THE 20/22 ACT SOCIETY

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Pravan Clinic(Puerto Rico Concierge) PR Coverage*

US Coverage*

NetworkHospital & Physician Network Not covered PPO PPO PPO

Laboratories Not covered PPO/Special PPO/Special PPO

Pharmacy Not covered PPO PPO PPO

US Network Not coveredUnitedhealthcare

(ER & services not available in PR with PA)

Unitedhealthcare (Open Access)

Unitedhealthcare (Open Access)

Medical Coverage: Cost Sharing (Member pays)

Up Front Deductible (US Services Only)

N/A N/A N/A$2,000 individual $4,000 family

*PRAVAN Health visits $0 $0 $0 N/A

Hospitalization Not covered $200 $200 20% after deductible

Emergency Room - Accident Not covered $0 $0 20% after deductible

Emergency Room - Sickness Not covered $50 $50 20% after deductible

Ambulatory Surgery Not covered $100 $100 20% after deductible

Generalist 10 visits per year $0 at Pravan, $8 $0 at Pravan, $8 20% after deductible

Specialist Not covered $15 $15 20% after deductible

Sub-Specialist Not covered $22 $22 20% after deductible

Chiropractor Manipulation Not covered $10 $10 20% after deductible

Physical & Respiratory Therapy Not Covered $10 $10 20% after deductible

Laboratory & X-Rays Not Covered 40% 40% 20% after deductible

Special Labs Net Not Covered 30% 30% 20% after deductible

Specialized Tests Not Covered 40% 40% 20% after deductible

Diag & Off. Surg. Proced. Not Covered 20% 20% 20% after deductible

Endoscopy Services Not Covered 20% 20% 20% after deductible

Chemotherapy & Radiotherapy Not Covered 20% 20% 20% after deductible

Other Limitations N/A No Specialty Drugs No Organ Transplant 20% after deductible

Pharmacy Coverage: Cost Sharing (Member pays)

Drug Coverage Not Covered PDL A PDL B PDL B

Dispensing Rule Not Covered Generic First Option Generic First Option Generic First Option

Generic Preferred Not Covered $7 $7 $7

Generic Non Preferred Not Covered 20% min. $15 20% min. $15 20% min. $15

Brand Preferred Not Covered 20% min. $25 20% min. $25 20% min. $25

Brand Non-Preferred Not Covered 20% min. $45 20% min. $45 20% min. $45

Specialty Drugs Not Covered 20% only chemo 20% only chemo 20% only chemo

Dental Coverage: Cost Sharing (Member pays)

Diagnostic & Preventive Not Covered 0% 0%

N/A

Space Maintainers, Restorative & Oral Surgery

Not Covered 20% 20%

Endodontics & Periodontics Not Covered 20% / 50% 20% / 50%

Prostodonthics Not Covered N/A / 50% N/A / 50%

Orthodontics Not Covered Not Covered Not Covered

Max. PMPY Not Covered $1,000 $1,000

Vision Care Benefit: Cost Sharing (Member pays)

Benefit per Member Not Covered One refraction exam One refraction exam One refraction exam

PRODUCT SUMMARY

In PR In US

For questions please write to us:mcssociety@medicalcardsystem.com

* Services received in the US does not accumulate to MOOP, except for emergency rooms services.

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PR Coverage*(per month)

Individual CoupleFamily Rates

(Two Children or Less)Family Rates

(Three Children or More)

18-24 $225.30 $457.03 $564.32 $763.86

25-29 $242.46 $491.36 $598.65 $819.65

30-34 $263.92 $527.84 $658.73 $899.04

35-39 $306.83 $609.38 $755.28 $1,027.78

40-44 $394.81 $798.20 $933.37 $1,272.39

45-49 $495.65 $989.16 $1,111.47 $1,519.15

50-54 $620.10 $1,240.21 $1,396.84 $1,905.37

55-59 $712.37 $1,418.30 $1,529.88 $2,087.75

60-64 $817.51 $1,635.01 $1,682.22 $2,293.74

65-99 $1,493.40 $2,993.23 $3,076.92 $4,190.53

Pravan Clinic(Puerto Rico Concierge)

Individual

18+$1,800

annual fee

US Coverage*(per month)

Individual Couple Family Rates (Two Children or Less)

Family Rates (Three Children or More)

18-24 $340.90 $691.54 $853.88 $1,155.82

25-29 $366.87 $743.49 $905.82 $1,240.23

30-34 $399.34 $798.68 $996.73 $1,360.36

35-39 $464.28 $922.06 $1,142.83 $1,555.16

40-44 $597.39 $1,207.77 $1,412.31 $1,925.28

45-49 $749.98 $1,496.72 $1,681.78 $2,298.65

50-54 $938.29 $1,876.58 $2,113.59 $2,883.05

55-59 $1,077.90 $2,146.06 $2,314.88 $3,159.02

60-64 $1,236.99 $2,473.97 $2,545.40 $3,470.70

65-99 $2,259.69 $4,529.12 $4,655.74 $6,340.77

RATES

MCS reserves the right to review rates and benefits after beta pilot results and will make them available 60 days before effective date. Only offered through a bonafide Association , each participant or their employer must be an active member of

The 20/22 Act Society to be eligible for this plan.

*PR Coverage & US Coverage include the Pravan membership.

For questions please write to us:mcssociety@medicalcardsystem.com

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Required Documentation to be elegible to this product:

a. Bona fide group or member: Bona Fide Association’s active membership certificate. Must include the Bona Fide Association’s official logo and must be signed by the Association’s authorized personnel.b. Bona fide employees (for groups): tax quarterly statement.c. Copy of the member’s IRS decree. d. MCS’ GAF requirements.

ELEGIBILITY RULES

How can I buy this product?

Individuals or employers members of The 20/22 Act Society can purchase these products

Individual Employers (Group)

Eligible:

a. Spouseb. Biological child, adopted child or children under the age of twenty six (26) placed for adoption.c. Stepchildren under the age of twenty six (26) years.d. Children or stepchildren declared by the court as a dependent, regardless of age.e. Consensual partners, when this inclusion is allowed by the employer’s human resources policy.

Non eligible:

a. Father or motherb. Children or stepchildren over the age of twenty six (26).c. Grandparentsd. Other collateral relatives (cousins, uncles, etc.)e. Any other non-eligible dependents, as established by MCS.d. Individual members are not eligible to purchase PR coverage.

Eligible groups:

a. All active members of the Association will be eligible. b. Employees of active association members’ through group sponsored health plans and who live in PR for at least 180 days a year.c. All new members will have a thirty (30) day waiting period before qualifying for the Association’s health coverage. Exception to this rule is having belonged to another association that offers health insurance to its members and the participant can provide evidence of said membership.

Eligible Employees:

a. Full time employees, who work thirty (30) hours or more a week, or part time employees working seventeen and half (17.5) hours or more in a week under an employee-employer relationship and not as a false front in order to be able to obtain health care coverage. Employees must appear in Social Security reports, tax statements, State Insurance Fund Corporation returns or Driver Insurance payrolls. b. Owners or members that are not in any of the documents listed in subsection 6(a), must provide business corporation documents and present a “480 Form” or any legal document proving ownership or partnership.c. Newly hired employees, not yet included in the tax statement, must provide copy of the last two pay stubs.d. In the case of individual coverage, the prospect must be a bona fide employee of an active member of the Association. e. Must live in PR for at least 180 days a year.

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Buy MCS Plan

Make sure you have acquired your MCS health insurance plan.

Application Download

Pravan will send you a link in a text message to download the patient application, where you will be able to communicate directly with your medical team!

Initial Labs

After your questionnaire is complete, Pravan will prepare a lab order (as part of your annual exam) and help coordinate a home visit lab draw.

Preparing for your Initial Visit

Two days prior to your initial visit, a Pravan Clinic nurse will send you a preparation protocol to make sure the results from your initial visit tests are as accurate as possible.

Medical Questionnaire

Once you have downloaded the app, you will complete a 20 minute online medical questionnaire. Your physician will review this information prior to your initial visit.

Schedule the Initial Medical Evaluation

One your lab results are received to Pravan Clinic, an initial visit will be scheduled.

Membership Activation

Your Pravan Clinic Membershipis activated for you :)

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Group Name:

UnitedHealthcareGroup Number:

UnitedHealthcareMember ID:

VI-Equicare PPO Open Access within USVI Only

Administered by UnitedHealthcare Insurance Company and Its Affiliates

Member:

Effective Date:

Payer ID:MCS-XXXXXX

Health Plan: (80840) - 911- 87726-04

XXXXXX

233 XX XXXX 02

06/01/2020

87726

JUAN DEL PUEBLO

Dependant: JUANITO DEL PUEBLO

DENTAL INFORMATION

Dental Options PPO 30

Group Number : <Insert Group Number>

Payor ID: <Insert Payor ID>

Product ID: <Insert Product ID>

UnitedHealthcare Options PPO

Administered by UnitedHealthcare Insurance Company and Its Affiliates

PRAVAN HEALTH

Pravan Clinic MemberOnboarding Journey

Welcome to pravan health!

How we’re redefining healthcare

Pravan Clinic is a 3,500 square foot membership-based concierge medical clinic focused on prevention and wellness, offering 24/7 priority access a network of Puerto Rico’s leading doctors, specialists, nurses, care coordinators, nutritionists and wellness coaches. This benefit is available for all The 20/22 Act Society products.

Dedicated Primary Care

24/7 Access

E-prescriptions & Medical Records

Coordinated Care

Nutrition

787.339.2639www.pravanhealth.com/contact-us/8:30 a.m. - 5:30 p.m.Mondays to Saturdays

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Welcome to your Concierge Service

Please, contact your MCS Concierge Executive:

For Sales: 787.314.5331 or 787.758.2500 ext. 5415For Renewals: 787.645.7067 or 787.758.2500 ext. 5126

For Services: 787.945.1230 or 1.855.627.1755mcsconcierge@medicalcardsystem.com

One-Stop-Shop for your insurance needs

Call or email us.Our experts will talk

with you and evaluate your needs

We care.Help us understand and we will make

everything peaceful and worry-free.

We are herefor you.

We will keep you informed every step

of the way.

Concierge Unit Services

Appointment coordination

Claim payments & reimbursement requests

Duplicate requests

Provider recommendations

UHC coordination and resolution

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111K+560 1,700+ 6,100+* 1.1M+*Centers ofExcellence

ConvenienceCare Centers

Hospitals UnitedHealth Premium®

Care Physicians(those meeting UnitedHealth Premium Quality and Cost Efficiency Criteria)

Doctors and Health Professionals

Facility Finder: Online access through myuhc.com to directories and a comprehensive physician and facility search 24/7/365.

For claims and emergency assistance please contact MCS at:

Medical Claims Address:

This card does not guarantee coverage. To find a providerOutside the USA

For Providers:

In the USA for Members:1.888.758.1616

UnitedHealthcare Global

PO Box 740372, Atlanta, GA 30374

1.877.563.9016

1.877.563.9016

www.welcometouhc.com/us1

Network access in your market may also be provided by: CONNECTION Dental,

MaximumCare, Diversified (NV), DentalNet (AL) or Premier Dental (MN). Additional

discounts may also be available through Stratose, an out-of-network network partner.

For Dental Providers:

Dental Claims Address: PO Box 30567, Salt Lake City, UT 84130-05671.800.822.5353 | www.dbp.com

Group Name:

UnitedHealthcareGroup Number:

UnitedHealthcareMember ID:

VI-Equicare PPO Open Access within USVI OnlyAdministered by UnitedHealthcare Insurance Company and Its Affiliates

Member:

Effective Date:

Payer ID:MCS-XXXXXXHealth Plan: (80840) - 911- 87726-04

XXXXXX

233 XX XXXX 02

06/01/202087726

JUAN DEL PUEBLODependant: JUANITO DEL PUEBLO

DENTAL INFORMATION Dental Options PPO 30Group Number : <Insert Group Number>Payor ID: <Insert Payor ID> Product ID: <Insert Product ID>

UnitedHealthcare Options PPOAdministered by UnitedHealthcare Insurance Company and Its Affiliates

mcs.com.pr

PHARMACIES Rx Bin: 610228 Rx PCN: MCSRX01 Rx Grp: PPX

Claims: PO Box 740372 Atlanta, GA 30374This card does not guarantee coverage.United Healthcare Options PPO

For Assistance Call: 1.877.563.9016Payer ID: 87726UnitedHealthcare Group Number: 912656

For providers in USA

Servicio al Cliente: 787.281.2800Customer Service:1.888.758.16161.866.627.4327

1.866.727.6271

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Contrato:Suscriptor:Dependiente:

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PR Coverage US Coverage

UnitedHealthcare Network

With nearly 1,100,000 providers across the country, we have networks designed to help you better control costs and meet the unique health care needs of employees.

www.welcometouhc.com/us11.877.563.9016

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Is PR Coverage included when US Coverage is selected?Yes. If you selected the US Coverage you will have coverage in both Puerto Rico and United States. In such case, you will have two separated shared-cost structures: one for services received in Puerto Rico and another for services received in the United States.

Can dental and vision coverage be used in mainland?No. Currently, only Medical, not Dental or Vision Coverage, are provided in the United States.

Are pre-existing conditions covered by the policy? If not, how are pre-existing conditions defined. Yes, pre-existing conditions are covered within your plan. MCS Life Insurance Company does not discriminate against insured or dependents with prior medical conditions. However, your medical services might have limitations or exclusions. Please refer to your policy or certificate of benefits for more details.

Do the plans have any lifetime caps on amounts that are covered?There are no lifetime amounts limits for Medical services. For groups with Orthodontia coverage (in Puerto Rico) will have a $1,000 lifetime maximum of coverage.

Is there any advantage to doing it as a group as opposed to individual?By belonging to The 20/22 Act Society provide its members who wants to buy an insurance healthplan the same benefits that the groups belonging to the same association have: primes, cost shares and benefits are identical. Both individuals and groups, member of the The 20/22 Act Society can select the PR Coverage or the US Coverage.

Are there separate insurance cards used for Puerto Rico and the US?If you chose the PR Coverage you will be given a green card with MCS Life logo in the upper left side, and with the UnitedHealthcare logo in the lower right side of the card. If you selected the US Coverage you will be given a white card with UnitedHealthcare logo in the left upper left part of the card and MCS logo in the upper right part of the card.

Any exclusions or important fine print on the use of US Healthcare to highlight? Any restrictions on amount of time spent in the US continuously?It’s important to point out that The 20/22 Act Society healthplans does not accumulate health expenses amounts for services received in the United States to the maximum out-of-pocket (MOOP), except for Emergency Room services. In addition, the The 20/22 Act Society healthplans does not cover Specialty Drugs inside its pharmacy coverage, except for chemotherapy, radiotherapy & medications used in the chemotherapy preparation with applicable coinsurance.

FAQ

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If I just get an individual policy for myself now, could I add my family in a month or two?As per The 20/22 Act Society Health Insurance Policy, only “direct dependents” might become eligible for coverage under your policy if they qualify as such at the moment of the enrollment. Such term refers to a spouse, or to a biological or adoptive child under age 26. Children, regardless of age, also qualify if unable to support themselves due to any mental or physical disability arisen before reaching age 26. Others “direct dependents” are stepchildren, foster children, non-emancipated minors whose custody are granted to main insured, and finally, any person of any age whose guardianship has been designated to main insured.

But if changes arose after getting your health insurance, for adding a new dependent in your coverage you must file the change request to MCS Life within 30 days after the change has taken place. Acceptable changes are:- marriage, - divorce, - a new child is born or adopted, or granted custody under the main insured.

Is there any waiting period before utilizing the insurance in either Puerto Rico or the states?No. You can use your health plan immediately from the very beginning of the effective date. However, certain services may require a waiting period: such as a 90-days waiting period from the effective date for Organ & Bone Marrow transplant (only applicable to PR Coverage), or a 6-month dietary plan before a Bariatric Surgery.

Looking at the brochure, it’s unclear what the cost sharing percentage would be for something catastrophic like a bad car accident...what percentage are surgeons covered at? The brochure is only a summary of most common received services. For a more detailed description, reviewing the policy and the table of copayment or coinsurance is encouraged.

This is a health insurance coverage, we do not offer catastrophic insurance. In the case of a car accident in Puerto Rico, coverage would rely on the Car Accident Compensation Administration (Spanish acronym ACAA).

Does this insurance cover you globally?No, but insured may submit a reimbursement request for Emergency Services received outside the United States. In such case, reimbursement will be based in the usual and customary rates of the place of service, minus a coinsurance depending your coverage.

FAQ

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Does the rates for a family under US Coverage include Pravan and PR Coverage in that monthly rate or is that in addition to?In the US Coverage, the health insurance coverage inside Puerto Rico and the Pravan service in the Island are part of the prime rates already paid by the main insured. No additional costs will be charged.

However, a person not interested in buying any health insurance, may benefit from the services of the stand-alone Pravan Clinic Benefits with a $1,800 annual fee.

Is the medical deductible for a 12-month period? Is reset Jan 1, or a one-time cost?A deductible is applied each policy year, if you have the US Coverage. At each renewal date of your health plan, a distinct deductible might apply.

Can you provide a summary of benefits or the policy?The insured will have access to both documents. At the health insurance enrollment, a Summary of Benefits & Coverage (SBC) is delivered to each insured person.

If the insured person belongs to a Group Healthplan, after 30 days from the policy effective date will have online access to his or her Certificate of Benefits, under the policy of that group, inside the MyMCS tool.

If the insured person has an individual healthplan, will have access to a hard copy of the policy upon request, after 30 days from the policy effective date.

FAQ

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WELLNESS AND VALUE ADDED PROGRAMS

This preventive healthcare program aims to establish a participant profile that allows for the early identification of health risks through lifestyle modifications, thus preventing the occurrence or progress of diseases, and promoting the early and adequate care of chronic or high-prevalence conditions, such as diabetes and hypertension.

This innovative program provides a combination of traditional or conventional medicine with therapeutic modes of holistic medicine to promote good health and prevent diseases. Covered modes include medical acupuncture, therapeutic massage and natural medicine, among others.

This is an innovative initiative for insureds and their dependents that promotes and supports a healthy lifestyle through nutritional counseling and physical conditioning. These interventions are developed by health professionals, such as nutritionists and certified personal trainers.

This telemedicine program provides quick and easy access to general practitioners, internists, family doctors and pediatricians through virtual consultations from your computer, tablet or mobile phone.

The Healthy Mothers and Babies program is aimed at educating pregnant women on prenatal and postpartum care, as well as baby care. When participating in the program, pregnant women identified as high risk will receive guidance and coordination of services by an obstetric nurse.

You left your health plan card at home? Don’t worry. We know you have your smartphone at hand, so download My MCS app, retrieve your virtual card, show it to your health provider and… Problem solved! With our app you may access instantly, everywhere, the 7 MCS services you use most frequently.

This comprehensive mental health services coordination program also provides treatment for controlled substance abuse and an Employee Assistance Program (EAP). All these services are offered 24 hours a day, seven days a week. To coordinate services, call 1.866.627.4327.

A wellness program, in which by visiting one of our MCS Care Clubs and getting a Health Risk Assessment (HRA), you may enjoy a monthly reimbursement of $10 for the first twelve consecutive months of gym membership up to $120 annually.

This is an exclusive discount program for MCS Life insureds. Through partnerships with different suppliers, MCS allows you to enjoy discounts on products and services for your well-being and daily enjoyment during different times of the year. Just present your MCS plan card and a photo ID, and you can enjoy exclusive offers and discounts at hundreds of participant establishments throughout the island.

MiMCS

Restrictions, conditions or terms may apply. MCS Life Insurance Company complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. MCS Life Insurance Company cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1.888.758.1616 (TTY: 1.866.627.8182). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1.888.758.1616 (TTY: 1.866.627.8182). Subscribed by MCS Life Insurance Company. (Rev. February 2020)

The Pravan Clinic option will only be available for 18+ members and requires an annual payment. For MCS Society PR Concierge and MCS Society Full Concierge pricing is by age band of the main holder. The main holder must be an active member of The 20/22 Act Society or and employee of a member of The 20/22 Act Society. There are individual, couple and family rated contracts for the main holder to select acccording to the amount of dependents. All members nut be residents in Puerto Rico and must comply with The 20/22 Act Society elegibility criterea. All participants are subject to comply with the elegibility rules for the health plan established by MCS and The 20/22 Act Society. In couple and families where both spouses are members of the society, the age of the eldest member will be the price used. MCS reserves the right to review rates and benefits after beta pilot results and will make them available 60 days before effective date. Maximum out of pocket (MOOP) in Puerto Rico is $6,350 individual and $12,700 family. US services do not accumulate towards the MOOP except for emergencies due to the EHB benchmark in Puerto Rico.

Send your name and contact information to:

Tel: 787.758.2500

mcssociety@medicalcardsystem.com

mcs.com.pr @MCSPuertoRico