2013MARICOPA

BENEFITGUIDE

INTEGRATEDHEALTH SYSTEM

WELCOME TO YOUR2013 Ð 2014 BENEFITS!

Maricopa Integrated Health System (MIHS) benefits add value beyond your paycheck.

As an employee of MIHS, you have a total compensation package: a combination of pay and benefit programs that is among the best in our industry. This benefit guide describes the key features of our programs. They are designed to give you choices about the types and levels of protection that you want.

This benefit guide provides a brief summary of your MIHS benefits for 2013-2014.

BENEFIT TIPS• Wellness is the first step to health and success. Get your

Biometric Screening and annual physical at no charge. Go to www.mycigna.com and complete the Health Risk Assessment.

• Read this Benefit Guide carefully so you can understand your choices and make the best decisions for you and your family. Rates are included in this guide beginning on page 23.

• Regarding each provided plan, it is your responsibility to find out if a specific provider is in the network for all services rendered, even services performed at MIHS facilities.

TABLE OF CONTENTSSteps to Enroll Online 2

Employee Eligibility 3

Eligibility by Employment Classification 4

Medical and Prescription Drug Benefits 5

Medical and Prescription Drug Plans Comparison 6

The MIHS Network 7

Wellness Incentives 8

MeMD 8

Working On Wellness 9

Employee Assistance Program (EAP) 9

Cigna’s Personalized Wellness Program 10

Dental Benefit 11

Vision Benefits 12

Flexible Spending Accounts (FSA) 13

Life Insurance 14

Disability 15

Voluntary Benefits 16

Other Benefits 17

Paid TIme Off and Employee Illness Bank 17

Retirement Plans 18

Limitations and Exclusions 19

Legal Notices 21

2013-2014 Rates 23

Benefit Contacts Back

Benefit Guide Disclaimer: This benefit guide highlights key features of the Maricopa County Special Health Care District benefits program and does not include all plan rules and details. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be any inconsistencies between this guide and the legal plan documents, the plan documents are the final authority. Maricopa County Special Health Care District reserves the right to change or discontinue its benefit plans at any time without prior advance notice. Participation in any of the plans is not a contract of employment.

STEPS TO ENROLL ONLINE

• Log on to the Maricopa website at www.mihs.org/foremployees/benefits.

• Click on “Click here to enroll.” Do NOT use the browser’s back button during your enrollment process as this could result in loss of information.

• Make sure the computer that you are on has Adobe Acrobat Reader. If it does not, you will not be able to view some of the forms. There is no charge to download the software. Visit http://get.adobe.com/reader/.

• Enter your Employee ID followed by 277 and your Password, your 8-digit date of birth. After entering both, click LOGIN. Please note if you reset your password, you will need to include the 277 after your ID number.

• The first time you log in, you will be prompted to change your password. Change your password to a number or name that you will remember.

• Once you have completed your enrollment, you will have the opportunity to print your election confirmation.

• If you need to make changes to your elections, click on the benefit that you want to change. After you have made the change, it will bring you back to the Confirmation of Elections screen. (Please note that you are only allowed to change your future elections during the Annual Enrollment period or during a Qualifying Event.)

• Once all changes are made, click on the PRINTER-FRIENDLY VERSION icon in the upper right corner above the Benefit Detail to print the PDF version of your enrollment.

• After printing your confirmation, click on the CONTINUE button at the bottom of the page.

• Once logged into the benefit portal, click on the “ENROLL NOW” button located in the Take Action box. Navigate through each of the enrollment prompts being sure to read each page’s instructions carefully.

• Congratulations! You are enrolled.

• If you need to make additional changes or print your confirmation, use the Back button to return to your Confirmation of Elections and repeat Step 3.

• Click on the Logout button to exit the system.

Step 1 - Log on

Step 3 - Confirmation of Elections

Step 4 - Employee Logout

Step 2 - Enroll

As a participant in the MIHS group insurance benefits, you may enroll in your coverage online. Below are instructions to help you log in and enroll. Remember, it is important that you either Enroll or Waive each benefit until your enrollment shows as ýCompleted.ý

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EMPLOYEE ELIGIBILITY

Employee EligibilityFull-time and part-time employees scheduled to work at least 20 hours per week and Residents are eligible for coverage. For benefit plan purposes, a benefit eligible employee is defined as a full-time employee working 32-40 hours per week or a part-time employee working 20-31 hours per week.

Benefit eligible employees are eligible on the first day of the month following date of hire. Employees changing status from a part-time to full-time position or a full-time to part-time position are eligible for coverage on the first day of the month following their status change.

Online enrollment for full-time and part-time benefit eligible employees must be completed within 30 days of the date of employment or date of status change to a benefit eligible position. Once the online enrollment is completed, no changes are allowed. The next opportunity to elect benefit coverages will be during the next Annual Enrollment period, or during a Qualifying Event.

Employees are responsible for notifying the Human Resources Benefit Department if they will be off work without pay. To maintain benefit coverage, premiums must be paid to the Benefit Department every pay period. An invoice will be mailed to the employee, following a notification for a leave of absence. If the employee fails to make premium payments on time, the employee’s benefits will be terminated and cannot be reinstated until the next Annual Enrollment period.

Please Note: Benefits terminate on the last day of the month based on the final day of physical work, providing the employee premiums are current or can be collected through payroll deduction.

Eligible DependentsDependents you can cover include:

• Legal spouse.

• Child(ren) up to age 26. (Benefits terminate on the last day of the month of the child’s 26th birthday.)

• Eligible children include natural children, stepchildren, legally adopted children and children for whom you have legal guardianship.

• Children are eligible regardless of tax dependency, marital or student status.

• Any child of any age who resides with you and who was medically certified as disabled prior to his/her 26th birthday and who is primarily dependent upon your support.

MIHS requires appropriate documentation to prove dependent relationships prior to the close of any enrollment period. Documentation includes marriage certificates for spouses and birth certificates for children, as well as other legal documents. A Social Security number is required for all enrolled dependents.

Qualifing EventsEmployees may only change (add or delete) covered dependents following a Qualifying Event (with the exception of Annual Enrollment). The employee is responsible for contacting the Benefits Department within 30 days regarding each Qualifying Event.

• Birth or adoption of a child;

• Marriage or divorce;

• Death of spouse and/or dependents;

• Dependent’s loss of eligibility (see definition of Eligible Dependent);

• Termination or commencement of employment of employee’s spouse with health care coverage;

• Taking an unpaid leave of absence by the employee or spouse;

• Becomes eligible for Medicare;

• Loses Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible or become eligible for a states’ premium assistance program under Medicaid or CHIP (60 days to request enrollment change);

• Other events as the Plan Administrator determines to be permitted under I.R.S. Section 125 or other applicable guidelines issued by the Internal Revenue Service.

Documentation is required for all Qualifying Events.

For birth, adoption or placement for adoption, the acquired dependent of a covered employee will be covered effective the day of the event, provided that enrollment for the dependent is requested within 30 days from the date of the event.

For all other events, including a new spouse, coverage will be effective the first of the month following the date of the qualifying event, provided that enrollment is requested within 30 days from the date of the event.

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BenefitFull-Time

(40-32 hours)Part-Time

(31-20 hours)Residents

Medical Plans Yes Yes Yes

Dental Plans Yes Yes Yes

Vision Plan Yes Yes Yes

Flexible Spending Accounts Yes Yes Yes

Telemedicine Yes Yes Yes

Basic Life/AD&D Yes Yes Yes

Optional Life/AD&D Yes Yes Yes

Voluntary Short Term Disability Yes Yes Refer to Contract or Academic Affairs

Accident Insurance Yes Yes Yes

Critical Illness Insurance Yes Yes Yes

Employee Assistance Program Yes Yes Yes

Long Term Disability Yes Yes Not Eligible

Retirement – ASRS Yes Yes Not Eligible

Deferred Compensation - 457(b) Yes Yes Yes

Supplemental Retirement - 401(a) Yes, age restriction of 40 and older. Irrevocable election.

Working on Wellness Program Yes Yes Yes

PTO and EIB Yes Yes No

Pet Health Care Program Yes Yes Yes

MetLaw Yes Yes Yes

ELIGIBILITY BY EMPLOYMENT CLASSIFICATION

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MEDICAL AND PRESCRIPTION DRUG BENEFITS

Summary of BenefitThe medical program provides the framework for good health and well-being. Two plans are offered through Cigna Healthcare – the Point of Service (POS) plan and the Health Reimbursement Account (HRA) plan.

Both plans include MIHS facilities, such as Maricopa Medical Center (MMC), Comprehensive Health Center (CHC) and Family Health Centers (FHC), and providers as part of Cigna’s network.

The POS plan requires the employee to select a Primary Care Physician (PCP) to facilitate the most cost effective services and treatments. The POS plan has a large network of providers and gives the employee freedom to use out-of-network providers at a reduced benefit level.

The HRA plan provides employees the freedom to manage the cost of their care while offering a larger network of providers, which includes out-of-network services at a reduced benefit level.

MIHS funds the HRA plan with an initial $600 dollars for individual coverage and $1,200 for employee plus one or more dependents. Unused MIHS funds roll-over to the next plan year to a maximum of $1,500 single and $3,000 family coverage.

Pre-existing condition limitations do not apply to services or treatment rendered in-network under the POS plan. Out-of-network coverage under the POS and all services under the HRA plan are subject to pre-existing condition limitations. During the first 12 months of coverage, any illness or condition treated or diagnosed during the three (3) months immediately preceding the eligibility date of coverage is subject to pre-exisiting condition limitations. No pre-existing condition limitations can be applied for pregnancy. Note: Individuals under age 19 are not subject to the medical plans’ pre-existing condition limitations.

Cigna Plan Benefits• The HealthCare 24-Hour Information line connects you to a registered

nurse at 800-Cigna-24

• Healthy Rewards program

• Behavioral Health provides access to professional consultation via telephone for help with family/work concerns

• Interactive website is available to learn more about the plans and get health information 24 hours a day

• Preventive Care for every covered family member

• No referral required for OB/GYN annual well women visits on any offered plan

• Emergency and urgent care are covered worldwide

• Prescription drug coverage, which includes use of MIHS pharmacies, is built into the medical plan options; Mail order services are available

• NEW! — Per Health Care Reform, there are new preventive screening and services available for women in 2013. These services will be covered at 100%, not subject to the deductible, when you use in-network providers. They include, for example, annual well-women and prenatal preventive visits; prescribed contraceptives; and breastfeeding support, supplies, and counseling for new mothers.

• NEW! — Step Therapy in the prescription drug program requires you to try a lower cost prescription before moving to a higher cost brand drug. Your physician can authorize a brand name drug if there is a clinical reason that prevents you from taking the alternative therapy.

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*Out-of-Network provider charges are subject to Reasonable & Customary (R&C) plan limits, which may be less than the provider’s actual charge. Members are fully responsible for all charges above R&C limits. ***Claims must be coded by the provider as routine, preventive care. Copays will not be waived for diagnostic services rendered.

MEDICAL AND PRESCRIPTION PLAN COMPARISON

Cigna Plans POS Plan HRA Plan

In-Network Out-of-Network* In-Network Out-of-Network*

Plan Year Deductible (PYD)MIHS Contributes to your Account $600 Individual / $1,200 EE +

One / More Amount prorated based on eligibility date

Individual $750 $2,250 $2,000 $6,000

Family $1,500 $4,500 $4,000 $12,000

Plan Year Out-of-Pocket Maximum Includes PYD

Individual $2,000 $5,250 $2,500 $6,000

Family $4,000 $10,500 $5,000 $12,000

Office Visits

Preventive Services*** Covered at 100% Not Covered Covered at 100% 30% after PYD

Primary Care Physician Office Visit $25 copay 40% after PYD* 10% after PYD 30% after PYD

Specialist Physician Office Visit $50 copay 40% after PYD* 10% after PYD 30% after PYD

Urgent Care Visit $50 copay $50 copay 10% after PYD 30% after PYD

Emergency Room Visit $250 copay $250 copay 10% after PYD 10% after PYD

Physician Services

In / Outpatient Physician ServicesDMG Physician Services

20% after PYD 40% after PYD 10% after PYD 30% after PYD

Inpatient Hospital Services - Excludes all Physician Charges

Room & Board; Lab & X-ray Services$750 copay + PYD

then 20%40% after PYD 10% after PYD 30% after PYD

Outpatient Facility Services - Excludes all Physician Charges

Operating, Recovery & Procedure Rooms Treatment Room: Lab & X-ray; Anesthesia

$500 copay + PYD then 20%

40% after PYD 10% after PYD 30% after PYD

Advanced Radiological Imaging $50 copay after PYD 40% after PYD 10% after PYD 30% after PYD

Physical, Occupational & Speech Therapy (60-visit maximum for all combined services)

$50 copay 40% after PYD 10% after PYD 30% after PYD

Additional Details

Requires Primary Care Physician Yes No No No

Pre-Existing Condition Limitation Does Not Apply Applies Applies Applies

POS Plan

MIHS Facilities Arizona Network

In-Network*Retail Rx Drugs- 30 day supply (MIHS Outpatient Pharmacy may be utilized)

Generic $5 $10

Brand Formulary $20 $30

Non-Formulary $40 $50

Mail Order Rx Drugs-90 day supply

Generic $15 $20

Brand Formulary $50 $60

Non-Formulary $90 $100

HRA Plan

MIHS Facilities Arizona Network

In-Network*Retail Rx Drugs- 30 day supply

Generic 0% After Plan Year Deductible and Out-of-

Pocket Maximum

0% After Plan Year Deductible and Out-of-

Pocket MaximumBrand Formulary

Non-Formulary

Mail Order Rx Drugs-90 day supply

Generic 0% After Plan Year Deductible and Out-of-

Pocket Maximum

0% After Plan Year Deductible and Out-of-

Pocket MaximumBrand Formulary

*Out-of-Network Rx is Not Covered.

Pharmacy Plan Design Comparison

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MIHS facilities**

When you use a MIHS Facility: POS Plan HRA PlanPlan Year Deductible (PYD)

Individual N/A N/A

Family N/A N/A

Plan Year Out-of-Pocket Maximum

Individual N/A N/A

Family N/A N/A

Coinsurance (carrier pays)

MIHS Facilities 100% 100%

MIHS Outpatient Facilities 100% 100%

Office Visits

Preventive Services*** Covered at 100% Covered at 100%

Primary Care Physician Office Visit Same as your plan on pg 6 Same as your plan on pg 6

Specialist Physician Office Visit Same as your plan on pg 6 Same as your plan on pg 6

Urgent Care Visit Same as your plan on pg 6 Same as your plan on pg 6

Emergency Room Visit Same as your plan on pg 6 Same as your plan on pg 6

Physician Services

In / Outpatient Physician Services DMG Physician Services Same as your plan on pg 6 Same as your plan on pg 6

Inpatient Hospital Services - Excludes all Physician Charges

Room & Board; Lab & X-ray Services Covered at 100% Covered at 100%

Outpatient Facility Services - Excludes all Physician Charges

Operating, Recovery & Procedure Rooms Covered at 100% Same as your plan on pg 6

Treatment Room: Lab & X-ray; Anesthesia Covered at 100% Covered at 100%

Advanced Radiological Imaging Covered at 100% Covered at 100%

Physical, Occupational & Speech Therapy (60-visit maximum for all combined services)

Covered at 100% Covered at 100%

Additional Details

Requires Primary Care Physician Same as your plan on pg 6 N/A

Pre-Existing Condition Limitation Same as your plan on pg 6 Same as your plan on pg 6

THE MIHS NETWORK

**MIHS Facilities include Maricopa Hospital, CHC and FHCs; applies to all Cigna plans: POS and HRA.***Claims must be coded by the provider as routine, preventive care. Copays will not be waived for diagnostic services rendered.

When you use a MIHS facilty, you can save significantly. Below is a list of local facilities: • Avondale Family Health Center

• Chandler Family Health Center

• El Mirage Family Health Center

• Glendale Family Health Center

• 7th Ave. Family Health Center

• S. Central Family Health Center

• Sunnyslope Family Health Center

• 7th Avenue Walk-in Clinic

• Guadalupe Family Health Center

• Maryvale Family Health Center

• Mcdowell Family Health Center

• Mesa Family Health Center

• Maricopa Medical Center

• Comprehensive Healthcare Center

• Desert Vista Behavioral Health Center

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WELLNESS INCENTIVES

Wellness Incentives for those Enrolled in the Medical PlansAt MIHS, we recognize that our success as a company depends on you, our employees. By taking steps to improve our overall health, we have more energy and use fewer health care services, which saves us all money in our medical plan – and generally makes us more productive at work.

Because MIHS understands that making big lifestyle changes can be hard, we are always looking at new ways to provide you with the tools and resources to help you move in the right direction. Again this year, we are offering you the chance to reduce your medical insurance premium by completing a Biometric Screening and Health Assessment.

To reduce your medical insurance premium by $20 per pay period you must complete your Biometric Screening through Employee Health and a Health Assessment at www.mycigna.com. The $20 per pay period premium reduction applies to all coverage levels in the POS and HRA medical plans.

Current Employees: You have from February 1 - March 31 of every year to complete the Biometric Screening and Health Assessment. If you do not complete these during that time, you must wait until the following year.

New Employees: You have 60 days from your hire date to complete the Biometric Screening and Health Assessment. Once we receive a confirmation of your completion, your reduced premiums will begin no later than 45 days after receipt.

Steps for completing a Health Assessment:

• After you have your Biometric Screening results, go to www.mycigna.com.

• If you have not previously accessed the mycigna website, please click Register; otherwise, you may proceed by entering your User ID and Password.

• From the home screen under Manage My Health (drop down menu), select My Health Assessment.

• Begin your Health Assessment. If you have previously taken the Health Assessment, click Take Again.

• Answer all questions.

• Once you have answered all of the questions, please print your confirmation for your records. Also, bring a copy to Human Resources within 60 days of your hire date.

To protect your confidentiality, MIHS does not have access to individual Biometric Screening and Health Assessment results. The data collected by LabCorp and Cigna will only be used to determine health and wellness programs that would benefit employees and families.

Health Assessment:

- NEW!

MeMD lets you consult with a medical provider through the Internet with a webcam or by telephone. A MeMD exam saves you time and potentially hundreds of dollars by helping you avoid costly emergency room visits.

The majority of minor ailments and non-life-threatening medical issues can be treated through MeMD online or by phone without the hassle of going to the doctor’s office. You can be treated while at home, the office, or traveling!

MeMD exams cost only $30 for MIHS employees and dependents.

Have strep throat and need antibiotics? On the road and forgot your meds at home? Whatever the case, should you require a prescription it will be electronically routed through MeMD to the local pharmacy of your choice.

Visit www.memd.me/employer/mihs for more information.

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WORKING ON WELLNESS

MIHS places a high value on achieving personal health goals. It’s time to be in good health and recommit to goals or establish new ones.

Our Wellness Program, WOW, will create ways throughout the year for employees to reach their personal health goals. We will promote healthy lifestyles and provide informational tools and resources to help pave the way to improved health. We hope you will join MIHS in making a personal commitment to incorporate healthy lifestyle changes into your daily routines.

Wellness is defined as the condition of good physical and mental health, especially when maintained by proper diet, exercise and habits. Wellness is the sum of healthy habits and your lifestyle…small changes can have a BIG impact!

Did you know that 50-70% of all diseases are associated with modifiable health risks and are therefore preventable? Obesity, poor diet, inactivity and smoking account for:

• 80% of heart disease and stroke

• 80% of type 2 diabetes

• 40% of cancer

MIHS wants all employees to Work on Wellness together. Our Wellness Program offers activities and resources throughout the year to help you get healthy.

Here are some examples:

• Healthier choices in the cafeteria and vending machines

• Weight management programs

• Preventive care, including on-site mammograms and prostate screenings

• On-site flu shots

• Increased physical activity; walking programs

• Stress management

• Smoking cessation

To kick things off for your health journey, we encourage you to schedule a routine Biometric Screening and physical with your doctor so you will know your numbers (blood pressure, cholesterol, blood sugar, etc.). MIHS medical plans pay for preventive care at 100% - no copay or deductible – when using network providers.

Then go online to www.mycigna.com and take the Health Assessment and create your own Personal Health Record. Read about this and other Cigna wellness tools on page 10.

This is your year! Start to reflect on your life and the behaviors that make you healthy or unhealthy. Then begin taking small steps to drive healthy changes and challenge yourself along the way. MIHS and the Wellness Team will be here to help you. Watch for WOW programs and activities and participate.

The Employee Assistance Program (EAP) is a professional counseling service offering confidential help for short-term day-to-day concerns or during difficult times. Counseling through the EAP is a free benefit provided for all employees and eligible dependents. The cost of this benefit is paid entirely by MIHS. Participation in the medical plan is not necessary.

EAP counselors can help with a wide range of life’s concerns, and in most cases, a visit to a local consultant is all that is needed. When additional help is indicated, the EAP will seek the best resources and will assist with referrals to other providers and programs.

The ComPsych EAP Guidance Resources plan provides up to eight individual counseling sessions per person, per problem, per year for employees and dependents. Counseling is available by phone or in person and appointments can be scheduled 24 hours a day, seven days a week by calling 866-376-4219.

Online information, tools and services are available at www.guidanceresources.com (registration required, enter: MIHS).

The EAP provides a full range of counseling and referral services for individual, family and marital concerns; stress and job-related pressures; child and domestic abuse; and chemical and alcohol dependency.

In addition to the individual counseling sessions for personal matters, the staff is available to all employees for debriefing sessions following critical incidents that may occur in the workplace. Resources are also available to assist with financial issues such as getting out of debt, retirement planning and tax questions. Employees may also seek legal support from qualified attorneys for assistance with divorce and family law, real estate transactions and bankruptcy concerns.

EMPLOYEE ASSISTANCE PROGRAM

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CIGNAÕS PERSONALIZED WELLNESS PROGRAM

Cigna is committed to helping you and your family improve your health.

To do this successfully, you need to be more fully engaged in your health care decisions — moving from a passive role to an active, informed participant.

Cigna online coaching programs provide you with an opportunity to change your behaviors and improve your health. You also have the flexibility to address your lifestyle concerns in a way that is most convenient for you.

Influencing, educating and motivating you to overcome barriers and change your health behaviors helps you improve your health, well-being and productivity.

How it worksThere are two ways to participate in online coaching:

• Take the Cigna Health Assessment to identify health risks and behaviors.

• Self-enroll in a coaching module focused on nutrition, stress, physical activity or sleep. A “Welcome” e-mail will explain the purpose of the program and how it will work.

Once enrolled, you are given a choice of start dates. Throughout coaching, receive communications to help stay engaged for the duration of the program.

To startLog in to www.myCigna.com and select the “Manage My Health” tab in the top right corner of the page. Select “How Healthy Are You?” in the middle of the screen and follow the steps through the questionnaire. Try to have your blood pressure, total cholesterol and HDL cholesterol values with you when completing the Health Assessment.

My Wellness ScoreAfter completing the Health Assessment, you will receive a wellness score based on how you compare to people in your gender and age group. Do not worry if your numbers are not what you hoped for. You can update the assessment whenever you make a change to your health. You will be surprised how a few simple changes can improve your wellness score.

Online Health Coaching ProgramsMaking better choices for ourselves is never easy. We all want to do better, but we do not always have the support we need. That is what makes My Assessment and Online Health Coaching Programs so easy. You can access them day or night, answer questions with ease and confidentiality. So, do not wait any longer. Choose a program and begin today!

Sleep Better, Feel Better, Live Better

Learn how to decrease your stress levels and improve the quantity and quality of your sleep, as well as your energy and alertness.

Energy and Performance

Focus on increasing your energy levels and fitness through better lifestyle habits, and learn how to reach and maintain better body weight.

Feel Better, Look Better

You can get healthier and feel healthier by making better eating and exercise choices and decreasing your weight and Body Mass Index score.

Strength and Resilience

Find the support you need to balance work and life, decrease stress levels and improve coping skills.

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Dental Plan Comparison Employer Dental Services (EDS) MetLife - Preferred Dentist Program (PDP)

In-Network In-Network Out-of-Network*

Deductible (per plan year) Deductible applies only to Basic and Major Services

Employee None $50 per person

Family None $100 per family unit

Plan Year Maximum (per plan year) None - Unlimited $2,000 per person

Covered Services

Office Visit $5 Copay None None

Routine Cleaning or Preventive100% after $5 Copay for children 100% after $7 Copay for adults

100% 80% of PDP Fee

Basic 80% - 90% based on dental schedule 80% after deductible 60% of PDP Fee

Major 50% - 60% based on dental schedule 50% after deductible 50% of PDP Fee

Orthodontia / Specialty Services Up to a 25% discount 50% 50% of PDP Fee

Endodontics (root services) performed by General Dentist

70% - 75% based on dental schedule

80% after deductible 60% of PDP Fee

Periodontics (gum services) performed by General Dentist

55% - 70% based on dental schedule

80% after deductible 60% of PDP Fee

Orthodontia Lifetime Max (per person)

None - Unlimited $3,000 per person

DENTAL BENEFITS

Summary of BenefitMIHS offers a choice of two dental plans — a Dental HMO (DHMO) and a Preferred Dentist Program (PDP).

The Employers Dental Services (EDS) DHMO Plan is a discount dental plan that offers the convenience of a fixed copayment schedule for utilizing the plan’s contracted providers and facilities. Employees select a Primary Care Dentist from the EDS network.

The MetLife Dental PDP Plan gives the freedom to choose either a participating dentist or an out-of-network dentist. There are considerable cost savings when using a dentist who is in the MetLife network.

The following is a brief highlight of the major plan provisions for each dental option.

EDS Dental Plan• Select a Primary Care Dentist from EDS’s network

• No deductibles

• No Yearly Maximum benefits

• Orthodontic benefits for children and adults

• Discounts for Orthodontia and specialty dentists

MetLife Dental Plan• No Primary Care Dentist necessary

• In and Out-of-Network benefits

• No deductible for preventive and diagnostic or Orthodontia services

• $2,000 Plan Year Maximum

• $3,000 Lifetime Orthodontia Maximum

MetLife does not issue ID cards.

If you would like an ID card, you can go online to www.MetLife.com/myBenefits (Enter Company Name: MIHS) and print a MetLife card.

When you visit the dentist, let them know you are a MetLife member, then verify your identification.

MetLife Dental Tip:

*Out-of-Network services subject to charges in excess of fees that participating PDP dentists have agreed to accept as payment in full.

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VISION BENEFITS

The Avesis Vision Plan provides you and your family with quality vision benefits at an affordable cost.

The program is designed to encourage you and your family to visit the optometrist or ophthalmologist regularly to maintain your vision health.

In addition, optometrists and local service facilities can supply you with the necessary hardware and materials to meet your daily vision needs.

The following is a brief highlight of the major plan provisions.

• In- and Out-of-Network benefits

• Plan year benefits

• Copay for all office visits and materials in-network

• Discounts available at point-of-purchase

Vision Plan Design Avesis

In-Network Out-of-Network

Benefit Frequency

Vision Exam Once per plan year*

Spectacle Lenses or Contact Lenses** Once per plan year*

Frames Once per plan year*

Covered Services

Vision Examination Covered in full after $10 copay Up to $45

Laser Vision CorrectionCovered at a discount from select providers less $300 allowance; in lieu of all

other services for the benefit year$300 allowance in lieu of all other services for that

plan year

Additional ServicesLens tints, scratch resistant, UV, and anti-reflective coatings covered in full. All others will receive up to 20% off lens options, and additional purchases over

benefit year allowances or items not covered by plan.N/A

Materials

Standard Spectacle Lenses Including standard Polycarbonates and Standard Progressive Lenses (Level I & II)

Covered in full after $10 copay $45-$85 depending on lens type

Frame*** Covered in full after $10 copay (Up to $150 allowance) Up to $50

Contact Lenses

Elective Up to $150 allowance (can be used toward contact lenses and fitting fees) Up to $150

Medically Necessary Covered in Full Up to $250

*Plan year runs July 1 to June 30.

**Contact lenses may be elected in lieu of lenses and frames.

***Wal-Mart locations limit to $68 retail value.

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FLEXIBLE SPENDING ACCOUNTS (FSA)

This is an account that allows you to contribute pre-tax dollars on an annual basis to use for health care and dependent care expenses.

Employees can participate in this Flexible Spending Account (FSA) benefit even if they are not enrolled in MIHS’s benefit plans. Eligible expenses are determined based on IRS regulations and claims must be submitted within 90 days of the plan year-end. Any money left in the FSA, after the deadline, is forfeited. This is known as the “use-it-or-lose-it” rule, and it is an IRS requirement.

Participating in either (or both) the Health Care or Dependent Care FSA can reduce taxes while allowing pre-tax dollars to pay for your qualified expenses for dependent spouse or child(ren).

Using Your FSA Dollars

For both the Health Care and Dependent Care Spending Account, a stored-value (debit) card simplifies the process of paying for qualified expenses. It provides electronic access to your pre-tax contributions. Manual claim filing is also available.

For the Health Care Spending Account, you have access to your funds from day one of participation in the account. The funds in the Dependent Care Spending Account are only reimbursed up to the current amounts deposited in the account.

Health Care Spending AccountYou can deposit as much as $2,500 a plan year ($260 minimum) on a pre-tax basis (this also includes $2,500 per tax year). You reimburse your personal funds with money from the Health Care Spending Account for medical expenses such as copays, co-insurance, over-the-counter medications (see tip below), and more. A comprehensive list of eligible health care expenses is available online at http://www.discoverybenefits.com/participants/eligible-expenses/medical-expenses-fsa-hsa.

Dependent Care Spending AccountPre-tax money that you deposit into the account pays for daycare expenses for dependent children up to age 13, or a dependent adult. Care expenses are reimbursable if the services enable you and your spouse to work. Expenses are also reimbursable if your spouse is disabled or attends school full-time at least five months of the year. You can deposit up to $5,000 a year total ($2,500 each if married, filing separately).

You can reimburse your personal funds with money from the Dependent Care Spending Account for eligible expenses such as nursery school tuition, day care center, summer day camp and dependent-adult day care center expenses, and more. Care can be provided inside or outside your home. A comprehensive list of eligible dependent care expenses is available online at http://www.discoverybenefits.com/participants/eligible-expenses/dependent-care-expenses.

Over-the-counter (OTC) medications require a prescription from your doctor to be an eligible Health Care Spending Account expense. Prescriptions must be filled at a pharmacy.

Please refer to the Discovery Benefits website to verify eligible FSA expenses.

FSA Tip:

13

LIFE INSURANCE

Basic Group Term Life Insurance and AD&D

To ensure that all benefit eligible employees have a basic level of protection, MIHS provides Basic Group Term Life insurance and AD&D at no cost.

The Accidental Death and Dismemberment (AD&D) benefit pays in addition to Basic Life insurance if the employee’s death or covered loss is due to an accident.

Both policies are provided at no cost to employees. The Basic Group Term Life policy is convertible to an individual policy upon termination of employment from MIHS. Note: Benefit must be elected through our online enrollment system.

Amount of Coverage

The Basic Group Term Life plan covers benefit eligible employees with a policy equal to 1 times basic annual earnings (excludes overtime, shift differential, premiums, etc.) rounded to the next higher $1,000 to a maximum of $500,000. The AD&D policy amount equals the life benefit. Benefits are reduced to 65% at age 70 and 50% at age 75. Coverage terminates at retirement.

Employee Voluntary Term Life Insurance and AD&D

Summary of Benefit

When it comes to protecting the financial security of you and your family, nothing is more important than planning ahead. Part of any personal financial plan should include adequate life insurance coverage that provides protection against financial hardship in the event of an unexpected death.

Even if you already have a life insurance policy, it is important to ask yourself – does it provide the protection you need to cover all of your financial responsibilities? Voluntary Term Life insurance can be purchased in addition to the Basic Group Term Life insurance provided by MIHS.

Voluntary Term Life insurance covers you for as long as you remain eligible and continue to pay your premium. Because Voluntary Life is a Term Life insurance product, it does not build any cash value for you to borrow against or receive upon policy cancellation. The Voluntary Term Life policy is convertible to an individual policy upon termination from employment from MIHS.

Amount of Coverage

Eligible employees may purchase Voluntary Term Life insurance coverage in the following amounts, rounded to the next higher $1,000:

• 1, 2, 3, 4, or 5 times annual base earnings

The Guaranteed Issue amount for Voluntary Term Life combined is $250,000. For employees age 70+, the maximum coverage is $50,000.

An equal amount of AD&D insurance is included with the Employee Voluntary Life insurance. Benefits are reduced to 65% at age 70 and to 50% at age 75. Coverage terminates at retirement.

Note: Evidence of Insurability (EOI) must be provided for amounts in excess of $250,000. Additionally, any annual increase in coverage or coverage for late entrants require EOI.

Spouse Voluntary Term Life Insurance and AD&D

Summary of Benefit

This is Voluntary Group Term Life insurance that can be purchased for an employee’s spouse.

Amount of Coverage

The Spousal Voluntary Term Life insurance can be purchased in $5,000 increments and cannot exceed 50% of the employee’s coverage amount or $250,000. An equal amount of AD&D insurance is included with the spouse optional life insurance.

Note: EOI must be provided for amounts in excess of $30,000. Additionally, any annual increase in coverage or coverage for late entrants require EOI.

Dependent Children Voluntary Term Life Insurance

Summary of Benefits

This is Voluntary Group Term Life insurance that can be purchased for employee’s dependents.

Amount of Coverage

Coverage for the dependent child(ren) are flat dollar amounts as follows:

• Child(ren): $1,000, $5,000 or $10,000

Note: The Dependent Life Insurance Rate is not affected by the number of children. Rate is based on the coverage amount and covers each child for the same amount. Dependent children can be covered up to age 26.

If your Voluntary Life Insurance ceases due to termination of your employment, you may apply for portable coverage on your own up to the amount of Voluntary Life Insurance that ceased. The minimum amount of portable coverage is $10,000.

If you elect to apply for portable coverage of any amount of Voluntary Term Insurance, you may also apply for Dependent Life insurance which ceased due to your termination.

Notes: Voluntary Life

14

DISABILITY

Short Term Disability (STD) Plan

This voluntary plan can help provide additional financial protection by providing a benefit while disabled.

This plan does not cover disabilities due to occupational sickness or injury but can help employees prepare for a non-work related short-term disability.

Benefits from a disability plan can supplement lost income to help pay expenses such as mortgage or rent payments, utility bills and other household expenses (e.g., food, clothing and other necessities). It can also cover copayments and other medical costs not covered under other plans.

Amount of Coverage

Eligible employees have a coverage amount up to 60% of base income to a maximum of $2,500 per week.

Maximum Benefit Period

Disability benefits will begin on the first day following the elimination period. There are three elimination period options to choose from: 7 days, 14 days, or 30 days of continuous absence due to a covered sickness, pregnancy, or injury. Benefit payments could continue for a period of up to 26 weeks.

Note: Any disability which occurs in the first 12 months of coverage which is attributed to a pre-existing condition for which you were treated or diagnosed for the condition or illness in the 12 months prior to the effective date of coverage will not be a covered disability. Changes in elected elimination period option may initiate additional pre-existing limitation.

Long Term Disability (LTD) PlanMember Information

Active members making contributions to the Arizona State Retirement System (ASRS) are also part of the ASRS Long Term Disability Plan, funded by a separate employee and employer contribution.

The LTD plan provides a monthly benefit designed to partially replace income lost during periods of total disability greater than six months resulting from a covered injury, sickness or pregnancy.

ASRS has contracted with Sedgwick Claim Management Services, Inc (Sedgwick CMS) for administration of this LTD plan.

You must be an active member making contributions to the Arizona State Retirement System to be eligible for the ASRS Long Term Disability Plan.

This is funded by employee and employer contributions.

Long Term Disability Tip:

15

VOLUNTARY BENEFITS

These plans are voluntary - you choose whether or not to purchase coverage. You pay 100% of the premiums for plans elected. Enrollment in these plans occurs only during the initial eligibility period and Annual Enrollment.

Group Accident InsuranceSummary of Benefit

If you are like most people, you do not budget for accidents. And when an accident occurs, you may not be thinking about the charges that can accumulate while you are at the emergency room — the ambulance ride, use of the emergency room, surgery and anesthesia, stitches, cast, wheelchair, crutches, x-rays. But these costs can add up fast.

The Group Accident plan will pay you a benefit, regardless of other insurance you have. It provides benefit payments directly to you (unless otherwise assigned). You can use the financial benefit any way you choose. There are no pre-existing condition clauses with this coverage.

Coverage Benefits

There are no medical questions and you can take the coverage with you if you leave MIHS for any reason. Coverage is available for on-and-off-job accidents. Coverage is available for your spouse and children.

Group Critical Illness InsuranceSummary of Benefit

A severe, life threatening illness can happen to anyone at any time. If you or someone in your family suffers a serious illness, you can be hit hard with immediate medical expenses and reduced income from being out of work. Health benefits may pay part of the medical bills and disability coverage may help ensure a continuing income; however, many immediate expenses may not be covered.

The Group Critical Illness plan rounds out our benefits program by supplementing your medical or disability coverage options. It pays an immediate benefit directly to each participant (unless otherwise assigned) who is diagnosed with a critical illness; re-occurrence benefits* if the condition returns; and additional occurrence* benefits if another covered illness/procedure is incurred. You may use the benefits any way you choose.

Coverage Options

Coverage includes a $50 benefit for an annual health screening (dependent children are not eligible for the health screening benefit). You can select the policy amount from $5,000 – $50,000 in $5,000 increments. Coverage is also available for your spouse and children. Children are covered at no additional premium.

Coverage Benefits

You may wish to purchase this coverage during the initial guarantee issue period to access maximum policy amounts available ($40,000 for employee and $20,000 for spouse) without answering medical questions. You can take the coverage with you if you leave MIHS for any reason.

* Additional occurrences must be separated from the prior different Critical Illness by at least six months and it is not caused by or contributed to by a Critical Illness for which benefits have been paid. Re-occurrence benefits must be separated by at least 12 months or for cancer 12 months treatment free. Cancer that has spread (metastasized) even though there is a new tumor, will not be considered an additional occurrence unless you have been treatment free for 12 months.

Heart Attack, Stroke, Cancer (internal or invasive), Major Organ Transplant, Paralysis, Coma, Kidney Failure, Occupational HIV, Burns and Loss of Sight/Hearing/Speech are covered 100% of face amount payable. Coronary Artery Surgery and Carcinoma in Situ are covered 25% of face amount payable.

When Carcinoma in situ is paid, it will reduce the Cancer benefit by 25%. When Coronary Artery Bypass Surgery is paid, it will reduce the Heart Attack benefit by 25%.

Critical Illness Notes:

16

OTHER BENEFITS

United Pet CareUnited Pet Care offers MIHS employees a pet health care membership program that includes preventive and diagnostic care. All office visits are $35.00.

Annual exams and vaccines are covered at no charge ($35.00 office visit applies). Procedures in your veterinarian’s office are provided at a 20-50% savings. Specialists provide services at a 10-20% savings.

Visit http://unitedpetcare.com/group.php?gid=maricopa_integrated_health_system to select a CHOICE 2000 II participating veterinarian from United Pet Care’s provider directory. The monthly membership fee is based on the number of pets enrolled on or before the 25th of each month. Enroll online through Benefit Harbor and the membership fee will be deducted bi-weekly from your paycheck.

Once an animal is added, they must remain on the plan the entire plan year unless the pet has passed away. Then, we require documentation of the passing.

MIHS Employee AdvantageThe MIHS Employee Advantage program offers exclusive discounts and voluntary benefits to employees of Maricopa Integrated Health System. Employees can benefit from group discount rates on Auto & Home insurance from Kemper and Metlife, as well as VPI pet insurance. Employees can also find special pricing for a wide variety of products and services, including movie tickets, cell phone service plans, wholesale clubs, financial services and much more.

The MIHS Employee Advantage website includes both national and local discount programs, and monthly email communications feature new and seasonal offers that provide extra savings and timely discounts. Additionally, if products or services are available to MIHS employees but not listed on the website, employees can nominate those providers for addition by accessing the site’s nomination form. For more information or inquiries regarding the MIHS Employee Advantage program, visit http://www.beneplace.com/mihs or call 800-683-2886.

MetLaw - NEW!MetLaw is a new legal benefit that provides full coverage for legal matters, such as estate planning, real estate and consultations, on an unlimited number of legal matters. For more information, call 1-800-821-6400 or visit info.legalplans.com.

Paid-Time Off (PTO) and Employee Illness Bank (EIB)MIHS Eligible Employees will earn PTO and EIB each pay period based on the number of hours paid. Hours paid in excess of 40 hours in a work week are not used to calculate PTO and EIB accruals. Employees will not earn PTO and EIB for unpaid periods including unpaid leaves of absence.

Covered Employees who are in a paid status of 40 hours per week will accrue PTO and EIB as follows:

PTO Accrual

Months of Credited Service

Hours Per Pay Period

Hours Per Year

Max Accruals Per Hour

1 – 36 months1 month – 3 years

4.65 120.9 .0581

37 – 72 months3 – 6 years

5.55 144.3 .0694

73 – 120 months6 – 10 years

6.90 179.4 .0863

121 – 180 months10 – 15 years

7.90 205.4 .0988

181 – 228 months15 – 19 years

8.50 221.0 .1063

229 months +19 years +

8.80 228.8 .1100

EIB Accrual

Months of Credited Service

Hours Per Pay Period

Hours Per Year

Max Accruals Per Hour

1 – 36 months1 month – 3 years

1.55 40.3 .0194

37 – 72 months3 – 6 years

1.85 48.1 .0231

73 – 120 months6 – 10 years

2.30 59.8 .0288

121 – 180 months10 – 15 years

2.30 59.8 .0288

181 – 228 months15 – 19 years

2.30 59.8 .0288

229 months +19 years +

2.30 59.8 .0288

Note: Eligible Employees who are in a paid status of 20-39.99 hours per week will accrue a prorated amount of PTO & EIB based on the number of hours paid and months of service.

17

RETIREMENT PLANS

Retirement PlanThe Arizona State Retirement System (ASRS) is a state agency providing retirement benefits, Long Term Disability insurance and other benefits to employees of the state, counties, municipalities, universities and community colleges, school districts and other political entities. Once an employer agency becomes a member of the ASRS, employees in covered positions must also become members. Membership is a mandatory condition of employment for all public employees in a position that meets the eligibility and membership criteria defined in Arizona Revised Statute (A.R.S. 38-711).

Questions? Call members services at 602-240-2000 or 602-344-5559. Also visit online at www.azasrs.gov.

All employees hired to work 20 hours or more per week for more than 19 weeks in a fiscal year are required to contribute to the ASRS.

Deferred Compensation Plan, 457(b)This is a retirement savings plan administered by Nationwide Retirement Solutions that allows you to put aside for 2013 as much as $17,500 per year if you are under the age of 50, or $23,000 if you are over age 50 on a pre-tax basis.

The money in a 457(b) account is automatically deducted from your paycheck and has higher growth potential because earnings accumulate tax-deferred.

This program is flexible and can be increased or decreased at any time. Withdrawals will be taxed as ordinary income upon separation of service.

Nationwide offers a variety of investment options. You have full control over how your money is invested and you pay no commissions.

For more information, visit online at www.maricopadc.com.

Supplemental Retirement Savings Plan (SRSP), 401(a)The SRSP is a supplemental defined contribution plan qualified under Section 401(a) of the Internal Revenue Code established by ASRS. Eligibility is limited to those employees who meet the criteria for ASRS membership and who are at least 40 years of age.

Contributions made under 401(a) do not reduce the amounts you can contribute to the 457(b) plan. For 2013, employees may contribute up to 100% of pay or $51,000, whichever is lower.

The IRS places restrictions on employee contributions – specifically, employees make a one-time irrevocable election (i.e., the amount of the initial election cannot be changed). The contributions are not included in the employee’s gross income until distribution from the Plan.

Also, the decision to participate in the SRSP must be made within two years of eligibility date or the employee will be deemed to have irrevocably declined to be a member of the Plan.

Employee contributions are fully vested immediately and cannot be withdrawn prior to termination of employment. Nationwide provides administration of the 401(a) plan and investment options. Contact Nationwide Retirement Solutions for more information or visit www.maricopadc.com.

18

LIMITATIONS AND EXCLUSIONS

Short-Term Disability

Benefits won’t be paid for disability due to:

1. any act of war, declared or undeclared, insurrection, rebellion, or act of participation in a riot;

2. An intentionally self-inflicted injury;

3. A commission of, or attempt to commit, an assault, battery, or felon, or engagement in any illegal occupation;

4. Loss of professional license, occupational license or certification;

5. Commission of a crime under state or federal law;

6. An injury arising from any employment;

7. Injury or sickness covered by Worker’s Compensation.

We will not pay a benefit for any period of disability during which any employee is incarcerated.

Pre-existing Condition Limitation for employees without coverage under prior carrier

We will not pay benefits for any period of Disability starting within the first 12-months after the Effective Date of an Employee’s Certificate which is caused by, contributed to, or results from a Pre-existing Condition.

A claim for benefits for loss starting after 12-months from the Effective Date of an Employee’s Certificate will not be reduced or denied on the grounds that it is caused by a Pre-existing Condition unless it is excluded by name or specific description.

In addition, we will not pay the increase in an Employee’s coverage made at an Annual Open Enrollment Period if he/she has a pre-existing condition. An Employee has a pre-existing condition if:

1. he/she received medical treatment, consultation, care or services including diagnostic measures; or took prescription drugs or medicines in the 12 months just prior to the date his/her coverage increased; or he/she had symptoms for which an ordinarily prudent person would have consulted a health care provider in the 12 months just prior to the date his/her coverage increased; and

2. the disability begins in the first 12 months after his/her increase in coverage.

Take Over Pre-Existing Condition Limitation

When the plan becomes effective, we will provide coverage for an employee if:

• he or she is not in active employment because of sickness or injury;

• he or she was covered by the prior policy

An employee’s coverage is subject to the payment of premium. An employee’s payment will be limited to the amount that would have been paid by the prior carrier. We will reduce an employee’s payment by any amount for which his or her prior carrier is liable.

We may send a payment if an employee’s disability results from a pre-existing condition if he or she was:

• In active employment and insured under the policy on its effective date;

• Insured by the prior policy at the time of change

In order to receive a payment an employee must satisfy the pre-existing condition provision under:

• our plan;

• the prior carrier’s policy, if benefit would have been paid had the policy remained in force.

If an employee does not satisfy Item 1 or 2 above, we will not make any payments. If an employee satisfies Item 1, we will determine his or her payments according to our policy provisions.

If an employee satisfied Item 2, we will administer his or her claim according to our policy provisions. However, his or her payment will be the lesser of:

1. The weekly benefit that would have been payable under the terms of the prior plan if it had remained in force;

2. The weekly payment under our policy

An employee’s benefits will end on the earlier of the following dates:

1. The end of the maximum benefit period under the plan;

2. The date benefits would have ended under the prior policy if it had remained in force

If an employee changes to a shorter elimination period or an increase in benefit amount during the initial enrollment or subsequent open enrollment, then the employee will be subject to the 12 month pre-existing condition limitation.

Accident

We will not pay benefits for injury contributed to, caused by, or resulting from:

1.War – being exposed to war or armed conflict.

2. Suicide - committing or attempting to commit suicide, while sane or insane.

3. Sickness - having any disease or bodily/mental illness or degenerative process. We also will not pay benefits for any related medical/surgical treatment or diagnostic procedures for such illness.

4. Self-Inflicted Injuries - injuring or attempting to injure yourself intentionally.

5. Racing - Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.

6. Aviation - operating, learning to operate, serving as a crew member on, or jumping or falling from any aircraft, including those which are not motor-driven.

7. Illegal Acts - participating or attempting to participate in an illegal activity, or working at an illegal job.

8. Sports - participating in any professional or semi-professional organized sport.

9. Avocations - mountaineering using ropes and/or other equipment, parachuting or hand-gliding.

Critical Illness

This plan contains a 30-day Waiting Period. This means a 25% benefit is payable for any insured who has been diagnosed with a specified critical illness before their coverage has been in force 30 days from the Effective Date shown in the Rider Schedule; or at your option, you may elect to void this rider from the beginning and receive a full refund of premium.

Pre-Existing Conditions Limitation

“Pre-existing Condition” means a sickness or physical condition which, within the 12-month period prior to an Insured’s Effective Date resulted in the Insured receiving medical advice or treatment.

We will not pay benefits for any Critical Illness starting within 12 months of an Insured’s Effective Date which is caused by, contributed to, or resulting from a Pre-existing Condition.

A claim for benefits for loss starting after 12 months from an Insured’s Effective Date will not be reduced or denied on the grounds that it is caused by a Pre-existing Condition. A critical Illness will no longer be considered Pre-existing at the end of 12 consecutive months starting and ending after and Insured’s Effective Date.

If a Certificate under the Plan has been issued as a replacement for a Certificate previously issued to an Employee under our previous Plan, then the pre-existing condition limitation provision of this Plan applies only to any additional benefits or increase in benefit amounts over the prior Certificate. Any remaining period of pre-existing condition limitation under the prior Certificate would continue to apply to the prior level of benefits.

Exclusions We won’t pay for loss due to:

1. Intentionally self inflicted injury or action

2. Suicide or attempted suicide while sane or insane

3. Illegal activities or participation in an illegal occupation

4. War-declared or undeclared or military conflicts, participation in an insurrection or riot, civil commotion or state of belligerence

5. Substance Abuse

Diagnosis must be made and treatment received in the United States

Occupational HIV Exclusions

1. No benefits will be paid for Occupational HIV resulting from a needle stick or sharp injury or a mucous membrane exposure to blood or bloodstained bodily fluid, which occurred prior to the effective date of this rider

2. We will not pay for any cost incurred for HIV tests or any relating testing

3. No benefits will be paid for HIV contracted outside the United States.

Additional Benefits (Comma, Paralysis, Severe Burns, Loss of sight, speech or hearing) Limitations and Exclusions

This rider contains a 30-day Wait Period. This means a 25% benefits is payable for any insured who has been diagnosed with a specified critical Illness before their coverage has been in force 30 days from the Effective Date show in the Rider Schedule; or at your option, you may elect to void this rider from the beginning and receive a full refund or premium.

1. No benefits will be paid if the Specified Critical Illness is a result of: a. Intentionally self inflicted injury or action; b. Suicide or attempted suicide while sane or insane; c. Illegal activities or participation in an illegal occupation; d. War, declared or undeclared, or military conflicts, participation in an insurrection or riot, civil commotion or state of belligerence; or e. Substance Abuse.

2. No benefits will be paid for loss which occurred prior to the effective date of this Rider.

3. No benefits will be paid for diagnosis made outside the United States.

19

LEGAL NOTICES

Employee Benefit Plan Privacy Notice

This Notice Describes How Health Information About You May Be Used and Disclosed and How You Can Get Access To This Information. Please Review It Carefully. If you have any questions about this Notice, please contact the Benefits Department.

Who Will Follow This Notice: This Notice describes the health information practices of MIHS and that of any third party that assists in the administration of Plan claims. Third Party Administrator, (TPA) which provides administrative services to the Plan, also has a Privacy Notice regarding its use and disclosure of health information.

How We Protect Health Information: We understand that health information about you and your health is personal. We are committed to protecting health information about you. We create a record of the health care claims reimbursed under the Plan for Plan administration purposes. This Notice applies to all of the health records we maintain. Your personal doctor or health care provider may have different policies or notices regarding the doctor’s use and disclosure of your health information created in the doctor’s office or clinic.

This Notice will tell you about the ways in which we may use and disclose health information about you. It also describes our obligations and your rights regarding the use and disclosure of health information. We are required by law to make sure that health information that identifies you is kept private; give you this Notice of our legal duties and privacy practices with respect to health information about you; and follow the terms of the notice that is currently in effect.

How We May Use and Disclose Health Information About You: The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose in a category will be listed.

For Treatment (as described in applicable regulations). We may use or disclose health information about you to facilitate medical treatment or services by providers. We may disclose health information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about your prior prescriptions to a pharmacist to determine if a pending prescription is contraindicating with prior prescriptions. For Payment (as described in applicable regulations). We may use and disclose health information about you to determine eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your health history to determine whether a particular treatment is experimental, investigational, or health necessary or to determine whether the Plan will cover the treatment.

We may also share health information with a utilization review or precertification service provider. Likewise, we may share health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.

For Health Care Operations (as described in applicable regulations). We may use and disclose information about you for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information in connection with: conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities.

As Required By Law: We will disclose health information about you when required to do so by federal, state or local law. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government

programs, and compliance with civil rights laws. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order.

We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Special Situations

Disclosure to MIHS: Information may be disclosed to another health plan maintained by the Health Plan Sponsor for purposes of facilitating claims payments under that plan. In addition, medical information may be disclosed to the Health Plan Sponsor personnel solely for purposes of administering benefits under the Plan.

Organ and Tissue Donation: If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Workers’ Compensation: We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

National Security and Intelligence Activities: We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. If you are a member of the armed forces, we may release health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.

Public Health Risks: We may disclose health information about you for public health activities. These activities include the following: to prevent or control disease, injury, or disability; to report births and deaths; to report child abuse or neglect; to report reactions to medications or problems with products; to notify people of recalls of products they may be using; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; to notify the appropriate government authority if we believe a patient has been the victim of abuse, or neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Coroners, Medical Examiners and Funeral Directors: We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.

Your Rights Regarding Health Information About You: You have the following rights regarding health information we maintain about you.

Right to Inspect and Copy: You have the right to inspect and copy health information that may be used to make decisions about your Plan benefits. To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to us. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. Your request to inspect and copy may be denied in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed.

Right to Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan. To request an amendment, your request must be made in writing and submitted to us. In addition, you must provide a reason that supports your request. Your request for an amendment may be denied if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: is not part of the health information kept by or for the Plan; was not created by us, unless

20

LEGAL NOTICES

the person or entity that created the information is no longer available to make the amendment; is not part of the information which you would be permitted to inspect and copy; or is accurate and complete.

Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures” where such disclosure was made for any purpose other than treatment, payment, or health care operations.

To request this list or accounting of disclosures, you must submit your request in writing to us. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

We are not required to agree to your request. To request restrictions, you must make your request in writing to. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to us. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Changes to This Notice: We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice on the Plan website. The Notice will contain on the first page, in the top right hand corner, the effective date.

Complaints: If you believe your privacy rights have been violated, you may file a complaint with the Plan or with the Secretary of the Department of Health and Human Services. To file a complaint with the Plan, contact your Benefits Representative at 602.344.1821 or benefits.mailbox@mihs.org. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Other Uses of Health Information: Health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

Mothers and Newborns

Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Women’s Health and Cancer Rights Act of 1998

The Women’s Health and Cancer Rights Act of 1998 requires group health plans that offer medical and surgical benefits for mastectomies to also provide coverage for specific mastectomy related reconstruction and services after the surgery. This notice is intended to advise you and your beneficiaries of your rights under the law. All health care plans that provide benefits to participants or beneficiaries in connection with a mastectomy also are required to provide the following coverage in a manner determined in consultation with the attending physician and the patient for:

1. Reconstruction of the breast on which the mastectomy was performed;

2. Surgery and reconstruction of the other breast for asymmetrical appearance;

3. Prostheses and treatment of physical complications in all stages of the mastectomy, including lymphedemas (swelling associated with the removal of lymph nodes).

Mastectomy coverage is available under the general provisions of the Health Plans. Coverage for mastectomy is subject to the deductibles, coinsurance payments, copayments, and terms and conditions applicable under each health plan.

Medicaid and the Children’s Health Insurance Program (CHIP)

Offer Free Or Low-Cost Health Coverage To Children And Families

If you are eligible for health coverage from your employer, but are unable to afford the premiums, Arizona has premium assistance programs that can help pay for coverage. Arizona uses funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in an eligible State, you can contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.

To request special enrollment or obtain more information, call 877-764-5437 or visit http://www.azahcccs.gov/applicants/default.aspx.

21

LEGAL NOTICES

Medicare Part D

Note: If you or your family members aren’t currently covered by Medicare and won’t become covered by Medicare in the next 12 months, this notice does NOT apply to you.

The purpose of this notice is to advise you that the prescription drug coverage listed below under the MIHS medical plan is expected to pay out, on average, at least as much as the standard Medicare prescription drug coverage will pay in 2012. This is known as “creditable coverage.”

Why this is important. If you or your covered dependent(s) are enrolled in any prescription drug coverage during 2012 listed in this notice and/or become covered by Medicare, you may decide to enroll in a Medicare prescription drug plan later and not be subject to a late enrollment penalty – as long as you had creditable coverage within 63 days of your Medicare prescription drug plan enrollment. You should keep this notice with your important records.

Notice of Creditable Coverage

Please read this notice carefully. It has information about prescription drug coverage with MIHS and prescription drug coverage available for people with Medicare. It also tells you where to find more information to help you make decisions about your prescription drug coverage.

You may have heard about Medicare’s prescription drug coverage (called Part D), and wondered how it would affect you. Prescription drug coverage is available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans also offer more coverage for a higher monthly premium.

Individuals can enroll in a Medicare prescription drug plan when they first become eligible, and each year from November 15 through December 31. Individuals leaving employer coverage may be eligible for a Medicare Special Enrollment Period.

If you are covered by the POS or HRA prescription drug plan offered by MIHS, you’ll be interested to know that coverage is, on average, at least as good or better than the standard Medicare prescription drug coverage for 2012. This is called creditable coverage. Coverage under these plans will help you avoid a late Part D enrollment penalty if you are or become eligible for Medicare and later decide to enroll in a Medicare prescription drug plan.

If you decide to enroll in a Medicare prescription drug plan and you are an active employee or family member of an active employee, you may also continue your employer coverage. In this case, the employer plan will continue to pay primary or secondary as it had before you enrolled in a Medicare prescription drug plan. If you waive or drop the MIHS coverage, Medicare will be your only payer. You can re-enroll in the employer plan at Annual Enrollment, or if you have a special enrollment event.

You should know that if you waive or leave coverage with MIHS and you go 63 days or longer without creditable prescription drug coverage (once your applicable Medicare enrollment period ends), your monthly Part D premium will go up at least 1% per month for every month that you did not have creditable coverage. For example, if you go 19 months without coverage, your Medicare prescription drug plan premium will always be at least 19% higher than what most other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to enroll in Part D.

You may receive this notice at other times in the future – such as before the next period you can enroll in Medicare prescription drug coverage, if MIHS’ prescription drug coverage changes, or upon your request.

More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. Medicare participants will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. Here’s how to get more information about Medicare prescription drug plans:

• Visit www.medicare.gov for personalized help.

• Call your State Health Insurance Assistance Program (see a copy of the Medicare & You handbook for the telephone number).

• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov or call 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this notice. If you enroll in a Medicare prescription drug plan after your applicable Medicare enrollment period ends, you may need to provide a copy of this notice when you join a Part D plan to show that you are not required to pay a higher Part D premium amount.

For more information about this notice or your prescription drug coverage, call the Benefits Department at 602-344-1821.

22

Medical Rates Without Biometric Screening and Health Assessment

Cigna POS Bi-weekly rates Cigna HRA Bi-weekly RatesFull-time Part-time Full-time Part-time

Employee Only $84.42 $221.25 Employee Only $62.47 $165.55

Employee/Spouse $147.11 $272.55 Employee/Spouse $106.25 $198.94

Employee/Child(ren) $116.19 $246.52 Employee/Child(ren) $84.96 $180.89

Family $214.95 $315.05 Family $154.06 $227.88

Medical Rates With Biometric Screening and Health Assessment*

Cigna POS Bi-weekly rates Cigna HRA Bi-weekly RatesFull-time Part-time Full-time Part-time

Employee Only $64.42 $201.25 Employee Only $42.47 $145.55

Employee/Spouse $127.11 $252.55 Employee/Spouse $86.25 $178.94

Employee/Child(ren) $96.19 $226.52 Employee/Child(ren) $64.96 $160.89

Family $194.95 $295.05 Family $134.06 $207.88

EDS Dental Bi-weekly ratesFull-time Part-time

Employee Only $1.90 $1.90

Employee/Spouse $3.60 $3.60

Employee/Child(ren) $4.72 $4.72

Family $5.43 $5.43

MetLife Dental Bi-weekly ratesFull-time Part-time

Employee Only $8.93 $13.90

Employee/Spouse $19.83 $30.96

Employee/Child(ren) $21.30 $32.17

Family $27.41 $42.35

Avesis Vision Bi-weekly ratesFull-time Part-time

Employee Only $2.79 $2.79

Employee/Spouse $5.25 $5.25

Employee/Child(ren) $5.75 $5.75

Family $7.40 $7.40

* See Page 4 for information on how to lower your per-paycheck premiums by $20.

2013 - 2014 BI-WEEKLY RATES

Age Smoker Non-Smoker Age Smoker Non-Smoker

<30 $0.0360 $0.0277 50-54 $0.1412 $0.0688

30-34 $0.0374 $0.0300 55-59 $0.2483 $0.1131

35-39 $0.0438 $0.0346 60-64 $0.2525 $0.1445

40-44 $0.0591 $0.0374 65-69 $0.3826 $0.2354

45-49 $0.0785 $0.0448 70+ $0.9577 $0.5945

Annual Base Pay $

Times 1X, 2X, 3X, 4X or 5X

Coverage Amount

Round up to the next $1,000

And divide by 1,000

Times Rate

Equals Bi-weekly cost $

Employee Term Life/AD&D

Medical

Dental

Vision

23

Age Bi-weekly Rate

Age Bi-weekly Rate

Age Bi-weekly Rate

<25 $0.0429 40-44 $0.0785 60-64 $0.4837

25-29 $0.0494 45-49 $0.1149 65-69 $0.9254

30-34 $0.0646 50-54 $0.1726

35-39 $0.0720 55-59 $0.3175

Coverage Bi-weekly Rate

$1,000/child $0.06

$5,000/child $0.30

$10,000/child $0.60

Coverage Bi-weekly Rate

Employee Only $4.62

Employee/Spouse $6.92

Employee/Child(ren) $9.23

Family $11.54

Coverage Bi-weekly Rate

One Pet $4.89

Two Pets $9.32

Three Pets $13.66

Additional Pets $4.29

Non-tobacco $10,000 $20,000 $30,000 $50,000 Tobacco $10,000 $20,000 $30,000 $50,000

18-29 $2.47 $4.13 $5.79 $9.12 18-29 $3.58 $6.35 $9.12 $14.65

30-39 $3.85 $6.90 $9.95 $16.04 30-39 $6.02 $11.24 $16.45 $26.88

40-49 $6.99 $13.18 $19.36 $31.73 40-49 $13.78 $26.75 $39.72 $65.65

50-59 $11.98 $23.15 $34.32 $56.65 50-59 $23.19 $45.58 $67.96 $112.73

60-69 $18.72 $36.62 $54.53 $90.35 60-69 $36.62 $72.44 $108.25 $179.88

Age 7 Day 14 Day 30 Day Age 7 Day 14 Day 30 Day

Coverage Amount $

Divide by 1,000

Times Rate

Equals Bi-weekly cost $

Annual Base Pay $

Divide by 52

Weekly Base Pay

Times 60% (.60)

Times Rate

And divide by 10

Equals Bi-weekly cost $

Spouse Term Life/AD&D

Child(ren) Term Life

STD

Accident United Pet Care

Critical Illness

Flat rate for Child policy covers all children regardless of number of children. This is not a per child or per policy deduction.

45-49 $0.44 $0.35 $0.26

50-54 $0.50 $0.41 $0.34

55-59 $0.70 $0.55 $0.42

60-64 $0.94 $0.71 $0.51

65+ $1.02 $0.81 $0.54

16-24 $0.65 $0.52 $0.34

25-29 $0.68 $0.58 $0.40

30-34 $0.60 $0.48 $0.33

35-39 $0.45 $0.37 $0.26

40-44 $0.44 $0.34 $0.25

2013 - 2014 BI-WEEKLY RATES

Coverage Bi-weekly Rate

Family $7.62

MetLaw

24

Carrier Contacts for MIHS Benefits

Benefit Plan Administrator Contact Number Website

POS Medical Plan/Rx Cigna Arizona Network 800-244-6224 www.cigna.com

HRA Medical Plan/Rx Cigna Open Access Plus Network 800-244-6224 www.cigna.com

EDS Dental EDS 800-722-9772 www.mydentalplan.net

MetLife Dental MetLife 800-942-0854www.MetLife.com/myBenefits Enter

Company Name: MIHS

Vision Avesis 800-828-9341 www.avesis.com

Flexible Spending Accounts (FSA) Discovery Benefits 866-451-3399 www.discoverybenefits.com

MeMD MeMD 855-636-3669 www.memd.me/employer/mihs

Basic Life/AD&D Insurance Lincoln Financial Group 800-423-2765 www.lincoln4benefits.com

Voluntary Life/AD&D Insurance Lincoln Financial Group 800-423-2765 www.lincoln4benefits.com

Voluntary Short Term Disability Continental American 800-433-3036 www.aflacgroupinsurance.com

Accident Insurance Continental American 800-433-3036 www.aflacgroupinsurance.com

Critical Illness Continental American 800-433-3036 www.aflacgroupinsurance.com

Employee Assistance Program ComPsych 866-376-4219www.guidanceresources.com

Registration Required Enter: MIHS

Retirement Plan ASRS 602-240-2000 www.azasrs.gov

Long Term Disability ASRS 602-240-2000 www.azasrs.gov

Deferred Comp 457(b) and 401(a) Nationwide 602-266-2733 (ext. 1170) www.maricopadc.com

Working on Wellness Program MIHS Employee Health 602-344-5210 N/A

Pet Health Care Program United Pet Care 602-266-5303 www.unitedpetcare.com

MIHS Employee Advantage BenePlace Discount Program 800-683-2886 www.beneplace.com/mihs

COBRA Conexis 877-722-2667 www.conexis.org

MetLaw Hyatt Legal Plans 800-821-6400 info.legalplans.com

MIHS Benefit Questions

If you have general questions regarding any of the available benefit plans, you should contact your HR Benefits representative at 602-344-5495, 602-344-1821 or send an email to Benefits.mailbox@mihs.org.