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2024 Benefit Guide - Pioneer Engineering

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www.elitebenefitsgroup.comELITEBENEFITSGROUPENHANCE - EDUCATE - ENGAGE - ENROLL - EMPOWER

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Pioneer Engineering is committed to a comprehensive employeebenefitprogram that helps our employees stay healthy, feel secure andmaintain a work/life balance.The benefits program was designed to provide you with a competitive level of standard coverage while  allowing  you  the  flexibility  to  choose benefits  that  reflect  your  needs  and  personal circumstances. In addition to receiving coverage for health insurance, you have the opportunity to choose other coverage that best meets your needs.www.elitebenefitsgroup.com

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1. DEDUCTIBLEThe amount you must pay before your insurance company starts to pay for covered services each year.3. COPAYMENTSA fixed amount you pay for covered services such as doctor visit or diagnostic test.5. COVEREDSERVICESMedical services included in your insurance plan, such as doctor visits, hospital stays and diagnostic tests.7. OUT-OF-NETWORK A doctor or medical facility that isnot contracted with your insurance company. Using out-of-network providers can result in you paying a higher portion of the medical bills or possibly the entire bill.2. COINSURANCEThe percentage of a medical expense you are responsible for paying. This usually kicks in after you have met your deductible.4. OUT-OF-POCKETMAXIMUMThe most you have to pay for covered services in a plan year.6. IN-NETWORKThe doctors, hospitals and other medical facilities and suppliers that contract with your insurance company to provide medical services.8. PROVIDERThe person or facility providing services to you, including doctors, hospitals and pharmacies.www.elitebenefitsgroup.comYOU SHOULD KNOW8TERMS

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United Healthcare is our medical carrier. Below is a brief summary of the medical plan. Using In- Network facilities and physicians will result in significant cost savings to the member. Network facilities and physicians can be found at www.myuhc.com > Find a provider > Medical Directory > Employer and Individual Plans > Choice Pluswww.elitebenefitsgroup.comPlan Design 1- BTFPIN NETWORKOUT OF NETWORKParticipant80% 20%50%50%CaCaalelelndnddararYYeaear DeeDeductible (CYD)IndividualFamily$5,000$10,000$10,000$20,000Maximum mOuOt of PocoockeketIndividualFamily$7,150$14,300$20,000$40,000Office VisisititPrimary Care Visits (non-surgical)Specialist Visit (non-surgical)Urgent Care VisitPreventive CareRetailPPrerescscription*Preferred Generic(PSOR\HH&RQWULEXWLRQ (Semi-MonthlyEmployee onlyEmployee and SpouseEmployee and Child (ren)Employee and Family$20/ $45 / $80$0.00$125$300PlanHospitalIn-Patient ServicesOut-Patient ServicesEmergency Room$150MEDICAL INSURANCEDeductible and Coinsurance Deductible and Coinsurance $300 Copay then 20% Coinsurance$15 Copay$100 Copay$25 CopayNo Copay50% Coinsurance50% Coinsurance50% Coinsurance50% CoinsuranceDeductible and Coinsurance Deductible and Coinsurance $300 Copay then 50% Coinsurance$20/ $45 / $80 Download Summary of Benefits

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United Healthcare is our medical carrier. Below is a brief summary of the medical plan. Using In- Network facilities and physicians will result in significant cost savings to the member. Network facilities and physicians can be found at www.myuhc.com > Find a provider > Medical Directory > Employer and Individual Plans > Choice Pluswww.elitebenefitsgroup.comPlan Design 2- DE87IN NETWORKOUT OF NETWORKParticipant100% 0%80%20%CaCaalelelndnddararYYeaear DeeDeductible (CYD)IndividualFamily$2,500$5,000$5,000$10,000Maximum mOuOt of PocoockeketIndividualFamily$2,500$5,000$10,000$20,000Office VisisititPrimary Care Visits (non-surgical)Specialist Visit (non-surgical)Urgent Care VisitPreventive CareRetailPPrerescscription*Preferred Generic(PSOR\HH&RQWULEXWLRQ (Semi-MonthlyEmployee onlyEmployee and SpouseEmployee and Child (ren)Employee and FamilyDeductible and Coinsurance$40.00$200$450PlanHospitalIn-Patient ServicesOut-Patient ServicesEmergency Room$250MEDICAL INSURANCEDeductible and Coinsurance Deductible and Coinsurance Deductible and CoinsuranceDeductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance No CopayDeductible and Coinsurance Deductible and Coinsurance Deductible and Coinsurance Deductible and CoinsuranceDeductible and Coinsurance Deductible and Coinsurance Deductible and CoinsuranceHSADeductible and Coinsurance Download Summary of Benefits

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DENTALwww.elitebenefitsgroup.comCLASSTYPE OF SERVICEINSURANCE PAYSNetworkWhen you receive services from a dentist in our network, your cost may be lower. Network dentists agree to lower their fees for dental services and not charge you the difference. You’ll have access to the Principal Plan Dental network, with more than 117,000 dentists nationwide. Visit Humana.com to find a dentist or call 1-800-233-4013.Dental insurance can help preserve your smile with easy-to-use coverage that promotes overall wellness.Benefits can help with a variety of dental costs, from routine cleanings to more advanced procedures. Coverage is available for you, your spouse and dependent children.Plan detailsThe benefit year maximum for this plan is $2,000 per person.Class A, B and C services apply toward the benefit year maximum.This plan has a deductible of $50 per person.The co-insurance for this plan is:INSURANCEClass AClass BClass CPreventive ServiceBasic ServiceMajor Service100%80%50%

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SGB0041AIN-NETWORKOUT-OF-NETWORK Calendar-year deductible(excludes orthodontia services)Individual$50Family$150Individual$50Family$150Deductible applies to all services excluding preventive services.Calendar-year annual maximum (excludes orthodontia services)$2,000 + extended annual maximum (see section below)Preventive services• Routine oral examinations (3 per year)• Bitewing x-rays (2 films under age 10, up to 4 films ages 10and older)• Routine cleanings (3 per year)• Periodontal cleanings (4 per year)• Fluoride treatment (1 per year, through age 16)• Sealants (permanent molars, through age 16)• Space maintainers (primary teeth, through age 15)• Oral Cancer Screening (1 per year, ages 40 and older)100% no deductible100% no deductible Basic services• Emergency care for pain relief• Amalgam fillings (1 per tooth every 2 years,composite for anterior/front teeth)• Oral surgery (tooth extractions including impactedteeth)• Stainless steel crowns• Harmful habit appliances for children (1 perlifetime, through age 14)80% after deductible 80% after deductible xMajor services50% after deductible 50% after deductible • Crowns (1 per tooth every 5 years)• Inlays/onlays (1 per tooth every 5 years)• Bridges (1 per tooth every 5 years)• Dentures (1 per tooth every 5 years)• Denture relines/rebases (1 every 3 years, following 6months of denture use)• Denture repair and adjustments (following6 months of denture use)• Periodontics (scaling/root planing and surgery1 per quadrant every 3 years)• Endodontics (root canals 1 per tooth per lifetime and 1 re-treatment)x xs[pspaceExtended Annual MaxAdditional coverage for preventive, basic, and major services after the calendar-year maximum is met (excludes orthodontia)30% 30%Employee Contributions Semi-Monthly)EmployeeEmployee and SpouseEmployee and Child (ren)Employee and FamilyNo Charge $18.00$27.00$44.00

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SGB0041AHumana Vision 150IN-NETWORK (Member cost)OUT-OF-NETWORK (Reimbursement)Exam with dilation asnecessary • Retinal imaging 1$10Up to $39Up to $30Not coveredContact lens exam options 2• Standard contact lens fit and follow-up• Premium contact lens fit and follow-upUp to $40 10% off retailNot coveredNot coveredFrames 3$150 allowance20% off balance over $150$80 allowanceStandard plastic lenses 4• Single vision• Bifocal• Trifocal• Lenticular$10$10$10$10Up to $25Up to $40Up to $60Up to $100Lens options 4• UV coating• Tint (solid and gradient)• Standard scratch-resistance• Standard polycarbonate - adults• Standard polycarbonate - children <19• Standard anti-reflective coating• Premium anti-reflective coatingx– Tier 1– Tier 2– Tier 3• Standard progressive (add-on to bifocal)• Premium progressive– Tier 1– Tier 2– Tier 3– Tier 4x• Photochromatic / plastic transitions• Polarized$15$15$15$40$40$25Premium anti-reflective coatings as follows:$37$4880% of charge less $20 allowance$10Premium progressives as follows:$75$85$100$55 copay, 80% of charge less $120 allowance$7580% of chargeNot covered Not covered Not covered Not covered Not coveredUp to $25Premium anti-reflective coatings as follows:Up to $25 Up to $25 Up to $25 Up to $40Premium progressives as follows:Up to $40 Up to $40 Up to $40 Up to $40Not coveredNot coveredContact lenses 5(applies to materials only)• Conventionalx• Disposable• Medically necessary$150 allowance,15% off balance over $150$150 allowance$0$128 allowance$128 allowance$210 allowance

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SGB0041AFrequency • Examination• Lenses or contact lenses• FrameOnce every 12 months Once every 12 months Once every 24 monthsOnce every 12 months Once every 12 months Once every 24 monthsDiabetic Eye Care: care and testing for diabetic members• Examination- Up to (2) services per year• Retinal Imaging- Up to (2) services per year• Extended Ophthalmoscopy- Up to (2) services per year• Gonioscopy- Up to (2) services per year• Scanning Laser- Up to (2) services per year$0$0$0$0$0Up to $77Up to $50Up to $15Up to $15Up to $331 Member costs may exceed $39 with certain providers. Members may contact their participating provider to determinewhat costs or discounts are available.2 Standard contact lens exam fit and follow up costs and premium contact lens exam discounts up to 10% may vary byparticipating provider. Members may contact their participating provider to determine what costs or discountsare available.3 Discounts may be available on all frames except when prohibited by the manufacturer. 4 Lens option costs may vary by provider. Members may contact their participating provider to determine if listed costsare available. 5 Plan covers contact lenses or lenses for frames, but not both.XDONOTDELETEIN-NETWORK (Member cost)OUT-OF-NETWORK (Reimbursement)Employee Contributions (Semi-Monthly)EmployeeEmployee and SpouseEmployee and Child (ren)Employee and FamilyNo Charge$8.00$8.00$14.00

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%(1(),76(/,*,%,/,7< $VDQHPSOR\HHRIPioneer Engineering\RXKDYHDFFHVVWRWKHIROORZLQJ EHQHILWVIRUWKH3ODQ<HDU-DQXDU\24±'HFHPHEHU4Core Plan Benefits offered:࠮࠮United Healthcare- Choice Plus =PZPVU+LU[HS7SHU (Humana) :+2,6(/,*,%/($1':+(1 $OODFWLYHIXOOWLPH(PSOR\HHVZKRZRUNDWOHDVW37KRXUVSHUZHHN(PSOR\HH EHQHILWVDUHHIIHFWLYHWKHILUVWRIWKHPRQWKIROORZLQJ30GD\VRIDFWLYHHPSOR\PHQW(/,*,%/('(3(1'(176 <RXPD\HQUROO\RXUHOLJLEOHGHSHQGHQWVLQFRYHUDJH7KH\LQFOXGH-/HJDO6SRXVH-&KLOGUHQXSWRDJHUHJDUGOHVVRIVWXGHQWVWDWXVRUPDULWDOVWDWXVLQFOXGLQJQDWXUDOFKLOGUHQVWHSFKLOGUHQDQGOHJDOO\DGRSWHGFKLOGUHQLQFOXGLQJFKLOGUHQOLYLQJZLWK\RXEHIRUHWKHDGRSWLRQLVILQDOZKRDUH\RXUGHSHQGHQWVRUIRUZKRP\RXDUHUHTXLUHGWRSURYLGHKHDOWKFDUHFRYHUDJHXQGHUD4XDOLILHG0HGLFDO&KLOG6XSSRUW2UGHU&+$1*,1*<285&29(5$*('85,1*7+(<($5 ,I\RXQHHGWRFKDQJH\RXUFRYHUDJHWKURXJKRXWWKH\HDU\RXPD\RQO\GRVRLI\RX H[SHULHQFHDQHOLJLEOHFKDQJHLQVWDWXVOLIHHYHQWVXFKDV࠮ )PY[O(KVW[PVU࠮ *OHUNLPU0UZ\YHUJL*V]LYHNL(KKYLZZ,TWSV`TLU[:[H[\Z࠮ +LH[OPU[OL-HTPS`࠮ +LWLUKLU[*OPSK9LHJOLZ3PTP[PUN(NL࠮ +P]VYJL(UU\STLU[࠮ -43(9LSH[LK3LH]L࠮ 3LNHS:LWHYH[PVU4HYYPHNL࠮ :WV\ZL3VZZVM6[OLY*V]LYHNL࠮ ,UYVSSTLU[PU4HYRL[WSHJL*V]LYHNL<RXPXVWPDNHFKDQJHVWR\RXUEHQHILWFRYHUDJHZLWKLQGD\VRIDQHOLJLEOH FKDQJHLQVWDWXVOLIHHYHQW:+$7+$33(16,),'21¶7(152//" ,I\RXGRQRWHQUROOLQWKHEHQHILWVSURJUDP\RXZLOODXWRPDWLFDOO\UHFHLYH³GHIDXOW´ FRYHUDJHZKLFKLV1R&RYHUDJH,IODWHURQ\RXGHFLGHWRHQUROOLQEHQHILWV\RXPD\EHVXEMHFWWREHQHILWZDLWLQJ SHULRGVUHTXLUHHYLGHQFHRILQVXUDELOLW\DQGRUEHUHTXLUHGWRZDLWXQWLOWKHQH[W $QQXDO(QUROOPHQWwww.elitebenefitsgroup.com

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The information in this Enrollment Guide is intended for illustrative purposes and informational purposes only. The information contained herein was taken from various summary plan descriptions, certificates of coverage and benefit information. Every effort was taken to accurately report your benefits however discrepancies and errors are always possible. It is not intended to alter or expand rights or liabilities set forth in the official plan documents or contracts. It is not an offer to contract nor are there any express or implied guarantees. In case of a discrepancy between this information and the actual plan documents, the actual plan documents will prevail. If you have any questions about this summary, please contact Human Resources or Elite Benefits GroupELITE BENEFITS GROUPMEDICALUnited Healthcare-Choice Pluswww.myuhc.com DENTAL / VISION713-575-3722CONTACT INFORMATIONwww.elitebenefitsgroup.comHUMAN RESOURCESCanion Boyd 832-307-0010cboyd@pioneerengineer.comHumanaHumana.com1-800-233-4013