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

Health Options

Plan 1 Plan 2 Plan 3Plan NameTraditional Traditional TraditionalPlan TypeSELF-FUNDED PPO COPAYPLANSELF-FUNDED PPO COPAYPLANSELF-FUNDED PPO COPAYPLANMedical Plan Design$1,500 In-network/$3,000 Out-of-network$2,500 In-network/$5,000 Out-of-network$3,500 In-network/$7,000 Out-of-networkIndividual Deductible$3,000 In-network/$6,000 Out-of-network$5,000 In-network/$10,000 Out-of-network$7,000 In-network/$14,000 Out-of-networkFamily Deductible70% In-network/40% Out-of-network70% In-network/40% Out-of-network70% In-network/40% Out-of-networkCoinsurance$6,600 In-network/$19,800 Out-of-network$7,150 In-network/$21,450 Out-of-network$9,100 In-network/$27,300 Out-of-networkTotal Ind Plan OOP Maximum$13,200 In-network/$39,600Out-of-network$14,300 In-network/$42,900Out-of-network$18,200 In-network/$54,600Out-of-networkTotal Fam Plan OOP MaximumIndividual/Family deductible Individual/Family deductible Individual/Family deductibleFamily Deductible AccumulationMethod$40/$60 copay, then covered at100%$40/$60 copay, then covered at100%$40/$60 copay, then covered at100%PCP/Specialist VisitWalmart Health Virtual Care,Vori HealthWalmart Health Virtual Care,Vori HealthWalmart Health Virtual Care,Vori HealthTelemedicine Vendor(s)$0 per visit for Urgent Care orTalk Therapy visitsUp to three Walmart HealthVirtual Care Urgent Care visitsper individual and five WalmartHealth Virtual Care Talk Therapyvisits per individual are includedper month.$0 per visit for Urgent Care orTalk Therapy visitsUp to three Walmart HealthVirtual Care Urgent Care visitsper individual and five WalmartHealth Virtual Care Talk Therapyvisits per individual are includedper month.$0 per visit for Urgent Care orTalk Therapy visitsUp to three Walmart HealthVirtual Care Urgent Care visitsper individual and five WalmartHealth Virtual Care Talk Therapyvisits per individual are includedper month.Walmart Health Virtual CareTelemedicine$0 copay for initial evaluation$0 copay for 12-month treatmentplans for knee, lumbar spine,cervical spine, hip, and/orshoulder painOther Vori Health coveredcharges subject to deductibleand coinsurance$0 copay for initial evaluation$0 copay for 12-month treatmentplans for knee, lumbar spine,cervical spine, hip, and/orshoulder painOther Vori Health coveredcharges subject to deductibleand coinsurance$0 copay for initial evaluation$0 copay for 12-month treatmentplans for knee, lumbar spine,cervical spine, hip, and/orshoulder painOther Vori Health coveredcharges subject to deductibleand coinsuranceVori Health virtual muscle andjoint care Telemedicine$75 copay, then covered at100%$75 copay, then covered at100%$75 copay, then covered at100%Urgent Care VisitCigna LocalPlus / Cigna OAP Cigna LocalPlus / Cigna OAP Cigna LocalPlus / Cigna OAPMedical NetworkDeductible and coinsurance Deductible and coinsurance Deductible and coinsuranceOP SurgeryCIGNA PBM CIGNA PBM CIGNA PBMPharmacy Benefit Manager$20/$50/$75 $20/$50/$75 $20/$50/$75Rx Coverage (Generic/Brand/Non-preferred brand)Deductible and coinsurance Deductible and coinsurance Deductible and coinsuranceDXLDeductible and coinsurance Deductible and coinsurance Deductible and coinsuranceER TreatmentN/A N/A N/AAMECalendar Year, deductible creditincludedCalendar Year, deductible creditincludedCalendar Year, deductible creditincludedDeductible and OOP AccrualPeriodGroup Name: Ranger InspectionPlan/Rate SummaryPlease review this proposal. If you are ready to move forward, contact your Licensed Agent or Sales Representative to discuss the next steps.Plans quoted in this proposal: 4

Stop-Loss Insurance and Financial DetailsAnnual Aggregate Attachment PointSpecific Attachment PointMonthly Bill MedicalEmployeeEmployee + SpouseEmployee + ChildFamilyStop-loss PremiumAdmin, Sales and General ExpensesClaims AccountTotal$10,000.08Plan 1$10,000.00$756.39$1,928.80$1,474.97$2,496.09$1,669.65$749.49$833.34$3,252.48$10,000.08Plan 2$10,000.00$694.82$1,771.77$1,354.89$2,292.88$1,481.18$673.18$833.34$2,987.70$10,000.08Plan 3$10,000.00$621.26$1,584.21$1,211.46$2,050.16$1,255.98$582.10$833.34$2,671.42Group Name: Ranger Inspection Cigna LocalPlusCigna OAPStop-Loss Insurance and Financial DetailsAnnual Aggregate Attachment PointSpecific Attachment PointMonthly Bill MedicalEmployeeEmployee + SpouseEmployee + ChildFamilyStop-loss PremiumAdmin, Sales and General ExpensesClaims AccountTotal$10,000.08Plan 1$10,000.00$689.78$1,758.92$1,345.06$2,276.25$1,459.24$673.45$833.34$2,966.03$10,000.08Plan 2$10,000.00$635.91$1,621.56$1,240.02$2,098.48$1,295.02$606.03$833.34$2,734.39$10,000.08Plan 3$10,000.00$573.34$1,462.00$1,118.00$1,892.00$1,104.29$527.71$833.34$2,465.34

Dental/Vision

DENTALDental 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.The benefit year maximum for this plan is $2,000 per person.Class A, B and C services apply toward the benefit year maximum.Plan detailsThis plan has a deductible of $50 per person.Families only pay the deductible for a maximum of three people. Applies only to class B and C services.www.elitebenefitsgroup.comCLASS TYPE OF SERVICEINSURANCE PAYSNetworkOur national dental network offers more than 323,000 access points. Members may choose any dentist but may receive additional savings by choosing an in-network dentist. Plus, services not covered by this plan may also still be eligible for in-network savings. Out-of-network benefits are paid at the network negotiated rate.The co-insurance for this plan is:INSURANCE(Network: UNUM) $2,000, 100% 80% 50%Class AClass BClass CPreventive ServiceBasic ServiceMajor Service100%80%50%

Covered Procedures & Waiting PeriodsRoutine exams and cleanings (twice every 12 months)-One additional cleaning per 12 months if member is insecond or third trimester of pregnancy.X-rays-Bitewing X-rays (up to four films; once every 12 months)-Full mouth/panoramic x-rays (once every five years)Children’s services (up to age 14)-Fluoride treatment (once every 12 months)-Sealants (once every 36 months)-Space maintainers (up to age 14; once every 24 months)Adjunctive pre-diagnostic oral cancer screening (for age 40 orolder; once every 12 months).Simple restorative services (fillings) Simple extractionsEmergency treatmentRepair of crown, denture or bridgeOral surgery (extractions and impacted teeth)Anesthesia (subject to review; covered with complex oral surgery)Periodontics (gum treatments)Endodontics (root canals)Inlays and onlaysCrownsBridgesDenturesEndosteal implants (in lieu of an approved three-unit bridge)Preventive services (Class A): No waiting periodBasic services (Class B): No waiting periodMajor services (Class C): 12 - month waiting periodMonthly PremiumEmployeeEmployee and SpouseEmployee and Child (ren)Employee and Family$33.14$62.59$86.27$125.56www.elitebenefitsgroup.com

Dental insurance offers an optional vision rider to help pay for eye exams and materials, such as glasses and contact lenses. This coverage can help you maintain healthy vision and overall wellness, as well as provide valuable financial protection for you, your spouse and dependent children.www.elitebenefitsgroup.comVISION BENEFITSIN-NETWORKS OUT OF NETWORK ALLOWANCECO-PAYSSTANDARD PLASTIC LENSES 1 (once per 12 months)FRAMES 1 (once per 12 months)CONTACT LENSES (once per 12 months) (Includes fit, follow-up and materials) in lieu of eyeglass lenses and framesExam (once per 12 months)Materials$10$25Up to $35See belowSingle visionBifocalTrifocalLenticularProgressivePolycarbonate lenses (for children to age 19)Covered by co-payCovered by co-payCovered by co-payCovered by co-pay$80 allowance$70 allowanceUp to $25Up to $40Up to $50Up to $50Up to $40N/Achoose any frame avaiable at provider locations$120 allowanceUp to $50ElectiveMedically NecessaryUp to $120 allowanceUp to $210 allowanceUp to $100 allowanceUp to $210 allowanceVISIONMonthly PremiumEmployeeEmployee and SpouseEmployee and Child (ren)Employee and Family$6.25$12.35$13.00$20.35

Added Value Services

Voluntary Benefits 101What are voluntary benefits?Sometimes called “supplemental insurance,” voluntary benefits are policies you buy to add to the health and life insurance your employer may already provide. These benefits can help you pay for things your other insurance won’t, such as lost wages, out-of-pocket expenses and household bills.Advantages*Flexibility Use claim payments however you like – pay deductibles, co-payments and other expenses not covered by your health or life insurancePortability Take coverage with you if you leave your job or retireStability Maintain coverage whether or not you’re employedConvenience Pay premiums using your choice of payroll deduction, bank dra or direct billingTo learn more about voluntary benefits, contact us at 713-575-3722ColonialLife.comUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.Policies Accident insurance Helps cover out-of-pocket expenses in the event of a covered accidentCancer and critical illness insurance Helps with the high cost of cancer or critical illness diagnosis and treatmentDental insurance Helps pay for dental procedures, like routine cleanings, crowns and root canalsDisability insurance Helps replace part of your regular income if you are unable to work because of a covered injury or illnessHospital confinement indemnity insurance Helps pay for covered hospital-related expenses, such as outpatient surgery and diagnostic proceduresLife insurance Protects the people who depend on you by helping cover final expenses and loss of income*Advantages may not apply to all products. See your Colonial Life benefits counselor forcomplete details.