2020 BENEFITS OVERVIEW

22002200

The benefits illustrated above are meant to serve as a summary of the benefits available under the carrier’s plan. Should any discrepancy arise, the carrier’s documents supersede this illustration. Once enrolled, you will receive a Combined Evidence of Coverage and Disclosure Form that explains the exclusions and limitations, as well as the full range of covered services of your plan, in detail.

MEDICAL

Medical Benefits

202200 PLAN CHOICES

EMPLOYEE CONTRIBUTION PER MONTH

Out Of Network

$19,500$39,000

$22,500$44,100

50%Ded + 50%Ded + 50%

Ded + 50%

Ded + 50%

Ded + 50%

Ded + 50%

Ded + 50%

Ded + 50%(20 per year)

Ded + 50%(30 per year)

In Network

$6,500$13,000

$7,350$14,700

0%

No Charge

Ded + 0%

Ded + 0%

Ded + 0%

Ded + 0%

$5 / $25$50$65

Out Of Network

$3,000$9,000

$15,000$30,000

40%Ded + 40%Ded + 40%

Ded + 40%

Ded + 40%

Ded + 40%/$800 max

Ded + 40%/$1,000 per day

Ded + 40%/$350 max

Ded + 40%(20 per year)

Ded + 40%(30 per year)

Copay + 50%

In Network

$1,000$3,000

$5,000$10,000

20%$35 / $35$35 Copay

No Charge

Ded + 20%

Ded + 20%

Ded + 20%

Ded + 20%

$35 Copay(20 per year)

$35 Copay(30 per year)

$5 / $20$30$50

Out Of Network

$250$750

$10,500$21,000

40%Ded + 40%Ded + 40%

Ded + 40%

Ded + 40%

Ded + 40%/$800 max

Ded + 40%/$1,000 per day

Ded + 40%/$350 max

Ded + 40%(20 per year)

Ded + 40%(30 per year)

Copay + 50%

In Network

$250$750

$5,000$3,500$7,00020%

$20 / $20$20 Copay

No Charge

Ded + 20%

Ded + 20%

Ded + 20%

Ded + 20%

$30 (20 per year)

$20 (20 per year)

$20 (30 per year)

$5 / $15$50$45

ANTHEM BLUE CROSS EElleemmeennttss CChhooiiccee PPPPOO 66550000

ANTHEM BLUE CROSSCLASSIC PPO 1000/35/20

ANTHEM BLUE CROSS PREMIER 250/20/20

KAISER HMO 15

Lifetime Maximum BenefitDeductible Individual FamilyOut of pocket maximum Individual FamilyCo-Insurance (your cost)Office visit (pcp/specialist)Urgent carePreventive services/well baby careLabs and x-rays

MRI/CT/PET

Hospitalization

Outpatient surgery

Emergency room

Acupuncture

Chiropractic services

PrescriptionsRx deductible

Generic Brand Non-formulary

FULL PLAN DESCRIPTION

Employee onlyEmployee + spouseEmployee + child/renEmployee + family

In Networkunlimited

NoneNone

$1,500$3,000

N/A$15 / $15$15 Copay

No Charge

No Charge

No Charge

$250 per admission

$15 per procedure

$100 Copay

$15 Copay

Not Covered

$10$25$25

$100.32$838.71$715.65

$1,330.97

unlimited

includes deductible

unlimited

includes deductible

$150 (Waived if admitted) then Ded + 20%

$164.62$980.15$708.33

$1,591.83

unlimited

includes deductible

$100 (Waived if admitted) then Ded + 20%

$323.39$1,329.44$994.10

$2,084.00

Ded + 0%

Ded + 0%

$35 / $35(1st 3 visits)

$35/$35 (1st 3 visits)

$35 / $35(1st 3 visits)

$500 / $1,500 Deductible

$72.39$757.26$562.30

$1,195.57

Copay + 50%$250 max

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2020

ANTHEM BLUE CROSS

In Network

$50/$150

$50/$150

80%

50%

negotiated fee

Out Of Network

$50/$150

$50/$150

80%

50%

90th percentile

$1,500

not covered

$0

100%

not covered

basic

basic

basic

basic

basic

-

$54.41

$68.56

$128.96

EMPLOYEE CONTRIBUTION PER MONTH

DENTAL

Annual Max

Orthodontia Lifetime Max

Deductible

Preventive

Basic (Individual/Family)

Major (Individual/Family)

Coinsurance

Preventive

Basic

Major

Orthodontia

Important Provisions

Endodontic Services

Periodontal Maintenance

Periodontal Surgery

Oral Surgery (Simple Extractions)

Oral Surgery (Complex Extractions)

Usual & Customary

Employee only

Employee + spouse

Employee + child/ren

Employee + family

VISION ANTHEM BLUE CROSS

in network

$10

$25

100%

covered after copay

$130

$130 + 20%

out of network

n/a

n/a

up to $49

$35

$49

$74

$92

$50

every 12 months

every 12 months

every 12 months

every 24 months

-

$4.59

$5.25$11.14

Office visit copay

Materials copay

Eye exam reimbursement

Lenses

Single vision

Bifocal

Trifocal

Contact lenses

Frames allowance

Eye exam

Lenses

Contact lenses

Frames

EMPLOYEE CONTRIBUTION PER MONTH

Employee only

Employee + spouse

Employee + child/ren

Employee + family

Dental, Vision, Life, and Disability Benefits

BASIC LIFE ANTHEM BLUE CROSS

All Eligible Employees

$50,000

Same as Benefit Amount

$50,000

ClassBenefit AmountAD&D BenefitGuaranteed Issue

SHORT-TERMDISABILITY

ANTHEM BLUE CROSS

All Eligible Employees

Yes

$2,500

7 Days

7 Days

12 Weeks

ClassTaxable BenefitBenefit PercentageBenefit MaximumElimination Period

AccidentSickness

Benefit Duration

LONG-TERMDISABILITY

ANTHEM BLUE CROSS

All Eligible Employees

Yes

60%

$10,800

$10,800

90 Days

SSNRA

2 Years

3/12

ClassTaxable BenefitBenefit PercentageBenefit MaximumGuaranteed IssueElimination PeriodBenefit DurationOwn OccupationPre-Existing

60%

OPTIONALLIFE

ANTHEM BLUE CROSS

All Eligible Employees

$10,000 increments;

5X salary up to $500,000

$10,000

$5,000 increments up to $250K

not to exceed 50% of EE benefit

$15,000

Class

Benefit Amount

Spouse Benefit

AD&D BenefitGuaranteed Issue

Child Benefit

Same as Benefit Amount

FULL PLAN DESCRIPTION

FULL PLAN DESCRIPTION

PLAN DETAILS

PLAN DETAILS

PLAN DETAILS

PLAN DETAILS

More Benefits

Imagine having a counselor, a lawyer and a financial consultant on call when- ever you need them. Actually, you don’t have to imagine it because with Resource Advisor, you already do. And, it’s included with your Anthem Blue Cross group life and/or disability plan at no extra cost.

• Find out more

EMPLOYEE ASSISTANCE PROGRAM (EAP)

• Convenience—consolidate all yourstudent loans into a single loan

• Flexibility—choose from a varietyof loan terms

• No Commitment—no-obligationrate quote

• $300 welcome bonus if you signup and refinance through this link.

SOFI: STUDENT LOAN COST REDUCTION

FLEXIBLE SPENDING ACCOUNT (FSA)• Premier provides eligible employ-

ees the opportunity to enroll in amedical FSA plan, as well as adependent care plan. Both plansoffer employees tremendousopportunities to make pre-taxpayroll withholdings to pay forqualified medical and dependentcare expenses.

• Find out moreFARM FRESH TO YOU

• Healthy groceries to your home

• Local farms, organically grown

• 10% discount and convenientdelivery by entering promo code“NEWFRONT10”

• Find out more

QUESTIONS? Contact your Newfront Benefits Consultant, Sabrina Louie by phone 415-878-3711 or sabrina.louie@newfront.com

WELLNESS/COMMUTING BENEFIT PROGRAM:

ALTERNATIVE BENEFIT CHOICE: STUDENT LOAN REPAYMENT PROGRAM

Being able to bring one’s natural self to work every day requires our employees to prioritize their physical and mental wellness. We also understand that com-muting expenses quickly add up and any extra support can help. Premier is very committed to supporting physical, mental and financial wellness in our employees and offers a $50/month reimbursement program for wellness and/or commuting related expenses so that employees are able to rejuvenate and recharge outside of work. All permanent, full-time employ-ees of Premier are eligible for this benefit.

GYM DISCOUNTS• Low or no registration fees

• Nationwide locations

• Website: 24 Hour Fitness clickhere for more information

COMMUTER BENEFIT PROGRAM

• This program allows employees totap into an existing federal program(Sec 132) to pay for transit passesand vanpool expenses on a pre-tax basis. IRS limit is $270 per monthfor transit, and $270 for parking.

• Find out more

New! Student Loan Repayment Program (administered by Goodly):

All employees have the opportunity to enroll in our new Student Loan Repay-ment Program. Anyone who chooses to enroll will receive $50 a month towards paying down their student loans. Premier Talent Partners will send the contribution to Goodly each month, who will then send it directly to your servicer. You should make your regular monthly payment to stay eligible for that month's contribution. Thanks to these contributions, you will save money on interest and cut time off your loan!

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• Premier will enroll all employeeswho have elected the AnthemElements Choice PPO medical planinto the HRA plan through BRI.Premier will contribute $3,000 HRAfunds towards the $6,500 deductibleto be used on co-pays. Rx, andmedical expenses only.

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HEALTH REIMBURSEMENT ACCOUNT (HRA)