin pumps, blood glucose meters and strips, urine testing strips, insulin, syringes, lancets, alcohol swabs and pharmacological agents for controlling blood sugar) 60% after 100% after $20 copay 60% after 60% after 100% after $20 copay 60% after 60% after 2
Research Triangle Institute International Medical Plan International In-Network U.S. Out of Network U.S. External Prosthetic 60% after Appliances Durable Medical Equipment 60% after Dental Accident 100% after $20 copay 60% after (Limited to a continuous course of treatment started within six months of accidental injury to sound natural teeth) Women s Preventive Services (As defined by PPACA including Annual well-woman visits, Screening for gestational diabetes, FDAapproved contraception methods and contraceptive counseling; including birth control and sterilization, HPV DNA testing for women 30 years and older, Sexuallytransmitted infection counseling, HIV screening and counseling, Domestic violence screening and counseling) Breast-feeding equipment and supplies (Limited to one rental of one breast pump per birth as ed or prescribed by a physician. Includes related supplies and counseling) Delaware Mandated Autism 60% after Spectrum Diss Coverage (Coverage for the screening, diagnosis and treatment of autism spectrum dis and medications as prescribed by licensed providers) Well Child Care 3
International Medical Plan Immunizations (For children birth to age 18) Includes diphtheria, hepatitis A, hepatitis B, measles, mumps, pertussis, polio, rubella, tetanus, varicella, Haemophilus influenza B) Research Triangle Institute International In-Network U.S. Out of Network U.S. Adult Preventive Care Travel Immunizations (Employee and Dependent immunizations required for travel are included.) Travel Immunizations (Employee and Dependent immunizations required for travel are included.) Papanicolaou Screening Test (One test per calendar year for females over age 18) Prostate Cancer Screening (One test per calendar year for males over age 50) Mammograms (One baseline exam for asymptomatic women ages 35-39; one exam every two years for asymptomatic women ages 40-49; one exam annually for women age 50 and over and whenever prescribed) Lead Poisoning Screening (For children at or around 12 months and children under age 6 who are considered to be high risk) Colorectal Cancer Screening (Age 50 and older or any person deemed as high risk of colon cancer) Routine Eye Exam Exam: Every 24 months $100 maximum Hardware: $100 maximum every 24 months 100% not subject to 100% not subject to 100% not subject to 4
Hearing Exam: One every 24 months Hardware: Limited to dependent children under age 24, maximum of $1,000 per hearing aid unit necessary for each ear, every three years. Research Triangle Institute 60% after Direct Access to Obstetricians and Gynecologists You do not need prior authorization from the plan or from any other person (including a primary care provider) in to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, visit www.cignaenvoy.com or contact customer service at the phone number listed on the back of your ID card. Selection of a Primary Care Provider This plan generally allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members. For children, you may designate a pediatrician as the primary care provider. 5
Global Wellness Programs Pre-Assignment Assistance Program Health and Well-Being Assessment (HA) Research Triangle Institute Pre-Assignment Assistance Program - Cigna's Pre-Assignment Assistance is a unique clinical program that offers comprehensive case management, care coordination, inpatient management, evacuation assistance, and online expert second opinions for employees and dependents either in the U.S. or abroad. The tool can be accessed prior to or during assignment through Cigna's secure web portal Cigna Envoy. Employees that utilize the Pre- Assignment Assistance Program are more likely to have a successful assignment. The HA is a short, online assessment that is core to our wellness solutions and the first step to identifying personal health risks. Those who complete the HA, immediately receive a personalized health risk profile report. The HA is a medically validated by the World Health Organization. Pharmacy Management Purchased Inside the United States Only Prescription Drugs Pharmacy Participating Pharmacy Non-Participating Pharmacy Generic Brand Non-Preferred Brand Name Mail Order Drugs $15 copay per 30 day prescription or refill $35 copay per 30 day prescription or refill 20% coinsurance per prescription or refill 20% coinsurance per prescription or refill $50 copay per 30 day prescription or refill 20% coinsurance per prescription or refill Generic Brand Non-Preferred Brand $45 copay per 90 day prescription or refill $105 copay per 90 day prescription or refill $150 copay per 90 day prescription or refill In-network coverage only In-network coverage only In-network coverage only 6
Research Triangle Institute Emergency Medical Evacuation/Repatriation Emergency Evacuation Family Travel Arrangements Return of Dependent Children Repatriation of Mortal Remains Return of Traveling Companion 100% coverage not subject to the for services approved by International SOS Economy round-trip airfare to the place of hospitalization for one family member for hospitalizations in excess of 7 days One-way Economy airfare to return dependent children to their country of residence 100% coverage not subject to the In the event of hospitalization or evacuation, and a traveling companion s air ticket is no longer usable, one-way economy airfare will be provided to the original point of departure. International Dental Plan Calendar Year Maximum (for Class I, II, III) Lifetime Maximum (for Class IV) Deductible (waived for Class I) $1,500 $1,500 $25 Individual / $75 Family Aggregate Class I Class II Class III Preventive Services Diagnostic General Preventive Basic Services Restorative (Basic) Endodontics Periodontics Prosthodontics Removable (Maintenance) Prosthodontics Fixed Bridge (Maintenance) Oral Surgery Major Services Restorative (Major) Prosthodontics Removable (Installation) Prosthodontics Fixed Bridge (Installation) 100%, not subject to 50% after Class IV Orthodontia (for dependent children under age 19) after a $50 lifetime subject to a $1,500 lifetime maximum 50% after lifetime 7
Long Term Disability Insurance Research Triangle Institute Monthly Benefit 60% of base monthly salary to a maximum benefit of $8,500 Elimination Period Duration 90 days Reducing Benefit Duration (RBD) Definition of Disability Partial Disability Recurrent Disability Survivor Benefits Offsets Mental Illness Limitation Age at Disability <60 60 61 62 63 64 65 66 67 68 69 and over 24 month Own Occupation Included 6 months 3 months Max Benefit Period to age 65 60 months 48 months 42 months 36 months 30 months 24 months 21 months 18 months 15 months 12 months US Social Security, CPP-QPP, Local Country Social Programs & other standard offsets. 24 months Minimum Monthly Benefit $50 Maternity Coverage Included Pre-existing Exclusion 3/6/12 Waiver of Premium Included Cost of Living Adjustment Cost of Living freeze 8