Page 8 - Quarles

Key Cost Differences between the Medical Plans

Your Cost KeyCare PPO Plan HealthKeepers POS Plan

Before the You pay a percentage (no copays) of eligible You pay copays for most in-network services,
deductible medical expenses out-of-pocket until your share such as a doctor’s office visit. For some
of expenses add up to the annual deductible. medical services you pay a percentage of the
cost. There is only a deductible for out-of-
network services.

After the deductible Once the deductible is met, you pay 20% (in- You continue paying copays for in-network
network) or 40% (out-of-network) and the plan services or a percentage of the cost. Once your
pays your remaining eligible expenses. Once expenses reach the out-of-pocket maximum,
your expenses reach the out-of-pocket the plan pays 100% of any additional eligible
maximum, the plan pays 100% of any additional expenses for the rest of the year.
eligible expenses for the rest of the year.

Preventive care Both plans cover 100% of expenses from in-network providers for annual health screenings,
physicals, immunizations and other routine services.

Contribution rates Higher Lower

Anthem KeyCare PPO Plan
Bi-Weekly Contribution Rates

Deducted from paychecks before taxes are withheld

Associate Associate + Associate + Associate
+ Family
Only 1 Child Spouse
$213.20
Non-Tobacco User with Basic Vision $37.49 $61.23 $191.88
$220.01
Non-Tobacco User with Preferred Vision $39.83 $65.47 $196.12
$233.20
Tobacco User with Basic Vision $47.49 $71.23 $211.88
$240.01
Tobacco User with Preferred Vision $49.83 $75.47 $216.12

Anthem HealthKeepers HMO Plan
Bi-Weekly Contribution Rates

Deducted from paychecks before taxes are withheld

Associate Associate + Associate + Associate +
Family
Only 1 Child Spouse
$148.34
Non-Tobacco User with Basic Vision $28.16 $46.68 $133.50
$155.15
Non-Tobacco User with Preferred Vision $30.50 $50.92 $137.74
$168.34
Tobacco User with Basic Vision $38.16 $56.68 $153.50
$175.15
Tobacco User with Preferred Vision $40.50 $60.92 $157.74

Non-Tobacco Users Discount
Non-tobacco users receive discounted rates after certifying they are not tobacco users on the Tobacco
Confirmation Release form. If you are a tobacco-user, you can get the discounted contribution rate by
enrolling in and completing the Company-paid Tobacco Cessation Program. For more information on the
Tobacco Cessation Program, contact Human Resources.

7 2016-2017 Benefits Guide