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Your Company Your Logo 2013 Employee Benefit Guide

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A benefit guide is an excellent resource for employees that provides current plan year benefit information in a convenient booklet format. Available in hard-copy and digital.

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Page 1: Sample Benefit Guide

Your Company

Your Logo

2013 Employee Benefit Guide

Page 2: Sample Benefit Guide

Welcome to your 2012 Benefits! Our Open Enrollment period is from March 1st thru March 31st. Elections you make during open enrollment will become effective April 1st. iSi offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family.

Page 3: Sample Benefit Guide

Who is Eligible? If you are an iSi full-time employee (working 40 or more hours per week) you are eligible to enroll in the benefits described in this guide. Your dependents are eligible for benefits as well.

How to Enroll Open Enrollment: The first step is to review your current benefit elections. Verify your personal information and make any changes necessary to your benefit elections. New Hires: The first step is to review your available benefits outlined in this guide. Then, make your appropriate elections on the forms provided by your Human Resources department. Once you have made your elections, you will not be able to change them until the next open enrollment period unless you have a qualified change in status.

When to Enroll The open enrollment period runs from March 1st through March 31st. The benefits you elect during open enrollment will be effective from April 1st through March 31st. Non exempt employees are eligible for benefits the first of the month following 90 days of employment. You should complete your enrollment forms 15 days prior to your effective date. If your enrollment forms are not received within 15 days after your effective date you will not be able to enroll in company benefits until the next open enrollment period.

How to Make Changes Unless you have a qualified change in status, you cannot make changes to the benefits you elect until the next open enrollment period. Qualified changes in status include: marriage, divorce, legal separation, birth or adoption of a child, change in child’s dependent status, death of spouse, child or other qualified dependent, change in residence due to an employment transfer for you or your spouse, commencement or termination of adoption proceedings, or change in spouse’s benefits or employment status.

Page 4: Sample Benefit Guide

Contact Information Refer to this list when you need to contact one of your benefit vendors. A L L B E N E F I T S Shari Spaet, Account Manager [email protected] 913-754-5926 Gary Davis and Jeff Wipperman, Producers [email protected] [email protected] M E D I C A L Preferred Health Systems www.phsystems.com 1-800-990-0345 D E N T A L Delta Dental of Kansas www.deltadentalks.com 1-800-234-3375 V I S I O N EyeMed www.eyemedvision.com 1-866-268-4063 The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Guide was taken from various summary plan descriptions and benefit information. 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 Human Resources.

What’s Inside

Page 5: Sample Benefit Guide

iSi offers medical coverage for all eligible full-time employees with Preferred Health Systems. You are offered your choice from three different medical plan options. The group offers a triple option plan with varying premiums and deductibles. A detailed benefit summary for each plan is outlined on the following pages. A separate hand out includes your per payroll premium costs for each plan as well as your election form and enrollment forms to enroll and/or make any changes to enroll/terminate a dependent.

Medical Insurance

Page 6: Sample Benefit Guide

PHYSICIAN OFFICE VISITPCP office visit Specialist office visitOB/GYN services do not require a Referral Authorization

DEDUCTIBLE (per Benefit Period)IndividualFamily

COINSURANCEIndividualFamily

COINSURANCE MAXIMUMIndividual

Integrated Solutions, Inc.

At least two (2) family members must contribute toward the family Deductible. Thefollowing do not count toward meeting the Deductible: Copayments; penalties; chargesfor Non-Covered Services; or difference between the actual billed charges of a Non-Contracting Provider and Allowed Amounts.

20% of Allowed Amounts 40% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

(The portion of the Allowed Amount payable by the Member after the Deductible hasbeen met)

$1,000 $3,000

$40 Copayment 40% of Allowed Amounts

$500 $1,000$1,000 $2,000

PREFERRED PLUS OF KANSAS, INC.Point of Service

PLAN C500-20-1KSUMMARY OF BENEFITS

Benefit Period: Benefits accumulate from April 1 to March 31Preferred Health Systems is offering a Point of Service (POS) benefit plan through Preferred Plus of Kansas (PPK). To enroll for coverage in PPK,Employees and all covered Dependents must select a Primary Care Physician (PCP). When you or your Dependents are in need of Health CareServices, to receive the PCP Option benefit level, services must be provided or referred in advance by your PCP. Services which are not providedor referred by your PCP are covered at the Self-Referral Option benefit level. If the Physician or Provider does not contract with PPK to acceptour Allowed Amounts, you will be responsible for the difference between billed charges and Allowed Amounts in addition to the applicableDeductible and Coinsurance, which could be substantial. For Non-Covered Services or services that exceed a benefit maximum, theMember will be responsible for the entire billed charges of a Provider.

BENEFIT CATEGORYMEMBER RESPONSIBILITY

PCP OPTION SELF-REFERRAL OPTION

$20 Copayment 40% of Allowed Amounts

IndividualFamily

ANNUAL MAXIMUM ON ESSENTIAL BENEFITS

LIFETIME MAXIMUMPREVENTIVE CARE SERVICES

OUTPATIENT LAB Free Standing Outpatient Facility or in a Physician's OfficeOutpatient Hospital Services

OUTPATIENT X-RAY AND DIAGNOSTIC TESTINGMRI, CT SCANS, AND PET SCANS

MATERNITY CARE

Inpatient services

If the annual maximum benefit on Essential Benefits is exhausted, there will be noCoverage until the beginning of the following Benefit Period.

For other services, such as lab and x-ray, refer to the Outpatient Lab and Outpatient X-Ray and Diagnostic Testing sections.In order to receive the PCP Option level of benefits, services must be rendered by yourPCP or contracting OB/GYN (no referral required).

$1,000 penalty per non-emergency admission if services are not prior authorized.

Prenatal and Post Partum Office Visits $20 Copayment for the initial visit only

40% of Allowed Amounts

Subject to Inpatient Benefits 40% of Allowed Amounts

20% of Allowed Amounts 40% of Allowed Amounts

INPATIENT BENEFITS (Semi-Private Room, ICU, SNU, Hospice) 20% of Allowed Amounts 40% of Allowed Amounts$1,000 penalty for use of non-contracting Hospital within the Service Area.

$2,000 $6,000

This annual maximum applies only to Essential Health Benefits as defined by Section1302(b) of the Patient Protection and Affordable Care Act. Essential Health Benefitsinclude the following benefit categories: ambulatory patient services, emergencyservices, hospitalizations, maternity and newborn care, mental health and substance usedisorder services, prescription drugs, rehabilitative and habilitative services and devices,laboratory services, preventive and wellness services and chronic disease management,and pediatric services (including oral and vision care).

$2,000,000

20% of Allowed Amounts 40% of Allowed Amounts

$0 Copayment 40% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

None

$1,000 $3,000

40% of Allowed Amounts unless otherwise noted

100% Coverage

POS 1293 11/10 1 POS C-E MM 1/11

OPTION 1

sspaet
Highlight
Page 7: Sample Benefit Guide

OUTPATIENT SURGERY

ALLERGY TREATMENT

Physician office visit Physical therapy

Services must be prior authorized by PPK

Some services must be prior authorized by PPK

Specialist office visit

EMERGENCY SERVICES

If admitted, emergency room Copayment will be waived and inpatient benefits will apply.$150 Copayment, plus 20%

of Allowed Amounts after the Deductible

Members may self-refer to Contracting Providers and receive services at the PCP Optionlevel of benefits.

There is no coverage for non-Emergency Medical Conditions treated in a Hospitalemergency room.

If you receive Emergency Services from a non-contracting Hospital within the ServiceArea under circumstances where you have the ability to determine when and where toseek such services, you will be responsible for the difference between the Provider'sbilled charges and Allowed Amounts. In situations where you require EmergencyServices and have no control when or where such services are rendered, such services

ill b d h PCP O i l l d ill b ibl f h diff

$150 Copayment, plus 20% of Allowed Amounts after

the Deductible

Emergency Room

PCP office visit $20 Copayment 40% of Allowed Amounts

Urgent Care Facility $40 Copayment $40 Copayment

$20 Copayment 40% of Allowed AmountsThis benefit includes intensive outpatient programs and partial day hospitalization.

Coverage outside the Service Area for Dependent children is limited to Physician officevisits (including medically necessary lab and x-ray services), allergy shots, allergytreatment, and physical therapy. Services must be received from Contracting Providers,referred by the Dependent's PCP, and prior authorized by PPK. This benefit does notinclude preventive services such as routine physical exams and immunizations. All otherCovered Services received outside the Service Area are subject to the Self-ReferralOption level of benefits.INPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE Subject to Inpatient Benefits 40% of Allowed Amounts

$1,000 penalty per non-emergency admission if services are not prior authorized.OUTPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE

DEPENDENT CHILDREN OUT OF AREA CARE$40 Copayment 40% of Allowed Amounts$40 Copayment 40% of Allowed Amounts

20% of Allowed Amounts 40% of Allowed Amounts

$0 Copayment 40% of Allowed Amounts

Other services (e.g. lab, x-ray, anesthesia) are subject to applicable Copayments, Coinsurance and/or Deductible.

AMBULANCEDURABLE MEDICAL EQUIPMENTDISPOSABLE MEDICAL SUPPLIES

PCP office visit Specialist office visit

OUTPATIENT HOSPICE SERVICES

OUTPATIENT REHABILITATION

PCP office visit Specialist office visit

Coverage is provided following injuries, surgeries, or acute medical conditions.

PCP office visitSpecialist office visit

ORTHOTICS AND PROSTHETICS

(Speech, Physical, Occupational, Cardiac, and Pulmonary)$20 Copayment 40% of Allowed Amounts

INPATIENT REHABILITATION (Speech, Physical, Occupational)

$40 Copayment 40% of Allowed Amounts

$40 Copayment40% of Allowed Amounts40% of Allowed Amounts

SPINAL MANIPULATION SERVICES

20% of Allowed Amounts 40% of Allowed AmountsCoverage is limited to the original device unless repair and/or replacement is MedicallyNecessary.

$20 Copayment

Subject to Inpatient Benefits 40% of Allowed Amounts

INTRAVENOUS (IV) AND INJECTABLE MEDICATIONS 20% of Allowed Amounts 40% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

$40 Copayment 40% of Allowed Amounts

Inpatient services Subject to Inpatient Benefits 40% of Allowed AmountsHOME HEALTH CARE 20% of Allowed Amounts 40% of Allowed Amounts

Must be purchased from Contracting Providers and referred by your PCP. RECONSTRUCTIVE SURGERY FOLLOWING A MASTECTOMY

$20 Copayment 40% of Allowed Amounts

20% of Allowed Amounts

20% of Allowed Amounts 40% of Allowed AmountsDIABETIC EQUIPMENT AND SUPPLIES 20% of Allowed Amounts 40% of Allowed Amounts

20% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

will be covered at the PCP Option level and you will not be responsible for the differencebetween the Provider's billed charges and Allowed Amounts.

POS 1293 11/10 2 POS C-E MM 1/11

OPTION 1

Page 8: Sample Benefit Guide

PCP office visit Specialist office visit

TRANSPLANT SERVICESPCP office visit Specialist office visitInpatient services

PRESCRIPTION DRUGS

40% of Allowed Amounts

Subject to Inpatient Benefits 40% of Allowed Amounts

Mail Order Pharmacy: A 90-day supply, as specified by the quantity sufficient for a standard course of therapeutic treatment as defined by FDA guidelines.

34 day Supply:Tier 1A - Formulary - $3 CopaymentTier 1B - Formulary - $15 CopaymentTier 2 - Formulary - $30 Copayment

Tier 3 - Non-Formulary - $55 Copayment

90 day Supply:Tier 1A - Formulary - $7.50 Copayment

Tier 1B - Formulary - $37.50 CopaymentTier 2 - Formulary - $75 Copayment

Tier 3 - Non-Formulary - $137.50 Copayment

$20 Copayment 40% of Allowed Amounts$40 Copayment 40% of Allowed Amounts

$20 Copayment

Certain medications require Prior Authorization

Retail Pharmacy: A 34-day supply, as specified by the quantity sufficient for a standard course of therapeutic treatment as defined by FDA guidelines, or 100 unit doses, whichever is less.

Services for accidental injury to sound natural teeth will be covered up to a maximum of$1,000 of Allowed Amounts, if provided within twelve (12) months from the date ofinjury. This benefit maximum does not apply to Members under 18 years of age.

Some services require Prior Authorization by PPK. Prior Authorization is the process of PPK determining whether the Health Care Service is aCovered Service, Medically Necessary, and being rendered by Contracting Providers. Coverage is subject to eligibility and benefits remaining at thetime services are rendered. The Prior Authorization List is subject to change. An up-to-date Prior Authorization List can be found atwww.phsystems.com or by calling the Member Services department at 316-609-2390 or 1-800-660-8114 (outside Wichita).

Inpatient services

$40 Copayment 40% of Allowed AmountsSubject to Inpatient Benefits 40% of Allowed Amounts

Referral Process: In order to receive the PCP Option level of benefits, PPK Members are responsible for obtaining a Referral Authorization fromtheir PCP for all Health Care Services rendered outside his/her office except Emergency Services, obstetrical and gynecological care (from acontracting OB/GYN), and annual diabetic retinal eye exam. Contracting Providers must be utilized except for Emergency Services when you do nothave control over where such services are rendered. Mental health and substance abuse services do not require a PCP Referral Authorization;however, some services must be prior authorized by PPK.

ORAL SURGERY AND RELATED SERVICES

Basic Exclusions

This is a brief summary of the coverage available under this plan. It is not a legal document. The complete plan provisions, limitations,and exclusions are contained in the Certificate you will receive when you enroll.

Services of Non-Contracting Providers. *Services not medically necessary. *Cosmetic treatment/surgery. *Surgical treatment of obesity, medicalservices in conjunction with prescription weight loss therapy, and weight loss programs unless approved by PPK. *Experimental and investigationaltreatment. *Services for injuries or diseases related to employment and covered or required to be covered under a Workers Compensation program.*Services resulting from injuries related to the use of a motor vehicle which are covered or required to be covered under automobile insurance.*Duplication of benefits provided by Federal, State or local law. *Items not strictly to treat a medical condition.*Services or items for the convenienceof the Member or Provider. *Services or supplies related to an excluded service and subsequent complications.

PHS retains the right to adjust benefits as necessary to comply with changes in any federal or state law, statute or regulation, includingbut not limited to the federal Patient Protection and Affordable Care Act, as amended.

POS 1293 11/10 3 POS C-E MM 1/11

OPTION 1

Page 9: Sample Benefit Guide

PHYSICIAN OFFICE VISITPCP office visit Specialist office visitOB/GYN services do not require a Referral Authorization

DEDUCTIBLE (per Benefit Period)IndividualFamily

COINSURANCEIndividualFamily

COINSURANCE MAXIMUMIndividual

Integrated Solutions, Inc.

At least two (2) family members must contribute toward the family Deductible. Thefollowing do not count toward meeting the Deductible: Copayments; penalties; chargesfor Non-Covered Services; or difference between the actual billed charges of a Non-Contracting Provider and Allowed Amounts.

20% of Allowed Amounts 40% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

(The portion of the Allowed Amount payable by the Member after the Deductible hasbeen met)

$1,000 $3,000

$40 Copayment 40% of Allowed Amounts

$1,000 $2,000$2,000 $4,000

PREFERRED PLUS OF KANSAS, INC.Point of Service

PLAN C1000-20-1KSUMMARY OF BENEFITS

Benefit Period: Benefits accumulate from April 1 to March 31Preferred Health Systems is offering a Point of Service (POS) benefit plan through Preferred Plus of Kansas (PPK). To enroll for coverage in PPK,Employees and all covered Dependents must select a Primary Care Physician (PCP). When you or your Dependents are in need of Health CareServices, to receive the PCP Option benefit level, services must be provided or referred in advance by your PCP. Services which are not providedor referred by your PCP are covered at the Self-Referral Option benefit level. If the Physician or Provider does not contract with PPK to acceptour Allowed Amounts, you will be responsible for the difference between billed charges and Allowed Amounts in addition to the applicableDeductible and Coinsurance, which could be substantial. For Non-Covered Services or services that exceed a benefit maximum, theMember will be responsible for the entire billed charges of a Provider.

BENEFIT CATEGORYMEMBER RESPONSIBILITY

PCP OPTION SELF-REFERRAL OPTION

$20 Copayment 40% of Allowed Amounts

IndividualFamily

ANNUAL MAXIMUM ON ESSENTIAL BENEFITS

LIFETIME MAXIMUMPREVENTIVE CARE SERVICES

OUTPATIENT LAB Free Standing Outpatient Facility or in a Physician's OfficeOutpatient Hospital Services

OUTPATIENT X-RAY AND DIAGNOSTIC TESTINGMRI, CT SCANS, AND PET SCANS

MATERNITY CARE

Inpatient services

If the annual maximum benefit on Essential Benefits is exhausted, there will be noCoverage until the beginning of the following Benefit Period.

For other services, such as lab and x-ray, refer to the Outpatient Lab and Outpatient X-Ray and Diagnostic Testing sections.In order to receive the PCP Option level of benefits, services must be rendered by yourPCP or contracting OB/GYN (no referral required).

$1,000 penalty per non-emergency admission if services are not prior authorized.

Prenatal and Post Partum Office Visits $20 Copayment for the initial visit only

40% of Allowed Amounts

Subject to Inpatient Benefits 40% of Allowed Amounts

20% of Allowed Amounts 40% of Allowed Amounts

INPATIENT BENEFITS (Semi-Private Room, ICU, SNU, Hospice) 20% of Allowed Amounts 40% of Allowed Amounts$1,000 penalty for use of non-contracting Hospital within the Service Area.

$2,000 $6,000

This annual maximum applies only to Essential Health Benefits as defined by Section1302(b) of the Patient Protection and Affordable Care Act. Essential Health Benefitsinclude the following benefit categories: ambulatory patient services, emergencyservices, hospitalizations, maternity and newborn care, mental health and substance usedisorder services, prescription drugs, rehabilitative and habilitative services and devices,laboratory services, preventive and wellness services and chronic disease management,and pediatric services (including oral and vision care).

$2,000,000

20% of Allowed Amounts 40% of Allowed Amounts

$0 Copayment 40% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

None

$1,000 $3,000

40% of Allowed Amounts unless otherwise noted

100% Coverage

POS 1293 11/10 1 POS C-E MM 1/11

OPTION 2

sspaet
Highlight
Page 10: Sample Benefit Guide

OUTPATIENT SURGERY

ALLERGY TREATMENT

Physician office visit Physical therapy

Services must be prior authorized by PPK

Some services must be prior authorized by PPK

Specialist office visit

EMERGENCY SERVICES

$150 Copayment, plus 20%

of Allowed Amounts after the Deductible

Members may self-refer to Contracting Providers and receive services at the PCP Optionlevel of benefits.

There is no coverage for non-Emergency Medical Conditions treated in a Hospitalemergency room.

If you receive Emergency Services from a non-contracting Hospital within the ServiceArea under circumstances where you have the ability to determine when and where toseek such services, you will be responsible for the difference between the Provider'sbilled charges and Allowed Amounts. In situations where you require EmergencyServices and have no control when or where such services are rendered, such services

ill b d h PCP O i l l d ill b ibl f h diff

$150 Copayment, plus 20% of Allowed Amounts after

the Deductible

Emergency Room

PCP office visit $20 Copayment 40% of Allowed Amounts

Urgent Care Facility $40 Copayment $40 Copayment

$20 Copayment 40% of Allowed AmountsThis benefit includes intensive outpatient programs and partial day hospitalization.

Coverage outside the Service Area for Dependent children is limited to Physician officevisits (including medically necessary lab and x-ray services), allergy shots, allergytreatment, and physical therapy. Services must be received from Contracting Providers,referred by the Dependent's PCP, and prior authorized by PPK. This benefit does notinclude preventive services such as routine physical exams and immunizations. All otherCovered Services received outside the Service Area are subject to the Self-ReferralOption level of benefits.INPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE Subject to Inpatient Benefits 40% of Allowed Amounts

$1,000 penalty per non-emergency admission if services are not prior authorized.OUTPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE

DEPENDENT CHILDREN OUT OF AREA CARE$40 Copayment 40% of Allowed Amounts$40 Copayment 40% of Allowed Amounts

20% of Allowed Amounts 40% of Allowed Amounts

$0 Copayment 40% of Allowed Amounts

Other services (e.g. lab, x-ray, anesthesia) are subject to applicable Copayments, Coinsurance and/or Deductible.

AMBULANCEDURABLE MEDICAL EQUIPMENTDISPOSABLE MEDICAL SUPPLIES

PCP office visit Specialist office visit

OUTPATIENT HOSPICE SERVICES

OUTPATIENT REHABILITATION

PCP office visit Specialist office visit

Coverage is provided following injuries, surgeries, or acute medical conditions.

PCP office visitSpecialist office visit

ORTHOTICS AND PROSTHETICS

(Speech, Physical, Occupational, Cardiac, and Pulmonary)$20 Copayment 40% of Allowed Amounts

INPATIENT REHABILITATION (Speech, Physical, Occupational)

$40 Copayment 40% of Allowed Amounts

$40 Copayment40% of Allowed Amounts40% of Allowed Amounts

SPINAL MANIPULATION SERVICES

20% of Allowed Amounts 40% of Allowed AmountsCoverage is limited to the original device unless repair and/or replacement is MedicallyNecessary.

$20 Copayment

Subject to Inpatient Benefits 40% of Allowed Amounts

INTRAVENOUS (IV) AND INJECTABLE MEDICATIONS 20% of Allowed Amounts 40% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

$40 Copayment 40% of Allowed Amounts

Inpatient services Subject to Inpatient Benefits 40% of Allowed AmountsHOME HEALTH CARE 20% of Allowed Amounts 40% of Allowed Amounts

Must be purchased from Contracting Providers and referred by your PCP. RECONSTRUCTIVE SURGERY FOLLOWING A MASTECTOMY

$20 Copayment 40% of Allowed Amounts

20% of Allowed Amounts

20% of Allowed Amounts 40% of Allowed AmountsDIABETIC EQUIPMENT AND SUPPLIES 20% of Allowed Amounts 40% of Allowed Amounts

20% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

will be covered at the PCP Option level and you will not be responsible for the differencebetween the Provider's billed charges and Allowed Amounts.

POS 1293 11/10 2 POS C-E MM 1/11

OPTION 2

Page 11: Sample Benefit Guide

PCP office visit Specialist office visit

TRANSPLANT SERVICESPCP office visit Specialist office visitInpatient services

PRESCRIPTION DRUGS

40% of Allowed Amounts

Subject to Inpatient Benefits 40% of Allowed Amounts

Mail Order Pharmacy: A 90-day supply, as specified by the quantity sufficient for a standard course of therapeutic treatment as defined by FDA guidelines.

34 day Supply:Tier 1A - Formulary - $3 CopaymentTier 1B - Formulary - $15 CopaymentTier 2 - Formulary - $30 Copayment

Tier 3 - Non-Formulary - $55 Copayment

90 day Supply:Tier 1A - Formulary - $7.50 Copayment

Tier 1B - Formulary - $37.50 CopaymentTier 2 - Formulary - $75 Copayment

Tier 3 - Non-Formulary - $137.50 Copayment

$20 Copayment 40% of Allowed Amounts$40 Copayment 40% of Allowed Amounts

$20 Copayment

Certain medications require Prior Authorization

Retail Pharmacy: A 34-day supply, as specified by the quantity sufficient for a standard course of therapeutic treatment as defined by FDA guidelines, or 100 unit doses, whichever is less.

Services for accidental injury to sound natural teeth will be covered up to a maximum of$1,000 of Allowed Amounts, if provided within twelve (12) months from the date ofinjury. This benefit maximum does not apply to Members under 18 years of age.

Some services require Prior Authorization by PPK. Prior Authorization is the process of PPK determining whether the Health Care Service is aCovered Service, Medically Necessary, and being rendered by Contracting Providers. Coverage is subject to eligibility and benefits remaining at thetime services are rendered. The Prior Authorization List is subject to change. An up-to-date Prior Authorization List can be found atwww.phsystems.com or by calling the Member Services department at 316-609-2390 or 1-800-660-8114 (outside Wichita).

Inpatient services

$40 Copayment 40% of Allowed AmountsSubject to Inpatient Benefits 40% of Allowed Amounts

Referral Process: In order to receive the PCP Option level of benefits, PPK Members are responsible for obtaining a Referral Authorization fromtheir PCP for all Health Care Services rendered outside his/her office except Emergency Services, obstetrical and gynecological care (from acontracting OB/GYN), and annual diabetic retinal eye exam. Contracting Providers must be utilized except for Emergency Services when you do nothave control over where such services are rendered. Mental health and substance abuse services do not require a PCP Referral Authorization;however, some services must be prior authorized by PPK.

ORAL SURGERY AND RELATED SERVICES

Basic Exclusions

This is a brief summary of the coverage available under this plan. It is not a legal document. The complete plan provisions, limitations,and exclusions are contained in the Certificate you will receive when you enroll.

Services of Non-Contracting Providers. *Services not medically necessary. *Cosmetic treatment/surgery. *Surgical treatment of obesity, medicalservices in conjunction with prescription weight loss therapy, and weight loss programs unless approved by PPK. *Experimental and investigationaltreatment. *Services for injuries or diseases related to employment and covered or required to be covered under a Workers Compensation program.*Services resulting from injuries related to the use of a motor vehicle which are covered or required to be covered under automobile insurance.*Duplication of benefits provided by Federal, State or local law. *Items not strictly to treat a medical condition.*Services or items for the convenienceof the Member or Provider. *Services or supplies related to an excluded service and subsequent complications.

PHS retains the right to adjust benefits as necessary to comply with changes in any federal or state law, statute or regulation, includingbut not limited to the federal Patient Protection and Affordable Care Act, as amended.

POS 1293 11/10 3 POS C-E MM 1/11

OPTION 2

Page 12: Sample Benefit Guide

PHYSICIAN OFFICE VISITPCP office visit Specialist office visitOB/GYN services do not require a Referral Authorization

DEDUCTIBLE (per Benefit Period)IndividualFamily

COINSURANCEIndividualFamily

COINSURANCE MAXIMUMIndividual

Integrated Solutions, Inc.

At least two (2) family members must contribute toward the family Deductible. Thefollowing do not count toward meeting the Deductible: Copayments; penalties; chargesfor Non-Covered Services; or difference between the actual billed charges of a Non-Contracting Provider and Allowed Amounts.

20% of Allowed Amounts 40% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

(The portion of the Allowed Amount payable by the Member after the Deductible hasbeen met)

$2,000 $3,000

$40 Copayment 40% of Allowed Amounts

$1,500 $3,000$3,000 $6,000

PREFERRED PLUS OF KANSAS, INC.Point of Service

PLAN C1500-20SUMMARY OF BENEFITS

Benefit Period: Benefits accumulate from April 1 to March 31Preferred Health Systems is offering a Point of Service (POS) benefit plan through Preferred Plus of Kansas (PPK). To enroll for coverage in PPK,Employees and all covered Dependents must select a Primary Care Physician (PCP). When you or your Dependents are in need of Health CareServices, to receive the PCP Option benefit level, services must be provided or referred in advance by your PCP. Services which are not providedor referred by your PCP are covered at the Self-Referral Option benefit level. If the Physician or Provider does not contract with PPK to acceptour Allowed Amounts, you will be responsible for the difference between billed charges and Allowed Amounts in addition to the applicableDeductible and Coinsurance, which could be substantial. For Non-Covered Services or services that exceed a benefit maximum, theMember will be responsible for the entire billed charges of a Provider.

BENEFIT CATEGORYMEMBER RESPONSIBILITY

PCP OPTION SELF-REFERRAL OPTION

$20 Copayment 40% of Allowed Amounts

IndividualFamily

ANNUAL MAXIMUM ON ESSENTIAL BENEFITS

LIFETIME MAXIMUMPREVENTIVE CARE SERVICES

OUTPATIENT LAB Free Standing Outpatient Facility or in a Physician's OfficeOutpatient Hospital Services

OUTPATIENT X-RAY AND DIAGNOSTIC TESTINGMRI, CT SCANS, AND PET SCANS

MATERNITY CARE

Inpatient services

If the annual maximum benefit on Essential Benefits is exhausted, there will be noCoverage until the beginning of the following Benefit Period.

For other services, such as lab and x-ray, refer to the Outpatient Lab and Outpatient X-Ray and Diagnostic Testing sections.In order to receive the PCP Option level of benefits, services must be rendered by yourPCP or contracting OB/GYN (no referral required).

$1,000 penalty per non-emergency admission if services are not prior authorized.

Prenatal and Post Partum Office Visits $20 Copayment for the initial visit only

40% of Allowed Amounts

Subject to Inpatient Benefits 40% of Allowed Amounts

20% of Allowed Amounts 40% of Allowed Amounts

INPATIENT BENEFITS (Semi-Private Room, ICU, SNU, Hospice) 20% of Allowed Amounts 40% of Allowed Amounts$1,000 penalty for use of non-contracting Hospital within the Service Area.

$4,000 $6,000

This annual maximum applies only to Essential Health Benefits as defined by Section1302(b) of the Patient Protection and Affordable Care Act. Essential Health Benefitsinclude the following benefit categories: ambulatory patient services, emergencyservices, hospitalizations, maternity and newborn care, mental health and substance usedisorder services, prescription drugs, rehabilitative and habilitative services and devices,laboratory services, preventive and wellness services and chronic disease management,and pediatric services (including oral and vision care).

$2,000,000

20% of Allowed Amounts 40% of Allowed Amounts

$0 Copayment 40% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

None

$2,000 $3,000

40% of Allowed Amounts unless otherwise noted

100% Coverage

POS 1293 11/10 1 POS C-E MM 1/11

OPTION 3

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OUTPATIENT SURGERY

ALLERGY TREATMENT

Physician office visit Physical therapy

Services must be prior authorized by PPK

Some services must be prior authorized by PPK

Specialist office visit

EMERGENCY SERVICES

$150 Copayment, plus 20%

of Allowed Amounts after the Deductible

Members may self-refer to Contracting Providers and receive services at the PCP Optionlevel of benefits.

There is no coverage for non-Emergency Medical Conditions treated in a Hospitalemergency room.

If you receive Emergency Services from a non-contracting Hospital within the ServiceArea under circumstances where you have the ability to determine when and where toseek such services, you will be responsible for the difference between the Provider'sbilled charges and Allowed Amounts. In situations where you require EmergencyServices and have no control when or where such services are rendered, such services

ill b d h PCP O i l l d ill b ibl f h diff

$150 Copayment, plus 20% of Allowed Amounts after

the Deductible

Emergency Room

PCP office visit $20 Copayment 40% of Allowed Amounts

Urgent Care Facility $40 Copayment $40 Copayment

$20 Copayment 40% of Allowed AmountsThis benefit includes intensive outpatient programs and partial day hospitalization.

Coverage outside the Service Area for Dependent children is limited to Physician officevisits (including medically necessary lab and x-ray services), allergy shots, allergytreatment, and physical therapy. Services must be received from Contracting Providers,referred by the Dependent's PCP, and prior authorized by PPK. This benefit does notinclude preventive services such as routine physical exams and immunizations. All otherCovered Services received outside the Service Area are subject to the Self-ReferralOption level of benefits.INPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE Subject to Inpatient Benefits 40% of Allowed Amounts

$1,000 penalty per non-emergency admission if services are not prior authorized.OUTPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE

DEPENDENT CHILDREN OUT OF AREA CARE$40 Copayment 40% of Allowed Amounts$40 Copayment 40% of Allowed Amounts

20% of Allowed Amounts 40% of Allowed Amounts

$0 Copayment 40% of Allowed Amounts

Other services (e.g. lab, x-ray, anesthesia) are subject to applicable Copayments, Coinsurance and/or Deductible.

AMBULANCEDURABLE MEDICAL EQUIPMENTDISPOSABLE MEDICAL SUPPLIES

PCP office visit Specialist office visit

OUTPATIENT HOSPICE SERVICES

OUTPATIENT REHABILITATION

PCP office visit Specialist office visit

Coverage is provided following injuries, surgeries, or acute medical conditions.

PCP office visitSpecialist office visit

ORTHOTICS AND PROSTHETICS

(Speech, Physical, Occupational, Cardiac, and Pulmonary)$20 Copayment 40% of Allowed Amounts

INPATIENT REHABILITATION (Speech, Physical, Occupational)

$40 Copayment 40% of Allowed Amounts

$40 Copayment40% of Allowed Amounts40% of Allowed Amounts

SPINAL MANIPULATION SERVICES

20% of Allowed Amounts 40% of Allowed AmountsCoverage is limited to the original device unless repair and/or replacement is MedicallyNecessary.

$20 Copayment

Subject to Inpatient Benefits 40% of Allowed Amounts

INTRAVENOUS (IV) AND INJECTABLE MEDICATIONS 20% of Allowed Amounts 40% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

$40 Copayment 40% of Allowed Amounts

Inpatient services Subject to Inpatient Benefits 40% of Allowed AmountsHOME HEALTH CARE 20% of Allowed Amounts 40% of Allowed Amounts

Must be purchased from Contracting Providers and referred by your PCP. RECONSTRUCTIVE SURGERY FOLLOWING A MASTECTOMY

$20 Copayment 40% of Allowed Amounts

20% of Allowed Amounts

20% of Allowed Amounts 40% of Allowed AmountsDIABETIC EQUIPMENT AND SUPPLIES 20% of Allowed Amounts 40% of Allowed Amounts

20% of Allowed Amounts20% of Allowed Amounts 40% of Allowed Amounts

will be covered at the PCP Option level and you will not be responsible for the differencebetween the Provider's billed charges and Allowed Amounts.

POS 1293 11/10 2 POS C-E MM 1/11

OPTION 3

Page 14: Sample Benefit Guide

PCP office visit Specialist office visit

TRANSPLANT SERVICESPCP office visit Specialist office visitInpatient services

PRESCRIPTION DRUGS

40% of Allowed Amounts

Subject to Inpatient Benefits 40% of Allowed Amounts

Mail Order Pharmacy: A 90-day supply, as specified by the quantity sufficient for a standard course of therapeutic treatment as defined by FDA guidelines.

34 day Supply:Tier 1A - Formulary - $3 CopaymentTier 1B - Formulary - $15 CopaymentTier 2 - Formulary - $30 Copayment

Tier 3 - Non-Formulary - $55 Copayment

90 day Supply:Tier 1A - Formulary - $7.50 Copayment

Tier 1B - Formulary - $37.50 CopaymentTier 2 - Formulary - $75 Copayment

Tier 3 - Non-Formulary - $137.50 Copayment

$20 Copayment 40% of Allowed Amounts$40 Copayment 40% of Allowed Amounts

$20 Copayment

Certain medications require Prior Authorization

Retail Pharmacy: A 34-day supply, as specified by the quantity sufficient for a standard course of therapeutic treatment as defined by FDA guidelines, or 100 unit doses, whichever is less.

Services for accidental injury to sound natural teeth will be covered up to a maximum of$1,000 of Allowed Amounts, if provided within twelve (12) months from the date ofinjury. This benefit maximum does not apply to Members under 18 years of age.

Some services require Prior Authorization by PPK. Prior Authorization is the process of PPK determining whether the Health Care Service is aCovered Service, Medically Necessary, and being rendered by Contracting Providers. Coverage is subject to eligibility and benefits remaining at thetime services are rendered. The Prior Authorization List is subject to change. An up-to-date Prior Authorization List can be found atwww.phsystems.com or by calling the Member Services department at 316-609-2390 or 1-800-660-8114 (outside Wichita).

Inpatient services

$40 Copayment 40% of Allowed AmountsSubject to Inpatient Benefits 40% of Allowed Amounts

Referral Process: In order to receive the PCP Option level of benefits, PPK Members are responsible for obtaining a Referral Authorization fromtheir PCP for all Health Care Services rendered outside his/her office except Emergency Services, obstetrical and gynecological care (from acontracting OB/GYN), and annual diabetic retinal eye exam. Contracting Providers must be utilized except for Emergency Services when you do nothave control over where such services are rendered. Mental health and substance abuse services do not require a PCP Referral Authorization;however, some services must be prior authorized by PPK.

ORAL SURGERY AND RELATED SERVICES

Basic Exclusions

This is a brief summary of the coverage available under this plan. It is not a legal document. The complete plan provisions, limitations,and exclusions are contained in the Certificate you will receive when you enroll.

Services of Non-Contracting Providers. *Services not medically necessary. *Cosmetic treatment/surgery. *Surgical treatment of obesity, medicalservices in conjunction with prescription weight loss therapy, and weight loss programs unless approved by PPK. *Experimental and investigationaltreatment. *Services for injuries or diseases related to employment and covered or required to be covered under a Workers Compensation program.*Services resulting from injuries related to the use of a motor vehicle which are covered or required to be covered under automobile insurance.*Duplication of benefits provided by Federal, State or local law. *Items not strictly to treat a medical condition.*Services or items for the convenienceof the Member or Provider. *Services or supplies related to an excluded service and subsequent complications.

PHS retains the right to adjust benefits as necessary to comply with changes in any federal or state law, statute or regulation, includingbut not limited to the federal Patient Protection and Affordable Care Act, as amended.

POS 1293 11/10 3 POS C-E MM 1/11

OPTION 3

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iSi provides full-time eligible employees dental coverage through Delta Dental of Kansas. A detailed benefit summary of your dental plan is outlined on the following pages. A separate hand out includes your payroll premium costs as well as your election form and enrollment forms to enroll and/or make any changes to enroll/terminate a dependent.

Dental Insurance

Page 17: Sample Benefit Guide

DIAGNOSTIC & PREVENTIVE (Not subject to deductible)

100% 100% 100% Diagnostic:

• Oral examinations – once each six (6) months.

100% 100% 100% Preventive: Provides for the following:• Prophylaxis (Cleanings) - once each six (6) months.

BASIC (S bj t t D d tibl )

Summary of Dental Plan BenefitsINTEGRATED SOLUTIONS

Group #52038

Effective for April 1, 2011

Benefit % Paid

Maximum Contract Benefit Per Person:

Delta Dental PPO

Non-participating

The Maximum Benefit for all Covered Services for each Enrollee in any one Contract Year is: One Thousand Five Hundred Dollars ($1,500.00).

Includes the following procedures necessary to evaluate existing dental conditions and the dental care required:

Diagnostic x-rays – bitewings once each six (6) months for dependents under age eighteen (18) and once each twelve (12) months for adults age eighteen (18) and over.Full mouth x-rays or panoramic x-rays – once each five (5) years.

Topical Fluoride – once each six (6) months for dependent children under age nineteen (19).

Space Maintainers – for dependent children under age fourteen (14) and only for premature loss of primary molars.

Sealants – once (1) per lifetime for dependent children under age sixteen (16) when applied only to permanent molars with no caries (decay) or restorations on the occlusal surface and with the occlusal surface intact.

Deductible LimitationsCoverage for diagnostic and preventive services is not subject to any deductible amount. For all

Delta Dental

Premier

BASIC (Subject to Deductible)

80% 80% 80% Ancillary:

80% 80% 80% Oral Surgery:

80% 80% 80%

80% 80% 80% Endodontics:

80% 80% 80% Periodontics:

MAJOR (Subject to Deductible)

50% 50% 50%

50% 50% 50% Prosthodontics:

ORTHODONTICS (Subject to Deductible)

None None None Orthodontics:

DD3-003 (12/01/10) 2/21/11 rg

other covered benefits, the Contract Year deductible is:

Provides for one (1) emergency examination per plan year by the Dentist for the relief of pain.

Provides for extractions and other oral surgery including pre and post-operative care.$25 x 3

Dependent AgesRegular Restorative:

Provides amalgam (silver) restorations; composite (white) resin restorations on anterior (front) teeth; and stainless steel crowns for dependents under age twelve (12). Dependents are covered to age

twenty-six (26). Includes procedures for root canal treatments and root canal fillings.

a. Includes procedures for the treatment of diseases of the tissues supporting the teeth. Periodontal maintenance, including evaluation, is counted towards the limitation for prophylaxis.

b. Surgical periodontal procedures.

Special Restorative:

When teeth cannot be restored with a filling material listed in Regular Restorative Dentistry, provides for individual crowns.

This is a summary of benefits only and does not bind Delta Dental of Kansas to any coverage. Please refer to the Description of Dental Care Coverage for complete coverage information, including exclusions and limitations. Coverage as described in the employer group’s Agreement to Provide Dental Benefits (contract) is binding on all parties and supersedes all other

written or oral communications.

Includes bridges, partial and complete dentures, including repairs and adjustments.

Orthodontic appliances and treatment.

Page 18: Sample Benefit Guide

Welcome to Delta Dental of Kansas

Delta Dental of Kansas is a member of Delta Dental Plans Association, the leading andlargest underwriter of group dental coverage in the United States. Together with youremployer, we have designed a dental benefit plan to help protect the oral health of you and your covered dependents. Regular preventive dental care not only reduces the costand the pain generally associated with extensive dental work, but a healthy mouthcontributes to the overall well-being of every person. You are free to go to any dentist of your choosing; however, there will be a difference inpayment if the dentist is not a participating dentist with Delta Dental. If you receiveservices from a non-participating dentist, your out-of-pocket expenses may well increase. It is to your advantage to choose a Delta Dental PPO or Delta Dental Premier dentist. You may realize the maximum savings by seeing a Delta Dental PPO dentist. Since nearly 4 out of 5 dentists do contract with Delta Dental, throughout the United States, the chances are excellent your dentist is already a member. If you have any questions aboutwhether your dentist participates as a Delta Dental PPO or Delta Dental Premier dentist, ask your dentist when making an appointment or contact the Customer Service staff at Delta Dental of Kansas by calling (316) 264-4511 or toll free (800) 234-3375. You may also access our network, nationwide, through our website at www.deltadentalks.com. It is our pleasure to be of service to you.

Provider Look-Up Assistance:

DD3-006 (12/01/10)

Welcome to Delta Dental of Kansas

Delta Dental of Kansas is a member of Delta Dental Plans Association, the leading andlargest underwriter of group dental coverage in the United States. Together with youremployer, we have designed a dental benefit plan to help protect the oral health of you and your covered dependents. Regular preventive dental care not only reduces the costand the pain generally associated with extensive dental work, but a healthy mouthcontributes to the overall well-being of every person. You are free to go to any dentist of your choosing; however, there will be a difference inpayment if the dentist is not a participating dentist with Delta Dental. If you receiveservices from a non-participating dentist, your out-of-pocket expenses may well increase. It is to your advantage to choose a Delta Dental PPO or Delta Dental Premier dentist. You may realize the maximum savings by seeing a Delta Dental PPO dentist. Since nearly 4 out of 5 dentists do contract with Delta Dental, throughout the United States, the chances are excellent your dentist is already a member. If you have any questions aboutwhether your dentist participates as a Delta Dental PPO or Delta Dental Premier dentist, ask your dentist when making an appointment or contact the Customer Service staff at Delta Dental of Kansas by calling (316) 264-4511 or toll free (800) 234-3375. You may also access our network, nationwide, through our website at www.deltadentalks.com. It is our pleasure to be of service to you.

Provider Look-Up Assistance: (800)-234-3375

or check out our website: www.deltadentalks.com

From our website, you can Check your eligibility and plan information Print yourself an ID card Locate a participating Delta Dental PPO or Delta Dental Premier dentist

anywhere in the United States Estimate your out-of-pocket dental care costs with the Flexible Spending

Account Estimator Learn about oral health and wellness

Page 19: Sample Benefit Guide

iSi is offering full-time eligible employees vision coverage through EyeMed Vision Care. A detailed benefit summary of your vision plan is outlined on the following pages. A separate hand out includes your per payroll premium costs as well as your election form and enrollment forms to enroll and/or make any changes to enroll/terminate a dependent.

Vision

Page 20: Sample Benefit Guide

JULY 2009OPEN ENROLLMENT ONLYBACK_2 SIDED BENEFIT ANNOUNCEMENTSIZE 8.5” x 11”100# GLOSS TEXT

Integrated Solutions, Inc. hasselected EyeMed as yourvision wellness program. Thisplan allows you to improveyour health through a routineeye exam, while saving youmoney on your eye carepurchases. The plan isavailable through thousands ofprovider locationsparticipating on the EyeMedSELECT network.

To see a list of participatingproviders near you, go towww.eyemedvisioncare.comand choose SELECT from theprovider locator dropdownbox. You can also call 1-866-268-4063.

Enroll today to take advantageof an affordable way to helpensure a lifetime of healthyvision.

Out-of-NetworkVision Care Services Member Cost ReimbursementExam with Dilation as Necessary $10 Copay Up to $35Exam Options:Standard Contact Lens Fit and Follow-up Up to $40 N/APremium Contact Lens Fit and Follow-up 10% off retail price N/AFrames $120 Allowance; 20% off balance over $120 Up to $48Standard Plastic Lenses:Single Vision $25 Copay Up to $25Bifocal $25 Copay Up to $40Trifocal $25 Copay Up to $60Standard Progressive $25, 80% of charge less $55 Allowance Up to $40Premium Progressive $25, 80% of charge less $55 Allowance Up to $40Lens Options (paid by the member and added to the base price of the lens):Tint (Solid and Gradient) 20% off retail N/AUV Treatment 20% off retail N/AStandard Plastic Scratch Coating 20% off retail N/AStandard Polycarbonate 20% off retail N/AStandard Anti-Reflective Coating 20% off retail N/AOther Add-Ons and Services 20% off Retail Price N/AContact Lenses (allowance covers materials only):Conventional $135 Allowance; 85% of balance over $135 Up to $95Disposables $135 Allowance;plus balance over $135 Up to $95Medically Necessary $0 Copay, Paid in Full Up to $200LASIK and PRK Vision Correction Procedures: 15% off retail price OR N/A

5% off promotional pricingAdditional Pairs BenefitMembers also receive a 40% discount off complete pair eyeglass purchase and 15% discount offconventional contact lenses once the funded benefit has been used.Frequency:Exam Once every 12 monthsFrames Once every 24 monthsStandard Plastic Lenses or Contact Lenses Once every 12 months

Additional Purchases and Out-of-Pocket DiscountMember will receive a 20% discount on remaining balance at Participating Providers beyond plan coverage; the discount does notapply to EyeMed's Providers' professional services or disposable contact lenses.Members also receive a 40% discount off complete pair eyeglass purchases and a 15% discount off conventional contact lensesonce the funded benefit has been used.Benefits are not provided for services or materials arising from: Orthoptic or vision training, subnormal vision aids and anyassociated supplemental testing; Aniseikonic lenses; Medical and/or surgical treatment of the eye, eyes or supporting structures;Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; safetyeyewear; Services provided as a result of any Workers’ Compensation law, or similar legislation, or required by anygovernmental agency or program whether federal, state or subdivisions thereof; Plano (non-prescription) lenses and/or contactlenses; Non-prescription sunglasses; Two pair of glasses in lieu of bifocals; Services or materials provided by any other groupbenefit plan providing vision care; Certain brand name Vision Materials in which the manufacturer imposes a no-discount policy;or Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials orderedbefore coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of suchorder. Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency whenVision Materials would next become available.Benefits may not be combined with any discount, promotional offering, or other group benefit plans. Standard/PremiumProgressive Lens not covered - fund as a Bifocal Lens. Standard Progressive Lens covered - fund Premium Progressive as a Standard.Underwriter Insured Plans are underwritten by Fidelity Security Life Insurance Company of Kansas City, Missouri, except in NewYork. Fidelity Security Life Policy Number VC-73/VC-74, form number M-9059. This is a snapshot of your benefits. The Certificateof Insurance is on file with your employer.

_________________________________________________________________________________________

INTEGRATED SOLUTIONS, INC.

Value Added Features:In addition to the health benefits your EyeMed program offers,members also enjoy additional,value-added features including:• Eye Care Supplies - Receive 20% off retail price for eye care supplies like cleaning cloths andsolutions purchased at network providers (not valid on doctor's services or contact lenses).

• Laser Vision Correction - Save 15% off the retail price or 5% off the promotional price for LASIKor PRK procedures.

• Replacement Contact Lens Purchases - Visit www.eyemedcontacts.com to order replacementcontact lenses for shipment to your home at less than retail price.

Page 21: Sample Benefit Guide

iSi offers a $15,000.00 basic term life insurance policy through Advance Insurance Company of Kansas at no cost to full-time eligible employees. This insurance includes accidental death and dismemberment coverage and accelerated benefits. Employees have the option of purchasing additional coverage, as well as coverage for their spouse and dependent children under age 23.

iSi offers employees the opportunity to purchase supplemental insurance through Aflac at a group rate, many of which are pre-tax. Employees have the opportunity to purchase the following additional coverage: Accident Insurance, Cancer Insurance, and Hospital Confinement Insurance.

Life and AD&D Insurance

Supplemental Insurance

Page 22: Sample Benefit Guide

Actions to take at Open or Initial Enrollment: Enroll or terminate individual and/or dependent coverage in the Medical plan. Enroll or terminate individual and/or dependent coverage in the Dental plan. Enroll or terminate individual and/or dependent coverage in the Vision plan. Speak with your AFLAC representative to review/change/or add benefits. Forms to be completed to enroll or make changes: PHS Medical Enrollment Form to enroll in the Medical plan. Delta Dental of Kansas Dental Enrollment Form to enroll in the Dental plan. EyeMed Enrollment Form to enroll in the Vision plan. Where do I find these forms? They are included in a separate handout and extras with Human Resources. When are the forms due and where do I return them? Open Enrollment: iSi has made no plan changes for the 2012 plan year. All your benefits will remain the same for the 2012 plan year unless you turn in a new election form and/or employee application. These forms are due by March 16th and must be returned to Human Resources. If you are keeping the same plan elections with the same covered dependents you will not be required to complete any new forms. New Employees: All forms are due no later than 15 days prior to your effective date. If your enrollment forms are not received within 15 days after your effective date you will not

be able to enroll in company benefits until the next open enrollment period. Who do I contact with questions? Contact Shari Spaet at Power Group (913-754-5926) with any questions you may have. Other Information: All elections/changes made at this time will remain the same for the plan year ending March 31st, 2013, unless you have a qualified change in status.

What you need to know to enroll

Page 23: Sample Benefit Guide

Other important information

401 K Plan

iSi offers a 401k Plan through Allen, Gibbs, and Houlik and AGH Wealth Advisors. The plan includes both pre-tax and Roth benefit options that aid employees in saving for their retirement. Through the plan, employees may designate an amount or percentage to be deducted from their pay. Employees may contribute as much as they wish within the legal boundaries. Employees are eligible to contribute their own funds immediately upon hire. Upon completing 1 year of service, with a minimum of 1,000 hours, iSi

will match $0.33 for every $1.00 contributed by employees up to 6% of pay, for a total contribution of 2% of pay. Match eligibility dates are January 1 and July 1 of each year. Each year iSi evaluates its contribution plan.

Holidays iSi grants holiday paid time off to regular, full-time employees. iSi observes the following holidays:

- New Year’s Day - Memorial Day - Independence Day - Labor Day - Thanksgiving Day - Day after Thanksgiving - ½ Day Christmas Eve - Christmas Day

If employees are required to work on a recognized holiday, they will be paid their holiday pay as well as wages at two times their straight-time rate for the hours worked. Employees are eligible for holiday pay after a 90-day waiting period.

Page 24: Sample Benefit Guide

Vacation iSi offers vacation to regular, full-time employees for rest, relaxation, and enjoyment. Employees begin accruing vacation immediately according to the following schedule.

Employees are eligible to take vacation after 1 year of employment

Years of Eligible Service Accrual per Pay Period Immediately 3.08 hours (10 days per year) After 5 years 4.62 hours (15 days per year) After 15 years 6.15 hours (20 days per year)

Sick Leave iSi provides paid sick leave benefits to all eligible employees for periods of temporary absence due to illness or injury. Employees begin accruing sick leave immediately at the rate of 0.92 hours per pay period (3 days per year).

Employees are eligible to take sick leave after 1 year of

employment

Tuition Reimbursement iSi supports employees who wish to continue their education. The Tuition Reimbursement Program is available to full-time employees who work at least 40 hours per week and have at least one year of continuous service. iSi will reimburse the cost of tuition for up to 12 credit hours per year to a cap of $2,000 per

employee per calendar year for courses taken from an accredited college or university, subject to the requirements of the program.

Page 25: Sample Benefit Guide

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