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BRF Hospital Holdings
Benefit Guide 2013 - 2014

Welcome to BRF Hospital Holdings
Welcome to BRF Hospital Holdings
In recognition of the diverse needs of its employees, BRF Hospital Holdings offers a variety of employee benefit programs,
allowing you to select a level of protection and security best suited to your personal situation. This booklet provides an
overview of the following Benefit Plans:
Paid Time Off
Retirement
Medical
Dental
Vision
Flexible Spending Accounts (Health Care and Dependent Care)
Basic Life & Accidental Death & Dismemberment
Voluntary Life & Accidental Death & Dismemberment
Short and Long Term Disability
Critical Illness
Employee Assistance Program
Travel Assistance
More detailed plan information, access to carrier websites, and claim forms are available on the online enrollment website
www.enrollme.biz.
Each Plan described in this booklet is governed by a legal document called the Plan Document which can be found on the
online enrollment website, www.enrollme.biz. This booklet is not intended to be all-inclusive or supersede the individual
Plan Documents, rules or policies. Therefore, in the event of a discrepancy between this booklet and the Plan Documents,
the Plan Documents will be followed.
It is important for you to have a good understanding of each Benefit Plan that is offered. Please review this booklet
carefully and if you have any questions, please contact your local Human Resource/Benefits Department or HUB
International at 318-629-8769 or 877-309-2224.
BRF Hospital Holdings
BRF Hospital Holdings
2013 - 2014 Benefits

Table of Contents and Contact Information
Eligibility
Cost of coverage
See page:
Benefit
Full Time
60 hours/
bi-weekly
pay period
Part Time
40 hours/
bi-weekly
pay period
Family
Paid Time Off Shared 2
Retirement Shared 2
Basic Life & AD&D Employer Paid 3
Medical & Prescription Drugs Shared 3
Dental Employee paid 5
Vision Employee paid 6
Voluntary Life & AD&D Employee paid 7
Short Term Disability Employee paid 8
Long Term Disability Employee paid 9
Critical Illness Employee paid 10
Flexible Spending Accounts Employee paid 11
Online Enrollment 12
Contact Information
Provider Phone Number Website
HUB Benefits Helpline
318-629-8769
877-309-2224
Online Enrollment: www.enrollme.biz
Email: BRFHH@hubinternational.com
BlueCross BlueShield
Medical
AlwaysCare
Dental
Vision
Boon-Chapman
Health Care and Dependent Care
Flexible Spending Accounts
Mutual of Omaha
Basic Life & AD&D
Voluntary Life & AD&D
Short Term Disability
Long Term Disability
Employee Assistance Program (EAP)
Travel Assistance
HM Life Insurance Company
Critical Illness
Great-West Financial
Retirement Plan
800-830-1501 www.MyHealthToolKitLA.com
888-729-5433 x 2013 www.alwaysassist.com
800-252-9653 - Option 6 www.boonchapman.com
Claims:
Life: 800-775-8805
Disability: 800-877-5176
Portability / Conversion:
877-466-8367
800-316-2796
800-856-9947
Customer Service/Eligibility:
800-323-0774
Claims: 888-529-8983
www.mutualofomaha.com/
customer-service
www.mutualofomaha.com/EAP
www.hmig.com
800-338-4015 www.gwrs.com
BRF Hospital Holdings
2013 - 2014 Benefits

Benefits and Eligibility
Eligibility
This booklet provides a summary of the benefits you are
eligible to select as a benefits eligible employee of BRF
Hospital Holdings. Benefits eligible employees are employees
working at least 60 hours per bi-weekly pay period who have
satisfied the company defined waiting periods. This booklet
contains information that is important for you to know in
order to select the benefits that are best for you and your
family. All benefits and an individual’s right to them are
subject to federal regulations, BRF Hospital Holding’s policies
and procedures, the individual plan documents, and our
receipt of your executed and recorded election.
Effective Date of Coverage
Benefits are effective the first day of the month following
your first full calendar month of employment. For Example:
Date of hire = August 20th, Effective Date = October 1st
Dependent Coverage
An eligible dependent is defined as:
Your lawful spouse
You or your spouse’s child who is under age 26, including
a natural child, step child, a legally adopted child, a child
placed for adoption, or a child for whom you or your
spouse are the legal guardian; or
An unmarried child age 26 or over who is or becomes
disabled and dependent upon you
Dependent Certification Required for Medical
Insurance:
To deter fraud, abuse, and assure the proper use of
company funds and Plan Members’ premium dollars, BRF
Hospital Holdings joins the majority of public and private
health benefit programs by requiring proof that the
dependents covered are your legal dependents. All Active
employees are required to provide written proof that each
dependent to be covered under Your Medical Plan is your
actual legal dependent. This documentation is necessary
ONLY if you are enrolling in Medical Insurance. Failure to
provide this documentation within 30 days will result in the
inability to enroll your dependents under your Medical Plan.
If you have any questions about the dependent
verification policy, contact your local HR/Benefits
Department or HUB International.
Written Verification Required for Dependents:
If you are adding a dependent to your Medical Plan you
MUST submit dependent eligibility documentation.
Spouse:
To document a Legal Spousal Relationship, submit a copy of:
Marriage License, and Page 1 of your Federal Income Tax
Return if your filing status is “joint” – or Marriage License,
and if your filing status is “Married Filing Separate” also
submit Page 1 of both Federal Income Tax Returns; and
If you have not been married long enough to file a “joint”
Federal Income Tax Return, please only submit a
photocopy of your marriage license.
Children up to age 26 and disabled children:
Natural Child
A copy of the Certified Birth Certificate showing the
subscriber as the Parent;
Step Child
A copy of the Certified Birth Certificate showing the name
of the natural Parent, and proof that the natural parent
and the subscriber are married (e.g., Marriage License);
Adopted Child
Court documentation verifying completion of Adoption
Proceedings; or
A letter of placement from an Adoption Agency, an
Attorney or the State Department of Social Services,
verifying that adoption is in process;
Foster Child
A Court Order or other legal document placing the Child
with the subscriber, who is a licensed foster parent;
Other Children
For all other children for whom a subscriber has legal
custody, a Court Order or other legal document granting
custody to the subscriber. Documentation must verify that
the subscriber has guardianship responsibility for child, not
merely financial responsibility.
Incapacitated Child
Proof that incapacitation was established at time of
enrollment, and for the appropriate child type
documentation as outlined above based on relationship.
In addition, you should submit a copy of Page 1 of your
Federal Income Tax Return to demonstrate that the child
is principally dependent on you/the subscriber for support
and maintenance. If your incapacitated child is employed,
you may be asked to also submit a copy of Page 1 of his/
her Federal Income Tax Return.
1 BRF Hospital Holdings 2013 - 2014 Benefits

Benefits and Eligibility
Qualifying Events
Once you have enrolled in benefits, you cannot change your
elections unless you have a “qualifying event”, and you must
submit a change form to your HR/Benefits Department within
30 days of the event. You can obtain a change form from
your HR/Benefits Department or from the enrollment
website, www.enrollme.biz. For newly eligible dependents,
coverage will be effective as of the date of the event, when a
change form is submitted within 30 days.
IMPORTANT NOTE: Newborns are not automatically added
to your policy. You must complete a change form in order to
effectively add them to your coverage.
Change in Family Status affecting covered persons
such as:
Marriage or divorce
Death of a spouse or dependent child
Birth or adoption of a child
Loss of other coverage
Loss of dependent status (if a child reaches the age limit
under the plan or is no longer eligible as a dependent)
Change in your employment status affecting your
benefits such as:
Beginning or returning from a leave of absence
Changing to/from part time
Change in your spouse’s employment status causing
a gain or loss of health coverage for you, your spouse
or your eligible dependents:
Beginning or ending employment
Increasing or decreasing hours
Changes associated with a spouse’s open enrollment
period including changes in the type and cost of
coverage
Gain or loss of eligibility for Medicare/Medicaid for
you, your spouse, or your eligible dependents (Note -
Changes must be made within 60 days)
Paid Time Off (PTO)
Termination of Benefits
Your benefits will terminate on your termination
date.
Continuation of Medical Coverage
At Termination of Employment or Ineligibility of a
Dependent:
COBRA (Consolidated Omnibus Budget Reconciliation Act) is
a federal law, which requires that group plans offer covered
employees and dependents the opportunity to continue
health insurance coverage when coverage would normally
end for certain specified reasons. The following provisions
outline the requirements for continued coverage in
accordance with the law:
You and your covered dependents may continue
coverage for up to 18 months if coverage ends because
of either a permanent reduction in the number of hours
worked or termination of employment for any reason
other than gross misconduct. You and/or your covered
dependent must apply within 60 days of the date
coverage ends or the date you are notified of your
continuation rights, whichever is later
Your dependents may continue their coverage under the
group plan for up to 36 months if their coverage ends for
any of the following reasons
Divorce from the employee
Death of the employee, or
Dependent child reaches the maximum age or
otherwise ceases to qualify as a dependent under
the plan
Coverage would be effective the day after the event.
Paid time off will include between 15 and 25 days based on length of service, up to 10 days of Extended Sick Leave, and 9
paid holidays for all eligible employees (New Year’s Day, Memorial Day, Good Friday or Easter Sunday, 4 th of July, Labor Day,
Thanksgiving Day, Christmas Eve, Christmas Day, and 1 Floating Holiday). Eligible employees are those that work at least 40
hours per bi-weekly pay period. Please refer to the employee manual for more information.
Retirement Plan - Great-West Financial
The Retirement Plan encourages personal savings. BRF Hospital Holdings will contribute 3% of your pay into a 401k
retirement plan for all eligible employees. An eligible employee is one who works at least 40 hours per bi-weekly pay period.
In addition, employees can receive a matched benefit of 50% if they choose to contribute pre tax dollars from their check.
Employees can contribute up to $17,500 annually ($23,000 if over age 50). The maximum amount the hospital will match will
not exceed 3% of employees compensation. You are eligible to participate after 1 year of service, however if you are
employed on October 1, 2013 you are immediately eligible to participate. You can enroll on the first day of each quarter
(January 1 st , April 1 st , July 1 st and October 1 st ). Gradual vesting applies to the matching contributions. Please refer to the
Summary Plan Description and Enrollment Materials for more information.
BRF Hospital Holdings
2013 - 2014 Benefits
2

Basic Life & AD&D / EAP / Travel Assistance / Medical
Employer Paid Basic Life & AD&D
As an employee of BRF Hospital Holdings you are
provided with a Basic Life & Accidental Death &
Dismemberment (AD&D) policy in the amount of
$25,000 at no cost to you. Mutual of Omaha is the carrier
for this company paid benefit. It provides protection for you in
the event of a disabling injury or death. In addition to this
basic coverage, you have the option to purchase additional life
insurance for yourself and your family members. Your amount
of Basic Life & AD&D insurance will be reduced by 50% at age
70. If you leave the company, you may convert this Basic Life
policy into an individual, whole life policy.
Employee Assistance Program (EAP)
Mutual of Omaha sponsors your Employer Paid Employee
Assistance Program (EAP). This benefit provides free
confidential consultation and resource services to you and
your dependents. Master’s level professionals can provide
assistance for a variety of personal and professional matters
such as: emotional well being, family and relationships, legal
and financial, healthy life styles, and work and life transitions.
Your EAP includes a robust network of licensed and/or
certified mental health professionals. EAP Benefits include:
Unlimited telephonic access to EAP Professionals 24/7
3 face-to-face sessions (per calendar year) with a counselor,
legal, or financial consultant
Legal, financial, mental health, and substance abuse
assistance
Connecting employees with resources for:
Dependent Care Assistance & Referral Services
Elder Care Assistance & Referral Services
Travel Assistance
Travel Assistance through Mutual of Omaha provides access to
support professionals who can help you, your spouse, and
dependents find quality local medical care or provide other
emergency assistance functions in foreign locations. Services
include: Translation/interpreter services, locating legal
services, and assistance with lost, stolen, or delayed baggage.
Summary of Benefits & Coverage (SBC)
In accordance with Patient Protection and Affordable
Care Act (PPACA), BlueCross BlueShield has created a
Summary of Benefits & Coverage (SBC), which
provides additional information about your medical
plan. You can find the SBC online at
www.enrollme.biz, or you may request a copy by
contacting your HR representative.
Health Insurance Options
BRF Hospital Holdings is committed to providing a
comprehensive medical benefits program that will serve to
protect both your physical health as well as your financial well
being. You are offered two plan options through BlueCross
BlueShield (BCBS):
Plan 1 - Preferred Provider Organization (PPO)
The PPO plan provides a network of Louisiana providers.
There are no referrals required to see a specialist. As an
employee of BRF Hospital Holdings, you are encouraged to
utilize BRF Hospital Holding’s health care providers and will
receive lower out-of-pocket amounts by doing so. You may
also choose to use BCBS’s In-Network and Out-of-Network
providers, however, you will be subject to a higher copay and
deductible for services rendered.
Plan 2 - High Deductible Health Plan (HDHP)
This plan starts once you satisfy your deductible. You must
pay the deductible, $5,500 (individual), out-of-pocket before
your plan begins covering your care. HDHPs will cover
preventive services before you meet your deductible and
without having to pay a copay or coinsurance. Keep in mind
that this applies to services provided by In-Network providers.
Case Management
Case management is a special service of BCBS and ensures
your care is appropriate. The program assesses, plans, assists,
and backs options and services to meet an individual’s health
needs.
BRF Hospital Holdings will be assigned a Specific Case
Manager and all employees on the Medical Plans MUST
participate to achieve the most efficient and effective use of
medical resources.
Waive Medical Insurance
Note: If you elect not to participate in BRF Hospital
Holdings medical plans, you will need to go online and
enter your electronic signature ‘pin’ indicating you are
waiving health coverage. You will be prompted for
your pin on the Confirmation Page. If the reason for your
waiver of this coverage on you and your dependents
(including your spouse) is because of other health coverage,
you may be able to enroll yourself or your dependents in this
plan at a later date if such other coverage ends. You must
request enrollment within thirty (30) days after your other
coverage ends.
3
BRF Hospital Holdings
2013 - 2014 Benefits

Medical - BlueCross BlueShield
Feature
Annual Deductible 1
(Individual/Family 2 )
BRFHH Provider
PPO
BCBS
HDHP
BCBS - Bronze
In-Network Out-of-Network In-Network Out-of-Network
$0 $500 / $1,500 $2,500 / $7,500 $5,500 / $16,500 $11,000 / $33,000
Coinsurance Percentage 100% 85% 40% 80% 40%
Annual Out-of-Pocket Maximum 1
(Individual/Family 2 )
$1,000 / $3,000 $4,000 / $12,000
Unlimited /
Unlimited
$6,250 / $18,750
(Inc ded)
Unlimited / Unlimited
Preventive Care 100% 100% 40% after ded 100% 40% after ded
Office Copays / Coinsurance
Primary Care Physician
Specialist
High Tech Imaging (MRI, CAT
Scan, PET)
Office Diagnostic Lab & X-Ray
$10
$20
$20
$40
40% after ded
40% after ded
80% after ded
80% after ded
40% after ded
40% after ded
$25 $200 40% after ded 80% after ded 40% after ded
Included in Office
Visit Copay
Included in Office
Visit Copay
Outpatient Diagnostic Lab & X-Ray 100% 85% 40% after ded
40% after ded 80% after ded 40% after ded
Urgent Care N/A $75 per visit 40% after ded 80% after ded 40% after ded
Hospital Services
Inpatient Hospital Service
(requires preauthorization)
$250 per admit $600 per admit
40% after $2,500
Copay + ded
80% after ded 40% after ded
Outpatient Hospital Services $100 per visit $250 per visit 40% after ded 80% after ded 40% after ded
Emergency Room
(True Emergency/Non-Emergency)
$50 / $100
per visit
$150 / $250
per visit
80% after ded 40% after ded
Rehab Services $10 $30 40% after ded 80% after ded 40% after ded
Home Health - 100 visits per year
(requires preauthorization)
Mental Health
Inpatient Office Visits
N/A $40 40% after ded 80% after ded 40% after ded
$50 per day up to
$250 per admit
$100 per day up to
$600 per admit
40% after ded 80% after ded 40% after ded
Outpatient Office Visits $10 $20 40% after ded 80% after ded 40% after ded
Pharmacy - Caremark
RX Deductible 1
$150 (Brand Only)
Generic $10 (No deductible) 80% after ded 40% after ded
Brand
$30 Preferred / $60 Non-preferred / $120 Specialty
after deductible
80% after ded 40% after ded
1
Deductible and Out-of-Pocket Maximum - Based on Calendar Year. For the remainder of 2013 you will only be responsible for 25% of the amounts shown above.
2
Family Deductible and Out-of-Pocket Maximum - No one covered member is required to pay more than the Individual amount
BRF Hospital Holding’s Monthly Contribution to your Medical Plan
Medical Employee Only Employee & Spouse Employee & Children
(up to age 26)
Employee & Family
PPO $452.46 $606.55 $620.94 $914.48
HDHP $336.72 $422.08 $444.66 $660.14
Employee Bi-Weekly Medical Deduction
Medical Employee Only Employee & Spouse Employee & Children
(up to age 26)
Employee & Family
PPO $46.15 $196.15 $138.46 $276.92
HDHP $23.08 $138.46 $92.31 $184.62
BRF Hospital Holdings
2013 - 2014 Benefits
4

Dental - AlwaysCare
Basic Plan Enhanced Plan
Benefit Year
Maximum
$1,500 per calendar year for Type 1, 2, 3 $2,000 per calendar year for Type 1,2, 3
Plan Year
Deductible
No deductible for Preventive Services
One time $100 Lifetime applies to Basic and Major Services.
Deductible amount applies separately to each covered person
No deductible
Carryover Benefit
Members who take care of their teeth, but use only part of their annual maximum benefit during a benefit period are rewarded with
extra benefits in future years. If an insured submits qualifying claims for covered expenses during a benefit year and, in that benefit
year, receives benefits that are less than their group’s Threshold Limit, the insured will be credited a Carryover Benefit. Carryover
Benefits will be accrued and stored in the Insured’s Carryover Account to be used in the next benefit year. If an insured reaches his
or her Certificate Year Maximum Benefit, a benefit from the Insured’s Carryover Account will be paid up to the amount stored in the
Insured’s Carryover account. The accrued Carryover Benefits stored in the Carryover Account may not be greater than the
Carryover Account Limit.
Coinsurance
Type 1
Type 2
Type 3
Type 4
Type 1 /
Preventive
Services
Type 2 / Basic
Services
Type 3 / Major
Services
Type 4 /
Orthodontics
Carryover Benefit $350, Threshold Limit $700, Carryover Account
Limit $1,250
In-Network and Out-of-Network
100% of usual and customary fees
100% of scheduled fees
100% of scheduled fees
N/A
Waiting Period: None
· Routine exams (2 per 12 mos.)
· Prophylaxis (2 per 12 mos.)
· Bitewing x-rays (max 4 films; 1 per 12 mos.)
· Full mouth x-ray (1 per 24 mos.)
· Space maintainers to age 16 (1 per 24 mos.)
· Fluoride to age 16 (1 per 12 mos.)
· Sealants to age 16 (permanent molars, 1 per 36 mos.)
· Adjunctive pre-diagnostic oral cancer screening (max 1 per 12
mo for age 40+)
Waiting Period: None
· Emergency Pain (1 per 12 mos.)
· Fillings
· Anesthesia (subject to review, covered with complex oral
surgery)
· Simple extractions
· Non-Surgical Periodontics
· Oral surgery (surgical extractions & impactions)
· Crown, denture, bridge repair
· Full mouth x-ray (1 per 24 mos.)
Waiting Period: None
· Simple Periodontics
· Endodontics (root canals)
· Surgical Periodontics (gum treatments)
· Inlays and Onlays
· Crowns, Bridges, Dentures, and Endosteal Implants
N/A
Carryover Benefit $400, Threshold Limit $800, Carryover
Account Limit $1,500
In-Network - Negotiated Discount Fees (no balance billing) /
Out-of-Network - usual and customary
100%
80%
50%
50%
Waiting Period: None
· Routine exams (2 per 12 mos.)
· Prophylaxis (2 per 12 mos.)
· Bitewing x-rays (max 4 films; 1 per 12 mos.)
· Full mouth x-ray (1 per 24 mos.)
· Emergency Pain (1 per12 mos.)
· Space maintainers to age 16 (1 per 24 mos.)
· Fluoride to age 16 (1 per 12 mos.)
· Sealants to age 16 (permanent molars, 1 per 36 mos.)
· Adjunctive pre-diagnostic oral cancer screening (max 1 per 12
mo for age 40+)
Waiting Period: None
· Fillings
· Anesthesia (subject to review, covered with complex oral
surgery)
· Simple extractions
· Non-Surgical Periodontics
· Oral Surgery (surgical extractions & impactions)
· Endodontics (root canals)
· Crown, denture, bridge repairs
Waiting Period: None
· Inlays and Onlays
· Crowns, Bridges, Dentures, and Endosteal Implants
· Surgical Periodontics (gum treatments)
Waiting Period: None
· Separate Lifetime maximum: $1500
· Dependent children to age 19 only
Dental Employee Only Employee & Spouse
Employee & Children
(up to age 26)
Employee & Family
Basic Bi-Weekly Deduction $8.39 $15.77 $21.80 $29.17
Enhanced Bi-Weekly Deduction $13.31 $26.03 $31.64 $44.37
5
BRF Hospital Holdings
2013 - 2014 Benefits

Vision - AlwaysCare
EXAM covered every 12 months
Prescription Glasses
Standard Plastic Lenses covered every 12 months
Frames - once every 12 months
Once every 12 months
Contact Lenses
Includes evaluation, fitting, and follow-up care
Vision Care Services In-Network Out-of-Network Allowance
Exam $10 Copay Up to $35
Materials
Standard Plastic Lenses:
Single Vision
Bifocal Lined
Trifocal Lined
Lenticular
Progressive
$0 Copay
Covered
Covered
Covered
$80 Allowance
$70 Allowance
Up to $25
Up to $40
Up to $50
Up to $50
Up to $50
Lens Options:
Scratch resistant coating
Solid / Gradient tint
UV Coating
Frames:
Members choose from any
frame available at provider
locations
Covered
Covered
Covered
$130 Retail Allowance
($94 retail frame at Costco, WalMart, and
Sam’s Club)
N/A
N/A
N/A
Up to $50 retail allowance
Contact Lenses: Includes evaluation, fitting,
and follow up care
Elective
Medically Necessary
No Copay
Up to $130 Retail
Covered in full
Up to $100 retail
Up to $210 retail
Vision Employee Only Employee & Spouse
Employee & Children
(14 days up to age 26)
Employee & Family
Bi-Weekly Deduction $3.54 $5.95 $6.08 $9.80
BRF Hospital Holdings
2013 - 2014 Benefits
6

Voluntary Life & AD&D - Mutual Of Omaha
Life Benefit Employee Spouse Dependent
Amount
Increments of $10,000 up to 7 times
annual salary or $300,000
Increments of $10,000 up to $100,000
$10,000 for children 14 days old up to age 26
Age Reduction: Benefit will be reduced
by 50% at age 70 and will terminate at
retirement
Employee must elect coverage for
spouse to be eligible. Benefit not to
exceed 100% of employees elected
amount, benefit will terminate at
employee age 70
Employee must elect coverage for child(ren)
to be eligible. Newborn children to age 13
days are not eligible for a benefit.
Guarantee Issue
$300,000
$100,000
$10,000
Eligibility
Accidental Death &
Dismemberment
Living Care Benefit
Guarantee Issue
Portability
Conversion
You must be actively at work (able to perform all normal duties of your job) to be eligible for this benefit. Your spouse must be
able to perform normal activities and not confined at home, in a hospital, or in any other care facility
AD&D coverage is available if you or your dependents are injured or die as a result of an accident, and the injury or death is
independent of sickness and all other causes. The benefit amount depends on the type of loss incurred, and is either all or a
portion of the Principal Sum, which is equal to the amount of the life insurance benefit.
When diagnosed as terminally ill (having 12 months or less to live), you may withdraw up to 80% of your life insurance coverage
to a maximum of $240,000. The death benefit will be reduced by the amount withdrawn.
For timely entrants enrolled within 31 days of becoming eligible, the Guarantee Issue amount is available without any Evidence of
Insurability requirement. For late enrollees, Evidence of Insurability will be required for any amount and it will be provided at your
own expense.
When you are no longer an eligible employee, you will have 31 days to port coverage. This feature allows you to continue this
insurance for yourself and your dependents (if applicable), allowing you to keep the coverage until you are 70.
When you are no longer an eligible employee, you will have 31 days to convert coverage. This takes the term life policy to an
individual life insurance policy.
Waiver of Premium If you become totally and permanently disabled prior to age 60, your life insurance will continue in force without further payment
of premium on a year-to-year basis. You must be totally disabled for 9 months in order to qualify, and waiver terms at age 65.
*Subject to periodic submission of evidence of total and permanent disability.
Voluntary Life & AD&D Insurance Bi-Weekly Deduction
Spouse age is based on Employee age
Age $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $200,000 $300,000
0-19 $0.31 $0.63 $0.94 $1.26 $1.57 $1.88 $2.20 $2.51 $2.82 $3.14 $6.28 $9.42
20-24 $0.44 $0.88 $1.32 $1.75 $2.19 $2.63 $3.07 $3.51 $3.95 $4.38 $8.77 $13.15
25-29 $0.44 $0.88 $1.32 $1.75 $2.19 $2.63 $3.07 $3.51 $3.95 $4.38 $8.77 $13.15
30 - 34 $0.44 $0.88 $1.32 $1.75 $2.19 $2.63 $3.07 $3.51 $3.95 $4.38 $8.77 $13.15
35 - 39 $0.52 $1.03 $1.55 $2.07 $2.58 $3.10 $3.62 $4.14 $4.65 $5.17 $10.34 $15.51
40 - 44 $0.70 $1.40 $2.10 $2.81 $3.51 $4.21 $4.91 $5.61 $6.31 $7.02 $14.03 $21.05
45 - 49 $1.01 $2.01 $3.02 $4.02 $5.03 $6.04 $7.04 $8.05 $9.06 $10.06 $20.12 $30.18
50 - 54 $1.55 $3.09 $4.64 $6.18 $7.73 $9.28 $10.82 $12.37 $13.92 $15.46 $30.92 $46.38
55 - 59 $2.43 $4.86 $7.30 $9.73 $12.16 $14.59 $17.03 $19.46 $21.89 $24.32 $48.65 $72.97
60 - 64 $3.68 $7.36 $11.04 $14.71 $18.39 $22.07 $25.75 $29.43 $33.11 $36.78 $73.57 $110.35
65 - 69 $6.17 $12.34 $18.51 $24.68 $30.85 $37.02 $43.20 $49.37 $55.54 $61.71 $123.42 $185.12
Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 $100,000 $150,000
70 -74 $5.82 $11.63 $14.45 $23.26 $29.08 $34.89 $40.71 $46.52 $52.34 $58.15 $116.31 $174.46
75-99 $10.94 $21.88 $32.82 $43.76 $54.70 $65.64 $76.59 $87.53 $98.47 $109.41 $218.82 $328.22
Voluntary Life & AD&D Insurance Bi-Weekly Deduction for Children
Age $10,000
14 days up to 26 years $1.06
7
BRF Hospital Holdings
2013 - 2014 Benefits

Short Term Disability - Mutual of Omaha
Income Protection
Insurance
Eligibility
Maximum Weekly Benefit
Waiver of Premium
Pays a benefit for a disability resulting from a covered injury or sickness. Benefits begin on the 8th day (after a 7
day waiting period) for both injury and sickness, and continue while you are disabled up to the maximum benefit
duration of 12 weeks.
You must be actively at work (able to perform all normal duties of your job) to be eligible for coverage.
You have the option to elect either 40% or 60% of your weekly covered earnings to $1,500. The minimum benefit
amount is $25.
Beginning on the first of the month following the date of disability, you will not be required to pay premiums during
any time of approved total or partial disability.
Disability
Partial Disability
Continuation of Disability
Pre-Existing Condition
Benefit Exclusions
Portability
Disability and disabled mean that because of an injury or illness, a significant change in your mental or functional
abilities has occurred, for which you are prevented from performing at least one of the material duties of your
regular job and are unable to generate current earnings which exceed 99% of your weekly earnings from your
regular job. You can be totally or partially disabled during the elimination period.
If you become disabled and can work part time (but not full time), you may be eligible for partial disability benefits,
which will help supplement your income until you are able to return to work full time.
If you return to work full time but become disabled from the same disability within two weeks of returning to work,
you will begin receiving benefits again immediately.
Any sickness or injury for which you have received medical treatment, consultation, care or services (including
diagnostic measures or took prescribed medications) during the three (3) months prior to the coverage effective
date. Benefits will not be paid for a disability caused by, contributed to by or resulting from a pre-existing condition
unless the insured has been actively at work for one (1) full day following the end of six (6) consecutive months
from the date he/she became an Insured.
You will not receive benefits in the following circumstances:
Your disability is the result of a self-inflicted injury
An act of war, declared or undeclared
Your disability is the result of committing a felony
Your disability is covered under a worker’s compensation plan and/or is due to a job-related sickness or injury
which occurs out of or in the course of work for wage or profit
When you are no longer an eligible employee, you will have 31 days to port coverage. This will allow you to keep
the coverage up to age 70.
Your benefit is based on your Salary. Calculate your Bi-Weekly deduction using
the following examples (This example assumes a 40 hour work week):
40% of your Salary 60% of your Salary
Hourly Pay Rate 20.00 20.00
Times 40 - weekly payroll 800.00 800.00
Times 40% / 60% - weekly benefit 320.00 480.00
Times .060 19.20 28.80
Times 12 / by 26 to get your
Bi-Weekly Deduction
$8.86 $13.29
BRF Hospital Holdings
2013 - 2014 Benefits
8

Long Term Disability - Mutual of Omaha
Eligibility
Maximum Monthly Benefit
Maximum Benefit Duration
Elimination Period
Waiver of Premium
Survivor Income Benefit
You must be actively at work (able to perform all normal duties of your job) to be eligible for coverage.
You have the option to elect either 40% or 60% of your monthly covered earnings to a maximum of $12,000 per
month. The minimum benefit is $100.
Benefits continue to normal social security retirement age while you remain disabled.
90 days - The number of days you must be disabled prior to collecting disability benefits.
You will not be required to pay premiums during any time of approved total or partial disability.
A 3 months survivor benefit may be paid to your beneficiary if you should die while receiving qualifying disability
payments.
Disability
Partial Disability
Continuation of Disability
Pre-Existing Condition
Benefit Exclusions
Benefit Reductions
Benefit Termination
Portability
Disability and disabled mean that because of an injury or illness, a significant change in your mental or functional
abilities has occurred, for which you are prevented from performing at least one of the material duties of your regular
job and are unable to generate current earnings which exceed 99% of your weekly earnings from your regular job.
You can be totally or partially disabled during the elimination period.
If you become disabled and can work part time (but not full time), you may be eligible for partial disability benefits,
which will help supplement your income until you are able to return to work full time.
If you return to work full time but become disabled from the same disability within six months of returning to work,
you will begin receiving benefits again immediately.
Any sickness or injury for which you have received medical treatment, consultation, care or services (including
diagnostic measures or the taking of prescribed medications) during the 3 months prior to the coverage effective date.
A disability arising from any such sickness or injury will be covered only if it begins after you have performed your
regular occupation on a full time basis for 12 months following the coverage effective date.
You will not receive benefits in the following circumstances:
Your disability is the result of a self-inflicted injury
You were involved in a felony commission, act of war or participation in a riot
* See certificate for full list of exclusions
Your benefits may be reduced if you are receiving benefits from any of the following sources:
Any compulsory benefit act or law (such as state disability plans)
Any governmental retirement system earned as a result of working for the current policyholder
Any disability or retirement benefit received under a retirement plan
Any Social Security, or similar plan or act, benefits
Earnings the insured earns or receives from any form of employment
Workers compensation
This coverage will terminate when you terminate employment with this policyholder or at your retirement.
When you are no longer an eligible employee, you will have 31 days to port coverage, allowing you to continue this
insurance until you are 70.
Your benefit is based on your Salary. Calculate your Bi-Weekly deduction using the
following examples (This example assumes a 40 hour work week):
40% of your Salary 60% of your Salary
Hourly Pay Rate 20.00 20.00
Times 40 - weekly payroll 800.00 800.00
Times 52 / 12 3,466.67 3,466.67
Times 40% / 60% - monthly benefit 1,386.67 2,080.00
Times .0136 18.86 28.29
Times 12 / 26 to get your
Bi-Weekly Deduction
$8.70 $13.06
9
BRF Hospital Holdings
2013 - 2014 Benefits

Critical Illness - HM Life
Covered Critical Illnesses
Covered
Critical Illness
Myocardial Infarction (Heart
Attack)
Percentage of
Face amount
Covered
Critical Illness
100% + Major Organ Transplant 100%
Percentage of
Face amount
Coronary Artery Bypass 25% * End-stage Renal Disease
(Kidney Disease)
Stroke 100% Loss of Sight, Speech or
Hearing
100%
100% *
Invasive Cancer 100% + Coma 100% *
Carcinoma in Situ 25 % * Paralysis 100% *
Skin Cancer 10% *
+ Benefits paid for Carcinoma in Situ, Skin Cancer and Coronary Artery Bypass Surgery, reduce the benefit payable for
subsequently diagnosed Invasive Cancer and Heart Attack, respectively.
* Payable once per lifetime. Minimum benefit is $250.
Plan Type & Age
Guidelines
Benefit Options
Guarantee Issue Amount
Healthy Screening
Coverage
Pays a lump sum for
three types of
diagnoses – initial,
reoccurrence and
additional covered
occurrences
Employee and Spouse may be covered from ages 18 to 69 years, benefits reduce by 50% at 70
Children up to age 26
Employee - $2,500 up to $100,000; Spouse – Up to 100% of employee amount to a max of $100,000; Children
automatically get 25% of employee amount up to $20,000 at no additional cost
Employee - $25,000; Spouse - 50% of employee amount
$50 - One per covered individual per year. Benefit paid regardless of diagnosis or results of the test.
First Occurrence – provides a lump sum payment when a covered critical illness is first diagnosed
Reoccurrence – pays when a covered critical illness reoccurs. The reoccurrence must be separated from the initial
diagnosis by at least 180 days (365 days treatment - free for cancer) or separated from another reoccurrence by at least
180 days (365 days treatment - free for cancer)
Additional Occurrence – pays an additional benefit upon the diagnosis of a covered condition for which benefits
previously have not been paid. The diagnosis must be separated from the other critical illness by at least 180 days
Continuation of Coverage Employees continuously insured for at least 12 consecutive months under this plan or a prior plan may have the
opportunity to continue their coverage.
Pre-Existing Condition
Limitation
Issue Age
No benefits will be provided for the first 12 months a person is covered under the policy for conditions for which medical
advice or treatment was received or recommended during the 12 month period prior to the effective date of coverage.
If elected, your Critical Illness deductions will not change from year to year; your deductions will remain the same
throughout the life of your policy.
Employee
Issue Age
Critical Illness Benefit Amounts & Bi-Weekly Deduction
$2,500 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $50,000 $75,000 $100,000
18 - 24 $0.47 $0.70 $1.18 $1.65 $2.13 $2.60 $3.07 $4.97 $7.34 $9.55
25 - 29 $0.69 $1.06 $1.80 $2.54 $3.28 $4.02 $4.76 $7.71 $11.40 $14.93
30 - 34 $1.03 $1.61 $2.77 $3.93 $5.09 $6.25 $7.41 $12.05 $17.84 $23.47
35 - 39 $1.58 $2.54 $4.44 $6.35 $8.26 $10.17 $12.07 $19.70 $29.24 $38.61
40 - 44 $2.42 $3.98 $7.08 $10.18 $13.28 $16.39 $19.49 $31.90 $47.41 $62.76
45 - 49 $3.59 $5.99 $10.79 $15.58 $20.38 $25.17 $29.97 $49.15 $73.13 $96.94
50 - 54 $5.17 $8.74 $15.88 $23.03 $30.17 $37.32 $44.46 $73.04 $108.77 $144.32
55 - 59 $6.94 $11.92 $21.89 $31.86 $41.83 $51.80 $61.77 $101.65 $151.49 $201.17
60 - 64 $8.67 $15.09 $27.93 $40.77 $53.61 $66.45 $79.30 $130.66 $194.88 $258.92
65 - 69 $9.20 $16.20 $30.21 $44.21 $58.22 $72.22 $86.23 $142.25 $212.28 $282.15
Guarantee Issue - Employee Only
BRF Hospital Holdings
2013 - 2014 Benefits
10

Flexible Spending Account - Boon-Chapman
Flexible Spending Account (FSA)
This benefit provides you with the opportunity to set aside
tax-exempt dollars for out-of-pocket health care or
dependent care expenses incurred by you and/or your
eligible dependents. The deduction is made before taxes
are computed, thus making the spending account dollars
tax-free. FSA contributions are “use it or lose it” and
balances do not roll over from year to year.
You will have two different FSA policy years, the
first will begin October 1, 2013 and will end
December 31, 2013. The second FSA policy year will
begin January 1, 2014 and will end December 31,
2014.
You must determine the amount to be deducted from each
paycheck, and you will be provided with a Debit Card. Your
Health Care election will be pre-loaded with this amount for
your use throughout the 2013 Plan Year. The dependent
Care election is not preloaded and is only available as the
funds are payroll deducted. Determine the amount to be
withheld by forecasting your out-of-pocket health care and/
or dependent care expenses for the entire Plan year, plus
the grace period (January 1 st through March 15 th ). To
access the money in your account, you can either use your
FSA Debit Card at the time of service, or you can file a
claim form to request reimbursement. This form is available
in your HR / Benefits Department or you can find it on the
website www.enrollme.biz.
Qualifications and Eligible Expenses:
Many health care expenses, such as Copayments and
deductibles, are not fully reimbursed by health, dental, or
vision insurance and may be eligible for reimbursement
through a Health Care FSA. For a detailed list of health care
expenses that may qualify for reimbursement under the
Health Care Spending Account, visit the website
www.boonchapman.com.
Dependent Care FSA
Qualifications:
You may receive tax-exempt reimbursements for the care
of certain individuals in your household, which includes your
dependent children age 12 or younger and any other
individuals who reside with you and who rely on you for at
least half of their support or are physically or mentally
unable to care for themselves.
Eligible Expenses:
Daycare expenses are defined as those that are necessary
in order for you (and your spouse, if you’re married) to
continue working. You are required to report on your
annual federal income tax return the name(s) of those
providers of dependent care expenses whose expenses
have been reimbursed to you through your Dependent Care
Account.
Eligible Dependent Care Account expenses include:
Day-care costs for children 12 and under.
Schooling costs, not including food and clothing, for
either private or public schools, for children not yet in
kindergarten.
If expenses for food and clothing cannot be separated
from the total cost of child care, then they are eligible
expenses.
If your child is 12 years or younger and you pay for
before/after-school care, it is reimbursable
Babysitting and licensed day-care center costs
Minimal housekeeping services in your home as long as
day care is the primary duty
Elder care if dependent is claimed on your tax return
Costs of transportation, overnight camping, nursing care
facilities, and the schooling costs of children in the first
grade or above are generally ineligible expenses.
Health Care FSA Contributions
Minimum per year $150
Maximum per year $2,500
Dependent Care FSA Contributions
Minimum per year $150
Maximum per year $5,000 per household
11
BRF Hospital Holdings
2013 - 2014 Benefits

Online Enrollment Instructions
The Benefit Administration Systems website is home to all of the tools and resources you will need during Annual
Enrollment and throughout the year. It is also where you will enroll in your benefits. See below for a list of detailed
instructions that will navigate you through the enrollment process with ease.
Log On
Using any computer with Internet access, go to
www.enrollme.biz
Enter your user name and password:
Employee Username – Your Social Security
Number (no dashes)
Password – Last 4 digits of your Social Security
Number
You will change your password on the next screen -
Re-enter the last 4 digits of your Social Security
Number as the previous password, enter a new one
that is at least 5 characters, then re-enter the new
password
Click ‘Enroll In Benefits’ to proceed to your benefits
Employee / Dependent Information
From the menu on the left, click:
Employee Info – Verify your information on this page
and make necessary changes to address, phone
number, and/or email address
Dependent Info – Add or make changes to Dependent
information on this screen
Enter dependent information BEFORE selecting
your benefits
SSN, DOB, and Address are required for
each dependent
*Note: Specific documentation required -
See page 1 if enrolling dependents in
Medical coverage
Beneficiary info – Add or make changes to beneficiary
information on this screen. Since the company
provides a Basic Life policy all employees need to
provide this information
Electing Benefits
Click on each of the benefits from the left menu. On
the right, you will have the option to attain more
information and elect that benefit
If you are interested in the benefit, check the ‘I elect
coverage for this benefit’ box, and select the
dependents you wish to cover under that benefit
You may also use the left and right arrow keys to
scroll through each benefit
Confirm
Once you’ve made your choices, from the menu on
the left, click Confirmation
Verify the elections are what you want
Check the ’I Accept’ Box, enter your NEW password,
and click the blue ‘I Accept’ button
Wait for a message to appear telling you that you
have successfully enrolled in benefits
Print a confirmation of your enrollment or enter your
email address at the top of the screen to have a copy
of your confirmation page emailed directly to you
If you have any questions regarding the online
enrollment or if you do not have access to a
computer and are unable to enroll online, please
contact HUB International at 318-629-8769 or
877-309-2224, or you can contact HUB by email at
BRFHH@hubinternational.com.
Note: You MUST go to the online enrollment
website whether enrolling in benefits or not
to:
1) Enter beneficiaries for your Basic Life Policy
2) Decline Medical coverage by electronically
signing with your Pin number
BRF Hospital Holdings
2013 - 2014 Benefits
12

BRF Hospital Holdings
Benefit Guide 2013 - 2014
8/19/13