JOHN DEERE EMPLOYEE BENEFITS – 2018 HEALTHCARE BENEFIT SUMMARY · john deere employee benefits – 2018 healthcare benefit summary ... $1,500 for single coverage or $3,000 ... john

JOHN DEERE EMPLOYEE BENEFITS – 2018

HEALTHCARE BENEFIT SUMMARY

*Deductible applies. Allowed charge means, in order, contracted rates, reasonable and customary charges and billed charges. This is a summary only. SAP 0246_18.doc 07/12/2017 Page 1

Plan #0246 UHC CarePlus 1-888-JDEERE1 Benefit In-Network (Choice Plus) Out-of-Network

Annual Deductible In- and Out-of-Network deductibles cross-accumulate

$1,500 for single coverage or $3,000 for family coverage per calendar year


Maximum Out-of-Pocket Expense Does not include dental, vision, or charges in excess of reasonable and customary.


Unlimited

Physician Services – General Office Visits Hospital Visits Surgical Procedures

Office Outpatient Inpatient

Maternity Care Allergy Testing Allergy Injections

80% of allowed covered charge * 80% of allowed covered charge* 80% of allowed covered charge* 80% of allowed covered charge* 80% of allowed covered charge* 80% of allowed covered charge* (For employee and spouse only) (Dependents are not eligible) 80% of allowed covered charge* 80% of allowed covered charge*

50% of allowed covered charge* 50% of allowed covered charge* 50% of allowed covered charge* 50% of allowed covered charge* 50% of allowed covered charge* 50% of allowed covered charge* (For employee and spouse only) (Dependents are not eligible) 50% of allowed covered charge* 50% of allowed covered charge*

Preventive Services** Preventive Exam Mammograms Pap Tests Well-Child Care Immunizations Screenings Cholesterol Osteoporosis Expanded Women’s preventive health **Based upon U.S. Preventive Services Task Force (USPSTF) guidelines and the Affordable Care Act guidelines.

100% of allowed covered charge 100% of allowed covered charge 100% of allowed covered charge 100% of allowed covered charge 100% of allowed covered charge 100% of allowed covered charge

50% of allowed covered charge* 50% of allowed covered charge* 50% of allowed covered charge* 50% of allowed covered charge* 50% of allowed covered charge* 50% of allowed covered charge*

Hospital Services Inpatient Care Outpatient Care

80% of allowed covered charge* 80% of allowed covered charge* Pre-notification required

50% of allowed covered charge* 50% of allowed covered charge* Pre-notification required Failure to pre-notify will result in a $300 benefit reduction

Emergency Room Emergency Ambulance

80% of allowed covered charge* 80% of allowed covered charge to nearest facility*

Skilled Nursing Care 80% of allowed covered charge* Pre-notification required

50% of allowed covered charge* Pre-notification required

Home Health Care



Hospice 80% of allowed covered charge* Pre-notification required

Covered in-network only

Durable Medical Equipment 80% of allowed covered charge* Covered in-network only Prosthetic Devices 80% of allowed covered charge* Covered in-network only Physical/Occupational/Speech Therapy

80% of allowed covered charge* Maximum 60 combined treatment days per calendar year in- and out-of-network

50% of allowed covered charge* Maximum 60 combined treatment days per calendar year in- and out-of-network

Cardiac or Pulmonary Therapy 80% of allowed covered charge* Maximum 36 days per calendar year in- and out-of-network

50% of allowed covered charge* Maximum 36 days per calendar year in- and out-of-network

Chiropractic Services 80% of allowed covered charge* Maximum 12 visits per calendar year in- and out-of-network

50% of allowed covered charge* Maximum 12 visits per calendar year in- and out-of-network

JOHN DEERE EMPLOYEE BENEFITS – 2018

HEALTHCARE BENEFIT SUMMARY

*Deductible applies. Allowed charge means, in order, contracted rates, reasonable and customary charges and billed charges. This is a summary only. SAP 0246_18.doc 07/12/2017 Page 2

Benefit In-Network (Choice Plus) Out-of-Network Imaging and Laboratory Services 80% of allowed covered charge* 50% of allowed covered charge* Organ Transplants (Must use a URN provider)

80% of allowed covered charge* (Must be approved by UHC)


Mental Health Services including Autism Spectrum Disorder Office Visits Inpatient Care Outpatient Care

80% of allowed covered charge* 80% of allowed covered charge* 80% of allowed covered charge* (Must triage through United Behavioral Health)


Substance Abuse Services Office Visits Inpatient Care Outpatient Care



Prescription Drugs 31-day supply 90-day supply for maintenance drugs (Mail order program is available)

Participating Pharmacy 80% of allowed covered for tier 1 drugs* 80% of allowed covered for tier 2 drugs* 80% of allowed covered for tier 3 drugs*


Hearing (Benefit payable once every 36 mths) Exam Hearing Aids Hearing Aid Mgmt Svcs (HAMS) Network (where available) Exam Hearing Aids (Contact UHC for a list of providers)

100% of allowed covered charge - $70 benefit maximum* 100% of allowed covered charge - $1000 ($500 per ear) benefit maximum* 100% of allowed covered charge* 100% of allowed covered charge for pre-determined hearing aids*

Vision Care Eye Exam Single Vision Lens Bifocal Vision Lens Trifocal Vision Lens Lenticular Vision Lens Frame Contact Lenses

Participating UHC Vision Provider 100% of allowed covered charge after $5 copayment for adults age 19 and over. Copay is waived for children under age 19. 100% of allowed covered charge after $10 copayment 100% of allowed covered charge after $10 copayment. 100% of allowed covered charge after $10 copayment 100% of allowed covered charge after $10 copayment 100% of allowed covered charge after $10 copayment 100% of allowed covered charge after $50 copayment Exam, lenses (glasses or contact) and frame – once per 24 months – combined in- and out-of-network

Non-Participating UHC Vision Provider 100% of allowed coverd charge for children under age 19. $43.70 maximum reimbursement for adults age 19 and over. $35.00 maximum reimbursement per pair $52.50 maximum reimbursement per pair $70.00 maximum reimbursement per pair $87.40 maximum reimbursement per pair $24.80 maximum reimbursement $52.50 maximum reimbursement per pair Exam, lenses (glasses or contact) and frame – once per 24 months – combined in- and out-of-network

Dental Services Services provided through UnitedHealthcare Coordination of Benefits Non-Duplication of Benefit

Deere & Company reserves the right to suspend, amend, modify, or terminate the Plan(s) in any manner at any time, including the right to modify or eliminate any cost-sharing between the company and participants. Changes, which can be made at any time, are made by action of the company’s board of directors, or to the extent authorized by resolution of its board of directors, or by the Deere & Company Compensation Committee. In the event of a conflict between the language of the official Plan Documents and this document, the language of the official Plan Documents will control.