2025

EMPLOYEE BENEFITS GUIDE

We are committed to offering our employees a comprehensive benefits package at a competitive cost. As part of this commitment, we provide you with access to a variety of tools and resources including this Benefits Guide to help you make informed benefits decisions.

Benefit Plan Year: February 1st, 2025 – January 31st, 2026

The information in this Enrollment Guide is presented for illustrative purposes only and is based on information provided by your employer and various insurance carriers and should not be used for legal or other professional advice or service. The text contained in this Guide was taken from various summary plan descriptions and benefit information. Please refer to your summary plan description for additional information concerning services. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the Guide and the actual plan documents the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about your Guide, contact your HR representative.

Employee Benefits Service Guide

Locate a Medical, Dental, & Vision Provider

Health Insurance
• Blue Cross Blude Shield of Michigan- Find a Doctor
• Low Plan:BCN Network High: PPO Network
• BCBS of MI Customer Service- 313-225-9000
Dental & Vision Insurance
• MetLife – Log in to your account
• Dental – Find a Dentist
• Vision- Find a Vision Provider
• MetLife Customer Service- 1-888-245-2920

Voluntary Benefits
• Colonial Life- www.coloniallife.com
• Short Term Disability
• Accident
• Critical Illness with Cancer Benefit
• Life Insurance
• Hospital Confinement Insurance
• Enrollment or Benefit Questions: 1-866-321-3545

Allegra Nursing
Simply BlueSM PPO Plan $500/20% LG Effective Date: On or after February, 2025 Benefits-at-a-glance
This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional limitations and exclusions may apply. Payment amounts are based on BCBSM’s approved amount, less any applicable deductible and/or copay/coinsurance. For a complete description of benefits please see the applicable BCBSM certificates and riders, if your group is underwritten or any other plan documents your group uses, if your group is self-funded. If there is a discrepancy between this Benefits-at-a-Glance and any applicable plan document, the plan document will control.

Preauthorization for Select Services – Services listed in this BAAG are covered when provided in accordance with Certificate requirements and, when required, are preauthorized or approved by BCBSM except in an emergency.

Note: A list of services that require approval before they are provided is available online at bcbsm.com/importantinfo. Select Approving covered services.

Pricing information for various procedures by in-network providers can be obtained by calling the customer service number listed on the back of your BCBSM ID card and providing the procedure code. Your provider can also provide this information upon request.

Preauthorization for Specialty Pharmaceuticals – BCBSM will pay for FDA-approved specialty pharmaceuticals that meet BCBSM’s medical policy criteria for treatment of the condition. The prescribing physician must contact BCBSM to request preauthorization of the drugs. If preauthorization is not sought, BCBSM will deny the claim and all charges will be the member’s responsibility.

Specialty pharmaceuticals are biotech drugs including high cost infused, injectable, oral and other drugs related to specialty disease categories or other categories. BCBSM determines which specific drugs are payable. This may include medications to treat asthma, rheumatoid arthritis, multiple sclerosis, and many other diseases as well as chemotherapy drugs used in the treatment of cancer, but excludes injectable insulin.

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. Services from a provider for which there is no Michigan PPO network and services from an out-of-network provider in a geographic area of Michigan deemed a “low access area” by BCBSM for that particular provider specialty are covered at the in-network benefit level. If you receive care from a nonparticipating provider, even when referred, you may be billed for the difference between our approved amount and the provider’s charge

Note: If an in-network provider refers you to an out-of-network provider, all covered services obtained from that out-of-network provider will be subject to applicable out-of-network cost-sharing.
Benefits In-network Out-of-network
Deductibles $500 for one member,
$1,000 for the family (when two or more members are covered under your contract) each calendar year $1,000 for one member,
$2,000 for the family (when two or more members are covered under your contract) each calendar year
Note: Out-of-network deductible amounts also count toward the in- network deductible.
Flat-dollar copays • $40 copay for office visits and office consultations with a non-specialist provider
• $40 copay for medical online visits
• $60 copay for office visits and office consultations with a specialist provider
• $40 copay for chiropractic and osteopathic manipulative therapy
• $250 copay for emergency room visits
• $60 copay for each urgent care visit $250 copay for emergency room visits
Coinsurance amounts (percent copays)

Note: Coinsurance amounts apply once the deductible has been met. • 70% of approved amount for private duty nursing care
• 20% of approved amount for most other covered services • 70% of approved amount for private duty nursing care
• 40% of approved amount for most other covered services
Annual coinsurance maximums – applies to coinsurance amounts for all covered services – but does not apply to deductibles, flat-dollar copays, private duty nursing care coinsurance amounts and prescription drug cost-sharing amounts $2,500 for one member,
$5,000 for the family (when two or more members are covered under your contract) each calendar year $5,000 for one member,
$10,000 for the family (when two or more members are covered under your contract) each calendar year
Note: Out-of-network coinsurance amounts also count toward the in- network coinsurance maximum.
Annual out-of-pocket maximums – applies to deductibles, flat-dollar copays and coinsurance amounts for all covered services – including cost-sharing amounts for prescription drugs, if applicable $8,150 for one member,
$16,300 for the family (when two or more members are covered under your contract) each calendar year $16,300 for one member,
$32,600 for the family (when two or more members are covered under your contract) each calendar year
Note: Out-of-network cost-sharing amounts also count toward the in- network out-of-pocket maximum
Lifetime dollar maximum None

Preventive care services
Benefits In-network Out-of-network
Health maintenance exam -includes chest x-ray, EKG, cholesterol screening and other select lab procedures 100% (no deductible or copay/coinsurance), one per member per calendar year

Note: Additional well-women visits may be allowed based on medical necessity. Not covered

Benefits In-network Out-of-network
Gynecological exam 100% (no deductible or copay/coinsurance), one per member per calendar year

Note: Additional well-women visits may be allowed based on medical necessity. Not Covered
Pap smear screening -laboratory and pathology services 100% (no deductible or copay/coinsurance), one per member per calendar year Not covered
Voluntary sterilizations for females 100% (no deductible or copay/coinsurance) 60% after out-of-network deductible
Prescription contraceptive devices- includes insertion and removal of an intrauterine device by a licensed physician 100% (no deductible or copay/coinsurance) 100% after out-of-network deductible
Contraceptive injections 100% (no deductible or copay/coinsurance) 60% after out-of-network deductible
Well-baby and child care visits 100% (no deductible or copay/coinsurance)
• 8 visits, birth through 12 months
• 6 visits, 13 months through 23 months
• 6 visits, 24 months through 35 months
• 2 visits, 36 months through 47 months
• Visits beyond 47 months are limited to one per member per calendar year under the health maintenance exam benefit Not covered
Adult and childhood preventive services and immunizations as recommended by the USPSTF, ACIP, HRSA or other sources as recognized by BCBSM that are in compliance with the provisions of the Patient Protection and Affordable Care Act 100% (no deductible or copay/coinsurance) Not covered
Fecal occult blood screening 100% (no deductible or copay/coinsurance), one per member per calendar year Not covered
Flexible sigmoidoscopy exam 100% (no deductible or copay/coinsurance), one per member per calendar year Not covered
Prostate specific antigen (PSA) screening 100% (no deductible or copay/coinsurance), one per member per calendar year Not Covered
Routine mammogram and related reading 100% (no deductible or copay/coinsurance)

Note: Subsequent medically necessary mammograms performed during the same calendar year are subject to your deductible and coinsurance 60% after out-of-network deductible

Note: Out-of-network readings and interpretations are payable only when the screening mammogram itself is performed by an in-network provider.
One per member per calendar year
Colonoscopy-routine or medically necessary

One per member per calendar year

Physician office services
Benefits In-network Out-of-network
Office visits-must be medically necessary • $40 copay per office visit with a non- specialist provider
• $60 copay per office visit with a specialist provider
Note: Simply Blue applies deductible and coinsurance to office services. Services include diagnostic (including complex), therapeutic and surgery. An office visit copay still applies to the exam. Cost- sharing may not apply if preventive or immunization services are performed during the office visit. 60% after out-of-network deductible
Outpatient and home medical care visits-must be medically necessary 80% after in-network deductible 60% after out-of-network deductible
Office consultations-must be medically necessary • $40 copay for each office consultation with a non-specialist provider
• $60 copay for each office consultation with a specialist provider
Note: Simply Blue applies deductible and coinsurance to office services. Services include diagnostic (including complex), therapeutic and surgery. An office consultation copay still applies to the exam. Cost-sharing may not apply if preventive or immunization services are performed during the office consultation. 60% after out-of-network deductible
Online visits – must be medically necessary

Note: Online visits by a non-BCBSM selected vendor are not covered. $40 copay for online visits 60% after out-of-network deductible

Urgent care visits
Benefits In-network Out-of-network
Urgent care visits $60 copay for each urgent care visit
Note: Simply Blue applies deductible and coinsurance to office services. Services include diagnostic (including complex), therapeutic and surgery. An office visit copay still applies to the exam. Cost-sharing may not apply if preventive or immunization services are performed during the office visit. 60% after out-of-network deductible

Emergency medical care
Benefits In-network Out-of-network
Hospital emergency room $250 copay per visit (copay waived if admitted) $250 copay per visit (copay waived if admitted)
Ambulance services-must be medically necessary 80% after in-network deductible 80% after in-network deductible

Diagnostic services
Benefits In-network Out-of-network
Laboratory and pathology services 80% after in-network deductible 60% after out-of-network deductible
Diagnostic tests and x-rays 80% after in-network deductible 60% after out-of-network deductible
Therapeutic radiology 80% after in-network deductible 60% after out-of-network deductible

Maternity services provided by a physician or certified nurse midwife
Benefits In-network Out-of-network
Routine Prenatal and Postnatal Care visits 100% (no deductible or copay/coinsurance) 60% after out-of-network deductible
Delivery and nursery care 80% after in-network deductible 60% after out-of-network deductible

Semiprivate room, inpatient physician care, general nursing care, hospital services and supplies

Note: Nonemergency services must be rendered in a participating

Unlimited days

hospital.
Inpatient consultations 80% after in-network deductible 60% after out-of-network deductible
Chemotherapy 80% after in-network deductible 60% after out-of-network deductible

Alternatives to hospital care
Benefits In-network Out-of-network
Skilled nursing care-must be in a participating skilled nursing facility 80% after in-network deductible 80% after in-network deductible
Limited to a maximum of 120 days per member per calendar year
Hospice care

Up to 28 pre-hospice counseling visits before electing hospice services; when elected, four 90-day periods – provided through a participating hospice program only; limited to dollar maximum that is reviewed and adjusted periodically (after reaching dollar maximum, member transitions into individual case management)
Home health care:
 must be medically necessary
 must be provided by a participating home health care agency 80% after in-network deductible 80% after in-network deductible
Infusion therapy:
 must be medically necessary
 must be given by a participating Home Infusion Therapy (HIT) provider or in a participating freestanding Ambulatory Infusion Center (AIC)
 may use drugs that require preauthorization- consult with your doctor 80% after in-network deductible 80% after in-network deductible

Surgical services
Benefits In-network Out-of-network
Surgery- includes related surgical services and medically necessary facility services by a participating ambulatory surgery facility 80% after in-network deductible 60% after out-of-network deductible
Presurgical consultations 100% (no deductible or copay/coinsurance) 60% after out-of-network deductible
Voluntary sterilization for males

Note: For voluntary sterilizations for females, see “Preventive care services.” 80% after in-network deductible 60% after out-of-network deductible
Elective abortions 80% after in-network deductible 60% after out-of-network deductible

Human organ transplants
Benefits In-network Out-of-network
Specified human organ transplants-must be in a designated facility and coordinated through the BCBSM Human Organ Transplant Program (1-800-242-3504) 100% (no deductible or copay/coinsurance) 100% (no deductible or copay/coinsurance) – in designated facilities only
Bone marrow transplants -must be coordinated through the BCBSM Human Organ Transplant Program (1-800-242-3504) 80% after in-network deductible 60% after out-of-network deductible
Specified oncology clinical trials

Note: BCBSM covers clinical trials in compliance with PPACA. 80% after in-network deductible 60% after out-of-network deductible
Kidney, cornea and skin transplants 80% after in-network deductible 60% after out-of-network deductible

Note: Some mental health and substance use disorder services are considered by BSBCM to be comparable to an office visit or medical online visit. When a mental health or substance use disorder service is considered by BSBSM to be comparable to an office visit or medical online visit, we will process the claim under your office visit or medical online visit benefit.

Inpatient mental health care and inpatient substance use disorder
treatment Unlimited days
Residential psychiatric treatment facility
 covered mental health services must be performed in a residential psychiatric treatment facility
 treatment must be preauthorized
 subject to medical criteria 80% after in-network deductible 60% after out-of-network deductible
Outpatient mental health care:
 Facility and clinic
Note: Online visits by a non-BCBSM selected vendor are not covered.
80% after in-network deductible
80% after in-network deductible in participating facilities only
 Physician’s office 80% after in-network deductible 60% after out-of-network deductible
Outpatient substance use disorder treatment- in approved facilities
only 80% after in-network deductible 60% after out-of-network deductible (in-network cost-sharing will apply if there is no PPO network)

Autism spectrum disorders, diagnoses and treatment
Benefits In-network Out-of-network
Applied behavioral analysis (ABA) treatment-when rendered by an approved board-certified behavioral analyst, subject to preauthorization

Note: Diagnosis of an autism spectrum disorder and a treatment recommendation for ABA services must be obtained by a BCBSM approved autism evaluation center (AAEC) prior to seeking ABA treatment. 80% after in-network deductible 80% after in-network deductible
Outpatient physical therapy, speech therapy, occupational therapy, 80% after in-network deductible 60% after out-of-network deductible
nutritional counseling for autism spectrum disorder Physical, speech and occupational therapy with an autism diagnosis is
unlimited
Other covered services, including mental health services, for autism spectrum disorder 80% after in-network deductible 60% after out-of-network deductible

Other covered services
Benefits In-network Out-of-network
Outpatient Diabetes Management Program (ODMP)

Note: Screening services required under the provisions of PPACA are covered at 100% of approved amount with no in-network cost-sharing when rendered by an in-network provider.

Note: When you purchase your diabetic supplies via mail order you will lower your out-of-pocket costs. • 80% after in-network deductible for diabetes medical supplies
• 100% (no deductible or copay/coinsurance) for diabetes self- management training 60% after out-of-network deductible
Allergy testing and therapy 80% after in-network deductible 60% after out-of-network deductible
Chiropractic spinal manipulation and osteopathic manipulative therapy $40 copay per visit
Note: Simply Blue applies deductible and coinsurance to office services. Services include diagnostic (including complex), therapeutic and surgery. An office visit copay still applies to the exam. 60% after out-of-network deductible
Limited to a combined 12-visit maximum per member per calendar year
Outpatient physical, speech and occupational therapy-provided for rehabilitation

Limited to a combined 30-visit maximum per member per calendar year
Durable medical equipment

Note: DME items required under the provisions of PPACA are covered at 100% of approved amount with no in-network cost-sharing when rendered by an in-network provider. For a list of covered DME items required under PPACA, call BCBSM.
Note: Reference the Find A Doctor tool at bcbsm.com for in-network Durable Medical Equipment providers. 80% after in-network deductible 60% after out-of-network deductible
Prosthetic and orthotic appliances
Note: Reference the Find A Doctor tool at bcbsm.com for in-network Prosthetics/Orthotics providers. 80% after in-network deductible 60% after out-of-network deductible
Private duty nursing care 50% after in-network deductible 50% after in-network deductible

Blue Preferred® Rx LG Prescription Drug Coverage
PD-SP-CM $20/$60/50%-$80-$100/20%-$200/25%-$300-RXCM
Benefits-at-a-glance
Effective Date: On or after February, 2023

This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional limitations and exclusions may apply. Payment amounts are based on BCBSM’s approved amount, less any applicable deductible and/or copay/coinsurance. For a complete description of benefits please see the applicable BCBSM certificates and riders, if your group is underwritten or any other plan documents your group uses, if your group is self-funded. If there is a discrepancy between this Benefits-at-a-Glance and any applicable plan document, the plan document will control.

Prescription Drug Discount Program – Prescription drug manufacturers provide coupon programs for certain medications. Your benefit plan requires you to take advantage of BCBSM-approved coupon programs for select medications. This benefit may lower the cost-sharing typically required for these drugs. Your out-of-pocket expense will be no more than your benefit cost-sharing. When a manufacturer coupon is used, only the amount you paid for the prescription will apply towards your annual out-of-pocket maximum.
NOTE: Adjustments may be required to accurately reflect your annual out -of – pocket maximum to reflect your true out -of – pocket cost. This program may be discontinued at any time if it is no longer supported by the vendor.
Specialty Pharmaceutical Drugs – The mail order pharmacy for specialty drugs is AllianceRx Walgreens Pharmacy, an independent company. Specialty prescription drugs (such as Enbrel® and Humira® ) are used to treat complex conditions such as rheumatoid arthritis, multiple sclerosis and cancer. These drugs require special handling, administration or monitoring. AllianceRx Walgreens Pharmacy will handle mail order prescriptions only for specialty drugs. You may obtain specialty drugs through a Walgreens retail pharmacy as well as long as the drug is available at that location. You may want to call ahead to confirm availability at the location. If you go to a non-AllianceRx Walgreens Pharmacy, you may be responsible for 100% of the cost of the specialty drug. Other mail order prescriptions for non-specialty medications can continue to be sent to OptumRx home delivery pharmacy. (OptumRx is an independent company providing pharmacy benefit services for Blues members.) A list of specialty drugs is available on our Web site at bcbsm.com/pharmacy. If you have any questions, please call AllianceRx Walgreens Pharmacy customer service at 1- 866-515-1355.

We will not pay for more than a 30-day supply of a covered prescription drug that BCBSM defines as a “specialty pharmaceutical” whether or not the drug is obtained from a 90-Day Retail Network provider or mail-order provider. We may make exceptions if a member requires more than a 30-day supply. BCBSM reserves the right to limit the quantity of select specialty drugs to no more than a 15-day supply for each fill. Your copay/coinsurance will be reduced by one-half for each fill once applicable deductibles have been met.

Select Controlled Substance Drugs – BCBSM will limit the initial fill of select controlled substances to a 5-day supply. Additional fills for these medications will be limited to no more than a 30-day supply. The controlled substances affected by this prescription drug requirement are available online at bcbsm.com/pharmacy.

Note: Your prescription drug copays and coinsurance amounts, including mail order copay and coinsurance amounts, are subject to the same annual out-of-pocket maximum required under your medical coverage. The following prescription drug expenses will not apply to your annual out-of-pocket maximum.
 any difference between the Maximum Allowable Cost and BCBSM’s approved amount for a covered brand name drug
 the 25% member liability for covered drugs obtained from an out-of-network pharmacy

Benefits 90-day retail network pharmacy * In-network mail order provider In-network pharmacy (not part of the 90-day retail network) Out-of-network pharmacy

Benefits 90-day retail network pharmacy * In-network mail order provider In-network pharmacy (not part of the 90-day retail network) Out-of-network pharmacy
Generic or select prescribed over-the- counter drugs 1 to 30-day period You pay $20 copay You pay $20 copay You pay $20 copay You pay $20 copay plus an additional 25% of BCBSM approved amount for the drug
31 to 83-day period No coverage You pay $40 copay No coverage No coverage
84 to 90-day period You pay $40 copay You pay $40 copay No coverage No coverage
Preferred brand-name drugs 1 to 30-day period You pay $60 copay You pay $60 copay You pay $60 copay You pay $60 copay plus an additional 25% of BCBSM approved amount for the drug
31 to 83-day period No coverage You pay $120 copay No coverage No coverage
84 to 90-day period You pay $120 copay You pay $120 copay No coverage No coverage
Nonpreferred brand-name drugs 1 to 30-day period You pay $80 or 50% of the approved amount (whichever is greater), but no more than $100 You pay $80 or 50% of the approved amount (whichever is greater), but no more than
$100 You pay $80 or 50% of the approved amount (whichever is greater), but no more than
$100 You pay $80 or 50% of the approved amount (whichever is greater), but no more than
$100 plus an additional 25% of BCBSM approved amount for the drug
31 to 83-day period No coverage You pay $160 or 50% of the approved amount (whichever is greater), but no more than
$200 No coverage No coverage
84 to 90-day period You pay $160 or 50% of the approved amount (whichever is greater), but no more than $200 You pay $160 or 50% of the approved amount (whichever is greater), but no more than
$200 No coverage No coverage
Generic and 1 to 30-day preferred period brand-name
specialty drugs You pay 20% of approved amount, but no more than
$200 You pay 20% of approved amount, but no more than
$200 You pay 20% of approved amount, but no more than
$200 You pay 20% of approved amount, but no more than
$200 plus an additional 25% of BCBSM approved amount for the drug
31 to 83-day period No coverage No coverage No coverage No coverage
84 to 90-day period No coverage No coverage No coverage No coverage
Nonpreferred 1 to 30-day brand-name period specialty drugs You pay 25% of approved amount, but no more than
$300 You pay 25% of approved amount, but no more than
$300 You pay 25% of approved amount, but no more than
$300 You pay 25% of approved amount, but no more than
$300 plus an additional 25% of BCBSM approved amount for the drug
31 to 83-day period No coverage No coverage No coverage No coverage
84 to 90-day period No coverage No coverage No coverage No coverage

Note: Over-the-counter (OTC) drugs are drugs that do not require a prescription under federal law. They are identified by BCBSM as select prescription drugs. A prescription for the select OTC drug is required from the member’s physician. In some cases, over-the-counter drugs may need to be tried before BCBSM will approve use of other drugs * BCBSM will not pay for drugs obtained from out-of-network mail order providers, including Internet providers.

Benefits 90-day retail network pharmacy * In-network mail order provider In-network pharmacy (not part of the 90-day retail network) Out-of-network pharmacy
FDA-approved drugs 100% of approved amount less plan copay/coinsurance 100% of approved amount less plan copay/coinsurance 100% of approved amount less plan copay/coinsurance 75% of approved amount less plan copay/coinsurance
Prescribed over-the- counter drugs – when covered by BCBSM 100% of approved amount less plan copay/coinsurance 100% of approved amount less plan copay/coinsurance 100% of approved amount less plan copay/coinsurance 75% of approved amount less plan copay/coinsurance
State-controlled drugs 100% of approved amount less plan copay/coinsurance 100% of approved amount less plan copay/coinsurance 100% of approved amount less plan copay/coinsurance 75% of approved amount less plan copay/coinsurance
FDA-approved generic and select brand-name prescription preventive drugs, supplements and vitamins as required by PPACA (non-self- administered drugs are not covered) 100% of approved amount 100% of approved amount 100% of approved amount 75% of approved amount
Other FDA-approved brand-name prescription preventive drugs, supplements and vitamins as required by PPACA (non-self-administered drugs are not covered) 100% of approved amount less plan copay/coinsurance 100% of approved amount less plan copay/coinsurance 100% of approved amount less plan copay/coinsurance 75% of approved amount less plan copay/coinsurance
FDA-approved generic and select brand name prescription contraceptive medication (non-self- administered drugs are not covered) 100% of approved amount 100% of approved amount 100% of approved amount 75% of approved amount
Other FDA-approved brand name prescription contraceptive medication (non-self-administered drugs are not covered) 100% of approved amount less plan copay/ coinsurance 100% of approved amount less plan copay/ coinsurance 100% of approved amount less plan copay/ coinsurance 75% of approved amount less plan copay/ coinsurance
Disposable needles and syringes – when dispensed with insulin or other covered injectable legend drugs

Note: Needles and syringes have no copay/ coinsurance. 100% of approved amount less plan copay/coinsurance for the insulin or other covered injectable legend drug 100% of approved amount less plan copay/coinsurance for the insulin or other covered injectable legend drug 100% of approved amount less plan copay/coinsurance for the insulin or other covered injectable legend drug 75% of approved amount less plan copay/coinsurance for the insulin or other covered injectable legend drug
Select diabetic supplies and devices (test strips, lancets and glucometers)

For a list of diabetic supplies available under the pharmacy benefit refer to your BCBSM drug list at BCBSM.com/pharmacy 100% of approved amount less plan copay/ coinsurance 100% of approved amount less plan copay/ coinsurance 100% of approved amount less plan copay/ coinsurance 75% of approved amount less plan copay/ coinsurance

• BCBSM will not pay for drugs obtained from out-of-network mail order providers, including Internet providers.

Features of your prescription drug plan
Custom Drug List A continually updated list of FDA-approved medications that represent each therapeutic class. The drugs on the list are chosen by the BCBSM Pharmacy and Therapeutics Committee for their effectiveness, safety, uniqueness and cost efficiency. The goal of the drug list is to provide members with the greatest therapeutic value at the lowest possible cost.
• Generic drug tier – This tier includes generic drugs made with the same active ingredients, available in the same strengths and dosage forms, and administered in the same way as equivalent brand-name drugs. They also require the lowest copay/coinsurance, making them the most cost-effective option for the treatment. Select brand-name drugs may be included in the generic tier.
• Preferred brand-name drug tier – This tier includes non-specialty preferred brand-name drugs. These drugs are more expensive then generic and members pay more for them.
• Nonpreferred brand-name drug tier – This tier includes non-specialty brand-name drugs for which there’s either a generic alternative or a more cost-effective preferred brand-name drug available. Members pay more for these nonpreferred brand-name drugs.
• Generic and preferred specialty drug tier – This tier includes generic and preferred brand-name specialty drugs that are used to treat difficult health conditions. These drugs are generally more cost-effective than nonpreffered specialty drugs.
• Nonpreferred specialty drug tier – This tier includes nonpreferred brand-name, specialty drugs that are used to treat difficult health conditions. Members pay more for nonpreferred specialty drugs because there are cost- effective generic or preferred drugs available.
Prior authorization/step therapy A process that requires a physician to obtain approval from BCBSM before select prescription drugs (drugs identified by BCBSM as requiring preauthorization) will be covered. Step Therapy, an initial step in the “Prior Authorization” process, applies criteria to select drugs to determine if a less costly prescription drug may be used for the same drug therapy. Some over-the-counter medications may be covered under step therapy guidelines. This also applies to mail order drugs. Claims that do not meet Step Therapy criteria require preauthorization.
Details about which drugs require preauthorization or step therapy are available online site at
bcbsm.com/pharmacy.
Mandatory maximum allowable cost drugs If your prescription is filled by any type of network pharmacy, and the pharmacist fills it with a brand-name drug for which a generic equivalent is available, you MUST pay the difference in cost between the BCBSM approved amount for the brand-name drug dispensed and the maximum allowable cost for the generic drug plus your applicable copay regardless of whether you or your physician requests the brand name drug. Exception: If your physician requests and receives authorization for a nonformulary brand-name drug with a generic equivalent from BCBSM and writes “Dispense as Written” or “DAW” on the prescription order, You pay only your applicable copay. Note: This MAC difference will not be applied toward your annual in-network deductible, nor your annual coinsurance/copay maximum.
Quantity limits To stay consistent with FDA approved labeling for drugs, some medications may have quantity limits.

Blue Care Network Low Plan Requirement:
Participants are required to choose a Primary Care Physician (PCP):
• Blue Care Network (BCN) is an HMO that requires you to select a PCP.
• You don’t need to choose your PCP during open enrollment, but you must call BCN Customer Service at 1-800-662-6667 to select a PCP before your first visit.

How to Find a Doctor Online:

1. Visit BCBSM.com
2. Select “Search without logging in”
3. Choose “All plans”
4. Enter the city
5. Add the doctor’s name
6. Click “Search”
7. Note the doctor’s ID number
   Customer Service 1-800-662-6667
   8 a.m. to 8 p.m. Monday through Friday

Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 02/01/2025 • 01/31/2026 Blue Care

• of Michigan Allegra Nursing
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of the Blue Cross and Blue Shield Assoc,at,on /0

Low Plan

Coverage for: Family I Plan Type: HMO

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately.
This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, call (800) 662-6667 or visit www.bcbsm.com. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary/ or call (800) 662-6667 to request a copy.

What is the overall deductible?

Are there services covered before you meet your deductible?
Are there other deductibles for specific services?

$4000/$8000

Yes. Preventive care and routine maternity care

No.

Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.
This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your deductible. See a list of covered g_reventive services at https://www.healthcare.qov/coveraqe/preventive-care-benefits/.

You don’t have to meet deductibles for specific services.

What is the out-of-pocket Out-of-Pocket Maximum: limit for this plan? $6350/$12700

The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.

What is not included in the out-of-Qocket limit?

Will you pay less if you use a network Qrovider?

Do you need a referral to see a specialist?

Premiums, balance billed charges and health care this plan does not cover

Yes. See www.bcbsm.com or call (800) 662-6667 for a list of network g_roviders

Yes.

Even though you pay these expenses, they don’t count toward the out-of-pocket limit.

This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services such as lab work). Check with your provider before you qet services.
This plan will pay some or all of the costs to see a specialist for covered services but only if you have a referral before you see the specialist.

1 of 6

Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information
Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most)

If you visit a health care provider’s office or clinic Primary care visit to treat an
injury or illness 50% coinsurance Not covered 50% coinsurance for medical online visits with
a BCN participating provider.
Specialist visit 50% coinsurance Not covered Requires referral. 30 combined visits for spinal
manipulations performed by a chiropractor or osteopathic physician.
Preventive care/screening/ immunization No charge; deductible does not apply.
Not covered You may have to pay for services that aren’t
preventive. Ask your provider if the services needed are preventive. Then check what your
plan will pay for.

If you have a test Diagnostic test (x-ray, blood
work)
50% coinsurance Not covered
May require Prior authorization
Imaging (CT/PET scans, MRIs) 50% coinsurance Not covered

If you need drugs to treat your illness or condition
More information about prescription drug coverage is available at www.bcbsm.com/ DRLIST Generic Tier 50% coinsurance Not covered Any overall deductible/out-of-pocket maxes apply. 84-90 day retail & 31-90 day mail order copays are 2x the 30-day copay. 50% co- insurance for sexual dysfunction drugs. No charge for Generic contraceptives and preventive Drugs covered in full. Select diabetic supplies and equipment are covered – applicable cost sharing will apply. Cost-sharing may not apply to certain preferred glucometers as defined on the drug list. See Durable Medical Equipment section for diabetic supply
cost share.
Preferred Brand Tier 50% coinsurance Not covered

Non-Preferred Brand Tier

50% coinsurance

Not covered

Preferred Specialty Tier
50% coinsurance
Not covered Limited to a 30 day supply. Specialty drugs are covered only when obtained from the BCN
Exclusive Specialty Pharmacy Network.

Non-Preferred Specialty Tier
50% coinsurance
Not covered Limited to a 30 day supply. Specialty drugs are covered only when obtained from the BCN
Exclusive Specialty Pharmacy Network.
If you have outpatient
surgery Facility fee (e.g., ambulatory
surgery center) 50% coinsurance Not covered Requires prior authorization/50% coinsurance
for weight reduction procedures, TMJ,

Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information
Network Provider
(You will pay the least) Out-of-Network Provider
(You will pay the most)
orthognathic surgery, reduction mammoplasty,
male mastectomy.
Physician/surgeon fees 50% coinsurance Not covered See “Outpatient surgery facility fee”

If you need immediate medical attention Emergency room care 50% coinsurance 50% coinsurance None
Emergency medical transportation
50% coinsurance 50% coinsurance Non-emergent transport is covered when with
prior authorization
Urgent care 50% coinsurance 50% coinsurance None

If you have a hospital stay
Facility fee (e.g., hospital room)
50% coinsurance
Not covered Requires prior authorization/50% coinsurance for weight reduction procedures, TMJ, orthognathic surgery, reduction mammoplasty,
male mastectomy.
Physician/surgeon fees 50% coinsurance Not covered See “Hospital stay facility fee”
If you need behavioral health services (mental health and
substance use disorder) Outpatient services 50% coinsurance Not covered Requires prior authorization
Inpatient services 50% coinsurance Not covered Requires prior authorization

If you are pregnant
Office visits No charge for routine
prenatal and postnatal visits. Deductible does
not apply
Not covered Non-routine visits apply your office visit cost share.
Childbirth/delivery professional
services 50% coinsurance Not covered
None
Childbirth/delivery facility
services 50% coinsurance Not covered

If you need help recovering or have other special health needs Home health care 50% coinsurance Not covered Custodial care not covered.

Rehabilitation services
50% coinsurance
Not covered Requires prior authorization/Limited to 60 visits
per calendar year for any combination of
outpatient rehabilitation therapies. Subject to meaningful improvement within 60 days.
Habilitation services 50% coinsurance Not covered Requires prior authorization. PT/OT/ST for
autism spectrum disorder has unlimited visits.
Skilled nursing care
50% coinsurance Not covered Requires prior authorization. Limited to 45
days per calendar year. Custodial care not

Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information
Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most)
covered.

Durable medical equipment

50% coinsurance

Not covered Requires prior authorization and must be
obtained from a BCN supplier. Convenience and comfort items not covered. Home use only. Diabetic supplies covered 50% coinsurance. Certain diabetic supplies are also covered through the pharmacy benefit,
applicable pharmacy cost sharing will apply.
Hospice services 50% coinsurance Not covered Inpatient care requires prior authorization.
Housekeeping and custodial care not covered.

If your child needs dental or eye care Children’s eye exam Not covered Not covered Contact benefit administrator for coverage
information.
Children’s glasses Not covered Not covered Contact benefit administrator for coverage information.
Children’s dental check-up Not covered Not covered Contact benefit administrator for coverage
information.

Excluded Services & Other Covered Services:
Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
Acupuncture
Hearing aids

Routine eye care (Adult)
Cosmetic surgery
Long term care
Routine foot care
Dental Care (Adult)
Non emergency care outside of the U.S.
Weight loss programs
Elective Abortion
Private-duty nursing

Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa, or the U.S. Department of Health and Human Services at 1-877-267-2323 x61565 or www.cciio.cms.gov. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596.
Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact: Blue Care Network, Appeals and Grievance Unit, MC C248, P.O. Box 284, Southfield, MI 48086 or fax . 1-866-522-7345.
For state of Michigan assistance contact the Department of Insurance and Financial Services, Office of General Counsel-Appeals Section, 530 W. Allegan Street, 7th Floor, P. O. Box 30220, Lansing, MI 48909-7720, michigan.gov/difs; call 1-877-999-6442 or fax: 517-284-8838
For Department of Labor assistance contact the Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.
Additionally, a consumer assistance program can help you file your appeal. Contact the Michigan Health Insurance Consumer Assistance Program (HICAP), Department of Insurance and Financial Services, P. O. Box 30220, Lansing, MI 48909-7720, michigan.gov/difs; Ofir-hicap@michigan.gov.
Does this plan provide Minimum Essential Coverage? Yes.
Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRIRCARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit.
Does this plan meet Minimum Value Standards? Yes.
If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace. (IMPORTANT: Blue Care Network of Michigan is assuming that your coverage provides for all Essential Health Benefits (EHB) categories as defined by the State of Michigan. The minimum value of your plan may be affected if your plan does not cover certain EHB categories, such as prescription drugs, or if your plan provides coverage for specific EHB categories, for example, prescription drugs, through another carrier.)
Language Access Services:
To get help reading in your language call the customer service number on the back of your ID card.
––––––––––––––––––––––To see examples of how this plan might cover costs for a sample medical situation, see the next section.––––––––––––––––––––––

About these Coverage Examples:

The plan’s overall deductible $4,000
Specialist coinsurance 50%
Hospital (facility) coinsurance 50%
Other coinsurance 50%
This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services
Diagnostic tests (ultrasounds and blood work)
Specialist visit (anesthesia)

Total Example Cost $12,700
In this example, Peg would pay:

The plan’s overall deductible $4,000
Specialist coinsurance 50%
Hospital (facility) coinsurance 50%
Other coinsurance 50%
This EXAMPLE event includes services like: Primary care physician office visits (including disease education)
Diagnostic tests (blood work)
Prescription drugs
Durable medical equipment (glucose meter)

Total Example Cost $5,600
In this example, Joe would pay:

The plan’s overall deductible $4,000
Specialist coinsurance 50%
Hospital (facility) coinsurance 50%
Other coinsurance 50%
This EXAMPLE event includes services like: Emergency room care (including medical supplies)
Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy)

In this example, Mia would pay:

ADDENDUM – LANGUAGE ACCESS SERVICES and NON-DISCRIMINATION
We speak your language
If you, or someone you’re helping, needs assistance, you have the right to get help and information in your language at no cost. To talk to an interpreter, call the Customer Service number on the back of your card, or 877-469-2583, TTY: 711 if you are not already a member.
Si usted, o alguien a quien usted está ayudando, necesita asistencia, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al número telefónico de Servicio al cliente, que aparece en la parte trasera de su tarjeta, o 877-469-2583, TTY: 711 si usted todavía no es un miembro.

benötigt, haben Sie das Recht, kostenlose Hilfe und

Kundendienstes auf der Rückseite Ihrer Karte an oder 877-469-2583, TTY: 711
Se tu o qualcuno che stai aiutando avete bisogno di

nella tua lingua gratuitamente. Per parlare con un

ng tulong, may karapatan ka na makakuha ng tulong at

Customer Service sa likod ng iyong tarheta,
o 877-469-2583, TTY: 711
miyembro.
Important disclosure

discriminate on the basis of race, color, national origin,

interpreters and information in other formats. If you need these services, call the Customer Service number on the back of your card, or 877-469-2583, TTY: 711 if you are not already a member. If you believe that Blue Cross Blue

basis of race, color, national origin, age, disability, or sex, you can file a grievance in person, by mail, fax, or email

N u quý v i mà quý v , c n tr giúp, quý v s có quy c giúp và có thêm thông tin
b ng ngôn ng c a mình mi nói chuy n v i m t thông d ch viên, xin g i s D ch v Khách hàng m t sau th c a quý v , ho c 877-469-2583, TTY: 711 n u quý v
i là m t thành viên.
Nëse ju, ose dikush që po ndihmoni, ka nevojë për asistencë, keni të drejtë të merrni ndihmë dhe informacion falas në gjuhën tuaj. Për të folur me një përkthyes, telefononi numrin e Shërbimit të Klientit në anën e pasme të kartës tuaj, ose 877-469-2583, TTY: 711 nëse nuk jeni ende një anëtar.

indicato sul retro della tua scheda o chiama il
877-469-2583, TTY: 711 se non sei ancora membro.

600 E. Lafaye
phone: 888-605-6461, TTY: 711, fax: 866-559-0578,
email: CivilRights@bcbsm.com. If you need help filing a

to help you.

Complaint Portal available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail, phone, or email at: U.S. Department of Health & Human

20201, phone: 800-368-1019, TTD: 800-537-7697, email:
. Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.html.

Preferred Care MI: Flex Facts HRA   

A Health Reimbursement Account (HRA) is an account funded by Preferred Care MI in the plan year (February 1st, 2025 – January 31st, 2026) to assist you with eligible expenses associated with all Blue Cross Blue Shield’s Low Plan with a Single: $3,200 Deductible, Employee+1 (+1 = Spouse or 1 Child) and Family $6,400 Deductible.

Employees and their dependents will receive the following:

Participating Employer Account Funding HRA Annual Contribution
Employee $1,000
Employee+1 (+1 = Spouse/Child(ren)) $2,000
Family $2,000

All benefits eligible employees who elect a Preferred Care MI Health Insurance Plan. You can use this benefit for yourself and/or any family member covered by the health plan.

Flex Facts: www.Flexfacts.com, Preferred Care MI’s HRA carrier, will issue one HRA debit card to each eligible employee when you first become eligible. The card is valid through the expiration date listed on the card if you continue to be enrolled in the Low health plan. You may use your HRA benefit for out-of-pocket expenses associated with the health plans deductible or copays.

The HRA benefit cannot be used for costs that are not covered by the health plan, such as band- aids, over-the-counter medications, eye glasses, contact lenses, dental procedures, etc.

• All healthcare deductible and copay related expenses
• Pharmacy RX: use the Flex Facts HRA card to pay for your prescriptions at point of service. If you use mail order then enter the HRA card number on the mail order form to pay for your prescriptions.
• PCP, Specialist: Deductible or copays
• Durable Medical Equipment: All DME expenses.
• Inpatient Hospital Stays: Deductible related expenses
• Outpatient Surgery: Deductible related expenses

• Submit a paper claim form: If you incur an out-of-pocket expense for medical or prescriptions then you will proceed as follows: Fill out a BCBS of MI Claim Form with a copy of your receipt to apply your expense to the deductible. Fill out a Flex Facts Claim form with a copy of your receipt to get you reimbursed for your out of pocket expenses.
• Keep your receipts. Saving your receipts is always the way to go. Flex Facts may ask you for verification of a purchase and you’ll need to show the receipt as proof. You may also need your receipts for tax purposes.
• Failure to follow the above guidelines may result in temporary deactivation of your HRA card. Once you have provided appropriate documentation to Flex Facts, your claim will be processed and your card reactivated.

You will have to create a participant account online at Flexfacts.com or you may obtain information on the available balance by calling Flex Facts at 877.943.2287

Contact Flex Facts at 877.943.2287

If an employee decides to leave Preferred Care MI, the HRA is immediately discontinued the day of termination of employment. The employee will have 30 days to submit a claim for services incurred prior to the termination of employment. If an employee elects COBRA continuation health insurance coverage, the HRA will be reinstated for the remainder of the calendar year only.

No.

Flex Facts Phone: 877.943.2287 Fax: 877.747.8564 7 Grant Avenue, Lakewood, NJ 08701

Virtual care that’s always there
When your primary care provider isn’t available, you don’t need an appointment to get convenient and affordable health care you can trust.
• For your entire family
• 24/7, anywhere in the U.S.
• At home or on the go
• U.S. board-certified doctors and nurse practitioners
Also, behavioral health care is available by appointment. Many therapists and

Membership has its benefits
Blue Cross Blue Shield of Michigan and Blue Care Network members can score big savings on a variety of health-related products and services from businesses in Michigan and across the United States.
We’ve got plenty of deals to keep you and your family healthy.
Member discounts with Blue365 offers exclusive deals on things like:
• Fitness and wellness: Health magazines, fitness gear and gym memberships
• Healthy eating: Cookbooks, cooking classes and weight-loss programs
• Lifestyle: Travel and recreation
• Personal care: Lasik and eye care services, dental care and hearing aids
Cash in on discounts
Start saving today! Show your Blue Cross or Blue Care Network ID card at participating local retailers or use an offer code online to take advantage of these savings. For a full list of discount offers, log in or register at
bcbsm.com and click Member Discounts with Blue365®on your home page. You can also conveniently access discounts on the go with the Blue Cross mobile app. Search BCBSM in Google Play™ or the App Store®to download our mobile app.

Blue Cross Blue Shield
Blue Care Network
of Michigan

Blue365
Because health is a big deal'”

Member discounts with Blue365
Take advantage of discounts from the businesses listed below and many more.

BetterHfuilth D-l.ll-h.a…n..s..

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Reebok

Tru)Hearing
Bringing You the Sound$ of Life

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You can conveniently access discounts from any device anytime, anywhere.

Blue Cross Blue Shield
Blue Care Network
of Michigan

Nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association

Program information valid as of August 2018.

The Blue365 program is brought to you by the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield plans. Blue365 offers access to savings on items that members may purchase directly from independent vendors, which are different from items that are covered under health care plan policies with Blue Cross Blue Shield of Michigan or Blue Care Network, its contracts with Medicare or any other applicable federal health care program. Neither Blue Cross Blue Shield of Michigan, Blue Care Network nor the Blue Cross and Blue Shield Association recommends, endorses, warrants or guarantees any specific vendor or item.

Dental
Metropolitan Life Insurance Company

Plan Design for: Allegra Nursing Home
Original Plan Effective Date: February 1, 2024
Network: PDP Plus
The Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs. You get benefits for a wide range of covered services — both in and out of the network. The goal is to deliver cost-effective protection for a healthier smile and a healthier you.

Coverage Type: In-Network1
% of Negotiated Fee2 Out-of-Network1
% of Negotiated Fee2
Type A – Preventive 100% 100%
Type B – Basic Restorative 80% 80%
Type C – Major Restorative 50% 50%
Type D – Orthodontia 50% 50%

Deductible3
Individual $50 $50
Family $150 $150

Annual Maximum Benefit:
Per Individual $1750 $1750

Orthodontia Lifetime Maximum – Ortho applies to Child Only Child to age 19
$1000 per Person $1000 per Person
Dependent Age: Eligible for benefits until the day that he or she turns 26.

1. “In-Network Benefits” refers to benefits provided under this plan for covered dental services that are provided by a participating dentist. “Out-of-Network Benefits” refers to benefits provided under this plan for covered dental services that are not provided by a participating dentist. Utilizing an out-of-network dentist for care may cost you more than using an in- network dentist.
2. Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.
3. Applies to Type B and C services only.

The Preferred Dentist Program is designed to provide the dental coverage you need with the features you want. Like the freedom to visit the dentist of your choice – in or out of the network. .
If you receive in-network services, you will be responsible for any applicable deductibles, cost sharing, negotiated charges after benefit maximums are met, and costs for non-covered services. If you receive out-of-network services, you will be responsible for any applicable deductibles, cost sharing, charges in excess of the benefit maximum, charges in excess of the negotiated fee schedule amount or R&C Fee, and charges for non-covered services.

• Plan benefits are based on the percentage of the negotiated fee – the fee that participating dentists have agreed to accept as payment in full for covered services, subject to any deductibles, copayments, cost sharing and benefit maximums. Negotiated fees are subject to change.

Selected Covered Services and Frequency Limitations*

Type A – Preventive How Many/How Often:

Oral Examinations 2 in 12 months
Bitewing X-rays (Adult/Child) 1 in 12 months
Prophylaxis – Cleanings 2 in 12 months
Topical Fluoride Applications 1 in 12 months – Children to age 14
Sealants 1 in 60 months – Children to age 14

Type B – Basic Restorative How Many/How Often:

Type C – Major Restorative How Many/How Often:

Type D – Orthodontia

*Alternate Benefits: Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pretreatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plan’s reimbursement for those services, and your out-of-pocket expense. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment.

The service categories and plan limitations shown above represent an overview of your Plan of Benefits. This document presents many services within each category, but is not a complete description of the Plan. Please see your Plan description/Insurance certificate for complete details. In the event of a conflict with this summary, the terms of your insurance certificate will govern.

We will not pay Dental Insurance benefits for charges incurred for:

1. Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which We deem experimental in nature;
2. Services for which You would not be required to pay in the absence of Dental Insurance;
3. Services or supplies received by You or Your Dependent before the Dental Insurance starts for that person;
4. Services which are primarily cosmetic (For residents of Texas, see notice page section in your certificate).
5. Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for:
   • scaling and polishing of teeth; or
   • fluoride treatments.
   For NY Sitused Groups, this exclusion does not apply.
6. Services or appliances which restore or alter occlusion or vertical dimension.
7. Restoration of tooth structure damaged by attrition, abrasion or erosion.
8. Restorations or appliances used for the purpose of periodontal splinting.
9. Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco.
10. Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss.
11. Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work.
12. Missed appointments.
13. Services
    • covered under any workers’ compensation or occupational disease law;
    • covered under any employer liability law;
    • for which the employer of the person receiving such services is not required to pay; or
    • received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital.
    For North Carolina and Virginia Sitused Groups, this exclusion does not apply.
14. Services paid under any worker’s compensation, occupational disease or employer liability law as follows:
    • for persons who are covered in North Carolina for the treatment of an Occupational Injury or Sickness which are paid under the North Carolina Workers’ Compensation Act only to the extent such services are the liability of the employee, employer or workers’ compensation insurance carrier according to a final adjudication under the North Carolina Workers’ Compensation Act or an order of the North Carolina Industrial Commission approving a settlement agreement under the North Carolina Workers’ compensation Act;
    • or for persons who are not covered in North Carolina, services paid or payable under any workers compensation or occupational disease law.
    This exclusion only applies for North Carolina Sitused Groups.
15. Services:
    • for which the employer of the person receiving such services is required to pay; or
    • received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital.
    This exclusion only applies for North Carolina Sitused Groups.
16. Services covered under any workers’ compensation, occupational disease or employer liability law for which the employee/or Dependent received benefits under that law.
    This exclusion only applies for Virginia Sitused Groups.
17. Services:
    • for which the employer of the person receiving such services is not required to pay; or
    • received at a facility maintained by the policyholder, labor union, mutual benefit association, or VA hospital.
    This exclusion only applies for Virginia Sitused Groups.
18. Services covered under other coverage provided by the Employer.
19. Temporary or provisional restorations.
20. Temporary or provisional appliances.
21. Prescription drugs.
22. Services for which the submitted documentation indicates a poor prognosis.
23. The following when charged by the Dentist on a separate basis:
    • claim form completion;
    • infection control such as gloves, masks, and sterilization of supplies; or
    • local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.
24. Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food.
    For NY Sitused Groups, this exclusion does not apply.
25. Caries susceptibility tests.
26. Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
27. Other fixed Denture prosthetic services not described elsewhere in this certificate.
28. Precision attachments, except when the precision attachment is related to implant prosthetics.
29. Initial installation or replacement of a full or removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
30. Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
31. Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it.
32. Implants to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
33. Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
34. Fixed and removable appliances for correction of harmful habits.1
35. Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards.1
36. Diagnosis and treatment of temporomandibular joint (TMJ) disorders. This exclusion does not apply to residents of Minnesota.1
37. Repair or replacement of an orthodontic device.1
38. Duplicate prosthetic devices or appliances.
39. Replacement of a lost or stolen appliance, Cast Restoration, or Denture.
40. Intra and extraoral photographic images.
41. Services or supplies furnished as a result of a referral prohibited by Section 1-302 of the Maryland Health Occupations Article. A prohibited referral is one in which a Health Care Practitioner refers You to a Health Care Entity in which the Health Care Practitioner or Health Care Practitioner’s immediate family or both own a Beneficial Interest or have a Compensation Agreement. For the purposes of this exclusion, the terms “Referral”, “Health Care Practitioner” , “Health Care Entity”, “Beneficial Interest” and Compensation Agreement have the same meaning as provided in Section 1-301 of the Maryland Health Occupations Article.
    This exclusion only applies for Maryland Sitused Groups
    1Some of these exclusions may not apply. Please see your Certificate of Insurance. Common Questions … Important Answers
    Who is a participating dentist?
    A participating, or network, dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for covered services provided to plan members, subject to any deductibles, copayments, cost sharing and benefit maximums. Negotiated fees typically range from 30-45% below the average fees charged in a dentist’s community for the same or substantially similar services.*

In addition to the standard MetLife network, your employer may provide you with access to a select network of dental providers that may be unique to your employer’s dental program. When visiting these providers, you may receive a better benefit, have lower out-of-pocket costs and/or have access to care at facilities at your worksite. Please sign into MyBenefits for more details.

• Based on internal analysis by MetLife. Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Savings from enrolling in a dental benefits plan will depend on various factors, including the cost of the plan, how often members visit a dentist and the cost of services rendered. Negotiated fees are subject to change.

How do I find a participating dentist?
There are thousands of general dentists and specialists to choose from nationwide –so you are sure to find one that meets your needs. You can receive a list of these participating dentists online at www.metlife.com/dental or call 1-800-275-4638 to have a list faxed or mailed to you.

What services are covered by my plan?
Please see your Certificate of Insurance for a list of covered services.
May I choose a non-participating dentist?
Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating (out-of-network) dentist, your out-of-pocket costs may be greater than your out-of-pocket costs when visiting an in-network dentist.

Can my dentist apply for participation in the network?
Yes. If your current dentist does not participate in the network and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.* The website and phone number are for use by dental professionals only.

• Due to contractual requirements, MetLife is prevented from soliciting certain providers.

How are claims processed?
Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive email alerts when a claim has been processed. If you need a claim form, visit www.metlife.com/dental or request one by calling 1-800-275-4638.

Can I get an estimate of what my out-of-pocket expenses will be before receiving a service?
Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. The estimate helps you prepare for the cost of dental services. We recommend that you request a pre-treatment estimate for services in excess of $300. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.

Can MetLife help me find a dentist outside of the U.S. if I am traveling?
Yes. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (collect) when outside the U.S. to receive immediate care until you can see your dentist. Coverage will be considered under your out-of-network benefits.** Please remember to hold on to all receipts to submit a dental claim.
*International Dental Travel Assistance services are administered by AXA Assistance USA, Inc. (AXA Assistance). AXA Assistance provides dental referral services only. AXA Assistance is not affiliated with MetLife and any of its affiliates, and the services they provide are separate and apart from the benefits provided by MetLife. Referral services are not available in all locations.
** Refer to your Certificate of Insurance for your out-of-network dental coverage.

How does MetLife coordinate benefits with other insurance plans?
Coordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. These rules determine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan.

Do I need an ID card?
No, You do not need to present an ID card to confirm that you are eligible. You should notify your dentist that you are enrolled in a MetLife Dental Plan. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system.

Do my dependents have to visit the same dentist that I select?
No. You and your dependents each have the freedom to choose any dentist.

Superior Vision Plan Summary

With your Superior Vision Preferred Provider Organization (PPO) Plan you can:
• Go to any licensed Superior vision provider and receive coverage. Just remember your benefit dollars go further when you stay in network.
• Choose from a large network of ophthalmologists, optometrists and opticians, from private practices to retailers like Costco®
Optical, Walmart®, Sam’s Club® and Visionworks®.

In-network
value added features:
Additional savings on lens enhancements:5 Save an average 20-25% savings over retail on all lens enhancements not otherwise covered under the Superior Vision Insurance program.
Additional savings on glasses and sunglasses:5 20% savings on additional pairs of prescription glasses and nonprescription sunglasses, including lens enhancements.
Additional savings on frames:5 20% off any amount over your frames allowance.

Additional savings on contacts:5 Conventional contacts: 20% off the amount that you pay over your allowance and on purchases of additional contact lenses.
Disposable contacts: 10% off the amount that you pay over your allowance and on purchases of additional contact lenses.
Laser vision correction:5 Savings of 20% – 35% off the national average price of traditional LASIK are available at over 1,000 locations across our nationwide network of laser vision correction providers.

Other in-network features – continued:
Hearing discounts:5 A National Hearing Network of hearing care professionals, featuring Your Hearing Network, offers Superior Vision members discounts on services, hearing aids and accessories. These discounts should be verified

Monthly Premiums
• Employee Only: $6.86

• Employee + Spouse: $11.51
• Employee + Child(ren): $11.75

• Employee + Family: $18.59

In-network benefits
There are no claims for you to file when you go to an in-network Superior vision provider. Simply pay any copays or member out of pocket amount (MOOP) and, if applicable, any amount over your frame/contact allowance at the time of service.
Frequency
Eye exam Once every 12 months
• Eye health exam, dilation, prescription and refraction for glasses: Covered in full after $10
copay.
• Retinal imaging: Up to a $39 copay on routine retinal screening when performed by a private practice provider.

Frame Once every 24 months
• Allowance: $150 after $25 eyewear copay1.

• Additional allowance of $25 at select providers. Visit metlife.com/mybenefits to locate participating providers Look for the star icon ( ).

Standard corrective lenses Once every 12 months
• Single vision, lined bifocal, lined trifocal, lenticular: Covered in full after $25 eyewear copay1.

Standard lens enhancements2 Once every 12 months
• Standard Polycarbonate (child up to age 18)3: Covered in full after $25 eyewear copay1.

• Progressive Standard, Progressive Premium/Custom, Standard Polycarbonate (adult)3, UV coating, Scratch-resistant coatings, Solid or Gradient Tints, Anti-reflective, Photochromic, Blue Light filtering, Digital Single Vision, Polarized, High Index (1.67 / 1.74): Your cost will be limited to a member out of pocket amount (MOOP) that MetLife has negotiated for you. These amounts may be viewed after enrollment at metlife.com/mybenefits.

1Materials co-pay applies to lenses and frames only, not contact lenses.
2The above list highlights some of the most popular lens enhancements and is not a complete listing.
3Polycarbonate lenses are covered for dependent children, monocular patients, and patients with prescriptions +/- 6.00 diopters or

Contact lenses (instead of eye glasses)4 Once every 12 months
• Contact fitting and evaluation:
• Standard fitting: Covered in full after $25 copay
• Specialty fitting: $50 allowance after $25 copay Elective lenses: $150 allowance

• Necessary lenses: Covered in full with prior authorization

prior to service. • Discounts:4
• Conventional contacts: 20% off the amount that you pay over your allowance and on purchases of additional contact lenses Disposable contacts: 10% off the amount that you pay over your allowance and on purchases of additional contact lenses
• Disposable contacts: 10% off the amount that you pay over your allowance and on purchases of additional contact lenses

We’re here to help
Find a Superior Vision provider at www.melife.com/vision and select ‘Superior Vision by MetLife’.

For general questions at any time, call 1-833-EYE-LIFE (1-833-393-5433). Once your coverage is effective, visit our member website at www.metlifecom/mybenefits.

4 Not all providers participate in vision program discounts, including the member out-of- pocket features. Call your provider prior to scheduling an appointment to confirm if the discount and member out-of-pocket features are offered at that location. Discounts and member out-of-pocket are not insurance and subject to change without notice. Materials co- pay applies to lenses and frames only, not contact lenses.
5 These features may not be available in all states and with all in-network vision providers. Discounts are not available at Walmart and Sam’s Club. Please check with your in-network vision provider.

Out-of-network reimbursement
You pay for services and then submit a claim for reimbursement. The same benefit frequencies for in-network benefits apply. Once you enroll, visit www.metlife.com/mybenefits for detailed out-of-network benefits information.

• Materials allowance after a $0 copay • Single vision lenses: up to $30 • Progressive lenses: up to $50
• Eye exam: up to $45 after a $0
copay. • Lined bifocal lenses: up to $50
• Frames: up to $70 • Lined trifocal lenses: up to $65
• Contact lenses: • Lenticular lenses: up to $100
• Elective up to $105
• Necessary up to $210

Important: If you or your family members are covered by more than one health care plan, you may not be able to collect benefits from both plans. Each plan may require you to follow its rules or use specific doctors and hospitals, and it may be impossible to comply with both plans at the same time. Before you enroll in this plan, read all of the rules very carefully and compare them with the rules of any other plan that covers you or your family.
Savings from enrolling in a MetLife Vision Plan will depend on various factors, including plan premiums, number of visits to an eye care professional by your family per year and the cost of services and materials received. Be sure to review the Schedule of Benefits for your plan’s specific benefits and other important details.

MetLife Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY. Certain claims and network administration services are provided through Superior Vision Services, Inc. (“Superior Vision”), a Delaware corporation. Superior Vision is part of the MetLife family of companies.

Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods, and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details.

Basic Term Life / AD&D
Metropolitan Life Insurance Company

Plan Design for: Allegra Nursing Home Original Plan Effective Date: February 1, 2024
For All Active Full Time Employees working at least 30 hours per week

Basic Life $15,000
Accidental Death & Dismemberment An amount equal to Your Basic Life Insurance.
Plan Maximum $15,000
Non-Medical Maximum $15,000
Age Reduction Formula (reduces by) Other
Employee Contribution
• Basic Life 0%
• AD&D 0%
Term Life Features (1):
• Continuation of Life insurance while totally disabled as defined by the Group Policy (2)
• Life Settlement Account (3)
• Portability (4)
• Grief Counseling (5)
• Funeral Discounts and Planning Services (6)

Additional Features:
• WillsCenter.com (7)

AD&D Features (1):
• Seat Belt Benefit (8) • Air Bag Benefit
• Child Care Benefit • Common Carrier Benefit
• Life Settlement Account (3) • Travel Assistance and Identity Theft Solutions (9)

What Is Not Covered?
Like most insurance plans, this plan has exclusions. In addition, a reduction schedule may apply. Please see your benefits administrator or certificate for specific details.

Accidental Death & Dismemberment insurance does not include payment for any loss which is caused by or contributed to by: physical or mental illness, diagnosis of or treatment of the illness; an infection, unless caused by an external wound accidentally sustained; suicide or attempted suicide; injuring oneself on purpose; the voluntary intake or use by any means of any drug, medication or sedative, unless taken as prescribed by a doctor or an over-the-counter drug taken as directed; voluntary intake of alcohol in combination with any drug, medication or sedative; war, whether declared or undeclared, or act of war, insurrection, rebellion or riot; committing or trying to commit a felony; any poison, fumes or gas, voluntarily taken, administered or absorbed; service in the armed forces of any country or international authority, except the United States National Guard; operating, learning to operate, or serving as a member of a crew of an aircraft; while in any aircraft for the purpose of descent from such aircraft while in flight (except for self preservation); or operating a vehicle or device while intoxicated as defined by the laws of the jurisdiction in which the accident occurs.
Life and AD&D coverages are provided under a group insurance policy (Policy Form GPNP99 or G2130-S) issued to your employer by MetLife. Life and AD&D coverages under your employer’s plan terminates when your employment ceases when your Life and AD&D contributions cease, or upon termination of the group insurance policy. Should your life insurance coverage terminate for reasons other than non-payment of premium, you may convert it to a MetLife individual permanent policy without providing medical evidence of insurability.

This summary provides an overview of your plan’s benefits. These benefits are subject to the terms and conditions of the contract between MetLife and your employer. Specific details regarding these provisions can be found in the certificate. If you have additional questions regarding the Life Insurance program underwritten by MetLife, please contact your benefits administrator or MetLife. Like most group life insurance policies, MetLife group policies contain exclusions, limitations, terms and conditions for keeping them in force. Please see your certificate for complete details.

Nothing in these materials is intended to be advice for a particular person or individual. Please consult with your own advisors for such advice.

(1) Features may vary depending on jurisdiction.
(2) Total disability or totally disabled means your inability to do your job and any other job for which you may be fit by education, training or experience, due to injury or sickness. Please note that this benefit is only available after you have participated in the Basic/Supplemental Term Life Plan for 1 year and it is only available to the employee.
(3) Subject to state law, and/or group policyholder direction, the Total Control Account is provided for all Life and AD&D benefits of
$5,000 or more. The TCA is not insured by the Federal Deposit Insurance Corporation or any government agency. The assets backing TCA are maintained in MetLife’s general account and are subject to MetLife’s creditors. MetLife bears the investment risk of the assets backing the TCA, and expects to earn income sufficient to pay interest to TCA Accountholders and to provide a profit on the operation of the TCAs. Guarantees are subject to the financial strength and claims paying ability of MetLife.
(4) Subject to state availability. To take advantage of this benefit, coverage of at least $20,000 must be elected.
(5) Grief Counseling services are provided through an agreement with LifeWorks US Inc. LifeWorks is not an affiliate of MetLife, and the services LifeWorks provides are separate and apart from the insurance provided by MetLife. LifeWorks has a nationwide network of over 30,000 counselors. Counselors have masters or doctoral degrees and are licensed professionals. The Grief Counseling program does not provide support for issues such as: domestic issues, parenting issues, or marital/relationship issues (other than a finalized divorce). For such issues, members should inquire with their human resources department about available company resources. This program is available to insureds, their dependents and beneficiaries who have received a serious medical diagnosis or suffered a loss. Events that may result in a loss are not covered under this program unless and until such loss has occurred. Services are not available in all jurisdictions and are subject to regulatory approval. Not available on all policy forms.
(6) Services and discounts are provided through a member of the Dignity Memorial® Network, a brand name used to identify a network of licensed funeral, cremation and cemetery providers that are affiliates of Service Corporation International (together with its affiliates, “SCI”), 1929 Allen Parkway, Houston, Texas. The online planning site is provided by SCI Shared Resources, LLC. SCI is not affiliated with MetLife, and the services provided by Dignity Memorial members are separate and apart from the insurance provided by MetLife. Not available in some states. Planning services, expert assistance, and bereavement travel services are available to anyone regardless of affiliation with MetLife. Discounts through Dignity Memorial’s network of funeral providers are pre- negotiated. Not available where prohibited by law. If the group policy is issued in an approved state, the discount is available for services held in any state except KY and NY, or where there is no Dignity Memorial presence (AK, MT, ND, SD, and WY). For MI and TN, the discount is available for “At Need” services only. Not approved in AK, FL, KY, MT, ND, NY and WA.
(7) WillsCenter.com is a document service provided by SmartLegalForms, Inc., an affiliate of Epoq Group, Ltd. SmartLegalForms, Inc. is not affiliated with MetLife and the WillsCenter.com service is separate and apart from any insurance or service provided by MetLife. The WillsCenter.com service does not provide access to an attorney, does not provide legal advice, and may not be suitable

for your specific needs. Please consult with your financial, legal, and tax advisors for advice with respect to such matters.
(8) The Seat Belt Benefit is payable if an insured person dies as a result of injuries sustained in an accident while driving or riding in a private passenger car and wearing a properly fastened seat belt or a child restraint if the insured is a child. In such case, his or her benefit can be increased by 10 percent of the Full Amount — but not less than $1,000 or more than $25,000.
(9) Travel Assistance and Identity Theft Solutions services are administered by AXA Assistance USA, Inc. Certain benefits provided under the Travel Assistance program are underwritten by Certain Underwriters at Lloyd’s London (not incorporated) through Lloyd’s Illinois, Inc. Neither AXA Assistance USA Inc. nor the Lloyd’s entities are affiliated with MetLife, and the services and benefits they provide are separate and apart from the insurance provided by MetLife.

Voluntary Benefits Summary
There are several voluntary benefits available to help financially protect you and your family.

Short Term Disability Insurance: Substitute a portion of income if disabled from a covered accident or illness.

Accident Insurance: Helps offset unexpected medical expenses, such as deductibles and co-payments that can result from a fracture, dislocation or other covered accidental injury.

Critical Illness Insurance includes Cancer benefit: Provides a lump-sum benefit to help offset medical and nonmedical expenses related to a covered critical illness including cancer.

Hospital Plan: Provides a lump-sum benefit for covered hospital confinement to help offset the gaps caused by co-payments and deductibles in most major- medical plans.

Life Insurance: Provides financial security for loved ones by customizing coverage. Available Options: 10-, 15-, 20-, & 30-year Term Life Insurance & Whole Life Insurance.