Page 7 - QSC Benefits Guide 7-17 REMOTE

MEDICAL INSURANCE

Option 1 - PPO (OAP)

With the Preferred Provider Organization (PPO) option through Cigna, you have the freedom to choose your doctor without using a
primary care physician (PCP) and you may self-refer to specialists. You may use a PPO provider whose negotiated rates provide richer
levels of benefits with claim forms filed by the providers. You may also obtain services using a non-network provider; however, you will
be responsible for the difference between the covered amount and the actual charges and you may be responsible for filing claims.

Option 2 - HSA PPO (Choice Fund OAP)
The Health Savings Account (HSA) plan through Cigna combines a high deductible health plan (HDHP) with a special, tax-qualified
savings account. You may use your HSA funds to pay for current medical expenses or save toward future medical expenses.
Similar to the PPO plan, you have the freedom to choose your doctor without the requirement of selecting a PCP and you may
self-refer to specialists. You may use a PPO provider whose negotiated rates provide richer levels of benefits with claim forms filed
by the providers. You may also obtain services using a non-network provider; however, you will be responsible for the difference
between the covered amount and the actual charges and you may be responsible for filing claims. QSC will make an annual
contribution toward your employee/family health savings account, funded biweekly. In addition to the company contributions,
you may elect to make contributions into your account up to the IRS maximums. See page 10 for additional information.

HSA IRS Maximums 2017 2018
Employee
QSC Fund Maximum IRS Maximum
Employee $1,200 $2,200 = $3,400
Employee + Family* $2,400 $4,350 = $6,750 Indexed for Inflation
Catch-Up for Employees Ages 55+ N/A $1,000 = $1,000

Plan Features OAP PPO HSA PPO

Employee Premiums $$ $
Health Savings Account
Employer Funding P
Employee Funding P
Cost Sharing Contribution, Copay, Contribution, Copay,
Deductible, Coinsurance Deductible, Coinsurance
Network Size AAA AAA
In-Network Benefits P P

Non-Network Benefits P P
Preventive Care 100% (Ded Waived) 100% (Ded Waived)
(in-network)
Access to Providers Managed by You Managed by You
Primary Care Physician Not Required Not Required
Referral for Specialist Not Required Not Required

Page 7
Page 7