Out of State - Ultradent Products, Inc.

employeebenefits 2013 · 2014BENEFIT CARRIER CONTACT INFORMATIONUltradentCarol Pugmire801-553-4410 pcarol@ultradent.comMoreton & Company - Account ManagerDawn Parker801-715-7097 dparker@moreton.comToll Free: 800-594-8949www.moreton.comMeritain Health (SelectHealth) - MedicalCustomer Service (24 Hour Automated Line): 888-769-2100Customer Service: 800-847-8361PPO in your area: 800-343-3140www.meritain.comPre-Certification: 800-542-6355Pharmacy: 866-475-7589Provider Listing: www.aetna.com/docfind/custom/mymeritainHealthEquity - HSA Bank, Cafeteria Plan & Section 125866-346-5800 www.myhealthequity.comDental Select - Dental (Platinum Plan)800-999-9789 www.dentalselect.com801-495-3000Opticare of Utah - Vision800-363-0950 www.opticareofutah.com801-869-2020The Hartford - Life, Long-Term Disability(LTD)888-563-1124 - Life www.thehartfordatwork.com800-331-7234 - Life Underwriting800-752-9713 - Long-Term Disability866-854-5429 - Life Conversations800-243-6108 - Global Emergency ServicesBlomquist Hale Consulting - Employee Assistance Plan (EAP)801-262-9619 - Salt Lake www.blomquisthale.com801-225-9222 - Orem Brigham City - 435-723-1610801-392-6833 - Ogden All Others - 800-926-9619435-752-3241 - LoganColonial Life Insurance - Life800-325-4368 - Customer Service www.coloniallife.comSheri Paskins : 801-509-0933Vitality – Wellness Program877-224-7117 www.PowerofVitality.comHUMAN RESOURCESPlease contact Human Resources for any benefit related questions including benefit coverage, contributions, enrollment, benefit change forms,notification for changes in status, provider directories, and general carrier information.IRS REGULATIONSFailure to meet IRS Deadlines will affect your insurance coverage! IRS regulations govern how and when an employee may makecafeteria plan elections and changes to those elections. These rules require that employers enforce firm deadlines with respect to employeebenefit enrollment forms and the related cafeteria plan elections. This means that we cannot accept forms turned in after open enrollmentends. Furthermore, if you experience a qualifying event allowing you to add, drop or modify your coverage and related cafeteria plan electionmid-year, we must be notified of such event and the required forms must be completed generally within 30 days of such event, or you cannotmake the change. In addition, please be aware that with the exception of the birth, adoption or placement for adoption of a child, any cafeteriaplan election changes can only be implemented prospectively, i.e., on the first paycheck or period of coverage following our receipt of the form.Therefore, if you are making a change based on a qualifying event other than a new child, and you want changes implemented as of the date ofthe event, you must inform us of the change and turn in your form before such event occurs. If you do not turn in your form on time, you willnot receive coverage or be able to change your elections mid-year unless you have a special enrollment opportunity.SOCIAL SECURITY NUMBERSFederal law requires you to provide a valid Social Security Number for each person to be covered by any medical plan sponsored by your employer(yourself, your spouse, and all dependent children).MEDICARE PART DIf you have Medicare or will become eligible for Medicare in the next 12 months, Federal law gives you more choices about your prescription drugcoverage. See Human Resources for more information.VOLUNTARY BENEFITSVoluntary benefits are not sponsored or endorsed by your employer including for purposes of federal and state law, so federal ERISA lawis inapplicable.Note: This publication is only a partial summary of benefits and is provided for informational purposes only. It does not describe all elements of the summarized programs.For complete information regarding the benefits, plan provisions, limitations and exclusions, and for a description of claims procedures, refer to the formal benefit documentsthat will be provided to you after enrollment. In the event of a discrepancy or conflict between the information contained in this publication and the official benefit planprovisions, the official plan documents and insurance contracts will govern. Copies of these documents are available for your review from your Human Resources Department.No rights shall accrue to you and/or your dependents because of any statement, error or omission in this publication.

medicalplan 2013 · 2014NationCare HealthSave - Ultradent offers the following medical plan:NationCareAD: After DeductibleNetwork Non Network *¹ Single / Two Party or Family UnitDeductible (Individual / Family) $1,500 / $3,000 $3,000 / $6,000Out of Pocket Maximum 1² Limitations Apply - refer to benefit summary for$2,500 / $5,000 $5,000 / $10,000(Deductible Included)more details.Lifetime MaximumUnlimited$1,250,000* If you do not see a Aetna provider, you are responsible(Maximum / Year) to pay the balance of billed charges above the usual andOffice Visitscustomary charges.Primary Care$15 AD40% ADPreventiveCovered 100%Not CoveredSelectHealth uses Meritain to administer their out of stateSpecialists$15 AD40% ADplans. This also allows Ultradent to elect the network forChiropractic$15 AD 240% ADthe group. It has been found that the Aetna networkPrescriptions (Generic Required)Tier 1 / Tier 2 / Tier 3(within Meritain) does have an improved network for theRetail Pharmacy (30 Days)20% AD / 20% AD / 20% ADout of state employees as a whole. Here is a breakdownMail Order (90 Days)20% AD / 20% AD / 20% ADof who to contact in each situation.Injectable Drugs & Specialty Medications20% AD 40% ADSelectHealth -Diagnostic Lab / X-RayThe only thing SelectHealth does for Meritain plans isMinor (In Office)20% AD40% ADenrollment. Everything else is done by Meritain.Major20% AD40% ADOutpatient ServicesMeritain Health -Outpatient Surgery20% AD40% AD24 automated Customer Service Line for verification ofRehabilitation Therapy - Office$15 AD 240% AD 2benefits, claim status, request forHome Health20% AD40% ADID cards 888-769-2100Durable Medical Equipment20% AD40% ADTo Identify a PPO in your area 800-343-3140Inpatient ServicesHospital20% AD40% ADCustomer Service 800-847-8361Physician20% AD40% ADPre-Certification 800-542-6355Surgeon, Anesthesiologist20% AD40% ADThe phone number for pharmacy isRehabilitation Therapy - Facility20% AD 240% AD 2866-475-7589Maternitywww.meritain.com Online services to view your PlanHospital20% AD40% ADPhysician20% AD40% ADDesign and view your Explanation of Benefits (EOB).Emergency or Urgent CareUrgent CareEmergency RoomAmbulance Services (Emergencies Only)$35 AD$75 AD20% AD40% ADSee Network BenefitSee Network BenefitsAetnawww.aetna.com/docfind/custom/mymeritain Website tofind a participating provider in your area. You will onlyuse this website to find a participating provider. YouMental Healthare NOT enrolled in Aetna, you are using their leasedInpatient / Outpatient20% AD40% ADnetwork to receive discounts on services rendered. YourOutpatient - Office$15 AD40% ADEOB will come from Meritain.For all out-of-network services, the employee is responsible for pre-certification.NationCare Full Time Rates Total Monthly Premium Ultradent's Portion Employee's Portion Employee Per Pay PeriodEmployee (EE)EE + SpouseEE + Child(ren)EE + Family$346.90$728.50$624.40$1,075.30$261.90$583.50$494.40$900.30$85.00$145.00$130.00$175.00$42.50$72.50$65.00$87.50See HR for Part Time RatesRefer to the Vitality Wellness Program section in this guide to see how you can reduce your medical rates by participating in the VitalityWellness Program. Employees must be enrolled in the Medical Plan to be eligible to participate in the Vitality Wellness Program.2For a complete description of benefits, limitations, and exclusions, consult your Summary Plan Description,available from Human Resources or at www.meritain.orgThe benefits illustrated are in summary form only. They should not be construed as complete in and of themselves. They are only for comparison. In the case of a discrepancy,the plan documents apply. Please refer to the formal plan documents for a complete description of benefits, limitations, and exclusions.

healthsavingsaccount 2013 · 2014Can I contribute to both an HSA and FSA in the same year?Yes, a “Limited Purpose FSA” is permissible. A limited FSA only allows reimbursement of certain expenses that are not eligible for payment under the HDHP orHSA. Your employer has established a limited FSA to allow employees to contribute pre-tax dollars to an account which only reimburses expenses for dentaland vision services.What if I am a new hire or have a special enrollment and enroll in an HSA in the middle of a year?If you enroll in an HSA at any time other than the start of the plan year when you make your other elections, you may still contribute the maximum amountallowed for the calendar year. (See the chart on the previous page.) However, the IRS requires you to participate in the HDHP during a subsequent testing period(generally through the end of the following year). Failure to do so will result in adverse tax consequences.Why should I elect an HSA?1. Cost Savings• Tax benefits:• HSA contributions are excluded from federal income tax.• Interest earnings may be tax free.• Withdrawals for eligible expenses are exempt from federal income tax.• You pay a reduced medical plan premium contribution.• Unused money is held in interest-bearing savings or investment accounts from year to year.Note: Many states have passed legislation to provide favorable state tax treatment for HSAs. However, in a small number of states, amounts contributed to HSAsand interest earned on HSA accounts could be included in the employee’s compensation for state income tax purposes.2. Long-Term Financial Benefits• Save for future medical expenses, including retiree medical• Funds roll over year to year• This is your account – you take it with you. If you leave your employer you can do the following:• Leave your funds in the current HSA account;• Transfer your funds to an HSA with your new employer; or• Transfer your funds to another qualifying account within 60 days.3. Choice• You control and manage your health care expenses.• You choose when to use your HSA dollars to pay your health careexpenses.• You choose when to save your HSA dollars and pay health careexpenses out-of-pocket.• You can choose to increase or decrease your election during the year(as allowed by your employer).4Frequently Asked Questions -Can I use my HSA dollars for non-eligible expenses?Money withdrawn from an HSA account to reimburse non-eligibleexpenses is taxable income to the account holder and is subject toa tax penalty. An exception eliminates the taxable income issue ifthe account holder is over age 65, is disabled, or dies.When can I start using my HSA dollars?You can use your HSA dollars immediately following your HSAaccount activation and once contributions have been made.Can my HSA dollars be used for retirement health care costs?Yes, for expenses eligible for reimbursement, and Medicare andother health coverage premiums after age 65.Can I use the money in my account to pay for my dependents’medical expenses?Yes, you can use the money in the account to pay for medicalexpenses of yourself, your spouse, or your dependent children. Youcan pay for expenses of your spouse and dependent children evenif they are not covered by your HDHP.

HealthEquity - Understanding a Cafeteria Plan / Section 125:You can only elect the this plan is you waive the HSA and lose the Ultradent contribution. This plan is still available to all employee to use fordependent care reimbursement.Cafeteria Plan / Section 125Cafeteria Plan/Section 125 accounts enable you to pay certain qualifiedexpenses using tax-free dollars. Depending on your personal tax rate, this cansave you 10% to 30% or more on medical, dental, vision and/or dependent care outof-pocketcosts.The Flexible Spending Account (FSA) allows you to set aside up to $2,500 inpretax dollars to pay most out-of-pocket medical, dental or vision care expenses,including: medical and dental deductibles and co-payments, eye glasses, dentaland orthodontic work not covered by insurance. As of 2011 - Under the newhealthcare reform legislation, over-the-counter (OTC) drugs, medicines andbiologicals will be eligible for reimbursement only if the request is accompaniedby a doctor's prescription. This means items such as cough medicines, painrelievers, acid controllers, diaper rash ointment, to name a few, will no longerbe reimbursed unless there is doctor's prescription submitted along with thereimbursement request. As of January 1, 2013, under the AffordableCare Act, the maximum amount that can be contributed to FlexibleSpending Account is $2,500 per year.The Dependent Care Assistance Plan (DCAP) lets you set aside up to $5,000in pre-tax dollars to pay for eligible dependent care expenses so you (and ifmarried, your spouse) can work.The AdvantagesThere are some significant advantages to using the above reimbursement typeaccounts. Income directed to a reimbursement account is tax free. When you payless in taxes, you receive more spendable income. The accounts can save you10% to 30% or even more, depending on your personal tax rate. Convenientpayroll deductions help assure that you will have money available for out-ofpockethealth and/or dependent care expenses.How It WorksDuring annual enrollment, you decide how much you want to deposit into yourreimbursement account(s). That amount is deducted evenly during the plan yearfrom your paycheck before taxes are taken out. When you have an expense thatqualifies, you pay the bill, submit a claim, and you are reimbursed with tax-freedollars from your account.EligibilityYou will be eligible to participate in the account(s) when eligibility requirementsare met. Following are additional guidelines for determining eligible expenses:• The expense is for services received during the plan year (July 1 to July 30).• The expenses are not covered by any health care plan in which you areenrolled.• The IRS would otherwise let you deduct the expenses on your income taxes.The Dependent Care Assistance PlanWith the Dependent Care account you can set aside tax-free income to pay forqualified dependent care expenses, such as day care, that you normally pay withafter-tax dollars.You must meet the following criteria in order to set up this account:• You and your spouse both work;• You are a single head of household; or• Your spouse is disabled or a full-time student.Qualified dependents include children under 13 and/or dependents who arephysically or mentally handicapped and the expense must be incurred to allowyou to work. If your spouse is unemployed or doing volunteer work you cannotset up a reimbursement account.Each calendar year the IRS allows you to contribute the following amounts,depending on your family status:• If you are single, the lesser of your earned income or $5,000• If you are married, you can contribute the lowest of:• Your (or your spouse’s) earned income.• $5,000 if filing jointly, or $2,500 if filing separately.Use it or Lose itIf you don’t use all the pretax dollars you deposited in your account(s), you willforfeit any balance in the account(s) at the end of the plan year. You have 60days after the plan year ends to submit claims for expenses incurred during thatplan year.Once Enrolled, You May Not ChangeOnce you have designated how much you want to contribute on an annual basisto one or both of your reimbursement accounts, you cannot stop or change yourcontributions unless you have a qualifying Change Event as defined and limitedby the IRS. See Qualifying Change rules earlier in this guide.ReimbursementsTo claim reimbursements, fill out a claim form and attach any supportinginformation. For health care this will include receipts of the amount you paid andthe date(s) on which you or a dependent received services. For dependent carethis may include any contracts, letters, or receipts. You may send this informationto HealthEquity via either mail or fax.HealthEquity866-346-5800 www.healthequity.comJOHN'S EXPENSES JOHN'S SITUATION WITHOUT THE ACCOUNT JOHN'S SITUATION WITH THE ACCOUNTLENSES & FRAMES $280 JOHN'S ANNUAL EARNINGS $30,000 JOHN'S ANNUAL EARNINGS $30,000ORTHODONTIA $1,000 TAXES (25%) - $7,500 EXPENSES (BEFORE TAXES) - $2,500CO-PAYS $120 NET PAY $22,500 TAXABLE PAY $27,500ANTICIPATED SURGERY $1,100 EXPENSES (AFTER TAXES) - $2,500 TAXES (25%) $6,875TOTAL FOR THE YEAR $2,500 TAKE HOME PAY $20,000 TAKE HOME PAY $20,625JOHN'S TAKE HOME PAY INCREASES $625 BY USING THE REIMBURSEMENT ACCOUNTThe benefits illustrated are in summary form only. They should not be construed as complete in and of themselves. They are only for comparison. In the case of a discrepancy,the plan documents apply. Please refer to the formal plan documents for a complete description of benefits, limitations, and exclusions. 5cafeteriaplan/section125 2013 · 2014

wellnessprogram 2013 · 20146Get STARTEDOnce you’ve registered for Vitality, you’ll be ready to get started!We recommend you complete the Vitality Health Review (VHR), anassessment that evaluates your current health status and only takesabout 10 minutes to complete.Your VHR answers will enable Vitality to recommend health goalsthat are unique to you and you alone — and give you the tools,guidance and encouragement to achieve them.Get REWARDEDReap the benefits of healthy living when you participate in Vitalityand achieve your wellness goals!You’ll receive Vitality Bucks® for all the Vitality Points you earn. Eachpoint is worth a buck, and you can redeem your Vitality Bucks at theonline Vitality Mall. There, you will find more than 600,000 items,including the latest electronics, housewares, sporting equipment,designer goods and more!The higher your Vitality Status, the greater your discount in theVitality Mall!Take charge of your health.Vitality is an interactive and personalized wellness program that makes it easy for you to live your healthiest life!Whether you’d like to lose weight, become more active, improve your diet or simply maintain a healthy lifestyle, Vitalityis right for you! Once you register and become a member, it’s easy to get started. Before you know it, you’ll begin to makeVitality a natural part of your everyday life and enjoy the benefits of a healthy lifestyle at work, at home and at play.Get REGISTERED The first step is to register online for the program. It’s fast, free and easy!Set GOALSChoose the personal health goals you want to activate first, thenstart earning Vitality Points® for completing a wide variety of healthyactivities, all aimed at helping you accomplish your objectives. Toview your goals, navigate to My Profile > My Goals.Not ready for a goal? No problem! Engage in a variety of coreactivities for which you can earn points. Navigate to Home > EarningPoints for a complete list.Get ACTIVEwww.PowerofVitality.comEarn Vitality Points for every Vitality activity you complete and goalyou achieve. As you increase your points, you'll also increase yourVitality Status®. Start at Blue and move up to Bronze, Silver, Goldand ultimately, Platinum Vitality Status!BLUE BRONZE SILVER GOLD PLATINUMPrivacy is a top priority at Vitality, and we are committed to maintaining the highest level of confidentiality with all of the information we receivefrom our members.New Hires -Achieving Vitality Status®As you increase your points, you’ll alsoincrease your Vitality Status.As your status increases, you’ll earn greaterdiscounts on rewards from the VitalityMall!STATUS THRESHOLDSVITALITY MALL DISCOUNTMONTHLY HEALTH INSURANCEPREMIUM DISCOUNTThe benefits illustrated are in summary form only. They should not be construed as complete in and of themselves. They are only for comparison. In the case of a discrepancy,the plan documents apply. Please refer to the formal plan documents for a complete description of benefits, limitations, and exclusions.BLUENOT YET ACTIVEN/AN/ABRONZEHRA COMPLETED0%$20SILVER2,500 PTS10%$25GOLD6,000 PTS20%$35PLATINUM10,000 PTS40%$50

The first step in becoming a Vitality member is to register online for the program. After you register, you can start on yourpath to living your healthiest life! To get started, complete the Vitality Health Review (VHR). Completing your VHR providesyou with an evaluation of your health risks. It also helps Vitality develop a personalized program and goals designedspecifically for you. If you are unsure what to do next, refer to the checklist below to help you get going.NEW TO VITALITYGet started today! Reap the benefits of the Vitality program and start living your healthiest life.Register online forthe Vitality programUpdate or Confirm your emailcontact informationMY PROFILE > My AccountSchedule a Healthy HabitGET HEALTHY > Healthy Living >Healthy HabitsTrack your workouts using aVitality-approved fitness deviceGET HEALTHY > Fitness & Exercise >Fitness DevicesComplete an online NutritionCourseGet Healthy > Nutrition & HealthyEating > Online CoursesgetComplete the VitalityHealth Review (VHR)Vitality ActivitiesOnce you are registered and logged in, follow the paths for each activity below.For a complete list of activities, navigate to Home > Earning PointsComplete a Vitality Checkbiometric screening with a VitalitypartnerGET HEALTHY > Vitality CheckSign up at a Partner Health ClubGET HEALTHY > Fitness & Exercise >Partner Health ClubsDonate bloodGET HEALTHY > Healthy Living >Blood DonationComplete online health toolcalculatorsGET EDUCATED > Calculators FitnessDeviceswww.PowerofVitality.comReview and activate yourpersonal health goals andengage in Vitality activitiesSchedule a preventive screeningGET HEALTHY > Healthy Living >PreventionComplete a Fitness Assessmentwith a Vitality partnerGET HEALTHY > Fitness & Exercise >Fitness AssessmentSign up for an Athletic EventGET HEALTHY > Fitness & Exercise >Athletic EventsGet CPR or First Aid CertifiedGET EDUCATED > CertificationsPlease note: This list does not cover the program in its entirety. Please refer to the Vitality website for complete program activities, rules and details.Privacy is a top priority at Vitality, and we are committed to maintaining the highest level of confidentiality with all of theinformation we receive from our members.The benefits illustrated are in summary form only. They should not be construed as complete in and of themselves. They are only for comparison. In the case of a discrepancy,the plan documents apply. Please refer to the formal plan documents for a complete description of benefits, limitations, and exclusions. 7newmemberwellnessprogram 2013 · 2014

existingmemberwellnessprogram 2013 · 20148Get started on a new Vitality program year! Each year, you will be asked to complete the Vitality Health Review(VHR). Not only will you earn Vitality Points for completing it, but your VHR will provide you with anevaluation of your current health risks. It also helps Vitality take into account your recent wellness successesand develop a personalized program with goals designed to address your current wellness needs. Refer to thesteps below to get started on a new program year and continue earning points, achieving goals, and best of all,living your healthiest life!Your Vitality program year just renewed.Here’s what you can do to start off the new program year right!Log in to the Vitalityprogramwww.PowerofVitality.comNew program year start = more points!Complete theVHR questionnaireMY PROFILE > Vitality Health ReviewReceive completion points: Complete the VHRand earn 500 Vitality Points!Receive an VHR Bonus: Complete the VHRwithin 90 days and receive a bonus of 250Vitality Points!Receive a 10% Carryover Bonus: As an addedboost to help get you started in the newprogram year, Vitality will award you a bonusequal to 10% of your points earned in the lastyear. For example, if you earned 6,000 pointslast year, Vitality will reward you with 600bonus points! So, you’ll begin the newprogram year with 600 points, not 0.CONTINUINGImportant to note:You must complete the VHR each program year to reactivate your account.www.PowerofVitality.comReview, activate or continueyour personal health goalsAt renewal ...Vitality Points do resetYou will receive a 10% carryover bonus togive you a headstart.Points status does resetRewards status does not resetFor example, if you reach Gold Vitality Statusin year one, you’ll enjoy the benefits of Gold inthe remainder of year one and year two. Inorder to maintain or surpass Gold, you’ll haveto earn enough points, in year two, to reachthe desired status level.Vitality Bucks® do not resetYou only lose bucks when you spendthem!Privacy is a top priority at Vitality, and we are committed to maintaining the highest level of confidentialitywith all of the information we receive from our members.The benefits illustrated are in summary form only. They should not be construed as complete in and of themselves. They are only for comparison. In the case of a discrepancy,the plan documents apply. Please refer to the formal plan documents for a complete description of benefits, limitations, and exclusions.

Dental Select - Ultradent offers the following dental plan:SelectDent Plan - Platinum NetworkNetworkNon NetworkAnnual Deductible (Single / Family) None $50 / $150Maximum Annual Benefit - DentalMaximum Lifetime Benefit - Orthodontia$1,500$1,500Preventive & Diagnostic Covered 100% Covered 100% of R&CBasic Services 80% 80% of R&CMajor Services -12 Month Waiting Period for New Enrollees Only50% 50% of R&COrthodontia -12 Month Waiting Period for New Enrollees OnlyAll Members20% Discount then 50% 50%Specialists See Notes See NotesFULL TIME PREMIUM Total Monthly Ultradent's Portion Employee's Portion Employee Per Pay PeriodSingleFamily$40.01$121.64$40.01$94.64$0.00$27.00$0.00$13.50R&C - Reasonable & Customary Fees for UtahIn Network - General Dentists: All general dentists accept the Platinum fee schedule as payment in full. Specialists: After 20% discount, all paymentsmade by the plan are based on the Platinum fee schedule. Member is responsible for any difference between the billed amount and the plan payment.Out of Network - General Dentists & Specialists: Payments are based on R&C. Member is responsible for the difference between the dentist’s fee andthe plan payment.Opticare of Utah - Ultradent offers the following vision plan:OPTICARE 120B PLAN IN NETWORK OUT OF NETWORKEye ExamNo Examination BenefitLenses 1Plastic Single Vision / Bifocal / TrifocalProgressive Lenses (Standard No-Line) *Premium Progressive Options *Glass LensesPolycarbonateHigh IndexCoatingsScratch Resistant CoatingUltraviolet FilterOther Options: Anti-Reflective, Edge Polish,Tints, Mirrors, etc.Frames 1Allowance based on retail pricingBack-Up or Multiple Pairs **Contacts (In Lieu of Glasses) 1Benefit AllowanceAdditional Contact Purchases:Conventional ***Disposable ***EMPLOYEE RATES PER PAY PERIODSingleTwo PartyFamily$10 Co-pay$50 Co-payNo Discount15% Discount25% Discount25% Discount$10 Co-pay$10 Co-payUp to 25% Discount$120 AllowanceUp to 50% Discount$120 AllowanceRetailRetail$2.35$4.35$5.66$85 Allowance forLenses, Options andCoatings †$80 Allowance †$80 Allowance †Refractive Surgery (LASIK) - Discount $250 off per eye -LASIK services are not an insured benefit - this is a discountonly. All pre & post operative care is provided by StandardOptical Only and is based on Standard Optical retail fees.Discounts - Any item listed as a discount in the benefitoutline is a merchandise discount only and not an insuredbenefit. Providers may offer additional discounts.1 Frequency for Exams, Lenses, Frames, and Contacts:12 Months* Co-pays for progressive lenses may vary. This is asummary of plan benefits. The actual Policy will detail allplan limitations and exclusions.** 50% discount at Standard Optical locations Only. Allother Network discounts vary from 20% - 35%.*** Must purchase full year supply to receive discounts onselect brands. See provider for details.† Out of Network - Allowances are reimbursed at 75%when discounts are applied to merchandise. Promotionaland Online purchases are an exclusion to covered benefits.For additional information or to find providers in your areaplease visit: www.opticareofutah.comor call 1-800-363-0950.The benefits illustrated are in summary form only. They should not be construed as complete in and of themselves. They are only for comparison. In the case of a discrepancy,the plan documents apply. Please refer to the formal plan documents for a complete description of benefits, limitations, and exclusions. 9dentalandvisionplan 2013 · 2014

lifeinsuranceplans 2013 · 2014The HartfordBasic Life - 100% Company PaidEach eligible employee receives life insurance for themselves and their eligible dependents. These benefits will reduce to 65% at the insured's age65, to 40% at age 70 and to 25% at age 75. AD&D benefits match this reduction schedule. Life and AD&D benefits terminate upon retirement.Basic Term Life insurance includes waiver of premium coverage. The waiver of premium does not apply to any AD&D benefits.BENEFITSCOVERAGELife Insurance - Employee1x SalaryAccidental Death & Dismemberment (AD&D) - Employee Only1x SalarySeatbelt Benefit - Employee Only (Paid for a death resulting from an auto accident while properly wearing a seatbelt)1x Salary ($50,000 Maximum)Life Insurance - Spouse $10,000Life Insurance - Child(ren) - live birth to age 26 $5,000Please see Certificate of Coverage summary for more detailed benefit information.Global Emergency Services - A Free, Value-Added Servicewww.thehartford.com/employeebenefits - 1-800-243-6108: GLD 09012The Hartford’s Travel Assistance Program is provided by Worldwide Assistance Services, Inc. Toll-free emergency assistance is available to you,your spouse, and your dependents’ 24 hours a day, 7 days a week when traveling 100 miles or more from your primary home (national orinternational travel) for 90 days or less. Please keep the wallet-size ID card with important contact information handy for easy access when planningfor or while on a trip.The Hartford’s Travel Assistance Program provides three kinds of services for your business or vacation travels - Pre-Trip Information, EmergencyMedical Assistance and Emergency Personal Services. A service qualifies only if Worldwide Assistance Services was contacted at the timeof service and arranged or pre-approved it. Please be aware that the Travel Assistance Program is not travel or medical insurance; rather it is aservice provider of global emergency medical services. Travel Assistance Program’s services do not replace medical insurance during medicalemergencies away from home. Rather, they are available to help you access the help you need in an emergency. All medical costs incurred shouldbe submitted to your health plan and are subject to the policy limits of your health coverage.• Visa, Passport, Inoculation and ImmunizationRequirements• International “Hot Spots”• Travel Advisories• Foreign Exchange RatesLife Conversations - A Free, Value-Added Servicewww.harfordlifeconversations.com - 1-866-854-542910The following specialized services are available to you:• Embassy and Consular Referrals• Medical Referrals• Medical Monitoring• Medical Evacuation• Repatriation• Traveling Companion Assistance• Dependent Children Assistance• Emergency Medical Payments• Return of Mortal Remains• Replacement of Medication or EyeglassesServices include the following:• Free on-line will preparation service. It has been shown that most Americans do not have a legal will.• Estate planning, funeral planning and negotiation. Using this professional service can save a family between $1,250 and $5,500 in funeralcosts.• Estate Guidance Access Code: WILLHLF• Funeral Planning: HFEVLCThe benefits illustrated are in summary form only. They should not be construed as complete in and of themselves. They are only for comparison. In the case of a discrepancy,the plan documents apply. Please refer to the formal plan documents for a complete description of benefits, limitations, and exclusions.

The HartfordVoluntary Supplemental Life - 100% Employee PaidSupplemental Group Term Life Insurance product is available on a voluntary basis. This coverage is in addition to the company provided amountsand the premiums are 100% employee paid through payroll deduction. Coverage is available only to employees eligible for benefits and coveredunder the basic Group Term Life Insurance provided by the employer.Employees may select any amount from $20,000 to $800,000 in increments of $5,000. Spouse coverage may be equal to but not exceed theemployee's Supplemental Coverage amount from $20,000 to $400,000 in increments of $5,000. Unmarried, dependent children under the ageof 26 are eligible for either $5,000 or $10,000 of Supplemental Term Insurance.All Supplemental Insurance amounts can be purchased at any time and are subject to evidence of insurability. Each applicant must complete aGroup Life Health Form. Insurance will become effective only after underwriting approval by The Hartford. Supplemental Group Term Insuranceincludes waiver of premium coverage. Supplemental Life benefits will reduce to 65% at the insured’s age 65, to 40% at age 70 and to 25% at age75. Benefits terminate upon retirement. Supplemental Life offers a Right of Conversion (see Human Resources upon termination for a conversionform). Rate sheets and enrollment forms are available from Human Resources. The rates are also listed on the enrollment form.Please see Certificate of Coverage summary for more detailed benefit information.Voluntary Long Term Disability - 100% Employee PaidUltradent Products, Inc. makes Group Long Term Disability (LTD) available to you through The Hartford. The Hartford is a financially stablecompany and has a well established reputation for service, experience, and expertise in the disability field.BENEFITSMonthly Benefit60% of Covered Earnings (Including Commissions)Monthly Maximum $5,000Elimination Period90 DaysMaximum Duration of BenefitSocial Security Normal Retirement AgeEligibility - If you are an active regular employee working 20 hours or more per week, you are eligible to participate in the LTD program the firstday of the month following 90 days of employment.Guarantee Issue - You have 31 days from the date of your initial eligibility to enroll without proof of insurability. If you decline now, but laterdecide to enroll, you will be required to provide evidence of good health that is satisfactory to The Hartford and understand that your request forcoverage may be denied.The benefits illustrated are in summary form only. They should not be construed as complete in and of themselves. They are only for comparison. In the case of a discrepancy,the plan documents apply. Please refer to the formal plan documents for a complete description of benefits, limitations, and exclusions. 11lifeanddisabilityinsuranceplans 2013 · 2014

employeeassistanceandvoluntarybenefits 2013 · 2014Blomquist Hale ConsultingEmployee Assistance Program - 100% Company PaidUltradent Products, Inc. offers a valuable service for all Ultradent employees, theirdependents, and anyone living underneath the employee’s roof. This service iscalled “The Employee Assistance Program” (EAP) and will be administered throughBlomquist Hale Consulting.What is an Employee Assistance Program (EAP)?The EAP is a resource to help members address a broad range of personal difficulties thatmay be causing them distress. It provides brief, face-to-face counseling to helpresolve such concerns as marital difficulties, family problems, stress, depression,anxiety, and to assess for drug/alcohol dependence.These counseling services are free, with no co-pay. EAP offers highly professional,confidential counseling to you and your covered dependents. There is no pre-set limiton the number of free sessions offered and visits to the life assistance counselingservice do not count against your mental health benefit.Most problems are addressed in just a few sessions over a couple of months. However,some types of problems are not appropriately treated by short-term counselingand may require a referral to the SelectHealth panel of mental health providers.Patients who wish may still go directly to the traditional Mental Health Benefit asoffered by their medical plan.Most services are available by appointment. Assistance will be available for lifethreatening emergencies 24 hours per day, 7 days per week. To receive assistance,simply call your local EAP office to make an appointment.Prevention is always the best medicine. If any type of problem distresses you or yourfamily members, please utilize the expertise made available by this valuable service.Colonial - ACCIDENT INSURANCE - 100% Employee Paid12To reach an EAP Representative Call 1-800-926-9619All services are free and accessible 24 hours a day, 365 days a year.The EAP is your resource for every thing - from the everyday to theunexpected. At times, we can all use help with a personal problem or issuethat is interfering with our life or work. Most people experience personalor family challenges in the course of their lives. Our professional counselorsare available to discuss the issues you face in your life, including:Life ChangesBirth/AdoptionChild CareParentingFamily ConflictsStressDepressionJob PressuresLegal AdviceFinancesElder CareRelationshipsGriefAgingDrugs/AlcoholEating DisordersFor Appointments Call:Brigham City 435-723-1610Logan 435-752-3241Ogden 801-392-6833Orem 801-225-9222Salt Lake City 801-262-9619Other Areas Call 800-926-9619OFFICE HOURS:Monday - Friday8 AM - 5 PMSALT LAKE OFFICE HOURS:Monday - Thursday8 AM - 8 PMFriday8 AM - 5 PMSaturday8 AM - 3 PMACCIDENTS ARE UNEXPECTED HOW YOU CARE FOR THEM SHOULDN’T BE!What’s a part of your everyday life?Little League · Weekend Sport · Leisure Hobbies · Exercising · Gardening · Chores · Fix-up projects around the house? · Going to work every day? These are justa few of the routine, everyday activities we all enjoy. Unfortunately, accidents are also a part of everyday life. And we often don’t think about the accidentalinjuries, or even the accidental deaths, that may happen during the course of a day.Accident insurance from Colonial Life & Accident Insurance Company can help. It pays specific benefit amounts for injuries received in a coveredaccident to help with the out-of-pocket costs such as deductibles and co-insurance associated with an accident. Benefits include:• Emergency treatment, ambulance, accident follow-up doctor visits and hospitalization. Medical treatment for fractures and dislocations or physicaltherapy.• Crutches, wheelchairs or other medical aids you may need as a result of your accident.• And many moreACCIDENT -PLAN A OPTION WITH $50 HEALTH SCREENING BENEFITPER PAYCHECK DEDUCTIONPLAN AEmployee Employee/Spouse One-Parent Family Two-Parent FamilyPremium $4.76 $7.72 $7.82 $10.78ACCIDENT - HIGH PLAN OPTION WITH $50 HEALTH SCREENING BENEFITPER PAYCHECK DEDUCTIONPLAN BEmployee Employee/Spouse One-Parent Family Two-Parent FamilyPremium $8.77 $14.32 $15.58 $21.14The benefits illustrated are in summary form only. They should not be construed as complete in and of themselves. They are only for comparison. In the case of a discrepancy,the plan documents apply. Please refer to the formal plan documents for a complete description of benefits, limitations, and exclusions.

Colonial - CRITICAL ILLNESS INSURANCE - 100% Employee PaidCOULD YOU SURVIVE FINANCIALLY IF YOU BECAME CRITICALLY ILL?Chances are you know someone who has faced a critical illness, so you know the physical and emotional drain such an illness can impose. But have youthought about the financial problems it can bring?Fortunately, the odds of surviving a critical illness are in your favor, but would you be prepared for the many expenses that can accompany a critical illness?Even if you have health insurance, that coverage may not pay for everything, such as co-insurance, deductibles, caregivers, special medical equipment,household modifications and extra living expenses.Specified Critical Illness Insurance from Colonial Life & Accident Insurance Company can help. It pays a benefit upon diagnosis of a coveredspecified critical illness for you to use where it’s needed most. Covered specified critical illnesses include:• Heart attack (myocardial infarction)• Stroke• End stage renal (kidney) failure• Cancer• And more…Plus, your personal accident and critical illness policies have other important features:• Benefits are paid directly to you, unless you specify otherwise.• Benefits are paid regardless of any other insurance you may have with other insurance companies.• The coverage is portable; you can take it with you if you change jobs or retire.NOTE: Policies have exclusions and limitations that may affect benefits payable. For cost and complete details, please see your Colonial benefits counselor.Policies or provisions may vary or be unavailable in some statesCritical Illness including Cancer with Subsequent Diagnosis and Health Screening BenefitNON-TOBACCO - $10,000 BENEFIT (BASED ON EMPLOYEES AGE AND TOBACCO USE) - PER PAYCHECK DEDUCTIONSAGE Employee Employee / Spouse One-Parent Family Two-Parent Family17-24 $3.18 $4.90 $4.08 $5.8025-29 $4.23 $6.50 $5.08 $7.3530-34 $5.28 $8.10 $6.18 $9.0035-39 $6.88 $10.55 $7.73 $11.4040-44 $8.23 $12.60 $9.08 $13.4545-49 $10.73 $16.45 $11.58 $17.3050-54 $14.73 $22.65 $15.58 $23.5055-59 $18.08 $27.75 $18.93 $28.6060-64 $23.83 $36.60 $24.63 $37.4065-70 $26.38 $40.50 $27.18 $41.35Critical Illness including Cancer with Subsequent Diagnosis and Health Screening BenefitTOBACCO - $10,000 BENEFIT (BASED ON EMPLOYEE AGE AND TOBACCO USE)AGE Employee Employee / Spouse One-Parent Family Two-Parent Family17-24 $4.13 $6.30 $4.98 $7.2025-29 $5.83 $8.95 $6.68 $9.8030-34 $7.93 $12.15 $8.78 $13.0035-39 $10.38 $15.90 $11.23 $16.8040-44 $12.93 $19.90 $13.78 $20.7545-49 $16.58 $25.45 $17.43 $26.3050-54 $22.43 $34.40 $23.23 $35.2555-59 $28.28 $43.45 $29.13 $44.3060-64 $36.03 $55.35 $36.88 $56.2065-70 $40.18 $61.75 $41.03 $62.60Critical Illness rates are locked in at purchase age and do not increase as you get older. Benefit amount for spouse is 50% of employee's benefit and benefitamount for children is 25% of employee's benefit.* Higher benefit levels are available. See your Colonial Representative for additional rates and information.Policy provisions/rates may vary by state. See your brochures and representative for plan details and limitations.The benefits illustrated are in summary form only. They should not be construed as complete in and of themselves. They are only for comparison. In the case of a discrepancy,the plan documents apply. Please refer to the formal plan documents for a complete description of benefits, limitations, and exclusions. 13voluntarybenefitscontinued 2013 · 2014