Goodwill | 2018 Benefits Overview

Blue Cross Blue Shield of Kansas City: PPO Medical Plans – Eligible for employees working 30+ hours per week.

Preferred-Care Blue Network PPO 2000 Premium Plan PPO 6500 – Value Plan

Deductible: Individual $2,000 $6,500

Deductible: Family $6,000 $13,000

Member Co-Insurance 100% 100%

Out-of-Pocket Maximum: Individual $2,000 $6,500

Out-of-Pocket Maximum: Family $6,000 $13,000

Preventive Care Covered at 100% Covered at 100%

Office Visit (PCP / Specialist) $30 Copay / $60 Copay Deductible

Urgent Care $60 Copay Deductible

Emergency Room Deductible Deductible

Hi Tech Diagnostics (MRI, MRA, etc.) Deductible Deductible

Inpatient Hospital Deductible Deductible

Outpatient Hospital Deductible Deductible

Retail Prescriptions: Tier 1/ Tier 2/ Tier 3 $10 / $30 / $50 $12 for tier 1/Deductible for Tier2 and 3

Mail Order Prescriptions: Tier 1/ Tier 2/ Tier 3 $30 / $90 / $150 $30 for tier 1/Deductible for Tier2 and 3

Health Risk Assessment Incentive Visit “A Healthier You” on www.mokangoodwill.org/benefits to take your Health Risk Assessment today for theopportunity to reduce your monthly premiums by $25 each month. You and your covered spouse may complete this assessment.

Delta Dental of Kansas: Dental Plan

Premier & PPO Networks

Preventive 100%

Deductible: Individual $50 (applies to Basic & Major only)

Deductible: Family $150 (applies to Basic & Major only)

Basic 80%

Major 50%

Annual Benefit Maximum $1,000 per person

Orthodontia 50% (Lifetime max $1,000)

Ameriflex: Flexible Spending Account

You can reallocate your annual compensation to pay for eligible health costs that may not be covered by your benefit plan and/or dependent care expenses. In essence, you will be paying for these expenses on a pre-tax basis. This is a voluntary plan and the amount you designate as your Annual Salary Reallocation should be conservative. Participants can roll over up to $500 of unused FSA dollars to the next year.

Medical Expenses: Set aside up to $2,650 pre-tax to pay for unreimbursed qualified healthcare expenses

Dependent Care Expenses: Set aside up to $5,000 (or $2,500 if married filing separately) for qualified dependent care

Out of Pocket Maximum includes deductible, coinsurance, and copayments.

BELOW IS A BRIEF OUTLINE OF IN-NETWORK BENEFITS

For additional details and Out of Network benefits, please refer to the Summary Plan Descriptions at www.mokangoodwill.org/benefit .

Includes orthodontic appliances and treatment, interceptive and corrective, for dependent children under age nineteen (19).

SunLife: Vision Plan

VSP Signature Network Frequency Benefit

Examination Every 12 months $10 Copay

Single Vision Lenses Every 12 months $25 Copay

Lined Bifocal Lenses Every 12 months $25 Copay

Line Trifocal Lenses Every 12 months $25 Copay

Frames Every 24 months $130 Allowance, 20% off balance over $130

Contact Lenses Every 12 months $130 Allowance

Lasik Discount Once Per Lifetime 15% off retail price, 5% off promotional price

MetLife: Voluntary Life and Accidental Death & Dismemberment – Eligible for employees working 30+ hours per week.

Benefit Increments Guarantee Issue Maximum

Employee Coverage Up to 5 times base salary $10,000 $150,000 $500,000

Spouse Coverage Up to 50% of employee coverage $5,000 $50,000 $250,000

Child(ren) coverage Up to 50% of employee coverage for amounts of $1,000 ,$2,000, $4,000, $5,000 or $10,000

MetLife: Voluntary Short Term Disability – Eligible for employees working 30+ hours per week.

Elimination Period 14th day Accident or Sickness

Short Term Disability Benefit 60% of weekly earnings to a maximum of $1,000

Benefit Duration 11 Weeks

USAble: Voluntary Life and Accidental Death & Dismemberment

Life and AD&D Coverage $10,000 for employee only

Life and AD&D Coverage $25,000 for executive class

SunLife: Voluntary Accident and Critical Illness

Type of Plan Benefit

Accident Insurance Coverage: Off the Job (Including Wellness Benefit)

Fixed benefits based on the type of injury & treatment received. Pays

cash dollars directly to you regardless of medical insurance benefits.

$50 per year wellness benefit for each covered individual for a covered health screening.

Critical Illness Insurance Coverage: (Including Wellness Benefit)

Lump sum benefit (depending on the level of coverage selected) upon

diagnosis of a critical illness; Heart Attack, Stroke, Cancer. Pays cash

dollars directly to you regardless of medical insurance benefits.

$50 per year wellness benefit for each covered employee and spouse for a covered health screening.

All Life and AD&D amounts are subject to an age reduction schedule.

To purchase Spouse &/or Child(ren) coverage, you must have coverage on yourself. Guarantee Issue is applicable at initial eligibility only.

Short Term disability includes a pre-existing condition clause.

Goodwill | 2018 Rate Grids – Supplement to Benefit Overview

Employee Life and AD&D Semi-Monthly Premiums

Premiums are based on the employee's age on each policy anniversary

Benefit in Age

000’s thru 29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

$20 1.24 1.44 1.74 2.14 3.34 5.14 8.54 14.24 26.84 43.34

$30 1.86 2.16 2.61 3.21 5.01 7.71 12.81 21.36 40.26 65.01

$40 2.48 2.88 3.48 4.28 6.68 10.28 17.08 28.48 53.68 86.68

$50 3.10 3.60 4.35 5.35 8.35 12.85 21.35 35.60 67.10 108.35

$60 3.72 4.32 5.22 6.42 10.02 15.42 25.62 42.72 80.52 130.02

$70 4..34 5.04 6.09 7.49 11.69 17.99 29.89 49.84 93.94 151.69

$80 4.96 5.76 6.96 8.56 13.36 20.56 34.16 56.96 107.36 173.36

$90 5.58 6.48 7.83 9.63 15.03 23.13 38.43 64.08 120.78 195.03

$100 6.20 7.20 8.70 10.70 16.70 25.70 42.70 71.20 134.20 216.70

$110 6.82 7.92 9.57 11.77 18.37 28.27 46.97 78.32 147.62 238.37

$120 7.44 8.64 10.44 12.84 20.04 30.84 51.24 85.44 161.04 260.04

$130 8.06 9.36 11.31 13.91 21.71 33.41 55.51 92.56 174.46 281.71

$140 8.68 10.08 12.18 14.98 23.38 35.98 59.78 99.68 187.88 303.38

$150 9.30 10.80 13.05 16.05 25.05 38.55 64.05 106.80 201.30 325.05

Spouse Life and AD&D Semi-Monthly Premiums

Premiums are based on the employee's age on each policy anniversary

Benefit in Age

000’s Thru 29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

$5 0.31 0.36 0.44 0.54 0.84 1.29 2.14 3.56 6.71 10.84

$10 0.62 0.72 0.87 1.07 1.67 2.57 4.27 7.12 13.42 21.67

$15 0.93 1.08 1.31 1.61 2.51 3.86 6.41 10.68 20.13 32.51

$20 1.24 1.44 1.74 2.14 3.34 5.14 8.54 14.24 26.84 43.34

$25 1.55 1.80 2.18 2.68 4.18 6.43 10.68 17.80 33.55 54.18

$30 1.86 2.16 2.61 3.21 5.01 7.71 12.81 21.36 40.26 65.01

$35 2.17 2.52 3.05 3.75 5.85 9.00 14.95 24.92 46.97 75.85

$40 2.48 2.88 3.48 4.28 6.68 10.28 17.08 28.48 53.68 86.68

$45 2.79 3.24 3.92 4.82 7.52 11.57 19.22 32.04 60.39 97.52

$50 3.10 3.60 4.35 5.35 8.35 12.85 21.35 35.60 67.10 108.35

Child Amount for Voluntary Life $1,000 $5,000 $10,000

Child Life and AD&D Premium 0.145 0.73 1.46

MetLife: Voluntary Life and AD&D

Premiums

Coverage available up to 50% of employee elected amount. To calculate rate, multiply available rate by your desired election amount or contact Human Resources. AD&D cost required in all available Life Insurance policies.

Coverage available up to $500,000 depending on employee salary. To calculate rate, multiply available rate by your desired election amount or contact Human

Resources. AD&D cost required in all available Life Insurance policies.

*Employee must also be enrolled in coverage to elect for Child Life and AD&D.

USAble All Staff Coverage: Voluntary Life and AD&D

$10,000 of coverage $1.60 semi-monthly deduction

Semi-Monthly Accident Premiums

Employee Only $7.94

Employee & Spouse $10.40

Employee & Child(ren) $12.29

Family $14.75

MAXIMUM WEEKLY BENEFITAGE SCHEDULE WITH SEMI-MONTHLY DEDUCTION

<44 45-49 50-54 55-59 60+

$100 2.70 2.55 2.90 3.80 4.15

$150 4.05 3.83 4.35 5.70 6.23

$200 5.40 5.10 5.80 7.60 8.30

$250 6.75 6.38 7.25 9.50 10.38

$300 8.10 7.65 8.70 11.40 12.45

$350 9.45 8.93 10.15 13.30 14.53

$400 10.80 1.20 11.60 15.20 16.60

$450 12.15 11.48 13.05 17.10 18.68

$500 13.50 12.75 14.50 19.00 20.75

$550 14.85 14.03 15.95 20.90 22.83

$600 16.20 15.30 17.40 22.80 24.90

$650 17.55 16.58 18.85 24.70 26.98

$700 18.90 17.85 20.30 26.60 29.05

$750 20.25 19.13 21.75 28.50 31.13

$800 21.60 20.40 23.20 30.40 33.20

$850 22.95 21.68 24.65 32.30 35.28

$900 24.30 22.95 26.10 34.20 37.35

$950 25.65 24.23 27.55 36.10 39.43

$1,000 27.00 25.50 29.00 38.00 41.50

USAble: Voluntary Life Premiums

MetLife: Short Term Disability Premiums

*Coverage available up to 60% of your weekly income. Coverage is rounded to the nearest $50.

SunLife: Accident Premiums

$25,000 of coverage $4.00 semi-monthly deduction

SunLife: Critical Illness Premium

Goodwill | 2018 Benefits Overview

Type of Coverage Employee Semi-Monthly Rates Medical: PPO 2000 – Premium Plan

Employee Only $61.63Employee & Spouse $141.75Employee & Child(ren) $117.10Family $172.57Medical: PPO 6500 – Value Plan

Employee Only $24.59Employee & Spouse $56.56Employee & Child(ren) $46.72Family $68.86Dental:

Employee Only $13.71Employee & Spouse $26.72Employee & Child(ren) $25.57Family $38.99Vision:

Employee Only $3.95

Employee & Spouse $7.86

Employee & Child(ren) $8.46

Family $12.48

CONTACT INFORMATION

Contact for questions about benefits and enrollments

(816) 842-7425 Extension 252

benefits@mokangoodwill.orgwww.mokangoodwill.org/benefits

Contact for questions about claims, issues, and coverage

Nathan Johnson (913)643-4146njohnson@trussadvantage.com

Kara Vincent (913)754-5927 kvincent@trussadvantage.com

Blue Cross Blue Shield of Kansas City Medical 888-989-8842 or 816-395-2950

www.bluekc.com

Delta Dental of Kansas Dental 800-733-5823

www.deltadentalks.com

SunLife Vision, Voluntary Benefits 800-733-7879

www.assurantemployeebenefits.com

USAble Basic Life/AD&D 800-370-5856

www.usablelife.com

MetLife Voluntary Life/AD&D, Disability 800-638-5433

www.metlife.com

Ameriflex Flexible Spending Account 888-868-3539

www.myameriflex.com

New Directions Behavioral Health Employee Assistance Program 800-528-5763

www.ndbh.com

PTO Grid for 2018Years of Service PTO A PTO B PTO C

0 0 3.69 4.27

1 2.15 3.69 4.27

2 2.15 5.23 5.81

3 2.15 5.23 5.81

4 2.15 5.23 5.81

5 2.15 6.77 7.35

6 2.15 6.77 7.35

7 2.15 6.77 7.35

8 2.15 8.31 8.89

9 2.15 8.31 8.89

10 2.15 9.23 9.81

Part-Time Employees (after one year of service)

Full-Time Employees Retail Management

(with required 45 hour work week)

This is a brief description of your benefits. If a discrepancy exists, benefits outlined in the carrier certificate will prevail.