SUMMARIES OF BENEFITS AND COVERAGE: Only available on Exchange Gold Gold Option A Gold Option A Zero Cost Share 58326WI0090001-02 2020 Gold Option A Limited Cost Share 58326WI0090001-03 2020 Gold Option B Gold Option B Zero Cost Share 58326WI0090012-02 2020 Gold Option B Limited Cost Share 58326WI0090012-03 2020 Gold Option C Gold Option C Zero Cost Share 58326WI0090013-02 2020 Gold Option C Limited Cost Share 58326WI0090013-03 2020 Silver Silver Option A Silver Option A Zero Cost Share 58326WI0090002-02 2020 Silver Option A Limited Cost Share 58326WI0090002-03 2020 Silver Option B Silver Option B Zero Cost Share 58326WI0090015-02-02 2020 Silver Option B Limited Cost Share 58326WI0090015-03 2020 Silver Option C Silver Option C Zero Cost Share 58326WI0090016-02 2020 Silver Option C Limited Cost Share 58326WI0090016-03 2020 Bronze Bronze Option A Bronze Option A Zero Cost Share 58326WI0090006-022020 Bronze Option A Limited Cost Share 58326WI0090006-032020 Bronze Option B Bronze Option B Zero Cost Share 58326WI0090018-02 2020 Bronze Option B Limited Cost Share 58326WI0090018-03 2020 Bronze Option C Bronze Option C Zero Cost Share 58326WI0090019-02 2020 Bronze Option C Limited Cost Share 58326WI0090019-03 2020 Bronze Option D Bronze Option D Zero Cost Share 58326WI0090020-02 2020 Bronze Option D Limited Cost Share 58326WI0090020-03 2020