SEIU Local 2015 Member Benefits

MetLife Dental and Vision

All plan information is available at: www.seiu2015benefits.org

Reliance Standard Life/AD&D and Accident

Benefits Information

Eligibility for Member BenefitsSEIU Local 2015 dues-paying members with a signed union card on file and in good standing

How to Enroll• Visit the SEIU Local 2015 benefits website www.SEIU2015benefits.org and register to enroll online • Request enrollment information by calling the SEIU Local 2015 Benefits Center at 1.877.421.0177• Coverage will be effective the 1st of the following month if enrollment is processed by the 15th of the current month• Once enrolled, you must stay on the plan for a minimum of six (6) months

SEIU Local 2015 WebsiteVisit the SEIU Local 2015 benefits website at www.SEIU2015benefits.org to:• Enroll in all benefits• Update personal contact information• Enroll qualified dependents• Access plan information• Access claim forms• Cancel or change your benefits enrollment

SEIU Local 2015 Benefits CenterSEIU Local 2015 offers a dedicated benefits center to help members and their families with their benefits needs. You can contact the Benefits Center at 1.877.421.0177, Monday through Friday, 8:30AM-5:30 PM for assistance with:• Enrollment• Updating personal contact information• Enrolling qualified dependents• Understanding claims and doctor estimates• Filing Life and AD&D and Accident claims• Eligibility confirmation• Locating a dental and vision provider• The SEIU Local 2015 Benefits Center offers assistance in: - English - Spanish - Armenian - Korean - Mandarin - Cantonese - Vietnamese - Russian

Online Enrollment Guide

Step 1: Visit www.seiu2015benefits.org and click on ‘Register’ to create a User Name and Password.

Step 2: Enter your SSN and DOB on the registration page. Please note that the ‘Company Key’ is seiu2015 (lower-case).

Step 3: From the Home Page, you can enroll in benefits by clicking ‘Start Here’.

Step 4: You can update your personal information, your dependent information or enroll in benefits by clicking on one of the options provided.

Step 5: Update your personal information, dependent information, and begin your benefit elections.

Step 6: To select your coverage, click on ‘I Want Coverage’. Click on ‘Waive Coverage’ if you do not wish to enroll.

Step 7: Once you have made your benefit elections, click on ‘Approve’.

Step 8: Continue to click ‘Approve’ until you receive your Confirmation Number. Your enrollment is now complete!

The SEIU Local 2015 HMO Dental plan helps support you in maintaining and improving your oral health by providing coverage for over 400 procedures. The SEIU Local 2015 HMO Dental Plan has a $5 copay for office visits and

is supported by one of the largest dental provider networks in California, with over 10,700 dentists.

MetLife HMODental

What’s the Difference Between HMO and PPO Dental Benefits?

Dental HMO plans require members to select a preferred in-network primary care dentist from MetLife. All care must be coordinated through that dentist; out-of-network dental care will not be covered under the HMO Plan. Dental HMOs have a set copay amount that the insured pays for each procedure.

Dental PPO plans allow members to see any preferred dentist in-network and will also provide partial benefits if the insured seeks care from a dentist who is out-of-network. Dental PPO plans have a deductible and an annual benefit maximum, and cover a percentage of each dental procedure.

HMO Dental Benefits*

MetLife HMO Dental Monthly Rates

*This is a summary only. Please refer to the Schedule of Benefits for a full list of covered services and the plan’s limitations and exclusions at www.seiu2015benefits.org.

Coverage Monthly RateMember Only $19.54Member Plus 1 $37.12Member Plus 2 or more $51.79

Preventive services White fillings on front teeth

Porcelain crowns

Adult and child orthodontics

Root canals (per tooth)

Extractions (non-surgical)

Partial & Complete Dentures

Implants

BENEFIT$ 0

$ 0

$ 185-$410

$ 80-$200

$ 0

Varies widely by individual

COPAY

$ 1,945

$ 210-$365

MetLife PPO Scheduled Reimbursement Dental

PPO Scheduled Reimbursement Dental Benefits*

PPO Scheduled Reimbursement Monthly Rates

*This is a summary only. Please refer to the benefit summary for maximum amounts MetLife will cover for each benefit. Benefit summary and plan limitations and exclusions can be found at www.seiu2015benefits.org.

The SEIU Local 2015 PPO Scheduled Reimbursement Dental plan allows you to visit any licensed dentist, in or out-of-network. Although the PPO Scheduled Reimbursement dental plan costs more than the HMO dental plan, it is offered for members who do not have access to an in-network HMO dentist. The PPO Scheduled Reimbursement dental benefits are based on a maximum that MetLife has agreed to cover. The benefits listed below indicate the amount for services that MetLife has agreed to cover up to a maximum for each covered benefit. We encourage you to contact

your dentist and ask them if they’re contracted and in-network with MetLife to ensure that you receive the best benefit. MetLife does not have control over the amounts that out-of-network dentists charge for services. Although the MetLife PPO Scheduled Reimbursement dental plan allows access to a much larger network of dentists than the HMO dental plan, the out-of-pocket costs to members to obtain services is much higher than the HMO dental plan.

BENEFIT In-Network Out-of-Network

Preventive services

Basic

Major

Calendar year deductible:

Individual

Family

Calendar year maximum

Orthodontia

75%

50%

30%

$50

$150

$1,000

Not Covered

75%

50%

30%

$50

$150

$1,000

Not Covered

Treatment Maximum Benefit Paid by MetLife*Limited oral evaluation $37Crown $247Protective restoration (fillings) $25

Coverage Monthly RateMember Only $35.86Member Plus 1 $68.12Member Plus 2 or more

$95.02

Sample MetLife Reimbursements*

MetLife Vision

Service

Routine Eye Exam

Exam, Lens and Contacts Frequency

Frame Frequency

Single, Bifocal, Trifocal Lenses

Frames

Contact Lenses (Necessary)

Benefit

$15 copay

12 months

24 months

$25 copay

$130 allowance, 20% additional

Covered in full

MetLife Vision Monthly Rates

SEIU Local 2015 members can save up to 60% on vision wear and services. You can choose from thousands of participating ophthalmologists, optometrists and opticians at private practices or at popular retail

locations, like Costco Optical and Visionworks.

MetLife Vision Benefits*

*This is a summary only. Please refer to the Schedule of Benefits for a full list of covered services and the plan’s limitations and exclusions at www.seiu2015benefits.org.

Coverage Monthly RateMember Only $6.13Member Plus 1 $11.67Member Plus 2 or more $18.42

Finding a Provider

MetLife HMO Dental

1: Go to www.metlife.com

2: I want to find a MetLife: Click on blue box indicating Dentist • Input Zip Code • For Network Type: Click Dental HMO/Management Care• Click on submit

3: Make sure Network type is indicating “Dental DHMO/Man-aged Care”• For Plan Name: Click on MET185A• You can search by dentist, or dental practice name, or mile

radius based on zip code entered• Click Search to obtain results

4: The facility ID number listed under the dental provider name will be required to complete the member benefit en-rollment form

MetLife PPO Scheduled Reimbursement Dental

1. Go to www.metlife.com

2. I want to find a MetLife: Click on blue box indicating Dentist Input your Zip Code For Network Type: Click on PDP Plus

3. Click submit to obtain results

Vision

1. Go to www.metlife.com

2. I want to find a MetLife: Click on blue box indicating Dentist Input your Zip Code For Network Type: MetLife Vision PPO

3. Click submit to obtain results

Reliance Standard Life and AD&D

Reliance Standard Member Supplement Life and AD&D Monthly Rates

SEIU Local 2015 members now have access to Life and Accidental Death and Dismemberment (AD&D) insurance for themselves and their eligible dependents through Reliance Standard. These benefits offer protection for families in the event of a death. The SEIU Local 2015 plan offers life and AD&D benefits for all members at the same cost,

regardless of your age. If you have been denied for life insurance in the past, you are still eligible for this plan at the benefit and monthly cost below. AD&D offers an additional benefit amount for deaths due to an

accident and for dismemberment due to an accident such as loss of a limb, loss of eyesight, etc. You will not be required to submit any health information to sign up for this plan!

Additional Benefits and Plan Information*•Allmembersareeligibleforthisbenefitregardlessofage,gender,andhealthcondition.Thereis no medical exam or medical information required to enroll!•Benefitsreduceto$2,500atage70.Forexample,ifyouareenrolledinthe$10,000insurance policy, your benefit will reduce to $2,500, at $4.00 per month, when you turn age 70.•MembersmustbeenrolledinLife/AD&Dcoverageforthemselvesinordertoenrolltheir spouse/domestic partner and/or child(ren)•Spouse/domesticpartnercoverageterminateswhentheyturnage70•Childcoverageterminateswhenyourchildturnsage26,unlessmentallyand/orphysically disabled.•Bereavementcounselingandtravelassistanceisavailableformembersandtheirfamilies.

*For further explanation and details of your benefits, please contact the SEIU Local 2015 Benefits Center and review the Plan Documents on www.SEIU2015benefits.org.

Coverage Monthly Rate$5,000 $4.00

$10,000 $5.95$20,000 $10.90

Reliance Standard Dependent Supplement Life and AD&D Monthly Rates

Dependent Coverage Monthly RateSpouse $5,000 $3.75Child(ren) $1,000 $1.25

Reliance Standard Accident

SEIU Local 2015 members now have access to Accident coverage for themselves and eligible dependents through Reliance Standard. Whether it’s an automobile accident, sports injury, or a slip and fall, an accident can bring

expenses that are devastating to your family’s finances. Accident coverage offers protection for members and their eligible dependents in the event of an accident by providing a cash benefit for every covered expense, including

AD&D coverage - from x-rays to ambulance services - regardless of what is covered by your medical insurance.

Coverage Monthly RateMember Only $9.47Member Plus Spouse $17.22Member Plus Child(ren) $20.18 Family $23.45

*This is a summary only. Please refer to the Schedule of Benefits for a full list of covered services and the plan’s limitations and exclusions at www.seiu2015benefits.org.

Ricky is on a walk with his dogs when a cat passes by and causes both of his dogs to wrap their leash around his legs trying to chase after the cat. Ricky falls and hurts his arm. He is taken to the hospital in an ambulance and given an MRI to check for injuries. The MRI confirms a concussion and he stays the night in the hospital

for observation. Below is a breakdown of what SEIU Local 2015’s Accident plan covers:

PROCEDURE BENEFITAmbulance Ride $150

Emergency Room Visit $200Hospital Admission $1,000

MRI $200Concussion $150

Follow-up doctor visit $75Total Benefit $1,775

Here’s an example of how SEIU Local 2015’s Accident plan can help *

Additional Benefits and Plan Information*•Memberandspousemustbeundertheageof70toenroll.•CoverageisNOTavailabletomembersanddependentscoveredbyMedicarePartAandPartB.•Childcoverageterminateswhenchildreachesage26,unlessmentallyand/orphysically disabled. •AgereductionforAD&Dbenefitapplies