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2012: Enrollment Presentation

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1 2012: Enrollment Presentation
Welcome to the U.S. Renal Care Open Enrollment presentation. U.S. Renal Care believes in making an impact not only within our industry but also with our employees. 2012: Enrollment Presentation

2 Costs of Healthcare U.S. Renal Care costs are expected to average $8,918 per employee per year in At this rate, our costs will almost double in the next 5 years. This is simply not sustainable. This year U.S. Renal Care will spend over $8 million in medical benefits alone. That equates to $8,918 per employee. At the rate our costs keep rising, we will be spending close to $15 million by This is simply not sustainable.

3 Costs of Healthcare Nearly 1 in 3 adults has high blood pressure and does not know it Chronic diseases related to lifestyle or personal behavior account for 87% of total healthcare spending Heart disease is the #1 killer in the United States Tobacco use continues to be the leading cause of preventable death in the U.S. and can lead to serious illness, disability and decreased quality of life An estimated 66% of U.S. adults are either overweight or obese Approximately 87% of our claims are for lifestyle related illnesses such as obesity, high blood pressure, and diabetes. Simply being diagnosed with these conditions is not the cost driver. The cost driver is when following a diagnosis, the condition is not properly managed which results in unexpected expenses such as trips to the emergency room and/or diagnostic testing. It’s these unexpected expenses that are driving up our healthcare costs. As a healthcare company, we strive to provide caring, compassionate and quality healthcare services to our patients. This is also our goal for our employees; however, our increasing healthcare costs are putting us in a position to make significant changes in an effort to remain competitive. Beginning in 2012, you will see a strategic focus on wellness and chronic condition management. It’s only by maintaining our own health and properly managing our chronic conditions that we can begin to lower our healthcare costs and live a longer, healthy life. U.S. Renal Care is very interested in the health and well-being of its employees which is why we are investing in programs to keep you healthy and better manage chronic conditions.

4 one-half of our large claims.
What’s New in 2012? General: Spouses who have access to employer sponsored group coverage elsewhere are no longer allowed to participate in the USRC medical plans – regardless of the price or quality of the other coverage. A spousal affidavit will be required to enroll a spouse in a USRC medical plan Beginning January 1st 2012, spouses who have access to coverage at their own employer are no longer eligible to participate in the U.S. Renal Care medical plans. When we review our current claims, 18% of our claims are for spouses. If we want to keep costs as low as possible for our employees, spouses who have access to coverage through their own employer will be required to take that coverage – regardless of cost or quality. Employees who want to enroll a spouse for coverage will have to sign an affidavit confirming there is not coverage available elsewhere. USRC strives to keep healthcare costs as low as possible for its employees. Historically, spouses have accounted for 18% of our medical claims and one-half of our large claims.

5 What’s New in 2012? Medical: Pharmacy
Greater emphasis on wellness and chronic condition management A spousal affidavit will be required to enroll a spouse in a USRC medical plan Pharmacy Tobacco cessation drugs will be moved to Tier 1 of the formulary As we have stated in previous slides, U.S. Renal Care is investing heavily in programs and resources to help employees live a healthy and productive lifestyle. Part of this investment includes establishing a tobacco-free workplace. To help you stop using tobacco, we have moved tobacco cessation drugs, such as Chantix, to Tier 1 of our pharmacy formulary. This means you can purchase a tobacco cessation drug for the price of a generic. USRC will be launching additional wellness programs during 2012 so please watch your mailbox!

6 Benefit Costs – Who Pays for What?
Premium Taxation Medical U.S. Renal Care & You Pre-Tax Dental Vision You Basic Life Insurance U.S. Renal Care Pre-Tax* Supplemental Life and AD&D Insurance Post-Tax Employee Assistance Program N/A Short-Term Disability EE Portion – Post-Tax USRC Portion – Pre-Tax Long-Term Disability Flexible Spending Accounts U.S. Renal Care provides a large selection of benefits that help protect your health, wealth and well being. The company provides some benefits at no cost to you, some you pay for and other benefit costs are split between U.S. Renal Care and you. This mix and match benefits program helps you create the best program that fits your needs and your lifestyle. The benefits highlighted throughout this presentation are intended as a high-level overview. For additional details please refer to the plan’s Summary Plan Description. *Premium for coverage amounts over $50,000 are shown as imputed income on your W2

7 Medical Benefits U.S. Renal Care will offer two medical plans through Aetna POS II – traditional network-based plan that allows members to choose any healthcare provider POS II with Health Savings Account Plan – a high-deductible health plan with the added benefit of a Health Savings Account (HSA) Aetna Benefits POS II In Network POS II w/ HSA Annual Health Savings Account Single Family N/A $500 $1,000 Annual Deductible $3,000 $2,000 $4,000 Out-of-Pocket Maximum $9,000 $8,000 Office Visit PCP Specialist $30 $40 80% after deductible U.S. Renal Care offers the choice of two medical plans through Aetna: The POS plan is a network-based plan that allows members to choose any healthcare provider. You will have lower costs if you select an in-network provider. In an open access POS plan, you do not need to elect a primary care physician and you do not need a referral to seek specialized care. The POS with Health Savings Account, of HSA, is a high-deductible health plan that works the same as the POS Plan but includes the added benefit of a Health Savings Account. We will discuss how a Health Savings Account works further in this presentation.

8 POS II Plan A POS plan uses a network of providers
A lower level of coverage is provided for care received outside the network No “primary care physician” referral required to visit specialist Copay and coinsurance This plan offers increased benefits but costs more than the POS with HSA plan A POS Medical Plan provides access to both in-network and out-of-network providers. The plan offers office visit copays and as you need more comprehensive care, you will pay 20% of the costs after paying your deductible.

9 POS II Plan – Consider This…
Of the employees currently enrolled in the POS II plan single coverage Only 31% have reached single deductible ($1,000) Only 39% have paid $500 or greater toward their deductible 27% have paid less than $100 of the $1,000 deductible Of the employees currently enrolled in the POS II plan family coverage Only 3 people have reached the family deductible ($3,000) Only 7% have paid $1,500 or greater toward their deductible 42% have paid less than $100 of the $3,000 deductible The vast majority of our employees are enrolled in the POS II plan, however; this plan has higher employee contributions than the POS w/ HSA. If you are enrolled in the POS II plan and have not met your deductible, you may want to consider enrolling in the POS w/ HSA plan to save money on your monthly contributions. While the POS w/ HSA plan has higher deductibles, it has lower per pay period contributions. Those who do not have a lot of claims may save money by enrolling in the POS w/ HSA plan. Think of it as “pay now or pay later”. Those who enroll in the POS II plan pay more in employee contributions regardless of their claim activity. Those who enroll in the POS w/ HSA plan pay less in employee contributions and only pay out of pocket when they have claims. U.S. Renal Care encourages you to consider BOTH your employee contributions per pay period as well as your average claims per year when you review your 2012 plan options. Fast Fact: You should consider your annualized contributions when selecting the plan you enroll. If you are not meeting the deductible in the POS II plan, you may less out of pocket in the HSA plan. *data thru September 30, 2011 in-network benefits only.

10 Medical Benefits - HSA Give employees access to a fund they can use for their current or future healthcare expenses Employees become better informed and more involved in making decisions about their own care Employees will spend the money wisely Unused money will rollover and grow over time Money in your fund earns interest Your account is portable – if you change health benefits, insurance plans or jobs, your HSA goes with you Can be funded by the employer, employee or both Federal government mandates the maximum amount that can be contributed each year Money is put in fund pre-tax USRC funds: $500 a year for individual; or $1,000 a year for family You may contribute up to the 2012 maximum: $3,100 individual; or $6,250 family Let’s talk now about the POS w/ HSA plan. This is our lowest cost plan. This plan requires you to meet your deductible before the plan will pay coinsurance. The HSA portion of this plan is a fund that you own. Think of the fund as a savings account for medical expenses. U.S. Renal Care will provide $500 for individual coverage and $1,000 for family coverage to your fund. One half of this money is put in your account in the month of January and the other half is put in your account in July. You can also contribute to the HSA fund, tax-free, through payroll deductions. The maximum amount you can contribute is $3,100 for individual and $6,250 for family. Once you have money in your HSA fund, and you use the medical plan, you decide if you want to pay for the medical expense using funds in the HSA. Money in your HSA earns interest and if you leave U.S. Renal Care or change insurance providers you can take your HSA fund with you. It’s important to note the federal government sets the guidelines for HSA plans. This means to qualify, the plan must include a high deductible and require pharmacy to be subjected to the same medical deductible before using copays. The government also mandates the maximum amount that can be contributed to the HSA fund pre-tax each year.

11 Medical Benefits - HSA Protects you from high costs
Amount that needs to be satisfied before health coverage begins Protects you from high costs Coinsurance similar to traditional plans Out-of-pocket maximums are in place for added peace of mind Option to reimburse from this account Receive tax-free interest earnings while your money remains in your HSA If HSA funds are used for eligible expenses, then withdrawals are tax free. Health Coverage (ex. 80% In-Network) HSA Fund ($500 Single / $1,000 Family) Annual Deductible (ex: $2,000 Single / $4,000 Family) Preventive Care As you go up the “stairs of the health care house,” you’ll incur expenses that go towards your deductible. Once you reach “upstairs,” or your deductible, then your 80% health coverage is applied. You can use your HSA to save tax dollars on medical expenses you incur. Money in your HSA can also be invested! Preventive Care covered 100% (ex: Annual Physical) In an effort to help everyone understand how the HSA works, let’s walk through an example: [CLICK MOUSE] We start with a traditional high deductible POS plan. The plan includes a $2,000 single and $4,000 family deductible. Members in this plan must meet the deductible before the plan begins to pay a portion of the costs. Preventive care is always covered at 100% - it is not subject to the deductible. After we reach our deductible, the plan begins to share in the costs. Our plan pays 80% of the costs and you pay the remaining 20%. The HSA is a fund of money that builds over time based on contributions (both U.S. Renal Care’s and yours) and money in the fund can be used at any time to offset your medical out-of-pocket expenses. For example, if you have $250 in the fund on January 1st and need to go to the doctor on January 10th because of a fever. If the office visit is $100; you could pay the $100 from the HSA fund. Conversely, maybe you prefer to pay the $100 out of your own pocket and save the money in the HSA fund in the event you have an unexpected medical expense. The money in the fund would stay in the account until you decide to use it – earning interest along the way.

12 Medical Plans Contributions
Per Pay Period Contributions POS II POS II w/ HSA Employee Bi-Weekly Cost USRC’s Bi-Weekly Cost Total Bi-Weekly Cost Employee Only $40.39 $201.08 $241.47 $29.76 $191.41 $221.18 Employee + Spouse $140.55 $389.99 $530.53 $82.32 $403.62 $485.94 Employee + Child(ren) $122.47 $371.24 $493.72 $72.40 $379.82 $452.22 Family $226.41 $556.31 $782.72 $127.71 $589.22 $716.94 As we all know, the cost of quality health coverage has increased over the past few years. At the same time, we need healthcare that protects our physical health as well as healthcare that protects our financial well being. That is why U.S. Renal Care believes it is important to invest in quality plans that are cost effective, easy to use and valuable to you. We’ve highlighted the bi-weekly costs for each plan on this slide. You will see that U.S. Renal Care continues to pay the majority of the costs for coverage. Remember, spouses are not eligible to participate in a U.S. Renal Care medical plan if they have access to coverage elsewhere. Employees who wish to enroll a spouse for medical coverage will be required to complete a spousal affidavit prior to their being approved to participate in the plan.

13 Medical Plans Contributions
Plan Comparison Calculator ExponentHR Plan Information Website Links To assist you in determining your total out of pocket costs, U.S. Renal Care has posted a calculator on ExponentHR which will allow you to compare high level plan designs, better understand how claims would be paid under each plan, and estimate your total out of pocket costs for the year. To access the calculator, simply log in to ExponentHR, select Plan Information, then Website Links and use the drop down box to select calculator. Select Calculator

14 Prescription Drugs Prescription drug coverage is included with the medical plans offered U.S. Renal Care encourages all employees to save money by selecting generics when available 76% of brand name drugs have a therapeutic generic equivalent Generic medications are a safe and cost-effective alternative to brand-name drugs Ask your doctor for a generic brand of the drug prescribed If you must use a brand-name drug, ask your doctor for a drug that is a preferred brand Aetna Benefits POS II In Network POS II w/ HSA Deductible Retail (30 Day Supply) Generic Brand Non Formulary No Deductible $15 $35 $50 After Deductible $10 $30 Mail (90 Day Supply) $45 $105 $150 $20 $60 $100 Prescription drugs will continue to be offered through the Aetna medical plan. There is no pharmacy deductible in the POS II plan; members simply pay the appropriate copay for the tier of drug they are purchasing. Prescription drugs on the HSA plan are subject to the same deductible as medical expenses. This is a combined deductible, meaning that you pay the deductible once. After you have paid your deductible, you will have pharmacy copays based on the tier of drug you are purchasing.

15 Medical Plans: Condition Management
The Aetna medical plans include access to Health Connections – a condition management program to help employees manage certain chronic conditions The program provides access to a nurse who provides one-on-one education and support Conditions include: Vascular: Diabetes, congestive heart failure, coronary artery disease, hypertension, hyperlipidemia, Pulmonary: Asthma, COPD Cancer: Breast, lung, prostate, colorectal, lymphoma / leukemia Gastrointestinal Gastro esophageal reflux disease (GERD), peptic ulcer disease, chronic hepatitis, inflammatory bowel disease Orthopedic / rheumatologic: Osteoporosis, rheumatoid arthritis Neurological Geriatrics, migraines, seizure disorders, Parkinson's Other: Chronic Kidney disease, end stage renal, cystic fibrosis, HIV, chronic low back pain, sickle cell anemia, weight management U.S. Renal Care’s medical plans include access to Health Connections; a condition care management program to help members with chronic conditions better manage their conditions. Health Connections is a voluntary health management program that helps you understand and better manage a wide variety of health conditions. This program is provided to employees and their families who are enrolled in one of U.S. Renal Care’s medical plans free of charge. Participation in the program helps you reduce the need for emergency care and unscheduled office visits while potentially reducing your medical costs.

16 PPO Buy-Up with Adult and Child Orthodontia
Dental Benefits U.S. Renal Care offers two PPO dental benefit plans through Aetna The PPO buy-up plan includes adult and child orthodontia Aetna Benefits PPO Basic PPO Buy-Up with Adult and Child Orthodontia Annual Deductible (for Basic & Major) Single Family $50 $150 Services Diagnostic and Preventive Basic Major Orthodontia 100% 80% 50% Not Covered Annual Maximum $1,500 Orthodontia Lifetime Maximum Employee Contributions (Per Pay Period) Employee Only Employee + Spouse Employee + Child(ren) $6.12 $12.25 $13.78 $19.91 $8.78 $17.55 $19.74 $28.52 U.S. Renal Care offers two dental benefit plans through Aetna PPO Basic PPO Buyup with Adult and Child Orthodontia The dental coverage offers you a network of providers but also allows you to receive treatment from a provider of your choice. If you use a network provider you will pay less out of pocket. In-network providers will not charge more than Aetna’s allowable fee, so you will not be balance billed for more than your normal percent of the cost. If you receive services by an out-of-network provider, you will have to pay the difference between your dentist’s charges and Aetna’s allowable fee in addition to your normal percentage of cost

17 Vision Benefits U.S. Renal Care offers a vision plan through VSP
You pay 100% of the costs for vision care VSP Benefits Vision Plan In-Network Frequency Limitations Eye Exams Lenses Frames Contact Lenses 1 per 12 Months 1 per 24 Months Eye Exam Copay $10 Materials Allowance Contacts $100 Allowance $115 Allowance Employee Contributions (Per Pay Period) Employee Only Employee + Spouse Employee + Child(ren) Family $1.96 $3.91 $4.19 $6.69 U.S. Renal Care offers a vision benefit plans through VSP. Participation in the vision plan is voluntary and you pay 100% of the costs. The vision plan offers you a network of providers but also allows you to receive treatment from a provider of your choice. If you use a network provider you will pay less out of pocket costs. The 2012 Vision benefits provide services for eye exams, glasses and contacts. Once again, keep in mind that if your doctor charges more than the reasonable and customary charge you may be required to pay the extra amount.

18 None – Paid by U.S. Renal Care
Disability Benefits U.S. Renal Care offers short and long-term disability through MetLife Short-term disability benefits are paid 50% by U.S. Renal Care and 50% by you Long-term disability benefits are provided by U.S. Renal Care at no cost to you MetLife Short Term Disability Benefit Percentage 60% Elimination Period (Accident & Sickness) 14 Days Weekly Maximum $1,000 Benefit Duration 11 Weeks Monthly Employee Contributions (Per $10 Weekly Benefit) $0.123 If you’re unable to work due to a sickness or injury, disability income insurance can help you meet expenses and maintain your standard of living. It can help you pay bills like your mortgage, tuition and car payments, and help cover expenses for food, clothing and utilities. By replacing a portion of your income, disability income insurance can help provide financial security until you get back on your feet and return to work. U.S. Renal Care offers both short and long term disability through MetLife. The costs for short term disability are shared between you and U.S. Renal Care. U.S. Renal Care pays 100% of the costs for your Long Term Disability insurance. MetLife Long Term Disability Benefit Percentage 60% Elimination Period 90 Days Monthly Maximum $10,000 Employee Contributions None – Paid by U.S. Renal Care

19 Basic Life and AD&D Benefits
U.S. Renal Care offers Basic Life and Accidental Death and Dismemberment (AD&D) insurance through Prudential Basic Life and AD&D benefits are provided by U.S. Renal Care at no cost to you Prudential Basic Life and AD&D Basic Life and AD&D Coverage 1 Times Annual Earnings Maximum $300,000 Employee Contributions None – Paid by U.S. Renal Care Life insurance gives you the peace of mind you only get from knowing that you've protected your loved ones. In the event of your passing, life insurance provides money directly to your beneficiaries to help them pay expenses. U.S. Renal Care provides basic life and Accidental Death and Dismemberment insurance in an amount equal to 1 times your basic annual earnings. This coverage is offered through Prudential and U.S. Renal Care pays 100% of the costs for this benefit.

20 Supplemental Life and AD&D Benefits
U.S. Renal Care offers Supplemental Life and Accidental Death and Dismemberment (AD&D) insurance through Prudential Supplemental Life and AD&D benefits are paid for by you Prudential Supplemental Life and AD&D Supplemental Life Benefit Amount Employee Spouse Child(ren) $10,000 Increments to a maximum of $300,000 or 5 times salary $5,000 Increments to a maximum of $150,000, not to exceed 50% of employee’s amount $1,000 increments to a maximum of $10,000 not to exceed 10% of employee’s amount* Guarantee Issue Lesser of $100,000 or 3 times basic annual earnings $25,000 $10,000 Annual Enrollments Increases $10,000 Increments to a maximum of $40,000** All increases subject to EOI All amount Guaranteed Issue Supplemental AD&D Amount Same as Supplemental Life Varies based on Employee amount Varies based on Employee amount Employee Contributions Contributions are based on age. Please refer to benefits guide for pricing. You can elect to purchase additional life and AD&D insurance for yourself, your spouse and your dependent children. If you choose to elect supplemental life during your initial enrollment, you may elect up to the guarantee issue amount without providing proof of good health. In addition, if you waived supplemental life insurance when you were initially hired or if you participate in the plan and would like to increase your current coverage amount, you may elect up to $40,000 in increments of $10,000 without providing proof of good health. If you want to purchase an amount above the guarantee issue and allowed open enrollment increase amount, you will be required to complete an Evidence of Insurability form, or EOI. Your immediate coverage will equal the amount you elected up to the amount of guarantee issue. Any amount you elect that is over the guarantee issue will not be effective until you submit evidence of insurability (EOI) and you are approved by Prudential underwriting. *Amounts may be lower for children younger than 6 months. **During the annual enrollment period, current employees who previously waived coverage or those currently enrolled may select/increase coverage as noted w/o EOI, up to the lifetime maximum without regard to the GI limit. Employees previously denied due to unsatisfactory EOI remain late entrants and EOI will be required from first dollar.

21 Flexible Spending Accounts
Flexible Spending Account (FSA) administration will be provided by Discovery Benefits USRC offers two types of FSA accounts: Healthcare* & Dependent Care Healthcare Flexible Spending Account Dependent Care Flexible Spending Account Annual Maximum $2,000 $5,000 Types of Expenses Medical, dental, vision copays and deductibles, hearing aides, eye glasses, contact lens Day care, preschool, after school programs, elder care A Flexible Spending Account, or FSA, allows you to pay for a variety of out-of-pocket healthcare and dependent care expenses with pre-tax dollars. U.S. Renal Care offers Flexible Spending Accounts through Discovery Benefits. A Health Care Flexible Spending Account allows you to set aside pre-tax dollars from your paycheck to cover eligible health care expenses that are incurred, and not reimbursed for you and your dependent’s Medical/Rx, dental, or vision insurance. A Dependent Care Flexible Spending Account allows you to set aside pre-tax dollars from your paycheck to cover eligible dependent care expenses. Remember, as of January 1st 2011, over the counter medications are no longer eligible for reimbursement unless you have a prescription or letter of medical necessity from your physician. *Participants enrolled in the POS w/ HSA plan are eligible to enroll in the Limited Health Care FSA which can be used once you meet that plan’s medical deductible. REMEMBER: As part of Health Care Reform, over-the-counter medications (excluding insulin) purchased January 1, 2011 or after are ineligible for reimbursement under the Healthcare Spending Account unless prescribed by your physician. Doctor’s prescription or letter of medical necessity must be submitted with itemized receipt at the time of the claim.

22 Employee Assistance Program (EAP)
U.S. Renal Care offers an Employee Assistance Program (EAP) through Prudential as part of the Basic Life offering The program is available to all full-time employees and their family members at no cost Services include: up to 3 telephonic calls per issue for: Personal Counseling: depression, marital and family conflicts, job pressure, stress / anxiety, grief, loss, etc. Legal Guidance: divorce and family law, bankruptcy, criminal actions, civil suits, real estate transactions, contracts, etc. Financial Advisors: saving for college, getting out of debt, retirement planning, estate planning, tax questions, etc. U.S. Renal Care understands the challenges that life can bring each of us. That’s why we have included access to EAP counselors as part of our basic life benefit. The EAP provides confidential access to counseling services for a variety of issues including depression, stress, marital issues, legal and financial challenges. The EAP is available to full time employees and their dependents at no cost. Each member can receive up to three sessions per issue. The program is confidential and U.S. Renal Care will never see a listing of who called the program or why. The EAP is 100% confidential. U.S. Renal Care will not receive any specific detail regarding who is accessing the program or why.

23 How You Can Manage Costs
Proactively manage your health If you have a chronic condition, enroll in the Health Connections program Purchase generic drugs when possible Consider where you seek treatment Healthcare costs are rising rapidly and we all can impact these rising costs by making good decisions about how and where we seek care. We’ve talked about getting your annual exams and talking to your doctor about how to manage your chronic condition. Let’s talk now about where you seek care. We wanted to demonstrate the average costs of care in multiple settings. Depending on the plan you enroll, you may have office visit copays or you may be required to pay a portion of the costs. As you can see, seeking care at your primary care physician’s office, urgent care or convenience clinic results in much lower costs than the emergency room. The emergency room is the most expensive place to seek treatment and should be reserved for life threatening or serious injuries and illnesses. Keep in mind too, the Aetna nurse line is always available to you, 24 hours a day, 7 days a week. Event Average Cost Primary care physician visit $117 Specialist (physician) visit $137 Urgent care* $164 Convenience care clinic visit** $74 Emergency room visit $798 Aetna Nurseline Free * Urgent care clinics are care centers primarily used to treat patients who have an injury or illness that requires immediate care, but is not serious enough to warrant a visit to an emergency room. ** Convenience care clinics are health care clinics located in retail stores, supermarkets and pharmacies that treat uncomplicated minor illnesses and provide preventative health care services.

24 What To Do Next? Open Enrollment runs from 11/14/2011 – 11/28/2011
For additional information, please visit ExponentHR Choose the Benefits button Click on “2012 Benefits Guide” Print if desired For detailed plan designs, please visit ExponentHR Click on “Plan Information” Click on drop down and choose appropriate plan Enroll via ExponentHR Directions on page 15 of the Benefits Guide See your Administrator or call the Benefits Department for more information Visit AetnaNavigator.com for other tools to help manage your health Drug & Hospital comparison tools Cost estimators Online health education tools If you would like to get more information on your plans, please visit ExponentHR and select “Benefits”. If you want to find a doctor, or explore health and wellness tools available to you as part of our medical plan, please visit Aetna’s member page at AetnaNavigator.com.

25 The information contained in this presentation is intended as an overview. If there are any differences between this information and the official Plan Documents, the Plan Documents will govern.


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