Navajo Nation Employee Benefits Program

1. Navajo NationEmployee Benefits Program 2019 Employee Orientation

2. Participating Enterprises Dine Biolta School Board Association Dine College Kayenta Township Commission KTNN Radio Station/Native Broadcast Enterprise Navajo Agricultural Products Industry Navajo Arts & Crafts Enterprise Navajo Engineering Construction Authority Navajo Nation Hospitality Enterprise Navajo Nation Shopping Centers, Inc. Navajo Technical University Navajo Times Publishing Company, Inc. Navajo Transitional Energy Company, LLC Navajo Tribal Utility Authority and LGA Chapters

3. Plan Information • Tribal Self-Funded Plan • Regular status employees working more than 20 hours per week • Employers and employees fund the Plan by contribution of payroll premiums • Approximately 60% is Navajo Nation • (Employees – 6,500+ Total Members – 15,000+)

4. Plan Information No Liability for Indian Health Services or any Federally-Funded Health Care Providers: The Plan Administrator holds the position that neither it nor the Plan is liable for expenses or reimbursement for medical, surgical, hospital or related services to which the covered member is entitled to receive from or through the United States Public Health Service or any federally funded health care providers, or sponsored Indian Health Service programs, including referrals; nor in any event is the Plan to be considered or understood to be an “alternative source” for payment of the expense of such services.

5. Premium Rates Employee and Family

6. Monthly Health Premium Rates Employer pays a large portion of premium on behalf of its employees: Employee’s monthly cost is $32.12 for health/$1.60 for disability Family coverage an additional $158.25 for health *Rates exclude life premiums for employee and dependent

7. Enrollment Employee & Family

8. Election of Coverage Eligibility Dates: • Date of Hire • Coverage must be elected within 31 days • Qualifying Event • marriage • birth of a child • adoption • establishment of legal guardianship • child support court order • Loss of health coverage • Open Enrollment • October – November of every year

9. Termination of Coverage Group Health Group Life & Optional Term Ends last day of the covered month at midnight Life Conversion packet will be mailed (limitations apply) Call (877) 275-6387 for rates Ends last day of the covered month at midnight COBRA Election form will be mailed (limitations apply) Single Rate - $349.96/mo. Family Rate - $888.02/mo. As of 01/01/2019

10. Benefits Health, Life, and Disability

11. Group Health Insurance Patient Protection & Affordable Care Act (PPACA) Compliant • Affordable • Covers all Essential Medical Benefits • Preventive Benefits - No Cost Share • No Pre-Existing Exclusions • Behavioral and Mental Health Coverage • Dependent Coverage up to 26th birthday

12. Preferred Provider Organization – PPO The Plan networks with quality health care providers who contractually provide services and supplies on a reduced fee basis to the covered members of employer sponsored health plans Choice of a health care provider is up to the covered member Exclusions and limitations apply *Check the back of insurance cards for logo of network www.hmatpa.com

13. Medical Program Annual Deductible: $400 single/$800 family* Paid by the patient to the provider before the Plan starts to pay its portion PPO Co-insurance: 20% after deductible is met Non-PPO Co-insurance: 40% after deductible is met (Emergency room services 20% after deductible is met) Copay: $350/ER visit or $250/Inpatient stay Annual Out-of-pocket max: $4,000 single/$8,000 family* Paid by the patient before the Plan starts to pay 100% for the rest of year Added Benefits: Alternative Care (massage, chiropractic, acupuncture) Native Traditional Healing Benefit * Based on usual and customary rates (limitations apply). Please refer to Plan Document and/or Summary of Benefits & Coverage

14. How it Works…

15. How it Works…

16. Behavioral Health Services Preventive Benefits Exam, Immunizations/Vaccinations Alternative Care (Chiropractic, Massage, Acupuncture, Holistic) Native Traditional Healing Benefit Outpatient Counseling – Medically Necessary to Treat a Condition Inpatient Treatment – Mental Health, Substance Abuse/Addiction (Pre-Certification Required) Exclusions and Limitations: • Court Ordered, Employment Related, Licensing

17. Pharmacy Program Retail Pharmacy Co-Payment Generic $20 per script Brand $40 per script Non-formulary Brand $70 per script Mail Order Pharmacy Co-payment Generic $40 for 90-day supply Brand $80 for 90-day supply Non-formulary Brand $120 for 90-day supply Specialty Drug Pharmacy 20% up to $200 max

18. Dental Program Annual Deductible $200 single/$600 family Paid by the patient to the provider before the Plan starts to pay its portion $1,500 annual max Class I – Preventive (100%) Class II & III – Basic & Major(Both at 80%) $2,000 lifetime max 50%* Class IV – Orthodontics (Limited to children under the age of 19) * Based on usual and customary rates (limitations apply). Please refer to Plan Document and/or Summary of Benefits & Coverage

19. Vision Program Benefit: $200/year per member Exam (once per year) Lenses (once per year) Frames (once per year) Contact lenses (in lieu of lenses and frames) Added Benefit: Lasik Benefit $500 lifetime Benefit

20. Secure Online Member Portal http://members.hmatpa.com Review Claims Status View Plan Benefits and Coverage Check Eligibility and Enrollment Request ID Cards Update Mailing Address Provider Search

21. Group Life Insurance Employee based on Basic Annual Salary Two policies per Employee 24 hour coverage on/off the job Class 1 - $30,000+ Basic $125,000 & AD&D $125,000 Class 2 - $20,000 less than $30,000 Basic $ 90,000 & AD&D $ 90,000 Class 3 - $17,000 less than $20,000 Basic $ 80,000 & AD&D $ 80,000 Class 4 - $14,000 less than $17,000 Basic $ 65,000 & AD&D $ 65,000 Class 5 - $12,000 less than $14,000 Basic $ 55,000 & AD&D $ 55,000 Class 6 - $10,000 less than $11,999 Basic $ 50,000 & AD&D $ 50,000 Spouse: Basic $ 7,500 Child: Basic $ 5,000

22. Accidental Benefits Loss of Life Doubles the policy (limitations apply) Dismemberment Based on schedule of losses, percentages of the AD&D policy may be payable to the employee

23. Accidental Benefits-Addt’l • Air Bag Benefit payable if an insured person dies as a result of injuries sustained in an accident while driving or riding in a private passenger car that was equipped with air bags. • Seat Belt Benefit payable if an insured person dies as a result of injuries sustained in an accident while driving or riding in a private passenger car and wearing a properly fastened seat belt (or a child restraint if the insured is a child). • Common Carrier Benefit payable if an insured person dies as a result of injuries sustained while traveling in a Common Carrier. The additional amount payable is 100% of the Full Amount. • Child Care Center Benefit provides funds for your eligible dependent children, 12 years old or younger, to attend a licensed child care facility for up to four consecutive years if you should suffer a fatal accident. The yearly benefit for each eligible child is equal to $5,000 or the actual amount of child care costs incurred (whichever is less), and cannot exceed an overall total of 12% of the Full Amount. In order to be eligible, dependent children must be enrolled in a licensed child care center at the time of your accidental death. • Child Education Benefit provides tuition funds for each of your eligible dependent children to attend a college or other accredited institution for up to 4 years if you should suffer a fatal accident. To qualify, your dependent children must be enrolled in the institution at the time of your accidental death or must enroll within one year of your accidental death. The yearly benefit for each eligible child is equal to $10,000 or the actual amount of tuition costs incurred, whichever is less. The total benefit maximum is 20% of the Full Amount for each eligible child. • Spouse Education Benefit provides tuition funds for your spouse if you should suffer a fatal accident. The benefit is payable for up to one year and is equal to the lesser of the actual cost of tuition, $5,000 or 3% of the Full Amount. Your spouse must be enrolled in an accredited school at the time of your accidental death • Hospitalization Benefit helps defray hospitalization costs that result from an accident. It is provided as a monthly income to the insured and is equal to one percent of your Full Amount per month, subject to a four-day waiting period and a maximum of $2,500 per month, with a maximum duration of 12 months.

24. Accelerated Benefits Employee Only Diagnosis of terminal illness, less than 12 months May apply for up to 80% of basic life policy to be payable (any amount withdrawn will reduce the policy) *In the event person recovers, amount withdrawn is not required to pay back

25. Beneficiary Primary Beneficiaries will receive proceeds Contingent Beneficiaries will receive proceeds in the event ALL Primary Beneficiaries are not living at time of employee’s loss of life Beneficiaries can be: Adults, Minors, Related, Non-related, Organizations, Estate, Trusts/Wills If more than one beneficiary, the percentage share must equal 100%, if no percentage share is specified, surviving beneficiaries within the class will share proceeds equally

26. Optional Term Life- Metlife Employee: $10,000 to $300,000 in $10,000 increments, up to the lesser of 5X your basic annual earnings or $300,000 (*Guarantee Issue $50,000-no health questions) Spouse: $5,000 to $100,000 in $5,000 increments, up to the lesser of 100% of your coverage amount of $100,000 (*Guarantee Issue $15,000-no health questions) Child: $5,000 each (up to age 26) *Guarantee Issue must be elected within 31 days of New Hire Date Enrollment is open Year Around-Statement of health questionnaire is required after 31 days of hire to determine approval Online Enrollment is available at www.mybenefits.metlife.com Paper Enrollment is available

27. How to calculate…

28. Short-Term Disability Insurance Employee ONLY • Totally disabled non-work related illness or injury • Under physician’s care for the disability • Exhaust ALL Sick Leave hours (Excludes: PTO, AL or Vacation) • Coverage starts on 1st day of accident or 7th day for illness/maternity (once Sick leave is exhausted) • 60% of average weekly salary ≤ $400 • Maximum 52 weeks W-2 issued at end of year if benefits paid *Uncollected Premiums during absence are payable upon return to work

29. Family Medical Leave Act\DPM Employer’s Personnel Policies & Procedures Provides eligible employees with job protected and unpaid leave for qualified medical and family reasons Allows eligible employees to take up to 12 weeks of unpaid leave during any 12 month period Approval for Disability benefits should not be assumed as approval by Employer of the employee’s absence from their job

30. Supplemental Life Insurance -Colonial Accident Whole Life and Term Life Critical Illness and Cancer Insurance Short Term Disability Buy-Up Dental Benefits w/ Vision Rider MDLive is being offered AGAIN! Open Enrollment Begins October 1, 2019 and continues thru December 31, 2019 Speak with a Representative to Elect Coverage Annalisa Kurz (602) 722-0988 or Lea Dennison (505) 870-8657

31. MD Live Video

32. Plan Statistics Claims

33. Claims Experience * Excludes Rx & Disability

34. 2019 2nd Quarter Top 10 Benefit Categories by Paid Amounts

35. 2019 2nd Quarter Claims Paid by Line of Coverage

36. 2018 Plan Utilization by Member Type

37. Websites www.isd.benefits.navajo-nsn.gov General Plan Information & Benefits Documents and Forms www.members.hmatpa.com Member’s access to claims information www.hmatpa.com Provider Search for discounted health service costs

38. Health Resources Division of Health - www.nndoh.org Navajo Special Diabetes Project Health Education Program Behavioral & Mental Health Services Community Health Representatives Aging and Long Term Care Services Breast & Cervical Cancer Program Woman, Infants, and Children Department of Dine Education - www.nnosers.org Office of Special Education & Rehabilitation

39. Administration Building One Second Floor PO Box 1360 Window Rock, AZ 86515 (928) 871-6300 (928) 871-6408 Fax Ahéhée’DóóHágoónee’