Common use of ACO Plan Clause in Contracts

ACO Plan. The lesser of the Employer’s contribution for the Choice Passport Plan for 2020; or the actual cost of the ACO Plan premium. Employees shall be responsible for the difference between the monthly premium and the Employer’s monthly contribution. Based on a 6.0% premium increase for the Choice Passport Plan, this results in the following Employer contributions: Single: $621.28, plus $75 per month to be deposited in a VEBA account (plus an additional $75 per month in a VEBA for completion of 2019 Wellness Program). Employee share: $0.00/month. Family: $1,588.48, plus $45 per month to be deposited in a VEBA account (plus an additional $75 per month in a VEBA for completion of 2019 Wellness Program). Employee share: $35.58/month. Passport Copay Plan: Single: $398.88 (Employee share: $473.72/month) Family: $748.22 (Employee share: $1,542.00/month)

ACO Plan. The lesser of the Employer’s contribution for the Choice Passport Plan for 20202019; or the actual cost of the ACO Plan premium. Employees shall be responsible for the difference between the monthly premium and the Employer’s monthly contribution. Based on a 6.0% premium increase for the Choice Passport Plan, this results in the following Employer contributions: Single: $621.28587.26, plus $75 per month to be deposited in a VEBA account (plus an additional $75 per month in a VEBA for completion of 2019 2018 Wellness Program). Employee share: $0.00/month. Family: $1,588.481,507.16, plus $45 per month to be deposited in a VEBA account (plus an additional $75 per month in a VEBA for completion of 2019 2018 Wellness Program). Employee share: $35.5828.02/month. Passport Copay Plan: Single: $398.88 (Employee share: $473.72425.50/month) Family: $748.22 (Employee share: $1,542.001,415.54/month)

ACO Plan. The lesser of the Employer’s contribution for the Choice Passport Plan for 20202018; or the actual cost of the ACO Plan premium. Employees shall be responsible for the difference between the monthly premium and the Employer’s monthly contribution. Based on a 6.00.3% premium increase for the Choice Passport Plan, this results in the following Employer contributions: Single: $621.28555.16, plus $75 per month to be deposited in a VEBA account (plus an additional $75 per month in a VEBA for completion of 2019 2017 Wellness Program). Employee share: $0.00/month. Family: $1,588.481,430.48, plus $45 per month to be deposited in a VEBA account (plus an additional $75 per month in a VEBA for completion of 2019 2017 Wellness Program). Employee share: $35.5820.90/month. Passport Copay Plan: Single: $398.88 (Employee share: $473.72379.98/month) Family: $748.22 (Employee share: $1,542.001,296.12/month)

ACO Plan. The lesser of the Employer’s contribution for the Choice Passport Plan for 20202022; or the actual cost of the ACO Plan premium. Employees shall be responsible for the difference between the monthly premium and the Employer’s monthly contribution. Based on a 6.03.5% premium increase for the Choice Passport Plan, this results in the following Employer contributions: Single: $621.28642.26, plus $75 225 per month quarter to be deposited in a VEBA account (plus an additional $75 225 per month quarter in a VEBA for completion of 2019 2021 Wellness Program). Employee share: $0.00/month. Family: $1,588.481632.66, plus $45 per month 135 quarter to be deposited in a VEBA account (plus an additional $75 225 per month quarter in a VEBA for completion of 2019 Wellness 2021Wellness Program). Employee share: $35.5844.70/month. Passport Copay Plan: Single: $398.88 (Employee share: $473.72511.88/month) Family: $748.22 (Employee share: $1,542.001640.80/month)

ACO Plan. The lesser of the Employer’s contribution for the Choice Passport Plan for 20202018; or the actual cost of the ACO Plan premium. Employees shall be responsible for the difference between the monthly premium and the Employer’s monthly contribution. Based on a 6.00.3% premium increase for the Choice Passport Plan, this results in the following Employer contributions: ACO Plan (Continued): Single: $621.28555.16, plus $75 per month to be deposited in a VEBA account (plus an additional $75 per month in a VEBA for completion of 2019 2017 Wellness Program). Employee share: $0.00/month. Family: $1,588.481,430.48, plus $45 per month to be deposited in a VEBA account (plus an additional $75 per month in a VEBA for completion of 2019 2017 Wellness Program). Employee share: $35.5820.90/month. Passport Copay Plan: Single: $398.88 (Employee share: $473.72379.98/month) Family: $748.22 (Employee share: $1,542.001,296.12/month)

ACO Plan. The lesser of the Employer’s contribution for the Choice Passport Plan for 2020; or the actual cost of the ACO Plan premium. Employees shall be responsible for the difference between the monthly premium and the Employer’s monthly contribution. Based on a 6.0% premium increase for the Choice Passport Plan, this results in the following Employer contributions: Single: $621.28, plus $75 per month to be deposited in a VEBA account (plus an additional $75 per month in a VEBA for completion of 2019 Wellness Program). Employee share: $0.00/month. ACO Plan (Continued): Family: $1,588.48, plus $45 per month to be deposited in a VEBA account (plus an additional $75 per month in a VEBA for completion of 2019 Wellness Program). Employee share: $35.58/month. Passport Copay Plan: Single: $398.88 (Employee share: $473.72/month) Family: $748.22 (Employee share: $1,542.00/month)