Page 2 - Tetra Renewal 2020

The Tetra Corporation

2020 Renewal Benefits

 BCBSM CB PPO Platinum $500: $500 Single/$1,000 Family
Deductible, 10% coinsurance to an Annual maximum of
$500/$1,000, Annual Out of Pocket Maximum $6,600/$13,200

 BCBSM Blue Dental PPO Plus 100/80/50/50 with Pediatric Dental:
Class I covered 100%, Class II covered 80%, Class III covered
50%, Class IV (Ortho) covered 50%. $25 Single/$75 Family
Deductible applies to Class II and Class III services, Annual
Maximum $1000 per member per calendar year. Lifetime Ortho
maximum of $1,000.

 BCBSM Blue Vision: 12/12/12, Eye Exam/Lenses/Frames every 12
months. $5 Eye Exam copay/$10 Materials copay, $130
Allowance

 Principal Life/AD&D-Executives : Benefit Amount-$200,000

 Principal Life/AD&D-All other eligible: Benefit Amount-$100,000

 Principal Short-Term Disability: Elimination Period-8/8/12, Weekly
Benefit-60% of pre-disability earnings up to $1,500

 Principal Long-Term Disability: Elimination Period-90 Days, Monthly
Benefit-60% of pre-disability earnings up to $10,000

 Principal 401K