GOLDEN LIMOUSINE BENEFITS

4/1/2021 -3/31/2022
Golden Limousine is pleased to offer our employees’ health benefits for this next renewal year.
You will have an option of a “Base plan”, “Buy up plan” or “Value Plan”.
Below is a breakdown of plans. Enclosed is a copy of rates, summary of each plan, enrollment form, and waiver form.

Base plan: Blue Care Network 1000/2000 deductible, 20% copay.

This plan is not changing. Most of you are currently on this plan. We will be keeping this as our base plan. Golden
Limousine will pay 50% of your single rate. Your copay will continue to be 50% of your single rate. If you choose to add
dependents your cost is 100% of additional rate to add them. Your rates are based on your age at renewal
(04/01/2021). Please see attached rate sheet for renewal rates effective 4/01/2021.

Top Plan “Buy up plan”: Blue Care Network 0 deductible, 20% copay.
This plan will be replacing the Blue Cross plan we had last year. This is a “buy up” plan. Golden Limousine will pay 50% of
your single rate. Your copay will continue to be 50% of your single rate and additional $40.00 per month additional buy
up charge. If you choose to add dependents your cost is 100% of additional rate to add them. Your rates are based on
your age at renewal (04/01/2021). Please see attached rate sheet for renewal rates effective 4/01/2021.

Value Plan: Blue Care Network H.S.A. 4500 single deductible / 9000
accumulation family deductible.
This is a new plan offered this year. H.S.A.’s are plans that offer a high deductible plan. Golden Limousine will pay 50%
of your single rate. Your copay will continue to be 50% of your single rate. This is the least expensive option for you.
Please note with a H.S.A. plan EVERYTHING is subject to your deductible other than wellness benefits. After you have
met your deductible most everything is covered at 100%. Prescription coverage will then have a copay. Pleas review the
benefit summary to understand how the H.S.A. works. If you are adding family members, the 9000 deductible is a family
deductible and the entire family’s bills are added until the 9000 is met. H.S.A.’s also offer tax benefits as you can open
an H.S.A. account at your local bank or credit union. If you are interested in the H.S.A plan and have further questions,
please contact our agent Kathe Meade. You can email her at kathe@meadewheeler.com or call her at 517-414-4433. If
you choose to add dependents your cost is 100% of additional rate to add them. Your rates are based on your age at
renewal (04/01/2021). Please see attached rate sheet for renewal rates effective 4/01/2021.

Dental: Dental is included in your benefit package. Golden Limousine will pay 50% of single rate. You are
responsible for 50% of rate and 100% of dependents. The 2021 rates are also included in this packet.
ALL employees must fill out either an enrollment form or waiver form. The enrollment form is highlighted for you.
Please indicate plan you wish to enroll in. Please return to Carol Bell no later than Wednesday, March 31, 2021. The
first payroll change will be on your April 23 rd pay.

If you have any benefit questions or need help with rates, please contact Kathe Meade. You can email her at
kathe@meadewheeler.com or call her at 517-414-4433.