2024 Health Plan Notices

2024 Health Plan Notices for Benefits Eligible Employees HIPAA SPECIAL ENROLLMENT RIGHTS If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact the Plan Administrator. FAMILY AND MEDICAL LEAVE ACT (FMLA) If the Company and employee (you) are covered under the federal Family and Medical Leave Act (FMLA), then you can take up to 12 weeks of unpaid leave during a 12-month period for one or more of the following reasons: • for the birth and care of the newborn child of the employee; • for placement with the employee of a son or daughter for adoption or foster care; • to care for an immediate family member (spouse, child, or parent) with a serious health condition; or • to take medical leave when the employee is unable to work because of a serious health condition. If you are covered by FMLA, you will have certain rights to maintain health benefits during the FMLA leave. You will be notified of any requirement for you to make any premium payments to maintain health benefits and the arrangements for making such payments along with the possible consequences of failure to make such payments on a timely basis (i.e., the circumstances under which coverage may lapse) and your potential liability for payment of health insurance premiums paid by the employer during your unpaid FMLA leave if you fail to return to work after taking FMLA leave. For more information about FMLA, contact the Plan administrator. GRANDFATHERED STATUS The Plan believes that none of the group health plans available under the Plan are “grandfathered health plans” as described under the Patient Protection and Affordable Care Act (the “Affordable Care Act”).

SPECIAL RULE FOR MATERNITY AND INFANT COVERAGE Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the attending provider or physician, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable). SPECIAL RULE FOR WOMEN’S HEALTH COVERAGE (WHCRA) If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, 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; prostheses; and treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and co-insurance applicable to other medical and surgical benefits provided under the ABC Company Health Plan. If you would like more information on WHCRA benefits, please call your Plan Administrator. NOTICE REGARDING LIFETIME AND ANNUAL DOLLAR LIMITS In accordance with applicable law, any lifetime dollar limits and annual dollar limits set forth in the Plan shall not apply to “essential health benefits,” as such term is defined under Section 1302(b) of the Affordable Care Act. The law defines “essential health benefits” to include, at minimum, items and services covered within certain categories including emergency services, hospitalization, prescription drugs, rehabilitative and habilitative services and devices, and laboratory services. A determination as to whether a benefit constitutes an “essential health benefit” will be based on a good faith interpretation by the Plan Administrator of the guidance available as of the date on which the determination is made. PATIENT PROTECTION DISCLOSURE You have the right to designate any participating primary care provider who is available to accept you or your family members (for children, you may designate a pediatrician as the primary care provider). For information on how to select a primary care provider and for a list of participating primary care providers, contact the Plan Administrator. You do not need prior authorization from the Plan or from any other person, including your primary care provider, in order to obtain access to obstetrical or gynecological care from a health care professional; however, you 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, contact the health plan. Page 2

AFFORDABLE CARE ACT CONSUMER PROTECTIONS a.) Coverage for Children Up to Age of 26 The Affordable Care Act of 2010 requires that the Plan must make dependent coverage available to adult children until they turn 26 regardless of if they are married, a dependent, or a student. (b.) Prohibition of Lifetime Dollar Value of Benefits: the Affordable Care Act of 2010 prohibits the Plan from imposing a lifetime limit on the dollar value of benefits. (c.) Your Health Insurance Cannot be Rescinded The Affordable Care Act of 2010 prohibits the Plan, or any insurer, from rescinding your health insurance coverage except as permitted under the Act. (d.) Prohibition of Pre-Existing Conditions No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. (e.) Prohibition of Restrictions on Annual Limits on Essential Benefits The Affordable Care Act of 2010 prohibits the Plan, or any insurer, effective January 1, 2014, from placing annual limits on the value of essential health benefits. (f) Notice of Marketplace/Exchange You have the option to purchase health insurance at the Health Insurance Marketplace. The Marketplace offers "one-stop shopping" to find and compare private health insurance options as well as a premium tax credit or a cost sharing reduction for certain qualified individuals. If you purchase a health plan through the Marketplace, you will lose any employer contribution toward the cost of your health coverage. Employer contributions to employer-provided coverage may be excludable for federal income tax purposes. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.Healthcare.gov for more information and contact information for a Health Insurance Marketplace in your area. MICHELLE’S LAW Michelle’s Law provides continued health and dental insurance benefits under the Plan for dependent children who are covered under the Plan as a student but lose their student status in a post-secondary school or college because they take a medically necessary leave of absence from school. If your child is no longer a student because he or she is out of school because of 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. Page 3

THE GENETIC INFORMATION NONDISCRIMINATION ACT (GINA) GINA prohibits the Plan from discriminating against individuals on the basis of genetic information in providing any benefits under the Plan. Genetic information includes the results of genetic tests to determine whether someone is at increased risk of acquiring a condition in the future, as well as an individual’s family medical history. WELLNESS Your health plan is committed to helping you achieve your best health. If your Plan includes a Wellness program that provides rewards or surcharges based on your ability to complete an activity or satisfy an initial health standard, and if you think you might be unable to meet a standard for a reward under the wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact the Plan Administrator and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status. YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS When you get emergency care or get treated by an out-of-network provider at an in- network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. What is “balance billing” (sometimes called “surprise billing”)? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider. You are protected from balance billing for: Emergency services If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost- sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you Page 4

give written consent and give up your protections not to be balanced billed for these post- stabilization services. Certain services at an in-network hospital or ambulatory surgical center When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections. You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network. When balance billing isn’t allowed, you also have the following protections: You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly. Your health plan generally must: • Cover emergency services without requiring you to get approval for services in advance (prior authorization). • Cover emergency services by out-of-network providers. • Base what you owe the provider or facility (cost-sharing) on what it would pay an in- network provider or facility and show that amount in your explanation of benefits. • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit. If you believe you’ve been wrongly billed, you may contact the Centers for Medicare & Medicaid . Services https://www.cms.gov/nosurprises Visit https://www.cms.gov/nosurprises/Policies-and-Resources/Overview-of-rules-fact-sheets for more information about your rights under federal law. Page 5

PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs, but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more . information, visit www.healthcare.gov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State to find out how to Medicaid or CHIP office or dial 1-877- KIDS NOW or www.insurekidsnow.gov apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at or call 1-866-444-EBSA (3272). www.askebsa.dol.gov If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. Contact your State for more information on eligibility: Alabama Arkansas Contact Center: Website: http://myalhipp.com/ Website: http://myarhipp.com/ 1-800-221-3943/ State Relay Phone: 1-855-692-5447 Phone: 1-855-MyARHIPP (855- 711 692-7447) CHP+: Alaska https://www.colorado.gov/paci The AK Health Insurance California fic/hcpf/child-health-plan-plus Premium Payment Program Website: CHP+ Customer Service: 1- Website: Health Insurance Premium 800-359-1991/ State Relay 711 http://myakhipp.com/ Payment (HIPP) Program Health Insurance Buy-In Phone: 1-866-251-4861 http://dhcs.ca.gov/hipp Program (HIBI): Email: Phone: 916-445-8322 https://www.mycohibi.com/ CustomerService@MyAKHIPP.c Fax: 916-440-5676 HIBI Customer Service: 1-855- om Email: hipp@dhcs.ca.gov 692-6442 Medicaid Eligibility: Colorado http://dhss.alaska.gov/dpa/Pa ges/medicaid/default.aspx Health First Colorado Website: https://www.healthfirstcolorad o.com/ Health First Colorado Member Page 6

Florida Kansas Massachusetts Website: Website: Website: https://www.flmedicaidtplreco https://www.kancare.ks.gov/ https://www.mass.gov/masshe very.com/flmedicaidtplrecover Phone: 1-800-792-4884 aloh/pa y.com/hipp/index.html HIPP Phone: 1-800-967-4660 Phone: 1-800-862-4840 Phone: 1-877-357-3268 TTY: 711 Georgia Kentucky Email: Website: Kentucky Integrated Health masspremassistance@accentu https://medicaid.georgia.gov/h Insurance Premium Payment re ealth-insurance- Program (KI-HIPP) Website: Minnesota premium-payment-program- https://chfs.ky.gov/agencies/d hipp ms/member/Pages/kihipp.asp Website: Phone: 678-564-1162 Press 1 x https://mn.gov/dhs/people- Phone: 1-855-459-6328 we-serve/children-and GA CHIPRA website: Email: families/health-care/health- https://medicaid.georgia.gov/p KIHIPP.PROGRAM@ky.gov care-programs/programs-and rograms/third-oarty- KCHIP Website: services/other-insurance.jsp liability/childrens-health- https://kidshealth.ky.gov/Page Phone: 1-800-657-3739 insurance-programs- s/index.aspx Missouri reauthorization-act-2009- Phone: 1-877-524-4718 Website: chipra Kentucky Medicaid Website: phone: 678-562-1162, Press 2 https://chfs.ky.gov/agencies/d http://www.dss.mo.gov/mhd/p Indiana ms articipants/pages/hipp.htm Phone: 573-751-2005 Healthy Indiana Plan for low- Louisiana Montana income adults 19-64 Website: www.medicaid.la.gov Website: or www.ldh.la.gov/lahipp Website: http://www.in.gov/fssa/hip/ Phone: 1-888-342-6207 http://dphhs.mt.gov/Montana Phone: 1-877-438-4479 (Medicaid hotline) or 1-855- HealthcarePrograms/HIPP All other Medicaid 618-5488 Phone: 1-800-694-3084 Website: (LaHIPP) Email: https://www.in.gov/medicaid/ HHSHIPPProgram@mt.gov Phone 1-800-457-4584 Maine Nebraska Iowa Enrollment Website: Website: Medicaid Website: https://www.maine.gov/dhhs/ http://www.ACCESSNebraska.n https://dhs.iowa.gov/ime/mem ofi/applications-forms e.gov bers Phone: 1-800-442-6003 Phone: 1-855-632-7633 Medicaid Phone: 1-800-338- TTY: Maine relay 711 Lincoln: 402-473-7000 8366 Private Health Insurance Omaha: 402-595-1178 Hawki Website: Premium Webpage: http://dhs.iowa.gov/Hawki https://www.maine.gov/dhhs/ Nevada Hawki Phone: 1-800-257-8563 ofi/applications-forms Medicaid Website: HIPP Website: Phone: -800-977-6740. http://dhcfp.nv.gov https://dhs.iowa.gov/ime/mem TTY: Maine relay 711 Medicaid Phone: 1-800-992- bers/medicaid-a 0900 to-z/hipp HIPP Phone: 1-888-346-9562 Page 7

New Hampshire Oregon Vermont Website: Website: Website: https://www.dhhs.nh.gov/prog http://healthcare.oregon.gov/P http://www.dvha.vermont.gov/ rams- ages/index.aspx members/medicaid/hipp- services/medicaid/health- program insurance-premiums-program Phone: 1-800-699-9075 Phone: 1-800-250-8427 Phone: 603-271-5218 Pennsylvania Virginia Toll free number for the HIPP Website: Website: program: 1-800-852-3345, ext. https://www.dhs.pa.gov/Servic https://coverva.dmas.virginia.g 5218 es/Assistance/Pages/HIPPProg ov/learn/premiumassistance/f New Jersey ram.aspx Phone: 1-800-692- amis-select Medicaid Website: 7462 CHIP Website: Children's https://coverva.dmas.virginia.g http://www.state.nj.us/human Health Insurance Program ov/learn/premiumassistance/h services/ (CHIP) (pa.gov) ealth-insurance-premium- dmahs/clients/medicaid/ CHIP Phone: 1-800-986-KIDS payment-hipp-programs Medicaid Phone: 609-631-2392 (5437) Medicaid/CHIP Phone: 1-800- CHIP Website: 432-5924 http://www.njfamilycare.org/in Rhode Island Washington dex.html Website: Website: CHIP Phone: 1-800-701-0710 http://www.eohhs.ri.gov/ https://www.hca.wa.gov/ New York Phone: 1-855-697-4347, or Phone: 1-800-562-3022 401-462-0311 Website: (Direct RIte Share Line) West Virginia https://www.health.ny.gov/hea South Carolina Website: lth_care/medicaid/ http://mywvhipp.com/ Phone: 1-800-541-2831 Website: http://dhhr.wv.gov/bms/ North Carolina https://www.scdhhs.gov Phone: 1-888-549-0820 Medicaid Phone: 304-558-1700 Website: South Dakota CHIP Toll-free phone: 1-855- https://medicaid.ncdhhs.gov/ MyWVHIPP (1-855-699-8447) Phone: 919-855-4100 Website: http://dss.sd.gov Wisconsin North Dakota Phone: 1-888-828-0059 Texas Website: Website: https://www.dhs.wisconsin.gov http://www.hhs.nd.gov/healthc Website: /badgercareplus/p-10095.htm are https://hs.texas.gov/services/fi Phone: 1-800-362-3002 Phone: 1-844-854-4825 nancial/health-insurance- Wyoming Oklahoma premium-payment-hipp- program Website: Website: Phone: 1-800-440-0493 https://health.wyo.gov/healthc http://www.insureoklahoma.or Utah arefin/medicaid/programs-and g Medicaid Website: eligibility/ Phone: 1-888-365-3742 https://medicaid.utah.gov/ Phone: 1-800-251-1269 CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669 Page 8

IMPORTANT NOTICE ABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with your employer and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare 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. 2. Your employer has determined that the prescription drug coverage offered by the employer sponsored medical plans are, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and are therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join a Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens to Your Current Coverage If You Decide to Join a Medicare Drug Plan?

Your current coverage pays for other health expenses, in addition to prescription drugs. If you are actively employed and decide to join a Medicare drug plan, your current medical coverage will not be affected; you can keep this coverage if you elect part D and this plan will coordinate with Part D coverage. If you are actively employed and you decide to join a Medicare drug plan and drop your current medical coverage, be aware that you and your dependents may be able to get this coverage back at the next open enrollment period or upon a qualifying status change if you remain otherwise eligible to enroll in the Plan. If you are no longer actively employed and you decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents will not be able to get this coverage back. When Will You Pay a Higher Premium (Penalty) To Join a Medicare Drug Plan? You should also know that if you drop or lose your current coverage and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice or Your Current Prescription Drug Coverage… Contact the plan administrator for further information. Page 10

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 drug plans. For more information about Medicare prescription drug coverage: • Visit www.medicare.gov • Call your State Health Insurance Assistance Program (see the inside back cover of 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. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1- 800-772-1213 (TTY 1-800-325-0778). Page 11