2023-2024 Benefits Guide

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Welcome to your 2023-2024 Benefits Guide The Edwards Aquifer Authority offers a comprehensive insurance benefits package to current eligible employees as well as COBRA members. Our health and welfare benefits provide both choice and value to meet the needs of our diverse workforce. This booklet offers a comprehensive overview of your health and welfare benefits options, including details about eligibility, enrollment, and the plans available to you to help you choose benefit plans that best suit your individual needs. It also explains how life changes and changes to your employment status can affect your benefits. The information in this booklet reflects the terms of the benefit plans in effect as of October 1, 2023. Please note that this is a summary of your benefits only, additional requirements, limitations and exclusions may apply. Refer to applicable plan summary documents and regulations located at the end of this booklet for details. The applicable policy issued by the carrier will take precedence if there is a difference between the provisions therein and those of this document.

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What’s Inside ENROLLMENT ELIGIBILITY .................................................................................................... 4 BENEFIT CARRIER CONTACT INFORMATION ........................................................................ 8 MEDICAL PLANS ................................................................................................................. 11 MEDICAL PLAN SUMMARY COMPARISON CHART ............................................................. 12 VISION PLAN....................................................................................................................... 19 DENTAL PLAN ..................................................................................................................... 22 HEALTH REIMBURSEMENT ACCOUNT (HRA)...................................................................... 25 FLEX SPENDING ACCOUNTS (FSA) ...................................................................................... 25 GROUP TERM LIFE INSURANCE .......................................................................................... 27 ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) COVERAGE .................................... 27 LIFE INSURANCE FEATURES................................................................................................ 28 LONG-TERM DISABILITY (LTD) ............................................................................................ 29 OPTIONAL TERM LIFE INSURANCE ..................................................................................... 29 WELLNESS .......................................................................................................................... 33 OPTIONAL BENEFITS........................................................................................................... 36 LEAVE ................................................................................................................................. 41 RETIREMENT ...................................................................................................................... 41 TRAINING ........................................................................................................................... 43 REQUIRED NOTICES............................................................................................................ 44

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ENROLLMENT ELIGIBILITY Employee Eligibility All active full-time employees are eligible for full benefits. Full-time is defined as employees who work more than 30 hours per week. Dependent Eligibility Dependents who meet the descriptions listed below are eligible for coverage. Full-time employees may elect medical, dental, and dependent life coverage for their dependents within 30 days of being hired. Current full-time employees may elect health care coverage for their dependents during the Open Enrollment period or within 30 days of experiencing a Qualifying Life Event. • Your spouse – the person to whom you are legally married. • Your child – your biological child, child with a qualified medical support order, legally adopted child, or child placed in the home for the purpose of applicable state and federal laws through the end of the month in which the child turns age 26. • Your stepchild – the child of your spouse for as long as you remain legally married to the child’s parent through the end of the month in which the child turns age 26. • Legal guardianship – a child for whom you have legal guardianship in accordance with an Order of Guardianship pursuant to applicable state or federal laws or a child for whom you are grant court-ordered temporary or other custody through the end of the month in which the child turns age 26. • Your adopted child – a child through adoption through the end of the month in which the child turns age 26. • Other Medical Support Order – a child in accordance with a Court Order pursuant to applicable state or federal laws. • Children over the age of 26 with permanent intellectual or physical disabilities if: o They were enrolled before they turned 26 and remain covered or they were over the age of 26 at the time of the enrollee’s initial enrollment; and o They are incapable of self-sustaining employment because of the intellectual or physical disability; and o They are dependent on the enrollee for care and financial support. How to Enroll in Benefits New hires will complete their benefit enrollment forms through the NEOGOV Onboarding portal and will also create an ADP account as first-time users to make benefit elections. Instructions will be emailed to new hires on how to register for ADP and make benefit elections. Current EAA employees will elect benefits via ADP during the annual Open Enrollment period. Instructions to make benefit elections will be emailed to employees prior to each annual Open Enrollment period. Employees are automatically enrolled in the following EAA plans and the required payroll deductions for TCDRS: • Basic Life & AD&D Insurance – no cost to the employee • Long Term Disability – no cost to the employee • Texas County District Retirement System (TCDRS) – 7% mandatory contribution Benefit elections become effective on the first of the month following date of hire. TCDRS becomes effective on date of hire.

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Coverage Effective Dates The following effective dates apply provided the appropriate enrollment transaction (electronic or paper form) has been completed within the applicable enrollment period. Your coverage is effective for you and your dependent as follows: New Hire If you enroll within 30 days from date of hire, coverage for you and any dependents you enroll will be effective on the first of the month following date of hire. Annual Open Enrollment If you enroll during annual Open Enrollment, coverage for you and any dependents you enroll will be effective on the beginning of the plan year, October 1st. If you do not submit the appropriate enrollment forms during the required eligibility period of 30 days, you will have to wait until the next open enrollment period or experience a qualifying life event to make enrollment changes to your medical health plans. Coverage End Dates Coverage for you and your dependents will end on the earliest of the following: • The date the plan in question is terminated. • The last day of the month, in which you voluntarily terminate you or your dependents’ coverage. • The last day of the month in which you or your dependents no longer meet eligibility requirements. • The last day of the month your dependents no longer meet eligibility due to age. Waiving Coverage If you have medical coverage under another plan, you may choose to decline (waive) the EAA’s medical plans. When an employee makes this choice, a “Declination of Coverage” form must be completed and returned to Human Resources. If you decide later that you would like coverage, you will not be able to enroll until the next Open Enrollment period or within 30 days of a qualifying life event. Some examples of other coverage could be: • Your spouse’s or parents’ plan • A government insurance program • An individual policy or other group coverage Qualifying Life Events A qualifying event is a life event that may allow an employee to add or drop coverage after being hired and outside of the Open Enrollment period. The change must be consistent with the event and documentation (i.e., marriage license, birth certificate, divorce decree, etc., ) must be provided to the HR Administrator within 30 days of the event. Please call or email the HR Administrator to schedule an appointment. You can add, drop or change coverage for yourself and your dependents when you experience a Qualifying Life Event such as: • Marriage • Divorce • Birth or adoption of a child

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• Death • Child reaching age 26

• Child’s loss of eligibility on another plan • Spouse’s gain or loss of other coverage A child is terminated from medical and dental on the last day of the month he/she attains age 26. When a child gains or loses Children’s Health Insurance Program also known as CHIP, employees have 60 days to provide documentation of the gain or loss of coverage to make a corresponding change to their coverage (adding or dropping). If notification isn’t made to the HR Administrator within 30 days of the event, then employees must wait until the next Open Enrollment period. However, you must notify the HR Administrator to drop coverage for dependents who no longer meet eligibility requirements. Coverage effective dates for Qualifying Life Events Qualifying Event – Other than Birth/Adoption of Child If you enroll within 30 days of the qualifying life event, coverage for you and any dependents you enroll will be effective on the first day of the month following the date you submit the enrollment form. Qualifying Event – Birth/Placement/Adoption of Child If you enroll within 30 days of the date of birth, coverage will be effective on the date of birth; even if you have family coverage, you must complete an enrollment form. Premium is due for any period of dependent coverage if the dependent is subsequently enrolled, unless, specifically not allowed by applicable law. Additional premium may not be required when dependent coverage is already in force. If you enroll within 30 days of the court-ordered adoption, placement for adoption, guardianship or conservatorship of a child, coverage will be effective on the date of the adoption, placement for adoption, guardianship or conservatorship; even if you have family coverage, you must complete a Benefits Enrollment Form. Enrollment Tips • Have Social Security numbers, birth dates and required documentation to enroll your eligible dependents. • Choose your options carefully. Once you make an election as a new hire, during open enrollment or within the 30-day qualifying event window, you cannot cancel or change to another plan (i.e., switch your health insurance plan). Group insurance plan premiums are deducted from your paycheck before calculating payroll taxes. Because of these pretax tax savings, the IRS determines when you may make changes—either annually during open enrollment or during the plan year if you experience a qualifying life event. • If you are a new hire, complete your enrollment forms via NeoGov Onboard. • Enroll online in ADP during open enrollment or within 30 days from your date of hire if you are a new employee. If you miss either of these enrollment deadlines, then you must wait until the next open enrollment period unless you experience another qualifying event during the year that allows you to make a change. • If you are hired during open enrollment and your benefits become effective prior to the new plan year, you will have to make new hire elections for the current year first, and then make open enrollment elections/changes for the next plan year. • Medical benefit plans run from October 1st through September 30th.

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• Medical deductibles run from January 1st through December 31st. Enrollment Form Errors It is your responsibility to ensure that information on your Benefits Enrollment Form is correct. If an error occurs, notify the Human Resources Administrator immediately. Premium Deduction Errors It is your responsibility to verify that the premium deductions taken from your paycheck are correct. Any deduction errors must be reported immediately to the HR Administrator. If an underpayment occurs, the EAA has the right

to collect any additional premiums owed. Human Resources Contact Information

Human Resources Representative Contact Information

Hilda Campos, HR Administrator

(210) 477-8508

hcampos@edwardsaquifer.org

Raquel Garza, Director of HR

(210) 477-5137

rgarza@edwardsaquifer.org

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BENEFIT CARRIER CONTACT INFORMATION Contact the HR Administrator for questions regarding insurance plans, premiums, eligibility or enrollment. For claims information, please contact the provider below for assistance. Provider/Plan Contact Information Website MEDICAL Blue Cross Blue Shield (800) 521-2227 Claims Mailing Address: P.O Box 660044 Dallas, TX 75266-0044 www.bxcbstx.com DENTAL Guardian Group #00024715 (800) 275-4638 Claims Mailing Address: PO Box 981282 El Paso, TX 79998 www.guardianlife.com LIFE INSURANCE Reliance Standard Life Insurance Company Life, AD&D, Vol Life Policy #GL161012 LTD Policy #LTD131287 (800) 351-7500 Claims Mailing Address: P.O. Box 7818 Philadelphia, PA 19101-7818 www.rsli.com HRA/FSA Proficient Benefit Solutions www.proficientbenefits.com

(210) 659-8100 (888) 659-8151 ask@proficientbenefits.com

RETIREMENT TCDRS Group# 448

Member Services (800) 823-7782

www.TCDRS.org

MissionSquare 457 Group #304645 IRA Group #701784 IRA Group #705239 RHS Group #801871

(800) 669-7400 Mailing Address: PO Box 96220 Washington, DC 20090

www.missionsq.org

401a Group #100069(MP) 401a Group #1000105 (PS)

Voluntary Benefits

Legal Shield

(800) 654-7757 memberservices@legalshield.com (800) 992-3522 admin@canalichiogroup.com (319) 355-8511 admin@canalichiogroup.com (210) 489-6239 or call any Gold’s Gym location directly (210)-246-9600 or call any YMCA location directly 800-891-2565 customercare@petbenefits.com

www.legalshield.com

AFLAC

www.aflac.com

TransAmerica

www.transamerica.com

Gold’s Gym

www.goldsgym.com

YMCA

www.ymcasatx.org

Pet Benefit Solutions

https://www.petbenefits.com/lan d/edwardsaquifer https://www.texastuitionpromise fund.com/ https://www.getpeanutbutter.co m/

Texas Tuition Promise Fund

1-800-445-4723

Peanut Butter Student Loan Program support@getpeanutbutter.com

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PLAN CHOICES Medical Dental Vision Life Insurance FSA HRA

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MEDICAL PLANS Medical coverage for full-time employees is provided through Blue Cross Blue Shield and have two medical plan options to choose from, the Preferred Provider Organization (PPO) plan or the High Deductible Health Plan (HDHP). Each plan provides comprehensive major medical and prescription drug coverage as well as preventative care benefits and wellness programs. The premium rates for the medical plans being offered by the EAA are effective for the current plan year and run from October 1, 2023 through September 30, 2023. The EAA will pay 100% of the premium for the employee only cost on both plans. Employees may elect to add dependent coverage to their plan however the cost associated with adding dependent coverage is to be paid for by the employee. The PPO plan is a Preferred Provider Organization plan that provides in and out of network coverage and has pre-set copays and deductibles. Once you meet your calendar year deductible, the plan will pay 70% coinsurance for in-network covered services while you pay 30%. For additional information regarding the various services, deductibles and copays, please refer to the Summary of Benefits located at the end of this booklet. PPO Plan Table I Biweekly Employee Cost Monthly Employee Cost Employee Only $0.00 $0.00 Employee + Spouse $335.27 $670.53 Employee + Child(ren) $258.95 $517.89 Employee + Family $594.29 $1,188.57

HDHP Plan

The HDHP is a high deductible health plan that provides in and out of network coverage. Services under this plan are paid 100% by the employee until the calendar year deductible has been met. Once the calendar year deductible has been met, the plan covers benefits at 100%. For additional information regarding the various

Biweekly Employee Cost

Monthly Employee Cost

Table II

Employee Only

$0.00

$0.00

Employee + Spouse

$228.77

$457.53 $353.39 $811.01

Employee + Child(ren) $176.70

Employee + Family

$405.51

services, deductibles and copays, please refer to the Summary of Benefits located at the end of this booklet. To compare the premium between the two plans and determine what your biweekly cost will be, see Tables I and II. These tables reflect what the biweekly and monthly costs are. Premiums for benefits are based on 24 pay periods annually. Employees who enroll in a medical plan will be automatically enrolled in a Health Reimbursement Arrangement (HRA) account. An HRA account is an employer-funded plan that reimburses employees for qualified medical expenses at no cost to employees. Depending on the plan that is selected, the EAA will contribute a set dollar

amount towards the employee’s Health Reimbursement Arrangement (HRA) account. For new hires, this contribution amount is prorated. The prorated amount is determined by the number of full months from an employee’s hire date to the remainder of the plan year. For example, if you are hired on July 5th and elect the PPO plan, then the HRA amount

HRA ANNUAL CONTRIBUTION

PPO Plan

$1,000.00 $3,499.99 $1,000.00 $500.00

HDHP Medical

HDHP Dental & Vision

HDHP FSA

will be 5/12th of the annual contribution ($1000/12 X 5 = 416.67). Employees enrolled in the PPO Plan will be enrolled in an HRA that can be applied to medical, dental and vision expenses. Employees enrolled in the HDHP plan will be enrolled in two separate HRA accounts. One account is exclusive to medical expenses and the other is only for dental and vision expenses. If enrolled in the HDHP plan, you will also receive an employer FSA contribution. For more info on FSA accounts, refer to page 17.

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For a brief overview of the two plans, please see the following comparison chart. This chart will allow you to compare the two plans side by side. MEDICAL PLAN SUMMARY COMPARISON CHART The table below reflects an overview of some of the more common services used.

BCBS PPO

BCBS HDHP

OUT-OF- NETWORK

Services you may need Deductible Credit from Prior Credit Coinsurance Stop-loss Credit from Prior Carrier Calendar Year Deductible Individual

IN-NETWORK

IN-NETWORK

OUT-OF-NETWORK

Yes

Yes

Yes

Yes

Yes

No

Yes

No

$5,000 $10,000

$14,700 $29,400

$6,000 $12,000

$12,000 $24,0000

Family

Coinsurance Stop-loss Maximum per cal. year Individual $5,600

Unlimited Unlimited

$6,000 $12.000

Unlimited Unlimited

Family

$14,700

Office Visits

Primary Care Physician

$45 copay $90 copay

100% after cal yr deductible

50% coinsurance

30% coinsurance

Specialist

Virtual Visit (MD Live)

$0 copay

$44 copay

Preventative care

Preventive Care/Screening (Routine Physicals)

No charge; deductible does not apply

No charge; deductible does not apply

50% coinsurance

30% coinsurance

Diagnostic Testing

No charge; deductible does not apply

No charge; deductible does not apply

X-Ray / Blood work

50% coinsurance

30% coinsurance

Other Diagnostic Procedures Imaging (CT/PET scans, MRIs)

100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible

30% coinsurance

50% coinsurance

30% coinsurance

Durable Medical Equipment

30% coinsurance

50% coinsurance

30% coinsurance

Physician/Surgeon Fees

30% coinsurance

50% coinsurance

30% coinsurance

Urgent Care

$75 copay

50% coinsurance

30% coinsurance

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$500 copay plus 30% coinsurance

$500 copay plus 30% coinsurance

100% after cal yr deductible

100% after cal yr deductible

Emergency Room Care

Non-Emergency Situations (Preauthorization required) Facility Charges (Hospital room) 30% coinsurance

100% after cal yr deductible

50% coinsurance

30% coinsurance

Physician/Surgeon Charges

Emergency Medical Transportation

100% after cal yr deductible

100% after cal yr deductible

30% coinsurance

30% coinsurance

Facility Fee

Out-Patient Ambulatory Surgery Center In-Patient Hospital Room Extended Care Services Home Health Care

100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible

30% coinsurance

50% coinsurance

30% coinsurance

30% coinsurance

50% coinsurance

30% coinsurance

30% coinsurance

50% coinsurance

30% coinsurance

Skilled Nursing Facility

No Charge; deductible does not apply

Hospice Care

50% coinsurance

30% coinsurance

Mental Health/Behavior Health/ Substance Abuse Services Inpatient Services 30% coinsurance

50% coinsurance

30% coinsurance

Outpatient Services (Office Visits) All other outpatient services

$45 copay

50% coinsurance

30% coinsurance

30% coinsurance

50% coinsurance

30% coinsurance

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Prescription Drug Coverage Retail Prescription (copays per 30-day supply) Preferred Generic Drugs Preferred $0 Non-Preferred $10

$10 plus 50% additional charge $20 plus 50% additional charge $70 plus 50% additional charge $120 plus 50% additional charge $150 plus 50% additional charge

Non-Preferred Generic Drugs Preferred Brand Drugs

Preferred $10 Non-Preferred $20 Preferred $50 Non-Preferred $70

No charge after deductible plus 50% additional charge

100% after cal yr deductible

Preferred $100 Non-Preferred $120

Non-Preferred Brand Drugs

Preferred Specialty Drugs Non-Preferred Specialty Drugs

$150 per Rx

$250 per Rx $250 plus 50% additional charge Mail Service Prescription (copays per 90-day supply) Deductible does not apply Preferred Generic Drugs No Charge

Non-Preferred Generic Drugs Preferred Brand Drugs Non-Preferred Brand Drugs

$30 per Rx

100% after cal yr deductible

Not Applicable

Not Applicable

$150 per Rx

$300 per Rx More information about prescription drug coverage is available at https://www.bcbstx.com/rx-drugs/drug- lists/drug-lists

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MEDICAL PLAN FEATURES Preferred Pharmacy Network

A Preferred Pharmacy Network is included in your prescription drug benefit plan. When you fill a prescription for up to a 30-day supply of a covered prescription drug from a retail pharmacy that contracts to participate in the Preferred Pharmacy Network, you may pay the lowest copay/coinsurance amount. If you fill a prescription at a non- preferred, in-network pharmacy, you may pay a higher copay or coinsurance. You can also fill a prescription for up to a 90-day supply of a covered prescription drug at a retail pharmacy that participates in the Preferred Pharmacy Network. To find a preferred pharmacy, sign in to myprime.com. Please note that changes may be made to the participating pharmacies in the future BCBS Top Preferred Pharmacies are: HEB, Walmart, Walgreens and Sam’s Club. IMPORTANT: CVS is out of the BCBS network . If you currently fill your prescriptions at CVS, you’ll still have access to more than 55,000 in-network pharmacies nationwide (without CVS). To find a new in-network pharmacy visit myprime.com and select “Find a Pharmacy” or call the Pharmacy Program number on the back of your member ID card. Once you find a new in-network pharmacy, you can easily transfer your prescriptions by doing one of the following: 1. Take your prescription bottle/bag to your new pharmacy. They can contact your current pharmacy to transfer your prescription. 2. Call your new pharmacy and ask them to contact your current pharmacy for your prescription information. 3. Ask your doctor to contact your new pharmacy with your prescription information. Moving to Home Delivery If you take any long-term medicine(s), consider using the PrimeMail home delivery service to help you save time and money. Up to a 90-day supply of your covered prescriptions can be shipped to you anywhere in the U.S., with free standard shipping. To choose home delivery:

1. Register and/or sign in to myprime.com. Click on “Fill with PrimeMail”. 2. Go to “Transfer to PrimeMail” and click on “Fill with PrimeMail”. You can also call PrimeMail at 800-423-1973 to transfer your prescription. Provider Finder Provider Finder from Blue Cross and Blue Shield of Texas (BCBSTX) is an innovative tool for helping you choose a provider, plus estimate, and manage health care costs. By logging in to Blue Access for MembersSM (BAM) you can use Provider Finder to: • Find a network primary care physician, specialist or hospital. • Filter search results by doctor, specialty, ZIP code, language and gender – even get directions.

• Estimate the cost of hundreds of procedures, treatments and tests and your out-of-pocket expenses. • Determine if Blue Distinction Center® (BDC), BDC+ or Blue Distinction Total Care is an option for treatment.

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• View patient feedback or add your review for a provider.

It’s easy to get started with Provider Finder by registering for Blue Access for Members (BAM): 1. Go to bcbstx.com. 2. Click the Log In tab, and then click the Register Now link. 3. Use the information on your BCBSTX ID card to complete the process. 4. Then, log in to BAM. Provider Finder is located under the Doctors & Hospitals tab. You can also call a BCBSTX Customer Service Advocate at the toll-free telephone number on the back of your member ID card for help in locating a provider. Get assistance while you are away from home. Text BCBSTXAPP to 33633 to get the BCBSTX App. The app lets you use BAM while you are on the go. You can stay connected to your claim’s activity, member ID card and coverage details – you can also receive prescription reminders and health tips via text messages. Blue365 Discount Program insurance. There are no claims to file and no referrals or preauthorization’s. Once you sign up for Blue365 at blue365deals.com/bcbstx, weekly “Featured Deals” will be emailed to you. These deals offer special savings for a short period of time. Below are some of the ongoing deals offered to Blue365 members. TruHearing® | Beltone™ | American Hearing Benefits - Members (and possibly their immediate family members) could get savings on hearing tests, evaluations and hearing aids. Jenny Craig® | Sun Basket | Nutrisystem® - Members can work toward reaching their weight loss goals with savings from leading programs. You may save on healthy meals, membership fees (where applicable), nutritional products and services. Fitbit® - You can customize your workout routines with Fitbit’s family of trackers and smartwatches that can be employed seamlessly with your lifestyle, your budget and your goals. Members receive a 20% discount on Fitbit devices plus free shipping. Reebok | SKECHERS® - Reebok, a trusted brand for more than 100 years, makes top athletic equipment for all people, from professional athletes to kids playing soccer. You can get 20% off select models. SKECHERS, an award- winning leader in the footwear industry, offers exclusive pricing on select men’s and women’s styles. You can get 30% off plus free shipping on their online orders. Livekick - Livekick is the future of private fitness. You can choose from training or yoga over live video with a private coach. You can get fit and feel healthier with action-packed 30-minute sessions that you can do from home, gym or hotel while traveling. You’ll also get a free two-week trial and 20% off a monthly plan on any Live Online Personal Training. The Fitness Program The Fitness Program gives you flexible options to help you live a healthy lifestyle. As a Blue Cross and Blue Shield Blue365 is just one more advantage you have by being a Blue Cross and Blue Shield of Texas (BCBSTX) member. With this program, you may save money on health and wellness products and services from top retailers not covered by

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of Texas member, the Fitness Program is available exclusively to you and your covered dependents (age 16 and older). The program gives you access to a nationwide network of fitness locations. Choose one location close to home and one near work or visit locations while traveling. Other program perks include: • Flexible Gym Network: A choice of gym networks to fit your budget and preferences. • Studio Class Network: Boutique-style classes and specialty gyms with pay-as-you-go option and 30% off every 10th class. • Family Friendly: Expands gym network access to your covered dependents at a bundled price discount. • Convenient Payment: Monthly fees are paid via automatic credit card or bank account withdrawals. The Fitness Program Features Mobile App: Allows you to access location search, studio class registration, location check-in and activity history. • Real-time Data: Provided to the mobile app and Well onTarget portals. • Complementary and Alternative Medicine (CAM) Discounts Through the Whole Health Living Choices Program: Save money through a nationwide network of 40,000 health and well-being providers, such as acupuncturists, massage therapists and personal trainers. To take advantage of these discounts, register at whlchoices.com. • Blue PointsSM: Get 2,500 points for joining the Fitness Program. Earn additional points for weekly visits. You can redeem points for apparel, books, electronics, health and personal care items, music and sporting goods. • Web Resources: You can go online to find fitness locations and track your visits Blue365: EyeMed Vision Discount Program The EyeMed Vision Discount through Blue365 offers savings on eyeglasses, contact lenses, eye exams, accessories and laser vision correction. The EyeMed network consists of major national and regional retail locations, such as LENSCRAFTERS®, PEARLE VISION®, Target Optical®, Sears Optical® and JCPenney Optical, as well as independent ophthalmologists and optometrists. Additionally, you may go online to in-network providers at contactsdirect.com Visit eyemedexchange.com/blue365, click Find a Provider and begin your search. Be sure the Advantage network is selected. For more information about Blue365, log in to Blue Access for MembersSM (BAMSM) at bcbstx.com. Click the My Coverage tab at the top, and then click the Discounts link on the left. You do not need a referral. Simply visit any EyeMed provider and show your BCBSTX medical ID card. Note : This is not insurance. When contacting EyeMed or any retailer or provider in the EyeMed Advantage network, be sure to refer to the discount program. Virtual Visits Getting sick after hours or on weekends used to mean a lengthy, costly trip to the emergency room or urgent care

center. But with your virtual visits benefit, provided by Blue Cross and Blue Shield of Texas (BCBSTX) and powered by MDLIVE, the doctor is in 24/7/365. And you don’t have to leave the comfort of your own home. Virtual visits allow you to consult a doctor for non-emergency situations by phone, mobile app or online video anytime, anywhere. Speak to a doctor or schedule an appointment at a time that works best for you.

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With virtual visits, you get: • 24/7 access to an independently contracted, board-certified doctor • Access via online video, mobile app or telephone • If necessary, e-prescription sent to your local pharmacy

Virtual visits doctors can treat a variety of health conditions, including allergies, ear problems (age 12+), pink eye, asthma, fever (age 3+), rash, cold/flu, nausea, sinus infections and more. Also available is talk therapy which allows you to speak with a licensed counselor, therapist or psychiatrist for support with virtual visits, available by appointment. You can choose who you want to work with for issues such as anxiety, depression, trauma and loss or relationship problems. Activate your account or schedule a virtual visit • Go to Blue Access for MembersSM or MDLIVE.com/bcbstx. • Download the MDLIVE app from Apple’s App Store, StoreSM or Google PlayTM. • Call MDLIVE at (888) 680-8646. • Text BCBSTX to 635-483. (MDLIVE’s online assistant Sophie will help you activate your account. 24/7 Nurseline The 24/7 Nurseline from BCBS offers you access to speak to nurses anytime you need them. Their nurses can answer your questions and try to help you decide whether you should go to the emergency room, urgent care center, or make an appointment with your doctor. You can also call the 24/7 Nurseline whenever you or your covered family members need answers to health questions about asthma, headaches, cuts or burns, back pain, high fever, sore throat, diabetes, and much more. When you call, you can access an audio library of more than 1,000 health topics – from allergies to surgeries – with more than 500 topics available in Spanish. Call 800-581-0393 to reach the 24/7 Nurseline and talk to a nurse at any time.

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VISION PLAN The EAA offers voluntary vision insurance through Blue Cross Blue Shield of Texas. Our vision benefits plan gives you the freedom to choose any in-network provider with the option to pick any frames, any lenses, and any contacts. With the right combination of retail and independent doctors, you will have access to providers with weekend and evening hours. Benefits can be applied online at Glasses.com—providing access to a huge selection of frames and lenses with 3-D virtual try-on technology. Please see the table below for a list of pricing for this voluntary pre-tax benefit. Dependent coverage is available to age 26.

For a complete list of in-network providers near you, visit eyemedvisioncare.com/bcbstx or call 1-855-556-8796. For LASIK providers, call 1-877-5LASER6

Vision Plan Biweekly Employee Cost

Monthly Employee Cost

Employee Only

$4.13 $7.84

$8.25 $15.67 $16.49 $24.25

Employee + Spouse

Employee + Child(ren) $8.25

Employee + Family

$12.13

Out-of-Network Reimbursement

Vision Care Service

In-Network Member Cost

FREQUENCY Examination

Once every 12 months Once every 12 months Once every 24 months

Lenses or contact lenses

Frame

Contact lens eval/fitting

N/A

VISION CARE SERVICES Exam with dilation as necessary Contact lens fit and follow up FRAMES Any available frame at provider location

$10 copay

Up to $30

Up to $40 for standard; 10% off retail price for premium

N/A

$0 Copay, $150 Allowance, 20% off balance over $150

Up to $75

STANDARD LENSES Single vision

$25 copay $25 copay $25copay $25 copay $90 copay

Up to $25 Up to $40 Up to $55 Up to $55 Up to $40 Up to $40

Bifocal Trifocal

Lenticular

Standard progressive lens Premium progressive lens LENS OPTIONS Tint (solid and gradient) Scratch resistant coating Polycarbonate lenses Ultraviolet coating Anti-reflective coating

See table on next page

$15

N/A

$0

Up to $5

$0 kids; $40 adults

Up to $5 KIDS

$15

N/A N/A N/A N/A N/A

See table on next page

High index lenses Polarized lenses

20% off retail 20% off retail

Photocromatic/transitions plastic

$75

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Summary of Benefits continued

CONTACT LENSES (in lieu of spectacle lenses) Conventional

$0 copay, $150 Allowance, 15% off balance $0 copay, $150 Allowance, plus balance over $150

Up to $120 Up to $120

Disposable

Medically necessary

$0 copay, paid in full

Up to $210

OTHER Laser vision correction

15% retail price or 5% off promotional price

N/A

Additional pairs benefit

40% off purchase of complete pair of eyeglasses and a 15% off conventional contact lenses once the funded benefit has been used 40% off hearing exams and low price guarantee on discounted hearing aids 20% off non-covered items with limitations

N/A

Amplifon hearing discount

N/A

Additional discounts

N/A

Progressive price list

Member cost in-network

Standard progressive

$90 copay

Premium progressives as follows: Tier 1

$110 $120 $135

Tier 2 Tier 3 Tier 4

$90 copay, 80% of charge less $120 Allowance

Anti-reflective coating price list* Standard anti-reflective coating

Member cost in-network

$45

Premium anti-reflective coatings as follows: Tier 1

$57 $68

Tier 2 Tier 3

80% of charge

Other add-ons price list Photochromic (plastic)

Member cost in-network

$75

Polarized

80% of charge

For additional information regarding the various services and how often you may receive services, please refer to the Summary of Benefits located at the end of this booklet.

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Blue Cross and Blue Shield of Texas reserves the right to make changes to the products on each tier and the member’s out-of-pocket costs. *Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands. Maximize Your Contacts Benefit

With your vision benefit, you’re eligible for either contacts or spectacle lenses within the defined benefit frequency. If you use your benefit for contacts, you’re still eligible to use your frame benefit, too.

$130 frame allowance $10 lens copay $130 contact allowance

Sample vision plan

• You buy contacts (apply $130 contacts allowance) • You buy a pair of glasses (apply $130 frame allowance and 20% off any amount over, plus receive 20% off

Sample member transaction

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DENTAL PLAN

The EAA offers 2 dental insurance plans through Guardian Life. Both plans are PPO plans that can meet your needs; the difference is how out-of-network benefits are reimbursed. If you visit a dentist in the Guardian network, you will receive the most savings through either plan. To verify that your dentist is in network, visit the Guardian website. Make sure PPO is selected under Plan Type and search by location, dentist last name, or office name. If your dentist is in-network, you may consider enrolling in the Value Plan as the coinsurance amounts are higher resulting in increased coverage. If you currently have a dentist that is NOT in the Guardian network, and you do NOT want to change your dentist, you may consider enrolling in the NAP plan as it pays up 90% of the usual and customary rate within the service area for an out-of-network provider. Both plans have an individual deductible of $50. The types of services that you receive at the dentist’s office are categorized by type. The table below will show what percentage the plan covers after you meet your deductible based on the type of services you receive. IMPORTANT: After selecting a plan, you cannot change your selection until the next Open Enrollment period. PREVENTATIVE SERVICES include oral exams, cleanings, X-Rays, fluoride treatment, sealants. BASIC SERVICES include fillings, periodontal maintenance procedures, periodontal services, periodontal surgery, simple extractions, complex extractions, Endodontic Services, root canals. MAJOR SERVICES include bridges & dentures, implants, single crowns, repair and maintenance of crowns, general anesthesia, inlays, onlays, veneers, TMJ.

Guardian Dental Plans

PPO Value Plan

PPO Network Access Plan (NAP)

In-Network

Out-of-Network

In-Network

Out-of-Network

Deductible

$50

$50

Period

Calendar Year 3 per family Preventative

Calendar Year 3 per family Preventative

Family Limit Waived For

Annual Maximum Maximum Rollover Rollover Amount Account Limit Claim Payment Basis Threshold

$1500 plus Maximum Rollover

$1500 plus Maximum Rollover

$700 $350 $1,250

$700 $350 $1,250

Negotiated Fee Schedule

Negotiated Fee Schedule

Negotiated Fee Schedule

90

th % UCR

Coinsurance

Preventative

100% 100%

100% 100%

100%

100%

Basic Major

80% 50%

80% 50%

60%

60%

Orthodontia

50% for children (Orthodontia in Progress – covered)

50% for children (Orthodontia in Progress – covered)

Orthodontia Lifetime Maximum

$1500

$1500

Dependent Age Limits

To Age 26

To Age 26

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Pick the plan that best suits your needs

Value Plan

Network Access Plan (NAP)

In-network and out-of-network benefits are paid at the same coinsurance percentages. Both plans allow you to retain the freedom of choice to see any dentist, in-network or out of network.

Description

Preventive services covered at 100%. Coinsurance for other services is higher than the Network Access Plan (increased coverage).

Preventive services covered at 100%. Coinsurance for other services is lower than the Value Plan (decreased coverage).

Coinsurance

In-Network

Member benefits are based on discounted (negotiated) rates.

Out-of-Network Member pays the difference over network negotiated rates.

Member costs are based on usual and customary (UCR) rates.

For additional information regarding the various services and how often you may receive services, please refer to the Summary of Benefits located at the end of this booklet.

Employee Bi-Weekly Cost

Premiums are the same for either plan. Employee only dental coverage is offered at no cost to employees. If dependents were to be added, then employees will be responsible for the difference of their premium amounts. Refer to the table on the left to view monthly and bi-weekly costs.

Employee Monthly Cost

Dental Rates

Employee Only

$0.00

$0.00

Employee + Spouse Employee + Child(ren) Employee + Family

$30.37 $49.60 $87.58

$15.19 $24.80 $43.79

Guardian’s Dental Maximum Rollover With Maximum Rollover, Guardian will roll over a portion of the unused annual dental maximum into a personal Maximum Rollover Account (MRA), which can be used in future years if the plan’s annual maximum is reached. As an added advantage, additional money is rolled over if in- network dentists are used exclusively during the benefit year. To qualify, a member must have a paid claim (not just a visit) and must not have exceeded the paid claims threshold during the benefit year. Each member's MRA may not exceed the MRA limit. The employee and each enrolled dependent maintain separate MRAs based on their own claim activity. You may view your annual MRA statements online at wvw.GuardianAnytime.com How Maximum Rollover Works If you use $700.00 or less of the $1,500.00 annual maximum and submit at least one claim, then you will be eligible to rollover up to $350.00 of the annual maximum not used. You can accumulate up to $1250 over an extended period of time. ANNUAL MAXIMUM: $1,500.00 THRESHOLD $700.00 MAX ROLLOVER AMOUNT $350.00 IN-NETWORK ONLY ROLLOVER AMOUNT $500.00 MAX ROLLOVER ACCOUNT LIMIT $1,250.00

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International Dental Travel Assistance While traveling internationally. Guardian members can get a referral to a local dentist for immediate dental care through the International Dental Travel Assistance Program. This service is available 24/7, in over 200 countries. Coverage will be considered under the out-of-network benefits. Guardian Davis Vision Access Discount Plan If you are enrolled in dental coverage you can receive discounts on vision care services or supplies from your vision provider if they are under contract with the Davis Vision network. The Guardian Davis Vision Access plan is a

AVERAGE DISCOUNTS

discount program that helps you save and stay on top of your eye care. This discount program does not serve as traditional vision insurance. You must pay the entire discounted fee directly to your Davis Vision network doctor. Discounts are not available from providers outside the Davis Vision network. Find a participating doctor near you by visiting Guardian website or call 1-800-877-7195.

Eye Exams

15% off usual charge 20%-80% off usual charge 10%-20% off usual charge 15%-25% off usual charge

Frames, Standard Lenses and Lens Options

Contact Lens

Contact Lens Professional Services

Laser Surgery

Up to 25% off usual charge

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Manage Your Benefits Go to http://www.Guardianlife.com to access secure information about your Guardian benefits including access to an image of your ID Card and the ability to find a provider. HEALTH REIMBURSEMENT ACCOUNT (HRA) The Health Reimbursement Arrangement (HRA) is administered through Proficient Benefits Solutions. An HRA is an employer sponsored benefit contributed 100% by the EAA and is designed to help offset medical expenses incurred by you. The HRA functions the same as an FSA plan. Even if you do not elect medical and dental coverage for your dependents, you can still utilize your HRA funds to cover their eligible expenses. The HRA contribution provided by the EAA is tied to the medical plan elected. Employees who elect the HDHP plan, are eligible to enroll in the medical HRA and a dental/vision HRA. Employees who elect the PPO plan, are only eligible to enroll in the Medical HRA.

Please refer to the table on the right for annual maximum contribution. As mentioned, for new hires, this contribution amount is prorated. The prorated amount is determined by the number of full months from an employee’s hire date. For example, if you are hired on July 5th and elect the PPO plan, then the HRA amount will be 5/12th of the annual contribution ($1000/12 X 5 = 416.67). Amounts are also prorated for the dental/vision HRA.

HRA ANNUAL CONTRIBUTION January 1 PPO $1,000.00 HDHP Medical $3,499.99 HDHP Dental & Vision $1,000.00

You can receive reimbursement from your HRA for eligible medical, dental and vision expenses incurred by you or an eligible dependent during the current plan year, January 1 – December 31. HRA funds must be reimbursed during the plan year in which the expense was incurred. For example, expenses incurred in plan year 2023, must be reimbursed from funds during the same year (2023). Claims are processed by Proficient Benefit Solutions. You CANNOT cash the HRA annual contribution out and the funds must be spent on eligible expenses. Any money that is not used during the plan year will be rolled over for use in future years for medical expenses up to a maximum of $2,500. At the end of the plan year and allotted run-off period, any funds over $2,500 are rolled over to a Retirement Health Savings Account (RHS) in April of each year. For more information regarding an RHS, please see the RHS section of this booklet. For those enrolled in the PPO Plan, $2500.00 will be rolled into the HRA account for the following year. For those enrolled in the HDHP Plan, $1500.00 of the $2500.00 will be rolled into their Medical HRA account for the following year. The remaining $1000.00 will be rolled over into their Dental and Vision HRA account. Eligible Expenses HRA eligible expenses are the same as FSA eligible expenses. A list of HRA eligible expenses can be found here. HRA Run Off Period December 31st is the last day to incur claims for the 2023 plan year, and you must submit all claims by March 31, 2023. FLEX SPENDING ACCOUNTS (FSA) A Flexible Spending Account (FSA) is a tax advantaged benefit plan administered by Proficient Benefit Solutions that allows employees to set aside portions of their salary to pay for their family’s health and/or daycare expenses. The amount set aside is not subject to payroll taxes. Flexible spending accounts contributions are based on the plan year (October 1, 2023 to September 30, 2024) election. IMPORTANT : You are not eligible to contribute towards a Medical FSA or be enrolled in the employer FSA, if you or your spouse have a Health Savings Account (HSA).

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Medical FSA You can receive reimbursement from your Health Care FSA for eligible medical and dental expenses incurred by you or an eligible dependent using your pre-tax dollars. Claims will be processed through Proficient Benefits Solution. The maximum amount you may contribute to your Health Care FSA for plan year 2023-2024 is $3,050.00. Employees who enroll in the HDHP medical plan will receive FSA funds from the EAA and the amount

is pro-rated if you are a new hire. Please refer to the table on the right for the plan year amount. If you have funds remaining at the end of the plan year, a maximum of $610 will carry over to the next plan year while any funds in excess of $610 will be forfeited.

EAA FSA CONTRIBUTION

PPO

HDHP

October 1

N/A

$500.00

The entire annual amount is prefunded at the beginning of the plan year for immediate use on eligible expenses for current employees. You must enroll as a new hire for the FSA or enroll for the FSA every year during open enrollment or after a qualifying life event. The IRS publishes information on FSAs and eligible expenses on their website. If you have questions about an expense, please contact Proficient at (210) 659-8100, option 1. You may also view a list of eligible expenses on the Proficient Benefits Solution website. Dependent Care FSA A Dependent Care FSA offers an opportunity to save money on daycare expenses for eligible dependents. The maximum amount you may contribute to your Dependent Care FSA is $5,000 for individuals or married couples filing jointly or $2,500 for a married person filing separately. Also, the person whose daycare expenses you are claiming must satisfy the definition of a Tax Dependent, per IRS regulations. If you are a new hire and enrolling mid-year, you may want to choose a lower annual amount now and then increase it during open enrollment for the next year. For example, if you are hired in June and you choose a $4,000 annual contribution amount, that amount is divided by the number of payrolls left in the plan year (October – September) and that amount will be deducted from each paycheck (i.e. you elect $5,000, there are 7 pay periods remaining in the plan year, $714.28 will be deducted from each paycheck). You can receive reimbursement from your Dependent Care FSA for expenses that have already been incurred and only up to the dollar amount that has already been deposited into your account. If you have funds remaining at the end of plan year these funds will be forfeited. FSA Run Off Period September 30th is the last day to incur claims for the 2023-2024 plan year, and you must submit all claims by December 31, 2024. Reimbursement Process for FSA and HRA When you incur an eligible expense for you or your dependents, you may upload the Explanation of Benefits and/or receipts to the Proficient Portal or the Proficient Connect app. Claims are processed on a weekly basis and reimbursements are issued up to the available balance of your FSA and/or your Health Reimbursement Account. Monies will be reimbursed first from an employee’s FSA account then from the HRA account. To receive reimbursements for a covered expense under your health or dental coverage you must submit an itemized receipt or Explanation of Benefits (EOB) issued from the health and/or dental insurance plan. For all eligible expenses, you must submit documentation showing the following information: • Provider Name and Address • Patient Name

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