Supplement to your TRS ActiveCare Plan 1

1. Supplement to your TRS ActiveCare Plan 1 True Costs of Health Care = Premiums You Pay + Out of Pocket Costs SISLink-edu

2. TRSActiveCare I Dr. Visits and Rx cost are applied to the deductible then paid at 80% SISLink-edu

3. TRSActiveCare II Co-pays are an additional out of pocket cost • Dr. office co-pays $30-$50(specialist) • Rx Benefit co-pay: 10-25-45/ Maintenance 15-35-60 • Hospital co-pay $100 per day to max of $500/admission • Out-Patient Surgery co-pay $100 SISLink-edu

4. TRSActiveCare III No Deductible Co-pays are an additional out of pocket cost • Dr. office co-pays $20-$30(specialist) • Rx Benefit co-pay: 10-25-40/ Maintenance 15-35-55 • Hospital co-pay $100 per day to max of $500/admission • Out-Patient Surgery co-pay $100 SISLink-edu

5. SISLinkIn-Hospital Benefit • This benefit helps pay the out-of-pocket expenses an Insured Person incurs for a Hospital Confinement due to injury or sickness, provided: • The Insured is under the regular care and attendance of a Physician; and • such expenses are covered by the Insured Person’s Major Medical/Comprehensive Policy • Such benefits are limited to the Deductible and/or the Coinsurance Amount the Insured Person is required to pay under his Major Medical/Comprehensive Policy, and include: • In-patient Hospital stays • In-patient surgeries • Physician’s in-hospital charges • Benefits are “per Insured Person per Plan Year”. -The Maximum Plan Year Benefit limit is $2,500.- SISLink-edu

6. SISLinkOut-PatientBenefit • Pays up to the maximum benefit selected for medically necessary out-patient treatment of an Injury or Sickness. Out-patient benefits include treatment under the regular care and attendance of a physician at a hospital, physician’s office (except those expenses allocated as a physician’s office visit expense), out-patient surgical or emergency facility or a diagnostic testing facility or similar facility that is licensed to provide out-patient treatment. Benefits are limited to the difference between the benefit paid by your major medical plan and actual out-patient expenses incurred. • The Out-Patient II Benefit is a “per Insured Person per Plan Year” benefit with a Family Maximum Limit equal to 2 times the “Per Person” benefit. -The Maximum Plan Year Benefit limit is $1,250.- SISLink-edu

7. ActiveCarePlan II Participants SISLink-edu

8. SIS Rates for Plan II Participants SISLink-edu

9. SIS Rates for Plan II Participants SISLink-edu

10. SIS Rates for Plan II Participants SISLink-edu

11. ActiveCarePlan III Participants SISLink-edu

12. SIS Rates for Plan III Participants SISLink-edu

13. SIS Rates for Plan III Participants SISLink-edu

14. SIS Rates for Plan III Participants SISLink-edu

15. ClaimExample 1 SISLink-edu

16. ClaimExample 2 SISLink-edu

17. ClaimExample 3 SISLink-edu

18. ClaimExample 4 SISLink-edu

19. ClaimExample 5 SISLink-edu

20. Example 6AssumptionsTaking 3 drugs: $30 Generic, $70 Preferred, and $120 Non-Preferred Brand per Month - 2 Dr. Office Visits at $85 per visit in 1 Year SISLink-edu