Office of Human Resources October 27, 2017 Little Rock, AR 72204 501-671-2219 www.uaex.edu

Cooperative Extension (CES) Benefits Open Enrollment

November 1-30, 2017 All changes must be received in Human Resources by 11-30-2017

All changes must be received by 11-20-2017 to receive any new ID cards by 1-1-2018 Changes are effective 1-1-2018

Throughout this letter you’ll be referred to our website, www.uaex.edu/OpenEnrollment, for detailed information and forms. If you do not have access to a computer, phone or smart device with an internet browser, contact our office for assistance, 501-671-2219. If you are enrolled in the UA UMR medical plan, you should have received two booklets from the University of Arkansas System that describe the new medical plan options and voluntary benefits in detail. These are posted on our open enrollment website so all employees can review them. Go to www.uaex.edu/OpenEnrollment and click the Open Enrollment Decision Guide link. You may also view the Decision Guide on the new University of Arkansas System website effective November 1 at www.uasys.edu. A copy of this CES packet and the Benefits Bulletin will be available under the Open Enrollment Documents and Forms tab.

Not sure what benefits you have now? Included in this notification is a summary of your current 2017 plan year benefit elections. Any enrollments and changes you make during Open Enrollment will not be reflected in Banner Self Service until 1/13/2018. You can view your benefits enrollment and per pay period premiums at any time in Banner Self Service, Log into the Banner Self Service Link: http://uaex.edu/links and click on Banner Self Service (SSB). Use your Banner User ID and password to login. Click Employee Services, then Benefits and Deductions, then Benefit Statement, then My Benefit Summary and Select, Select.

You can view your designated life insurance beneficiaries at any time in CEDAR. Go to the CEDAR Link and log in: http://cedar.uaex.edu and then click on HR: Your Personnel Records and then Display Matches by Name. Review form(s) Group Benefits Enrollment Form or Group Benefits Change Form for the most recently named beneficiary. Your retirement plan beneficiaries are maintained by your plan sponsor. If you are enrolled in the UA Retirement Plan, simply log into your TIAA-CREF and/or Fidelity account to update your beneficiary on-line, or call TIAA-CREF, www.tiaa-cref.org 1-800-842-2776 / Fidelity, www.fidelity.com 1-800-343-0860. If you participate in the state retirement plan, APERS, beneficiary forms are available at www.apers.org or call 1-501-682-7800.

What changes can I make during Open Enrollment?

1. *Enroll in or cancel Medical, Dental, Vision 2. *Add or remove dependents to your Medical, Dental, Vision coverage 3. Change your medical plan between 3 options: Classic, the new Health Savings Plan (includes a Health Savings

Account or “HSA” feature), or the new Premier Plan 4. Change the status of Medical, Dental and Vision premiums between after-tax and pre-tax 5. Enroll in Flexible Spending Accounts - Healthcare and/or Dependent Day Care 6. Enroll in Optional Long Term Disability 7. Enroll in Voluntary Benefits

*You are required to provide documentation proving dependent eligibility (e.g. marriage license, birth certificate) in order to add a spouse or child.

How do I enroll or make changes?

Medical, Dental, Vision, Flexible Spending Account (FSA), Optional Long Term Disability: Use the appropriate enrollment Form. Go to www.uaex.edu/OpenEnrollment, click the Open Enrollment Forms tab and select the appropriate form. You must re-enroll in an FSA every year in which you wish to continue this benefit. The form(s) should be sent to our office – by fax, email or in person. The fax number is 501-671-2251. The deadline for our office’s receipt of the form is 4:30 p.m. on Thursday, November 30, 2017.

What’s New? Are there any changes for 2018? MEDICAL Go to www.uaex.edu/OpenEnrollment, and click the Open Enrollment Decisions Guide on our website for details. Review the UA Open Enrollment Decision Guide for examples of which medical plan may work best for you.

2 new plans: Premier Plan and Health Savings Plan. Classic Plan will continue to be offered, giving you a choice of 3 medical plans.

Don’t pick a plan solely on your premium cost. Click and look closely at the benefits on the “At a Glance” Medical Plan Options located on the Open Enrollment Documents & Rates tab so you can estimate what your out-of-pocket costs will be.

The Point of Service Plan is discontinued after 12-31-2017. Current POS participants will default to the Classic plan unless we receive your form to change to the Premier or Health Savings Plan.

Classic copay changes: Specialist office visit and Urgent Care Center copays increase from $50 to- $55. Prescription copays increase to $55 in tier 2, and $90 in tier 3. Tier 1 remains at $15.

Because the new Health Savings Plan is a qualified high deductible plan as defined by the IRS, anyone who elects that plan will also enroll in a Health Savings Account (HSA). You may make pre-tax payroll deducted contributions and the University will also make a contribution (detailed in UA Open Enrollment Decision Guide). The University contribution is not guaranteed in future years. Minimally you should put your premium savings into your HSA to build it up.

Those who are approaching or already age 65 and entitled to Medicare are not eligible for the Health Savings Plan/HSA benefit plan.

New medical ID cards will be issued.

UAMS SmartCare benefits will be offered to all other UA campuses for the first time.

DENTAL Go to www.uaex.edu/OpenEnrollment, and click the Open Enrollment Documents and Rates tab and review materials listed under UA Dental Plan section for details.

Our plan administrator changes from Delta Dental of Arkansas to Arkansas Blue Cross/Blue Shield. Make sure your dentist is in the Dental PPO Select Plus Network by visiting this website: www.uasdental.blueadvantagearkansas.com or call 1-844-662-2281 toll-free.

No change to premiums.

Addition of orthodontia coverage for children under age 18. Plan pays 50% up to lifetime limit of $2,000 per child. Be sure to take this into account when planning your 2018 out of pocket costs to run through your healthcare FSA.

New dental ID cards will be issued.

VISION Go to www.uaex.edu/OpenEnrollment, and click the Open Enrollment Documents and Rates tab and review materials listed under the UA Vision Plan section for details.

No changes to benefits or premiums.

This plan is a discount program for purchasing glasses or contacts. Select between two plans: Basic or Enhanced.

FLEXIBLE SPENDING ACCOUNT (FSA) Go to www.uaex.edu/OpenEnrollment, and click the Open Enrollment Documents and Rates tab and review materials listed under the UA Flexible Spending Account section for details including “How FSAs work” and plan descriptions. Be conservative when deciding your 2018 contribution as ‘use it or lose it’ rules apply.

FSAs require annual re-enrollment. The deadline is 11-30-2017 to enroll in a 2018 FSA.

The Healthcare FSA annual limit increases to $2,600. Dependent Daycare FSA remains $5,000 if single or married and file a joint tax return, or $2,500 if married and file a separate tax return.

You cannot enroll in a Healthcare FSA if you enroll in the new Health Savings medical plan. Instead you would make pre-tax contributions to your Health Savings Account (HSA). Unlike an FSA, there is no ‘use it or lose it’ component in an HSA.

Be sure to put your ANNUAL amount, not payroll deduction, when you complete the form to enroll in your 2018 FSA.

Healthcare FSA: You have until March 31 next year (2018) to file claims incurred through Dec. 31 of this year (2017). Any balance over $50 and under $500 automatically rolls over. [Exception, if you enroll in the new Health Savings medical plan, there is no rollover.]

Dependent Daycare FSA: You have until March 31 next year to file claims. None of the remaining 2017 funds after that date will rollover. However, you do have a grace period in which to incur expenses. The grace period is through March 15, 2018 to incur daycare expenses and be reimbursed from your 2017 FSA. But March 31, 2018 remains the deadline to file claims.

New benny cards will be issued for employees with cards that expire 12/2017.

VOLUNTARY BENEFITS Go to www.uaex.edu/OpenEnrollment, and click the Open Enrollment Documents and Rates tab and review materials listed under the UA Voluntary Benefits section for each plan for additional information and enrollment instructions. These are individual policies. You apply for enrollment directly to the company. Premiums are payable directly to the company, for example through bank draft.

Home/Auto (through Liberty Mutual). Can enroll at any time.

Prepaid Legal (through LegalShield). Can enroll at any time.

ID Theft Protection (through ID Watchdog). Can enroll at any time.

Life and Disability Insurance Coverage

Go to www.uaex.edu/OpenEnrollment, and click the Open Enrollment Documents and Rates tab and review materials listed under the UA Life and Disability Plan section for details. These are group plans fully insured by Standard Insurance Company. To apply for additional life insurance, you must complete the appropriate Group Benefit Change form and the Standard Application via the online application.

Small rate increase for Optional Life, Dependent Life, and Optional Long Term Disability. See the rate calculation formula on the last page of this packet.

Basic Life Insurance: Covers you for one times your salary, up to $50,000. 100% paid by Extension. This is automatic, no action on your part required.

Optional Life Insurance: You can apply for additional coverage in increments of 1, 2, 3 or 4 times your salary, not to exceed $500,000. No open enrollment, must apply to Standard via link provided for online form.

Dependent Life Insurance: You can cover your spouse for $10,000, $15,000 or $20,000. Children from birth to 26th birthday are covered at 50% of spouse’s coverage. No open enrollment, must apply to Standard via the link provided for the online application.

Accidental Death and Dismemberment: This plan has perpetual open enrollment; you can make changes at any time of the year. Changes are effective the first of the following month.

Basic Long Term Disability Insurance: Covers first $20,000 of salary. Automatic, 100% paid by Extension. Benefit is 60% salary replacement if you are on unpaid leave of absence or terminated due to a medical disability lasting over 6 months.

Optional Long Term Disability Insurance: Covers your salary over $20,000. Same benefit as Basic plan. Open Enrollment applies, however you must apply to Standard via the link provided for the online application. If you sign up during Open Enrollment, your plan will be subject to a 12-month pre-existing condition exclusion period. Pre-existing means that you had symptoms, took medications, had treatment, or were diagnosed during the six month period immediately prior to your 1/1/2018 effective date of coverage. To determine the cost for employees with an annual salary above $20,000:

1. Take your annual salary (up to $100,000 max) and subtract $20,000. 2. Multiply that figure by .00512 for your annual cost. 3. Divide by # of pay periods in the year: 24 semi-monthly.

Catastrophic Leave Bank Program Go to www.uaex.edu/OpenEnrollment, and click the Open Enrollment Forms tab and review materials listed under the Catastrophic Leave Bank Program section for details. Donations to the Catastrophic Leave Bank Program may be made throughout the year, upon resignation or upon retirement. A donation cannot be accepted if it would reduce the combined sick and annual leave balance of the donor to less than 80 hours. The minimum donation is one hour.

Check Your Dependents Only lawful spouses and children under age 26 can be covered. A child can be your biological child, a child for

which you have legal custody or have adopted (court document required), and stepchildren if you are married to the child’s parent.

You are required to provide documentation proving dependent eligibility (e.g. marriage license, birth certificate) in order to add a spouse or child.

You CANNOT cover ex-spouses, domestic partners, boyfriends or girlfriends, fiancées, grandchildren, nieces and nephews, parents, or anyone already covered under a UA insurance plan (can’t have double coverage).

If claims or University premiums are paid for an ineligible dependent, the employee will be liable for costs and be subject to disciplinary action, including termination of employment.

Future Changes

Tobacco users will pay an additional $50 monthly premium surcharge for their medical coverage starting January 2019. Contact UMR directly (customer service number listed on your ID card) to learn about free Chantix prescription under our medical plan to ‘kick the habit’.

The required UA Retirement Plan contribution will continue to increase by 1% each July until it reaches 5% in 2020. Currently the required contribution is 2%. It will increase to 3% in July 2018 (automatic, no action on your part needed). If that percent, combined with your additional voluntary percent contribution, is 10% or higher, you benefit from the 10% match.

Be thoughtful in your open enrollment choices. After the 11-30-2017 deadline, you are locked into your choices for 2018 unless you experience a “qualifying event” such as marriage, divorce, birth, or change in spouse’s employment status.

Need Help? Have Questions? Your Human Resources office is just a short walk, phone call, or email away.

Your Benefits Team -Human Resources Phone: (501) 671-2219 Fax: (501) 671-2251

Email: yourbenefits@uaex.edu Web address: http://www.uaex.edu/OpenEnrollment

Webinar Events UMR (Healthcare) – Tuesday, November 7, 2017 at 2:00 p.m. AR BCBS (Dental) – Tuesday, November 14, 2017 at 2:00 p.m.

Registration notifications will be provided in November.

Federal

Benefits

Notice:

Federally

benefited

employees

electing to

participate

in a Dental

and/or

Flexible

Spending

Account are

required to

do so under

the UA

System

Plans.

Federal Employees’ Health Benefits (FEHB) Program Open Season runs from 11/13/2017 through 12/11/2017.

During open season, you may enroll in, change, or cancel an existing enrollment in a health plan. Changes will be

effective January 1, 2018. Please note that the 2017 Federal Open Season information will be posted on the OPM

website, www.opm.gov/insure.

To change your enrollment, download and complete SF 2809 (link located below) and return it to Human Resources by

fax 1-501-671-2251, email, mail, or in person no later than 12/11/2017. Be sure to make copies of any enrollment forms

before sending them to Human Resources. Human Resources will return a date-stamped copy of all completed

enrollment change forms received.

As a result of the Affordable Care Act, FEHB plans have been providing a summary document on their websites which

details information about health plan benefits and coverage. The Summary of Benefits and Coverage (SBC) document

includes information on the following and will continue to have a disclaimer indicating that the plan brochure remains the

official statement of benefits:

Cost – deductibles, copayments, coinsurance, and out-of-pocket limits

Coverage – covered services, examples of covered services, and excluded services

Rights – rights to continue coverage as well as grievance and appeal rights

A statement that coverage under the plan qualifies as “minimum essential coverage”

A statement that the health coverage of the plan meets the minimum value standard for the benefits the plan

provides

The SBC is available at www.opm.gov/healthcare-insurance/healthcare/plan-information/summary-of-benefits.

Copies of all FEHB plan brochures can be viewed at www.opm.gov/FEHBbrochures. You are encouraged to visit the

OPM website for FEHB notifications and rate sheets. Your FEHB health plan will contact you to offer the option of

obtaining your 2018 benefit brochure online or obtaining a paper copy of the benefit brochure. If you did not previously

request a paper copy of your health plan brochure, you will not automatically receive one.

Federal Healthcare Open Season

FEHB Summary of Benefits

Insurance Fast Facts

Federal Healthcare Plan Comparison

2018 Federal Health Benefits (FEHB) Premium Rates

Federal Health Benefits Election Form SF 2809 – enroll/change/cancel FEHB coverage

FEHB 2018 Rates

*Health Plan Options listed are those Employer Employee Total

with current employee enrollment. Plan Semi-Monthly 2018 Semi-Monthly 2018 Semi-Monthly

Rates reflect 24 month pay cycle Codes Contribution Amount Premium Amount Amount

BCBS Standard Self 104 $248.36 $122.59 $370.95

BCBS Standard Family 105 $565.05 $294.62 $859.66

BCBS Standard Self Plus One 106 $531.92 $279.30 $811.21

BCBS Basic Self 111 $239.61 $79.87 $319.48

BCBS Basic Family 112 $565.05 $196.06 $761.11

BCBS Basic Self Plus One 113 $531.92 $186.16 $718.08

GEHA High Family 312 $565.05 $291.69 $856.74

GEHA High Self Plus One 313 $531.92 $261.32 $793.23

MHBP - Standard Self 454 $218.42 $72.81 $291.22

MHBP - Standard Family 455 $507.59 $169.20 $676.78

MHBP - Standard Self Plus One 456 $502.76 $167.59 $670.35

*Out-of- network benefits are available. If services are received out-of-network, a higher out-of-network annual deductible, higher coinsurance

percentage and higher out-of-pocket maximums apply. In-network deductibles do not apply to out-of-network deductibles and visa versa. For more information about out-of-network coverage, or to get a copy of the complete terms of coverage, visit www.umr.com or contact UMR at 1-888-438-6105.

FOOTNOTES:

(a) Deductible means a fixed dollar amount that you must incur each calendar year before the health plan begins to pay for covered medical services. The

calendar year deductible applies to all Covered Services except for Preventive Care Services and for those services in the Classic and Premier Plans where a Co-payment applies in, unless otherwise noted. In-network deductibles do not apply to out-of-network deductibles and visa versa. Two individual deductibles = the family deductible.

(b) Coinsurance means a fixed percentage of charges you must pay toward the cost of covered medical services. Coinsurance applies to all Covered Services except those for which a Co-payment applies unless otherwise noted.

(c) Medical Out of Pocket Maximum is the maximum combined deductible, coinsurance and copayments you will pay in any calendar year. It does not include

costs for services not covered by the plan such as exclusions, limitations and pharmacy copayments. In the Classic and Premier Plans the maximum OOP for prescriptions drugs is a separate OOP from medical expenses. In the Health Savings Plan the medical OOP and pharmacy OOP are combined. Family OOP max requires two individual family member meet the individual OOP max.

(d) Co-Payment means a fixed dollar amount that you must pay each time you receive a particular medical service. You pay a co-payment when you obtain

health care directly from your Network Primary Care Physician or a Network Specialist. Certain services rendered in the Network Primary Care Physician or Network Specialist’s office are not subject to the deductible. Services rendered in the Network Primary Care Physician or Network Specialist’s office that are subject to deductible, coinsurance and additional copayments include advanced imaging such as MRI, CT Scans, PET Scans and Nuclear Medicine (imaging studies using medical radioisotopes), Temporomandibular Joint Disorder (TMJ) treatment and all therapy including chiropractic.

(e) When you obtain health care through a Non-UMR Provider, your benefit payments for covered services will be based on the Maximum Allowable Payment

for out-of-network services, as determined by UMR. Charges in excess of the Maximum Allowable Payments do not count toward meeting the deductible or meeting the limitation on your Out of Pocket maximum. Non-UMR Providers may bill the patient for amounts in excess of the Maximum Allowable Payment.

(f) Well baby/child visits from an In-Network provider are covered in full from birth until the day the child attains age 19. (g) In the Classic Plan maternity inpatient charges are subject to co-payment and coinsurance. With any of the medical plans it is your responsibility to

notify Human Resources within 31 days of the birth or adoption of your child in order to obtain coverage for your newborn. (h) In the Classic and Premier Plans the maximum combined Inpatient co-payment per calendar year is $1,200 per person (no more than one co-payment per

30 calendar days). (i) In the Classic and Premier Plans the TMJ deductible is separate from the other In-Network or Out-of-Network deductibles. The TMJ deductible is in addition

to any In-Network or Out-of-Network deductible and requires pre-authorization. (j) Vision Exams: Ophthalmologist or Optometrist in-network and out-of-network benefits are the same. (k) In the Classic and Premier Plans, , co-payments at non-participating pharmacies will be $20.00 for Tier 1, $60.00 for Tier 2, and $95.00 for Tier 3. If a new

enrollee has to get a prescription prior to receiving his/her pharmacy card, he/she will have to pay for the prescription in full, apply for reimbursement, and will be reimbursed less the $20.00, $60.00, or $95.00 co-payments. Alternatively, if the enrollment process has been completed and benefits are in effect, a temporary prescription drug ID card can be printed by going to www.medimpact.com, registering and clicking on ‘member ID card’. A complete summary of prescription drug benefits is also on the above web-address. Excluded or non-covered medication or devices do not apply to the OOP maximum.

(l) Preventive care services and cancer screenings will follow the U.S. Preventive Task Force Recommendations. See the health plan Summary Plan

Description for details on coverage. The following procedures for all plans will require pre-authorization before the services are rendered:

1. Any admission to Inpatient Facilities or Partial Hospitalization Units 2. Any referral by your PCP to an Out-of-Network Provider 3. Pre-Natal/Maternity Care. Authorization includes physician care and one ultra sound. Additional ultrasounds require pre-authorization. UAMS offers

a $500 waiver of out-of-pocket expenses for deliveries at its hospital. 4. Home Health Care and Home Infusion Services 5. Transplant Services (including the evaluation to determine if you are a candidate for transplant by a transplant program) 6. All Advanced Imaging (CT, MRI, Thallium Stress Test, PET. Go to www.UMR.com for a complete listing) regardless of place of service. 7. MRI of the Breast

Note: Certain other services have special Pre-authorization including surgical treatment of Temporomandibular Joint Dysfunction (TMJ), Accidental Injury to Teeth.

The Smoking Cessation Program: smoking cessation program provides free PCP visits and $0 copay for certain nicotine addiction drugs. The Diabetes Management Initiative and the Healthy Heart Program provide the opportunity for $0 copayments on certain medications. For more information on all programs call UMR 888-438-6105 *Nutritional Counseling and Weight Management Services: One annual visit with a dietitian and up to three additional visits in conjunction with health coaching for those who have a BMI of 27 and above. Prior authorization is required and continued approval contingent upon program compliance. Metabolic weight loss programs are reimbursable up to $1000/ life time for individuals with a BMI of 30 and above who participate in coaching. Prior authorization is required. For more information call UMR 888-438-6105

Effective: January 1, 2018

UNIVERSITY OF ARKANSAS Medical Plans Comparison showing UAMS SmartCare

This is not a legal document. Complete benefit descriptions and exclusions are contained in the Summary Plan Description available through your campus HR Office. Please note that all medical services (e.g., durable medical equipment, hospice, ambulance, some therapies, chiropractic) may not be available at UAMS.

For UAMS appointments, call the SmartCare Concierge

(501) 686-8749

CLASSIC under

CLASSIC under

Other In-Network Providers

PREMIER under

PREMIER(j) under

Other In-Network Providers

HEALTH SAVINGS PLAN

under

HEALTH SAVINGS PLAN(j)

under Other In-Network

Providers

INDIVIDUAL DEDUCTIBLE (c)

FAMILY DEDUCTIBLE

$750

$1,500

$1,250

$2,500

$150

$300

$650

$1,300

$2,700

$5,400

COINSURANCE (d) 20% 25% 15% 20% 5% 10%

OUT OF POCKET MAXIMUM (g) Individual (If complete wellness)(h) Family (If complete wellness) (h)

$4,750 ($3,350) $9,500 ($6,700)

$5,250 ($3,850)

$10,500 ($7,700)

$2,500 ($2,000) $5,000 ($4,000)

$3,000 ($2,500) $6,000 ($5,000)

$6,150

$12,300

$6,650

$13,300

PRIMARY CARE OFFICE VISIT(b) $20 copay $35 copay $10 copay $25 copay 5% after

deductible 10% after

deductible

SPECIALIST OFFICE VISIT(b) $40 copay $55 copay $30 copay $45 copay 5% after

deductible 10% after deductible

DIAGNOSTIC LAB TESTING (In office)

20% coinsurance 25% coinsurance Paid in full Paid in full 5% after

deductible 10% after

deductible

PREVENTIVE CARE SERVICES(a) Annual Wellness Exams (at PCP or

OB/GYN); Well Baby/Child Visits; Immunizations; Mammograms (first

one each year); Colorectal Cancer Screening

Paid in full Paid in full Paid in full Paid in full Paid in full Paid in full

HOSPITAL INPATIENT SERVICES (e) Semi-private/Intensive care room & board & Maternity inpatient services

$150 copay + deductible +

20% coinsurance

$300 copay + deductible +

25% coinsurance $150 copay $300 copay

5% after deductible

10% after deductible

EMERGENCY ROOM (Copay waived if admitted)

$150 copay 1st visit $200 copay 2nd visit

$250 copay after 2nd visit

$150 copay 1st visit $200 copay 2nd visit

$250 copay after 2nd visit 10% after deductible

THERAPY Speech , PT, OT, Chiropractic (30 visits combined, pre-approval required for additional visits)

$ 35 copay + deductible + coinsurance

$25 copay + deductible + coinsurance

10% after deductible

MATERNITY (f)

Hospital Inpatient costs apply at delivery; no member cost for covered prenatal care and physician delivery

charges

Hospital Inpatient costs apply at delivery; no member cost for

covered prenatal care and physician delivery charges

5% after deductible

10% after deductible

ADVANCED IMAGING (CT, PET, MRI, & Nuclear Medicine) Prior authorization required

$50 copay + deductible

+ coinsurance

$100 copay + deductible

+ coinsurance deductible + coinsurance

5% after deductible

10% after deductible

URGENT CARE VISIT Not available $55 copay Not available $50 copay Not available 10% after deductible

OUTPATIENT SERVICES a. Diagnostic Lab Services

b. Diagnostic Testing and Surgical

Services

a. 20% coins b. deductible + 20% coins.

a. 25% coins b. $150 copay+ ded. + 25% coins.

deductible + coinsurance

5% after

deductible

10% after

deductible

PRESCRIPTION DRUGS (i) $1,600 OOP Max Individual $3,200 OOP Max Family (Separate from Medical OOP Max)

$15 Tier1 $55 Tier 2 $90 Tier 3

$10 Tier1 $50 Tier 2 $80 Tier 3

10% after deductible OOP medical and RX OOP

are combined

FOOTNOTES: (a) Preventive care services from an In-Network provider include:

Well baby/child visits from birth until the day the child attains age 19

Preventive care services and cancer screenings per the U.S. Preventive Task Force Recommendations. See the Summary Plan Description for details on coverage.

Note that mammograms and nutritional counseling/weight management are not covered if you go out-of-network. (b) Co-Payment (“copay”) means a fixed dollar amount that you must pay each time you receive a particular medical service. You pay a copay

when you obtain health care directly from your Network Primary Care Physician (PCP) or Network Specialist. Referrals are NOT required for Network Specialist office visits.

(c) Deductible means a fixed dollar amount that you must incur each calendar year before the health plan begins to pay for covered medical services. In-network deductibles do not apply to out-of-network deductibles and vice versa. Two individual deductibles = family deductible

(d) Co-insurance (“coins”) means a fixed percentage of charges you must pay toward the cost of covered medical services, after satisfying the annual deductible.

(e) Maximum combined inpatient copays per calendar year is $1,200 per person (no more than one hospital admission copay per 30 calendar days).

(f) Maternity inpatient charges are subject to deductible, co-payment and coinsurance. It is your responsibility to notify UAMS Human Resources and submit the required enrollment forms within 31 days of the birth or adoption of your child in order to obtain coverage for your newborn.

(g) Medical Out of Pocket Maximum is the maximum combined deductible, coinsurance and copayments you will pay in any calendar year. It does not include costs for services not covered by the plan such as exclusions, limitations and pharmacy copayments. In the Classic and Premier Plans the maximum OOP for prescriptions drugs is a separate OOP from medical expenses. In the Health Savings Plan the medical OOP and pharmacy OOP are combined. Family OOP max requires two individual family member meet the individual OOP max.

(h) Wellness incentive requirements will be announced to employees the prior year and may include one or more of the following: completion of annual biometric screening, on-line health risk assessment, selection of a Primary Care Physician, preventive care, tobacco free, and participation in disease management programs. Employees who enroll in the health plan after the annual wellness window will be subject to the lower OOP max in their first calendar year of coverage. Wellness incentives, including the reduced OOP max, do not apply to retiree, surviving family or COBRA members.

(i) In the Classic and Premier Plans, co-payments at non-participating pharmacies will be $20.00 for Tier 1, $60.00 for Tier 2, and $95.00 for Tier 3. If a new enrollee has to get a prescription prior to receiving his/her pharmacy card, he/she will have to pay for the prescription in full, apply for reimbursement, and will be reimbursed less the $20.00, $60.00, or $95.00 co-payments. Alternatively, if the enrollment process has been completed and benefits are in effect, a temporary prescription drug ID card can be printed by going to www.medimpact.com, registering and clicking on ‘member ID card’. A complete summary of prescription drug benefits is also on the above web-address. Excluded or non-covered medication or devices do not apply to the OOP maximum.

(j) Out-of- network benefits are available. If services are received out-of-network, a higher out-of-network annual deductible, higher coinsurance percentage and higher out-of-pocket maximums apply. In-network deductibles do not apply to out-of-network deductibles and visa versa. For more information about out-of-network coverage, or to get a copy of the complete terms of coverage, visit www.umr.com or contact UMR at 1-888-438-6105. When you obtain health care through a Non-UA-UMR Provider, your benefit payments for covered services will be based on the Maximum Allowable Payment for out-of-network services, as determined by UMR. Charges in excess of the Maximum Allowable Payments do not count toward meeting the deductible or meeting the limitation on your co-insurance maximum. Non-UA-UMR Providers may bill the patient for amounts in excess of the Maximum Allowable Payment.

The following procedures will require pre-authorization before the services are rendered: 1. Any admission to Inpatient Facilities or Partial Hospitalization Units 2. Any referral by your PCP to an Out-of-Network Provider 3. Pre-Natal/Maternity Care 4. Home Health Care, Home Infusion Services, or Hospice (inpatient or outpatient) 5. Transplant Services (including the evaluation to determine if you are a candidate for a transplant by a transplant program) 6. All Advanced Imaging (CT, MRI, Thallium Stress Test, PET; go to www.UMR.com for a complete listing), regardless of place of service. 7. MRI of the breast

NOTE: Certain other services have special Pre-authorization requirements: Surgical treatment of TMJ, Accidental Injury to Teeth. Procedures for testing and treatment of a diagnosed condition are subject to deductible and co-insurance.

University of Arkansas Disease Management Programs:

Tobacco-free 4 life smoking cession program provides free PCP visits and zero copay for Chantix, a medication for nicotine addiction. Contact Onlife Health at 1-877-369-0285.

Diabetes Management Initiative and Healthy Heart Programs provide the opportunity for zero copays on many generic medications. For more information on this and other wellness programs, call UMR at 1-866-575-2540.

Nutritional Counseling and Weight Management Services: One annual visit with a dietitian and up to 3 additional visits in conjunction with health coaching for those who have a BMI of 27 and above. Prior authorization is required and continued approval contingent upon compliance with health coaching engagement. Metabolic weight loss programs are reimbursable up to $1000/life time for individuals with a BMI of 30 and above who participate in health coaching (prior authorization required). Call UMR at 1-888-438-6105 for more information.

AR BCBS Dental Insurance and Rate Sheet

Dental Coverage Arkansas BlueCross BlueShield

a) Deductible: $50 individual/$100 family. See below for services subject to

deductible b) Annual Maximum Payment: $1,500 Per Person Per Calendar Year c) Benefit Period: Calendar year (January 1 – December 31)

Schedule of Benefits Subject to Deductible In-Network Out-of-Network

Coverage A – Diagnostic and Preventive Services

● Exams & Cleanings (twice a year) ●·Bitewing and periapical X-rays as required ● Full-mouth X-rays once in any three (3) year period ● Fluoride treatments once per benefit period for children to age nineteen (19) ● Sealants (once per permanent tooth) for children to age nineteen (19)

No 100% 90%

Coverage B – Basic Restorative Services

● Fillings (amalgam & composite/resin) ● Simple & Surgical Extractions. ● Oral surgery ● Root Canals

Yes 80% 72%

Coverage C – Major Restorative Services

● Crowns & bridges ● Prosthodontics ● Endosteal implants

Yes 50% 45%

Coverage D – Orthodontics (for dependent children to age 18)

● Up to $2,000 life-time limit No 50% 40%

Carryover Benefit Rider – must have received at least one covered service during the calendar year to qualify.

● Carryover Benefit: $375 – carryover benefit maximum $1,500 ● Claims Threshold: Less than $750

Provider Network – To find an in-network dentist, visit uasdental.blueadvantagearkansas.com and select “Find a Dentist.” You can search for

a dentist by city, ZIP code, distance, doctor name or specialty. Payments to non-Blue Cross/Blue Shield providers will be paid as out-of-network and payment will be based on the BCBS Maximum Plan Allowance (MPA) and not billed charges. Non-BCBS providers can balance bill for amounts excess of the MPA.

This is not a legal document. Complete benefits descriptions and exclusions are contained in the Summary Plan Description, available from Human Resources at http://hr.uark.edu.

Arkansas Blue Cross Blue Shield (AR BCBS) Insurance Premiums

Semi-Monthly Rates Effective *January 1, 2018

75% - 100% Appointment Employee Employer Total

Employee only $8.00 $8.00 $16.00

Employee & Spouse $16.53 $16.47 $33.00

Employee & Child(ren) $13.93 $13.92 $27.85

Employee, Spouse, & Child(ren) $22.45 $22.40 $44.85

50%-74% Appointment

Employee only $10.57 $5.43 $16.00

Employee & Spouse $21.85 $11.18 $33.00

Employee & Child(ren) $18.39 $9.46 $27.85

Employee, Spouse, & Child(ren) $29.63 $15.22 $44.85

SUPERIOR VISION - Vision Plan Benefits for the University of Arkansas

Superior Vision Services P.O. Box 967 Rancho Cordova, CA 95741 1-800-507-3800 www.superiorvision.com

You may choose from two plans: Basic Plan and Enhanced Plan

Basic Plan Enhanced Plan Co-payments Co-payments

Exam $10 Exam $10

Materials¹ $20 Materials¹ $20

Contact Lens Fitting $25 Contact Lens Fitting $25

Monthly Premiums

Monthly Premiums

Emp. Only $5.76 Emp. Only $11.62

Emp. & spouse $11.43 Emp. & spouse $22.97

Emp. & child(ren) $11.19 Emp. & child(ren) $22.52

Emp. & family $17.01 Emp. & family $34.22

Services/Frequency Services/Frequency

Exam 1 per calendar year Exam 1 per calendar year

Frames 1 per 2 calendar years Frames 1 per calendar year

Contact Lens Fitting 1 per calendar year Contact Lens Fitting 1 per calendar year

Contact Lens 1 allowance per calendar year Contact Lens 1 allowance per calendar year

Benefits In-Network Out-of-Network In-Network Out-of-Network

Exam (MD) Covered in full Up to $42 Covered in full Up to $42

Exam (OD) Covered in full Up to $36 Covered in full Up to $36

Frames $125 retail allowance Up to $70 $150 retail allowance Up to $84

Contact Lens Fitting (standard²) Covered in full Not Covered Covered in full Not Covered

Contact Lens Fitting (specialty ²) $50 retail allowance Not Covered

$50 retail allowance Not Covered

Lenses (standard) per pair

Single Vision Covered in full Up to $28 Covered in full Up to $28

Bifocal Covered in full Up to $42 Covered in full Up to $42

Trifocal Covered in full Up to $56 Covered in full Up to $56

Progressive See Descripton³ Not Covered Covered in full⁴ Not Covered

Scratch coating See discount features Not Covered Covered in full Not Covered

UV coating See discount features Not Covered Covered in full Not Covered

Contact Lenses³ $120 retail allowance Up to $100 $150 retail allowance Up to $100 Co-payments apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursement. ¹Materials co-pay applies to lenses and frames only, not contact lenses. ²See your benefits materials for definitions of standard and specialty contact lens fittings. ³Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus copay. ⁴If premium progressive lenses are selected, members receive an allowance based on the provider’s charge for standard progressive lenses. ³Contact lenses are in lieu of eyeglass lenses and frames benefit.

DISCOUNT FEATURES

Look for providers in the Provider Directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-30%) prior to service as they vary.

Discounts on Covered Materials Frames: 20% off amount over allowance Lens option: 20% off retail Progressive: 20% off amount over retail lined trifocal lens, including lens options

The following options have out-of-pocket maximums⁶ on standard (not premium, brand, or progressive) lenses.

Maximum Member Out-of-Pocket Single Vision Bifocal & Trifocal Scratch coat $13 $13 Ultraviolet coat $15 $15 Tints, solid or gradients $25 $25 Anti-reflective coat $50 $50 Polycarbonate $40 20% off retail High index 1.6 $55 20% off retail Photochromics $80 20% off retail ⁶Discounts and maximums may vary by lens type. Please check with your provider.

Discounts on Non-Covered Exam and Materials

Exams, frames, and prescription lenses: 30% off retail Lens options, contacts, other prescription materials: 20% off retail Disposable contact lenses 10% off retail

Refractive Surgery Superior Vision has a nationwide network of refractive surgeons and leading LASIK networks who offer members a discount. These discounts range from 15%-50%, and are the best possible discounts available to Superior Vision.

The Plan discount features are not insurance.

All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan.

Discounts are subject to change without notice.

Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions.

Optional Life, Dependent Life and Accidental Death and Dismemberment Insurance Rate Sheet

Optional Life Insurance

You have the option of buying additional term life insurance as a new hire or upon proof of insurability. You may choose additional

coverage of one, two, three, or four times your annual salary rounded up to the next thousand. Maximum coverage is $500,000. You

pay the cost of this coverage. The cost is based on your age:

Present Age Rate per $1,000 Present Age Rate per $1,000

Under age 25 .042 50 through 54 .193

25 through 29 .042 55 through 59 .361

30 through 34 .059 60 through 64 .554

35 through 39 .067 65 through 69 1.067

40 through 44 .084 70 and older 1.722

45 through 49 .126 Updated as of 1/1/2018

To figure your cost, do the following:

1. Multiply your annual salary by 1, 2, 3, or 4 (depending on the level of coverage you choose)

2. Round that amount up to the nearest $1,000.00 and divide by $1,000.00

3. Multiply by the rate in the chart above based on your age

4. The result is your monthly cost

Optional Dependent Life Insurance You may choose from the following provisions: Updated as of 1/1/18

Level of Coverage Spouse Each Eligible Child Monthly Rate

I $10,000 $5,000 $2.85

II $15,000 $7,500 $4.27

III $20,000 $10,000 $5.69

Optional Accidental Death and Dismemberment Insurance

You have the option of enrolling yourself and your family. *You are limited to 15 times your annual salary (rounded up to the next

level) for all coverage amounts in excess of $150,000. Maximum coverage is $300,000. You pay the cost of coverage according to

the following schedule: Updated as of 1/1/15

Amount of Employee's

Coverage

Monthly Cost

Employee Only

Amount of Spouse's

Coverage

Amount of Child's

Coverage

Monthly Cost Employee

& Family

$25,000 $.38 $15,000 $ 5,000 $.75

50,000 .75 30,000 10,000 1.50

75,000 1.13 45,000 15,000 2.25

100,000 1.50 60,000 20,000 3.00

125,000 1.88 75,000 25,000 3.75

150,000 2.25 90,000 30,000 4.50

*175,000 2.63 105,000 35,000 5.25

*200,000 3.00 120,000 40,000 6.00

*225,000 3.38 135,000 45,000 6.75

*250,000 3.75 150,000 50,000 7.50

*275,000 4.13 165,000 55,000 8.25

*300,000 4.50 180,000 60,000 9.00