Common use of AP Sponsored Group Health and Dental Plans Clause in Contracts

AP Sponsored Group Health and Dental Plans. a. The design summaries for the Employer’s group health plans are as follows: Premium Plan Basic Plan In Network Out-of-Network In-Network Out of Network Individual/Family Individual/Family Individual/Family Individual/Family Deductible $500/$1,000 $1,000/$2,000 $900/$1,800 $2,100/$4,200 Coinsurance 85% 60% 75% 60% Out-of-pocket maximum (deductible and Rx add up to OOP) $2,400/$4,800 $4,000/$8.000 $3,400/$6,800 $6,500/$13,000 In-patient Hospital You pay: $200 copay then deductible, coinsurance Plan pays 60% You pay: $200 copay, then deductible, coinsurance Plan pays 60% Office Visit You pay $30 PCP / $45 Specialist Plan pays 60% You pay $30 PCP/ $45 Specialist Plan pays 60% Emergency Room $150 copay $150 copay $150 copay $150 copay Retail Rx Mail order Rx Generic Rx $10 copay $20 copay Brand Rx 20% (minimum $30, maximum $100) 20% (minimum $60, maximum $200) Non-Preferred 30% (minimum $50, maximum $100) 30% (minimum $100, maximum $200) Limited Retail Network: Walgreens, Wal-Mart, Xxxxx Xxxxx are excluded from the retail network. Mandatory Rx Mail-order and generics National preferred formulary adopted No coverage for compound drugs. Vision Exam / Lenses / Frames (Contacts in lieu of Lenses) You pay $20/$20/Plan pays up to $175 Plan pays up to $40 / $40 / $80 / Plans pays up to $45. HDHP with HAS In Network Out of Network Deductible (Individual/Family) $1,400/$2,800 $2,800/$5,600 Coinsurance, you pay 20% 40% Out-of-Pocket Maximum (Individual/Family) $6,750/$13,500 $13,500/$27,000 HSA Contribution Limits (no AP contribution) $3,550/$7,100 1Subject to IRS regulations b. The design summaries for the Employer’s Dental plans are as follows: Major Provisions Premium Basic Non orthodontics In Network Out of Network In Network Out of Network Deductible Individual/Family $100/$200 $100/$200 Maximum Unlimited $1,000 $750 Diagnostic: Periodic Oral Evaluation 1 time per 6 months 100% 100% 100% 85% Preventive Cleanings: 1 time per 6 months 100% 100% 100% 85% Basic General/simple extractions/oral surgery 80% 80% 70% 55% Major Inlays/Crowns - frequency limits apply 50% 50% 40% 30% Orthodontics Eligibility requirement Child up to age 19 or 23 if unmarried, full-time student Child up to age 19 or 23 if unmarried, full-time student Maximum $1,000 per person per lifetime $1,000 per person per lifetime Diagnosis to correct misalignment of the teeth 50% 50% 40% 40% c. The following provisions and restrictions will apply to the plans:

AP Sponsored Group Health and Dental Plans. a. The design summaries for the Employer’s group health and dental plans are as follows: : a) No changes in employee contributions or schedule of benefits through June 30, 2019. b) On July 1, 2019, the contribution amount increases by 20% for the premium plan, and 15% for the basic plan. c) On January 1, 2020, the contribution amount increases by 20% for the premium plan, 15% for the basic plan, and a high deductible plan with an HSA is offered to employees. d) On January 1, 2021, the contribution amount increases 20% for the premium plan, 15% for the basic plan and 15% for the high deductible plan. e) On January 1, 2022, the contribution amount increases 20% for the premium plan, 15% for the basic plan and 15% for the high deductible plan. Premium Plan Basic Plan In Network Out-of-Network In-Network Basic Plan Out of Network Individual/Family Individual/Family Individual/Family Individual/Family Deductible $500/$1,000 $1,000/$2,000 $900/$1,800 $2,100/$4,200 Coinsurance 85% 60% 75% 60% Out-of-pocket maximum (deductible and Rx add up to OOP) $2,400/$4,800 $4,000/$8.000 $3,400/$6,800 $6,500/$13,000 and Rx add up to OOP) In-patient Hospital You pay: $200 copay then deductible, coinsurance Plan pays 6070% You pay: $200 copay, then deductible, coinsurance Plan pays 60% Office Visit You pay $30 PCP / $45 Specialist Plan pays 6070% You pay $30 PCP/ $45 Specialist Plan pays 60% Emergency Room $150 copay $150 copay $150 copay $150 copay Retail Rx Mail order Rx Generic Rx $10 copay $20 copay Brand Rx 20% (minimum $30, maximum $100) 20% (minimum $60, maximum $200) Non-Preferred 30% (minimum $50, maximum $100) 30% (minimum $100, maximum $200) Limited Retail Network: Walgreens, Wal-Mart, Xxxxx Xxxxx are excluded from the retail network. Mandatory Rx Mail-order and generics National preferred formulary adopted No coverage for compound drugs. Vision Exam / Lenses / Frames (Contacts in lieu of Lenses) You pay $20/$20/Plan pays up to $175 Plan pays up to $40 / 40/$40- lieu of Lenses) pays up to $40 / 175. $80 / 80/Plans pays up to $45. HDHP with HAS In Network Out of Network Deductible (Individual/Family. f) $1,400/$2,800 $2,800/$5,600 Coinsurance, you pay 20% 40% Out-of-Pocket Maximum (Individual/Family) $6,750/$13,500 $13,500/$27,000 HSA Contribution Limits (no AP contribution) $3,550/$7,100 1Subject to IRS regulations b. The design summaries for the Employer’s Dental plans are plan benefits as follows: Major Provisions Premium Basic Non orthodontics In Network Out of Network In Network Out of Network Deductible Individual/Family $100/$200 $100/$200 Maximum Unlimited $1,000 $750 Diagnostic: Periodic Oral Evaluation 1 time per 6 months 100% 100% 100% 85% Preventive Cleanings: 1 time per 6 months 100% 100% 100% 85% Basic General/simple extractions/oral surgery 80% 80% 70% 55% Major Inlays/Crowns - frequency limits apply 50% 50% 40% 30% Orthodontics Eligibility requirement Child up to age 19 or 23 if unmarried, full-time student Child up to age 19 or 23 if unmarried, full-time student Maximum $1,000 per person per lifetime $1,000 per person per lifetime Diagnosis to correct misalignment of the teeth 50% 50% 40% 40%: c. g) The following provisions and restrictions will apply to the plans:: Medical Plan Benefits: Medical and prescription out-of-pocket expenses will be aggregated annually for purposes of determining whether a participant has satisfied the annual out-of-pocket maximum under the applicable plan. Behavioral Health Claim Benefits will have full case management. Applied Behavioral Analysis Therapy (ABA) is included. Prescription Drug Benefits: Smoking cessation products will be included within the schedule of benefits for the prescription drug program, subject to applicable co-pay. Other Requirements: Limits on the following services: Chiropractic 30 visits per year Therapies 30 visits per year Home health care/private duty 120 visits per year Skilled nursing facility 120 visits per year Mental Health Substance Abuse Under mental health parity effective 2011, visit limits Emergency Room visit benefits paid for emergencies only

AP Sponsored Group Health and Dental Plans. a. The design summaries for the Employer’s group health and dental plans are as follows: a. The group health insurance plan in effect on August 31, 2013 shall remain in effect, unchanged in all respects, through December 31, 2014. b. Effective January 1, 2015, employees may elect to participate either in a Premium Plan or Basic Plan for medical, prescription drugs and vision benefits as follows: Premium Plan Basic Plan In Network Individual/Family Out-of-Network Individual/Family In-Network Out of Network Individual/Family Out-of- Network Deductible $400/$800 $900/$1,800 $800/$1,600 $2,000/$4,0 00 Coinsurance 90% 70% 80% 60% Out-of-pocket maximum (deductible and Rx Accumulate to OOP) $1200/$2400 $3,500/$7,000 $2,400/4,800 $6,000/$12, 000 In-patient hospital You pay: $200 copay, then deductible, coinsurance Plan pays: 70% You pay: $200 copay, then deductible, coinsurance Plan pays: 60% Office Visit You pay: $30 PCP/ $40 Specialist Plan pays: 70% You pay: $30 PCP/ $40 Specialist Plan pays: 60% Emergency Room $150 copay $150 copay $150 copay $150 copay Prescription Drugs Retail Rx Mail order Rx Generic Rx $10 copay $20 copy Brand Rx 20% (minimum $30, maximum $60) 20% (minimum $60, maximum $120) Non-Preferred Brand 30% (minimum $50, maximum $100) 30% (minimum $100, maximum $200) Limited Retail Network Walgreens, Wal-Mart, Xxxxx Xxxxx: excluded from the retail network Mandatory Rx Mail-order and generics Vision Exam/Lenses/Frames (Contacts in lieu of Lenses) In-Network: You pay: $20/$20/plan pays Up to $175 Out-of-Network: Plan pays up to $40/$40 – $80/plan pays up to $45 c. Effective January 1, 2016, employees may elect to participate either in a Premium Plan or Basic Plan for medical, prescription drugs and vision benefits as follows: Premium Plan Basic Plan In Network Individual/Family Out-of-Network Individual/Family In-Network Individual/Family Out-of- Network Deductible $500/$1,000 $1,000/$2,000 400/$800 $900/$1,800 $2,100/$4,200 800/$1,600 $2,000/$4,0 00 Coinsurance 85% 60% 75% 60% Out-of-pocket maximum (deductible and Rx add up Accumulate to OOP) $2,400/$4,800 1,900/$3,800 $4,000/$8.000 3,500/$7,000 $3,400/$6,800 2,900/5,800 $6,500/$13,000 6,000/$12, 000 In-patient Hospital hospital You pay: $200 copay copay, then deductible, coinsurance Plan pays pays: 60% You pay: $200 copay, then deductible, coinsurance Plan pays pays: 60% Office Visit You pay $30 PCP / $45 Specialist Plan pays 60% You pay pay: $30 PCP/ $45 Specialist Plan pays pays: 60% You pay: $30 PCP/ $45 Specialist Plan pays: 60% Emergency Room $150 copay $150 copay $150 copay $150 copay Prescription Drugs Retail Rx Mail order Rx Generic Rx $10 copay $20 copay copy Brand Rx 20% (minimum $30, maximum $100) 20% (minimum $60, maximum $200) Non-Preferred Brand 30% (minimum $50, maximum $100120) 30% (minimum $100, maximum $200240) Limited Retail Network: Network Walgreens, Wal-Mart, Xxxxx Xxxxx are Xxxxx: excluded from the retail network. network Mandatory Rx Mail-order and generics National preferred formulary adopted No coverage for compound drugs. Vision Exam / Lenses / Exam/Lenses/Frames (Contacts in lieu of Lenses) In-Network: You pay pay: $20/$20/plan pays Up to $175 Out-of-Network: Plan pays up to $175 Plan 40/$40 – $80/plan pays up to $40 / $40 / $80 / Plans pays up to $45. HDHP with HAS 45 d. Dental plan benefits are as follows: Premium Plan Basic Plan In Network Out of Network Deductible (Individual/Family) $1,400/$2,800 $2,800/$5,600 Coinsurance, you pay 20% 40% Family Out-of-Pocket Maximum (Individual/Family) $6,750/$13,500 $13,500/$27,000 HSA Contribution Limits (no AP contribution) $3,550/$7,100 1Subject to IRS regulations b. The design summaries for the Employer’s Dental plans are as follows: Major Provisions Premium Basic Non orthodontics In Network Out of Network In Network Out of Network Deductible Individual/Family $100/$200 $100/$200 In-Network Individual/Family Out-of- Network Calendar Year Maximum Unlimited Unlimited $1,000 $750 Diagnostic: Periodic Oral Evaluation 1 time per 6 months Deductible $50 $50 Individual $100/Family $200 Preventive 100% 100% 100% 85% Preventive Cleanings: 1 time per 6 months 100% 100% 100% 85% Basic General/simple extractions/oral surgery 80% 80% 70% 55% Major Inlays/Crowns - frequency limits apply 50% 50% 40% 30% Orthodontics Eligibility requirement Child up to age 19 or 23 if unmarried, full-time student Child up to age 19 or 23 if unmarried, full-time student Maximum $1,000 per person per lifetime $1,000 per person per lifetime Diagnosis to correct misalignment of the teeth 50% 50% 40% 40% c. The following provisions and restrictions will apply to the plans:

AP Sponsored Group Health and Dental Plans. a. The design summaries for the Employer’s group health and dental plans are as follows: a. The group health insurance plan in effect on August 31, 2013 shall remain in effect, unchanged in all respects, through December 31, 2014. b. Effective January 1, 2015, employees may elect to participate either in a Premium Plan or Basic Plan for medical, prescription drugs and vision benefits as follows: Premium Plan Basic Plan In Network Individual/Famil y Out-of-Network Individual/Fam ily In-Network Out of Network Individual/Family Individual/Family Individual/Family Individual/Family Out-of- Network Deductible $500/$1,000 $1,000/$2,000 400/$800 $900/$1,800 $2,100/$4,200 800/$1,600 $2,000/$4 ,000 Coinsurance 90% 70% 80% 60% Out-of-pocket maximum (deductible and Rx Accumulate to OOP) $1200/$2400 $3,500/$7,000 $2,400/4,800 $6,000/$1 2,000 In-patient hospital You pay: $200 copay, then deductible, coinsurance Plan pays: 70% You pay: $200 copay, then deductible, coinsurance Plan pays: 60% Office Visit You pay: $30 PCP/ $40 Specialist Plan pays: 70% You pay: $30 PCP/ $40 Specialist Plan pays: 60% Emergency Room $150 copay $150 copay $150 copay $150 copay Prescription Drugs Retail Rx Mail order Rx Generic Rx $10 copay $20 copy Brand Rx 20% (minimum $30, maximum $60) 20% (minimum $60, maximum $120) Non- Preferred Brand 30% (minimum $50, maximum $100) 30% (minimum $100, maximum $200) Limited Retail Network Walgreens, Wal-Mart, Xxxxx Xxxxx: excluded from the retail network Mandatory Rx Mail-order and generics Vision Exam/Lenses/Frames (Contacts in lieu of Lenses) In-Network: You pay: $20/$20/plan pays Up to $175 Out-of-Network: Plan pays up to $40/$40 – $80/plan pays up to $45 c. Effective January 1, 2016, employees may elect to participate either in a Premium Plan or Basic Plan for medical, prescription drugs and vision benefits as follows: Premium Plan Basic Plan In Network Individual/Fam ily Out-of- Network Individual/Fam ily In-Network Individual/Fam ily Out-of- Network Deductible $400/$800 $900/$1,800 $800/$1,600 $2,000/$4 ,000 Coinsurance 85% 60% 75% 60% Out-of-pocket maximum (deductible and Rx add up Accumulate to OOP) $2,400/$4,800 1,900/$3,800 $4,000/$8.000 3,500/$7,000 $3,400/$6,800 2,900/5,800 $6,500/$13,000 6,000/$1 2,000 In-patient Hospital hospital You pay: $200 copay copay, then deductible, coinsurance Plan pays pays: 60% You pay: $200 copay, then deductible, coinsurance Plan pays pays: 60% Office Visit You pay $30 PCP / $45 Specialist Plan pays 60% You pay pay: $30 PCP/ $45 Specialist Plan pays pays: 60% You pay: $30 PCP/ $45 Specialist Plan pays: 60% Emergency Room $150 copay $150 copay $150 copay $150 copay Prescription Drugs Retail Rx Mail order Rx Generic Rx $10 copay $20 copay copy Brand Rx 20% (minimum $30, maximum $100) 20% (minimum $60, maximum $200) Non-Preferred Brand 30% (minimum $50, maximum $100120) 30% (minimum $100, maximum $200240) Limited Retail Network: Network Walgreens, Wal-Mart, Xxxxx Xxxxx are Xxxxx: excluded from the retail network. network Mandatory Rx Mail-order and generics National preferred formulary adopted No coverage for compound drugs. Vision Exam / Lenses / Frames Exam/Lenses/Fra mes (Contacts in lieu of Lenses) In-Network: You pay pay: $20/$20/plan pays Up to $175 Out-of-Network: Plan pays up to $175 Plan pays up to 40/$40 – $40 / $40 / $80 / Plans 80/plan pays up to $45. HDHP with HAS d. Dental plan benefits are as follows: Premium Plan Basic Plan In Network Out of Network Deductible (Individual/Family) $1,400/$2,800 $2,800/$5,600 Coinsurance, you pay 20% 40% Family Out-of-Pocket Maximum (Individual/Family) $6,750/$13,500 $13,500/$27,000 HSA Contribution Limits (no AP contribution) $3,550/$7,100 1Subject to IRS regulations b. The design summaries for the Employer’s Dental plans are as follows: Major Provisions Premium Basic Non orthodontics In Network Out of Network In Network Out of Network Deductible Individual/Family $100/$200 $100/$200 In-Network Individual/Family Out-of- Network Calendar Year Maximum Unlimited Unlimited $1,000 $750 Diagnostic: Periodic Oral Evaluation 1 time per 6 months Deductible $50 $50 Individual $100/Family $200 Preventive 100% 100% 100% 85% Preventive Cleanings: 1 time per 6 months 100% 100% 100% 85% Basic General/simple extractions/oral surgery 80% 80% 70% 55% Major Inlays/Crowns - frequency limits apply 50% 50% 40% 30% Orthodontics Eligibility requirement Child up to age 19 or 23 if unmarried, full-time student Child up to age 19 or 23 if unmarried, full-time student Maximum $1,000 per person per lifetime $1,000 per person per lifetime Diagnosis to correct misalignment of the teeth 50% 50% 40% 40% c. e. The following provisions and restrictions will apply to the plans:: Medical Plan Benefits: Medical and prescription out-of-pocket expenses will be aggregated annually for purposes of determining whether a participant has satisfied the annual out-of-pocket maximum under the applicable plan. Prescription Drug Benefits: Smoking cessation products will be included within the schedule of benefits for the prescription drug program, subject to applicable co-pay. Other Requirements: Prior Authorization Physician must submit qualifying medical criteria to allow for utilization of medication within the following classes: ADHD/Narcolepsy; Anti-obesity; Pain/Topical; and Testosterone. Safety & Monitoring Solution Letter-based clinical intervention program designed to curb misuse or overuse of controlled substance medications (poly-pharmacy, poly-physician and total # Rx triggered). Mandatory Mail Program allows for two fills at a retail pharmacy before requiring participants to use the mail order benefit for subsequent refills. (An additional fill will be allowed for the first time an individual is denied the prescription). Mandatory Generics Program When members, or their physicians, request a brand when a generic is available, the member will pay the generic co pay plus the difference in ingredient cost between the brand and generic. Limited Retail Network Excludes some chains including Walgreens, Xxxxx Xxxxx and Wal-Mart Medical Plan Limits on the following Services: Chiropractic 30 visits year Therapies 30 visits year Home health care/Private duty 120 visits year Skilled nursing facility 120 visits year Mental Health Substance Abuse Under Mental Health Parity effective 2011, visit limits Emergency room visit benefits paid for emergencies only