benefits at a glance

Medical Option Cigna Enhanced Cigna Standard / Standard Value Cigna HDHP CIGNA Minimum Value (MV)
Features Open Access Plus Network Open Access Plus / Local Plus Network Open Access Plus Network Open Access Plus Network
Working Spouse Mandate: If your spouse/domestic partner is eligible for medical insurance through his/her employer, your spouse/domestic partner will not be
eligible for the Randstad medical plans.
Coverage Year
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Jan 1 – Dec 31,
You Pay: You Pay: You Pay: You Pay: You Pay: You Pay: You Pay: You Pay:
2021

Coverage Year $400/individual $1,200/individual $750/individual $2,250/individual $1,500/individual $4,500/individual $5,000/individual $15,000/individual
Deductible $1,200/family $3,600/family $2,250/family $6,750/family $3,000/family $9,000/family $10,000/family $30,000/family

Coinsurance
15% 35% 20% 40% 20% 40% 40% 60%
(member pays)

Out-of-Pocket
Maximum
(includes
$3,000/individual $9,000/individual $4,000/individual $12,000/individual $5,000/individual $15,000/individual $7,000/individual $21,000/individual
deductibles, co-
$9,000/family $27,000/family $12,000/family $36,000/family $10,000/family $30,000/family $14,000/family $42,000family
insurance and
medical
copays)

Embedded
N/A N/A N/A N/A $7,900 N/A N/A N/A
Individual

Maximum Employee Contribution

Health Savings
N/A N/A N/A N/A $3,600 – individual* N/A N/A
Account (HSA)
$7,200 – family*

Preventive 35% after

Covered at 100% Covered at 100% 40% after deductible Covered at 100% 40% after deductible Covered at 100% 60% after deductible
Care deductible

Primary Care Primary Care

35% after 20% after 40% after
Provider (PCP): Provider (PCP): 40% after deductible 40% after deductible 60% after deductible
deductible deductible deductible
$35 copay/visit $35 copay/visit
Office Visits
Specialist Care Specialist Care
35% after 20% after 40% after
Provider (SCP): Provider (SCP): 40% after deductible 40% after deductible 60% after deductible
deductible deductible deductible
$50 copay/visit $50 copay/visit

Inpatient
15% after 35% after 20% after 40% after
Hospitalization 20% after deductible 40% after deductible 40% after deductible 60% after deductible
deductible deductible deductible deductible
/Surgery

Outpatient 15% after 35% after 20% after 40% after

20% after deductible 40% after deductible 40% after deductible 60% after deductible
Surgery deductible deductible deductible deductible
Emergency Care

Emergency 20% after 40% after

$250 copay/visit $250 copay/visit $250 copay/visit $250 copay/visit 20% after deductible 40% after deductible
Room deductible deductible

Urgent Care 20% after 40% after

$50 copay/visit $50 copay/visit $50 copay/visit $50 copay/visit 20% after deductible 40% after deductible
Ctr deductible deductible
Prescription Drugs: Your prescription drug program is administered by Express Scripts
Retail
(30-day supply)
20% after 40% after
Generic $12 copay $12 copay Not Covered Not Covered
deductible deductible

20% after 40% after

Brand Name 20% coinsurance ($30 min/$75 max) 20% coinsurance ($30 min/$75 max) Not Covered Not Covered
deductible deductible

Non-Formulary 20% after 40% after

35% coinsurance ($50 min/$150 max) 35% coinsurance ($50 min/$150 max) Not Covered Not Covered
Brand deductible deductible

Mail Order
20% after 40% after
Generic $30 copay $30 copay Not Covered Not Covered
deductible deductible
20% coinsurance ($75 min/$187.50 20% after 40% after
Brand Name 20% insurance ($75 min/$187.50 max) Not Covered Not Covered
max) deductible deductible
Non-Formulary 20% after 40% after
35% coinsurance ($125 min/$375 max) 35% coinsurance ($125 min/$375 max) Not Covered Not Covered
Brand deductible deductible
Lifetime
Maximum No maximum No maximum No maximum No maximum
Benefits

Cigna Standard Value Plan is offered in eligible markets only displayed within your benefits web portal and utilizes an exclusive high performing network called the Local Plus Network.

If you do not reside in a geographic area serviced by any of the medical plan options shown in this overview, you may be eligible for the Cigna Out-of-Area option (not shown).

* In addition to the 2021 IRS maximums, participants age 55 and older are allowed an annual catch-up contribution of an additional $1,000.
benefits at a glance
Vision Option Features - EyeMed Life Insurance - MetLife
Out-of-Network
In-NetworkSelect Network Reimbursement Plan Options Coverage Descriptions
**

Eye Company paid

$0 copay $50 Basic Life Insurance
Examination - $25,000

Employee paid
Lenses - Covered up to: Optional Life and AD&D Insurance 1x – 5x Annual Salary
Maximum $500,000
Employee Paid
- Increments of $10,000
Spousal/Domestic Partner Life
Single Vision $0 copay $42 - Maximum is 50% of combined employee
Insurance
life coverage amount or $200,000,
whichever is less
Employee Paid
Bifocal $0 copay $78 Dependent Child Life Insurance
- $2,500 -$7,500
Trifocal $0 copay $130 Life insurance is reduced upon age 65
Lenticular $0 copay $130
Standard
$45 copay $140
Progressive

Premium Refer to EyeMed Fixed Premium Short-Term Disability Long-Term Disability Insurance
$196
Progressive Progressive price list Insurance (STD) – Reed/CIGNA (LTD) – Reed/CIGNA

You may enroll in the Randstad LTD plan.

You may enroll in the Randstad STD.
$0 copay; $150 allowance, 20% Benefits are payable after 180 calendar
Frames $90 Benefits are payable after a 14 day
discount over $150 days of disability until age 65 (or until you
elimination period.
are no longer disabled if sooner).

Plan pays 50% of your annual benefit
salary up to a maximum $1,000 weekly
Contact Lenses - Covered up to:
benefit, for up to 180 days or until your
no longer disabled whichever occurs first.
Long-Term Disability - Employee Paid -
Plan pays 50% of your annual benefit
salary up to a maximum $5,000 monthly
benefit (maximum salary of $200,000).

$0 copay; $130 allowance, 15%

Conventional $130 Disability benefits are limited if age 65 or older
discount over $130
$0 copay; $130 allowance, plus balance
Disposable $130
over $130

Medically
$0 co-pay, paid in full $210 Dental Option Features - Delta Dental
Necessary

Benefits are payable once every calendar year. PPO Plus Premier
(Eyeglass lenses and contact benefits cannot be used in the same calendar year) PPO, Premier, and Out-of-Network

** Member reimbursement Out-of-Network will be the lesser of the listed amount

or the member's actual cost from the Out-of-Network provider. In certain states,
members may be required to pay the full retail rate and not the negotiated $50/individual
Deductible
discount rate with certain participating providers. Please see EyeMed's online $150/family
provider locator to determine which participating providers have agreed to the
discounted rate.

Preventive Care Covered at 100%*

Basic Care Covered at 80%, after deductible*

Additional Benefits Major Care Covered at 50%, after deductible*

Free in-person counseling for you and your eligible
Employee
dependents (up to six sessions per incident) Covered at 50%*
Assistance Orthodontics
Additional guidance resources (legal, financial, work-life (adults & children)
Plan
balance, etc.) available by phone and online
After meeting the eligibility requirements of 90-days of service,
the month following you will be able to visit
401(k) Plan MillimanBenefits.com to view your specific 401K plan details. Maximum Benefits
Milliman will send a Welcome Kit once eligible which provides
log in details.
Benefits
Enrollment https://randstadus.wixsite.com/rpgenrollmentguide Dental Services $2,000/coverage year
Guide
Attoryneys available for various personal legal needs
MetLife Legal
Discount rates (no cost for many services) Orthodontic Services $1,500 lifetime (adults and children)
Plan
Post-tax payroll deductions
Transit Please visit the Benefits Web Portal at
Commuter https://staffing.benefitsnow.com or call 877-601-7453 to learn
more about this benefit * Out-of-Network reasonable and customary (R&C) fee charge based on the lowest of
Benefits
the dentist's actual charge, the dentist's usual charge for same or similar service, or
MetLife the charge of most dentist's in the same geographic area for same or similar service
Voluntary Discounted auto and home insurance available at group rates as determined by Delta Dental.
Home and Post-tax payroll deductions
Auto

Eligibility for benefits: Employees are considered full-time and eligible for health & welfare benefits regardless of the number of hours worked. Eligible employees will
have 30 days from their first day worked to elect benefits, which then become effective the first day of the month following the first day worked.

Employees with no pay for 30 days will be considered terminated as of their 30th day with benefits ending on date of termination. If rehired within 90-days of their termination date, previous
benefit elections will be reinstated as of first day worked after rehire, to include no coverage. If rehired after 90-days of their termination date, the employee will be treated as a new hire
and will be required to re-enroll.

This benefits at a glance simply provides an overview of some of the key features of each plan for which you may be eligible and is not intended to replace the official and controlling plan
provisions, which are contained in the plan documents and policies, as applicable for each benefit. If there are differences, the official plan documents or policies will always govern over the
content of this document. Benefits eligibility and waiting periods may vary by plan and employment status. This benefits at a glance is not a guarantee of your eligibility to receive benefits
and is not to be construed to create a contract of employment between Randstad or its subsidiaries and you. Randstad reserves the right to amend, modify, suspend or terminate the plans in
whole or in part at any time.