To From Re Date Eligible U S Summit Peak

To: From: Re: Date: Eligible U.S. Summit Peak Employees Summit Peak Benefits 2005 Health and Welfare Open Enrollment November 1, 2004 Welcome to the 2005 Health and Welfare Open Enrollment process. The Open Enrollment period for plan year 2005 begins on Monday, November 1, 2004, and ends on Friday, November 19, 2004. During this time, you have the opportunity to enroll in or make changes to your elections in the Medical, Dental, and Optional Life Insurance programs. Additionally, you may elect to contribute to a Flexible Spending Account (Health Care and/or Dependent Care Reimbursement Accounts) for plan year 2005. Please note that if you elected to contribute to a Flexible Spending Account (FSA) in 2004, this election will not be carried into plan year 2005. Changes to health and welfare benefit elections are permitted only once a year during the Open Enrollment period. You cannot change your coverage options at any time other than during the Open Enrollment period unless you experience a qualified change in family status. Such “Life-Changing Events” include: ! ! ! ! Marriage Divorce or legal separation Birth or adoption of a child Spouse changes coverage due to change in employment ! Death of a dependent ! Child no longer satisfies the definition of eligible dependent If you experience a “Life-Changing Event” during the plan year, you must notify Human Resources within 30 days of the event if you wish to make a change to your health and welfare benefit elections. If the change is not submitted within 30 days of the event, you will not be able to make changes to your health and welfare benefit elections until the next Open Enrollment period. Due to administrative changes at CIGNA, beginning January 1, 2005, Summit Peak has a new CIGNA account number. The new account number is 3209084. If you are enrolled in a CIGNA health plan you will receive a new ID card(s) prior to January 1, 2005. Please notify your physician(s), dentist(s), pharmacist(s) and other providers of the change. Please take a moment to review the important benefits information included in this packet: Open Enrollment Instructions Benefit Changes for 2005 Enrollment Confirmation Worksheet If you have any questions, please refer to the enclosed Summit Peak U.S. Employee Benefits Brochure or log on to Summit Peak’s U.S. Benefits website at www.mybensite.com/summitpeak. For details on Summit Peak’s employee benefits, go to www.mybensite.com/summitpeak Remember: If you are enrolling in the FSA or making benefit election changes for 2005, you must return the enclosed Enrollment Confirmation Worksheet no later than Friday, November 19, 2004. Open Enrollment Instructions Consider Your Options: Take a few minutes to review the following “Benefit Changes for 2005” section and the enclosed personalized Enrollment Confirmation Worksheet. Complete the Enrollment Confirmation Worksheet: If you wish to make changes to your current health and welfare benefit elections, and/or make FSA contributions in 2005, you must complete, sign and date the Enrollment Confirmation Worksheet. Note that if you decide not to make any changes to your current elections you do not need to complete this worksheet. However, if you want to make contributions to the FSA in 2005, you must complete, sign and date this worksheet to reflect this election. Review Your Updated Enrollment Confirmation Statement: If you submit an Enrollment Confirmation Worksheet with changes or enroll in an FSA, you will receive an updated confirmation statement with your new benefit elections. Please review your personalized confirmation worksheet for accuracy and notify Human Resources of any discrepancies. Flexible Spending Account: Eligible employees who wish to participate in 2005 MUST enroll! ! ! ! Passive Enrollment: If you are not making changes and are not enrolling in an FSA, you do not need to return the Enrollment Confirmation Worksheet. ! ! ! Changes in Benefit Elections: If making changes, complete the Enrollment Confirmation Worksheet. ! New CIGNA ID Cards: All members will receive new ID cards for plan year 2005. ! ! ! Optional Supplemental Life and Voluntary Accidental Death and Dismemberment Insurance: Optional Supplemental Life: 1, 2 or 3 times annual base salary Optional Spouse/Dependent Life Insurance: $5,000 Spouse Life Insurance $5,000 Child Life Insurance ! ! ! VAD&D: 1 – 10 times annual base salary ! ! Eligible employees who wish to participate in a Flexible Spending Account (FSA: Health Care Reimbursement and/or Dependent Care Reimbursement) must complete the enclosed Enrollment Confirmation Worksheet and return it to Summit Peak Benefits in the enclosed, postage-paid envelope. Enrollment for this benefit is not automatic; elections made for plan year 2004 will not be carried into 2005. If you wish to make contributions in 2005 you must make this election during the Open Enrollment period. Please be aware that the allowance for each FSA election is a minimum of $120 per year and a maximum of $5,000 per year. If you do NOT wish to make changes to your current health and welfare benefit elections, and you are not participating in an FSA, you do not need to complete the Enrollment Confirmation Worksheet. Your current benefit elections will remain the same for 2005. If you are enrolling in an FSA for 2005, you MUST complete the FSA section on the Enrollment Confirmation Worksheet. Please read the “Benefit Changes for 2005” section, for important information regarding the health and welfare program’s design changes effective January 1, 2005. If you are making changes to your health and welfare benefit elections, and/or enrolling in an FSA for 2005, please complete, sign and date the Enrollment Confirmation Worksheet and return it to Summit Peak Benefits in the enclosed postage-paid envelope no later than Friday, November 19, 2004. Regardless of whether you make changes to your medical and dental elections, all participants will receive new CIGNA ID cards with a new account number for plan year 2005. You should receive your new CIGNA ID card prior to January 1, 2005. If you have not received your new ID card by December 24, 2004, please notify Human Resources. When you receive your new CIGNA ID card, please notify your physician(s), dentist(s), pharmacist(s) and other providers of the change. Eligible employees may purchase Optional Employee Supplemental Life Insurance benefits in increments of 1, 2 or 3 times annual base salary (rounded to the next highest $1,000). If you would like to enroll, increase or decrease your Optional Employee Supplemental Life Insurance benefits, please complete and return the following to Summit Peak Benefits: o The Enrollment Confirmation Worksheet o If you are enrolling in or increasing your Optional Employee Supplemental Life Insurance you must complete the MetLife Statement of Health Form which can be found on the Summit Peak U.S. Benefits website, www.Summit Peak.com/benefits. Eligible employees may purchase $5,000 of Spouse Life and $5,000 of Child Life Insurance. Eligible employees may purchase Voluntary Accidental Death and Dismemberment (VAD&D) insurance in increments of 1 – 10 times annual base salary (rounded to the next highest $1,000). If you would like to enroll, increase or decrease your VAD&D benefits, please complete the Enrollment Confirmation Worksheet and return it toSummit Peak Benefits. You do NOT need to complete a MetLife Statement of Health Form. Benefit Changes for 2005 Due to the rapidly increasing cost of healthcare, Summit Peak, like most employers, has experienced premium increases. Medical, dental and prescription costs continue to rise in double digits. In order to retain a competitive, cost-effective health and welfare benefit package, employees will be sharing in the increased cost of healthcare for 2005. The new bi-weekly contributions will be as follows: Medical, Rx and Vision Employee EE + One EE + Family 2005 Employee Bi-Weekly Rate $30.00 $85.00 $106.00 Dental PPO Plan Employee EE + One EE + Family 2005 Employee Bi-Weekly Rate $3.50 $9.50 $11.50 Summit Peak encourages its employees to use their health and welfare benefits as efficiently as possible. Starting January 1, 2005, the following medical and prescription benefit changes will take effect: Benefit Description Office Visit Copay Emergency Care New Benefits Effective January 1, 2005 $15 Primary Care $25 Specialist $50 Urgent Care Facility $100 Emergency Room Copay Waived if Admitted New Formulary: $0 Summit Peak Generic $5 Generic $15 Preferred Brand $35 Non-Preferred Brand New Formulary: $0 Summit Peak Generic $10 Generic $30 Preferred Brand $70 Non-Preferred Brand ! A “Formulary” is a list of approved medications designed to promote quality, cost-effective pharmaceutical care, while providing you with access to medications that help you maximize your health care dollars. In order to save money, ask your provider to prescribe medication(s) for you from the CIGNA formulary. For more information about the new Formulary and a complete list of medications, please go to www.Summit_Peak.com/benefits or call CIGNA pharmacy services at (800) 244-6224 (888 CIGNA24). ! ! Prescriptions (Retail) (30 day supply) Mail Order Prescriptions (90 day supply)