HEALTH PLAN NOTICES ends, you (or your covered dependent) will have up to an additional six months of continuation coverage under You are protected from balance billing for: USERRA. Emergency services If you have continuation rights under both laws for the Company Health Plans, instead of making this combined If you have an emergency medical condition and get emergency services from an out-ofnetwork provider or facility, COBRA and USERRA election: (1) you may make an election under only COBRA; or (2) you may make an election under the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and only USERRA. For information about how to make a USERRA-only or COBRA-only election, consult the Plan coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re Administrator. in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. Wellness Program Disclosure Certain services at an in-network hospital or ambulatory surgical center Your health plan is committed to helping you achieve your best health. If a Wellness Program is offered, rewards for When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out- participating in a wellness program are available to all employees. If you think you might be unable to meet a standard of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This for a reward under the wellness program, you might qualify for an opportunity to earn the same reward by different applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, means. Contact the Plan Administrator and we will work with you (and, if you wish, with your doctor) to find a hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your wellness program with the same reward that is right for you in light of your health status. 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. Women’s Health and Cancer Rights Act (WHCRA) You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of- If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health network. You can choose a provider or facility in your plan’s network. and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be When balance billing isn’t allowed, you also have the following protections: provided in a manner determined in consultation with the attending physician and the patient, for all stages of You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities to produce a symmetrical appearance, prostheses, and treatment of physical complications of the mastectomy, directly. including lymphedema. These benefits will be provided subject to the same deductibles and co-insurance applicable Your health plan generally must: to other medical and surgical benefits provided under the Company Health Plan. If you would like more information 1. Cover emergency services without requiring you to get approval for services in advance (prior authorization). on WHCRA benefits, please call your Plan Administrator. 2. Cover emergency services by out-of-network providers. Your Rights and Protections Against Surprise Medical Bills 3. 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. When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory 4. Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of- surgical center, you are protected from surprise billing or balance billing. pocket limit. What is “balance billing” (sometimes called “surprise billing”)? If you believe you’ve been wrongly billed, you may contact the Plan Administrator or you may contact the Centers for When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, Medicare & Medicaid Services https://www.cms.gov/nosurprises. Visit https://www.cms.gov/nosurprises/Policies- 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 and-Resources/Overview-of-rules-fact-sheets for more information about your rights under federal law. 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.