Common use of Swedish PPO Medical Plan Clause in Contracts

Swedish PPO Medical Plan. Employees enrolled in the Swedish PPO Medical Plan would pay the following shown as twice-monthly premiums (payroll contributions). Per pay period amount would be less if 26 payroll contributions per year. Full-Time (0.75 – 1.0 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee Only $3.00 $35.50 Employee + Child $19.00 $51.50 Employee + Children $35.50 $68.00 Employee + Spouse/Domestic Partner (DP) $54.00 $96.50 Employee + Spouse/DP + Child $70.00 $112.50 Employee + Spouse/DP + Children $86.50 $129.00 Part-Time (0.5 – 0.74 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee Only $3.00 $35.50 Employee + Child $84.00 $116.50 Employee + Children $165.00 $197.50 Employee + Spouse/DP $195.50 $238.00 Employee + Spouse/DP + Child $276.50 $319.00 Employee + Spouse/DP + Children $357.50 $400.00 For plan year 2020, employees enrolled in the PPO plan will automatically pay the twice-monthly costs with Wellness credit as shown above. Swedish Kaiser of Washington HMO. For plan year 2020, employees enrolled in the Kaiser HMO Medical Plan will pay the following twice-monthly premiums (payroll contributions): Full-Time (0.75 – 1.0 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee only $28.78 $45.45 Employee + child(ren) $83.38 $100.05 Employee + spouse/ DP $103.11 $136.45 Employee + family $157.66 $191.00 Part-Time (0.5 – 0.74 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee only $43.78 $60.45 Employee + child(ren) $116.53 $133.20 Employee + spouse/ DP $148.01 $181.35 Employee + family $220.81 $254.15 For plan year 2020, employees enrolled in the Swedish Group Health HMO Medical Plan will automatically pay the twice-monthly costs with Wellness credit as shown above. Employee only $0 Employee + child(ren) $12.00 Employee + spouse/ DP $20.00 Employee + family $32.00 Employee only $12.50 Employee + child(ren) $32.00 Employee + spouse/ DP $45.00 Employee + family $64.45 For all health insurance plans, employees covering domestic partners and their domestic partner’s children will have additional income tax withholding on the value of medical, dental and vision coverage through Swedish, in compliance with tax law.

Swedish PPO Medical Plan. Employees enrolled in the Swedish PPO Medical Plan would will pay the following shown as twice-monthly premiums (payroll contributions). Per pay period amount would be less if 26 payroll contributions per year. ): Full-Time (0.75 – 1.0 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee Only $3.00 $35.50 Employee + Child $19.00 $51.50 Employee + Children $35.50 $68.00 Employee + Spouse/Domestic Partner (DP) $54.00 64.00 $96.50 Employee + Spouse/DP + Child $70.00 80.00 $112.50 Employee + Spouse/DP + Children $86.50 96.50 $129.00 Part-Time (0.5 – 0.74 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee Only $3.00 $35.50 Employee + Child $84.00 $116.50 Employee + Children $165.00 $197.50 Employee + Spouse/DP $195.50 205.50 $238.00 Employee + Spouse/DP + Child $276.50 286.50 $319.00 Employee + Spouse/DP + Children $357.50 367.50 $400.00 For plan year 20202016, employees enrolled in the PPO plan will automatically pay the twice-monthly costs with Wellness credit as shown above. Swedish Kaiser of Washington Group Health HMO. For plan year 20202016, employees enrolled in the Kaiser Group Health HMO Medical Plan will pay the following twice-monthly premiums (payroll contributions): Full-Time (0.75 – 1.0 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee only $28.78 25.83 $45.45 42.50 Employee + child(ren) $83.38 76.83 $100.05 93.50 Employee + spouse/ DP $103.11 94.16 $136.45 127.50 Employee + family $157.66 145.16 $191.00 178.50 Part-Time (0.5 – 0.74 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee only $43.78 39.83 $60.45 56.50 Employee + child(ren) $116.53 107.83 $133.20 124.50 Employee + spouse/ DP $148.01 136.16 $181.35 169.50 Employee + family $220.81 204.16 $254.15 237.50 For plan year 20202016, employees enrolled in the Swedish Group Health HMO Medical Plan will automatically pay the twice-monthly costs with Wellness credit as shown above. Swedish HSA Medical Plan. For plan year 2016, employees enrolled in the HSA Medical Plan will pay the following twice-monthly premiums (payroll contributions): Full-Time (0.75 – 1.0 FTE) Twice-monthly Contribution Employee only $0 Employee + child(ren) $12.00 11.00 Employee + spouse/ DP $20.00 19.00 Employee + family $32.00 30.00 Part-Time (0.5 – 0.74 FTE) Twice-monthly Contribution Employee only $12.50 12.00 Employee + child(ren) $32.00 30.50 Employee + spouse/ DP $45.00 43.00 Employee + family $64.45 61.50 For plan year 2016, Employees will receive a one-time only automatic health incentive from the Employer to its Health Savings Account (IRS eligibility rules apply) in the amount of $1,500 and an additional automatic contribution of $700 will be added for dependent coverage (for a maximum of $2,200 per employee). For employees who become newly eligible for and enrolled on the Swedish HSA Medical Plan with an effective date of July 1 or later in the year, the employee will receive 50% of the wellness contribution. For all health insurance plans, employees covering domestic partners and their domestic partner’s children will have additional income tax withholding on the value of medical, dental and vision coverage through Swedish, in compliance with tax law.

Swedish PPO Medical Plan. Employees enrolled in the Swedish PPO Medical Plan would will pay the following shown as twice-monthly premiums (payroll contributions). Per pay period amount would be less if 26 payroll contributions per year. ): Full-Time (0.75 – 1.0 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee Only $3.00 $35.50 Employee + Child $19.00 $51.50 Employee + Children $35.50 $68.00 Employee + Spouse/Domestic Partner (DP) $54.00 64.00 $96.50 Employee + Spouse/DP + Child $70.00 80.00 $112.50 Employee + Spouse/DP + Children $86.50 96.50 $129.00 Part-Time (0.5 – 0.74 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee Only $3.00 $35.50 Employee + Child $84.00 $116.50 Employee + Children $165.00 $197.50 Employee + Spouse/DP $195.50 205.50 $238.00 Employee + Spouse/DP + Child $276.50 286.50 $319.00 Employee + Spouse/DP + Children $357.50 367.50 $400.00 For plan year 20202016, employees enrolled in the PPO plan will automatically pay the twice-monthly costs with Wellness credit as shown above. Swedish Kaiser of Washington Group Health HMO. For plan year 20202016, employees enrolled in the Kaiser Group Health HMO Medical Plan will pay the following twice-monthly premiums (payroll contributions): Full-Time (0.75 – 1.0 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee only $28.78 25.83 $45.45 42.50 Employee + child(ren) $83.38 76.83 $100.05 93.50 Employee + spouse/ DP $103.11 94.16 $136.45 127.50 Employee + family $157.66 145.16 $191.00 178.50 Part-Time (0.5 – 0.74 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee only $43.78 39.83 $60.45 56.50 Employee + child(ren) $116.53 107.83 $133.20 124.50 Employee + spouse/ DP $148.01 136.16 $181.35 169.50 Employee + family $220.81 204.16 $254.15 237.50 For plan year 20202016, employees enrolled in the Swedish Group Health HMO Medical Plan will automatically pay the twice-monthly costs with Wellness credit as shown above. Swedish HSA Medical Plan. For plan year 2016, employees enrolled in the HSA Medical Plan will pay the following twice-monthly premiums (payroll contributions): Full-Time (0.75 – 1.0 FTE) Twice-monthly Contribution Employee only $0 Employee + child(ren) $12.00 11.00 Employee + spouse/ DP $20.00 19.00 Employee + family $32.00 30.00 Part-Time (0.5 – 0.74 FTE) Twice-monthly Contribution Employee only $12.50 12.00 Employee + child(ren) $32.00 30.50 Employee + spouse/ DP $45.00 43.00 Employee + family $64.45 61.50 For plan year 2016, Employees will receive a one-time only automatic health incentive from the Employer to their Health Savings Account (IRS eligibility rules apply) in the amount of $1,500 and an additional automatic contribution of $700 will be added for dependent coverage (for a maximum of $2,200 per employee). For employees who become newly eligible for and enrolled on the Swedish HSA Medical Plan with an effective date of July 1 or later in the year, the employee will receive 50% of the wellness contribution. For all health insurance plans, employees covering domestic partners and their domestic partner’s children will have additional income tax withholding on the value of medical, dental and vision coverage through Swedish, in compliance with tax law.

Swedish PPO Medical Plan. Employees enrolled in the Swedish PPO Medical Plan would pay the following shown as twice-monthly premiums (payroll contributions). Per pay period amount would be less if 26 payroll contributions contributions. per year. Full-Time (0.75 – 1.0 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee Only $3.00 $35.50 Employee + Child $19.00 $51.50 Employee + Children $35.50 $68.00 Employee + Spouse/Domestic Partner (DP) $54.00 $96.50 Employee + Spouse/DP + Child $70.00 $112.50 Employee + Spouse/DP + Children $86.50 $129.00 Part-Time (0.5 – 0.74 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee Only $3.00 $35.50 Employee + Child $84.00 $116.50 Employee + Children $165.00 $197.50 Employee + Spouse/DP $195.50 $238.00 Employee + Spouse/DP + Child $276.50 $319.00 Employee + Spouse/DP + Children $357.50 $400.00 For plan year 2020, employees enrolled in the PPO plan will automatically pay the twice-monthly costs with Wellness credit as shown above. Swedish Kaiser of Washington HMO. For plan year 2020, employees enrolled in the Kaiser HMO Medical Plan will pay the following twice-monthly premiums (payroll contributions): Full-Time (0.75 – 1.0 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee only $28.78 $45.45 Employee + child(ren) $83.38 $100.05 Employee + spouse/ DP $103.11 $136.45 Employee + family $157.66 $191.00 Part-Time (0.5 – 0.74 FTE) Twice-monthly Contributions with Wellness Credit Twice-monthly Contributions without Wellness Credit Employee only $43.78 $60.45 Employee + child(ren) $116.53 $133.20 Employee + spouse/ DP $148.01 $181.35 Employee + family $220.81 $254.15 For plan year 2020, employees enrolled in the Swedish Group Health HMO Medical Plan will automatically pay the twice-monthly costs with Wellness credit as shown above. Employee only $0 Employee + child(ren) $12.00 Employee + spouse/ DP $20.00 Employee + family $32.00 Employee only $12.50 Employee + child(ren) $32.00 Employee + spouse/ DP $45.00 Employee + family $64.45 For all health insurance plans, employees covering domestic partners and their domestic partner’s children will have additional income tax withholding on the value of medical, dental and vision coverage through Swedish, in compliance with tax law.