Effective January 1, 2015

Kavi MarketplaceProducts and Services

This marketing brochure may contain a brief summary of benefits and is not considered “Evidence of Coverage.” Please refer to policy/plan documents for a complete description of the controlling terms,

coverages, exclusions, limitations, and conditions of your coverage. In case of discrepancy between this information and the actual plan documents, the actual plan documents will prevail.

Contents

About Kavi Marketplace 1

Benefits Snapshot 2

Medical Plan 3

Dental Plan 5

Vision Plan 7

About the Platform 9

About the Customer Service 10

About the Managing General Agent 11

1

About Kavi Marketplace

Kavi Marketplace, powered by TailorWell, is a one-stop shop that bundles all the tools necessary for small groups to enjoy great benefits. It is designed to make healthcare interaction easy, with consolidated billing, no administrative fees, and an easily accessible online enrollment platform. Kavi is the only platform that offers Moda small group plans outside the Washington HealthplanFinder. Product offerings through Kavi include Moda Health’s 2015 small-group products and large-group dental and vision benefits specifically selected from Delta Dental of Washington and VSP.

Through TailorWell, employers perform their own online administration via a comprehensive, real time platform and employees shop and enroll in an online marketplace. Key advantages to using TailorWell include: online shopping, decision support and enrollment, comprehensive and highly accurate benefits administration, consolidated billing, frequent data exchange, and a My Benefits employee portal, which allows every TailorWell member to have a personalized website with their own benefit selections and cost summary.

Through Kavi, Moda will offer small-group comprehensive medical, pharmacy, and wellness plans. Moda is committed to the small-group market, as well as providing easy and simple ways for producers to get access to Moda’s full community-product portfolio. Because each distribution channel offers a distinctly unique value proposition to the market, Moda is committed to offering innovative plan designs, programs, and online tools so every client is able to find the right health plan to fit their lifestyle.

Delta Dental of Washington, the state’s leading dental benefits company, and VSP, the nation’s only not-for-profit vision company, will be providing dental and visions benefits. With several unique plan designs to choose from, employers will be empowered to pick the right combination of benefits to meet their needs, while taking advantage of Kavi’s group purchasing power.

Kavi products are available for all industries in Washington State, and are distributed to Moda appointed, and Kavi accredited producers via the Benefit Resource Hub (the HUB). The HUB provides accredited producers with secure, online access to Washington State’s premier health care insurance companies’ products.

To become accredited, or to learn more, please contact kavi.ins@wellsfargo.com.

2

Benefits Snapshot

Medical Plan: Moda Health• Available to employers with 1-50 employees • Community rated• “Rolling” 12-month plan year offerings• All Moda community-rated small group products available • All plans ACA compliant • All taxes/fees included in pricing• “Metallic” levels include Gold, Silver, and Bronze

Dental Plan: Delta Dental of Washington• Annual maximums from $1,000 to $2,000• Child and adult orthodontia riders (10 or more employees)• All plans include the Delta Dental PPO Network• All plans feature a $50 / $150 deductible• Available to groups with two or more employees

Vision Plan: VSP• Two plan options with distinct benefit frequencies• $10 copay for exams• Materials allowance and copays vary by plan• Choice Network included with both plan options• Available to groups with two or more employees

3

Medical Plan

Moda Health Plan, Inc. (Moda Health) is thrilled to offer health plans that help you and your employees find a way to better health.

You know your employees’ health relies on quality plans, programs, online tools and, most important, partnerships to help them along the way. We have all of that and a little bit more. We’re excited to help your entire group start on a journey to be better.

About Moda HealthOur health plans are designed to fit your employees’ lifestyle, so they can get well sooner and live well longer. For our part, we’ll provide:

> A diverse network of doctors and specialists in our First Choice Health PPO network and Connexus network.

> Expert health coaches, caring customer service reps and leading innovators in healthcare.

> A passionate commitment to rigorous service and clinical quality standards — like the NCQA commendable accreditation we earned for our quality PPO plans in Washington.

> A personal touch. We’ll connect your team with digital tools and real humans who have never heard the term phone tree.

For your part, we ask that each member of your group comes ready to be the MVP of his or her health. Don’t worry; we’ll help inspire them.

Discover more ways to be betterWhen you choose Moda Health, you get innovative plan designs, cost-effective benefits, and exceptional customer service. You’ll also appreciate partnering with a company that has national expertise and deep ties in the Pacific Northwest. Simply put:

We help you find the right care, at the right time, in the right place — and at the right price. In Moda Health, you’ll find a passionate partner to support your healthcare goals. Here’s what else you can count on:

> A pioneer in pharmacy services, with hundreds of thousands of members throughout Oregon, Washington and Alaska.

> A multi-faceted organization with a healthcare network serving business clients from Seattle to Spokane, from Ashland to Anchorage, and beyond.

> An online innovator with a wide range of free tools and programs to help you better manage your health.

> A team of health experts — doctors, nurses, counselors, pharmacists and coaches — who will make sure you get the most from your health plan.

Health plans for every body

7244320 (7/14) SS-1542

4

Medical Plan Comparison

Plan tier Description PCP office visit Specialist office visit Urgent care Emergency

room Coinsurance Individual deductible3

Out-of-pocket max per person3

Value Rx

All other Rx

PPO 500 Gold 151/500/20 $151 $301 $151 $200+20%1 20% $5004 $4,0005 $21 40%1

PPO 1000 Gold 151/1000/20 $151 $301 $151 $200+20%1 20% $1,0004 $4,0005 $21 40%1

PPO 1500 Silver 251/1500/20 $251 $451 $251 $200+20%1 20% $1,5004 $6,6005 $21 50%1

PPO 2000 Silver 251/2000/20 $251 $451 $251 $200+20%1 20% $2,0004 $6,6005 $21 50%1

PPO 3000 Silver 251/3000/20 $251 $451 $251 $200+20%1 20% $3,0004 $6,6005 $21 50%1

Beneficial 2000 Silver 351/2000/30

$35/visit1 first 5 visits, 30%

subsequent visits2 30%

$35/visit1 first 5 visits, 30%

subsequent visits2$200+30% 30% $2,0004 $5,5005 $21 50%1

Beneficial 4000 Bronze 351/4000/30

$35/visit1 first 5 visits, 30%

subsequent visits230%

$35/visit1 first 5 visits, 30%

subsequent visits2 $200+30% 30% $4,0004 $6,6005 $21 50%

Beneficial 5000 Bronze 351/5000/30

$35/visit1 first 5 visits, 30%

subsequent visits230%

$35/visit1 first 5 visits, 30%

subsequent visits2 $200+30% 30% $5,0004 $6,6005 $21 50%

Value 1500 Silver 351/1500/30 $351 $601 $351 $200+30% 30% $1,5004 $6,6005 $21 40%1

Value 2500 Silver 351/2500/30 $351 $601 $351 $200+30% 30% $2,5004 $6,6005 $21 40%1

Value 3500 Silver 351/3500/30 $351 $601 $351 $200+30% 30% $3,5004 $6,6005 $21 40%1

HSA 15006 Silver 30/1500/30 30% 30% 30% 30% 30% $1,5004 $5,5005 $21 40%

HSA 30006 Bronze 30/3000/30 30% 30% 30% 30% 30% $3,0004 $6,4505 $21 45%

HSA 50006 Bronze 30/5000/30 30% 30% 30% 30% 30% $5,0004 $6,4505 $21 30%

2015 Moda Health medical plans

1 Deductible waived2 Plan pays for first five visits with a copay, which may be used for either PCP office visits or urgent care for illness or

injury. Thereafter, the deductible and coinsurance apply.3 Individual deductible and out-of-pocket maximum listed are in-network benefits.

4 For family deductible, double amount.5 For out-of-pocket maximum per family, double amount. 6 HSA plans require the family deductible be met prior to benefits being paid when an individual and a spouse, or

one or more dependents, are enrolled.

8015430 (9/14)

All plans include embedded pediatric dental up to age 19. Deductible is waived on preventive dental.

modahealth.comHealth plans in Washington provided by Moda Health Plan, Inc.

This document is provided for informational purposes only, and is intended as a quick reference of Moda Health plan benefits. It is not considered a Summary of Benefits and Coverage (SBC), and should not be regarded as a replacement for the SBC. For cost and further details of the coverage, including exclusions, any reduction or limitations and the terms under which the policy may be continued in force, contact your producer or Moda Health.

In-network benefit comparisons

5

Maintaining good oral health is an essential part of good overall health. Disease and infections in the mouth are linked to diabetes, heart disease and stroke. At Delta Dental of Washington, we deliver dental benefits that complement medical coverage and help your clients support their employees’ wellness and productivity.

Dental benefits are highly valued by employees. According to our member research, 89% of employees rate dental an important or very important part of their benefits package—the same rate as medical coverage. As the most recognized and valued brand in dental benefits, coverage from us can be an important asset in attracting and retaining high-quality employees.

All of our Kavi Marketplace plan offerings are prevention-focused, giving employees access to high-quality care through the Delta Dental PPOSM network, with multiple plan designs to give employers a range of price points.

The Delta Dental difference: ● High quality coverage for services that help your clients support employees’ oral and overall health Preventive care covered at 100% encourages employees to get the care they need

● We negotiate with dentists to deliver the best discounts for care which helps keep rates and out-of-pocket costs low

● More choice and easy access to care We contract with more dentists than any other dental plan Our large PPO network means more choice for employees to see the dentist they want We contract directly and credential all of our in-network dentists to be sure they meet our high standards

for quality We never lease networks and don’t charge network access fees

● Local service Our service representatives are dental benefits specialists, located here in Washington You can count on us for responsive, personal service

We offer the best total value in dental benefits. If your clients are looking for easy access to care, low rates, high-quality coverage, and excellent service, they will thank you for helping them get IN with Delta Dental of Washington.

KAVI-1214

Delta Dental of Washington— the best value in dental benefits

6

KAVI-1214

Plan Feature PPO Plan AGroup #03875

PPO Plan BGroup #03876

PPO Plan CGroup #03877

PPO Plan DGroup #03878

Annual Deductible

Per PersonFamily Maximum

$50

$150

$50

$150

$50

$150

$50

$150

Annual Maximum $1,000 $1,500 $2,000 $2,000

Class I—Diagnostic and Preventive In Out In Out In Out In Out

ExamsProphylaxis FluorideX-RaysSealants

100% 80% 100% 80% 100% 80% 100% 100%

Delta Dental Plan Comparison

OrthoChild Only

OrthoFamily

Lifetime Max$1,000

Lifetime Max$1,000

Coverage

50% 50%

Annual deductibles are waived on Class I benefits.

All Plans are available to groups with 2 or more eligible employees.

Optional orthodontia coverage is available to groups with 10 or more eligible employees.

Class II—Restorative In Out In Out In Out In Out

RestorationsEndodonticsPeriodonticsOral Surgery

80% 70% 80% 70% 80% 70% 90% 80%

Class III—Major In Out In Out In Out In Out

CrownsDenturesPartialsBridgesImplants

50% 40% 50% 40% 50% 40% 50% 50%

7

Vision Plan

Get the best in eyecare and eyewear with Kavi Marketplaceand VSP® Vision Care.

Vision Plan

8

Coverage with a participating retail chain may be different. Once your benefit is effective, visit vsp.com for details. Coverage information is subject to change. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location.

1 Brands/Promotion subject to change.

©2014 Vision Service Plan. All rights reserved.VSP, VSP Vision care for life, and WellVision Exam are registered trademarks of Vision Service Plan. Flexon is a registered trademark of Marchon Eyewear, Inc. All other brands are trademarks or registered trademarks of their respective owners.

JOB#14061CM 08/14

Effective January 1, 2015Your VSP Vision Benefits SummaryKavi Marketplace and VSP provide you with a choice of affordable vision plans—choose the plan that’s right for you.

VSP Provider Network .......................... VSP Choice VSP Provider Network...........................VSP Choice

WellVision Exam® focuses on your eye health andoverall wellness$10 copay ...................................... every 12 months

WellVision Exam® focuses on your eye health andoverall wellness$10 copay...................................... every 12 months

Prescription Glasses$25 copayLenses ........................................... every 24 months• Single vision, lined bifocal, lined trifocal lenses• Polycarbonate lenses for dependent children• Average 20%-25% savings on other lens

enhancements Frame ............................................ every 24 months• $130 allowance for a wide selection of frames • $150 allowance for featured frame brands• 20% savings on the amount over your allowance• $70 allowance at Costco® Optical

–OR–Contact Lens (Instead of Glasses)…..every 24 months• Up to $60 copay for your contact lens exam

(fitting and evaluation)• $130 allowance for contacts

Prescription Glasses$40 copayLenses........................................... every 12 months• Single vision, lined bifocal, lined trifocal lenses• Polycarbonate lenses for dependent children• Average 20%-25% savings on other lens

enhancements Frame.............................................every 24 months• $150 allowance for a wide selection of frames • $170 allowance for featured frame brands• 20% savings on the amount over your allowance• $80 allowance at Costco® Optical

–OR–Contact Lens (Instead of Glasses)….every 12 months• Up to $60 copay for your contact lens exam (fitting

and evaluation)• $150 allowance for contacts

Visit vsp.com for details, if you plan to see a provider other than a VSP network provider.Exam………………..$45 Single Vision Lenses………………..$30 Lined Trifocal Lenses………..$65Frame……………….$70 Lined Bifocal Lenses……………….. $50 Contacts……………………...$105

Glasses and Sunglasses• 20% savings on additional glasses and sunglasses,

including lens enhancements, from any VSP providerwithin 12 months of your WellVision Exam

Laser Vision Correction• Average 15% off the regular price or 5% off the

promotional price, discounts only available from contracted facilities

Contacts• 15% savings on a contact lens exam (fitting and

evaluation)

JOB#11237CM 10/12

Kavi Plan A (with VSP Providers)

Kavi Plan B (with VSP Providers)

Extra Savings (applies to both plans)

Your Coverage with Out-of-Network Providers

9

About the PlatformTailorWell

Simple. Choice.

TailorWell was founded on the premise that the process of selecting, enrolling in and managing benefits should be easy and valuable for employees, employers, brokers, and carriers.

Founded in Seattle, WA TailorWell, through the Kavi Marketplace, is the only private exchange in the market that can be sold by benefits brokers as a turnkey, outsourced solution to employers.

Focused on Consumers TailorWell assembled a team of the nation’s top consumer technology and benefits experts to create a comprehensive private exchange solution. We created a marketplace of consumer friendly products and services, historically available only to large employers, and make them available to mid- to smaller- sized employers. The online marketplace experience is supported by a robust administration platform that helps employers manages all aspects of employee benefits.

Key Advantages of the TailorWell Private Exchange solution Online shopping, decision support and enrollment. The consumer friendly, online marketplace is designed to be familiar to anyone who shops online.

Comprehensive benefits administration. Employers are supported with everything they need to efficiently manage their benefits program – Eligibility, enrollment, status changes, payroll deduction, COBRA or Continuation of Coverage, and consolidated billing. TailorWell’s technology is integrated and operates in real time so that any changes to employee data or products are reflected immediately in everything from the user experience to the employer bill.

Consolidated billing. Employers have online access to a consolidated bill for all their benefit products and services. This bill is always current. Payments are made electronically or by check and TailorWell pays each carrier and vendor.

Frequent data exchange. Eligibility data is provided electronically to carriers in an aggregate file every two weeks (standard) or more often when requested. The quality and frequency of our data exchange results in less latency and fewer errors.

My Benefits employee portal. Every TailorWell member receives a personalized website with their own benefit selections and cost summary. This becomes the dashboard by which employees manage their benefits and receive communications, new offers and notifications about the benefits they have selected.

Customer service. Customer service agents use the same platform as employers and employees so support is clear, consistent, accurate and fast. The numbers to call for help with the Kavi Marketplace appear on the employer and employee web sites.

At TailorWell we help employers offer their employees more benefits options, while streamlining the benefits administration process. In today’s competitive marketplace, employers rely on TailorWell to help them effectively recruit and retain employees. Employees receive an intuitive, supported way to make personal benefits choices that best reflect their needs and the needs of their families.

10

About the Managing General AgentWells Fargo Program Services

Wells Fargo Program Services manages several Association Health Plans, small group community-rated products, as well as large group products. They are committed to offering innovative solutions and unparalleled service. Through various industry health trusts, Wells Fargo Program Services provides accredited producers with access to a comprehensive array of affordable healthcare products and services designed to meet the specific needs of their clients.

Driving Program Services’ success are two powerful and complementary components: technology and service. The Benefit Resource Hub (the HUB), Wells Fargo’s proprietary online platform, is the only web-based system uniquely designed for our wholesale model. Wells Fargo’s significant investment in developing the HUB demonstrates an on-going commitment to the small group market. The HUB not only provides efficient, one-stop electronic proposal submission capabilities, it also offers secure access to forms, benefit summaries and related resources specific to each trust. The team is committed to a two-day turnaround on the nearly 25,000 proposal requests received annually from more than 1,000 accredited producers across the state. The team not only delivers these proposals, but also handles the processing of all new business and renewals.

Wells Fargo Program Services is a dedicated team which, with more than 50 years of combined Trust management experience, is a dynamic group of professionals accustomed to the ever-changing health insurance environment.

Your Wells Fargo Program Services team will assist with:

• Rate and product design assessment on behalf of employers and accredited producers• Producer credentialing and training• Marketplace benchmarking• Value driven strategies• Employer presentations and enrollment meetings• Marketing• High level claim and service issues• General advocacy for accredited producers and companies

Wells Fargo Program Services takes pride in their ability to thrive in a fast-paced environment. Combining a creative approach with a “do-what-it-takes” attitude is what differentiates their team from the competition.

11

About the Program Manager

• Resource and advocate for accredited producers• Negotiates with carriers on behalf of group and producer• Provides industry specific benchmarking• Accessible for employer meetings upon request and availability• Producer credentialing seminars and training upon request• Facilitates value-driven solutions for producers and represented groups• Offering a creative strategy with product offerings to promote producer

competitiveness

Contact Information:Jesse Rawley, Program ManagerWells Fargo Insurance Services USA, Inc.601 Union Street, Suite 1300Seattle, WA 98101(206) 892-9521

jesse.d.rawley@wellsfargo.com

12

Notes

Kavi 5502 Marketing Brochure Last Revised: 12/11/14