Page 2 - 2016 Open Enrollment

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Table of Contents

Benefits Summary Information for the 2016
Medical .................................3

Dental ..................................5 Plan Year
The following information is intended to provide summary information
Vision ................................... 6 to assist you in the enrollment process for the 2016 Plan Year of First

Life, AD&D, Long Term Bank’s employee beneit programs. The summary information provided is
Disability, Short Term intended to briely outline coverage in the following plans.
Disability, and Long Term
Care ...............................7 „ Medical

Flexible Spending Accounts .... 9 „ Dental

Employee Contribution „ Vision
Rates............................ 10 „ Life and Supplemental Life

„ Accidental Death and Dismemberment (AD&D)

„ Long Term Disability (LTD)

„ Short Term Disability (STD)
„ Life with Long Term Care Protection

„ Healthcare Reimbursement Account

„ Dependent Care Reimbursement Account

The following is summary information intended only to assist you in
the Enrollment process. The entire provisions of eligibility, beneits, and
exclusions for each plan above are contained in the plan document or
group contract which applies speciically to each plan. In the event of a
conlict between the appropriate plan document or group contract and
this description, the plan document or group contract, whichever is in

place, will prevail.

First Bank