ABC Company Sectioned Benefit Summary

DENTAL PRINCIPAL –ABC PAYS 75% 2022 EMPLOYEE BENEFIT SUMMARY Individual Deductible $50 Family Deductible $150 Calendar Year Max $1,250 / member MEDICAL & HRA Preventive Care Covered 100% & Deductible BCBS OF MA –ABC PAYS 75% does not apply HMO BLUE NE $2,000 Basic Care Covered 80% Deductible* $2,000 / $4,000 Major Care Covered 50% PCP Office Visit $25 Covered 50% for children up to Orthodontia the orthodontia lifetime max of Specialist & Urgent Care Visit $45 $1,000 Emergency Room Visit $150 Diagnostic Visit $35 / $135* (x-ray) $35 / $70* (labs) VISION High-tech Imaging $500* for hospitals PRINCIPAL –ABC PAYS 75% $50* for other facility Outpatient Surgery $0 / $1,000* for HCH Exam $10 copay Every 12 months Inpatient Admission $0 / $1,000* for HCH Lenses PREFERRED BLUE PPO $2,500 Every 12 months $25 copay Deductible* $2,500 / $5,000 Frames Covered up to $130 allowance; PCP Office Visit $35 Every 24 months 20% off remaining balance Specialist & Urgent Care Visit $45 Contacts (instead of glasses) - Every 12 months Emergency Room Visit $250 Elective Contacts Covered up to $130 allowance Diagnostic Visit $50 for hospitals Contact Fitting & Up to $60 copay $0 for other facilities Evaluation High-tech Imaging $400 for hospitals Necessary Contacts Covered in full after $25 copay $150 for other facilities Outpatient Surgery $500* LIFE & DISABILITY Inpatient Admission 10% coinsurance* PRINCIPAL –ABC PAYS 100% PRESCRIPTION DRUGS –HMO & PPO Rx Retail $10/$45/$150/$225 Pays 2x your annual base earnings up to Rx Mail Order $20/$90/$300/$675 Basic Life $350,000. Benefit reduces to 65% at age and AD&D 65, and to 50% at age 70 *after deductible combined with HRA all costs shown are in-network. For out-of-network costs, refer to your plan document. Preventive care always $0 in-network. HRA –SENTINEL BENEFITS* Short- Pays you 66.67% of your weekly base Term salary, up to $2,400/week. Benefit begins ABC pays the below portion of each employee’s Disability on the 15th day and lasts up to 11 weeks medical deductible through the Health Reimbursement Arrangement (HRA). Individual Family Long- Pays you 66.67% of your monthly base Term salary, up to $10,000/month. Benefit HMO Second $1,000 Second $1,000 Disability begins on the 91st day and lasts up to Social Security Normal Retirement Age PPO Second $1,500 Second $3,000

FSA & COMMUTER RETIREMENT 401K SENTINEL BENEFITS & TASC EMPOWER RETIREMENT Employees can choose to contribute up Employees can contribute up to Healthcare to $2,850 pre-tax annually to a Maximum $20,500 annually. Employees age 50+ FSA Healthcare Flexible Spending Account Annual can contribute an additional $,6,500 (FSA). Funds may be used for eligible Contribution annually medical, dental, and vision expenses. Employees can choose to contribute up ABC ABC matches up to 4% of your annual Dependent to $5,000 pre-tax annually to a Contribution contribution Care FSA Dependent Care FSA ($2,500 if married and filing separately). Funds may be The 401(k)-retirement plan is used for eligible caregiving expenses. administered through Empower Employees can choose to contribute up Plan Retirement. You can create an online Commuter to $280 pre-tax monthly to both Administrator account to track your balances, & Parking Commuter & Parking accounts. Funds change your contribution amounts, may be used for eligible expenses to and and more. from work. PRINCIPAL PERKS EMPLOYEE COSTS PRINCIPAL BI-WEEKLY You and your family can access free, MEDICAL –BCBS HMO Employee confidential resources to help with any Assistance challenges you have. Access 24/7 Employee $95.50 Program consultations with a licensed mental health professionals & get referrals. Employee + Spouse $191.01 Get lost or stolen item recovery or Employee + Child(ren) $176.68 Travel replacement and medical assistance, Assistance including emergency medical Family $272.19 transportation, when traveling within the U.S. or internationally. MEDICAL –BCBS PPO Will & Employees can access ARAG’s free online Employee $98.72 Legal resources to create a will, healthcare Document power of attorney, durable power of Employee + Spouse $197.43 Center attorney, living will, and medical treatment authorization for minors. Employee + Child(ren) $176.68 ABC PERKS Family $281.34 ABC DENTAL ABC will match up to $250 annually of Employee $6.75 Charitable an employee’s eligible charitable Contributions contribution to a qualified nonprofit Employee + One $12.16 organization/group of organizations. Family $16.89 Each covered employee is eligible for VISION Professional $500 of support for professional Development development annually to enrich and Employee $0.88 further their growth. Employee + Spouse $1.61 Each employee is eligible for one Short-Term short-term loan for up to $1,000 every Employee + Child(ren) $1.88 Loan 5 years. Repayment is expected within 3 months or prior to the employee’s Family $2.80 leave date.