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Aug11-Jul12 Plan Summaries (Posted 6-21-11) Health Net Plan Comparison PPO $250 PPO $500 PPO $750 PPO $1000 PPO $1500 PPO $2500 Value $500 Value $1000 Value $2000 RX $10/$20/$40 RX $15/$30/$50 RX $15/$35/$60 RX $15/30%/50% PPO Contract - 2011 PPO Summary of Contract Changes HSA Qualified Plan Summaries HSA $2000 Single Only Summary HSA $4000 Family Summary HSA RX 20% (included with all HSA Plans) Health Net Links Health Net Website Provider Search Complimentary Care Network Effective 1/1/2011 Optum Health 877-369-2195 Optum Health - Complimentary Care Optum Health Provider Directory VSP Vision Plans VSP $10/25 VSP $0/10 VSP Website Provider Directory Guardian Dental Plans Benefit Summaries Plan 1000 Plan 1500 Plan 2000 Booklets Plan 1000 Plan 1500 Plan 2000 Other Products Resources for Living EAP Flyer LifeBalance Program Flyer Life Insurance Plans Benefit Summaries $10,000 Life / AD&D $20,000 Life / AD&D $30,000 Life / AD&D $40,000 Life / AD&D $50,000 Life / AD&D

Miscellaneous Summaries Pharmacy Disclosure Pharmacy Benefit Guide Domestic Partner Rider 24 Hour Coverage Flu Shot Policy 2010 Benefit Summaries 2009 Benefit Summaries Guardian Rollover Flyer Plan 1000 Rollover Flyer Plan 1500 Rollover Flyer Plan 2000 Rollover Flyer Booklets $10,000 Life / AD&D $20,000 Life / AD&D $30,000 Life / AD&D $40,000 Life / AD&D $50,000 Life / AD&D

General Forms

Enrollment Employee Enrollment Form Domestic Partner Affidavit Renewal Booklet

Billing & Premium Process BSI Admin/Reference Guide EFT Form, Terms & Conditions COBRA Administration BSI Administrative Agreement

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