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Non-Medicare Medical Plan OptionsHigh Deductible Health Plan(HDHP) and PPO 2006If you are a non-Medicare eligibleretiree, or are Medicare eligiblebut have dependents who are not,your plan options are the HDHPor the PPO 200. If you waivecoverage, you will not beeligible for medical coverage inthe future. The one exception isif you waive coverage because youare a dependent under anotherXcel Energy medical plan. Youmay then enroll in a retiree medicalplan during a future AnnualEnrollment period, or if your spouseexperiences a qualified life event.Creditable CoverageAs you consider your healthcareoptions, be aware that if you or yourdependents are Medicare eligibleand covered under the HDHP in2017 the plan is not creditable. Thisis important to understand sinceMedicare eligible members whodo not enroll in Medicare Part Dwhen first eligible and do not havecreditable prescription drugcoverage for any period of 63 daysor longer will likely have to pay ahigher Part D premium of onepercent (1%) per month for lateenrollment. This penalty isassessed when you enroll in anindividual Medicare Part D plan inthe future.plan yearTake time to do the math. Comparethe costs since there are multipleoptions: Enroll in HDHP and have theMedicare eligible person alsoenroll in a Medicare Part D plan Enroll in HDHP and know therewill be future penalties whenyou or your Medicare eligibledependent enrolls in a MedicarePart D plan Enroll in PPO 200 which is acreditable plan2017BenefitPPO 200In-network benefitsHigh Deductible Health Plan(HDHP)In-network benefitsRetiree CostsDeductible 200 individual 400 family 2,750 individual (medical & pharmacy) 5,500 family (medical & pharmacy)Annual Out-of-pocket Maximum* 1,500 individual 3,000 family 3,500 individual (medical & pharmacy) 7,000 family (medical & pharmacy)Preventive Visit20%, No deductible 0Office Visit/20% after deductibleCo-insurance10% after deductibleSpecialist Visit/20% after deductibleCo-insurance10% after deductibleER Co-pay/Co-insurance20% after deductible10% after deductibleInpatient Hospital20% after deductible10% after deductibleChiropractic Co-insurance20% after deductible10% after deductible20 visits per year20 visits per yearMental Health Office VisitCo-insurance20% after deductible10% after deductibleDurable Medical Equipment20% after deductible10% after deductibleAmbulance20% after deductible10% after deductiblePrescription Drug Co-pay/Co-insuranceGenerics- 20% ( 10 min, 20 max)After deductible:Formulary Brand- 20%Generics- 20% ( 10 min, 20 max)( 20 min, 50 max)Formulary Brand- 20%Non Formulary Brand- 50%( 20 min, 50 max)( 35 min, 90 max)Non Formulary Brand- 50%( 35 min, 90 max)Office visit co-insurance/co-pays accumulatestowards the annual out-of-pocket maximumon PPO 200 and HDHP. Prescription drugco-insurance only accumulates towards theannual out-of-pocket maximum with HDHP.* 7

Non-Medicare Medical Plan OptionsHealth Savings Account (HSA)8This section is intended to beinformational only. HSA guidelinesare subject to change per IRSregulations. For specific information,you should seek advice from atax advisor or refer to IRSPublication 969. HSA ContributionsIf you are not Medicare eligible, youmay contribute to your HSA on anafter-tax basis if you are enrolled inthe HDHP. During the year of yourretirement, ensure that all HSAcontributions have been depositedprior to making any additionalcontributions to avoid exceedingthe IRS limits.Once you retire, you will receiveinformation in the mail fromOptum Bank regarding your HSA.As long as you remain eligible,you can contribute after-tax fundsdirectly to Optum Bank. You willthen be able to receive the taxadvantage when you complete yourincome taxes. More information onHSAs can be found in IRS Publication969 or by contacting Optum Bankat 800-326.5506.Once you are entitled toMedicare (eligible and enrolled),you can no longer make HSAcontributions. However, you willContinuedbe able to continue to use yourHSA balance on eligible medicalexpenses until the account isdepleted and/or closed.Maximum HSA ContributionThe IRS sets the annual maximumcontribution into an HSA. If youare only covering yourself, you arelimited to 4,400 in 2017. If youcover dependents, then yourmaximum is 7,750 in 2017. Thesemaximum contributions include the 1,000 age 55 and older additionalcontribution. If you and your spouseboth participate in an HSA, yourcombined maximum contributionis 7,750. Keep in mind thepotential Xcel Energy contributionfor the Rally Health Survey (HS) andMy Health Choices count towardthe IRS contributions limits. You areonly eligible for HA and MHC whileyou are an active employee. Thereward you will be eligible for aspart of the My Health Choicesprogram will be the amount youhave earned by the end of themonth you retire.If you choose not to continueparticipation in the HDHP uponretirement, your 2017 HSAcontribution limit is proratedbased on the number of monthsyou were a participant in the plan.Seek advice from a tax advisorif you have further questions.Eligible HSA ExpensesIRA Rollover to Your HSAExamples of eligible HSA expensesinclude: medical expenses (paidwhile meeting the deductible orout-of-pocket maximum),prescription drugs, long-termcare premiums, and COBRApremiums. Dental and visionexpenses are also eligibleHSA expenses.IRS regulations allow for a once perlifetime rollover of an IRA into anHSA. Contact Optum Bank foradditional details on this option at800.326.5506.HSA dollars used to reimburseeligible expenses are non-taxable.However, you are not preventedfrom using your dollars for ineligibleexpenses. If you or a family memberaccidentally uses funds for ineligibleexpenses, you can fix this byworking directly with Optum Bank.Ineligible expenses are subjectto income tax and a 20 percentpenalty. Once you reach age 65,the penalty is removed andthe funds are only subject toincome tax.Note: The IRS excludes domesticpartners and their children as eligibledependents for HSA funds unlessspecific criteria is met. The IRSor your tax advisor can provideadditional information for yourindividual situation.Becoming Medicare EligibleWhen you or your dependentbecome eligible for Medicare dueto a disability or by turning age 65,you are required to enroll inMedicare Part A and Part B.Failure to do so may result insignificantly lower claims paymentfrom the health plan. Claims willbe processed as if Medicare paidprimary, whether you enrolled inMedicare or not. You will beresponsible for the Medicare portionof payments if you do not enroll inMedicare A & B. Please notify theHR Service Center of this changeas new plan options may becomeavailable to you.If you and your dependents are notMedicare eligible you will be able tochoose between the Xcel Energygroup HDHP or PPO 200. Both plansare available to the Medicare eligibleretiree who covers a non-Medicareeligible dependent. However, ifyou and your dependent(s) are allMedicare eligible, your coverage willtransition to the individual Medicareplans made available throughOneExchange, a Medicare Exchange.OneExchange—a MedicareExchangeAfter a thorough evaluation of thehealth care options available throughthe individual Medicare market,Xcel Energy concluded these plansprovide broad, comprehensivecoverage at affordable costs. In manycases, they provide more value thanthe plans Xcel Energy can offer.Based on these findings, Xcel Energyno longer offers a group-sponsoredretiree medical plan for Medicareeligible retirees and their Medicareeligible dependents.Instead, you will have a choice ofmedical, prescription drug, dentaland vision plans through theindividual Medicare market—eachwith different coverage optionsoffered from various insurancecompanies. OneExchange willassist you through the process.As a retiree of Xcel Energy, youwill be able to work directly witha licensed OneExchange benefitadvisor to choose and enroll in theplan that best meets your needs.Additionally, you will also be able tocall OneExchange at any time withquestions about your coverage orbenefit changes. OneExchangewill send a packet to you about60 days before you becomeMedicare eligible outlining yourplan options.Request MedicareInformationIf you and your covered dependentsare Medicare eligible at the time youretire, you are encouraged to contactOneExchange at 888.825.2664Monday through Friday from 7 a.m.to 8 p.m. Central Time, or visithttps://medicare.oneexchange.com/xcelenergy. A Getting StartedGuide and Enrollment Guide will bemailed to your home directly fromOneExchange after you contact them.9

OtherBenefits10Dental and Vision InsuranceLife InsuranceYou have the option of choosing anindividual plan or COBRA for bothdental and vision coverage. Onceyou become Medicare eligible, youwill also have the option to select aplan through OneExchange.If you are enrolled in lifeinsurance (Basic, Supplementaland Dependent) as an activeemployee, you are eligible forcontinuation through MinnesotaLife Continuation. You will receiveinformation and an election formdirectly from Flex Compensationregarding continuing this coverage. COBRA options are available fora maximum of 18 months. Thecosts of the plans are 102 percentof the current active plan costs.You will automatically receiveenrollment information in the mailfrom Flex Compensation uponyour retirement. Individual plans can be purchaseddirectly through Delta Dental andVSP. For plan options and pricinginformation, contact the vendorsdirectly. Delta Dental will requireyou to work with the organizationin the state you reside. Thechart below provides contactinformation for individual dentalplans. You contact VSP directlyat 800-877.7195.Delta 0.422.4234888.899.3729877.395.9420888.335.8214If you are enrolled in the PSCoGrandfathered Life / AD&DInsurance, Xcel Energy will continuea retiree life insurance benefit foryou at no cost. The amount of thisbenefit is 50 percent of the amountof life insurance you had just priorto your retirement. The other50 percent will be offered asMN Life Continuation throughFlex Compensation.Accidental Death &Dismemberment (AD&D)Any AD&D insurance (includingPSCo Grandfather Life/AD&D) youcarry as an active employee may beavailable to convert directly withThe Hartford. Contact the HRService Center at 800.689.7662 formore information and a conversionapplication. Applications must befiled with The Hartford within31 days following your retirement.ReimbursementAccounts401(k)Savings PlanHealth Care ReimbursementAccount (HCRA), LimitedPurpose Flexible SpendingAccount (LPFSA), DependentCare Reimbursement Account(DCRA) and TransportationReimbursement Account (TRA)Xcel Energy will notify Vanguardthat you have retired. A letteroutlining your payment options willbe mailed to your home addressapproximately two weeks afteryour retirement date.If you are a participant in theHCRA, LPFSA, DCRA, or TRA yourparticipation ends on the day youretire. You can continue to requestreimbursement for expensesincurred before your retirementdate. You have until March 31 ofthe following year to file your claimsfor all but the TRA. Claims forTRA must be submitted within sixmonths of the date the expenseswere incurred.If your retirement date is prior toDecember, you will be offeredthe opportunity to extend the timeyou are eligible to participate inHCRA, LPFSA and DCRA on anafter-tax basis through COBRAcontinuation for the remainder ofthe calendar year.Note: While an active employee youcan cease contributions to your TRAat any time by contacting the HRService Center at 800.689.7662.If your account balance is more than 1,000, you can defer distributionuntil a later date. If you chooseto defer payments, you must starttaking annual distributions byApril 1 following the year you turnage 70 ½.If your account balance is 1,000or less, and you do not request adistribution within 90 days ofretirement, Vanguard will schedulea payment date and you willautomatically receive a taxabledistribution.To request a direct rollover,lump sum distribution orinstallment payments, log onto vanguard.com or contactVanguard at 800.523.1188.If you are not registered foronline account access, log on tovanguard.com/register;you will need your plannumber (091809).Note: You will not be able torequest an immediate distribution.You must wait seven days afteryou register to access youraccount online.11

Notice of Creditable CoverageImportant Notice fromXcel Energy about YourPrescription Drug Coverageand Medicare12Please read this notice carefullyand keep it where you can find it.This notice has information aboutyour current prescription drugcoverage with Xcel Energy andabout your options under Medicare’sprescription drug coverage. Thisinformation can help you decidewhether or not you want to join aMedicare drug plan. If you areconsidering joining, you shouldcompare your current coverage,including which drugs are coveredat what cost, with the coverage andcosts of the plans offering Medicareprescription drug coverage in yourarea. Information about where youcan get help to make decisionsabout your prescription drugcoverage is at the end of this notice.There are two important thingsyou need to know about yourcurrent coverage and Medicare’sprescription drug coverage:1. Medicare prescription drugcoverage became available in 2006to everyone with Medicare. Youcan get this coverage if you join aMedicare Prescription Drug Planor join a Medicare Advantage Plan(like an HMO or PPO) that offersprescription drug coverage. AllMedicare drug plans provide at leasta standard level of coverage set byMedicare. Some plans may alsooffer more coverage for a highermonthly premium.2. Xcel Energy has determinedthat the prescription drug coverageoffered by the High DeductibleHealth Plan (HDHP) for nonMedicare covered individualswhere the HDHP is primary payer,PPO 200, PPO 400, LSDP, Pre ’88,’88-‘90, and M&M plan designs are,on average, for all plan participants,expected to pay out as much asstandard Medicare prescriptiondrug coverage pays and is thereforeconsidered Creditable Coverage.Because your existing coverage isCreditable Coverage, you can keepthis coverage and not pay a higherpremium (a penalty) if you laterdecide to join a Medicare drug plan.When Can You Join A MedicareDrug Plan?You can join a Medicare drug planwhen you first become eligible forMedicare and each year fromOctober 15th to December 7th.However, if you lose your currentcreditable prescription drugcoverage, through no fault of yourown, you will also be eligible for atwo (2) month Special EnrollmentPeriod (SEP) to join a Medicaredrug plan.What Happens To Your CurrentCoverage If You Decide to JoinA Medicare Drug Plan?coverage ends, you may pay ahigher premium (a penalty) to joina Medicare drug plan later.For More Information AboutThis Notice Or Your CurrentPrescription Drug Coverage.If you decide to join a Medicaredrug plan, your currentXcel Energy coverage will notbe affected.If you go 63 continuous days orlonger without creditable prescriptiondrug coverage, your monthlypremium may go up by at least1% of the Medicare base beneficiarypremium per month for every monththat you did not have that coverage.Contact the Xcel Energy HR ServiceCenter at 800.689.7662.Please Note: If you enroll in aMedicare prescription drug plan,you will not receive coordinatedcoverage. You will only receive aprescription drug benefit from yourMedicare plan or your Xcel Energyplan, but not both. Contact the HRService Center at 800.689.7662 ifyou have additional questions aboutwhat happens to your coverage ifyou enroll in a Medicare prescriptiondrug plan.If you do decide to join a Medicaredrug plan and drop your currentXcel Energy coverage, be aware thatyou and your dependents will notbe able to get this coverage back ifyou are a retiree. Active employeesmay re-elect coverage on an annualbasis.When Will You Pay A HigherPremium (Penalty) To JoinA Medicare Drug Plan?You should also know that if youdrop or lose your current coveragewith Xcel Energy and don’t join aMedicare drug plan within 63continuous days after your currentFor example, if you go 19 monthswithout creditable coverage, yourpremium may consistently be at least19% higher than the Medicare basebeneficiary premium.You may have to pay this higherpremium (a penalty) as long as youhave Medicare prescription drugcoverage. In addition, you may haveto wait until the following Octoberto join.Note: You will receive this noticeannually and at other times in thefuture, such as before the nextperiod you can enroll in Medicareprescription drug coverage, and ifthe coverage through Xcel Energychanges. You may also requesta copy.For More Information AboutYour Options Under MedicarePrescription Drug Coverage More detailed information aboutMedicare plans that offer prescriptiondrug coverage isin the “Medicare &You” handbook. You’ll get a copy ofthe handbook in the mail every yearfrom Medicare. You may also becontacted directly by Medicaredrug plans.Remember: Keep this Creditable Coverage notice. If youdecide to join one of the Medicare drug plans, you maybe required to provide a copy of this notice when you jointo show whether or not you have maintained creditablecoverage and, therefore, whether or not you are requiredto pay a higher premium (a penalty).For more information aboutMedicare prescription drugcoverage:Visit medicare.gov Call your State Health InsuranceAssistance Program (see theinside back cover of your copy ofthe “Medicare & You” handbookfor their telephone number) forpersonalized help Call 800.MEDICARE(800.633.4227). TTY usersshould call 877.486.2048.If you have limited income andresources, extra help paying forMedicare prescription drug coverageis available. For information aboutthis extra help, visit Social Securityon the web at socialsecurity.gov,or by phone at 800.772.1213(TTY 800.325.0778).Creditable Plan Designs Include:PPO 200Pre ’88HDHP*PPO 400‘88 - ‘90LSDPM&M*when Medicare is the secondary payer13

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under active and retiree Xcel Energy plans. Xcel Energy reserves the right to amend the benefits described at you should not elect medical any time. If you have questions on your health care benefit options, call the HR Service Center at 800.689.7662. Xcel Energy Retiree Benefits As an Xcel Energy retiree, you can choose medical coverage