Enhanced Analytics: AA Actuarial Assistant Company Name: Dewey, Countem, & Howe Plan Effective Date: 1/1/20 Plan Comparison Current Plan Design Proposed Plan Design Current vs. Proposed In Network Out of Network In Network Out of Network In Network Out of Network Deductibles Individual 2,000 4,000 4,000 8,000 2,000 4,000 Family 6,000 12,000 12,000 16,000 6,000 4,000 Coinsurance 90.0% 60.0% 90.0% 60.0% 0.0% 0.0% Max. Out of Pocket Individual 5,500 11,000 5,500 11,000 0 0 Family 11,000 22,000 11,000 22,000 0 0 Copays Emergency Room 250 250 0 0 Urgent Care 50 50 0 0 Physician - Primary Care 20 20 0 0 Physician - Specialist 40 40 0 0 Rx Retail Mail Order Retail Mail Order Retail Mail Order Generic 10 20 10 20 0 0 Brand - Formulary 25 50 25 50 0 0 Brand - Non-Formulary 50 100 50 100 0 0 Specialty 200 400 200 400 0 0 Projected Impact Difference % Change Expected Annual Plan Cost 1,917,346 1,644,931 -272,414.81 -14.2% Plan Cost Share* (%) 77.1% 72.9% -4.2% -5.4% Participants' Cost Share* (%) 22.9% 27.1% 4.2% 18.2% Participants' Cost Share* ($) 1,215 1,302 87.43 7.2% * Deductible + Coinsurance + Copays; does not include employee contributions 1 Powered by Claros Analytics