Medical Plan Side-by-Side Comparison

Blue Cross and Blue ShieldPPO BasicMember CostArthur J Gallagher & Co.Effective 1/1/2012PPO Advantage + H S AAnnual Deductible In-Network Out-of-Network In-Network Out-of-NetworkIndividual $700 $1,400 $1,500 $3,000Family $2,100 $4,200 $3,000 $6,000If member elects EE+Spouse, EE+Child(ren) or EE+Family coverage, both Individualand Family deductibles are tracked. Each member or covered dependent cancontribute an amount equal to the Individual deductible toward the Family deductibleamount.Member CostIf member elects EE+Spouse, EE+Child(ren) or EE+Family coverage, only the Familydeductible is tracked. Individual deductibles do not apply.Annual Out-Of-Pocket Maximum (includes deductible) In-Network Out-of-Network In-Network Out-of-NetworkIndividual $4,000 $8,000 $5,960 $11,900Family $12,000 $24,000 $11,900 $23,800H S A Employer ContributionEmployee OnlyFamilyAJG ContributionN/AN/APlan BenefitsAJG Contribution$500$1,000Plan BenefitsPhysician Services In-Network Out-of-Network In-Network Out-of-NetworkPhysician Office Visits (PCP/Specialist)100% after member copay of80% after Deductible (copays do60% after Deductible$25/$35not apply)60% after DeductibleProfessional Services (plan cost after deductible) 80% after Deductible 60% after Deductible 80% after Deductible 60% after DeductiblePhysician Emergency Medical/Accident Care Office Visit100% after member copay ofFacility$25/$35Office60% after Deductible 80% after Deductible 60% after DeductibleWellness & Preventive Care In-Network Out-of-Network In-Network Out-of-NetworkChildren: Coverage for physical exams, immunizations, & routinediagnostic tests100%, no deductible60% after Deductible100%, no Deductible 60% after DeductibleAdults: Coverage for one annual physical exam, one gynecologicalexam per calendar year, and routine diagnostic tests100%, no deductible60% after Deductible100%, no Deductible60% after DeductibleHospital In-Network Out-of-Network In-Network Out-of-NetworkInpatient Hospital ServicesIf member elects EE+Spouse, EE+Child(ren) or EE+Family coverage, both Individualand Family out-of-pocket totals are tracked. Each member or covered dependent cancontribute an amount equal to the Individual out-of-pocket total toward the Family outof-pocketamount.80% after DeductibleIf member elects EE+Spouse, EE+Child(ren) or EE+Family coverage, only the Familyout-of-pocket amount is tracked. Individual out-of-pocket maximums do not apply.60% after Deductible 80% after Deductible60% after DeductibleOutpatient Surgery and Diagnostic Tests80% after Deductible60% after Deductible80% after Deductible60% after DeductibleOutpatient Hospital ServiceHospital Emergency Medical/Accident CareFacility :Professional/other services:80% after Deductible$100 copay 1100%80% after deductible.60% after Deductible$100 copay 1100%80% after deductible.80% after Deductible80% after Deductible 160% after Deductible80% after Deductible 1Mental Health and Chemical Dependency Services In-Network Out-of-Network In-Network Out-of-NetworkOutpatient Mental Health/Chemical Dependency Office Visit100% after member $25 copay 60% after Deductible80% after Deductible60% after DeductibleInpatient Health Services80% after Deductible60% after Deductible80% after Deductible 60% after Deductible

Blue Cross and Blue ShieldEffective 1/1/12 Medco will be the Rx vendorMember CostArthur J Gallagher & Co.Effective 1/1/2012Member CostOutpatient Prescription Drugs 2, 3 In-Network Out-of-Network In-Network Out-of-NetworkRetail 30 day supplyGenericBrand Formulary 2Brand NonFormulary 2Specialty Drugs 3Mail Order 90 day supplyGenericBrand Formulary 2Brand NonFormulary 2Specialty Drugs 320% $7 minimum30% $20 Minimum40% $40 minimumNo Coverage20% $14 minimum30% $40 Minimum40% $80 minimum20%20% $7 minimum30% $20 Minimum40% $40 minimumNo CoverageNo CoverageFull cost applied to deductible.After deductible is met, membercoinsurance applies:20% $7 minimum30% $20 minimum40% $40 minimumNo CoverageFull cost applied to deductible.After deductible is met, membercoinsurance applies:20% $14 minimum30% $40 Minimum40% $80 minimum20%Full cost applied to deductible.After deductible is met, membercoinsurance applies:20% $7 minimum30% $20 minimum40% $40 minimumNo CoverageNo CoveragePrescription Drug Annual Out of Pocket Limit Same as Medical Same as Medical Same as Medical Same as Medical1Non-emergency ER Hospital Charges are not covered.2 If you request a brand name drug and a generic equivalent is available in the same drug category, you will pay the difference in cost between the generic and brand name drug.3 Plan benefits are only available for specialty drugs obtained through Accredo, a specialty mail order pharmacy.Note: This is intended as a brief summary of benefits. The Contracts and Summary Plan Description govern in all cases. Not all covered services, exclusions and limitations are shown here.