This summary provides a brief sketch of the provisions of the Fremont Rideout Health Group Benefit programs. Complete details of the various benefit plans can be found in the Employee Personnel Manual and legal plan documents. The legal plans for each benefit will be the governing documents.

HEALTH INSURANCES

All benefited employees are eligible for health, dental and vision insurance coverage on the 1st of the month after 30 days of employment, as benefit eligible.

An employee becomes eligible for benefits when they are hired or change status to a schedule of a minimum of 36 hours (12-hour shifts) or 40 hours (other shifts) per pay period.

MEDICAL – (BLUE CROSS PPO)

Medical Insurance benefits have an annual $500 deductible per person with an annual family maximum $1500 deductible. After meeting the appropriate deductible, covered services by participating providers are paid at 80% as outlined in the insurance booklet. Maximum out of pocket is $2,000 per covered member.

A $20 co-pay is required for each physician office visit. Pharmacy prescription co-pays are $10 for generic and $20 for non-generic. A cost savings mail-in program is available.

A maximum out-of-pocket benefit for non-participating providers is $6,000. Covered services provided by non-participating providers are subject to a $500 deductible per person, plus 40% of covered expenses, and are always responsible for any charges for services or supplies that are not covered and any charges that exceed covered expenses. Maximum lifetime benefit, while covered under this plan, is $5,000,000 (5 million).

EMPLOYEE MEDICAL DISCOUNTS

Employees and their dependents enrolled in the FRHG medical insurance plan will receive a 50% discount on co-pays and deductibles when using FMC, RMH, & BGMH hospital services.

DENTAL – (BUTTE SIERRA DENTAL)

The Dental Insurance benefit has a $50 deductible per calendar year per family member and pays up to $1,500 per calendar year per family member.

Covered services are paid as follows: preventive (deductible waived) 100%; restorative 80%; major restorative 50% after six months. The amount payable for any covered dental procedure will be reimbursed on a REASONABLE AND CUSTOMARY basis.

VISION – (VISION SERVICE PLAN)

Vision Insurance benefits has a $25.00 deductible per person per calendar year. The plan provides for a comprehensive examination once every 12 months, and one pair of standard lenses or one pair of contact lenses once every 12 months. Laser surgery is also available.

MEDICAL/DENTAL/VISION PREMIUMS

The hospital pays the medical, dental and vision insurance premiums for all regular full-time employees. Employees working on a regular part-time basis are required to pay a portion of the premium based on appointed status. The employee cost per pay period is a follows:

Appointed Status	Medical/Dental/ Vision Premium	Dental/Vision Only Premium
36-44	$58.00	$10.40
45-52	$49.00	$ 8.80
53-60