Specialty Business (Group Size 51+))Cardington Yutaka Technologies, Inc , Effective 4-1-2012

Your Anthem Benefits – NEW SALES!

Specialty Business (group size 51+))Cardington Yutaka Technologies, Inc , effective 4-1-2012 Anthem Life®, Dental Blue® and Blue View VisionSM Cost Share Options Anthem understands one size doesn't fit all when it comes to selecting corporate benefit plans for Life, Disability, Dental and Vision. That's why we strive to make it easy to mix and match options. You choose your employees’ deductibles, copayments, and the limits on certain services. Select one option from each of the following categories to customize your life and disability benefits, along with dental and vision benefit plans. Anthem Life – Life and Disability Submit all information required to your Life and Disability Underwriter. CSOS not required for Life and Disability quotes.

Group Name: Cardington Yutaka Technologies Inc. Specialty Business (group size 51+)

Blue View Vision SM - Exam Plus Plans Stand- Alone Frequency Limits (months) Copay Non-Network Vision Option Code Plan Type Copay Exam Exam, Lenses & Frame, Eyeglass Lenses Reimbursement Schedule (Check if or Contact Lenses Yes) 1 01019695909 Exam Plus NCS Discount 12 months – Exam Only Standard Exam OON 2 01029695909 Exam Plus $5.00 Discount 12 months – Exam Only Standard Exam OON 3 01039695909 Exam Plus $10.00 Discount 12 months – Exam Only Standard Exam OON 4 01049695909 Exam Plus $15.00 Discount 12 months – Exam Only Standard Exam OON 5 01059695909 Exam Plus $20.00 Discount 12 months – Exam Only Standard Exam OON 6 01069695909 Exam Plus NCS Discount 24 months – Exam Only Standard Exam OON 7 01079695909 Exam Plus $5.00 Discount 24 months – Exam Only Standard Exam OON 8 01089695909 Exam Plus $10.00 Discount 24 months – Exam Only Standard Exam OON 9 01099695909 Exam Plus $15.00 Discount 24 months – Exam Only Standard Exam OON 10 01109695909 Exam Plus $20.00 Discount 24 months – Exam Only Standard Exam OON

Blue View Vision SM - Full Service Plans Stand- Alone Frequency Limits (months) Copay Non-Network Vision Option Code Plan Type Copay Exam Exam, Lenses & Frame, Eyeglass Lenses Reimbursement Schedule (Check if or Contact Lenses Yes) 11 01019695891 Full Service NCS NCS 12/12/12/12 Standard Schedule is Covered 12 01029695891 Full Service $5.00 NCS 12/12/12/12 Standard Schedule is Covered 13 01039695891 Full Service $5.00 $5.00 12/12/12/12 Standard Schedule is Covered 14 01049695891 Full Service $5.00 $10.00 12/12/12/12 Standard Schedule is Covered 15 01059695891 Full Service $10.00 NCS 12/12/12/12 Standard Schedule is Covered 16 01069695891 Full Service $10.00 $10.00 12/12/12/12 Standard Schedule is Covered 17 01079695891 Full Service $10.00 $20.00 12/12/12/12 Standard Schedule is Covered 18 01089695891 Full Service $15.00 $15.00 12/12/12/12 Standard Schedule is Covered 19 01099695891 Full Service $20.00 $20.00 12/12/12/12 Standard Schedule is Covered 20 01109695891 Full Service NCS NCS 12/12/24/12 Standard Schedule is Covered 21 01119695891 Full Service $5.00 NCS 12/12/24/12 Standard Schedule is Covered 22 01129695891 Full Service $5.00 $5.00 12/12/24/12 Standard Schedule is Covered 23 01139695891 Full Service $5.00 $10.00 12/12/24/12 Standard Schedule is Covered 24 01149695891 Full Service $10.00 NCS 12/12/24/12 Standard Schedule is Covered 25 01159695891 Full Service $10.00 $10.00 12/12/24/12 Standard Schedule is Covered 26 01169695891 Full Service $10.00 $20.00 12/12/24/12 Standard Schedule is Covered 27 01179695891 Full Service $15.00 $15.00 12/12/24/12 Standard Schedule is Covered 28 01189695891 Full Service $20.00 $20.00 12/12/24/12 Standard Schedule is Covered 29 01199695891 Full Service NCS NCS 12/24/24/24 Standard Schedule is Covered 30 01209695891 Full Service $5.00 NCS 12/24/24/24 Standard Schedule is Covered 31 01219695891 Full Service $5.00 $5.00 12/24/24/24 Standard Schedule is Covered 32 01229695891 Full Service $5.00 $10.00 12/24/24/24 Standard Schedule is Covered 33 01239695891 Full Service $10.00 $0.00 12/24/24/24 Standard Schedule is Covered 34 01249695891 Full Service $10.00 $10.00 12/24/24/24 Standard Schedule is Covered 35 01259695891 Full Service $10.00 $20.00 12/24/24/24 Standard Schedule is Covered 36 01269695891 Full Service $15.00 $15.00 12/24/24/24 Standard Schedule is Covered 37 01279695891 Full Service $20.00 $20.00 12/24/24/24 Standard Schedule is Covered

Blue View Vision SM - Full Service Plans Stand Frequency Limits (months) -Alone Copay Non-Network Option Code Plan Type Copay Exam Exam, Lenses & Frame, Vision Eyeglass Lenses Reimbursement Schedule or Contact Lenses (Check if Yes) 38 01289695891 Full Service NCS NCS 24/24/24/24 Standard Schedule is Covered 39 01299695891 Full Service $5.00 NCS 24/24/24/24 Standard Schedule is Covered 40 01309695891 Full Service $5.00 $5.00 24/24/24/24 Standard Schedule is Covered 41 01319695891 Full Service $5.00 $10.00 24/24/24/24 Standard Schedule is Covered 42 01329695891 Full Service $10.00 NCS 24/24/24/24 Standard Schedule is Covered 43 01339695891 Full Service $10.00 $10.00 24/24/24/24 Standard Schedule is Covered 44 01349695891 Full Service $10.00 $20.00 24/24/24/24 Standard Schedule is Covered 45 01359695891 Full Service $15.00 $15.00 24/24/24/24 Standard Schedule is Covered 46 01369695891 Full Service $20.00 $20.00 24/24/24/24 Standard Schedule is Covered

Blue View Vision SM - Materials Only Plans

Stand Notes: . Frame Frequency Limits (months) -Alone Copay Copay Non-Network Allowance: $130 . Option Code Plan Type Lenses & Frame, or Vision Exam Eyeglass Lenses Reimbursement Schedule Contact Lens Allowance: Contact Lenses (Check if Yes) $130 . No Cost Share (NCS) means no 01019695917 Materials $15.00 12/12/12 Standard Schedule 47 deductible, copayment or Only Not Covered coinsurance up to the 48 01029695917 Materials $20.00 12/12/12 Standard Schedule maximum allowable Only Not Covered amount. However, a 49 01039695917 Materials $15.00 12/24/12 Standard Schedule member may be Only Not Covered responsible for any 50 01049695917 Materials $20.00 12/24/12 Standard Schedule balance due after the Only Not Covered plan payment, including, 51 01059695917 Materials $15.00 24/24/24 Standard Schedule but not limited to, Only Not Covered benefits that reflect No 52 01069695917 Materials $20.00 24/24/24 Standard Schedule Cost Share. Only Not Covered 53 01079695917 Materials $10.00 12/12/12 Standard Schedule Only Not Covered 54 01089695917 Materials $10.00 12/24/12 Standard Schedule Only Not Covered

Life and Disability products underwritten by Anthem Life Insurance Company. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. OH CSOS Specialty Rev. 05/11 Blue View Vision SM - Non-Network Reimbursement Schedule Procedure/Services Reimbursement Schedule

Exam up to $42 Single vision lenses up to $40 Bifocal lenses up to $60 Trifocal lenses up to $80 Elective contacts up to $105 Non-elective contact lenses up to $210 Frame up to $45

Group Name: Cardington Yutaka Technologies Inc. Specialty Business (group size 51+)

Prime & Complete Programs

Network Program Prime Complete

Employee Participation Voluntary 60% - 64% 65% - 69% Employer SIC 3714 70% - 74% Prior Coverage YES NO 75% - 79% Funding Type ASO Fully Insured 80% - 84% Contract Length 12 Months 16 Months 18 Months 24 months 85% - 89% 5% Commission or Other_____% _____pcpm Broker Commission 90% - 94% 95% - 99% Life and Disability products underwritten by Anthem Life Insurance Company. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue100% Cross and Blue Shield Association. IN CSOS Specialty Rev. 8/18/09 MEDLOCK Phyllis Nielsen (Direct Sale). NET OF Sales Representative COMMISSION

$1,000 $1,200 $1,250 $1,500 $1,750 $2,000 $2,250 In Network $500 $750 $2,500

Annual $1,000 $1,200 $1,250 $1,500 $1,750 $2,000 $2,250 Out of Network $500 $750 $2,500 Maximum Maximum Carryover YES NO Deductible Individual $0 $15 $20 $25 $30 $35 $40 $45 $50 $55 $60 $65 (In Network) $70 $75 $80 $85 $90 $95 $100 $100 Lifetime Per Person Applies to all categories except Diagnostic & Individual $0 $15 $20 $25 $30 $35 $40 $45 $50 $55 $60 $65 Preventive and Orthodontics (Out of Network) $70 $75 $80 $85 $90 $95 $100 $100 Lifetime Per Person

$100 Lifetime deductible is Family (In Network) 2 x Individual 3 x Individual Per Person per person and applies to all services except Orthodontics Family (Out of Network) 2 x Individual 3 x Individual Per Person Group Name: Specialty Business (group size 51+) Prime & Complete Programs

Out of Network coinsurance must be equal to or less than the In Network coinsurance. Coinsurances: (Percentage reflects Anthem’s responsibility)

Diagnostic & In Network 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Preventative Services Out of Network 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%

In Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Basic Restorative Out of Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%

In Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Endodontics Out of Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Periodontics In Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%

Life and Disability products underwritten by Anthem Life Insurance Company. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. OH CSOS Specialty Rev. 05/11 Out of Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%

In Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Oral Surgery Out of Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%

In Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Major Restorative Out of Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%

In Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Prosthetic Repairs Out of Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%

In Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Prosthetics Out of Network 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%

No Waiting Periods (For Voluntary requires prior coverage) Waiting Periods * Basic 0 Months 6 months 12 months 18 months 24 months Major 6 months 12 months 18 months 24 months For Waiting Periods only: Basic Restorative, Endodontics, Periodontics and Oral Surgery are included in “Basic”. Major Restorative, Prosthetic Repairs and Prosthetics are “Major”

Group Name: Specialty Business (group size 51+)

Prime & Complete Programs

th th th Out of Network 50 Percentile 70 Percentile 90 Percentile Reimbursement 60th Percentile 80th Percentile Reimbursement at Prime (MAC)

Coverage None Dependent Children Only (Ages 8 to 19) Adult & Dependent Children

Orthodontics 0% 40% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Coinsurance Out of network Maximum applies (Percentage reflects Anthem’s responsibility) toward the In Network Lifetime $500 In network $750 $1,000 $1,250 $1,500 $1,750 $2,000 $2,250 $2,500 Maximum. The total Maximum lifetime payout will not $500 exceed the In Network Out of Network $750 $1,000 $1,250 $1,500 $1,750 $2,000 $2,250 $2,500

Life and Disability products underwritten by Anthem Life Insurance Company. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. IN CSOS Specialty Rev. 8/18/09 Maximum Waiting Periods 0 Months 12 Months Waive for Prior Coverage YES NO

Dependent Age Children to age 19, 23 if student Children to age 26 Children to age 28

Detailed Coverage Options: Posterior Composites Alternated to Amalgam Benefits Covered as Composites Implants Standard – Covered Benefit Not Covered Brush Biopsy Standard – Covered Benefit Not Covered Pregnant / Diabetic extra services Standard – Covered Benefit Not Covered Pins, Posts & Cores Standard – Covered Benefit Not Covered Sealants Covered as Diagnostic & Preventative Covered as Basic Full Mouth Xrays Coverage every 5 years Coverage every 3 years Bitewing Xrays 2 x every 12 months 1 x every 12 months

Group Name: Specialty Business (group size 51+)

Anthem Dental Traditional:

Annual Maximum $50/N/A CLASS I CLASS II $500 $50/$100 Preventive Basic B $750 $50/$150 Diagnostic and Preventive Participating/Non-Participating Specialty $1,000 $75/$225 Providers CIF $1,250 st CIF 10% $1,500 1 Year Dental 10% 20% $2,000 Yes 20% 50% $2,500 No CLASS II CLASS III Annual Deductible Basic A Single/Family Major General Prosthodontic $0/$0 CIF 20% $25/$50 10% 40% $25/N/A 20% 50% $25/$75 50%

Life and Disability products underwritten by Anthem Life Insurance Company. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. OH CSOS Specialty Rev. 05/11 CLASS IV $2,500 Provider Allowance Orthodontic 70th percentile Stand Alone Dental None 80TH percentile Yes 40% Child only to age 19 90TH percentile 50% Child only to age 19 No 40% Child & Adult to Missing Tooth Benefit maximum dependent age Yes 50% Child & Adult to maximum dependent age

Notes: Orthodontic  CIF means covered in full. However, a member may be responsible for any balance due after the plan Benefit Lifetime Maximum payment, including but not limited to, benefits that $500 are covered in full.  Deductibles do not apply to preventive or orthodontics. $750  Missing Tooth Benefit provides coverage for procedures $1,000 associated with teeth missing prior to the effective date.  Orthodontic lifetime maximum does not apply to the $1,250 annual maximum. $1,500  Percentage reflects member’s responsibility. $2,000

Group Name: Specialty Business (group size 51+) Anthem Dental Traditional Summary of Benefits

Class I Preventive Services (no deductible) Covered services include exams, oral evaluations, X-rays (bitewing and complete series), cleaning and scaling, space maintainers and other selected diagnostic and preventive services. Class II General Services (deductible applies) Covered services include palliative (emergency) treatment, consultations, general anesthesia, intravenous sedation, office visits for observation, amalgam and composite restorations and Class III Prosthodontic Services (deductible applies) pin retention procedures. Covered services include onlays, crowns, dentures, bridges and repair of dentures and Class II Specialty Services (deductible applies) bridgework, implants Covered services include root canal therapy, apexification/recalcification, therapeutic and other selected prosthodontic services. pulpotomy, oral surgery, simple and surgical tooth extractions, periodontic services, Class IV Orthodontia Services (no deductible) gingivectomy, osseous surgery and other selected endodontics, oral surgery and periodontal Available as an optional benefit. Covered services include examination, records, minor services. treatment of tooth Life and Disability products underwritten by Anthem Life Insurance Company. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. IN CSOS Specialty Rev. 8/18/09 guidance, repositioning (straightening) of the teeth, interceptive or comprehensive orthodontic member’s effective date treatment and of coverage under this Plan. post-treatment stabilization. Missing Tooth Benefit (deductible applies) Available as an optional benefit. Covered services include removable prosthodontics (partials or dentures) or fixed prosthodontics (bridges) for the replacement of teeth (or tooth) lost prior to the