Common use of Benefits Plans Clause in Contracts

Benefits Plans. a. Members may select one of the following benefit plans: PAK A Medical: MESSA ABC Plan 1 IN Deductible: $1350/$2700 IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded Medical: N/A – Cash In Lieu of Medical $3,000 each calendar year IN Deductible: N/A IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: N/A Voluntary Abortion: N/A PAK C Medical: MESSA Choices II IN Deductible: $500/$1000 IN Coinsurance: 10% IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: SRX Mail Voluntary Abortion: Excluded PAK D Medical: MESSA ABC Plan 1 IN Deductible: $1350/$2700 IN Coinsurance: 10% IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded PAK E Medical: MESSA ABC Plan 2 IN Deductible: $2000/$4000 IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Voluntary Abortion: Excluded

Benefits Plans. a. Members may select one of the following benefit PAK plans: , which includes dental, vision, life, and long-term disability. If no election is made, the member shall default to PAK X. XXX A Medical: MESSA ABC Plan 1 IN Deductible: $1350/$2700 1400 1P; $2800 2P&FF IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Mail Rx Mail Voluntary Abortion: Excluded Medical: N/A – Cash In Lieu of Medical $3,000 each calendar year IN Deductible: N/A IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: N/A Voluntary Abortion: N/A PAK C Medical: MESSA Choices II IN Deductible: $500/$1000 IN Coinsurance: 10% IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: SRX Saver Rx Mail Voluntary Abortion: Excluded PAK D Medical: MESSA ABC Plan 1 IN Deductible: $1350/$2700 1300 1P; $2600 2P&FF IN Coinsurance: 10% IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Mail Rx Mail Voluntary Abortion: Excluded PAK E Medical: MESSA ABC Plan 2 IN Deductible: $2000/$4000 2000 1P; $4000 2P&FF IN Coinsurance: N/A 10% IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Mail Rx Voluntary Abortion: Excluded

Benefits Plans. a. Members may select one of the following benefit PAK plans: , which includes dental, vision, life, and long-term disability. If no election is made, the member shall default to PAK X. XXX A Medical: MESSA ABC Plan 1 IN Deductible: $1350/$2700 1400 1P; $2800 2P&FF IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Mail Rx Mail Voluntary Abortion: Excluded Medical: N/A – Cash In Lieu of Medical $3,000 each calendar year IN Deductible: N/A IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: N/A Voluntary Abortion: N/A PAK C Medical: MESSA Choices II IN Deductible: $500/$1000 IN Coinsurance: 10% IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: SRX Saver Rx Mail Voluntary Abortion: Excluded PAK D Medical: MESSA ABC Plan 1 IN Deductible: $1350/$2700 1400 1P; $2800 2P&FF IRS Minimum High Deductible (2023: $1500, $3000) IN Coinsurance: 10% IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Mail Rx Mail Voluntary Abortion: Excluded PAK E Medical: MESSA ABC Plan 2 IN Deductible: $2000/$4000 2000 1P; $4000 2P&FF IN Coinsurance: N/A 10% IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Mail Rx Voluntary Abortion: Excluded

Benefits Plans. a. Members may select one of the following benefit plans: PAK , which includes dental, vision, life, and long-term disability. If no election is made, the member shall default to Plan B. PLAN A Medical: MESSA ABC Plan 1 IN Deductible: $1350/$2700 1400 1P; $2800 2P&FF IN Coinsurance: N/A IN Copay (OV/UC/ER): Rx Coverage: N/A ABC Mail Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded PLAN B Medical: N/A – Cash In Lieu of Medical $3,000 each calendar year IN Deductible: N/A IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: N/A Voluntary Abortion: N/A PAK PLAN C Medical: MESSA Choices II IN Deductible: $500/$1000 IN Coinsurance: 10% IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: SRX Saver Rx Mail Voluntary Abortion: Excluded PAK PLAN D Medical: MESSA ABC Plan 1 IN Deductible: $1350/$2700 1400 1P; $2800 2P&FF IRS Minimum High Deductible (2023: $1500, $3000) IN Coinsurance: 10% IN Copay (OV/UC/ER): N/A Rx Coverage: 3 TIER Voluntary Abortion: Excluded PLAN E Medical: MESSA ABC Plan 2 IN Deductible: $2000 1P; $4000 2P&FF IN Coinsurance: 10% IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded PAK E Medical: MESSA ABC Plan 2 IN Deductible: $2000/$4000 IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Voluntary Abortion: Excluded

Benefits Plans. a. Members may select one of the following benefit plans: PAK , which includes dental, vision, life, and long-term disability. If no election is made, the member shall default to Plan B. PLAN A Medical: MESSA ABC Plan 1 IN Deductible: $1350/$2700 1400 1P; $2800 2P&FF IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Mail Rx Mail Voluntary Abortion: Excluded PLAN B Medical: N/A – Cash In Lieu of Medical $3,000 each calendar year IN Deductible: N/A IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: N/A Voluntary Abortion: N/A PAK PLAN C Medical: MESSA Choices II IN Deductible: $500/$1000 IN Coinsurance: 10% IN Copay (OV/UC/ER): $20/$25/$50 Rx Coverage: SRX Saver Rx Mail Voluntary Abortion: Excluded PAK PLAN D Medical: MESSA ABC Plan 1 IN Deductible: $1350/$2700 1400 1P; $2800 2P&FF IRS Minimum High Deductible (2023: $1500, $3000) IN Coinsurance: 10% IN Copay (OV/UC/ER): N/A Rx Coverage: 3 TIER Voluntary Abortion: Excluded PLAN E Medical: MESSA ABC Plan 2 IN Deductible: $2000 1P; $4000 2P&FF IN Coinsurance: 10% IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Mail Voluntary Abortion: Excluded PAK E Medical: MESSA ABC Plan 2 IN Deductible: $2000/$4000 IN Coinsurance: N/A IN Copay (OV/UC/ER): N/A Rx Coverage: ABC Rx Voluntary Abortion: Excluded