2025 Benefit Guide Cal Final Gersh (corrected)

2025 Employee Benefit Guide

Table of Contents Benefits for 2025

• Introduction

• Overview of Benefit Programs

• Medical Benefits

• Health Savings Account (HSA)

• Health Joy

• Dental Benefits

• Vision Benefits

• Flexible Spending Account (FSA)

• Life Insurance

• Long-term Disability Insurance

• Supplemental Health Benefits

• Commuter Benefits

• Employee Assistance Program (EAP)

• Family Planning & Women’s Health EAP (Carrot)

• Employee Discount & Perk Program

• Retirement Plan

• Online Enrollment

• Legal Notices

• Legal Notices - COBRA

• Legal Notices - FMLA

• Contact Page

This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.

2025 Employee Benefit Guide

Benefits for 2025 Introduction

For the 2025 plan year, The Gersh Agency has worked hard to offer a competitive total rewards package that includes valuable and competitive benefits plans. These programs reflect our commitment to keeping our staff healthy and secure. We understand that your situation is unique, and The Gersh Agency is offering an overall benefits package that can be shaped and molded by you to fit your needs. As an employee of The Gersh Agency enjoying your work and making valuable contributions to business are equally vital. The health, satisfaction and security of you and your family are important, not only to your well-being, but ultimately, in terms of achieving the goals of our organization. This benefits booklet is a summary description of your The Gersh Agency benefit plans. If there is a discrepancy between these summaries and the written legal plan documents, the plan documents shall prevail. This booklet and plan summaries do not constitute a contract of employment.

We hope this benefits booklet, along with our additional communication and decision-making tools, will help you make the best health care choices for you and your family.

2025 Employee Benefit Guide

Benefits for 2025 Overview of Benefit Programs

The Gersh Agency provides an array of benefits that can help you enjoy increased well-being, deal with an unexpected illness or accident, build and protect your financial security, balance your personal and professional life and meet everyday needs. These benefits are affordable, comprehensive, and competitive.

The table below summarizes the benefits available to eligible staff and their dependents. These benefits are described in greater detail in this booklet.

BENEFITS AT-A-GLANCE

Coverage

Carrier

Medical

Cigna

Dental

Cigna

Vision

Cigna

Life/AD&D

Mutualof Omaha

Long-Term Disability

Mutualof Omaha

Accident, Critical Illness, Hospital Indemnity

Cigna

Telemedicine/Health Wallet

HealthJoy

Employee Assistance Program (EAP)

Mutual of Omaha

Health Savings Account (HSA)

HSABank

Flexible Spending Account (FSA) Limited Purpose Flexible Spending Account (LFSA) Commuter Benefits

WEX

401(k)

ADP inc.

ELIGIBILITY

Full-time employees working a minimum of 30 hours per week and eligible dependents. Employee must be 21 years of age to be eligible for the 401(k).

2025 Employee Benefit Guide

Benefits for 2025

Medical

Cigna HMO Plan

What you pay

In Network (HMO Southern California Network)

Preventive Care

No Charge

Office Visit: PCP / Specialist (Referral Required to see a Specialist)

$20 Copay / $20 Copay

Emergency Room

$200 Copay (waived if admitted)

Urgent Care

$25 Copay

Complex Imaging (Outpatient)

$250 Copay after Deductible

Lab & X-Ray (Outpatient)

Plan pays 100%

Inpatient Hospital

$1,000 Copay after Deductible

Outpatient Surgery

$500 Copay after Deductible

Deductible (Individual / Family)

$500 / $1,000

Out-of-Pocket Max (Individual / Family)

$3,000 / $6,000

Rx Copays (Retail or Mail Order Supply)

$10 / $25 / $45

Notes: Plan requires referrals to see any type of specialist All employees must use doctors/hospitals that participate within the Cigna HMO Network All copays, deductibles, & coinsurance apply towards the out-of-pocket max

Employee Cost Per Pay Period (26)

HMO Plan

Employee Only Employee + 1

$60.00 $189.00 $286.00

Employee + Family

* Member may be responsible for any amount over the allowed amount

2025 Employee Benefit Guide

Benefits for 2025

Medical

Cigna HDHP/HSA Plan

In Network (National)

What you pay

Out of Network

Preventive Care

No Charge

30% after Deductible

Office Visit: PCP / Specialist

10% after Deductible

30% after Deductible

Emergency Room

10% after Deductible

Urgent Care

10% after Deductible

30% after Deductible

Complex Imaging (Outpatient)

10% after Deductible

30% after Deductible

Lab & X-Ray (Outpatient)

10% after Deductible

30% after Deductible

Inpatient Hospital

10% after Deductible

30% after Deductible

Outpatient Surgery

10% after Deductible

30% after Deductible

$2,000 / $4,000 Individual in a Family Max: $3,300

$6,000 / $12,000 Individual in a Family Max: $6,000

Deductible (Individual / Family)

Out-of-Pocket Max (Individual / Family)

$4,000 / $8,000

$11,000 / $22,000

Rx Copays (Retail or Mail Order Supply)- After Deductible

$10 / $40 / $60

Not Covered

Notes: Plan offers access to Cigna’s Open Access Plus National Network of doctors/hospitals All in-network services on this plan will first apply towards the in-network deductible Gersh will make an employer contribution of $750/$1,500 into a separate HSA account for any employee that elects this plan All copays, deductibles, & coinsurance apply towards the out-of-pocket max Out-of-Network services are paid based on allowable charges. Member may be responsible for paying the balance of the billed amount above that rate (commonly known as “balance billing”)

Employee Cost Per Pay Period (26)

HDHP/HSA Plan

Employee Only

$85.00

Employee + 1

$253.00

Employee + Family

$374.00

2025 Employee Benefit Guide

Benefits for 2025

Health Savings Account (HSA)

FOR 2025 THE GERSH AGENCY IS OFFERING A HEALTH SAVINGS ACCOUNT (HSA). THIS IS HOW AN HSA WORKS:

A health savings account (HSA) is a health care account and savings account in one. The main purpose of this account is to offset the cost of a qualifying high deductible health plan (HDHP) and provide savings for your out-of-pocket eligible health care expenses – those you and your tax dependents may have now, in the future, and during your retirement.

This is a “portable” account. You own your HSA! It’s included in your employee benefits package, but after you set up your account, it’s yours to keep, even if you change jobs or retire.

Once your HSA is established, money is contributed to your account by you, The Gersh Agency or friends and family, and you can then use your HSA dollars tax-free to pay for eligible health care expenses. You save money on expenses you’re already paying for, like doctors’ office visits, prescription drugs, and much more. For 2025, you may contribute up to $4,300 for employee only coverage and $8,550 for those covering dependents on the HDHP. WHY IS IT A GOOD IDEA TO HAVE AN HSA?

HSAs benefit everyone who is eligible to have this account – single individuals, families, and soon-to-be retirees. You save money on taxes in three ways:

› Tax-free deposits – The money you contribute to your HSA isn’t taxed (up to the IRS annual limit)

› Tax-free earnings – Your

› Tax-free withdrawals – The money used toward eligible health care expenses isn’t taxed – now or in the future.

interest and any investment earnings grow tax-free.

HSA funds roll over from year to year and accumulate in your account. There is no “use -it-or-lose- it” rule with HSAs, and you decide how and when to use your HSA funds, which can be used for eligible expenses you have now, in the future, or during retirement. And when you have a certain balance in your HSA, investment opportunities are available. › Setting aside pre-tax dollars into your HSA means you pay fewer taxes and increase your take-home pay by your tax savings. You save money on eligible expenses that you are paying for out of your pocket. The amount you save depends on your tax bracket. For example, if you are in the 30 percent tax bracket, you can save $30 on every $100 spent on eligible health care expenses.

Refer to your HSA documentation for more information.

2025 Employee Benefit Guide

Benefits for 2025

Medical

NEW Cigna PPO Plan

In Network (National)

What you pay

Out of Network

Preventive Care

No Charge

50% after deductible

Coinsurance

Plan pays 70%

Plan pays 50%

Office Visit: PCP / Specialist

$30 Copay / $50 Copay 50% after deductible

$350 Copay then 30% after Deductible (Copay waived if admitted)

Emergency Room

Urgent Care

$50 Copay

50% after Deductible

Complex Imaging (Outpatient)

30% after Deductible

50% after Deductible

Lab & X-Ray (Outpatient)

30% after Deductible

50% after Deductible

Inpatient Hospital

30% after Deductible

50% after Deductible

Outpatient Surgery

30% after Deductible

50% after Deductible

Deductible (Individual / Family)

$2,500 / $5,000

$3,000 / $6,000

Out-of-Pocket Max (Individual / Family)

$5,000 / $10,000

$15,000 / $30,000

Rx Copays (Retail or Mail Order Supply)

$15 / $35 / $70

Not Covered

Notes: Plan offers access to Cigna’s Open Access Plus National Network of doctors/hospitals All copays, deductibles, & coinsurance apply towards the out-of-pocket max Out-of-Network services are paid based on allowable charges. Member may be responsible for paying the balance of the billed amount above that rate (commonly known as “balance billing”)

Employee Cost Per Pay Period (26)

New PPO Plan

Employee Only

$123.40

Employee + 1

$431.36

Employee + Family

$577.56

* Member may be responsible for any amount over the allowed amount

2025 Employee Benefit Guide

Benefits for 2025

Medical

Cigna PPO Plan

In Network (National)

What you pay

Out of Network

Preventive Care

No Charge

40% after deductible

Office Visit: PCP / Specialist

$25 Copay / $40 Copay 40% after deductible

$250 Copay then 20% after deductible (Copay waived if admitted)

Emergency Room

Urgent Care

$25 Copay

40% after Deductible

Complex Imaging (Outpatient)

20% after Deductible 40% after Deductible

Lab & X-Ray (Outpatient)

20% after Deductible 40% after Deductible

Inpatient Hospital

20% after Deductible 40% after Deductible

Outpatient Surgery

20% after Deductible 40% after Deductible

Deductible (Individual / Family)

$1,250 / $3,750

$1,500 / $4,500

Out-of-Pocket Max (Individual / Family)

$4,000 / $8,000

$11,500 / $23,000

Rx Copays (Retail or Mail Order Supply)

$10 / $25 / $45

Not Covered

Employee Cost Per Pay Period (26)

PPO Plan

Employee Only

$253.39

Employee + 1

$600.00

Employee + Family

$800.00

* Member may be responsible for any amount over the allowed amount

2025 Employee Benefit Guide

Benefits for 2025

Medical

KEY TERMS TO REMEMBER

OUT-OF-POCKET MAXIMUM This is the total amount you can pay out of pocket each calendar year before the plan pays 100 percent of covered expenses for the rest of the calendar year. Most expenses that meet provider network requirements count toward the annual out-of-pocket maximum, including expenses paid to the annual deductible*, copays and coinsurance. *Except for Grandfathered medical plans

ANNUAL DEDUCTIBLE The amount you have to pay each year before the plan starts paying a portion of medical expenses. All family members’ expenses that count toward a health plan deductible accumulate together in the aggregate; however, each person also has a limit on their own individual accumulated expenses (the amount varies by plan).

COPAYS AND COINSURANCE These expenses are your share of cost paid for covered health care services. Copays are a fixed dollar amount, and are usually due at the time you receive care. Coinsurance is your share of the allowed amount charged for a service, and is generally billed to you after the health insurance company reconciles the bill with the provider.

PLAN TYPES

› EPO/PPO – A network of doctors, hospitals and other health care providers › HMO – A network that requires you to select a Primary Care Physician (PCP) who coordinates your health care › POS – Combines aspects of a PPO and HMO › HDHP – A plan that has higher annual deductibles in exchange for lower premiums.

2025 Employee Benefit Guide

Benefits for 2025 Medical

Understanding the full value of covered benefits allows you to take responsibility for maintaining good health and incorporating healthy habits into your lifestyle. Some examples include getting regular physical examinations, mammograms and immunizations. Through the plans offered by The Gersh Agency , all covered individuals and family members are eligible to receive routine wellness services like these, at no cost; all copays, coinsurance, and deductibles are waived.

WHICH PREVENTIVE CARE SERVICES ARE COVERED?

The US Preventive Services Task Force maintains a regular list of recommended services that all Affordable Care Act (i.e. Health Care Reform) compliant insurance plans should cover at 100% for in-network providers. Below is a list of common services that are included in the plans offered this year:

› Routine Physical Exam › Well Baby and Child Care › Well Woman Visits › Immunizations › Routine Bone Density Test › Routine Breast Exam › Routine Gynecological Exam

› Screening for Gestational Diabetes › Obesity Screening and Counseling › Routine Digital Rectal Exam › Routine Colonoscopy › Routine Colorectal Cancer Screening

› Routine Prostate Test › Routine Lab Procedures › Routine Mammograms

› Routine Pap Smear › Smoking Cessation

“An ounce of prevention is worth a pound of cure”

› Health Education/Counseling Services › Health Counseling for STDs and HIV › Testing for HPV and HIV › Screening and Counseling for Domestic Violence

2025 Employee Benefit Guide

Benefits for 2025 HealthJoy

A Better Employee Benefits Experience

HealthJoy is the virtual access point for all your healthcare navigation and employee benefits needs. HealthJoy provided free by your employer to help understand and make the most of your benefits. We connect you and your family with the right benefits at the right moment in your care journey, saving you time, money, and frustration. With 24/7 access to our dedicated healthcare concierge team, visits, and care navigation tools, you never have to walk alone. HealthJoy helps you locate in- network doctors, find extra savings on your prescriptions, and navigate your benefits. Our mobile app and dedicated member support team are always on hand to help make it easier to stay healthy and well.

You also have access to unlimited MeMd for Virtual Medical Care and Virtual Mental Health at no cost!

Chat with us today by logging into the HealthJoy app or call (877) 500-3212

BENEFIT S WALLET

HEALTHCAR E CONCIERGE

RX SAVINGS REVIEW

APPOINTMEN T BOOKING

HSA / FSA SUPPORT

PROVIDER RECS

2025 Employee Benefit Guide

Benefits for 2025 Enhanced Resources - Cigna

Lifestyle Benefits • Cigna Healthy Rewards ® to save money on health and wellness products and services.

• Online coaching programs help you maintain a healthy lifestyle • Personal health coaches to help improve your health and wellness • Programs to help you better manage stress, quit tobacco or lose weight • Simple, online health assessment designed to help you live a healthier life o Mental Health Benefits • Free Veteran Support Line available 24/7/365 to all veterans by calling 855.244.6211 • Talkspace • Headspace (rebrand of Ginger IO) o Medical Services

• Price Assure by Cigna through GoodRx • Answers by Cigna for Amazon Alexa • MD Live- Telemedicine services

2025 Employee Benefit Guide

Benefits for 2025 Find a Provider

*Please note that Cigna will not mail ID cards any longer. Members can log onto www.mycigna.com or call customer service to request

2025 Employee Benefit Guide

Benefits for 2025 Telemedicine

Behavioral Health

Primary Care

Urgent Care

Dermatology

On-demand care for minor medical conditions

Talk therapy and psychiatry from the privacy of home

Fast, customized care for skin, hair and nail conditions – no appointment required • Access to psychiatrists and therapists • Schedule an appointment that works for you • Option to select the same provider every session • Care for issues such as

Preventative care, routine care and specialist referrals

• Access to

• Preventative care

psychiatrists and therapists

checkups/wellness screenings available at no additional cost to identify conditions early

• On-demand 24/7/365, including holidays • Care for hundreds of minor medical conditions • A convenient and affordable alternative to urgent care centers and the emergency room

• Schedule an

appointment that works for you • Option to select the same provider every session • Care for issues such as anxiety, stress, life changes, grief and depression

• Routine care visits

allow you to build a relationship with the

same primary care provider (PCP) to help manage conditions • Receive orders for biometrics, bloodwork and screenings at local facilities

anxiety, stress, life changes, grief and depression

• Prescriptions available, if appropriate

2025 Employee Benefit Guide

Benefits for 2025 One Guide – Customer Service

2025 Employee Benefit Guide

Benefits for 2025 Head Space – Mental Health

Employees enrolled in the HDHP wHSA plan can use HSA dollars to pay for services. Employees enrolled in the Mid and Buy Up POS plan will receive a discounted rate by going through Cigna

2025 Employee Benefit Guide

Benefits for 2025 Talk Space – Mental Health

Employees enrolled in the HDHP with an HSA plan can use HSA dollars to pay for services. Employees enrolled in the Mid and Buy Up POS plan will receive a discounted rate by going through Cigna

2025 Employee Benefit Guide

Benefits for 2025 Dental Coverage

SUMMARY OF COVERAGE

*Referrals Required

In Network

Annual Deductible Individual | Family

None

Calendar Year Plan Max

Unlimited

Preventive Care Benefits

$5 Copay

Basic Services

Refer to Copay Schedule

Major Services

Refer to Copay Schedule

Orthodontia (Child / Adult)

$1,104 to $5,425

Employee Cost Per Pay Period (26)

Dental DHMO Plan

Employee

$5.00

Employee/Spouse

$10.00

Employee/Child(ren)

$7.00

Family

$15.00

2025 Employee Benefit Guide

Benefits for 2025 Dental Coverage

SUMMARY OF COVERAGE

In Network

Out-of-Network

Annual Deductible Individual | Family

$50 | $150

Calendar Year Plan Max

$2,500 per person

Preventive Care Benefits

100% deductible waived

You pay 20% after deductible You pay 50% after Deductible

Basic Services

100% afterdeductible

You pay 40% after Deductible

Major Services

Orthodontia (Adult / Child)

50% up to $2,000 Lifetime Maximum

Employee Cost Per Pay Period (26)

Dental DPPO Plan

Employee

$12.00

Employee/Spouse

$22.00

Employee/Child(ren)

$32.00

Family

$52.00

2025 Employee Benefit Guide

Benefits for 2025 Vision Coverage

SUMMARY OF COVERAGE

In Network

Out-of-Network

Eye exam (once per calendar year)

$10 Copay

Up to $45 Reimbursement

Lenses (Single / Bifocal / Trifocal / Lenticular) (once per calendar year)

Covered in Full after $10 Copay

Up to ($32 / $55 / $65 / $80) Reimbursement

Frame allowance (once per calendar year)

$130 Allowance

Up to $71 Reimbursement

Elective Contacts (once per calendar year)

$130 Allowance

Up to $105 Reimbursement

Medically Necessary Contacts (once per calendar year)

Covered in Full

Up to $210 Reimbursement

Employee Cost

Vision Plan

Per Pay Period (26)

Employee

$3.50

Employee + 1

$7.30

Family

$10.52

2025 Employee Benefit Guide

Benefits for 2025

Flexible Spending Account FSA

The Gersh Agency is offering a Flexible Spending Account (FSA) for 2025. This is how an FSA works:

› You set aside money for your FSA from your paycheck before taxes are taken out. › Then use your pre-tax FSA funds throughout the plan year to pay for eligible health care or dependent care expenses. This includes medical, dental, and vision expenses. › You save money on expenses you’re already paying for. › Healthcare FSA contribution Max: $3,300. Dependent care Account: $5,000.

You may also be able to carry over up to $660 of unused funds to the following plan year. Refer to your FSA documentation for more details.

DEPENDENT CARE FSA ELIGIBLE EXPENSES

HEALTH FSA ELIGIBLE EXPENSES

› Medical expenses: co-pays, co-insurance, and deductibles › Dental expenses: exams, cleanings, X-rays, and braces › Vision expenses: exams, contact lenses and supplies, eyeglasses, and laser eye surgery › Professional services: physical therapy,

› Care for your child who is under age 13 › Before and after-school care › Baby sitting and nanny expenses › Day care, nursery school, and preschool › Summer day camp › Care for a relative who is physically or mentally incapable of self-care and lives in your home

chiropractor, and acupuncture › Prescription drugs and insulin

› Over-the-counter health care items: bandages, pregnancy test kits, blood pressure monitors, etc.

Refer to your FSA documentation for more information.

2025 Employee Benefit Guide

Benefits for 2025 Life Insurance

SUMMARY OF COVERAGE

Life Insurance/AD&D benefit provides coverage for all eligible employees. Please refer to your benefits portal for your company paid benefit

Life Benefit Age Reduction for active employees over starting at age 65

Make sure you elect a beneficiary & it is kept up-to-date.

See enrollment site/benefit guide/HR for rates

This benefit is 100% covered by The Gersh Agency

2025 Employee Benefit Guide

Benefits for 2025 Voluntary Life Insurance

SUMMARY OF COVERAGE

Insured Benefits

• $10,000 up to a maximum of $500,000 • Increments of $10,000 • Guaranteed Issue: $150,000* • $5,000 up to a maximum of $250,000 • Increments of $5,000 • Guaranteed Issue: $30,000 • Cannot exceed 100% of EE’s coverage*

Employee

Spouse

• Increments of $1,000 up to $10,000 for children 14 days and older • Eligible from birth to 26 years old • Cannot exceed 100% of the employee’s coverage*

Child

This is a benefit you pay for as an employee • Coverage is available to all employees that meet eligibility requirements • Life Benefit Age Reduction for active employees over starting at age 65 • Guaranteed Issue: The amount of coverage you may buy within 31 days of initial eligibility for coverage without providing health information. This benefit does not have a true open enrollment. To enroll in any voluntary life amount after your initial eligibility period, you must complete an evidence of insurability form. There is no guarantee of approval of the voluntary life amount requested • Rates available on our ADP enrollment platform

2025 Employee Benefit Guide

Benefits for 2025

Long Term Disability Insurance

SUMMARY OF COVERAGE

Disability Insurance replaces a percentage of your income during extended periods of illness or injury that prevent you from performing your regular work. This benefit is an additional offering provided by Legacy Group Enterprises to enhance and increase your coverage at a lower cost.

Long-Term Disability (LTD)

60% of your monthly pre-disability earnings up to $15,000 per month for up to 2 years

180 day waiting period

This is a benefit you pay for as an employee • Coverage is available to all employees that meet eligibility requirements • Life Benefit Age Reduction for active employees over starting at age 65 • This benefit does not have a true open enrollment. To enroll in any voluntary life amount after your initial eligibility period, you must complete an evidence of insurability form. There is no guarantee of approval of the voluntary life amount requested • Rates available on our ADP enrollment platform

2025 Employee Benefit Guide

Benefits for 2025 Supplemental Health Benefits

2025 Employee Benefit Guide

Benefits for 2025 Commuter Accounts

Contribute pre-tax dollars for the cost of commuting! Must be working to use these accounts

Transit Expenses

2025 Maximum $325 per month, for common carrier including Uber Pool, Lyft Line, subway, & railroad use

Parking Expenses 2025 Maximum $325 per month

2025 Employee Benefit Guide

Benefits for 2025 Employee Assistance Program

2025 Employee Benefit Guide

Benefits for 2025 Carrot

Family Planning & Woman’s Health Employee Assistance Program

2025 Employee Benefit Guide

Benefits for 2025 Employee Discount & Perk Program

2025 Employee Benefit Guide

Benefits for 2025 The Gersh Agency Retirement Plan

SUMMARY OF COVERAGE

The Gersh Agency: Retirement Plan Summary

Your Group’s Plan Number: 428751

The Gersh Agency encourages you to accumulate savings for retirement through convenient 401(k) pre-tax and Roth (after- tax) payroll deductions.

Eligibility All employees are eligible after 60 days of continuous employment. You can choose to contribute to the Plan with before-tax contributions, and/or Roth 401(k) contributions.

Enrollment Employees will be auto-enrolled on the 1st of the month after 60 days of continuous employment. The default enrollment is a 3% pre-tax contribution, which will be deducted from your pay and deposited into your retirement account in the Plan’s default fund.

How to Change Contributions To review or make changes to your retirement contributions please refer to any of the below Account Resources.

Account Resources Website: workforcenow.adp.com Text: “Enroll 428751” to 72408 Call: 1-866-695-7526 App: ADP Mobile Solutions App Visit https://mobile.adp.com OR Scan the QR code

2025 Employee Benefit Guide

Benefits for 2025 Online Enrollment Overview

2025 Employee Benefit Guide

Benefits for 2025 Legal Notices

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that addresses the privacy and security of certain individually identifiable health information, called protected health information (or PHI). You have certain rights with respect to your PHI, including a right to see or get a copy of your health and claims records and other health information maintained by a health plan or carrier. For a copy of the Notice of Privacy Practices, describing how your PHI may be used and disclosed and how you get access to the information, contact Human Resources.

Women’s Health and Cancer Rights Act Enrollment Notice

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Woman’s Health and Cance r 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:

1. All stages of reconstruction of the breast on which mastectomy was performed. 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses. 3. Treatment of physical complications of the mastectomy, including lymphedema.

These will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this benefits plan If you would like more information on WHCRA benefits, call your plan administrator.

Newborns’ and Mothers’ Health Protection Act Disclosure

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 mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Patient Protection Notice

Your carrier generally may require the designation of a primary care provider. You have the right to designate any primary care provider who participates in your network and who is available to accept you or your family members. Until you make this designation, your carrier may designate one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the plan administrator.. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from your carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in your network who specializes in obstetrics or gynecology. The health care professional, however, 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 plan administrator..

2025 Employee Benefit Guide

Benefits for 2025 Legal Notices

HIPAA Special Enrollment Notice

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 en rollment 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. If you or your dependents lose eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP) or b ecome eligible for a premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents. You must request enrollment within 60 days of the loss of Medicaid or CHIP coverage or the determination of eligibility for a premium assistance subsidy. To request special enrollment or to obtain more information about the plan's special enrollment provisions, contact the plan administrator.

2025 Employee Benefit Guide

Benefits for 2025 Legal Notices

Premium Assistance Under Medicaid and t he Children’s Health Insurance Program (CH IP)

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 Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to 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” o pportunity, 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 www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2024. Contact your State for more information on eligibility –

ALABAMA-Medicaid

CALIFORNIA-Medicaid

Website: http://myalhipp.com/ Phone: 1-855-692-5447

Website: Health Insurance Premium Payment (HIPP) Programhttp://dhcs.ca.gov/hipp Phone: 916-445-8322 Fax: 916-440-5676 Email: hipp@dhcs.ca.gov

ALASKA-Medicaid

COLORADO-Health First Colorado (Colorado’s Medicaid

Program)&ChildHealth Plan Plus(CHP+)

The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711 CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442

ARKANSAS-Medicaid

FLORIDA-Medicaid

Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.c om/hipp/index.html Phone: 1-877-357-3268

Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)

2025 Employee Benefit Guide

Benefits for 2025 Legal Notices

GEORGIA-Medicaid

MAINE-Medicaid

GA HIPP Website: https://medicaid.georgia.gov/health- insurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party-liability/childrens- health-insurance-program-reauthorization- act-2009-chipra Phone: (678) 564-1162, Press 2

Enrollment Website: https://www.mymaineconnection.gov/benefits/s/?language= en_US Phone: 1-800-442-6003 TTY: Maine relay 711

Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms

Phone: -800-977-6740. TTY: Maine relay 711

INDIANA-Medicaid

MASSACHUSETTS-Medicaid and CHIP

Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone 1-800-457-4584

Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711 Email: masspremassistance@accenture.com

IOWA-Medicaid and CHIP (Hawki)

MINNESOTA-Medicaid

Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to- z/hipp HIPP Phone: 1-888-346-9562

Website: https://mn.gov/dhs/people-we-serve/children-and-families/health- care/health-care-programs/programs-and-services/other- insurance.jsp Phone: 1-800-657-3739

KANSAS-Medicaid

MISSOURI-Medicaid

Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 HIPP Phone: 1-800-967-4660

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005

KENTUCKY-Medicaid

MONTANA-Medicaid

Kentucky Integrated Health Insurance Premium Payment Program (KI- HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 Email: HHSHIPPProgram@mt.gov

LOUISIANA-Medicaid

NEBRASKA-Medicaid

Website: dhh.louisiana.gov/index.cfm/subhome/1/n/331 or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618- 5488 (LaHIPP)

Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178

2025 Employee Benefit Guide

Benefits for 2025 Legal Notices

NEVADA-Medicaid

SOUTH CAROLINA-Medicaid

Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900

Website: https://www.scdhhs.gov Phone: 1-888-549-0820

NEW HAMPSHIRE-Medicaid

SOUTH DAKOTA-Medicaid

Website: https://www.dhhs.nh.gov/programs-services/medicaid/health- insurance-premium-program Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext. 5218

Website: http://dss.sd.gov Phone: 1-888-828-0059

NEW JERSEY-Medicaid and CHIP

TEXAS-Medicaid

Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710

Website: Health Insurance Premium Payment (HIPP) Program | Texas Health and Human Services Phone: 1-800-440-0493

NEW YORK-Medicaid

UTAH-Medicaid and CHIP

Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831

Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669

NORTH CAROLINA-Medicaid

VERMONT-Medicaid

Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100

Website:Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health Access Phone: 1-800-250-8427

NORTH DAKOTA-Medicaid

VIRGINIA-Medicaid and CHIP

Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825

Website: https://coverva.dmas.virginia.gov/learn/premium- assistance/famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/health- insurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-800-432-5924

OKLAHOMA-Medicaid and CHIP

WASHINGTON-Medicaid

Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022

OREGON-Medicaid

WEST VIRGINIA-Medicaid and CHIP

Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075

Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

PENNSYLVANIA-Medicaid and CHIP

WISCONSIN-Medicaid and CHIP

Website: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPP- Program.aspx Phone: 1-800-692-7462 CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov) CHIP Phone: 1-800-986-KIDS (5437)

Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002

RHODE ISLAND-Medicaid and CHIP

WYOMING-Medicaid

Website: https://health.wyo.gov/healthcarefin/medicaid/programs- and-eligibility/ Phone: 1-800-251-1269

Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)

2025 Employee Benefit Guide

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