Medical Insurance Plans
Tyson Foods offers two different medical insurance plans:

• Basic medical coverage: single only $11.90 per week, or family only $32.10 per week. The following briefly explains the Group Health Plan coverage for which you become eligible to participate on the first of the month following three (3) months of full-time employment. Once you are enrolled in the Plan, you will be provided a Summary Plan Description (SPD) and identification card(s).
• Premium medical coverage: single only $17.00 per week, or family only $53.60 per week. The following briefly explains the Group Health Plan coverage for which you become eligible to participate on the first of the month following three (3) months of full-time employment. Once you are enrolled in the Plan, you will be provided a Summary Plan Description (SPD) and identification card(s).

Charts outlining the services covered in the two plans are found below.

	BASIC PLAN
BENEFITS	IN-NETWORK	OUT-OF-NETWORK
Deductible (per calendar year)	$400/Individual $800/Family	$400/Individual $800/Family
Coinsurance	80% of network fee schedule	50% of out-of-network fee schedule
Out-of-Pocket Maximum	$2,500/Individual/Year $5,000/Family/Year	No limit
Lifetime Benefit Maximum	$1,000,000	$1,000,000
COVERED EXPENSES
Primary Care Office Visits (provided by OB/GYN, pediatrician, internist, family practice, nurse practitioners, physician assistants)	$25 co-pay (deductible waived)	After deductible, 50% of out-of-network fee schedule
Specialty Office Visits	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Hospital/Surgical Inpatient & Outpatient	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Hospital Pre-notification Penalty	50% of Plan benefits to a maximum of $1,000	50% of Plan benefits to a maximum of $1,000
Lab & X-ray	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Emergency Room	After deductible and $100 co-pay, 80% of network fee schedule	After deductible and $100 co-pay, 50% of out-of-network fee schedule
Home Health Care/Hospice	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Chiropractic $500 annual maximum	After deductible, 50% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Mental/Nervous Treatment Outpatient: 30 visit annual max Inpatient/Outpatient: $2,000 annual maximum; $25,000 lifetime maximum	Not covered	Not covered
Preventive Care Services
Routine Physicals	Not covered	Not covered
Routine Mammograms	Not covered	Not covered
Well Child Visits	Not covered	Not covered
Well Child Immunizations    (up to age 17)	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Hearing Exams & Tests	Not covered	Not covered

	PREMIUM PLAN
BENEFITS	IN-NETWORK	OUT-OF-NETWORK
Deductible (per calendar year)	$400/Individual $800/Family	$400/Individual $800/Family
Coinsurance	80% of network fee schedule	50% of out-of-network fee schedule
Out-of-Pocket Maximum	$1,500/Individual/Year $3,000/Family/Year	No limit
Lifetime Benefit Maximum	$1,000,000	$1,000,000
COVERED EXPENSES
Primary Care Office Visits (provided by OB/GYN, pediatrician, internist, family practice, nurse practitioners, physician assistants)	$25 co-pay (deductible waived)	After deductible, 50% of out-of-network fee schedule
Specialty Office Visits	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Hospital/Surgical Inpatient & Outpatient	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Hospital Pre-notification Penalty	50% of Plan benefits to a maximum of $1,000	50% of Plan benefits to a maximum of $1,000
Lab & X-ray	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Emergency Room	After deductible and $100 co-pay, 80% of network fee schedule	After deductible and $100 co-pay, 50% of out-of-network fee schedule
Home Health Care/Hospice	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Chiropractic $500 annual maximum	After deductible, 50% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Mental/Nervous Treatment Outpatient: 30 visit annual max Inpatient/Outpatient: $2,000 annual maximum; $25,000 lifetime maximum	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Preventive Care Services
Routine Physicals	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Routine Mammograms	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Well Child Visits	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Well Child Immunizations    (up to age 17)	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule
Hearing Exams & Tests	After deductible, 80% of network fee schedule	After deductible, 50% of out-of-network fee schedule

Dental Plan
Eligibility: Once you have been covered in the Group Health Plan for six (6) months, you are automatically enrolled in dental coverage with no additional premium cost to you. Enrollment in this coverage will follow the medical choice of Single versus Family, and Basic versus Premium.

There is not a provider network for dental services and the plan pays up to usual and customary charges.

How Benefits are Paid:

	DENTAL PLAN
BENEFITS	BASIC	PREMIUM
Deductible (per calendar year)	$50/Individual	$50/Individual
Annual Benefit Maximum	$500/Individual	$1,000/Individual
Preventative	100% of usual and customary	100% of usual and customary
Basic	After deductible, 80% of usual and customary	After deductible, 80% of usual and customary
Major	After deductible, 50% of usual and customary	After deductible, 50% of usual and customary
Orthodontic $500 lifetime maximum	Not covered	50% of usual and customary for dependent children under age 23 only

Covered Care

• Preventative: Includes routine exams, cleanings, and bitewing x-ray twice a year.
• Basic: Treatments such as fillings, extractions, periodontal visits, and root canals.
• Major: Treatments such as TMJ, crowns, and dentures.

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Vision Care Coverage
Vision coverage under the Group Health Plan starts automatically six months after medical coverage and the type of coverage will be the same as the medial choice of Family versus Single and Basic versus Premium Plan. Vision coverage, provided through Vision Service Plan (VSP), features a network of independent vision care providers. There is no coverage for out-of-network providers.

	VISION PLAN
BENEFITS	BASIC	PREMIUM
Eye Examination	$25 co-pay; once every 12 months	$20 co-pay; once every 12 months
Lenses*	$25 co-pay; once every 24 months	$25 co-pay; once every 24 months
Frames*	Up to $75 retail value; once every 24 months	Up to $120 retail value; once every 24 months
Contact Lenses*	$25 co-pay up to $75 retail value; once every 24 months	$25 co-pay up to $120 retail value; once every 24 months

*Coverage is for either contact lenses OR frames/lenses, but not both.
Lenses include standard single vision, bifocal and trifocal lenses. Other lens types such as progressive, shaded, etc., can be purchased at an additional cost.

Your allowance applies to the cost of your contact lens exam and contact lenses. A 15% discount is applied to the cost of your contact lens exam from a VSP Provider. Your contact lens exam is performed in addition to your routine eye exam to check for eye health risks associated with improper wearing or fitting of contacts.

To receive a list of the vision providers, please call 1-800-877-7195, or view the VSP provider directory online at www.vsp.com. The Team Member's Social Security Number is the Member ID.

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CareMark Prescription Drug Coverage
Prescription drug coverage under the Group Health Plan begins following eligibility and enrollment for medical coverage. Prescription drugs are purchased through the CareMark CarePerform Network or the CareMark Mail Service Program. Online internet services are available at www.caremark.com. You can also call careMark at 1-800-390-2319. Prescription drugs purchased out-of-network are subject to an annual deductible.

	CAREMARK COVERAGE
PRESCRIPTION DRUG COVERAGE	IN-NETWORK	OUT-OF-NETWORK
Retail (up to 30-day supply)
Generic	100% after $12 co-pay	$50 deductible, then 50% of network pharmacy price
Preferred Brand    (on CareMark's Preferred    Drug List)	100% after $27 co-pay	$50 deductible, then 50% of network pharmacy price
Non-Preferred Brand    (not on CareMark's Preferred    Drug List)	100% after $55 co-pay	$50 deductible, then 50% of network pharmacy price
Mail Order (up to 90-day supply)
Generic	100% after $24 co-pay	$50 deductible, then 50% of network pharmacy price
Preferred Brand    (on CareMark's Preferred    Drug List)	100% after $54 co-pay	$50 deductible, then 50% of network pharmacy price
Non-Preferred Brand    (not on CareMark's Preferred    Drug List)	100% after $110 co-pay	$50 deductible, then 50% of network pharmacy price

Examples of nationwide retail pharmacy chains that participate in the CarePerform Network include: CVS, Eckerd, K-Mart, Kroger, Wal-Mart, Osco, Rite-Aid, Walgreen, Albertson's, Target, Shopko, Hyvee, plus independent CarePerform pharmacies in locations without access to the above chains.

How to Obtain In-Network Prescription Drugs

• Obtain a prescription order from your physician for up to a 30-day supply of medication for retail, or 90-day supply for mail order.
• Submit the prescription order to a CareMark CarePerform pharmacy or mail with a completed CareMark mail order form.

How to Obtain Out-of-Network Prescription Drugs

1. Pay full price for the medication up to a 30-day supply.
2. Submit a claim form directly to CareMark for processing.
3. After the deductible has been applied, CareMark will reimburse you 50% of the equivalent network pharmacy prescription price.

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