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2009-10 Plan Summaries Health Net PPO $250 PPO $500 PPO $750 PPO $1000 PPO $1500 PPO $2500 PPO $3000 50/50 $2500 Ded. 50/50 $5000 Ded. RX $10/$20/$40 RX $10/$50/$75 RX $15/$30/$50 RX $15/35%/50% PPO Contract PPO Contract Changes 2009 Health Net Contract Update Addendum 7/2009 Health Net Contract Update Addendum HSA Qualified Plan Summaries HSA $1500 Single $3000 Family HSA RX 20% (included with all HSA Plans) Health Net Links Health Net Website Provider Search VSP Vision Plans VSP $10/25 VSP $0/10 VSP Website Provider Directory Guardian Dental Plans Plan 1000 Plan 1000 With Ortho Plan 1500 Plan 1500 With Ortho Plan 2000 Plan 2000 With Ortho Guardian Maximum Rollover Handout Other Products Resources for Living EAP Flyer LifeBalance Program Flyer

2010-11 Plan Summaries (not rec'd as of 6-29-10) Health Net PPO $250 PPO $500 PPO $750 PPO $1000 PPO $1500 PPO $2500 PPO $3000 50/50 $2500 Ded. 50/50 $5000 Ded. RX $10/$20/$40 RX $10/$50/$75 RX $15/$30/$50 RX $15/35%/50% PPO Contract PPO Contract Changes HSA Qualified Plan Summaries HSA $1500 Single $3000 Family HSA RX 20% (included with all HSA Plans) Health Net Links Health Net Website Provider Search VSP Vision Plans VSP $10/25 VSP $0/10 VSP Website Provider Directory Guardian Dental Plans Plan 1000 Plan 1000 With Ortho Plan 1500 Plan 1500 With Ortho Plan 2000 Plan 2000 With Ortho Guardian Maximum Rollover Handout Other Products Resources for Living EAP Flyer LifeBalance Program Flyer Life Insurance Plans $10,000 Life / AD&D $20,000 Life / AD&D $30,000 Life / AD&D $40,000 Life / AD&D $50,000 Life / AD&D

Miscellaneous Summaries

Pharmacy Disclosure

Pharmacy Benefit Guide

Domestic Partner Rider

24 Hour Coverage

General Forms

Enrollment Employee Enrollment Form Domestic Partner Affidavit

Billing & Premium Process Billing & Monthly Premium Collection Delinquent Remittance Policies EFT Form, Terms & Conditions COBRA Administration Administrative Agreement QE Notice

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