1. Welcome to Montefiore’s Benefits Program!

2. For Your Benefit

3. Montefiore’s Benefits Program Healthcare Flexible Spending Accounts Life & Accident Insurance Disability

4. Who Is Eligible? You Your Family Members –Spouse –Children – up through age 26

5. Healthcare Medical Vision Dental

6. Medical MonteCare EPO MonteCare PPO Decline Coverage You & Montefiore share the premium cost of coverage

7. Provider Network MONTECARE EPOMONTECARE PPO CoverageIn-network OnlyIn-network/Out-of-network In-network Providers Hospitals and Other Facilities Empire BlueCard PPO and Montefiore Network (including Moses, Weiler, Wakefield, Westchester Square, The Children’s Hospital at Montefiore, Montefiore Mount Vernon Hospital, Montefiore New Rochelle Hospital, White Plains Hospital, Montefiore Ambulatory Surgical Facilities, Montefiore Imaging Center, Montefiore Department of Radiology, Advanced Endoscopy Center and NY GI Center) Physicians, Therapists and Counseling for Mental Health and Substance Abuse Montefiore Integrated Provider Association (MIPA) Montefiore Behavioral Care Integrated Provider Association (MBCIPA) Empire BlueCard PPO Network Empire Behavioral Health Network LaboratoriesQuest Laboratories, LabCorp and any hospital laboratory participating in the Empire BlueCard PPO and Montefiore Network (including Moses, Weiler, Wakefield, Westchester Square, The Children’s Hospital at Montefiore, Montefiore Mount Vernon Hospital, Montefiore New Rochelle Hospital, White Plains Hospital)

8. Your Share of the Cost - MONTECARE EPOMONTECARE PPO Montefiore Network Empire BlueCard PPO Network Out-of- network Montefiore Network Empire BlueCard PPO NetworkOut-of-network Individual/Family DeductibleNone$500/$1,000Not coveredNone$200/$400$1,000/$2,500 Individual/Family Out-of-pocket Maximum $5,350/$10,700Not covered$5,350/$10,700$6,000/$17,500 Physician (Primary Care or Specialist) $15 copay/visit20%*Not covered$15 copay/visit10%*30%* Hospital – Pre-certified$020%*Not covered; except in an emergency $0$1,000 copay30%* after $1,000 copay Outpatient Surgery$020%*Not covered$0$500 copay30%* MRI, MRA, CAT Scan, PET or Nuclear Cardiology $020%*Not covered$0$250 copay30%* Emergency Room (copay waived if admitted) $100 copay *after deductible

9. Prescription Drugs Generic Preferred (Formulary) Non-preferred (Non-formulary)Specialty Montefiore Outpatient Pharmacies 30-day supply*$0$20 copayYou pay 100% of the discounted cost $20 copay 90-day supply**$0$40 copayYou pay 100% of the discounted cost $40 copay Express Scripts Participating Retail Pharmacy (up to a 30-day supply ) $15 copay$45 copayYou pay 100% of the discounted cost $100 copay Home Delivery Pharmacy Service o 30-day supply* $15 copay$45 copayYou pay 100% of the discounted cost $100 copay o 90-day supply** $30 copay$90 copayYou pay 100% of the discounted cost $150 copay *new prescriptions for chronic and seasonal allergy medications **refills and all other prescriptions

10. Care Guidance Health & Lifestyle Assistance –Recovering from illness/injury –Managing chronic condition –Transitioning from inpatient care Voluntary, Confidential, Free

11. Vision Spectera Vision Plan –Low Option –High Option –You pay 100% of the premium cost Empire BlueCross BlueShield o SpecialOffers

12. Dental DHMOPreventive & Diagnostic DPPO DentistsUse DHMO dentistUse any dentist Individual Annual DeductibleNone $100 (does not apply to Preventive Care) Annual Maximum Benefits (for each covered person) None $1,500/$2,500 if you use a Montefiore dentist Preventive and Diagnostic Services $0 Basic Services$0Not covered20% 1 coinsurance after deductible Major Services30% 1 coinsuranceNot covered50% 1 coinsurance after deductible Orthodontics50% 1 coinsuranceNot covered20% 1 coinsurance after deductible Lifetime Orthodontic MaximumNone $2,000 1 Based on DPPO contracted fee schedules

13. Dental First year, you pay 100% of the premium cost After 1 year  Cigna DHMO – You pay 100% of the premium cost  Preventive & Diagnostic – Montefiore pays 100% of the premium cost  DPPO – You and Montefiore share the premium cost

14. Flexible Spending Account Before-tax Contributions Pay Eligible Expenses from Account No Taxes on Withdrawals You Save What You Don’t Pay in Taxes

15. Healthcare FSA Eligible Expenses – Deductibles, coinsurance, copayments – Amounts above R & C limits – Healthcare expenses for which you pay part or all of the cost Ineligible Expenses – Cosmetic surgery – Electrolysis – Teeth whitening

16. Dependent Care FSA Eligible Expenses – Day care in or outside your home – Before/After school care, Pre-school, Nursery school – Summer Day Camp Ineligible Expenses – Household services – Institutional Care – Overnight summer camp – Weekend or “evening out” babysitting

17. FSA Accounts Maximum Annual Contribution –$2,550 Healthcare Account –$5,000 Dependent Care Account Forfeit Unused Amounts Healthcare Debit Card Convenience Pay Me Back Claim Forms

18. Life Insurance Basic –1X Salary (up to $250,000) or $50,000 (Opt Down) –After 1 year Montefiore pays 100% of the premium cost Supplemental –1X – 7X Salary (up to $750,000) –Evidence of Insurability –You pay 100% of the premium cost Business Travel Accident o Montefiore pays 100% of the premium cost

19. AD&D Basic o 1X Salary (up to $250,000)  After 1 year Montefiore pays 100% of the premium cost Supplemental o 1X – 7X Salary (up to $750,000)  You pay 100% of the premium cost

20. Dependent Life Insurance Option 1 –$10,000 for your spouse –$5,000 for each child Option 2 –$20,000 for your spouse –$10,000 for each child You pay 100% of the premium cost

21. Short-term Disability Paid Sick Leave – accrued sick time o 100% base salary New York State Disability o 50% base salary, $170/week maximum Montefiore Supplementary Sick Pay o 2 / 3 base salary, maximum weekly benefits apply

22. Long-term Disability Mandatory Basic LTD –60% predisability earnings –Maximum monthly benefits based on position You pay 100% of the premium cost

23. For Annual Salary Threshold Maximum Monthly Basic LTD Benefit Maximum Monthly Basic and Buy-up LTD Benefit Executives/Faculty$120,000$6,000/month Basic $9,000/monthBuy-up $15,000/monthCombined Exempt/Non-Exempt$60,000 $3,000/month Basic $2,000/monthBuy-up $5,000/monthCombined Buy-up LTD

24. Group Legal Services You pay 100% of the premium cost Network of Participating Attorneys Legal Services o Consumer protection o Estate planning o Family law o Real estate

25. Commuter Benefits Mass Transit – Buses, Subways, Commuter Railroads, Ferry Boats, Van pool Parking

26. www.MyMonteBenefits.com

27. www.MonteBenefits.com or 888.860.6166

28. What happens if I don’t enroll? MonteCare EPO –Single coverage Preventive & Diagnostic Dental Care –Single coverage Basic Life and AD&D Insurance Mandatory Basic LTD

29. Welcome to Montefiore’s Benefits Program!