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1 Employee Medical Plan Premium Rates Coverage Monthly/Salary 130 Hours 140 Hours 150 Hours Each employer may choose to cover all of its Employees Field Employees Field Employees Field Employees employees or only its hourly field construction employees. Health Plan of Nevada HMO Medical - Northern Nevada Employee $ $2.74 $2.55 $2.38 Hourly Field Construction Employees Employee and spouse $ $5.48 $5.09 $4.75 All hourly field construction employees Employee and child(ren) $ $5.21 $4.84 $4.52 must be covered by the Plan unless they are Employee and family $1, $8.77 $8.15 $7.60 separately covered by collectively bargained plans. Hourly field construction employees become Sierra Health and Life PPO Medical - Northern Nevada eligible the first day of the second month Employee $ $3.02 $2.80 $2.62 following hours of work within a calendar Employee and spouse $ $6.03 $5.60 $5.23 month. All other employees become eligible the Employee and child(ren) $ $5.73 $5.32 $4.96 first day of the month following one full month Employee and family $1, $9.64 $8.95 $8.36 of work. Contributions must be paid for all hours worked by hourly field construction employees as soon as they begin employment, beginning Health Plan of Nevada HMO Medical - Southern Nevada with the first hour worked. Employee $ $2.07 $1.92 $1.79 Employee and spouse $ $4.13 $3.84 $3.58 All Other Employees Employee and child(ren) $ $3.93 $3.65 $3.40 If an employee who is not an hourly field Employee and family $ $6.61 $6.14 $5.73 construction employee can show verification of other coverage, he or she need not be covered by the Plan. Sierra Health and Life PPO Medical - Southern Nevada Employee $ $2.27 $2.11 $1.97 Employee and spouse $ $4.54 $4.22 $3.94 Employee and child(ren) $ $4.31 $4.01 $3.74 Minimum of 10 Enrolled Employees is required Employee and family $ $7.26 $6.75 $6.30 to participate in the Trust. Disclaimer Sierra Health and Life - PPO Dental 1. The coverage and eligibility descriptions listed Employee $25.70 $0.20 $0.19 $0.18 here are partial descriptions. Please refer to the Employee and spouse $51.39 $0.40 $0.37 $0.35 plan booklet. Employee and child(ren) $48.82 $0.38 $0.35 $0.33 Employee and family $82.22 $0.64 $0.59 $0.55

2 Coverage Sierra Health and Life (PPO) Coverage Health Plan of Nevada (HMO) In-Network Out-of-Network Lifetime Maximum Unlimited Unlimited Deductible-Calendar None $500 per Member per Year $1,000 per Member per Year Year (2per family) $1,000 per Family per Year $2,000 per Family per Year Out-of-Pocket Maximum- None $3,000 per Member per Year $6,000 per Member per Year Calendar Year $6,000 per Family per Year $12,000 per Family per Year Physician Services Office $15/$30 Copay $35 Copay (Deductible Waived) 40% (After Deductible) Preventive Care 100% 100% 40% (After Deductible) Well Baby Care (0-2 yr.) 100% 100% 40% (After Deductible) Hospital Services $300 Copay per Admit 20% (After Deductible) 40% (After Deductible) Lab and X-ray Inpatient $15 Copay 100% 40% (After Deductible) Outpatient $15 Copay $35 Copay (Deductible Waived) 40% (After Deductible) ER Visit $75 Copay $150 Copay (Deductible Waived) $150 Copay (Deductible Waived) (Waived if Admitted) Prescription Drug Applicable Copay Plus 30% Generic $25 Copay $25 Copay Brand Name $50 Copay $50 Copay Non-Formulary $75 Copay $75 Copay Substance Abuse/Chemical Dependency Inpatient $300 Copay per Admit 20% (After Deductible) 40% (After Deductible) Unlimited Days Outpatient $15 Group / $30 Individual $35 Copay (Deductible Waived) 40% (After Deductible) Unlimited Visits Mental Illness Facility-based Care-Inpatient $300 Copay per Admit 20% (After Deductible) 40% (After Deductible) Unlimited Days Outpatient Consultation $15 Group / $30 Individual $35 Copay (Deductible Waived) 40% (After Deductible) Unlimited Visits Disclaimer Benefits shown are applicable only to eligible (covered) charges. This summary is for comparison purposes only. All benefits are subject to policy terms and conditions. These are partial descriptions of Plan benefits and limits to benefits. Refer to the Schedule of Benefits and Evidence of Coverage for more specific information.

3 Health Plan of Nevada, Inc. HMO C15 Medical Plan (HCR) Lifetime Maximum Covered Services Medical Services Primary Care Physician Visit Specialist Visit Preventive Health Services Hospital Services - Elective Procedures Inpatient Outpatient Physician Surgical Services Inpatient Hospital Outpatient Facility Physician s Office (in addition to office visit copayment) Primary Care Physician Specialist Anesthesia Unlimited Member Pays $30 per visit No charge $300 per admission $50 per admission $50 per surgery $25 per surgery $30 per visit $100 per surgery Urgent Care Facility Within the Service Area Outside the Service Area $20 per visit $40 per visit Emergency Services Emergency Room Visit Hospital Admission Ground Ambulance $75 per visit; waived if admitted $300 per admission $50 per trip Diagnostic Services Routine Laboratory Routine X-ray This is a summary of Covered Services. Please refer to the HPN Evidence of Coverage, Disclosure Summary, Attachment A Benefit Schedule Form No. HPNmasBS2011-HCR, Endorsement Form No. HPN-GRP-HCR-ENDORSE(2011), and any other applicable Riders for additional information, limitations and exclusions of coverage. Copies of these documents are available upon request. Plan documents govern in resolving any benefit questions or payments. (11/11-PDf) 21NVHPN11972 PD-4584

4 Health Plan of Nevada, Inc. Plan Médico HMO C15 (HCR) Máximo de Por Vide Servicios cubiertos Servicios Médicos Visita al Médico de Atención Primaria Visita a Especialista Servicios de salud preventiva Servicios Hospitalarios - Procedimientos Electivos Con Internación Ambulatorios Servicios Quirúrgicos efectuados por Médico Hospital con Internación Centro Ambulatorio Consultorio del Médico (además del copago de la visita en consultorio) Médico de Atención Primaria Especialista Anestesia Ilimitado El Miembro paga $30 por visita Sin cargo $300 por admisión $50 por admisión $50 por cirugía $25 por cirugía $30 por visita $100 por cirugía Centro de Cuidados Urgentes Dentro del Área de Servicio Fuera del Área de Servicio $20 por visita $40 por visita Servicios de Emergencia Visita de Sala de Emergencias Admisión en Hospital Ambulancia Terrestre $75 por visita; anulado si hay internación $300 por admisión $50 por viaje Servicios de Diagnóstico Análisis de Laboratorio de Rutina Radiografías de Rutina Éste es un resumen de los Servicios Cubiertos. Si desea más información, consulte el Convenio de Cobertura HPN, el Resumen de Divulgación de Información, la Lista de Beneficios en el Anexo A formulario núm. HPNmasBS2011-HCR, El formulario núm HPN-GRP-HCR-ENDORSE(2011), y todas las cláusulas adicionales pertinentes, así como las limitaciones y exclusiones. Se pueden solicitar copias de estos documentos. Los documentos del plan regirán en la resolución de preguntas sobre beneficios o pagos.

5 Sierra Health and Life Insurance Company, Inc. Sierra 2010 Plan /60-X (HCR) Plan Provider Benefits After CYD, Insured pays 20% of EME Non-Plan Provider Benefits Lifetime Maximum Unlimited Unlimited Calendar Year Deductible (CYD) $500 of EME* per Insured $1,000 of EME per Insured separate Plan and Non-Plan Provider $1,000 of EME per Family $2,000 of EME per Family Calendar Year Coinsurance Maximum (after CYD) $3,000 of EME per Insured $6,000 of EME per Insured separate Plan and Non-Plan Provider $6,000 of EME per Family $12,000 of EME per Family Covered Services Insured Pays Insured Pays Physician Services After CYD, Insured pays Non-Specialist Office Visit 40% of EME plus all Specialist Office Visit charges in excess of EME Preventive Health Services Hospital Services Inpatient Outpatient Physician Surgical Services Inpatient Facility Outpatient Facility Physician's Office Anesthesia No charge After CYD, Insured pays 20% of EME Urgent Care Facility $50 per visit Emergency Services Emergency Room Facility Emergency Room Physician Ground Ambulance (Insured is responsible for all amounts exceeding any applicable maximum benefit and amounts exceeding the Plan's EME payment to Non-Plan Providers. Such amounts do not accumulate to the Calendar Year Coinsurance Maximum.) $150 per visit After CYD, Insured pays 20% of EME After CYD, Insured pays 20% of EME $150 per visit After CYD, Insured pays 20% of EME plus all charges in excess of EME After CYD, Insured pays 40% of EME plus all charges in excess of EME Diagnostic Services Routine Laboratory Routine X-ray After CYD, Insured pays 40% of EME plus all charges in excess of EME *EME (Eligible Medical Expenses) means the maximum amount the Plan will pay for a Covered Service in accordance with the Plan Reimbursement Schedule. The Plan Provider and Non-Plan Provider Calendar Year Coinsurance Maximums are separate and do not accumulate to one another. Non-Plan Provider charges in excess of EME may be substantial and do not accrue toward the Calendar Year Coinsurance maximum. This plan includes additional benefits, exclusions and limitations which are shown in the SHL Certificate of Coverage, Attachment A Benefit Schedule Form No. SHL-Sierra2010-masBS-July2011-HCR, Endorsement Form No. SHL-GRP-HCR- ENDORSE(2011), and any other applicable Riders and the Disclosure Summary. Copies of these documents are available upon request. Plan documents govern in resolving any benefit questions or payments. 41NVSHL10573 PD-4000 (09/10)

6 Sierra Health and Life Insurance Company, Inc. Sierra 2010 Plan /60-X (HCR) Beneficios para Proveedor Beneficios para Proveedor Perteneciente al Plan no Perteneciente al Plan Máximo de Por Vide Ilimitado Ilimitado Deducible por Año Calendario (CYD) $500 del EME* por Asegurado $1,000 del EME por Asegurado proveedores y no proveedores del Plan separados $1,000 del EME por Familia $2,000 del EME por Familia Coaseguro Máximo por Año Calendario (incluye el CYD) $3,000 del EME por Asegurado $6,000 del EME por Asegurado proveedores y no proveedores del Plan separados $6,000 del EME por Familia $12,000 del EME por Familia Servicios cubiertos El asegurado paga El asegurado paga Servicios del Médico Consulta en consultorio de médico no especialista Consulta en consultorio de médico especialista Servicios de salud preventiva Servicios de Hospital Paciente internado Paciente externo Servicios Médicos Quirúrgicos Instalación para pacientes internados Instalación para pacientes externos Consultorio medico Anestesia Sin cargo Después del CYD, el asegurado Después del CYD el asegurado paga el 40% del EME más todos los cargos que excedan el EME Centro de Atención Urgente $50 por consulta Servicios de Emergencia Sala de emergencias Médico de sala de emergencias Ambulancia terrestre (El asegurado es responsable de todas las cantidades que exceden la cantidad de beneficio máximo aplicable y las cantidades que exceden el pago del EME del plan a proveedores que no son del plan. Dichas cantidades no se aplican como parte del coaseguro máximo por año calendario.) Servicios de Diagnóstico Exámenes de laboratorio de rutina Radiografías de rutina $150 por consulta $150 por consulta mas todos los cargos que excedan el EME paga el 40% del EME mas todos los cargos que excedan el EME Después del CYD el asegurado paga el 40% del EME más todos los cargos que excedan el EME *EME (Gasto Médico Elegible) significa el monto máximo que el Plan pagará por un Servicio Cubierto de acuerdo con la Lista de Reembolsos del Plan. Los máximos del seguro compartido por año calendario para proveedores que pertenecen al Plan y que no pertenecen al Plan son separados y no son acumulables entre sí. Los cargos que exceden el EME de proveedores que no pertenecen al Plan pueden ser considerables y no cuentan hacia el máximo del seguro compartido por año calendario. Este Plan incluye beneficios adicionales, exclusiones y limitaciones que se indican en el Certificado de Cobertura de SHL, en la Lista de Beneficios del Anexo A Formulario No. SHL-Sierra2010-masBS-July2011- HCR, Formulario No. SHL-GRP-HCR-ENDORSE(2011), y en las Cláusulas Adicionales correspondientes y en el Resumen de Divulgación. Se pueden solicitar copias de estos documentos. Los documentos del plan regirán en la resolución de preguntas sobre beneficios o pagos.

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