EMPLOYEEBENEFITSPROGRAM

11211FM2920Rd.Tomball,TX77375BJservices.com

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WELCOMETOYOUREMPLOYEEBENEFITSBenefitsareamajorpartofyouroverallcompensation.Itisimportantthatyouareawareofyourbenefitsandthevaluetheyrepresenttoyouandyourfamily.Familiarizeyourselfwiththeinformationinthisguide.Ifyouhaveanyquestionsregardingtheinformationherein,pleasecontacttheappropriatepartyusingtheinformationbelow.

Benefit Carrier PhoneNumber Website

Medical BCBSTX 1-800-521-2227 www.bcbstx.com

MDLive BCBSTX 1-888-680-8646 www.bcbstx.com

HealthSavingsAccount HSABank 1-855-731-5220 www.hsabank.com

FlexibleSpendingAccount DiscoveryBenefits 1-866-451-3399 www.discoverybenefits.com

Dental Cigna 1-800-564-7642 www.cigna.com

Vision VSP 1-800-877-7195 www.vsp.com

LifeInsurance Cigna 1-800-362-4462 www.cigna.com

DisabilityInsurance Cigna 1-800-362-4462 www.cigna.com

BJBenefitResourceCenter BJServices 1-844-9BJ-TEAM benefits.bjservices.com

IntroducingtheBenefitResourceCenterTheBenefitResourceCenter(BRC)isyourone-callinformationhotline.TheBRCisstaffedwithBenefitAdvocateswhohavespecificknowledgeofyourplans.Letthemassistyouandyourfamilywithyourbenefitquestionsandclaimissues.TheBenefitAdvocateswillbeableto:

• Answeryourbenefitplan/policyquestions• Assistyouwitheligibilityandclaimproblemswithcarriers• Provideclaimappealsinformationandexplaintheprocess• Explainallowablefamilystatuselectionchanges(addingnewborns,marriage,divorce,etc.)• Providevendorplancontactinformation

BenefitResourceCenter855-USI-0110(Toll-Free)BRCSouthwest@usi.com

Monday-Friday8:00amto5:00pmCDT

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ENROLLMENTANDELIGIBILITYFull-timeemployeesworkingatleast30hoursperweekandtheireligibledependentsmayparticipateintheBJServicesBenefitsProgrambeginningontheirdateofhire.Generally,forthepurposeofthebenefitsprogram,dependentsaredefinedas:

Ifyourdependentsdonotfallintooneoftheforegoingcategories,theyareconsideredineligibledependents.Enrollmentofanineligibledependentisaviolationofcompanypolicies.Ifyouhaveanyquestionsregardingwhetheradependentiseligible,contacttheHumanResourcesDepartmentbyemailingbenefits@bjservices.com.

LifeStatusChangeEventsYoumaymakechangestoyourbenefitelectionsduringtheplanyearifyouexperienceoneofthefollowingevents:

Ifyouthinkyoumayhaveafamilystatuschangethatwouldallowyoutomakechangestoyourcoverage,youMUSTnotifyHumanResourceswithin31daysoftheevent.Failuretomaketimelynoticewouldrequireyoutowaituntilthenextopenenrollment.

• Yourlegalspouseordomesticpartner

• Yourdependentchilduptoage26(underthevoluntarydependentlifeplan,childrenareeligibletoage25)

• Yourdisabledchild(ren)ofanyagewhoaredependentonyouforsupport

• Marriage,divorce,legalseparationorannulment

• Deathofyourspouseorchild

• Birth,adoptionorplacementforadoptionofadependent

• Changeinemploymentstatusforyouoryourspouse

• Dependentsatisfyingorceasingtosatisfytheplan’seligibilityrequirements

• Lossof,orsignificantchangeto,youroryourspouse’scurrentcoverage

• Changeinresidencethataffectsyoureligibilityforcoverage

• Judgmentorcourtorder

• Enrollment/ceasingtobeenrolledinMedicareorMedicaid

• CeasingtobeenrolledintheChildren’sHealthInsuranceProgram(CHIP)

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MEDICALBENEFITSBJServicesoffersachoiceoftwomedicalplansofferedthroughBlueCrossBlueShieldofTexas(BCBSTX).ThePPOplanisatraditionalcopayanddeductibleplanthatoffersbothin-andout-of-networkbenefits.However,youwillpaylessout-of-pocketwhenyouutilizeaphysicianorfacilityintheBlueChoiceNetwork.TheHighDeductibleHealthPlan(HDHP)isaconsumer-drivenplanthatallowsyoutheopportunitytoopenaHealthSavingsAccount(HSA).YoucanlearnmoreaboutHSAsonthefollowingpage.Tofindalistofin-networkproviders,pleasevisitwww.bcbstx.com.Onthesite,youcanalsoregisterasamemberandkeeptrackofimportanthealthinformation,printreplacementIDcardsandlocatenearbydoctorsandpharmacies.Pleasenote,onlythein-networkbenefitsareshownbelow.Foracompletelistofbenefits,refertoyourplandocuments.

BCBSTX PPOPlan HDHPwithHSAPlanDeductible

• Individual• Family

$750$1,500

$1,500$3,000

Out-of-PocketMaximum• Individual• Family

$4,000$8,000

$5,000$10,000

OfficeVisit $25copay/$40copay 80%afterdeductiblePreventiveCare 100% 100%InpatientHospitalization 80%afterdeductible 80%afterdeductibleOutpatientServices 80%afterdeductible 80%afterdeductibleDiagnosticTests,Labs,X-Rays 100% 80%afterdeductibleMajorDiagnosticProcedures 80%afterdeductible 80%afterdeductibleEmergencyRoom $100copay;then80%afterdeductible 80%afterdeductibleMentalHealth 80%afterdeductible 80%afterdeductibleChemicalDependency 80%afterdeductible 80%afterdeductiblePrescriptionDrugs

• Generic• PreferredBrand• Non-PreferredBrand• Specialty

$10copay$35copay$60copay$120copay

80%afterdeductible

MailOrderDrugs 2xretailcopay 80%afterdeductibleEmployerHSAContributions N/A $500/$1,000

Bi-WeeklyPaycheckDeductionsTier PPO HDHP

EmployeeOnly $65.58 $42.92

Employee+Spouse $150.42 $130.36

Employee+Child(ren) $117.34 $101.97

Employee+Family $202.64 $175.32

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VIRTUALVISITS|MDLIVEGettingsickisneverconvenient,andfindingtimetogettothedoctorcanbehard.BCBSTXprovidesyouandyourcovereddependentsaccesstocarefornon-emergencymedicalissuesandbehavioralhealthneedsthroughMDLIVE.Whetheryou’reathomeortraveling,accesstoaboard-certifieddoctorisavailable24hoursaday,sevendaysaweek.Youcanspeaktoadoctorimmediatelyorscheduleanappointmentbasedonyouravailability.Virtualvisitscanalsobeabetteralternativethangoingtotheemergencyroomorurgentcarecenter.MDLIVEdoctorsandtherapistscanhelptreatthefollowingconditionsandmore:

GeneralHealth• Allergies• Asthma• Nausea• Sinusinfections

PediatricCare• Cold/flu• Earproblems• Pinkeye

BehavioralHealth• Anxiety/depression• Childbehavior/learningissues• Marriageproblems

ConnectAccesstheBCBSTXApp,onlinevideoortelephoneservice.

DiagnosePrescriptionssentelectronicallytothepharmacyofyourchoice,

(whenappropriate).

InteractReal-timeconsultationwithaboard-certifieddoctoror

therapist.

ContactMDLIVE

CallMDLIVE(888-680-8646)tospeakwithahealthservicespecialistordoctor.

Getconnectedtoday!Toregister,you’llneedtoprovideyourfirstand

lastname,dateofbirthandBCBSTXmemberIDnumber.

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WhereshouldIgoforcare?Helpingyouchoosetherightcarecenter

CareCenter WhywouldIusethiscarecenter? Whattypeofcarewouldtheyprovide*?

Whatarethecostandtimeconsiderations**?

DoctorsOffice Youneedroutinecareortreatmentforacurrenthealthissue.Yourprimarydoctorknowsyouandyourhealthhistory,canaccessyourmedicalrecords,providepreventiveandroutinecare,manageyourmedicationsandreferyoutoaspecialist,ifnecessary.

Ø RoutinecheckupsØ ImmunizationsØ PreventiveservicesØ Manageyour

generalhealth

Ø Oftenrequiresacopayand/orcoinsurance

Ø Normallyrequiresan

appointmentØ Littlewaittimewith

scheduledappointment

VirtualVisits Youhaveanon-emergencymedicalissueandgettingtothedoctor’sofficeisnotconvenient.VirtualVisits/MDLIVEisavailabletoyouandyourcovereddependents24/7fromanywhereyouhavetelephoneserviceoraninternetconnection.

Ø AllergiesØ AsthmaØ SinusInfectionsØ Cold/fluØ PinkeyeØ Anxiety/depression

Ø Requiresacopayorcoinsurance

Ø Youcanspeakwithadoctor

immediatelyorscheduleanappointmentbasedonyouravailability

ConvenienceCareClinic

Youmayneedcarequickly,butitisnotanemergency,andyourprimaryphysicianmaynotbeavailable.Urgentcarecentersoffertreatmentfornon-lifethreateninginjuriesorillnesses.Staffedbyqualifiedphysicians.

Ø CommoninfectionsØ Minorskin

conditionsØ FlushotsØ PregnancytestsØ MinorcutsØ Earaches

Ø Oftenrequiresacopayand/orcoinsuranceusuallyhigherthananofficevisit

Ø Walk-inpatientswelcome

withnoappointmentsnecessary,butwaittimescanvary

UrgentCareClinic Youmayneedcarequickly,butitisnotanemergency,andyourprimarycarephysicianmaynotbeavailable.Urgentcarecentersoffertreatmentfornon-lifethreateninginjuriesorillnesses.Staffedbyqualifiedphysicians.

Ø SprainsØ StrainsØ Minorbrokenbones(e.g.finger)Ø MinorinfectionsØ Minorburns

Ø Oftenrequiresacopayand/orcoinsuranceusuallyhigherthananofficevisit

Ø Walk-inpatientswelcome,but

waitingperiodsmaybelongeraspatientswithmoreurgentneedswillbetreatedfirst

EmergencyRoom Youneedimmediatetreatmentofaveryseriousorcriticalcondition.TheERisforthetreatmentoflife-threateningorveryseriousconditionsthatrequireimmediatemedicalattention.Donotignoreanemergency.Ifasituationseemslifethreatening,takeaction.Call911oryourlocalemergencynumberrightaway.

Ø HeavybleedingØ LargeopenwoundsØ Suddenchangeof

visionØ ChestpainØ MajorburnsØ SpinalinjuriesØ SevereheadinjuryØ DifficultybreathingØ Majorbrokenbones

Ø Oftenrequiresamuchhighercopayand/orcoinsurancethananofficevisitorurgentcarevisit

Ø Open24/7,butwaitingperiod

maybelongerbecausepatientswithlife-threateningemergencieswillbetreatedfirst

*Thisisasamplelistofservicesandmaynotbeall-inclusive.**Costsandtimeinformationrepresentsaveragesonlyandisnottiedtoaspecificcondition,levelofcoverageortreatment.Yourout-of-pocketcostswillvarybasedonplandesign.Notalltreatmentfacilitiesarecoveredequallyunderallplandesigns.AlwaysrefertoyourspecificPlanDocumentsforyourcoveragedetails.Sometreatmentsmayrequirepreauthorizationorareferralfromyourprimarycarephysician.Thisdocumentisforinformationalpurposesonlyasapartofyourhealthplanandnotasubstituteforyourdoctor’scare.Pleasediscusswithyourdoctorhowtheinformationprovidedisrightforyou.Yourpersonalhealthinformationiskeptprivateinaccordancewithyourplan’sprivacypolicy.

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HEALTHSAVINGSACCOUNT(HSA)AnHSAisatax-exemptsavingsaccountyouestablishexclusivelyforthepurposeofpayingforqualifiedmedicalexpenses.HSAsareonlyavailabletoindividualswhoareenrolledinaHighDeductibleHealthPlan(HDHP).YourBJServicesHSAisadministeredthroughHSABank.HSAdollarscanbeusedtopayformedicalandprescriptiondrugexpensesthatareappliedtowarddeductibles,over-the-countermedicationsifpurchasedwithaprescriptionandnon-coveredmedical,dentalandvisionexpenses,allsubjecttoIRSguidelines.HSAdollarsmayonlybeusedforexpensesincurredwhilecoveredunderanHDHPandafteryourHSAbankaccountisopened.

ContributingandUsingHSAFundsContributionstoyourHSAcomefromtwosources–youandyouremployer.Allthemoneyinyouraccountisyourstospendonqualifiedhealthcareexpensesortosaveforfutureexpenses.ThetablebelowshowsthemaximumamountthatcanbecontributedtoyourHSAin2017.Rememberthatanyoneage55andoldercancontributeanadditional$1,000annually.

CoverageLevel HSAAnnualContributionLimit(combinedemployerandemployeecontributions)

AutomaticContributionfromBJServices

(Totalvaluefundedinscheduledcontributions)

YourAnnualContributionMaximum

EmployeeOnly $3,400 $500 $2,900

Employee+Spouse $6,750 $1,000 $5,750

Employee+Child(ren) $6,750 $1,000 $5,750

Employee+Family $6,750 $1,000 $5,750

ChangingYourContributionsOnceyouestablishyourHSA,youcanchangeyourcontributionsatanytimeduringtheyear.Thisflexibilityenablesyoutocontributeasmuchasyourbudgetallows(uptotheannualmaximumslistedabove)andadjustyourcontributionstofityourhouseholdbudgetthroughouttheyear.

UseYourFundsWithaDebitCardYourHSAworkslikeasavingsaccount.YoudecidewhethertousethefundstopayforhealthcareexpensesoutofyourpocketorfromyourHSAusingaconvenientdebitcardprovidedbyHSABank.

QualifiedExpensesYoucanuseyourHSAforout-of-pocketexpensesthatwouldgenerallyqualifyforthemedical,dentalandvisionincometaxreduction.Qualifiedexpensesinclude,butarenotlimitedto,deductibles,officevisitcopays,prescriptiondrugs,hospitalstays,dentalandvisioncare. Forafulllistofqualifiedexpenses,visit:www.irs.gov/pub/irs-pdf/p502.pdf.

TaxAdvantagesYourHSAoffersanumberoftaxadvantages.Themoneyyoucontributetoyouraccountisdeductedfromyourpaycheckpre-tax,allmoneyintheaccountaccumulatestax-freeandpurchasesyoumakewithyourHSAarealsotax-free.Plus,themoneyinyouraccountisalwaysyourstokeep,evenifyouleavethecompanyorretire.

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FLEXIBLESPENDINGACCOUNTSFlexibleSpendingAccounts(FSAs)allowyoutohavepre-taxmoneydeductedfromyourpaychecktopayforcertainunreimbursedmedicalexpensesanddependentcarecosts.Sincecontributionsaremadethroughpayrolldeductionswithpre-taxdollars,youdecreaseyourtaxableincomeandincreaseyourtake-homepaybytakingadvantageofthisbenefit.BJServicesofferstwotypesofflexiblespendingaccounts.HealthCareFSAAHealthCareFSApaysfortheuncoveredorunreimbursedportionsofqualifiedmedicalexpenses.Usingpre-taxpayrollcontributions,youcanreceivereimbursementsfromyourHealthCareFSAforeligiblemedical,dentalandvisionexpensesincurredbyyouoraneligibledependent,aslongastheexpensesarenotcoveredorreimbursedbyotherplans.IfyouelecttheHealthCareFSA,youwillreceiveadebitcardtopayformedicalexpensesatthepointofservice.Pleasebesuretoobtainitemizedreceiptsforallservicespaidforbythedebitcard.YoumayberequiredtosubmitthemtotheFSAadministratortovalidateifyourpurchaseiseligibleundertheplan.Officevisitcopaysandover-the-countermedicinesorsuppliespurchasedfromavendorthathascompletedtheIRSvalidationprocesswillnotrequirereceipts.MaximumContributionAmounts:ThemaximumamounttheIRSallowsyoutocontributetoyourHealthcareFSAis$2,600perplanyear.TheHealthCareFSAhasa“UseitorLoseit”feature,meaninganyfundsleftinyouraccountinexcessof$500willnotcarryoverfromyear-to-year.Pleaseestimateyourhealthcarecostsconservatively.PleasenotethatyoucannotenrollintheHealthCareFSAifyouareenrolledintheHDHPHSA.DependentCareFSAADependentCareFSApaysfordaycare(childandadult),preschoolorotherchildcareservicesforyoureligibledependents.Youdecidehowmuchtocontribute,upto$5,000peryear,perhousehold,combined.Tobeeligibletousetheaccount,you(andyourspouseifmarried)mustworkoutsidethehome.Youmayclaimdependentcareexpensesforadependentthatliveswithyouandreliesonyouformorethanhalfofhisorherfinancialsupport.Youmustalsoclaimthepersonasadependentonyourfederalincometaxreturn.Eligibledependentsincludeyourlegaldependentchildren,spouseorparents(ifqualificationsaremet).MaximumContributionAmounts:ThemaximumamountthatyoumaycontributetoyourDependentCareFSAis$5,000perplanyear.ThereisnocarryoveroffundsassociatedwiththeDependentCareFSA,soagain,estimateyourneedsconservatively.PleasenotethatyoucanparticipateintheDCFSAwhetheryouareenrolledinthetraditionalPPOorHDHPHSA.

ExamplesofEligibleExpenses

HealthCareFSAMedicaldeductible,copays,well-babycare,prescriptiondrugs

Hearingexams,hearingdevicesVisioncare,contactlenses,correctiveeyesurgery

Dentalservices,orthodontia

DependentCareFSAIn-homebabysittingservicesduringworkhours(notbyanindividualyouclaimasadependent)

CareofapreschoolchildbyalicenseddaycarecenterordaycareproviderBeforeandafterschoolcare

Daycamp

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HSAandFSAComparisonWhileHSAsandFSAsaresimilar,therearesomekeydifferences.Thetablebelowbreaksdowncommonquestionsabouttheseaccounts.

HSA HealthCareFSA DependentCareFSA

AccountFundedBy Employeethroughpre-taxpayrolldeductions

Employeethroughpre-taxpayrolldeductions

Employeethroughpre-taxpayrolldeductions

EnrollmentIntegratedwithMedicalPlan Yes Yes Yes

ContributionLimits

Upto$3,400forindividual$6,750forfamily

55andolder$1,000additionalcatch-upallowance

$2,600 $5,000or$2,500ifmarriedandfilingseparately

CanBeUsedToPayForQualifiedHealthCareExpenses

Yes(cannotbeenrolledintheFSA)

Yes(cannotbeenrolledinthe

HSA)

No,canonlybeusedtopayforqualified

child/adultcareexpenses

CanBeUsedToPayForCopaysandCoinsurance Yes Yes No

DebitCard Yes Yes No

FundsRollOverFromYearToYear Yes No No

FundsAvailableAllfundsintheaccountareavailableoncetheyaredeposited(accrued)

Allfundsareavailableonthefirstdayoftheyear

Allfundsintheaccountareavailableoncetheyaredeposited(accrued)

Portability Alldepositsbelongtotheemployeeimmediately

FSAdollarsremainintheplanuntiltheendoftheplanyearoruntilyouremployment

ends

FSAdollarsremainintheplanuntiltheendoftheplanyearoruntilyouremploymentends

TimeLimitOnReimbursementNotimelimitfor

reimbursementofqualifiedmedicalexpenses

ExpensesmustbeincurredbyFebruary28,2018,andmustbefilledbyMay29,2018

ExpensesmustbeincurredandfiledbyFebruary28,

2018

UseItOrLoseItRuleApplies

No,yourfundsareyourstokeepandusethefollowingyear,evenifyouleavethe

company

Youcanrolloverupto$500butyouwillforfeitanyfundsinexcessof$500leftoverattheendoftheplanyear

Youwillforfeitanyfundsleftoverintheaccountattheendoftheplanyear

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DENTALBENEFITSYourdentalbenefitsareofferedthroughCigna.Whiletheplanoffersbothin-andout-of-networkbenefits,youwillpaylessout-of-pocketifyouvisitadentistwithintheTotalCignaDPPONetwork.Consultyourplandocumentstodetermineyourspecifictermsofcoverageandout-of-networkbenefitlevels.

TotalCignaDPPONetwork In-NetworkDeductible

• Individual• Family

$50$100

CalendarYearBenefitsMaximumAppliestoClassI,II,IIIandIXexpenses

$1,500

ClassI:DiagnosticandPreventiveOralexams,Cleanings,X-rays,FluorideApplication

Coveredat100%,nodeductible

ClassII:BasicRestorativeIncludesSealants,Fillings,Endodontics,Periodontics,OralSurgery,RepairstoBridges,DenturesandCrowns

80%afterdeductible

ClassIII:MajorRestorativeInlaysandOnlays,ProsthesisOverImplant,Crowns,BridgesandDentures

50%afterdeductible

ClassIV:OrthodontiaCoverageforDependentChildrentoage19

50%,nodeductible

OrthodontiaLifetimeBenefitsMaximum $1,500ClassIX:Implants 50%afterdeductible

Bi-WeeklyPaycheckDeductionsEmployeeOnly $4.15

Employee+Spouse $8.77

Employee+Child(ren) $11.08

Employee+Family $14.77

NeedHelpDecidingifCignaCoverageisRightForYou?

CallCignaduringyourenrollmentperiodtospeakwithacustomerrepresentativewhocanansweryourquestionsregardingthefeaturesandadvantagesofcoverage.You’llgetanswersonyourspecificplan,howtofindanin-networkdentistandalistofalltheproductsandresourcesavailabletoyou.

Formoreinformationcall800-564-7642,anytime24/7.

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VISIONBENEFITSYourvisionbenefitsareofferedthroughVSP.WhenyouenrollandvisitaVSPnetworkprovider,you’llreceivethebestcareatthelowestout-of-pocketcosts.Tofindaprovider,visitwww.vsp.comorcall800-877-7195.Atyourappointment,novisionIDcardisnecessary.However,youmayprintacardfromtheVSPwebsiteifyouchoose.

Benefit Description Copay Frequency

WellVisionExam • Focusesonyoureyesandoverallwellness $10 Every12months

PrescriptionGlasses • Planallowsforonepairofprescriptionglassesperyear

$25 SeeFramesandLenses

SafetyGlasses • Planallowsforonepairofsafetyglassesperyear(upto$100allowance)

$0

Frames • $200allowanceforawideselectionofframes• $220allowanceforfeaturedbrands• 20%savingsontheamountoveryourallowance• $70Costcoframeallowance

IncludedinPrescriptionGlasses

Every12months

Lenses • Singlevision,linedbifocalandlinedtrifocallenses

• Polycarbonatelensesfordependentchildren

IncludedinPrescriptionGlasses

Every12months

LensEnhancements • Standardprogressivelenses• Premiumprogressivelenses• Customprogressivelenses• Averagesavingsof20-25%onotherlensenhancements

$55$95-$105$150-$175

Every12months

Contacts(insteadofglasses)

• $180allowanceforcontactsandcontactlensexam(fittingandevaluation)

• 15%savingsonacontactlensexam(fittingandevaluation)

$0 Every12months

ExtraSavings GlassesandSunglasses:Extra$20tospendonfeaturedframebrands.Gotovsp.com/specialoffersfordetails.20%savingsonadditionalglassesandsunglasseswithin12monthsofyourlastWellVisionExam.RetinalScreening:Nomorethana$39copayonroutineretinalscreeningasanenhancementtoaWellVisionExam.LaserVisionCorrection:Average15%offtheregularpriceor5%offthepromotionalprice;discountsonlyavailablethroughcontractedfacilities.

Bi-WeeklyPaycheckDeductions

EmployeeOnly $5.16

Employee+Spouse $7.85

Employee+Child(ren) $7.99

Employee+Family $12.46

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BASICLIFEANDAD&DLifeInsurancecanhelpprotectyourlovedones’financialhealthifyouarenolongertheretosupportthem.Allactive,full-timeemployeesofBJServicesareeligibleforaBasicLifeandAD&Dbenefitof1xyourannualsalary,toamaximumof$500,000.ThisbenefitisofferedthroughCignaandisavailableatnocosttoyou.Shouldyourdeathbetheresultofanaccident,youwillalsoreceiveanAD&Dbenefitof1xyourannualsalary,toamaximumof$500,000.

VOLUNTARYLIFEINSURANCEAsanaddedlayerofprotection,youmaychoosetosupplementyourcompany-providedbasiclifeinsurancewithvoluntarytermlifeinsurancethroughCigna.Allactive,full-timeemployeesareeligibleforcoverage.Yourspouseandchild(ren)areeligibleforcoverageaslongasyouapplyforandareapprovedforcoverageyourself.

BenefitAmount Maximum GuaranteedIssueEmployee 1,2,3,4,5or6timessalary Lesserof6timessalaryor$1,500,000 $250,000

Spouse Unitsof$5,000 Lesserof$250,000or50%oftheemployeeamount $50,000

Children Unitsof$1,000 $10,000 N/A

EmployeeandSpouseMonthlyCostper$1,000ofLifeInsuranceCoverageSpouserateisbasedonemployee’sage.

Age 0-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+Rate $0.036 $0.047 $0.055 $0.068 $0.110 $0.196 $0.313 $0.454 $0.785 $1.273

Childlifeis$0.100per$1,000ofcoverage.

VOLUNTARYACCIDENTALDEATHANDDISMEMBERMENT(AD&D)INSURANCEIfyoupassawayorareseriouslyinjuredasaresultofacoveredaccidentorinjury,youoryourbeneficiarieswillreceiveasetamounttohelppayforunexpectedexpenses,orhelpyourlovedonespayforfutureexpensesafteryou’regone.Allactivefull-timeemployeescanelectcoverage.Yourspouseandchild(ren)areeligibleaslongasyouelectcoverageforyourself.YoudonothavetoenrollinvoluntarylifeinsurancetoelectvoluntaryAD&D.

BenefitAmount MaximumEmployee Unitsof$10,000 Lesserof6timessalaryor$1,500,00Spouse 50%ofemployeeamount 50%ofemployeeamounttoamaximumof$500,000

Children 20%ofemployeeamount 20%ofemployeeamounttoamaximumof$20,000MonthlyCostper$1,000ofAD&DCoverageEmployee:$0.021Family:$0.031

Whatis“GuaranteedIssue?”GuaranteedIssuemeansthatyoumaybeabletopurchasecoveragewithoutmedicalexamsorhealthquestions.Ifyouareanewhireandyouapplywithin31daysofyoureligibilitydatetoelectcoverageforyourself,youareentitledtochooseanycoverageoffered,uptotheGuaranteedIssueAmount,withoutprovidingevidenceofgoodhealth.However,ifyouapplyforanamountofcoverageinexcessoftheGuaranteedIssueAmount,youwillnotreceivecoverageuntiltheinsurancecompanyapprovesacceptableevidenceofgoodhealth.Seeyourplandocumentsformoredetailedinformation.

HowtoCalculateYourMonthlyCostStep1:Usethechartabovetofindyourmonthlyratebasedonyourageasofyoureffectivedate.Step2:Multiplythisratebyyourdesiredcoverageamount,inunits.Step3:Theresultisthemonthlycost.

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EMPLOYER-PAIDSHORT-TERMDISABILITYDisabilityinsurancepaysaportionofyoursalaryifyou’reunabletoworkduetoacovereddisability.Allactive,full-timeemployeesareeligibleforcoveragethroughCignaatnocosttoyou.

GrossWeeklyBenefit BenefitWaitingPeriod MaximumBenefitPeriod60%ofyourweeklycoveredearningstoa$3,000maximum

7daysforaccident7daysforsickness

26weeksforaccident26weeksforsickness

EMPLOYER-PAIDLONG-TERMDISABILITYLongtermdisabilitycoverageprovidesincomereplacementifyouareunabletoworkduetoacovereddisabilityforanextendedperiodoftime.Youmustbecontinuallydisabledfor180daysbeforethisbenefit,offeredthroughCigna,begins.

GrossMonthlyBenefit MaximumGrossMonthlyBenefit

BenefitWaitingPeriod DurationofPayments

50%ofyourmonthlycoveredearnings

$15,000 180daysforaccident180daysforsickness

Age62oryounger:Toage65orthedatethe42ndmonthlybenefitis

payable,iflaterAge63andolder:Seeplan

documentsBUY-UPLONG-TERMDISABILITY(EMPLOYEE-PAID)YoualsohavetheopportunitytopurchaseadditionallongtermdisabilitycoveragetoenhancewhatBJServicesprovides.

GrossMonthlyBenefit MaximumGrossMonthlyBenefit

BenefitWaitingPeriod DurationofPayments

60%ofyourmonthlycoveredearnings

$15,000 180daysforaccident180daysforsickness

Age62oryounger:Toage65orthedatethe42ndmonthlybenefitis

payable,iflaterAge63andolder:Seeplan

documentsEmployee’sMonthlyCostofCoverageMonthlyrateper$100ofmonthlycoveredearnings:$0.28

HowtoCalculateYourMonthlyCostStep1:Divideyourannualsalaryby12tocalculateyourmonthlyearningsStep2:Multiplyyourmonthlyearnings(or$25,000,whicheverisless)by$0.28Step3:Dividethetotalby100.Theresultisyourmonthlycost.

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Producedinpartnershipwith

TheinformationinthisBenefitsGuideisdesignedtoprovideanoverviewofthebenefitsofferedthroughBJ Services.Whileeveryeffortwastakentoaccurately reportyourbenefits,discrepanciesorerrorsarealwayspossible.Officialplandocuments,policiesandcertificatesofinsurancecontainthedetails,conditions,maximumbenefitlevelsandrestrictionsonbenefits.Theseofficialdocumentsgovernyourbenefitsprogram.IfthereisanydiscrepancybetweentheBenefitsGuideandtheofficialdocuments,theofficialdocumentsprevail.ThesedocumentsareavailableuponrequestthroughtheHumanResourcesDepartment.Informationprovidedinthisbrochureisnotaguaranteeofbenefits.BJServicesreservesthe righttomodify,change,revise,amendorterminatethesebenefitsplansatanytime. Ifyouhaveanyquestionsaboutthissummary,contactHumanResources.