Common use of Benefits Plans Clause in Contracts

Benefits Plans. a. Members may select one of the following medical plans, which includes dental, vision, life and LTD: PAK A Medical: MESSA ABC Plan 1 IN Deductible: $1400/ $2800 IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded Pak B Medical: MESSA Choices IN Deductible: $500/$1000 IN Coinsurance: 10 % IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: SRX Mail Voluntary Abortion: Excluded Cash in lieu: $250 per month plus non-medical benefits listed below. PAK C Pak D Medical: MESSA ABC Plan 1 IN Deductible: $1400/ $2800 IN Coinsurance: 10% IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded PAK E Medical: MESSA Plans 2 IN Deductible: $2000/$4000 IN Coinsurance: 0% IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: Saver Rx Voluntary Abortion: Excluded

Benefits Plans. a. Members may select one of the following medical plans, which includes dental, vision, life and LTD: PAK A Medical: MESSA ABC Plan 1 IN Deductible: $1400/ $2800 IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded Excluded b. vision, Life and LTD: PAK A Pak B Cash in lieu: $250 per month plus non-medical benefits listed below. PAK C Medical: MESSA Choices IN Deductible: $500/$1000 IN Coinsurance: 10 % IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: SRX Mail Voluntary Abortion: Excluded Cash in lieu: $250 per month plus non-medical benefits listed below. PAK C Pak D Medical: MESSA ABC Plan 1 IN Deductible: $1400/ $2800 IN Coinsurance: 10% IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded PAK E Medical: MESSA Plans 2 IN Deductible: $2000/$4000 IN Coinsurance: 0% IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: Saver Rx Voluntary Abortion: Excluded

Benefits Plans. a. Members may select one of the following medical plans, which includes dental, , b. vision, life Life and LTD: PAK A Medical: MESSA ABC Plan 1 IN Deductible: $1400/ 1350/ $2800 2700 IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded Pak B Medical: MESSA Choices IN Deductible: $500/$1000 IN Coinsurance: 10 % IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: SRX Mail Voluntary Abortion: Excluded Cash in lieu: $250 150 per month plus non-medical benefits listed below. PAK C Pak D Medical: MESSA ABC Plan 1 IN Deductible: $1400/ 1350/ $2800 2700 IN Coinsurance: 10% IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded PAK E Medical: MESSA Plans 2 IN Deductible: $2000/$4000 IN Coinsurance: 0% IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: Saver Rx Voluntary Abortion: Excluded

Benefits Plans. a. Members may select one of the following medical PAK plans, which includes dental, vision, life life, and LTD: long-term disability. If no election is made, the member shall default to PAK X. XXX A Medical: MESSA ABC Plan 1 IN Deductible: $1400/ 1300 1P; $2800 2600 2P&FF IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded Pak PAK B Medical: MESSA Choices N/A – Cash In Lieu of Medical $3,000 each calendar year IN Deductible: $500/$1000 N/A IN Coinsurance: 10 % IN Copay (OVN/UC/ER): $20/$25/$50 Rx Coverage: SRX Mail Voluntary Abortion: Excluded Cash in lieu: $250 per month plus non-medical benefits listed below. PAK C Pak D Medical: MESSA ABC Plan 1 IN Deductible: $1400/ $2800 IN Coinsurance: 10% A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail N/A Voluntary Abortion: Excluded N/A PAK E C Medical: MESSA Plans 2 Choices IN Deductible: $2000/$4000 500/$1000 IN Coinsurance: 0% N/A IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: Saver Rx Voluntary Abortion: Excluded

Benefits Plans. a. Members may select one of the following medical plans, which includes dental, vision, life and LTD: PAK A Medical: MESSA ABC Plan 1 IN Deductible: $1400/ 1350/ $2800 2700 IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded Pak B Medical: MESSA Choices IN Deductible: $500/$1000 IN Coinsurance: 10 % IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: SRX Mail Voluntary Abortion: Excluded Cash in lieu: $250 150 per month plus non-medical benefits listed below. PAK C Voluntary Abortion: Excluded Pak D Medical: MESSA ABC Plan 1 IN Deductible: $1400/ 1350/ $2800 2700 IN Coinsurance: 10% IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded PAK E Medical: MESSA Plans 2 IN Deductible: $2000/$4000 IN Coinsurance: 0% IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: Saver Rx Voluntary Abortion: Excluded