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Administered by:

Producers Equity GroupMember Benefits Program

Member Benefits Program

Call 888-SBUA-INS (888-728-2467) Managed by ETMG, LLC License #1544170 2 of 2

August 5, 2011 12:48 PM

About ETMG, LLC 3

Enrollment & Servicing Technology Platform 4

Member Benefits 5

Client Testimonials 6

SBU HealthSelect Plans 8

CriticalMed Plans 15

Ameritas Group Dental 18

EyeMed Vision Benefits 20

SBU Multiple Employer 401(k) Plan 23

Individual(k) Retirement Plan 27

Long Term Care Insurance 29

Albert PomalesBenefit Specialist LeadETMG, LLC

6300 Bridgepoint ParkwayBuilding One, Suite 480Austin, TX 78730

512.279.5600 main512.279.5605 direct512.682.8795 fax888.US1.ETMG toll [email protected]

Contact Information



August 5, 2011 12:48 PM

The Executive Team

What is ETMG and what is its role?

• A for-profit Texas limited liability company in situs in Austin, TX.• Managing General Agency & General Agency• Third Party Administrator TDI COA #14869• Premium Collection Agency • Develops and markets employee benefit programs and insurance management solutions

for employees of small businesses. • Target market is trade associations, 1099 affiliated contractor groups, interest groups, professional

employer organizations (PEOs), unions, and organizations comprised of or serving small businesses. • SBU is the initial association client of ETMG. • Dedicated to making available, on a large scale, welfare programs for its clients and their members.

About ETMG, LLC

TOM NEWBY President, Co-Founder

Sales and Product Development. Awarded Forbes Magazine Top 10 Health Insurance Brokerages (out of of 25,000) two consecutive years with his previous successful brokerage Global Benefit Solutions.

MARK ADAMS CEO, Executive Chairman & Co-Founder

Corporate Governance, strategic direction, and Investor Relations. Built numerous successful businesses into multi-million dollar ventures. Awarded Ernst and Young’s prestigious “Entrepreneur of the Year Award”.

JOHN CONSTANTINE Vice Chairman & Co-Founder

Corporate Governance, strategic direction, and Investor Relations. Successful Entrepreneur and managing partner of several Texas Surgical Centers. Mr. John Constantine has over 20 years experience in the healthcare field, including business management, investments, marketing and public relations.

JEFF BURNS Chief Operating Officer

Ongoing leadership and implementation of the companies’ strategic business plan, including infrastructure development, operations, management, and optimization of technical and administrative processes. Previous Co-founder of a $40M Austin-based technology start-up with over 20 years experience in technology and management.

OLIVER SANDLIN Corporate Legal Counsel

ETMG Corporate governance, licensing, and regulatory compliance. Principal Sandlin Law Firm, Austin, Texas.



August 5, 2011 12:48 PM

Enrollment & Servicing Technology Platform

Enrollment Solution Flexibility• Any benefit – core and/or worksite, administrative• Any method – laptop, call center, Internet, combo• Any time frame – annual, perpetual, subscription• Efficiency – interview timer, 24/7 supervision• Topaz signatures or PIN Voice• HIPAA compliant

Member Calls into Call CenterLicensed Call Center Representative asks several defining questions to guide them & select the appropriate plan.

No Pre-existing conditions

Not currently insured

|

Provided multiple options from multiple carriers

|

Review options:- Desired premium

- Deductible- PPO, HMO, or HSA

Looking to lower cost Has health insurance

|Increase deductible

Add Limited Benefit Plan Lower monthly payment

|Monthly Payment

Current ded. ($1000) $500Increase ded. ($3000) $242 Add LBP $138 NEW TOTAL $380

Looking to lower cost Has health insurance

| |Risk pool

Enroll in PPOHigher deductible

Add Limited Benefit Plan

| |Monthly Payment

PPO ded. ($2500) $598

Monthly Payment

PPO ded. ($5000) $454 Add LBP $138 NEW TOTAL $592

ETMG In-House Call Center Services• Provide an Agency toll-free number for association member use in enrollment and servicing questions• Provide Tier 1 support for general servicing, support, and all monthly premium billing questions. Refer all provider specific servicing

and/or billing questions to the carrier support line as a Tier 2 support request.• Provide marketing with the assistance of Association to include html email marketing, Agency website page hosting specific to

Association products, outbound telephone marketing, fax broadcast marketing, association periodical marketing, and direct mail solicitation, as may be agreed upon by the parties.

• Annual Enrollment Assistance – Provide direction and information to employees regarding enrollment process.• Actual Enrollment by phone, laptop, web-based application, or other medium• Benefit Eligibility Verification – Resolution of inquiries regarding basic eligibility and coverage.• Benefits Enrollment (New Hire) – provide enrollment for new association members and document steps that a new member must

follow when electing for benefits.• Benefits Issue Resolution – Provide information, follow up and resolution on benefits related issues.• Benefits Termination – Provide information and follow up regarding benefit coverage and system updating related to terminations.• Billing Process – Coordination, administration, implementation, and audit of individual ACH billing for monthly premiums of enrolled

association members.• Provide Audit Reports of enrolled and billed members to Association or Association designee as periodically required to maintain

membership and enrollment reconciliation. Provide audit statements of Association Royalty Fees paid and tie back to Agency revenue generated by the program.

• Claims Exception Coordination – Document inquiries regarding possible claim appeals and forward to the client for review.• COBRA Coordination – Coordination of COBRA requests with third party administrator or carrier.• Current Benefit Election Review – Provide current election information to Association members.• Death Claim Process – Issue resolution and follow up regarding death claims.• Electronic Eligibility Process – Document how eligibility information is sent electronically.• Family Status Change Process – Coordinate family status change requests and forms.• Long Term Disability Process – Provide information regarding long-term disability coverage and benefits.• Supplemental/Voluntary Process - Provide information on voluntary/supplemental products, coverage, and benefits and offer

enrollment for these products.• Long Term Care Process – Provide information regarding long-term care coverage and benefits and offer enrollment as this program

becomes available and is introduced to the Association.• All insurance products offered by Agency to Association Members will insured by A- (as determined by AM Best) or better.

Where do you live?

Do you take any medication on a regular basis?

What is your desired premium range, deductible, HSA, etc.?

Do you have any current health concerns/issues?

Human Resource Solutions• Eliminate Paperwork Problems• Complete all forms online• Automated forms can be

printed from the Web



August 5, 2011 12:48 PM

Member Benefits

By joining Small Business United and leveraging the strength of our association’s combined purchasing volume, your small business, association, or individual members are able to obtain discounts on products and services available only to large corporations. A monthly $4.17 membership fee & $6.00 processing fee apply.

SBU’s HRAnswerLink was developed specifically for small to mid-sized businesses to provide a Human Resource (HR) service delivered via a customized website, email, and phone communications. SBU’s HR Support Center - $9.95 per month

• Access state and federal laws that pertain to your business• Customize an employee handbook, forms, policies, & letters

HR On-Demand Upgrade - $34.95 per Month

• Unlimited HR consultations & advice by telephone or email• Unlimited HR document customization

HRAnswerLink

Online HR Support 24x7!

Background Checks, Health & Safety Training, Business Training, Labor Law Posters, Salary Reports, and more!

Access a nationwide network of pre-qualified attorneys offering free or discounted legal care. Plan Attorney Benefits:

• Unlimited initial phone consultations for new legal matters.• Review 5 ten page business documents each month. • Calls made on behalf of your business (2 per month).

Follow up calls - Hourly rate of $125.• Letters written on behalf of your business (3 per month).

Follow up letters - Hourly rate of $125.• Initial collection letters (10 per month).

Additional/Follow-up letters - Hourly rate of $125 or contingency fee %• 30 Minute one-on-one consultations for each new legal matter.

Additional time - Hourly rate of $125.• Registered Agent in all states you are incorporated or do business in.

Legal Plan

Guaranteed Low Hourly Rates - Plan attorneys charge $125.00 per hour, or give members a 40% discount off their usual and customary hourly rate.

Retainers - Example: 10 hrs. x $125.00 = $1,250.00 retainer fee Any unused portion of the retainer will be returned.

Contingency Fee Discounts - This fee is expressed as a percentage of the amount collected or awarded. In collection matters, your attorney will accept 18% if the case is settled before formal court proceedings begin. After proceedings begin, the fee is 27%. On all other contingency matters there is a 10% discount on the lower of either the state maximum or the attorney’s standard rate.

SBU Legal Plan Membership - $24.95 per month

Discount Printer/Copier Parts and SuppliesSBU has partnered with one of the nation’s largest suppliers of office machine parts and consumables to bring its members excellent discounts on ink & toner for nearly every office printing and copy machine made by every major manufacturer—and then some. SBU offers 20%-40% off the list price for toner and inkjet supplies, and we stock materials for these manufacturers:

Receive free UPS Ground shipping on orders of $75 or more!

AB DickApple ComputerBrotherCanonCitizenCompaqCopystarDanka InfotecDanka Office Imaging KodakDellDexDigital Equipment CorporationDuploEpsonFrancotyp-PostaliaFujitsuGenicomGestetner

Graphic EnterprisesHaslerHitachiHPIBMIkonImagistics (Pitney Bowes)JetfaxKodakKonica MinoltaKyocera Mita LanierLexmarkMonroeMuratecNashuatecNECNeopost

OceOkidataOlympiaOmnifaxOutput TechnologiesPanasonic Rex RotaryRicohRisoRoyal CopystarSamsungSanyoSavinSharp Standard DuplicatingTeco Information SystemTektronixToshibaXerox

SBU has partnered with OfficeMax to offer members-only deep discounts and access to over 12,000 products through the Instant Purchasing Account (IPA). Your IPA provides savings on office supplies, technology, furniture and more.

• No order charge for purchases over $50 • Orders can be shipped to a residence

OfficeMax

SMALL BUSINESS UNITEDASSOCIATION

MEMBER DISCOUNT CARD8888-001-0560-0022-07



August 5, 2011 12:48 PM

Client Testimonials

Client Testimonials

“ETMG is always available and willing to help on insurance issues as they come up. Not only did they put together various options for coverage that would cover almost all needs of our individual employees, but they take care of all the details when a new member comes on or an employee leaves. We don’t have the expertise they have, so it is comforting to have that support there when you need it.”

-Brian PlaterVP Finance and Business Operations

Fifth Generation, Inc.

“I cannot tell you how much your help meant… We are working on re-launching a 300+ agent office as Keller Williams Realty, and health benefits was a real turning point in many of the associates’ decisions to join the brokerage. I appreciate your willingness to give me your office number, cell phone number and even letting me know when you were leaving the office for the evening. You rock. What you do makes a huge difference for our people, and we are so grateful.”

-Ellen M. MarksDirector of Marketing & Communications

Keller Williams Realty International

“Let’s get real honest. Insurance in general is a painful topic. It’s difficult to understand and navigate, is constantly changing, often contradicts itself and of course costs squeamish amounts of money. Many businesses wake up one day to realize not only are they throwing profit out the window, but they’re even doing that part all wrong. That was us until we partnered up with ETMG. When we went to market looking for a whole new look to our benefits package ETMG was among 5 groups we met with. They were the only management group that offered real solutions for a non-traditional group like Technology Navigators. They provide us with great service and even better products. We have more employees now with the security of having insurance than ever AND get this, it costs less! If that’s not enough of a reason to give them a call, I don’t know what is. ETMG takes the pain of out of Insurance and we’re happy to be a client.”

-Jamie BihlTechnology Navigators

Administered by:


SBU HealthSelect PlansAssociations of Employer Groups

and 1099 Groups

Proposal for Small Business United II Austin, TexasProposal Date: June 24, 2011 | Effective Date of Coverage: September 1, 2011

Underwritten By: ACE American Insurance Company Term life insurance is underwritten by Combined Insurance Company of America, part of the ACE Group of Companies

Claims Administered By:Administrative Concepts, Inc. 994 Old Eagle School Rd., Ste. 1005 Wayne, PA 19087



August 5, 2011 12:48 PM

SBU HealthSelect Plans

BASIC 10 NEW PLAN! CHOICE 25 MAX 50

INPATIENT*

Hospital Confinement

- Day 1 Benefit Amount $1,000 x 1 day $2,000 x 1 day $2,500 x 1 day

- Days 2+ Benefit Amount Per Day $500 x 15 days $1,000 x 20 days $1,250 x 30 days

- Days 1+ Additional ICU Benefit Amount Per Day $250 x 5 days $750 x 5 days $850 x 6 days

Surgery Benefit Amount (Including Maternity) Per Surgery $750 x 1 surgery $2,000 x 1 surgery $4,000 x 1 surgery

- Anesthesia Benefit Amount - Per Surgery $185 x 1 surgery $500 x 1 surgery $1,000 x 1 surgery

Maximum Potential Inpatient Benefits $10,685 $26,000 $50,100

OUTPATIENT ILLNESS BENEFIT*

Physician Office Visit Pre-Pay (1,2) $10 $10 $10

- Benefit Amount Per Visit $75 x 10 visits $100 x 10 visits $100 x 10 visits

- Wellness Benefit Amount Per Visit $125 x 1 visit $125 x 1 visit $200 x 1 visit

- Well Child Care (Up to Age 4) Benefit Amount Per Visit $85 x 4 visits $100 x 4 visits $100 x 4 visits

Emergency Room (Sickness) Benefit Amount - Per Visit $225 x 1 visit $400 x 1 visit $500 x 1 visit

Surgery Benefit Amount Per Surgery $500 x 1 surgery $1,000 x 1 surgery $2,000 x 1 surgery

- Anesthesia Benefit Amount - Per Surgery $125 x 1 surgery $250 x 1 surgery $500 x 1 surgery

Diagnostic, X-Ray, Lab - Benefit Amount Per Test

- Class I: Laboratory - Blood Work, CMP, Lipid Panel $50 x 4 tests $50 x 4 tests $50 x 4 tests

- Class II: X-Rays, ECG, Pap/PSA Tests, All Other Diagnostic $75 x 2 tests $100 x 2 tests $100 x 2 tests

- Class III: Ultrasound, Mammogram $125 x 1 test $175 x 1 test $175 x 1 test

- Class IV: CT, PET, MRI $250 x 1 test $750 x 1 test $750 x 1 test

Maximum Potential Outpatient Benefit Per Year $2,790 $4,600 $5,925

OUTPATIENT ACCIDENT BENEFIT*

-Benefit % Payable 80% 80% 80%

-Deductible Per Accident $0 $0 $0

Maximum Benefit Per Year $2,000 per year $3,000 per year $3,000 per year

PRESCRIPTION BENEFIT*

- Retail - Generic Rx Copay $10 $10 $15

- Retail Preferred Brand Rx Copay $20 $20 $30

- Mail Order - Generic Rx Copay $25 $25 $35

- Mail Order - Preferred Brand Rx Copay $50 $50 $80

Prescription Benefit Maximum Per Year $300 per year $300 per year $600 per year

LIFE/AD&D/CRITICAL ILLNESS*

Critical Illness Benefit Amount Payable for 10 Conditions

Benefit Amount N/A $1,500 $2,000

Accidental Death & Dismemberment Benefit*

Benefit Amount $10k/$5k/$1k $25k/$5k/$1k $25k/$5k/$1k

Term Life Insurance (3)**** Benefit amounts listed are for: Employee/Spouse/Child(ren)

Benefit Amount $5k/$2k/$1k $5k/$2k/$1k $5k/$2k/$1k

OTHER SERVICES (2)

Teladoc: Telephonic Doctor Office Visits - $38 Fee YES YES YES

Care24: EAP and Nurseline YES YES YES

PHCS PPO Discounts YES YES YES

An indemnity-based medical plan which provides limited coverage for accidents, illness, and specified disease to help cover basic, minor-medical expenses.

(1) The office visit pre-pay is a service through the PHCS PPO Network (2) This service is not insurance and is not provided by ACE American Insurance Company. (3) Term Life is underwritten by Combined Insurance Company of America, part of the ACE Group of Companies.* For HealthSelect, we will not pay benefits for any loss, injury, or sickness that is caused by, or results from Pre-existing Conditions occurring within the first 12 months of coverage. *“Pre-existing Condition” means an illness, disease, or other condition of the Covered Person, that was treated, diagnosed or required medications in the 6 month period before the Covered Person’s coverage became effective under this Policy. Pre-existing conditions found during the 6-month look-back period will be excluded for the first 12 months of coverage under this Policy. Upon submission of a valid “Certificate of Creditable Coverage”, credit toward the pre-existing exclusion period will be given for all benefits except the “Critical illness” benefit. For details regarding the “Critical Illness” pre-existing exclusion see “What is not covered.”



August 5, 2011 12:48 PM

SBU HealthSelect Plans - Continued

BENEFIT DESCRIPTION

Office Visits We will pay benefits if a covered person visits a Doctor’s office for treatment, care or advice of an injury or sickness covered under the policy.

Emergency Room Visits (Sickness Only)We will pay benefits for Emergency Room Visits if a covered person requires treatment or services in a Hospital emergency room for a life-threatening condition due to sickness. Covered expenses include the attending Doctor’s charges, X-rays, laboratory procedures, use of the emergency room and supplies.

Wellness VisitsWe will pay benefits for an annual routine examination or well child care. Covered Services include a medical history, physical examination, X-rays and laboratory tests including a Pap test, colorectal screening, prostate cancer screening, mammography and bone density screening. We will pay benefits for up to 4 well child visits up to age 4.

Outpatient Laboratory Tests, Diagnostics, and X-Ray Expenses

We will pay benefits for Outpatient Laboratory Tests and X-rays if a covered person is not confined in a Hospital and the tests or x-rays are ordered by a Doctor and performed by an appropriately licensed technician.

Outpatient Accident Only Medical Expense Benefit

We will pay benefits for medically necessary expenses that result directly from a covered accident. Initial treatment must begin within 72 hours of the accident and covered expenses must be incurred within 90 days after the accident. These benefits are subject to the Deductibles, Coinsurance Rates, Co-Payments, Benefit Periods, Benefit Maximums and other terms or limits, if any, shown in the Schedule of Benefits. Covered expenses include medical services and supplies, emergency care, ambulance expenses, treatment of an injured tooth, prescription drugs andrehabilitative braces or appliances prescribed by a doctor.

Hospital Confinement Benefit We will pay benefits if a covered person is confined in a hospital because of a covered injury or illness for at least 24 consecutive hours.

Surgery and Anesthesia BenefitWe will pay benefits if a covered person undergoes surgery at the direction of a doctor for a covered injury or sickness. We will also pay benefits for anesthesia services for pre-operative screening and the administration of anesthesia during a surgical procedure whether on an inpatient or outpatient basis.

Critical Illness

Payable for 10 conditions: Cancer, Heart Attack, Renal Failure, Stroke, Major Organ Transplant, Multiple Sclerosis, Coronary Artery Bypass Surgery, Alzheimer’s, ALS, Terminal Illness. After coverage has been in effect for 90 days or more, if an employee is then diagnosed with any of the conditions listed in the schedule of benefits, we will pay the amount shown in the Schedule of Benefits for this benefit. The covered person must be under 65 years of age and survive for a period of one-hundred-eighty (180) days after diagnosis of Multiple Sclerosis. The covered person must be under 65 years of age and must survive for a period of thirty (30) days after diagnosis for any other covered illness. We will pay this benefit only once regardless of whether the covered person is diagnosed with more than one of the covered illnesses.

Accidental Death and Dismemberment Benefit

If a covered person suffers a loss within 365 days of a covered accident we will pay the percentage of the principal sum shown opposite that loss. If multiple losses occur, only one benefit amount, the largest, will be paid for all losses due to the same covered accident.

Term Life Insurance Benefit*If an insured person dies of natural causes or as the result of a covered accident, we will pay the death benefit amount listed in the schedule of benefits. We will not pay a death benefit if an insured person dies by suicide, while sane or insane, within two years of the date his/her insurance starts.

Prescription Drug BenefitsWe will pay benefits for expenses incurred by a covered person for the purchase of generic and preferred brand name prescription drugs from a Participating or Non-Participating Pharmacy. The co-payment must be incurred for each prescription drug or authorized refill before benefits are payable.

Value-added benefits are included with the HealthSelect Plan.These benefits are not insurance and are not provided by ACE American Insurance Group.

Insurance is underwritten by ACE American Insurance Company *Term Life is underwritten by Combined Insurance Company of America, part of the ACE Group of Companies.

MONTHLY RATES

BASIC 10 NEW PLAN! CHOICE 25 MAX 50

Member Only $165.50 $229.29 $294.49

Member + 1 $348.36 $483.02 $619.10

Family $494.36 $680.05 $878.50



August 5, 2011 12:48 PM

Value Added Services Enhance the Packaged Offering and Elevate the Consumer Experience for Employees

PPO Network Office Visit Pre-pay

Access to Network discounts at over 568,000 participating PHCS Network physicians and hospitals.

Service provides members affordable access to physicians by allowing them to pay a $10 Office Visit Pre-pay before insurance benefits are applied. MultiPlan delivers primary PPO network access under the PHCS Network, HealthEOS Network, and PHCS Savility brands. PHCS Network offers access in all states to 568,000 healthcare professionals, over 4,100 hospitals and 63,000 ancillary care facilities. No matter where health plan participants live, work, and seek healthcare, they have access to the largest independent primary PPO in the nation. Our passive approach to utilizing participating providers does not reduce insurance benefits or penalize a member for seeing a non-network provider. Using a network provider will discount the cost of services rendered and help to stretch our members’ insurance benefits. For members that happen to reach their insurance benefit maximums, they can continue to receive discounted prices from the network providers.

Prescription Drug Card

With ScriptSave® members enjoy instant savings for their entire household on brand name and generic medications.

Savings average 22%, with potential savings of up to 50% on brand name and generic prescription drugs at over 50,000 participating pharmacies. With wȄ95h, members can use their card for prescription fills and refills at over 60,000 participating pharmacies for co-pay benefits that will be processed in real-time at the point-of-purchase at the pharmacy.

Telemedicine

With Teladoc: For only a $38 consult fee, members can receive 24/7 access to affordable healthcare via phone consultations to diagnose, recommend treatment, and write short-term, non-narcotic prescriptions.

A lot of time goes into setting a doctor’s appointment and taking time off from work or out of busy, everyday lives. And after all that, the average face-to-face time with a doctor in a traditional office visit appointment is 3-5 minutes*. With TelaDoc, members have on-demand access to U.S. board certified and licensed doctors for telephone consultations to diagnose, recommend treatment, and write short-term, non-narcotic prescriptions. For only a $38 consult fee, members can receive quality care from the convenience of their homes or offices, as opposed to more expensive and less productive settings like an urgent care center or emergency room. Teladoc is not designed to replace employees’ primary care physicians. It simply allows them to resolve their routine medical issues at a fraction of the cost and time. [*According to a Merritt Hawkins Survey, 2009]

Nurseline and EAP

OptumHealth Care24 provides a toll-free, 24/7/365 Nurseline which provides an immediate and reliable source for non-emergency health information and confidential medical counseling for emotional and personal challenges. Includes 3 face-to-face counseling visits per condition.

Members are enrolled in an Employee Assistance Program and Nurseline through OptumHealth. Consultations are provided by registered nurses and masters level counselors. Additional resources are available including legal, financial, dependent care specialists, and an audio health information library. In addition to the telephonic services, members also have access to up to 3 face-to-face counseling sessions per condition at no cost to the member.

THESE SERVICES ARE NOT INSURANCE AND ARE NOT PROVDIED BY ACE AMERICAN INSURANCE CORP.

Value Added Services



August 5, 2011 12:48 PM

About Your New Plan

Quick Tips

www.Ternian.com 602.216.0006•

When one size does not fi t all. SM

How to use your new insurance plan...

1. WHO IS THE INSURANCE COMPANY?

2. WHAT TO DO AT A DOCTOR’S OFFICE VISIT.

3. ADDITIONAL SERVICES INCLUDED WITH YOUR PLAN.

• ACE American Insurance Company (A+ Rated)• You can see ANY doctor or hospital of your choice, and the

insurance plan will pay the same level of benefi t - no penalties. • For benefi ts and coverage questions call 1-800-964-7096

• Give the doctor offi ce staff your ID Card• Have them call 1-800-964-7096 (on your ID Card) to verify your coverage• Pay your offi ce visit fee (on your ID Card) at the time of service• Have the doctor bill the insurance company on your behalf

• If your doctor is part of the MultiPlan PHCS Network, you will also receive discounts on their billed charges. 1-866-750-7427

• For only $38, you can have a doctor consultation over the phone from the convenience of your home or offi ce with TelaDoc. 1-800-Teladoc

• At no additional cost, you can call Optum Care24 Nurseline to speak to a registered nurse immediately! 1-866-923-0018

Quick Tips













Quick Tips














• ACE American Insurance Company (A+ Rated)• You can see ANY doctor or hospital of your choice, and the insurance

plan will pay the same level of benefit - no penalties.• For benefits and coverage questions call 1-800-964-7096


• Give the doctor office staff your ID Card• Have them call 1-800-964-7096 (on your ID Card) to verify coverage• Pay your office visit fee (on your ID Card) at the time of service• Have the doctor bill the insurance company on your behalf



• For only $38, you can have a doctor consultation over the phone from the convenience of your home or office with TelaDoc. 1-800-Teladoc


How to Use Your New Insurance Plan



August 5, 2011 12:48 PM

How HealthSelect Max 50 Pays

This illustrative claim scenario is for informational purposes only and is not a guarantee of payment for the insurance plan. This is a sample of a potential claim scenario under fixed-indemnity and accident medical plans. Not all factors can be accounted for in an illustrative claim scenario as actual claims received are processed individually and adjusted according to the terms, provisions, limitations, and exclusions of each policy which may include state-specific provisions. In addition, providers determine and bill the insurance company with the applicable procedure code and diagnosis code for the services rendered. Provider billed amounts will vary. Provider discounts provided, if any, will vary based on geography and the provider’s contractual obligation with the PPO network. This illustration provides only a brief description of the limited accident and sickness coverage available. The policy issued contains full details of the coverage, reductions, limitations, exclusions, and termination provisions which govern any conflicting information that may be presented in the illustration.

TOTAL BILL YOU PAY HEALTHSELECT MAX 50 PAYS

LOW ANNUAL UTILIZATION

4 Physician visits- $100 each $400 $40 $360

1 Lab workup- $50 each* Class I $50 $0 $50

2 Generic prescriptions- $30 each $60 $30 $30

2 Brand prescriptions- $75 each $150 $60 $90

1 Emergency room visit- $700 each* $700 $200 $500

Annual total medical cost $1,360 $330 $1,030

MODERATE ANNUAL UTILIZATION






1 Broken finger (Accident)- $3,000 each* $3,000 $600 $2,400

Annual total medical cost $4,980 $1,130 $3,850

MAJOR ANNUAL UTILIZATION






1 Broken finger (Accident)- $3,000 each* $3,000 $600 $2,400

Three-day hospitalization- With one day in ICU and surgery performed, assuming anesthesia is included*

$25,000 Total Bill$15,000 PHCS discounted bill $4,150 $10,850

Annual total medical cost $19,980 after PHCS discount $5,280 $14,700

*Charges repriced as in-network.The limited medical plans proposed in this document are not basic health insurance or major medical coverage. They provide limited coverage for accidents, illness, and specified disease. The HealthSelect plans are comprised of a package of group insurance policies which are issued on a a separate and non-coordinating basis and include: fixed indemnity, accident-only, and limited-scope prescription drugs.

Plan pays $1,030You pay $330

$330

$1,030

Plan pays $3,850You pay $1,130

$1,130

$3,850

Plan pays $14,700You pay $5,280

$5,280

$14,700



August 5, 2011 12:48 PM

Exclusions & Limitations

For HealthSelect, we will not pay benefits for any loss, injury or sickness that is caused by, or results from:• *“Pre-existing Condition” means an illness, disease, or other condition of the Covered Person,

that was treated, diagnosed or required medications in the 6 month period before the Covered Person’s coverage became effective under this Policy. Pre-existing conditions found during the 6-month look-back period will be excluded for the first 12 months of coverage under this Policy. Upon submission of a valid “Certificate of Creditable Coverage”, credit toward the pre-existing exclusion period will be given for all benefits except the “Critical illness” benefit. For details regarding the “Critical Illness” pre-existing exclusion see “What is not covered.”

• Intentionally self-inflicted injury, suicide or attempted suicide.• War or any act of war, whether declared or not.• Service in the military, naval or air service of any country or international organization.• Piloting or serving as a crewmember or riding in any aircraft except as a fare-paying passenger

on a regularly scheduled or charter airline.• Commission of, or attempt to commit, a felony.• Commission of or active participation in a riot, or insurrection.• Bungee cord jumping, parachuting, skydiving, parasailing, hang-gliding.• Flight in, boarding or alighting from any aircraft except as a fare-paying passenger on a

regularly scheduled commercial airline.• An accident if the covered person is the operator of a motor vehicle and does not possess

a valid motor vehicle operator’s license, except while participating in Driver’s Education Program.

• Medical or surgical treatment, diagnostic procedure, administration or anesthesia, or medical mishap or negligence, including malpractice. [This exclusion applies to the Accidental Death and Dismemberment benefit only]

• Travel or activity outside the United States, Canada, or Mexico, except for a Medical Emergency.• Travel in any Aircraft owned, leased or controlled by the Policyholder, or any of its subsidiaries

or affiliates. An Aircraft will be deemed to be “controlled” by the Policyholder if the Aircraft may be used as the Policyholder wishes for more than 10 straight days, or more than 15 days in any year.

• Alcoholism, drug addiction or the use of any drug or narcotic except as prescribed by a Doctor unless specifically provided herein.

• Repair or replacement of existing dentures, partial dentures, braces, fixed or removable bridges, or other artificial dental restoration.

• Repair, replacement, examinations for, prescriptions, or the fitting of eyeglasses or contact lenses.

• While the covered person is legally intoxicated (as determined by that state’s laws) or while under the influence of any drug unless administered under the advice and consent of a Doctor.

• Elective Abortion. Elective Abortion means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed.

• Mental and Nervous Disorders.• Cosmetic surgery, except for reconstructive surgery needed as the result of an injury or

sickness.• Experimental or Investigational drugs, services, supplies or any procedure held to be

experimental or investigatory by Us at the time the procedure is done.• Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any related

procedures, including complications.• Sexual reassignment surgery, sexual transformation surgery, sexual transgendering surgery.• Services related to sterilization, reversal of a vasectomy or tubal ligation; in vitro fertilization

and diagnostic treatment of infertility or other problems related to the inability to conceive a child, unless such infertility is a result of a covered Injury or Sickness.

• Treatment or services provided by a private duty nurse, unless provided for in the Policy.• Organ or tissue transplants and related services.• Personal comfort or convenience items.• Rest or custodial cures.• Hearing aids.• Radial keratotomy.• Treatment by a family member or member of the Covered Person’s household.• Routine dental care and treatment, except for treatment of Injury as specified in the Policy.We will not pay benefits for any loss or Injury that is caused by, results from, or is contributed to by:1. Suicide or attempted suicide, intentionally self-inflicted injury.2. War or any act of war, whether declared or not.3. A Covered Accident that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon Our receipt of proof of service, We will refund anyt premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days.4. Sickness, disease, or any bacterial infection, except one that results from an accidental cut or wound or pyogenic infections that result from accidental ingestion of contaminated substances.5. Piloting or serving as a crewmember or riding in any aircraft except as a fare-paying passenger on a regularly scheduled or charter airline.6. Injury that occurs while the Covered Person is legally intoxicated (as determined by that state’s law) or while under the influence of any drug unless administered under the advice and consent of a Doctor.7. Medical or surgical treatment, diagnostic procedure, administration of anesthesia, or medical mishap or negligence, including malpractice.8. Commission of, or attempt to commit, a felony.9. Aggravation or re-injury of a prior Injury the Covered Person suffered prior to his or her coverage effective date, unless We receive a written medical release from the Covered Person’s Doctor.In addition to the above Exclusions, We will not pay Accident Medical Expense Benefits for any loss, treatement or services resulting from or contributed to by:• Treatment by persons employed or retained by the Policyholder, or by any Immediate Family

or member of the Covered Person’s household. • Treatment of sickness, disease or infections except pyogenic infections or bacterial infections

that result from the accidental ingestion of contaminated substances.

• Treatment of hernia, Osgood-Schlatter’s Disease, osteochondritis, appendicitis, osteomyelitis, cardiac disease or conditions, pathological fractures, congenital weakness, detached retina unless caused by an Injury, or mental disorder or psychological or psychiatric care or treatment (except as provided in the Policy), whether or not caused by a Covered Accident.

• Pregnancy, childbirth, miscarriage, abortion or any complications of any of these conditions.• Mental and nervous disorders (except as provided in the Policy).• Damage to or loss of dentures or bridges, or damage to existing orthodontic equipment

(except as specifically covered in the Policy).• Expenses incurred for treatment of temporomandibular or craniomandibular joint dysfunction

and associated myofacial pain (except as provided by the Policy).• Injury covered by Workers’ Compensation, Employer’s LIability Laws or similar occupational

benefits or while engaging in activity for monetary gain from sources other than the Policyholder.

• Cosmetic surgery, except for reconstructive surgery needed as the result of an Injury.• Any elective treatment, surgery, health treatment, or examination, including any service,

treatment or supplies that: (a) are deemed by us to be experimental; and (b) are not recognized and generally accepted medical practices in the United States.

• Eyeglasses, contact lenses, hearing aids, examinations or prescriptions for them, or repair or replacement of existing artifical limbs, orthopedic braces, or orthotic devices.

• Expenses payable by any automobile insurance Policy without regard to fault. (This exclusion does not apply in any state where prohibited.)

• Conditions that are not caused by a Covered Accident.• Participation in any activity or hazard not specifically covered by the Policy.• Any treatment, service, or supply not specifically covered by the Policy.This insurance does not apply to the extent that trade or economic sanctions or regulation prohibit Us from providing insurance, including, but not limited to, the payment of claims.No Prescription Drug Benefits will be paid for:• All over-the-counter products and medications unless shown in the definition of Prescription

Drug. This includes, but is not limited to, electrolyte replacement, infant formulas, miscellaneous nutritional supplements, and all other over-the-counter products and medications.

• Blood glucose meters and insulin injecting devices.• Depo-Provera; condoms, contraceptive sponges, and spermicides; sexual dysfunction drugs.• Biologicals (including allergy tests); blood products; growth hormones; hemophiliac factors;

MS injectables; immunizations; and all other injectables unless shown in the definition of Prescription Drug.

• Medical supplies and durable medical equipment.• Liquid nutritional supplements; pediatric Legend Drug vitamins; prescribed versions of

Vitamins A, D, K, B12, Folic Acid, and Niacin – used in treatment verses as a dietary supplement; and all other Legend Drug vitamins and nutritional supplements.

• Anorexiants; any cosmetic drugs including, but not limited to, Renova and skin pigmentation preps; any drugs or products used for the treatment of baldness; and topical dental fluorides.

• Refills in excess of that specified by the prescribing Doctor, or refills dispensed after one year from the original date of the prescription.

• Any drug labeled “Caution – limited by Federal Law for Investigational Use” or experimental drugs.

• Any drug which the Food and Drug Administration has determined to be contraindicated for the specific treatment.

• Drugs needed due to conditions caused, directly or indirectly, by a covered person taking part in a riot or other civil disorder; or the covered person taking part in the commission of a felony.

• Drugs needed due to conditions caused, directly or indirectly, by declared or undeclared war or any act of war; or drugs dispensed to a covered person while on active duty service in any armed forces.

• Any expenses related to the administration of any drug.• Drugs or medicines taken while in or administered by a Hospital or any other health care

facility or office.• Drugs covered under Worker’s Compensation, Medicare, Medicaid or other governmental

program.• Drugs, medicines or products which are not medically necessary.• Diaphragms; erectile dysfunction Legend Drugs; and infertility Legend Drugs.• Epi-Pen, Epi-Pen Jr., Ana-Kit, Ana-Guard; Glucagon-auto injection; and Imitrex-auto injection.• Smoking deterrents, Legend or over-the-counter drugs.• Replacement of stolen medication (except under circumstances approved by us), or lost,

spilled, broken or dropped Prescription Drugs.• Vacation supplies of Prescription Drugs (except under circumstances approved by us).• All newly marketed pharmaceuticals or currently marketed pharmaceuticals with a new

FDA approved indication for a period of one year from such FDA approval for its intended indication.

This insurance does not apply to the extent that trade or economic sanctions or regulation prohibit Us from providing insurance, including, but not limited to, the payment of claims.In addition, Critical Illness Benefits will not be paid for:• Injury or Sickness, other than one of the Covered Illnesses, even though such Injury or Sickness

may have been complicated by one of the Covered Illnesses;• The use, existence or escape of nuclear weapons, material or ionizing radiation from or

contamination by radioactivity from any nuclear fuel or waste from the combustion of nuclear fuel;

• Misuse of medication or the abuse of drugs or intoxicants;• Any Preexisting Condition, except where coverage has been in effect for a period of twelve (12)

consecutive months following the covered person’s effective date of coverage. “Preexisting Condition” means a Sickness suffered by a covered person for which he or she sought or received medical advice, consultation, investigation, or diagnosis, or for which treatment was required or recommended by a Doctor during the 12 months immediately prior to the covered person’s effective date of coverage, that directly or indirectly causes the condition to occur within the first 12 months from the covered person’s most recent effective date of coverage.

Administered by:


CriticalMed Plans



August 5, 2011 12:48 PM

CriticalMed Plans

CRITICALMED $15,000

CRITICALMED $25,000

CRITICALMED $50,000

INPATIENT

Hospital Confinement benefit amount per day $1,000 x 10 days $1,500 x 10 days $2,000 x 20 days

Additional ICU benefit amount per day $1,000 x 5 days $1,000 x 10 days $1,000 x 10 days

OUTPATIENT ACCIDENT ONLY COVERAGE

Benefit maximum, per year up to $15,000 $25,000 $50,000

-Benefit % payable 80% 80% 80%

-Deductible per year $1,500 $2,500 $5,000

Accidental Death and Dismemberment$15,000 Employee

$5,000 Spouse$1,000 Child(ren)

$25,000 Employee$10,000 Spouse

$1,000 Child(ren)

$50,000 Employee$10,000 Spouse

$1,000 Child(ren)

CRITICAL ILLNESS

Benefit Maximum $15,000 $25,000 $50,000

-Payable for 10 conditions:Cancer, Heart Attack, Renal Failure, Stroke, Major Organ Transplant, Multiple Sclerosis, Coronary Artery Bypass Surgery, Alzheimer’s, ALS, Terminal Illness.

OTHER SERVICES (1)

Care24: EAP and Nurseline YES YES YES

PHCS PPO Discounts YES YES YES

MONTHLY RATES

Employee $104.10 $143.51 $204.03

Employee +1 $223.74 $304.82 $432.68

Family $318.85 $437.35 $618.23(1) This service is not insurance and is not provided by ACE American Insurance Company.

CriticalMed is a buy-up option for employees enrolled in HealthSelect who are looking for enhanced coverage for catastrophic events. OR, a stand-alone option (instead of HealthSelect) for employees who are willing to self-pay their day-to-day medical expenses because they are more concerned about major events.

BENEFIT DESCRIPTION

Outpatient Accident Only Medical Expense Benefit

We will pay benefits for medically necessary expenses that result directly from a covered accident. Initial treatment must begin within 72 hours of the accident and covered expenses must be incurred within 90 days after the accident. These benefits are subject to the Deductibles, Coinsurance Rates, Co-Payments, Benefit Periods, Benefit Maximums and other terms or limits, if any, shown in the Schedule of Benefits. Covered expenses include medical services and supplies, emergency care, ambulance expenses, treatment of an injured tooth, prescription drugs andrehabilitative braces or appliances prescribed by a doctor.

Hospital Confinement Benefit We will pay benefits if a covered person is confined in a hospital because of a covered injury or illness for at least 24 consecutive hours.

Critical Illness

Payable for 10 conditions: Cancer, Heart Attack, Renal Failure, Stroke, Major Organ Transplant, Multiple Sclerosis, Coronary Artery Bypass Surgery, Alzheimer’s, ALS, Terminal Illness. After coverage has been in effect for 90 days or more, if an employee is then diagnosed with any of the conditions listed in the schedule of benefits, we will pay the amount shown in the Schedule of Benefits for this benefit. The covered person must be under 65 years of age and survive for a period of one-hundred-eighty (180) days after diagnosis of Multiple Sclerosis. The covered person must be under 65 years of age and must survive for a period of thirty (30) days after diagnosis for any other covered illness. We will pay this benefit only once regardless of whether the covered person is diagnosed with more than one of the covered illnesses.

Accidental Death and Dismemberment Benefit

If a covered person suffers a loss within 365 days of a covered accident we will pay the percentage of the principal sum shown opposite that loss. If multiple losses occur, only one benefit amount, the largest, will be paid for all losses due to the same covered accident.

Value-added benefits are included with the CriticalMed Plan.These benefits are not insurance and are not provided by ACE American Insurance Group.

PPO NetworksPrescription Discount Card

Access to Network discounts at over 568,000 participating PHCS Network physicians and hospitals. Save on brand name and generic prescription drugs at over 45,000 participating ScriptSave pharmacies

Nurseline and EAP

OptumHealth Care24 provides a toll-free, 24/7/365 Nurseline which provides an immediate and reliable source for non-emergency health information and confidential medical counseling for emotional and personal challenges. Includes 3 face-to-face counseling visits per condition.



August 5, 2011 12:48 PM

Glossary of Terms

The following definitions apply to the 10 payable conditions for the Critical Illness benefit:

“Cancer” means a malignant tumor characterized by the uncontrolled growth and spread of malignant cells and invasion of tissue. This includes Leukemia, Hodgkin’s Disease and invasive melanoma, but does not include:

1. non-invasive carcinoma in situ;2. Kaposi’s Sarcoma or other AIDS related cancers and cancer in the presence of Human Immunodeficiency Virus (HIV);3. Skin cancer or melanoma that is not invasive and has not exceeded .75 millimeters in depth; or4. early Prostate cancer diagnosed as T1NOMO or equivalent staging.

A Doctor certified as an Oncologist must confirm the diagnosis in writing. No coverage is provided if any symptom or medical problem which initiated the investigation leading to a diagnosis of Cancer commenced within 90 days following the effective date of coverage. In the event of any diagnosis based on such a symptom or medical problem, insurance for that covered person will terminate, and Our sole liability with respect to this benefit will be limited to a refund of premiums paid since the effective date.

“Heart Attack” means the death of a portion of heart muscle as a result of inadequate blood supply to the relevant area. Diagnosis must be confirmed in writing by a Doctor who is a certified cardiologist and should be based on new electrocardiograph changes consistent with heart attack as well as an elevation in cardiac enzyme levels.

“Renal Failure” or “Kidney Failure” means end-stage renal disease due to chronic irreversible failure of both kidneys’ ability to function, requiring the covered person to undergo regular hemodialysis, peritoneal dialysis, or renal transplantation. A Doctor who is certified in Nephrology must confirm the diagnosis in writing.

“Stroke” means that the covered person has suffered a cerebrovascular incident, excluding transient ischemic attack (TIA), producing infarction of brain tissue due to thrombosis, hemorrhage from an intracranial vessel or embolization caused by an extracranial source. There must be evidence of measurable permanent neurological deficit persisting for 30 consecutive days, supported by evidence that the deficit is resulting from the Stroke,confirmed in writing by a Doctor who is certified as a neurologist.

“Major Organ Transplant” means a surgery, as the recipient, for transplantation of any of the following organs or tissues: 1) heart2) liver3) lung4) kidney5) bone marrow.

“Multiple Sclerosis” means unequivocal diagnosis by a consulting Doctor who is a certified neurologist of a definite diagnosis of Multiple Sclerosis producing at least two episodes of well-defined neurological abnormalities lasting for a continuous period of at least 180 days and resulting in measurable disability. For a Covered Person diagnosed with Multiple Sclerosis, he or she must survive for a period of 180 days after diagnosis by a Doctor. The diagnosis must be supported by modern imaging techniques.

“Coronary Artery Bypass Surgery” means heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass grafts, excluding:1) non-surgical techniques such as balloon angioplasty;2) laser embolectomy; and3) other non-bypass techniques.

“Alzheimer’s Disease” means a degenerative brain disease of unknown cause that is the most common form of dementia. Memory impairment is a necessary feature for the diagnosis of this type of dementia. Change in one of the following areas must also be present: language, decision-making ability, judgment, attention, and other areas of mental function and personality. It results in a profound intellectual decline characterized by dementia and personal helplessness, and is marked histologically by the degeneration of brain neurons especially in the cerebral cortex and by the presence of neurofibrillary tangles and plaques containing betaamyloid.

“Lou Gehrig’s Disease” means amyotrophic lateral sclerosis (ALS), a rare fatal progressive degenerative disease that affects pyramidal motor neurons and is characterized by increasing and spreading muscular disease.

“Terminal Illness” means a Covered Person has a prognosis of twelve months or less to live, as diagnosed by a Doctor. For the purposes of determining the existence of a Terminal Illness, We will require that the Covered Person submit the following proof:

1) a written diagnosis and prognosis by two Doctors licensed to practice in the United States; and2) Supportive evidence satisfactory to Us, including but not limited to, radiological, histological or laboratory reports documenting the Terminal Illness.

Administered by:


Dental Benefits



August 5, 2011 12:48 PM

Ameritas Group Dental

Rates are guaranteed for 12 months following the effective association launch date and include Orthodontia if part of plan design.Rates include ID cards mailed to members home address.PLEASE NOTE: Rates assume enrollment in our electronic certificate (eCert) programContact your benefits administrator for details regarding these states.

COINSURANCE BASE PLAN BUY-UP PLAN

Type 1: 100% 100%

Type 2: 80% 80%

Type 3: 50% 50%

DEDUCTIBLE $75 per cal yr - Waived Type 1 (No Family Maximum)

MAXIMUM PER PERSON $1,000 per cal yr $2,000 per cal yr

PPO www.ameritasgroup.com/resources/419.asp

ALLOWANCE Type 1, 2, & 3 : 80th % of Usual and Customary

DENTAL REWARDS Dental Rewards is a program that if benefits used are less than $500 for the year then a $250 carryover will be awarded to your annual benefits maximum

WAITING PERIOD 3 months - Type 2 procedures & 6 months - Type 3 procedures (All Plan Members)

ORTHODONTIA SUMMARY Allowance All Plan Designs: In Network, discounted fee. Out of Network, U&C.

Coinsurance: 50%

Coverage for Adults: No

Lifetime Max: $1,000 per person

Waiting Period: 12 Months (All Plan Members)

TYPE 1: PROCEDURE (FREQUENCY)

Routine Exam (1 in 6 months) Bitewing X-rays (1 in 12 months)

Full Mouth/Panoramic X-rays (1 in 5 years) Periapical X-rays

Cleaning (1 in 6 months) Fluoride for Children 13 & under (1 per benefit period)

Routine Exam (1 in 6 months) Bitewing X-rays (1 in 12 months)

Full Mouth/Panoramic X-rays (1 in 5 years) Periapical X-rays

Cleaning (1 in 6 months) Fluoride for Children 13 & under (1 per benefit period)


Sealants (age 13 and under) Restorative Amalgams

Restorative Composites Denture Repair

Simple Extractions

Sealants (age 13 and under) Restorative Amalgams

Restorative Composites Denture Repair

Simple Extractions


Space Maintainers Onlays

Crowns (1 in 10 years per tooth) Crown Repair

Endodontics (nonsurgical) Endodontics (surgical)

Periodontics (nonsurgical) Periodontics (surgical)

Prosthodontics (1 in 10 years) (fixed bridge; removable complete/partial dentures)

Complete Extractions Anesthesia

Space Maintainers Onlays

Crowns (1 in 10 years per tooth) Crown Repair

Endodontics (nonsurgical) Endodontics (surgical)

Periodontics (nonsurgical) Periodontics (surgical)

Prosthodontics (1 in 10 years) (fixed bridge; removable complete/partial dentures)

Complete Extractions Anesthesia

MONTHLY RATE WITH ORTHODONTIA

AREA 1 AR, AL, IN, KY, LA, MO, MS, MT, ND, NC, NE, NM, OH, OK, SC, TN, UT, WV Not Approved in: NY, NH

Member Member + 1 Dependent

Member + 2 or More

$31.72 $60.32 $95.72

$36.16 $67.88

$105.56

AREA 2 AZ, CO, DC, DE, GA, ID, IL, KS, MD, ME, MI, MN, NV, OR, PA, RI, TX, VA, WI, WY Not Approved in: NY, NH


Member + 2 or More

$38.80 $76.08

$125.24

$45.76 $88.72

$143.80

AREA 3 AK, CA, CT, FL, HI, MA, NJ, WA, VT Not Approved in: NY, NH


Member + 2 or More

$47.52 $92.52

$150.28

$58.12 $111.56 $177.56

Administered by:


EyeMed Vision Benefits



August 5, 2011 12:48 PM

EyeMed Vision Benefits

EYEMED ACCESS NETWORK OUT OF NETWORK

Annual Eye Exam Covered in Full Up to $35

LENSES (PER PAIR)

Single Vision Covered in Full Up to $25

Bifocal Covered in Full Up to $40

Trifocal Covered in Full Up to $55

Lenticular 20% discount No Benefit

Progressive See lens options N/A

Frames $130 Up to $65

Frequencies (Exam/Lens/Frames) 12/12/24 Based on date of service 12/12/24 Based on date of service

DEDUCTIBLE, MAXIMUMS

Deductible $10 Exam/$25 Eye Glass Lenses No Deductible

Max Cal Yr None None

CONTACT LENSES

Fit & Follow up Exams Standard: Member cost up to $55 Premium: 10% off of retail

No Benefit No Benefit

CONTACTS

Elective Up to $130 Up to $104

Medically Necessary Covered in Full Up to $200

Progressive LensesStandard: $65 + lens deductible

Premium: Lens cost - 20% discount - $120 allowance + Standard Progressive cost

Up to $35

Std. Polycarbonate $40 No Benefit

Scratch Resistant Coating $15 No Benefit

Anti-Reflective Coating $45 No Benefit

Ultraviolet Coating $15 No Benefit

LASIK or PRKAverage discount of 15% off retail price or 5%

off promotional price at US Laser Network participating providers.

No Benefit

RATES

Member $7.72

Member + 1 Dependent $13.76

Member + 2 Dependent $18.60

Rates are guaranteed for 24 months following the effective date listed above. Rates include: home address mailing.PLEASE NOTE: Rates assume enrollment in our electronic certificate (eCert) program. If you choose to receive paper certificates, monthly rates will increase $.20 per member.The EyeMed Vision Benefit is not approved in NY or NH.

Administered by:


SBU Multiple Employer 401(k) Plan

6300 Bridge Point Parkway | Building One, Suite 480 | Austin, Texas 78730 | 512.279.5600 main | 512.279.4720 fax

If you are paying more than $600 per year in administration fees for your company retirement plan, you are paying too much. The SBU Multiple Employer 401(k) Plan offers participating companies a way to lower retirement plan costs and off-load much of the administrative and fiduciary responsibility associated with being the sponsor of a retirement plan.

The Multiple Employer Plan (MEP) is a qualified, defined contribution retirement plan solution that is designed to allow you to offer your employees access to a retirement plan savings ve-hicle that has all the bells and whistles of a Fortune 500 company 401(k). This plan also allows you, the employer, the opportunity to customize your plan design to meet the needs of your company. Attached please find a sample of the fund line up as well as a guide to understanding the potential cost savings and benefits of adopting into our Multiple Employer Plan.

Through SBU you are able to access ‘large plan’ service and pricing. With our Advisor at WD Financial, we are able to present the best mix of full plan services, plan participant education, investment options, and Plan Fiduciary Support. By utilizing the Small Business United MEP, you are getting a full, turn-key plan with minimal responsibilities and cost to your company. TransAmerica Retirement Services provides the 401(k) MEP platform and boasts more than 70 years of experience in the retirement services business. TransAmerica is a top provider, includ-ing eight years serving Multiple Employer Plans.

I would like to introduce Matthew Headley of WD Financial, who is an Accredited Investment Fiduciary® and Retirement Plan Consultant we have chosen to represent our client interests on the Multiple Employer Plan (MEP). He can be reached at [email protected] or by phone at 512-422-1171 (mobile) or 512-279-5608 (office).

Sincerely,

Small Business UnitedMultiple Employer 401(k) PlanAre you paying too much for your company retirement plan?

Tom NewbyPresident, Small Business United/ETMG

22 of 30



August 5, 2011 12:48 PM

Contact Information

[email protected]

Plan Advisor

Plan Consultant Matthew Headley- AIF®

What are the Potential Cost Savings Benefits of Adopting the SBU MEP as your Retirement Plan?

There are many benefits for your business to adopt a retirement plan through the SBU MEP, including: • Potential cost savings compared to operating a single employer plan on your own • Fiduciary support • Plan design flexibility • Reward tool for top performers • Access to more investment choices • Strong participant education support • Business tax deductions • Employee retention and recuitment • And many more

Presented by


What is a Multiple Employer Plan?

A Multiple Employer Plan, also referred to as an MEP, is a retirement plan for businesses that typically have a common interest, but that are not commonly owned or affiliated. Businesses that have retirement plans as well as businesses that want to begin a retirement plan are eligible to be a part of the Small Business United MEP. When your business elects to join the SBU Multiple Employer 401(k) Plan, you will be referred to as an “Adopting Employer”.



August 5, 2011 12:48 PM

Power • Choice • Freedom

Three Professional Companies, One Dynamic Opportunity.

Small Business United has taken the hassle out of retirement plans for SBU member companies with retirement plans and for those who would like to start one. As the sponsor of the plan, SBU holds the master document and is responsible for the annual Form 5500, the annual audit, plan testing, investment line-up, and most of the ad-ministrative and fiduciary responsibility normally accepted by a plan sponsor. As an adopting empoyer, you have the best of all worlds: lower costs and less administrative and fiduciary headaches with more services, resources, and support, as well as a plan you can customize to your individual business needs.


The Strengths of this Plan:

Cost Savings— One of the most compelling benefits your business may realize by adopting an MEP is the cost savings.

People – Our Retirement Plan Professionals are passionate, well-educated experts who are dedicated to providing a better alternative than you might find on your own.

Innovation – Plan services that can adapt to your business needs and provide the tools, resources, and services to support the plan you offer to employees.

Reliability – Commitment to quality that is measurable with attention to continuous improvement. TransAmerica has more than 200 Multiple Employer Plan Sponsors with over 6,000 Adopting Employers with a retention rate of 99%.

Expertise – Our experts allow you to focus on your business. We keep you informed, knowledgable, and in compli-ance, so you can make wise decisions for your plan.

Ongoing Plan Communication – Bilingual plan education and enrollment services provide a positive landscape for the future of your plan and participants. • An award-winning plan sponsor and participant website at www.TA-Retirement.com • Easy to understand quarterly plan statements• A customized annual plan review• The Recover Plan by TransAmerica helps your employees get back on track• Plan enrollment resources including an online enrollment option for participants• Plan performance monitoring

Let us help you distinguish your company with a retirement plan solution designed to deliver the power, choice, and freedom to change the future landscape of your business and employees.



August 5, 2011 12:48 PM

Plan Pricing and Service Fee Schedule

Installation Fees (Per Adopting Employer)Installation Fee: $100Annual SBU Association Fee: $500

Annual Record Keeping Fees: Fees are for routine/customary recordkeeping services. The Annual Recordkeping fees below are subject to a minimum Annual Recordkeeping Fee of $0 for each adopting employer.


NUMBER OF PARTICIPATING ADOPTING EMPLOYERS ANNUAL CHARGE PER PARTICIPANT

0+ $38

ADDITIONAL PARTICIPANT SERVICES

Distributions $50 per distribution

Distributions paid in installments $10 per installment

Loan setup $50 per loan

Annual loan maintenance $50 per loan

ENROLLMENT SERVICES

Enrollment via teleconference No Charge

Employer Enrollment Guide No Charge

Enrollment Kits No Charge

ENROLLMENT WORKSHOPS (PARTICIPATING EMPLOYER LEVEL)

Total Number of Participants in Attendance Number of Free Enrollment Days Charge

10-49 1 $0

50-74 2 $0

75-99 3 $0

100-124 4 $0

125-149 5 $0

More than 149 Negotiable Negotiable

Charge for fewer than 10 attendees during an enrollment day $300

Charge for days of enrollment in excess of free days given $300

An enrollment day is defined as 1 enroller conducting a maximum of 5 meetings in that day.

TransAmerica Financial Life Insurance Company offers a group annuity contract to Multiple Employer Plans that sponsor a multiple employer plan for their adopting employers. This is only a summary of some of the important terms and conditions of the contract issued to the plan trustee of the MEP. The terms of the contract are controlling.

This product is available under form number TA-AP-2001-CONT, a group variable annuity contract underwritten by Transamerica Financial Life Insurance Company.

Administered by:


Individual(k) Retirement Plan



August 5, 2011 12:48 PM

Individual(k) Retirement Plan

Individual(k): A BIG PLAN for a SMALL BUSINESSIndividual(k) provides business owners with the same advantages of larger 401(k)

plans—without the extensive administrative responsibilities, complex discrimination tests

and associated costs. And when compared with other small business retirement plans,

Individual(k)s are uniquely positioned to help clients save, protect and grow their assets.

888-SBUA-INS (888-728-2467)

Licensed Benefit Solution SpecialistsAvailable from 8am - 5pm (CST).

An Individual(k) plan is a cost-effective 401(k)/profit sharing plan

for small business owners. This type of retirement plan provides

a number of substantial benefits that are not generally available

through traditional small business retirement plans. Designed

exclusively for owner-only businesses and small businesses that can

exclude certain employees from coverage, the Individual(k) plan has

many advantages over conventional 401(k) plans that are typically

sponsored by companies with multiple employees. The Individual(k)

plan is designed to maximize contributions, but to be less complex

and less costly to maintain than the conventional 401(k) plan.

Reasons to look at an Individual(k) Retirement Plan

• Tax Advantages• Higher Contributions• Loan Provisions• Roth Capabilities• Low Cost• Simplified Plan Administration

The Individual(k) plan will be available through SBU & Summit beginning February 1, 2011.

How Individual(k)s WorkThe law changes that made the Individual(k) plan possible did not explicitly create a completely new type of

business retirement plan. Instead, what the new laws did was make a number of changes to the rules governing

401(k) plans that made them more attractive to certain small business owners. Prior to the passage of pension

reform, there was no practical reason to use a 401(k) plan for an owner-only business since they could receive the

same or greater benefits with less expense by establishing a profit sharing or money purchase plan. However, there

are some very compelling reasons for certain small business owners to consider Individual(k) plans, chief among

them, to maximize retirement savings.

Individual(k) Plan Cost Installation and Plan Setup Fee $125 for daily valued/$75 for traditional valued

Annual Fee $315 for the first participant account $150 for each additional participant.

Self-employed who are Good Candidates for an I(k) include:

Lawyers & Doctors with their own practices Real Estate Agents Clergy FREELANCE Writers or Graphic Designers Interior designers Consultants Plumbers Accountants CONTRACTORS Photographers

Administered by:


Long Term Care Insurance



August 5, 2011 12:48 PM

Long Term Care Insurance

Help Secure your future by planning aheadLong-term care refers to a variety of services and

supports that help you with health of personal care

needs over an extended period of time.

When might you need long-term care?

You may need long-term care if you:

• Develop a prolonged or chronic illness.• Sustain a serious injury or disability.• Develop a cognitive impairment that causes

memory loss or disorientation, such as Alzheimer’s.• Need assistance due to the normal frailties of aging.

There are several types of Long-Term Care“Skilled care” refers to care given by medical personnel, such as a registered nurse or professional therapist. It requires a physician-prescribed plan of care. “Personal care” focuses on helping with your activities of daily living. It is less involved and may be provided by trained professionals or even a family member.

It isn’t just for the elderly?Most of us think of long-term care as being only for the elderly and those in nursing homes, but that’s only part of the story. Forty percent of people currently receiving long-term care services are adults under the age of 65. And, most people receive long-term care services either in their own home, or in the home of a family member—not in a nursing home.

Anyone could need help with everyday Routines.The fact is, anyone at any age may need long-term care at some point in their lives. If you sustain an extensive injury or go through a prolonged illness, you may need help with your normal daily activities, such as bathing, getting dressed, or just getting around the house. If you become cognitively impaired, you may need help with meal preparation and eating, or reminders to take medications, or other kinds of support.

Understanding your need for long term care.Although these everyday activities may seem mundane, they are essential to maintaining your independence. Your ability, or inability, to perform these regular activities of daily living give long-term care professionals and those in the insurance industry a very practical measure to use when deciding if you need long-term care. Activities of daily living, often referred to as ADLs, include such regular activities as bathing, dressing, using the toilet, transferring to or from the bed or a chair, caring for incontinence, or eating.

It’s difficult to predict how long you may need care.You can’t predict the future, but these facts might give you an idea of how long you may need long-term care. On average, someone age 65 today will need some long-term care services for three years.

Your long term care needs may change overtime.The amount and type of long-term care services you need will often change gradually over time. For example, early on you may need only occasional help for a few activities of daily living, and may choose to receive that assistance in your own home. Over time, however, you may begin to require more regular assistance and choose to live in an assisted living center.

CALL TODAY! 1-877-YES-LTCI

43% of all claims for long-term care insurance benefits are from people under age 65.

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