WLISD EMPLOYEE ORIENTATION HEALTH PLANS Ø TWO HEALTH

WLISD EMPLOYEE ORIENTATION HEALTH PLANS Ø TWO HEALTH PLANS AVAILABLE Ø HCA M 9203 R Ø BUY-UP MM 02 Ø

WLISD HEALTH PLAN BUY-UP MM 02 HCA M 9203 R $500 $1500 DEDUCTIBLE (*$750 HCA/$750) $1, 500 FAMILY $3000 FAMILY (*$1500 HCA/$1500) *prorated for Sept. 1 st effective date

WLISD HEALTH PLAN BUY-UP MM 02 COINSURANCE AFTER DEDUCTIBLE SATISFIED $2500 EMPLOYEE $7500 MAX FOR FAMILY HCA M 9203 R COINSURANCE AFTER DEDUCTIBLE SATISFIED $3000 EMPLOYEE $6000 MAX FOR FAMILY

WLISD HEALTH PLAN BUY-UP MM 02 HCA M 9203 R 100% OF PREVENTATIVE CARE IS COVERED BY PLAN

WLISD HEALTH PLAN BUY-UP MM 02 HCA M 9203 R PRESCRIPTIONS $15 GENERIC $30 BRAND FORMULARY $45 BRAND NON-FORMULARY MAIL: 3 TIMES RETAIL COPAY FOR 90 DAY SUPPLY BRAND $25 GENERIC COPAY RETAIL: Plan pays 80% employee pays 20% OF ALLOWABLE AMOUNT AFTER CALENDAR YEAR DEDUCTIBLE MAIL: Plan pays 80% employee pays 20% OF ALLOWABLE AMOUNT AFTER CALENDAR YEAR DEDUCTIBLE

WLISD HEALTH PLAN BUY-UP PREMIUMS HCA PREMIUMS EMPLOYEE ONLY $211. 38 EMPLOYEE ONLY EMPLOYEE & CHILDREN $380. 49 EMPLOYEE & CHILDREN EMPLOYEE & SPOUSE $486. 18 EMPLOYEE & SPOUSE EMPLOYEE & FAMILY $655. 28 $0 $250 EMPLOYEE & FAMILY $250 MARRIED BOTH WLISD $135

WLISD HEALTH PLAN BUY-UP MM 02 FLEXIBLE SAVINGS ACCOUNT HCA M 9203 R HEALTH CARE ACCOUNT

Monthly Employee Only BUY-UP $211. 38 Annual $2536. 56 Employee Only HCA $0 $0 ____________________ Deductible & Coinsurance BUY-UP HCA $2, 500 $4, 500 -$750 HCA Annual Premium Total Cost $2, 536. 56 $0 $5, 036. 56 $3, 750. 000

Monthly Annual Employee & FAMILY BUY-UP $655. 28 $7863. 36 Employee & FAMILY HCA $250. 00 $3000. 00 _______________________ Deductible & Coinsurance BUY-UP HCA $9, 000 -$1500 HCA Annual Premium $7863. 36 $3000. 00 Total Cost $16, 863. 36 $10, 500. 00

Employee & FAMILY BUY-UP Married WLISD FAMILY HCA Monthly $655. 28 $7863. 36 $135. 00 $1620. 00 Deductible & Coinsurance BUY-UP HCA Annual $6, 000 -$1500 HCA Annual Premium Total Cost $7863. 36 $13, 863. 36 $1620. 00 $6, 120. 00

SCENARIO Suzie, Jim, Katie, and Jake with HCA Family coverage. $1500 -$750 HCA Deductible ($3000 - $1500 HCA total for family) $1500 Coinsurance each, Max $3000 For Family. HCA $750 individual or $1500 Family. January 2016 March 2016 May 2016 June 2016 July 2016 August 2016 October 2016 December 2016 Katie annual check-up – 100% covered, no cost Jake annual check-up – 100% covered, no cost Jim gets flu - Doctor’s visit $100, Prescription $100 No out of pocket. Covered by HCA Suzie – Annual exam – 100% covered, no cost Jake gets sick - Doctor’s visit $100, Prescription $100 No out of pocket. Covered by HCA Jim – Annual exam – 100% covered, no cost Katie allergies – Doctor’s visit $150, shots $150 No out of pocket, $300 from HCA Suzie sick – Doctor $85, Prescription $100 No out of pocket, $185 from HCA Jim sick - Doctor $100, Prescription $100 No out of pocket. Covered by HCA TOTAL PAID FROM HCA ACCOUNT $1085 TOTAL $415 in HCA rolls to next year.