October 1, 2012 – December 31, 2013

1. October 1, 2012 – December 31, 2013 Cape Coral Professional Firefighters Health Insurance Trust

3. Table Of Contents This illustration is intended to give a brief overview of benefits offered.  Refer to the contract/proposal/plan document for a detailed, accurate description of benefits.  This is an illustration based on estimated enrollment numbers.  Final rates will be based on actual enrollment, plan design chosen and plan effective date.  Every attempt has been made to accurately reflect the details of the plan, should there be any errors, the terms and conditions of the summary plan description/contract prevail.

4. Benefit Information Your Benefits Plan Cape Coral Professional Firefighters Health Insurance Trust offers three medical benefit options for you to choose from. The following pages will provide a basic summary of each plan offered. • Eligibility • You are eligible to join the Trust Benefit Plan on your date of hire. • You may also enroll your dependents in the Trust Benefit Plan when you enroll. Eligible dependents include: • Your spouse, unless you are legally separated or divorced; • A dependent who is 26 years of age or younger • Under the plan children include your natural children, step-children living with you, legally adopted children and any other children for whom you have legal guardianship. • When Can You Enroll? • You can sign up for benefits at any of the following times: • When hired as a firefighter by the City of Cape Coral Fire Department for continuous, full-time employment; • During the annual open enrollment period; • Within 30 days of a qualified family-status change. • If you do not enroll at the above times, you must wait for the next annual open enrollment period. • Extended Dependent Coverage • For medical coverage only, extended coverage may be offered for dependent children up to the end of the calendar year in which your dependent reaches age 30, if they meet the following requirements: • - Unmarried and do not have dependents of their own • - Are a resident of Florida or a student, AND • - Do not have coverage as a named subscriber, enrollee, or covered person under any other group insurance policy or individual health plan or entitled to Medicare benefits. 1

5. Medical plans About Your Medical Options For most people, medical insurance is no longer a “want” – it’s a need. We’ve all seen the cost of medical care skyrocket over the years, so we need insurance to help protect not only our physical fitness – but our financial fitness, as well. Cape Coral Firefighters Health Insurance Trust offers you three medical plans to choose from - all through Aetna. Benefits will vary depending on the plan you and your family choose. Under the Health Network Only Plan ( HMO), members are allowed to utilize doctors and facilities only in the Aetna Health Network Only network. The Health Network Option Plan (POS), provides members with the flexibility of utilizing doctors and facilities in or out of the Aetna Network. If a member utilizes care out-of-network, then their out-of-pocket costs will be higher than with a participating Aetna provider. Members are not required to choose or utilize a PCP (Primary Care Physician), but it is recommended that you do. The third plan is the Health Network Option (HDHP), a high deductible plan, which also gives members the flexibility of utilizing providers in or out of the Aetna Network. On the following page you can compare the above mentioned plans side-by-side. There’s sure to be a medical option that will help you and your eligible dependents stay physically and financially fit. Key Benefit Terms COBRA – A Federal law that allows workers and dependents who lose their medical coverage to continue any of these coverages for a specified length of time by electing and paying for continuation benefits. Coinsurance – The percentage of the medical charge that you pay after the deductible has been met. Copayment – A flat fee that you pay for medical services, regardless of the actual amount charged by your doctor or another provider. This generally applies to physician office visits and prescription drugs. Deductible – The amount you pay toward medical expenses each calendar year before the plan begins paying benefits. Maximum out of Pocket – The maximum amount (includes coinsurance and deductible) that an insured will have to pay for covered expenses under a plan. Once the out-of-pocket maximum is reached, the plan will cover eligible expenses at 100%. 2

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7. As you can see, the plan is designed to combine in-depth coverage with cost-effective prices. This summary contains highlights only and is subject to change. The specific terms of coverage, exclusions and limitations including legislated benefits are contained in the Summary Plan Description or Insurance Certificates. This plan is insured and / or administered by Aetna. PLEASE NOTE THAT OUT-OF-NETWORK SERVICES ARE SUBJECT TO BALANCE BILLING. 4

8. Aetna Value Adds Prescription Drug Benefits at a Reduced Cost – Did you know you can obtain prescription drugs at local retailers at a reduced cost and sometimes even free? Publix offers a variety of generic Oral Antibiotic medications to you absolutely free. Bring in your prescription for an approved medication and receive it FREE, up to a 14-day supply. Publix recently approved a medication for diabetes. CVS, Target, Walgreens & WalMartalso offer over 400 generic prescriptions for $4 and a 90 day supply for approx. $10 . Remember DO NOT show your Aetna ID card to receive these benefits, or you will be charged your Aetna drug rate. Member Resources Aetna Navigator ® Secure Member Website – Aetna Navigator is your secure member website. It’s where you go to: Find doctors, dentists, pharmacies & hospitals Get an ID card Look up a claim You’re mobile. So are we. Check your coverage Keep track of health care costs It’s personalized for you and your family It’s easy to get started – www.aetnanavigator.com You can also get a summary of your doctor visits, medical tests, prescriptions and other health activities. Look up health topics. Complete a Health Assessment. Beginning Right® Maternity Program Helping you and your baby grow healthy – together You get the Beginning Right Maternity management program with your Aetna plan. Information for a healthier pregnancy – You will get materials on – Prenatal care – Preterm labor symptoms – What to expect before/after delivery – Newborn care and more Special attention for Pregnancy risks Solid support to quit smoking Aetna Discount Programs Gym Memberships Eyeglasses and contacts Weight-loss programs ( Jenny Craig® - Nutrisystem® - eDiets® ) Chiropractic visits Massage therapy Acupuncture Hearing aids and more Personal Health Record Access family history details Review your office visits, prescriptions, conditions & treatments Get a health summary Download & share your information easily with health care providers Receive important medical alerts http://healthyis.aetna.com/personalhealth 24-hour Nurse Line for Health Questions Call a registered nurse toll-free Visit member sitewww.aetna.com Listen to Audio Health Library In addition to the network of physicians, hospitals, emergency rooms, and urgent care clinics, you also have the option of going to the convenient care clinics located within some grocery and drug stores, for minor illness such as ear aches, colds, flu and so on. By selecting one of these providers, you pay only the regular office visit copay; a significant savings over the emergency room and urgent care copayments. Please visit the various websites for locations, hours of operations and scope of services. CVS Minute Clinic: www.cvs.com Publix Little Clinic: www.Publix.com Walgreen’s Take Care Clinic: www.walgreens.com Frequently Asked Questions About Your Medical Plan Q. What should I do if I have a problem getting a claim paid? A. Start by contacting the carrier’s member services number to determine the nature of the problem. If the issue is the way the doctor or other service provider has billed the claim, then contact your doctor or Claims Advocate at USI. If the insurance company has an eligibility issue, contact Human Resources for assistance. Q. What is the difference between brand formulary, brand non-formulary, and generic drugs? A. Brand formulary is a prescription drug that is listed on the formulary (i.e., a list of prescription drugs covered by the plan). These drugs are protected by a patent issued to the original innovator or marketer. Brand non-formulary drugs are patent protected but are not listed. A generic equivalent drug can become available when the patent protection runs out, and is deemed equal in therapeutic power to the brand name originals. Q. When should I go the Urgent Care vs. Emergency Room? A. For non-life threatening injury/illness after normal doctor’s office hours. 5

9. Benefit Resource Center Services • Toll-free benefit call center available to: • Answer questions regarding your health and other benefit plans • Network: Is my doctor on the plan? • Plan Coverage: Does my plan cover this? • Billing: I received a bill from my provider, do I need to pay? • Once you’ve tried, but need help understanding how a carrier paid your claim • Specialist support to help you with complex claims issues • Medical appeals information and support • Life event (family status) rules – what changes can I make? • Life Insurance Beneficiary form requirements • How do I complete an Evidence of Insurability form and where do I send it? • What happens if I have coverage under two different medical plans? 6

10. Required Annual Employee Disclosure Notices • The Newborns’ and Mothers’ Health Protection Act of 1996 • The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits group and individual health insurance policies from restricting benefits for any hospital length of stay for the mother or newborn child in connection with childbirth; (1) following a normal vaginal delivery, to less than 48 hours, and (2) following a cesarean section, to less then 96 hours. Health insurance policies may not require that a provider obtain authorization from the health insurance plan or the issuer for prescribing any such length of stay. Regardless of these standards an attending health care provider may, in consultation with the mother, discharge the mother or newborn child prior to the expiration of such minimum length of stay. • Further, a health insurer or health maintenance organization may not: • Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely to avoid providing such length of stay coverage; • Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage; • Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such length of stay coverage; • Require a mother to give birth in a hospital; or • Restrict benefits for any portion of a period within a hospital length of stay described in this notice. • These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your SPD. Keep this notice for your records and call your Trust for more information. • Women’s Health and Cancer Rights Act of 1998 • The Women’s Health and Cancer Rights Act of 1998 requires Cape Coral Professional Firefighters to notify you, as a participant or beneficiary of the Cape Coral Professional Firefighters, Local 2424 Health and Welfare Plan, of your rights related to benefits provided through the plan in connection with a mastectomy. You, as a participant or beneficiary, have rights to coverage to be provided in a manner determined in consultation with your attending physician for: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; and • Prostheses and treatment of physical compilations of the mastectomy, including lymphedema. • These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your SPD. Keep this notice for your records and call Human Resources for more information. Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 Effective April 1, 2009, a special enrollment period provision is added to comply with the requirements of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009. If you or a dependent is covered under a Medicaid or CHIP plan and coverage is terminated as a result of the loss of eligibility for Medicaid or CHIP coverage, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after the date eligibility is lost. If you or a dependent becomes eligible for premium assistance under an applicable State Medicaid or CHIP plan to purchase coverage under the group health plan, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after you or your dependent is determined to be eligible for State premium assistance. Please note that premium assistance is not available in all states. Section 111 Effective January 1, 2009 group health plans are required by Federal government to comply with Section 111 of the Medicare, Medicaid, and SCHIPExtensionsof 2007’s new Medicare Secondary Payer regulations. The mandate is designed to assist in establishing financial liability of claims assignments. In other words, it will help establish who pays first. The mandate requires group health plans to collect additional information, more specifically Social Security numbers for all enrollees, including dependents 6 months of age or older. Please be prepared to provide this information on your benefits enrollment form when enrolling into benefits. 7

11. Required Annual Employee Disclosure Notices • Medicare Part D • This notice applies to employees and covered dependents who are eligible for Medicare Part D. • Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Cape Coral Firefighters Local 2424, and prescription drug coverage available for people with Medicare. It also explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll. At the end of this notice is information about where you can get help to make decisions about your prescription drug coverage. • Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. • Because your existing coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage. • Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from October 15th through December 7th. Beneficiaries leaving employer/union coverage may be eligible for a Special Enrollment Period to sign up for a Medicare prescription drug plan. • You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. • If you do decide to enroll in a Medicare prescription drug plan and drop your Cape Coral Professional Firefighters, Local 2424 prescription drug coverage, be aware that you and your dependents may be able to get this coverage back. Please contact us for more information about what happens to your coverage if you enroll in a Medicare prescription drug plan. • You should also know that if you drop or lose your coverage with Cape Coral Firefighters, Local 2424 and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. • If you go 63 days or longer without prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, your monthly premium will go up at least 1% per month for every month that you did not have that coverage. For example, if you go nineteen months without coverage, your premium will always be at least 19% higher than what many other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to enroll. • For more information about this notice or your current prescription drug coverage… • Contact our office for further information (see contact information below). NOTE: You will receive this notice annually and at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage through Cape Coral Professional Firefighters, Local 2424 changes. You also may request a copy. • For more information about your options under Medicare prescription drug coverage… • More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug plans: • Visit www.medicare.gov • Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help, • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. • For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you call them at 1-800-772-1213 (TTY 1-800-325-0778). • Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount. • Name of Entity/Sender: Cape Coral Professional Firefighters, Local 2424 • Contact--Position/Office: Sharon Thompson (239) 458-2424 8

12. Required Annual Employee Disclosure Notices continued HIPAA Privacy Policy for Fully Insured Plans with no Access to PHI The group health plan is a fully insured group health plan sponsored by the “Plan Sponsor”. The group health plan and the plan sponsor intend to comply with the requirements of 45 C.F.R. §164.530 (k) so that the group health plan is not subject to most of HIPAA’s privacy requirements. • I. No access to protected health information (PHI) except for summary health information for limited purpose and enrollment / dis-enrollment information. • Neither the group health plan nor the plan sponsor (or any member of the plan sponsor’s workforce) shall create or receive protected health information (PHI) as defined in 45 C.F.R. §160.103 except for (1) summary health information for purpose of (a) obtaining premium bids or (b) modifying, amending, or terminating the group health plan, and (2) enrollment and dis-enrollment information. • Insurer for group health plan will provide privacy notice • The insurer for the group health plan will provide the group health plan’s notice of privacy practices and will satisfy the other requirements under HIPAA related to the group health plan’s PHI. The notice of privacy practices will notify participants of the potential disclosure of summary health information and enrollment / dis-enrollment information to the group health plan and the plan sponsor. • No intimidating or retaliatory acts • The group health plan shall not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against individuals for exercising their rights , filing a complaint, participating in an investigation, or opposing any improper practice under HIPAAA. If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if your child was (1) covered under the plan and (2) enrolled as at student at a post-secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions). Your employer will require a written certification from the child’s physician that states that the child is suffering from a serious illness or injury and that the leave of absence is medically necessary. Patient Protection: If the Group Health Plan generally requires the designation of a primary care provider who participates in the network and who is available to accept you or your family members. For children, your may designate a pediatrician as the primary care provider. You do not need prior authorization from the carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology. The health care professionals, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, or for information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Plan Administrator or refer to the carrier website. It is your responsibility to ensure that the information provided on your application is accurate and complete. Any omissions or incorrect statements made by you on your application may invalidate your coverage. The carrier has the right to rescind coverage on the basis of fraud or misrepresentation. • No Waiver • The group health plan shall not require an individual to waive his or her privacy rights under HIPAA as a condition of treatment, payment, enrollment or eligibility. If such an action should occur by one of the plan sponsor’s employees, the action shall not be attributed to the group health plan. Michelle’s Law The law allows for continued coverage for dependent children who are covered under your group health plan as a student if they lose their student status because of a medically necessary leave of absence from school. This law applies to medically necessary leaves of absence that begin on or after January 1, 2010. 9

13. Important Contact Information If you have questions about any of the benefits or services described in this Guide, please contact the carrier or vendor that handles the plan administration. Toll-free customer service telephone numbers and websites are listed below for your reference. 10

14. Notes

15. Notes