2024 Cook Parker Benefit Booklet : simplebooklet.com

WELCOME TO OPEN ENROLLMENT Cook Parker & Associates, LLCPICK THE BEST BENEFITS FOR YOU AND YOUR FAMILY. Cook Parker & Associates, LLC strives to provide you and your family with a comprehensive and valuable benefits package. We want to make sure you’re getting the most out of our benefits—that’s why we’ve put together this Open Enrollment Guide. Open enrollment is a short period each year when you can make changes to your benefits. This guide will outline all of the different benefits Cook Parker & Associates, LLC offers, so you can identify which offerings are best for you and your family. Elections you make during open enrollment will become effective on January 1st. If you have questions about any of the benefits mentioned in this guide, please don’t hesitate to reach out to HR.WHO IS ELIGIBLE? If you’re a full-time employee at Cook Parker & Associates, LLC, you’re eligible to enroll in the benefits outlined in this guide. Full-time employees are those who work 30 or more hours per week. In addition, the following family members are eligible for medical, dental and vision coverage:  Spouses Natural, adopted, and court ordered children Grandchildren (if parent is on the plan as a dependent)HOW TO ENROLL Are you ready to enroll? The first step is to review your current benefits. Did you move recently or get married? Verify all of your personal information and make any necessary changes. Once all your information is up to date, it’s time to make your benefit elections. 1-on-1 enrollments will take place on Monday, November 14th.HOW TO MAKE CHANGES Unless you experience a life-changing qualifying event, you cannot make changes to your benefits until the next open enrollment period. Qualifying events include things like:  Marriage, divorce or legal separation Birth or adoption of a child Change in child’s dependent status Death of a spouse, child or other qualified dependent Change in residence Change in employment status or a change in coverage under another employer-sponsored plan

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Insurance PremiumsHealth Insurance Rates Cook Parker & Associates, LLCCook Parker & Associates contributes 80% of the EMPLOYEE ONLY premium.GOLD : G652CHCSILVER : S666CHCDental & Vision Insurance RatesAge RatesPlan ID: G652CHC Network: Blue Choice PPO Network Plan Type: ACA Metallic: GoldMonthly Monthly Monthly Monthly Monthly MonthlyAge Band Medical Cost Age Band Medical Cost Age Band Medical Cost Age Band Medical Cost Age Band Medical Cost Age Band Medical Cost<15 $394.20 23 $515.29 32 $609.59 41 $670.91 50 $920.31 59 $1,341.3015 $429.24 24 $515.29 33 $617.32 42 $682.76 51 $961.02 60 $1,398.5016 $442.63 25 $517.35 34 $625.56 43 $699.25 52 $1,005.85 61 $1,447.9617 $456.03 26 $527.66 35 $629.68 44 $719.86 53 $1,051.19 62 $1,480.4318 $470.46 27 $540.02 36 $633.81 45 $744.08 54 $1,100.14 63 $1,521.1419 $484.89 28 $560.12 37 $637.93 46 $772.94 55 $1,149.10 64+ $1,545.8720 $499.83 29 $576.61 38 $642.05 47 $805.40 56 $1,202.1721 $515.29 30 $584.85 39 $650.30 48 $842.50 57 $1,255.7622 $515.29 31 $597.22 40 $658.54 49 $879.08 58 $1,312.96Age RatesPlan ID: S666CHC Network: Blue Choice PPO Network Plan Type: ACA Metallic: SilverMonthly Monthly Monthly Monthly Monthly MonthlyAge Band Medical Cost Age Band Medical Cost Age Band Medical Cost Age Band Medical Cost Age Band Medical Cost Age Band Medical Cost<15 $343.00 23 $448.37 32 $530.42 41 $583.78 50 $800.79 59 $1,167.1115 $373.49 24 $448.37 33 $537.15 42 $594.09 51 $836.21 60 $1,216.8816 $385.15 25 $450.16 34 $544.32 43 $608.44 52 $875.22 61 $1,259.9217 $396.81 26 $459.13 35 $547.91 44 $626.37 53 $914.67 62 $1,288.1718 $409.36 27 $469.89 36 $551.50 45 $647.45 54 $957.27 63 $1,323.5919 $421.92 28 $487.38 37 $555.08 46 $672.56 55 $999.87 64+ $1,345.1120 $434.92 29 $501.73 38 $558.67 47 $700.80 56 $1,046.0521 $448.37 30 $508.90 39 $565.84 48 $733.08 57 $1,092.6822 $448.37 31 $519.66 40 $573.02 49 $764.92 58 $1,142.45

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Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2024 – 12/31/2024: G652CHC Blue Choice Gold PPOSM820 Coverage for: Individual/Family | Plan Type: PPOBlue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Crossand Blue Shield Association Page 1 of 8The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan wouldshare the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately.This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, visitwww.bcbstx.com/bb/grp/bb_gpsg12bcastxo_tx_2024.pdf or by calling 1-800-521-2227. For general definitions of common terms, such as allowed amount, balance billing,coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at www.healthcare.gov/sbc-glossary/ or call 1-855-756-4448 to request a copy.Important Questions Answers Why This Matters:What is the overalldeductible?Network: $1,500 Individual/$4,500FamilyOut-of-Network: $3,000Individual/$9,000 FamilyGenerally, you must pay all of the costs from providers up to the deductible amount before this planbegins to pay. If you have other family members on the plan, each family member must meet their ownindividual deductible until the total amount of deductible expenses paid by all family members meetsthe overall family deductible.Are there services coveredbefore you meet yourdeductible?Yes. In-Network Preventive HealthCare services, certain services with acopayment, and prescription drugs arecovered before you meet yourdeductible.This plan covers some items and services even if you haven’t yet met the deductible amount. But acopayment or coinsurance may apply. For example, this plan covers certain preventive serviceswithout cost-sharing and before you meet your deductible. See a list of covered preventive services atwww.healthcare.gov/coverage/preventive-care-benefits/.Are there other deductiblesfor specific services?No.You don’t have to meet deductibles for specific services.What is the out-of-pocketlimit for this plan?Network: $5,250 Individual/$10,500FamilyOut-of-Network: UnlimitedIndividual/Unlimited FamilyThe out-of-pocket limit is the most you could pay in a year for covered services. If you have other familymembers in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.What is not included in theout-of-pocket limit?Premiums, balance-billing charges,and health care this plan doesn'tcover.Even though you pay these expenses, they don't count toward the out-of-pocket limit.Will you pay less if you usea network provider?Yes. Seewww.bcbstx.com/go/bcppoor call 1-800-521-2227 for a list ofnetwork providers.This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You willpay the most if you use an out-of-network provider, and you might receive a bill from a provider for thedifference between the provider’s charge and what your plan pays (balance billing). Be aware, yournetwork provider might use an out-of-network provider for some services (such as lab work). Checkwith your provider before you get services.Do you need a referral tosee a specialist?No.You can see the specialist you choose without a referral.

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Page 2 of 8*For more information about limitations and exceptions, see the plan or policy document at www.bcbstx.com/bb/grp/bb_gpsg12bcastxo_tx_2024.pdf.All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.What You Will PayCommonMedical EventServices You MayNeedNetwork Providers(You will pay the least)Out-of-NetworkProviders(You will pay the most)Limitations, Exceptions, & OtherImportant InformationPrimary care visit totreat an injury orillness$45/visit; deductible does not apply 40% coinsurance Virtual Visits are available. See your benefitbooklet* (Your PCP) for details.Specialist visit $90/visit; deductible does not apply 40% coinsurance NoneIf you visit a health careprovider’s office or clinicPreventivecare/screening/immunizationNo Charge; deductible does not apply 40% coinsurance You may have to pay for services that aren'tpreventive. Ask your provider if the servicesneeded are preventive. Then check whatyour plan will pay for.Diagnostic test (x-ray, blood work)20% coinsurance 40% coinsurance Preauthorization may be required. See yourbenefit booklet* (Outpatient Lab and X-Rayservices) for details.If you have a testImaging (CT/PETscans, MRIs)$300/test; deductible does not apply 40% coinsurance Preauthorization may be required. See yourbenefit booklet* (Outpatient Lab and X-Rayservices) for details.Generic drugs(Preferred)Retail - Preferred Participating - No ChargeParticipating - $10/prescriptionMail - No Charge; deductible does not applyRetail - $10/prescription;deductible does not applyplus 50% additionalchargeGeneric drugs (Non-preferred)Retail - Preferred Participating -$10/prescriptionParticipating - $20/prescriptionMail - $30/prescription; deductible does notapplyRetail - $20/prescription;deductible does not applyplus 50% additionalchargeIf you need drugs to treatyour illness or conditionMore information aboutprescription drug coverageis available atwww.bcbstx.com/rx24/6TBrand drugs(Preferred)Retail - Preferred Participating -$50/prescriptionParticipating - $70/prescriptionMail - $150/prescription; deductible does notapplyRetail - $70/prescription;deductible does not applyplus 50% additionalchargeLimited to a 30-day supply at retail (or a 90-day supply at a network of select retailpharmacies). Up to a 90-day supply at mailorder. Specialty drugs limited to a 30-daysupply except for certain FDA-designateddosing regimens. Payment of the differencebetween the cost of a brand name drug and ageneric may also be required if a genericdrug is available. Additional Out-of-Networkcharge will not apply to any deductible or out-of-pocket amounts. Certain drugs requireapproval before they will be covered. Costsharing for insulin included in the drug list willnot exceed $25 per prescription for a 30-day

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Page 3 of 8*For more information about limitations and exceptions, see the plan or policy document at www.bcbstx.com/bb/grp/bb_gpsg12bcastxo_tx_2024.pdf.What You Will PayCommonMedical EventServices You MayNeedNetwork Providers(You will pay the least)Out-of-NetworkProviders(You will pay the most)Limitations, Exceptions, & OtherImportant InformationBrand drugs (Non-preferred)Retail - Preferred Participating -$100/prescriptionParticipating - $120/prescriptionMail - $300/prescription; deductible does notapplyRetail - $120/prescription;deductible does not applyplus 50% additionalchargeSpecialty drugs(Preferred)$150/prescription; deductible does not apply $150/prescription;deductible does not applyplus 50% additionalchargeSpecialty drugs(Non-preferred)$250/prescription; deductible does not apply $250/prescription;deductible does not applyplus 50% additionalchargesupply, regardless of the amount or type ofinsulin needed to fill the prescription.Facility fee (e.g.,ambulatory surgerycenter)20% coinsurance 40% coinsuranceIf you have outpatientsurgeryPhysician/surgeonfees20% coinsurance 40% coinsurancePreauthorization may be required. ForOutpatient Infusion Therapy, see your benefitbooklet* (Outpatient Facility Services) fordetails.Emergency roomcare$500/visit plus 20% coinsurance $500/visit plus 20%coinsuranceCopayment waived if admitted. Out-of-Network cost share is subject to Networkdeductible.Emergency medicaltransportation20% coinsurance 20% coinsurance Preauthorization may be required for non-emergency transportation; see your benefitbooklet* (Ambulance Services) for details.If you need immediatemedical attentionUrgent care $100/visit; deductible does not apply 40% coinsurance NoneFacility fee (e.g.,hospital room)20% coinsurance 40% coinsurance Preauthorization required. Preauthorizationpenalty: $250 Out-of-Network. See yourbenefit booklet* (Inpatient Hospital Services)for details.If you have a hospital stayPhysician/surgeonfees20% coinsurance 40% coinsurance Preauthorization required. See your benefitbooklet* (Inpatient Professional Services) fordetails.

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Page 4 of 8*For more information about limitations and exceptions, see the plan or policy document at www.bcbstx.com/bb/grp/bb_gpsg12bcastxo_tx_2024.pdf.What You Will PayCommonMedical EventServices You MayNeedNetwork Providers(You will pay the least)Out-of-NetworkProviders(You will pay the most)Limitations, Exceptions, & OtherImportant InformationOutpatient services $45/office visit; deductible does not apply;20% coinsurance for other outpatient services40% coinsurance Preauthorization may be required; see yourbenefit booklet* (Behavioral Health Services)for details.If you need mental health,behavioral health, orsubstance abuse servicesInpatient services 20% coinsurance 40% coinsurance Preauthorization required. Preauthorizationpenalty: $250 Out-of-Network. See yourbenefit booklet* (Behavioral Health Services)for details.Office visits Primary Care: $45/initial visit; deductible doesnot applySpecialist: $90/initial visit; deductible does notapply40% coinsuranceChildbirth/deliveryprofessional services20% coinsurance 40% coinsuranceIf you are pregnantChildbirth/deliveryfacility services20% coinsurance 40% coinsuranceCopayment applies to first prenatal visit (perpregnancy). Cost sharing does not apply forpreventive services. Depending on the typeof services, copayment, coinsurance, ordeductible may apply. Maternity care mayinclude tests and services describedelsewhere in the SBC (i.e., ultrasound).Home health care 20% coinsurance 40% coinsurance 60 visits/year. Preauthorization may berequired; see your benefit booklet* (ExtendedCare Services) for details.Rehabilitationservices20% coinsurance 40% coinsuranceHabilitation services 20% coinsurance 40% coinsuranceSeparate 35-visit maximum per benefit periodfor Habilitation and Rehabilitation services,including chiropractic care. Preauthorizationmay be required; see your benefit booklet*(Rehabilitation Services and HabilitationServices) for details.Skilled nursing care 20% coinsurance 40% coinsurance 25 days/year. Preauthorization may berequired; see your benefit booklet* (ExtendedCare Services) for details.Durable medicalequipment20% coinsurance 40% coinsurance Preauthorization may be required. See yourbenefit booklet* (Durable Medical Equipment)for details.If you need help recoveringor have other special healthneedsHospice services 20% coinsurance 40% coinsurance Preauthorization may be required. See yourbenefit booklet* (Extended Care Services) fordetails.

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Page 5 of 8*For more information about limitations and exceptions, see the plan or policy document at www.bcbstx.com/bb/grp/bb_gpsg12bcastxo_tx_2024.pdf.What You Will PayCommonMedical EventServices You MayNeedNetwork Providers(You will pay the least)Out-of-NetworkProviders(You will pay the most)Limitations, Exceptions, & OtherImportant InformationChildren’s eye exam No Charge; deductible does not apply Up to a $30reimbursement isavailable; deductible doesnot applyOne visit per year. Out-of-Networkreimbursement will not exceed the retail cost.See your benefit booklet* (Pediatric VisionCare Benefits) for details.Children’s glasses No Charge; deductible does not apply Up to a $75reimbursement isavailable; deductible doesnot applyOne pair of glasses every 12 months.Reimbursement for frames, lenses, and lensoptions purchased Out-of-Network isavailable (not to exceed the retail cost). Seeyour benefit booklet* (Pediatric Vision CareBenefits) for details.If your child needs dental oreye careChildren’s dentalcheck-up30% coinsurance 30% coinsuranceOral exams are limited to two every benefitperiod. Benefits for periodic andcomprehensive oral evaluations are limitedto a combined maximum of two every 12months. See your benefit booklet*(Pediatric Dental Benefits Rider) for details.

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Page 8 of 8The plan would be responsible for the other costs of these EXAMPLE covered services.Peg is Having a Baby(9 months of in-network pre-natal care and ahospital delivery)Mia’s Simple Fracture(in-network emergency room visit and followup care)Managing Joe’s Type 2 Diabetes(a year of routine in-network care of a well-controlled condition)The plan’s overall deductible $1,500Specialist copayment $90Hospital (facility) coinsurance 20%Other coinsurance 20%This EXAMPLE event includes services like:Specialist office visits (prenatal care)Childbirth/Delivery Professional ServicesChildbirth/Delivery Facility ServicesDiagnostic tests (ultrasounds and blood work)Specialist visit (anesthesia)Total Example Cost $12,700In this example, Peg would pay:Cost sharingDeductibles $1,500Copayments $400Coinsurance $2,100What isn’t coveredLimits or exclusions $60The total Peg would pay is $4,060The plan’s overall deductible $1,500Specialist copayment $90Hospital (facility) coinsurance 20%Other coinsurance 20%This EXAMPLE event includes services like:Primary care physician office visits (includingdisease education)Diagnostic tests (blood work)Prescription drugsDurable medical equipment (glucose meter)Total Example Cost $5,600In this example, Joe would pay:Cost sharingDeductibles $900Copayments $800Coinsurance $0What isn’t coveredLimits or exclusions $20The total Joe would pay is $1,720The plan’s overall deductible $1,500Specialist copayment $90Hospital (facility) coinsurance 20%Other coinsurance 20%This EXAMPLE event includes services like:Emergency room care (including medical supplies)Diagnostic test (x-ray)Durable medical equipment (crutches)Rehabilitation services (physical therapy)Total Example Cost $2,800In this example, Mia would pay:Cost sharingDeductibles $1,500Copayments $700Coinsurance $100What isn’t coveredLimits or exclusions $0The total Mia would pay is $2,300About these Coverage Examples:This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will bedifferent depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharingamounts (deductibles, copayments, and coinsurance) and excluded services under the plan. Use this information to compare the portionof costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.

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Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2024 – 12/31/2024: S666CHC Blue Choice Silver PPOSM844 Coverage for: Individual/Family | Plan Type: PPOBlue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Crossand Blue Shield Association Page 1 of 8The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan wouldshare the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately.This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, visitwww.bcbstx.com/bb/grp/bb_spsg15bcastxo_tx_2024.pdf or by calling 1-800-521-2227. For general definitions of common terms, such as allowed amount, balance billing,coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at www.healthcare.gov/sbc-glossary/ or call 1-855-756-4448 to request a copy.Important Questions Answers Why This Matters:What is the overalldeductible?Network: $4,250 Individual/$12,750FamilyOut-of-Network: $8,500Individual/$25,500 FamilyGenerally, you must pay all of the costs from providers up to the deductible amount before this planbegins to pay. If you have other family members on the plan, each family member must meet their ownindividual deductible until the total amount of deductible expenses paid by all family members meetsthe overall family deductible.Are there services coveredbefore you meet yourdeductible?Yes. In-Network Preventive HealthCare services, certain services with acopayment, and prescription drugs arecovered before you meet yourdeductible.This plan covers some items and services even if you haven’t yet met the deductible amount. But acopayment or coinsurance may apply. For example, this plan covers certain preventive serviceswithout cost-sharing and before you meet your deductible. See a list of covered preventive services atwww.healthcare.gov/coverage/preventive-care-benefits/.Are there other deductiblesfor specific services?No.You don’t have to meet deductibles for specific services.What is the out-of-pocketlimit for this plan?Network: $9,000 Individual/$18,000FamilyOut-of-Network: UnlimitedIndividual/Unlimited FamilyThe out-of-pocket limit is the most you could pay in a year for covered services. If you have other familymembers in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.What is not included in theout-of-pocket limit?Premiums, balance-billing charges,and health care this plan doesn'tcover.Even though you pay these expenses, they don't count toward the out-of-pocket limit.Will you pay less if you usea network provider?Yes. Seewww.bcbstx.com/go/bcppoor call 1-800-521-2227 for a list ofnetwork providers.This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You willpay the most if you use an out-of-network provider, and you might receive a bill from a provider for thedifference between the provider’s charge and what your plan pays (balance billing). Be aware, yournetwork provider might use an out-of-network provider for some services (such as lab work). Checkwith your provider before you get services.Do you need a referral tosee a specialist?No.You can see the specialist you choose without a referral.

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Page 2 of 8*For more information about limitations and exceptions, see the plan or policy document at www.bcbstx.com/bb/grp/bb_spsg15bcastxo_tx_2024.pdf.All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.What You Will PayCommonMedical EventServices You MayNeedNetwork Providers(You will pay the least)Out-of-NetworkProviders(You will pay the most)Limitations, Exceptions, & OtherImportant InformationPrimary care visit totreat an injury orillness$50/visit; deductible does not apply 50% coinsurance Virtual Visits are available. See your benefitbooklet* (Your PCP) for details.Specialist visit $90/visit; deductible does not apply 50% coinsurance NoneIf you visit a health careprovider’s office or clinicPreventivecare/screening/immunizationNo Charge; deductible does not apply 50% coinsurance You may have to pay for services that aren'tpreventive. Ask your provider if the servicesneeded are preventive. Then check whatyour plan will pay for.Diagnostic test (x-ray, blood work)30% coinsurance 50% coinsurance Preauthorization may be required. See yourbenefit booklet* (Outpatient Lab and X-Rayservices) for details.If you have a testImaging (CT/PETscans, MRIs)$300/test; deductible does not apply 50% coinsurance Preauthorization may be required. See yourbenefit booklet* (Outpatient Lab and X-Rayservices) for details.Generic drugs(Preferred)Retail - Preferred Participating - $5/prescriptionParticipating - $15/prescriptionMail - $15/prescription; deductible does notapplyRetail - $15/prescription;deductible does not applyplus 50% additionalchargeGeneric drugs (Non-preferred)Retail - Preferred Participating -$15/prescriptionParticipating - $25/prescriptionMail - $45/prescription; deductible does notapplyRetail - $25/prescription;deductible does not applyplus 50% additionalchargeIf you need drugs to treatyour illness or conditionMore information aboutprescription drug coverageis available atwww.bcbstx.com/rx24/6TBrand drugs(Preferred)Retail - Preferred Participating -$50/prescriptionParticipating - $70/prescriptionMail - $150/prescription; deductible does notapplyRetail - $70/prescription;deductible does not applyplus 50% additionalchargeLimited to a 30-day supply at retail (or a 90-day supply at a network of select retailpharmacies). Up to a 90-day supply at mailorder. Specialty drugs limited to a 30-daysupply except for certain FDA-designateddosing regimens. Payment of the differencebetween the cost of a brand name drug and ageneric may also be required if a genericdrug is available. Additional Out-of-Networkcharge will not apply to any deductible or out-of-pocket amounts. Certain drugs requireapproval before they will be covered. Costsharing for insulin included in the drug list willnot exceed $25 per prescription for a 30-day

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Page 3 of 8*For more information about limitations and exceptions, see the plan or policy document at www.bcbstx.com/bb/grp/bb_spsg15bcastxo_tx_2024.pdf.What You Will PayCommonMedical EventServices You MayNeedNetwork Providers(You will pay the least)Out-of-NetworkProviders(You will pay the most)Limitations, Exceptions, & OtherImportant InformationBrand drugs (Non-preferred)Retail - Preferred Participating -$100/prescriptionParticipating - $120/prescriptionMail - $300/prescription; deductible does notapplyRetail - $120/prescription;deductible does not applyplus 50% additionalchargeSpecialty drugs(Preferred)$250/prescription; deductible does not apply $250/prescription;deductible does not applyplus 50% additionalchargeSpecialty drugs(Non-preferred)$350/prescription; deductible does not apply $350/prescription;deductible does not applyplus 50% additionalchargesupply, regardless of the amount or type ofinsulin needed to fill the prescription.Facility fee (e.g.,ambulatory surgerycenter)$250/visit plus 30% coinsurance $300/visit plus 50%coinsuranceIf you have outpatientsurgeryPhysician/surgeonfees30% coinsurance 50% coinsurancePreauthorization may be required. ForOutpatient Infusion Therapy, see your benefitbooklet* (Outpatient Facility Services) fordetails.Emergency roomcare$650/visit plus 30% coinsurance $650/visit plus 30%coinsuranceCopayment waived if admitted. Out-of-Network cost share is subject to Networkdeductible.Emergency medicaltransportation30% coinsurance 30% coinsurance Preauthorization may be required for non-emergency transportation; see your benefitbooklet* (Ambulance Services) for details.If you need immediatemedical attentionUrgent care $100/visit; deductible does not apply 50% coinsurance NoneFacility fee (e.g.,hospital room)$300/visit plus 30% coinsurance $350/visit plus 50%coinsurancePreauthorization required. Preauthorizationpenalty: $250 Out-of-Network. See yourbenefit booklet* (Inpatient Hospital Services)for details.If you have a hospital stayPhysician/surgeonfees30% coinsurance 50% coinsurance Preauthorization required. See your benefitbooklet* (Inpatient Professional Services) fordetails.

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Page 4 of 8*For more information about limitations and exceptions, see the plan or policy document at www.bcbstx.com/bb/grp/bb_spsg15bcastxo_tx_2024.pdf.What You Will PayCommonMedical EventServices You MayNeedNetwork Providers(You will pay the least)Out-of-NetworkProviders(You will pay the most)Limitations, Exceptions, & OtherImportant InformationOutpatient services $50/office visit; deductible does not apply;30% coinsurance for other outpatient services50% coinsurance Preauthorization may be required; see yourbenefit booklet* (Behavioral Health Services)for details.If you need mental health,behavioral health, orsubstance abuse servicesInpatient services $300/visit plus 30% coinsurance $350/visit plus 50%coinsurancePreauthorization required. Preauthorizationpenalty: $250 Out-of-Network. See yourbenefit booklet* (Behavioral Health Services)for details.Office visits Primary Care: $50/initial visit; deductible doesnot applySpecialist: $90/initial visit; deductible does notapply50% coinsuranceChildbirth/deliveryprofessional services30% coinsurance 50% coinsuranceIf you are pregnantChildbirth/deliveryfacility services$300/visit plus 30% coinsurance $350/visit plus 50%coinsuranceCopayment applies to first prenatal visit (perpregnancy). Cost sharing does not apply forpreventive services. Depending on the typeof services, copayment, coinsurance, ordeductible may apply. Maternity care mayinclude tests and services describedelsewhere in the SBC (i.e., ultrasound).Home health care 30% coinsurance 50% coinsurance 60 visits/year. Preauthorization may berequired; see your benefit booklet* (ExtendedCare Services) for details.Rehabilitationservices30% coinsurance 50% coinsuranceHabilitation services 30% coinsurance 50% coinsuranceSeparate 35-visit maximum per benefit periodfor Habilitation and Rehabilitation services,including chiropractic care. Preauthorizationmay be required; see your benefit booklet*(Rehabilitation Services and HabilitationServices) for details.Skilled nursing care 30% coinsurance 50% coinsurance 25 days/year. Preauthorization may berequired; see your benefit booklet* (ExtendedCare Services) for details.Durable medicalequipment30% coinsurance 50% coinsurance Preauthorization may be required. See yourbenefit booklet* (Durable Medical Equipment)for details.If you need help recoveringor have other special healthneedsHospice services 30% coinsurance 50% coinsurance Preauthorization may be required. See yourbenefit booklet* (Extended Care Services) fordetails.

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Page 5 of 8*For more information about limitations and exceptions, see the plan or policy document at www.bcbstx.com/bb/grp/bb_spsg15bcastxo_tx_2024.pdf.What You Will PayCommonMedical EventServices You MayNeedNetwork Providers(You will pay the least)Out-of-NetworkProviders(You will pay the most)Limitations, Exceptions, & OtherImportant InformationChildren’s eye exam No Charge; deductible does not apply Up to a $30reimbursement isavailable; deductible doesnot applyOne visit per year. Out-of-Networkreimbursement will not exceed the retail cost.See your benefit booklet* (Pediatric VisionCare Benefits) for details.Children’s glasses No Charge; deductible does not apply Up to a $75reimbursement isavailable; deductible doesnot applyOne pair of glasses every 12 months.Reimbursement for frames, lenses, and lensoptions purchased Out-of-Network isavailable (not to exceed the retail cost). Seeyour benefit booklet* (Pediatric Vision CareBenefits) for details.If your child needs dental oreye careChildren’s dentalcheck-up30% coinsurance 30% coinsuranceOral exams are limited to two every benefitperiod. Benefits for periodic andcomprehensive oral evaluations are limitedto a combined maximum of two every 12months. See your benefit booklet*(Pediatric Dental Benefits Rider) for details.

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Page 8 of 8The plan would be responsible for the other costs of these EXAMPLE covered services.Peg is Having a Baby(9 months of in-network pre-natal care and ahospital delivery)Mia’s Simple Fracture(in-network emergency room visit and followup care)Managing Joe’s Type 2 Diabetes(a year of routine in-network care of a well-controlled condition)The plan’s overall deductible $4,250Specialist copayment $90Hospital (facility) copayment/coinsurance$300+30%Other coinsurance 30%This EXAMPLE event includes services like:Specialist office visits (prenatal care)Childbirth/Delivery Professional ServicesChildbirth/Delivery Facility ServicesDiagnostic tests (ultrasounds and blood work)Specialist visit (anesthesia)Total Example Cost $12,700In this example, Peg would pay:Cost sharingDeductibles $4,250Copayments $700Coinsurance $2,300What isn’t coveredLimits or exclusions $60The total Peg would pay is $7,310The plan’s overall deductible $4,250Specialist copayment $90Hospital (facility) copayment/coinsurance$300+30%Other coinsurance 30%This EXAMPLE event includes services like:Primary care physician office visits (includingdisease education)Diagnostic tests (blood work)Prescription drugsDurable medical equipment (glucose meter)Total Example Cost $5,600In this example, Joe would pay:Cost sharingDeductibles $900Copayments $1,000Coinsurance $0What isn’t coveredLimits or exclusions $20The total Joe would pay is $1,920The plan’s overall deductible $4,250Specialist copayment $90Hospital (facility) copayment/coinsurance$300+30%Other coinsurance 30%This EXAMPLE event includes services like:Emergency room care (including medical supplies)Diagnostic test (x-ray)Durable medical equipment (crutches)Rehabilitation services (physical therapy)Total Example Cost $2,800In this example, Mia would pay:Cost sharingDeductibles $2,000Copayments $700Coinsurance $0What isn’t coveredLimits or exclusions $0The total Mia would pay is $2,700About these Coverage Examples:This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will bedifferent depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharingamounts (deductibles, copayments, and coinsurance) and excluded services under the plan. Use this information to compare the portionof costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.

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Eye Exam, Lenses, Frames, Frequencies VSP Choice Network + Affiliates Out of Network Annual Eye Exam Covered in full Up to $45 Lenses (per pair) Single Vision Covered in full Up to $30 Bifocal Covered in full Up to $50 Trifocal Covered in full Up to $65 Lenticular Covered in full Up to $100 Progressive See lens options NA Frame Allowance $150** Up to $75Frequencies Exam/Lens/Frames 12/12/24 12/12/24Based on date of service Based on date of service **The Costco and Walmart allowance will be the wholesale equivalent. Deductible, Maximum Deductibles $10 Exam $10 Exam $25 Eye Glass Lenses or Frames* $25 Eye Glass Lenses or Frames Maximum per benefit period None None *Deductible applies to a complete pair of glasses or to frames, whichever is selected.Contact Lenses Fit & Follow Up Exams Member cost up to $60 No benefit Contacts Elective Up to $150 Up to $120Medically Necessary Covered in full Up to $210 Vision BenefitLens Options (member cost)* VSP Choice Network + Affiliates Out of Network (Other than Costco) Progressive Lenses Up to provider's contracted fee for Lined Bifocal Lenses. The patient is responsible for the difference between the base lens and the Progressive Lens charge. Up to Lined Bifocal allowance. Std. Polycarbonate Covered in full for dependent children $33 adults No benefit Scratch Resistant Coating $17-$33 No benefit Anti-Reflective Coating $43-$85 No benefit Ultraviolet Coating $16 No benefit *Lens Option member costs vary by prescription, option chosen and retail locations.Additional Focus® Choice Network Features (In Network) Contact Lenses Elective Allowance can be applied to disposables, but the dollar amount must be used all at once (provider will order 3 or 6 month supply). Applies when contacts are chosen in lieu of glasses. For plans without a separate contact fitting & evaluation (which includes follow up contact lens exams), the cost of the fitting and evaluation is deducted from the allowance. Lens Options (Member Cost)* $15 - Solid Plastic Dye (Except Pink I & II) $17 - Plastic Gradient Dye $31-$82 - Photochromatic Lenses (Glass & Plastic) Lens Option member cost vary by prescription and option chosen. Additional Glasses 20% off additional complete pairs of prescription glasses and/or prescription sunglasses.* Frame Discount VSP offers 20% off any amount above the retail allowance.* Laser VisionCareSM VSP offers an average discount of 15% off or 5% off a promotional offer for LASIK Custom LASIK and PRK. The maximum out-of-pocket per eye for members is $1,800 for LASIK and $2,300 for custom LASIK using Wavefront technology, and $1,500 for PRK. In order to receive the benefit, a VSP provider must coordinate the procedure. Low Vision With prior authorization, 75% of approved amount (up to $1,000 is covered every two years). Based on applicable laws, reduced costs may vary by doctor location.

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Basic Life and AD&D Insurance Cook Parker & Associates, LLC provides a Life Insurance and Accidental Death and Dismemberment (AD&D) Insurance to all full‐time employees working at least 30 hours per week. This benefit is provided at no cost to you through Mutual of Omaha. Coverage is provided based on employee class:• $25,000 for admin employees• $50,000 for accountants and partnersPlease make sure to update your beneficiary information during open enrollment. Benefits for Basic Life and AD&D reduced by 35% at age 65, and by 50% at age 70.Long Term Disability Pays up to 60% of your salary up to $6,000 monthly.Your benefitsbegin180daysafterthe onsetofyourdisablinginjuryorillness.This benefit is provided to you by Cook Parker & Associates and they cover 100% of the cost!!!LifeInsurance and LTDThis benefit is provided to you by Cook Parker & Associates and they cover 100% of the cost!!!AdditionalInsuranceThe following pages are for additional insurance products provided by Colonial Life:• Accident Insurance• Critical Illness / Cancer Insurance• Hospital Confinement (Medical Bridge)• Voluntary Short-Term Disability• Individual Term Life• Individual Whole LifeFor rates, speak to your Colonial rep during open enrollment!

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For more information, talk with your benefits counselor.Group Accident InsurancePreferred PlanColonialLife.comGAC4000 – PREFERRED PLANGroup accident insurance can help with medical or other costs associated with a covered accident or injury that your health insurance may not cover. With this coverage you may not need to use your savings or secure a loan to help pay those unexpected out-of-pocket expenses. Coverage options are available for you, your spouse and eligible dependent children. Benefits are per covered person per covered accident unless stated otherwiseAccident emergency treatment ................................................................................................ $150 One visit per covered person per covered accident and Up to four visits per covered person per calendar yearAccident follow-up doctor visit ..................................................................................................$50Up to four visits per covered person per covered accident andUp to 16 visits per covered person per calendar yearAccidental death Accidental deathPer covered person Accidental death common carrier¾ Named insured .....................................................................$50,000 .................. $200,000¾ Spouse ...............................................................................$50,000 .................. $200,000¾ Dependent child(ren) .............................................................. $10,000 ....................$40,000Examples of common carriers are mass transit trains, buses and planesAccidental dismembermentLoss or loss of use¾ One hand, arm, foot, leg or sight of an eye ......................................................................... $9,000¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination ................................ $18,000¾ One finger or one toe ................................................................................................... $1,050¾ Two or more fingers; two or more toes; or any combination ................................................... $2,100Air ambulance .................................................................................................................. $1,500 Transportation to or from a hospital or medical facilityAmbulance (ground).............................................................................................................. $300 Transportation to or from a hospital or medical facilityAppliance aid in personal locomotion or mobility ......................................................................... $100Walking boot, neck brace, back brace, leg brace, cane, crutches, walker and wheelchairBlood/plasma/platelets ......................................................................................................... $400 Required during treatment of a covered accidentBurn¾ 2nd-degree burns (covering at least 36% of the body’s surface) ..................................................$1,000¾ 3rd-degree burns (based on size) ......................................................................... $2,000 – $15,000Burn–skin gra ................................................................................... 50% of applicable burn benefitAs a result of 2nd-degree or 3rd-degree burns

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Catastrophic accidentTotal and irrecoverable loss or loss of use¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination; or¾ Loss of hearing in both ears or loss of ability to speak Subject to a 365-day elimination period; payable once per lifetime per covered person¾ Named insured ..................................................................................................................................................$50,000¾ Spouse ..................................................................................................................................................................$50,000 ¾ Dependent child(ren) .......................................................................................................................................$25,000Coma ...............................................................................................................$10,000Lasting for 14 or more consecutive daysConcussion ............................................................................................................ $375Dislocation (separated joint) Non-surgical Surgical¾ Hip ........................................................................................$3,000 $6,000¾ Knee (except patella) ..................................................................$1,500 $3,000¾ Ankle, bone or bones of the foot (other than toes) ...............................$1,200 $2,400¾ Collarbone (sternoclavicular) ..........................................................$800 $1,600¾ Collarbone (acromioclavicular and separation) ....................................$200 $400¾ Lower jaw ..................................................................................$720 $1,440¾ Shoulder (glenohumeral) ............................................................ $1,200 $2,400¾ Elbow ....................................................................................... $450 $900¾ Wrist ........................................................................................$600 $1,200¾ Bone(s) of the hand, (other than fingers) ............................................. $810 $1,620¾ Finger, toe ..................................................................................$200 $400¾ Incomplete dislocation or dislocation reduction.................................. 25% of the applicable without anesthesia non-surgical amountEmergency dental work ¾ Dental crown or denture ....................................................................................$300 ¾ Dental extraction .............................................................................................$100 Eye injury ..............................................................................................................$300 With surgical repair or removal of a foreign objectFracture (broken bone) Non-surgical Surgical¾ Skull, depressed fracture (except face/nose) ......................................$3,750 $7,500¾ Skull, simple non-depressed fracture (except face/nose) .......................$1,800 $3,600¾ Hip, thigh (femur) ......................................................................$3,150 $6,300¾ Body of vertebrae (excluding vertebral processes) ...............................$2,700 $5,400¾ Pelvis .....................................................................................$2,400 $4,800¾ Leg (tibia and/or fibula) ...............................................................$1,800 $3,600¾ Bones of the face or nose (except mandible or maxilla) ...........................$910 $1,820¾ Upper jaw, maxilla, upper arm between .......................................... $1,050 $2,100 elbow and shoulder¾ Lower jaw, mandible ................................................................. $1,200 $2,400¾ Kneecap, ankle, foot .................................................................. $1,200 $2,400¾ Shoulder blade, collarbone ......................................................... $1,200 $2,400¾ Vertebral processes ...................................................................... $630 $1,260¾ Forearm, hand, wrist ................................................................. $1,200 $2,400¾ Rib ..........................................................................................$375 $750¾ Coccyx .....................................................................................$320 $640¾ Finger, toe .................................................................................$200 $400¾ Chip fracture .................................................25% of the applicable non-surgical amountAlex was cleaning out the gutters when he fell. ALEX’S BENEFITS Ambulance $300Emergency room visit $150X-ray $60Hospital admission $1,000Hospital confinement $750Leg fracture (surgical) $3,600Physical therapy $360Appliance (crutches) $100Doctor’s follow-up oice visit $150$6,470EMERGENCY ROOM VISITAlex was taken by ambulance to the nearest emergency room and received immediate care.The doctor ordered an X-ray and discovered Alex had fractured his leg.DIAGNOSTIC PROCEDUREOver the next several weeks, he had three follow-up appointments with his doctor.DOCTORʼS OFFICE VISITAlex had eight sessions of PT to help him regain the strength in his leg.PHYSICAL THERAPYAlex was admitted to the hospital for surgery on his leg. He was confined for three days.HOSPITAL CONFINEMENTFor illustrative purposes only.Benefit amounts may vary and may not cover all expenses. The certificate has exclusions and limitations.ALEXʼS OUT-OF-POCKET EXPENSESWhen Alex totaled up the bills, he had to pay his annual deductible, as well as co-payments for the ambulance, emergency room, hospital, surgery, physical therapy and follow-up visits. Luckily, Alex had accident coverage to help with these expenses.Alex used crutches.APPLIANCE FOR MOBILITY

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For more information, talk with your benefits counselor.GAC4000 – PREFERRED PLANHospital admission .............................................................................................................$1,000Per covered person per covered accidentHospital confinement .................................................................................................. $250 per dayUp to 365 days per covered person per covered accidentHospital intensive care unit admission .................................................................................... $1,750 Per covered person per covered accidentHospital intensive care unit confinement ........................................................................ $400 per day Up to 15 days per covered person per covered accident Knee cartilage (torn) ............................................................................................................. $750 Laceration (no repair, without stitches) ..........................................................................................$50 Laceration (repaired by stitches)¾ Total of all lacerations is less than two inches long ................................................................... $150¾ Total of all lacerations is at least two but less than six inches long ................................................. $300 ¾ Total of all lacerations is six inches or longer ........................................................................... $600 Lodging (companion) ..................................................................................................$200 per day Up to 30 days per covered person per covered accident Medical imaging study (CT, CAT scan, EEG, MR or MRI) ..................................................................... $200 One benefit per covered person per covered accident per calendar yearOccupational or physical therapy ....................................................................................$45 per day Up to 10 days per covered person per covered accident Pain management for epidural anesthesia .................................................................................. $150 Prosthetic device/artificial limb One benefit per covered person per covered accident¾ One ....................................................................................................................... $1,250 ¾ More than one ........................................................................................................... $2,500 Rehabilitation unit confinement ....................................................................................$150 per day Immediately aer a period of hospital confinement due to a covered accident; up to 15 days per covered person per covered accident, not to exceed 30 days per covered person per calendar yearRuptured disc with surgical repair ............................................................................................ $900 Surgery¾ Cranial, open abdominal and thoracic .............................................................................. $1,500 ¾ Hernia with surgical repair ............................................................................................... $300Surgery (exploratory and arthroscopic) ....................................................................................... $225Tendon/ligament/rotator cu¾ One with surgical repair .................................................................................................. $900 ¾ Two or more with surgical repair ..................................................................................... $1,800 Transportation for hospital confinement ...................................................................$600 per round tripUp to three round trips for more than 50 miles from home per covered person per covered accidentX-ray ...................................................................................................................................$60

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For more information, talk with your benefits counselor.Group Critical Illness InsurancePlan 2 FullColonialLife.comIf you’re diagnosed with a covered critical illness or cancer, group critical illness insurance* from Colonial Life can help with your expenses, so you can concentrate on what’s most important – your treatment, care and recovery.*The policy name is Critical Illness and Cancer Group Specified Disease Insurance.For the diagnosis of this covered critical illness condition:1This percentage of the face amount is payable:Heart attack (myocardial infarction) 100%Stroke 100%End-stage renal (kidney) failure 100%Major organ failure 100%Coma 100%Permanent paralysis due to a covered accident 100%Blindness 100%Occupational infectious HIV or occupational infectious hepatitis B, C or D 100%Coronary artery bypass gra surgery/disease225%GROUP CRITICAL CARE PLAN 2 FULLFace amount: $_______________ Critical illness benefitSubsequent diagnosis of a dierent critical illness3If you receive a benefit for a critical illness, and later you are diagnosed with a dierent critical illness, the original percentage of the face amount is payable for that particular critical illness.Subsequent diagnosis of the same critical illness3If you receive a benefit for a critical illness, and later you are diagnosed with the same critical illness, 25% of the original face amount is payable. Critical illness conditions that do not qualify are: coronary artery bypass gra surgery/coronary artery disease2 and occupational infectious HIV or occupational infectious hepatitis B, C or D.

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ColonialLife.comCovered cancer benefitsFor this condition:1The amount payable is:Diagnosis of cancer (internal or invasive) 100% of the face amountDiagnosis of carcinoma in situ 25% of the face amountSkin cancer $500Diagnosis of cancer benefitCancer vaccine benefit: ...............................................................................$50This benefit is payable if you or your covered family members incur a charge for any FDA-approved cancer vaccine while your certificate is inforce.1 Please refer to the certificate for complete definitions of covered conditions. 2 Benefit for coronary artery disease applicable in lieu of benefit for coronary artery bypass gra surgery when health savings account (HSA) compliant plan is selected.3 Dates of diagnoses of a covered critical illness must be separated by at least 180 days.THIS POLICY PROVIDES LIMITED BENEFITS.Insureds in MA must be covered by comprehensive health insurance before applying for this coverage. EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESSWe will not pay the Critical Illness Benefit or Benefit Payable Upon Subsequent Diagnosis of a Critical Illness that occurs as a result of a covered person’s: alcoholism or drug addiction; felonies or illegal occupations; intoxicants and narcotics; psychiatric or psychological conditions; suicide or injuries which any covered person intentionally does to himself; war or armed conflict; or pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a critical illness.EXCLUSIONS AND LIMITATIONS FOR CANCER We will not pay the Diagnosis of Cancer Benefit, Diagnosis of Carcinoma in Situ Benefit, the Cancer Treatment and Care Benefit or the Skin Cancer Benefit for a covered person’s cancer (internal or invasive), carcinoma in situ or skin cancer that: is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexico; is a pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is initially diagnosed as having cancer (internal or invasive), carcinoma in situ or skin cancer. No pre-existing condition limitation will be applied for dependent children who are born or adopted while you are covered under the policy, and who are continuously covered from the date of birth or adoption. This is not an insurance contract and only the actual certificate provisions will control. Applicable to certificate form GCC1.0-C (including state abbreviations where used, for example: GCC1.0-C-TX). The certificate or its provisions may vary or be unavailable in some states. Please see your Colonial Life benefits counselor for details.11-16 | 100361-1Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2016 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

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For more information, talk with your benefits counselor.Hospital Confinement Indemnity InsurancePlan 2IMB7000 – PLAN 2The surgeries listed below are only a sampling of the surgeries that may be covered. Surgeries must be performed by a doctor in a hospital or ambulatory surgical center. For complete details and definitions, please refer to your policy.Tier 1 outpatient surgical procedures  Breast– Axillary node dissection– Breast capsulotomy– Lumpectomy  Cardiac– Pacemaker insertion  Digestive– Colonoscopy– Fistulotomy– Hemorrhoidectomy– Lysis of adhesions  Skin– Laparoscopic hernia repair– Skin graing  Ear, nose, throat, mouth– Adenoidectomy– Removal of oral lesions– Myringotomy– Tonsillectomy– Tracheostomy– Tympanotomy  Gynecological– Dilation and curettage (D&C)– Endometrial ablation– Lysis of adhesions  Liver– Paracentesis  Musculoskeletal system– Carpal/cubital repair or release– Foot surgery (bunionectomy, exostectomy,arthroplasty, hammertoe repair)– Removal of orthopedic hardware– Removal of tendon lesionOur Individual Medical BridgeSM insurance can help with medical costs that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children. Hospital confinement .........................................................................$_______________ Maximum of one benefit per covered person per calendar yearObservation room .................................................................................. $100 per visitMaximum of two visits per covered person per calendar yearRehabilitation unit confinement .................................................................$100 per dayMaximum of 15 days per confinement with a 30-day maximum per covered person per calendar yearWaiver of premiumAvailable aer 30 continuous days of a covered hospital confinement of the named insuredOutpatient surgical procedure  Tier 1.................................................................................................$_______________  Tier 2.................................................................................................$_______________Maximum of $________________ per covered person per calendar year for all covered outpatient surgical procedures combined

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THIS POLICY PROVIDES LIMITED BENEFITS.EXCLUSIONS We will not pay benefits for losses which are caused by: dental procedures, elective procedures and cosmetic surgery, felonies or illegal occupations, intoxicants or narcotics, pregnancy of a dependent child, psychiatric or psychological conditions, suicide or injuries which any covered person intentionally does to himself or herself, war, or giving birth within the first nine months aer the eective date of the policy. We will not pay benefits for hospital confinement of a newborn who is neither injured nor sick. We will not pay benefits for loss during the first 12 months aer the eective date due to a pre-existing condition. A pre-existing condition is a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within the 12 months before the eective date of the policy.For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy number IMB7000-AK and IMB7000-TX. This is not an insurance contract and only the actual policy provisions will control.ColonialLife.com©2016 Colonial Life & Accident Insurance Company, Columbia, SC | Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 6-16 | 101578-AK-TX  Breast– Breast reconstruction– Breast reduction  Cardiac– Angioplasty– Cardiac catheterization  Digestive– Exploratory laparoscopy– Laparoscopic appendectomy– Laparoscopic cholecystectomy  Ear, nose, throat, mouth– Ethmoidectomy– Mastoidectomy– Septoplasty– Stapedectomy– Tympanoplasty  Eye– Cataract surgery– Corneal surgery (penetrating keratoplasty)– Glaucoma surgery (trabeculectomy)– Vitrectomy Tier 2 outpatient surgical procedures  Gynecological– Hysterectomy– Myomectomy  Musculoskeletal system– Arthroscopic knee surgery with meniscectomy (knee cartilage repair)– Arthroscopic shoulder surgery– Clavicle resection– Dislocations (open reduction with internal fixation)– Fracture (open reduction with internal fixation)– Removal or implantation of cartilage– Tendon/ligament repair  Thyroid– Excision of a mass  Urologic – Lithotripsy

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Term Life InsurancePeace of mind for you and your loved onesYou want what’s best for your family, and that includes making sure they’re prepared for the future. With term life insurance from Colonial Life & Accident Insurance Company, you can provide financial security to help them cover their ongoing living expenses.Advantages of term life insurance  Lower cost when compared to cash value life insurance  Same benefit payout throughout the duration of the policy  Several term period options for flexibility during high-need years  Benefit for the beneficiary that is typically tax-freeBenefits and features  Stand-alone spouse policy available whether or not you buy a policy for yourself  Guaranteed premiums that do not increase during the selected term  Ability to convert all or a portion of the benefit amount into cash value life insurance  Flexibility to keep the policy if you change jobs or retire  Built-in terminal illness accelerated death benefit that provides up to 75% of the policy’s death benefit (up to $150,000) if you’re diagnosed with a terminal illness  Premium savings for face amounts over $250,000 based on your healthTERM LIFE (ITL5000)LIMRA, 2017 Insurance Barometer Study.of Americans would have trouble paying living expenses immediately or within several months if the primary wage-earner died.54%married/partnered consumersLIMRA, 2018 Insurance Barometer Study.1-in-3wish their spouse or partner would purchase more life insurance.

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How much coverage do you need?To learn more, talk with your Colonial Life benefits counselor.EXCLUSIONS AND LIMITATIONSIf the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage eective date or the date of reinstatement, we will not pay the death benefit. We will terminate this policy and return the premiums paid, without interest. Product may vary by state. For cost and complete details of the coverage, call or write your Colonial Life benefits counselor or the company. This brochure is applicable to policy forms ICC18-ITL5000/ITL5000 and rider forms ICC18-R-ITL5000-STR/R-ITL5000-STR, ICC18-R-ITL5000-CTR/R-ITL5000-CTR, ICC18-R-ITL5000-WP/R-ITL5000-WP, ICC18-R-ITL5000-ACCD/R-ITL5000-ACCD, ICC18-R-ITL5000-CI/R-ITL5000-CI, ICC18-R-ITL5000-CC/R-ITL5000-CC and applicable state variations. Spouse term life riderYour spouse may receive a maximum death benefit of $50,000; 10-year and 20-year spouse term riders are available. Children’s term life riderYou can purchase up to $20,000 in term life coverage for all of your eligible dependent children and pay one premium. The children’s term life rider may be added to either your policy or your spouse’s policy – not both.Accidental death benefit riderThe beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70. The benefit doubles if the accidental bodily injury occurs while riding as a fare-paying passenger using public transportation, such as ride-sharing services. An additional 25% will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt.Chronic care accelerated death benefit riderIf a licensed health care practitioner certifies that you have a chronic illness, you may receive an advance on all or a portion of the death benefit, available in a one-time lump sum or monthly payments. A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living. Premiums are waived during the benefit period. Critical illness accelerated death benefit riderIf you suer a heart attack (myocardial infarction), stroke or end-stage renal (kidney) failure, a $5,000 benefit is payable. A subsequent diagnosis benefit is included.Waiver of premium benefit riderPremiums are waived (for the policy and riders) if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period. 6-19 | 101895-1ColonialLife.com1 Any payout would reduce the death benefit. Benefits may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits.2 Activities of daily living are bathing, continence, dressing, eating, toileting and transferring.3 You must resume premium payments once you are no longer disabled.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2019 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.Optional ridersAt an additional cost, you can purchase the following riders for even more financial protection.£ YOU $ ___________________ Select the term period:£ 10-year£ 15-year£ 20-year£ 30-year£ SPOUSE $ ___________________ Select the term period:£ 10-year£ 15-year£ 20-year£ 30-yearSelect any optional riders:£ Spouse term life rider $ _____________ face amount for ________-year term period£ Children’s term life rider $ _____________ face amount£ Accidental death benefit rider£ Chronic care accelerated death benefit rider£ Critical illness accelerated death benefit rider£ Waiver of premium benefit rider

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Your cost will vary based on the level of coverage you select. Whole Life InsuranceYou can’t predict your family’s future, but you can be prepared for it.You like to think that you’ll be there for your family in the years to come. But if something happened to you, would your family have the income they need?It’s not easy to think about such serious circumstances, but it’s important to make sure your family is financially protected. You can gain peace of mind with whole life insurance from Colonial Life.Advantages of whole life insurance  Permanent coverage that stays the same throughout the life of the policy  Guaranteed level premiums that do not increase because of changes in health or age  Access to the policy’s cash value through a policy loan for emergencies  Benefit for the beneficiary that is typically tax-freeBenefits and features  Two plan options to choose what age your premium payments will end – Paid-Up at Age 70 or Paid-Up at Age 100  Stand-alone spouse policy available whether or not you buy a policy for yourself  Flexibility to keep the policy if you change jobs or retire  Built-in terminal illness accelerated death benefit that provides up to 75% of the policy’s death benefit (up to $150,000) if you’re diagnosed with a terminal illness  Immediate $3,000 claim payment that can help your designated beneficiary pay for funeral costs or other expenses  Pays cash surrender value at age 100 (when the policy endows)WHOLE LIFE (IWL5000)HealthAairs.org, End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported, July 2017.Talk with your benefits counselor for information about what level of coverage would work best for you.In the U.S., medical spending in the last 12 months of life is nearly $80,000 per person.$

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£ YOU $ ___________________ Select the option:£ Paid-Up at Age 70£ Paid-Up at Age 100£ SPOUSE $ _______________ Select the option:£ Paid-Up at Age 70£ Paid-Up at Age 100EXCLUSIONS AND LIMITATIONSIf the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage eective date or the date of reinstatement, we will not pay the death benefit. We will terminate this policy and return the premiums paid without interest, minus any loans and loan interest to you. Product may vary by state. For costs and complete details of the coverage, call or write your Colonial Life benefits counselor or the company.This brochure is applicable to policy forms ICC19-IWL5000-70/IWL5000-70, ICC19-IWL5000-100/IWL5000-100, ICC19-IWL5000J/IWL5000J and rider forms ICC19-R-IWL5000-STR/R-IWL5000-STR, ICC19-R-IWL5000-CTR/R-IWL5000-CTR, ICC19-R-IWL5000-WP/R-IWL5000-WP, ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD, ICC19-R-IWL5000-CI/R-IWL5000-CI, ICC19-R-IWL5000-CC/R-IWL5000-CC, ICC19-R-IWL5000-GPO/R-IWL5000-GPO and applicable state variations.Additional coverage optionsSpouse term life riderCover your spouse up to a maximum death benefit of $50,000; 10-year and 20-year spouse term riders are available.Juvenile whole life policyYou can purchase a policy while children are young and premiums are low – whether or not you buy a policy on yourself. You may also increase the coverage when the child is 18, 21 and 24 without providing proof of good health. The plan is paid-up at age 70.Children’s term life riderYou may purchase up to $20,000 in term life coverage for all of your eligible dependent children and pay one premium. The children’s term life rider may be added to either your policy or your spouse’s policy – not both.Accidental death benefit riderThe beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70. The benefit doubles if the accidental bodily injury occurs while riding as a fare-paying passenger using public transportation, such as ride-sharing services. An additional 25% will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt.Chronic care accelerated death benefit riderIf a licensed health care practitioner certifies that you have a chronic illness, you may receive an advance on all or a portion of the death benefit, available in a one-time lump sum or monthly payments. A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living (bathing, continence, dressing, eating, toileting and transferring). Premiums are waived during the benefit period.Critical illness accelerated death benefit riderIf you suer a heart attack (myocardial infarction), stroke or end-stage renal (kidney) failure, a $5,000 benefit is payable. A subsequent diagnosis benefit is included.Guaranteed purchase option riderIf you are age 50 or younger when you purchase the policy, you can add the rider, which allows you to purchase additional whole life coverage – without having to answer health questions – at three dierent points in the future. You may purchase up to your initial face amount, not to exceed a total combined maximum of $100,000 for all options.Waiver of premium benefit riderPremiums are waived (for the policy and riders) if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period. Once you are no longer disabled, premium payments will resume.Benefits worksheetFor use with your benefits counselorSelect any optional riders:£ Spouse term life rider $ _____________ face amount for ________-year term period£ Children’s term life rider $ _____________ face amount£ Accidental death benefit rider£ Chronic care accelerated death benefit rider£ Critical illness accelerated death benefit rider£ Guaranteed purchase option rider£ Waiver of premium benefit riderHOW MUCH COVERAGE DO YOU NEED?To learn more, talk with your benefits counselor.ColonialLife.com6-19 | 101935£ DEPENDENT STUDENT $____________£ Paid-Up at Age 70 £ Paid-Up at Age 100 1 Loan should be repaid to protect the policy’s value. 2 Any payout would reduce the death benefit. Benefits may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2019 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

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Employee Assistance ProgramAvailable Services When You Need Help the Most468037Life isn’t always easy. Sometimes a personal or professional issue can affect your work, health and general well-being. During these tough times, it’s important to have someone to talk with to let you know you’re not alone. With Mutual of Omaha’s Employee Assistance Program, you can get the help you need so you spend less time worrying about the challenges in your life and can get back to being the productive worker your employer counts on to get the job done. Learn more about the Employee Assistance Program services available to you.Enhanced EAP ServicesFeatures Value to Company and EmployeesEmployee Family Clinical Services• An in-house team of Master’s level EAP professionals who are available 24/7/365 to provide individual assessments • Outstanding customer service from a team dedicated to ongoing training and education in employee assistance matters • Access to subject matter experts in the field of EAP service deliveryCounseling Options • Exclusive Provider Network• National network of more than 10,000 licensed clinical providers• Network continually expanding to meet customer needs• Flexibility to meet individual client/member needsContinued on back.Visit the Employee Assistance Program website to view timely articles and resources on a variety of financial, well-being, behavioral and mental health topics.mutualofomaha.com/eapor call us: 1-800-316-2796We are here for you*California Residents: Knox-Keene Statute limits no more than three face-to-face sessions in a six-month period per person.Three sessions per year (per household) conducted by either face-to-face* counseling or videotelehealth via a secure, HIPAA compliant portal43746627

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Insurance products and services are offered by Mutual of Omaha Insurance Company or one of its affiliates. Mutual of Omaha Insurance Company is licensed nationwide. United of Omaha Life Insurance Company is licensed nationwide, except in New York. Companion Life Insurance Company is licensed in New York. Each underwriting company is solely responsible for its own contractual and financial obligations. Some exclusions or limitations may apply.Features Value to Company and EmployeesAccess • 1-800 hotline with direct access to a Master’s level EAP professional• 24/7/365 services available• Telephone support available in more than 120 languages• Online submission form available for EAP service requests• EAP professionals will help members develop a plan and identify resources to meet their individual needsEmployee Family Legal Services• Valuable resources – legal libraries, tools and forms – available on EAP website• A counseling session may be substituted for one legal consultation (up to 30 minutes) with an attorney• 25% discount for ongoing legal services for same issueEmployee Family Financial Services• Inclusive financial platform powered by Enrich that includes financial assessment tools, personalized courses, articles and resources, and ongoing progress reports to help members monitor their financial health• A counseling session may be substituted for one financial consultation (up to 30 minutes) with an attorney• 25% discount for ongoing financial services for same issueEmployee Family Work/Life Services• Child care resources and referrals• Elder care resources and referralsOnline Services • An inclusive website with resources and links for additional assistance, including:• Current events and resources• Family and relationships• Emotional well-being• Financial wellness• Substance abuse and addiction• Legal assistance• Physical well-being• Work and career• Bilingual article libraryEmployee Communication• All materials available in English and SpanishEligibility • Full-time employees and their immediate family members; including the employee, spouse and dependent children (unmarried and under 26) who reside with the employeeCoordination with Health Plan(s)• EAP professionals will coordinate services with treatment resources/providers within the employee’s health insurance network to provide counseling services covered by health insurance benefits, whenever possibleEnhanced EAP Services (continued)

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Take comfort in knowing that Travel Assistance* travels with you worldwide, offering access to a network of professionals who can help you with local medical referrals or provide other emergency assistance services in foreign locations.Enjoy Your Trip – We’ll Be There If You Need Us – 24/7Travel Assistance can help you avoid unexpected bumps in the road anywhere in the world. For you, your spouse and dependent children on any single trip, up to 120 days in length, more than 100 miles from home.Pre-trip Assistance**Minimize travel hassles by calling us pre-departure for:• Information regarding passport, visa or other required documentation for foreign travel • Travel, health advisories and inoculation requirements for foreign countries• Domestic and international weather forecasts• Daily foreign currency exchange rates• Consulate and embassy locationsEmergency Travel Support Services• Telephonic translation and interpreter services – 24/7 access to telephone translation services• Locating legal services – referrals for local attorney or consular offices and help maintain business and family communications until legal counsel is retained (includes coordination of financial assistance for bonds/bail)• Baggage – assistance with lost, stolen or delayed baggage while traveling on a common carrier• Emergency payment and cash – assistance with advance of funds for medical expenses or other travel emergencies by coordinating with your credit card company, bank, employer, or other sources of credit; includes arrangements for emergency cash from a friend, family member, business or credit card• Emergency messages – assistance with recording and retrieving messages between you, your family and/or business associates at any time• Document replacement – coordination of credit card, airline ticket or other documentation replacement• Vehicle return – if evacuation or repatriation is necessary, return your unattended vehicle to the car rental companyTake comfort in knowing that Travel Assistance* travels with you worldwide, Mutual SolutionsWorldwide Travel Assistance That Travels With You✁Services available for business and personal travel.For inquiries within the U.S. call toll free:1-800-856-9947Outside the U.S. call collect:(312) 935-3658Services available for business and personal travel.For inquiries within the U.S. call toll free:1-800-856-9947Outside the U.S. call collect:(312) 935-3658WORLDWIDE TRAVEL ASSISTANCEWORLDWIDE TRAVEL ASSISTANCE452632* Brought to you by Mutual of Omaha Insurance Company, 3300 Mutual of Omaha Plaza, Omaha, NE 68175. Services provided by AXA Assistance USA (AXA)**Available at any time, not subject to 100 mile travel radius44101310

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✁Carry this card with you when you travelBrought to you by Mutual of Omaha. Services provided by AXA Assistance USA.Carry this card with you when you travelBrought to you by Mutual of Omaha. Services provided by AXA Assistance USA.Medical Assistance• Locating medical providers and referrals• Communication on your medical status with family, physicians, employer, travel company and consulate• Emergency evacuation if adequate medical facilities are not available, including payment of covered expenses• Transportation home for further treatment – in the event of death, assist in the return of mortal remains• Transportation arrangements for the visit of a family member or friend if your hospitalization is more than seven calendar days• Return home for dependent children if your hospitalization is more than seven calendar days• Assistance with lodging arrangements if convalescence is needed prior to, or after, medical treatment• Coordination with your health insurance carrier during a medical emergency • Assistance obtaining prescription drugs or other necessary personal medical itemsIdentity TheftYour Travel Assistance benefit automatically includes Identity Theft Assistance, coordinated at no additional cost. Whether at home or traveling, this benefit provides education, prevention and recovery information to help you protect your identity.Education and Prevention• Comprehensive ID theft assistance guide• Tips to defend against ID theftRecovery Information• Information regarding the steps to recover from credit card and check fraud• Guidelines if your Social Security number is compromised• Instructions for lost or stolen passport• Contact list for financial institutions, credit bureaus and check companiesAssistanceIf you need help with an ID theft issue, case managers are available 24 hours a day, seven days a week and can be reached by calling the same toll-free number used to contact AXA: 800-856-9947.Travel Assistance Plan LimitationsAXA will not pay emergency evacuation, medically necessary repatriation, repatriation of remains or other expenses incurred while traveling within 100 miles of participant’s place of residence, or for any one of the following reasons:• A single trip lasts more than 120 days in length • Traveling against the advice of a physician• Traveling for medical treatment• Pregnancy and childbirth (exception: complications of pregnancy)There is a maximum benefit amount per person associated with emergency evacuation, medical repatriation and/or return of mortal remains.All additional costs would be the responsibility of the member. This includes medical costs which are the responsibility of the person receiving medical services. Services must be authorized and arranged by AXA Assistance USA, Inc. designated personnel to be eligible for this program. No reimbursement claims for out-of-pocket expenses will be accepted.Travel assistance services are independently offered and administered by AXA Assistance USA, Inc. (AXA). Insurance benefits provided as part of Travel Assistance underwritten by a third party. AXA is not affiliated in any way with Mutual of Omaha companies. Each company is responsible for its own financial and contractual obligations. There may be times when circumstances beyond AXA Assistance USA’s control hinder its endeavors to provide services. AXA Assistance USA will make all reasonable efforts to help you resolve the emergency situation. Both companies are responsible for their own contractual and financial obligations. Additional limitations may apply. Please contact AXA for specifics.

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452322This is not health insurance. Hearing services are administered by Amplifon Hearing Health Care, Corp. Amplifon Hearing Health Care is solely responsible for the administration of hearing health care services, and its own financial and contractual obligations. Mutual of Omaha Insurance Company has been authorized to provide marketing services including sales. Mutual of Omaha Insurance Company and Amplifon are independent, unaffiliated companies.Mutual SolutionsYour Hearing Discount ProgramProgram Benefits - In addition to your hearing care benefit, you will have access to complimentary aftercare*, including: Custom hearing solutions — wide choice of products from the industry’s leading brands Risk-free trial — find your right fit by trying your hearing aids for 60 days Follow-up care — ensures a smooth transition to your new hearing aids Battery support — battery supply or charging station to keep your hearing aids powered Warranty — 3-year coverage for loss, repairs, or damage Financing — no interest for those who qualify Savings for family and friends — your parents, siblings, in-laws, and friends qualify, too*Risk-free trial - 100% money back guarantee if not completely satisfied, no return or restocking fees. Follow-up care - for one year following purchase. Batteries - two year supply of batteries (80 cells/ear/year) or one standard charger at no additional cost. Warranty - Exclusions and limitations may apply. Contact Client Services (1-844-267-5436) for details.Accessing Your Benefits is as Easy as ...1. Call Amplifon at 1-888-534-1747 and a Patient Care Advocate will assist you in finding a hearing care provider near you. 2. Our advocate will explain the Amplifon process, request your mailing information and assist you in making an appointment with a hearing care provider. 3. Amplifon will send information to you and the hearing care provider. This will ensure your Amplifon discounts are activated.To learn more visit amplifonusa.com/mutualofomaha.Level 1 Level 2 Level 3 Level 4 Level 5Hearing Aid FeaturesStandardfeaturesAdditional, easy-to-use functionsDesigned for work and playEnhanced to keep you on the goLeading technology keeps you connectedOne Simple Price$995 $1,495 $1,795 $2,195 $2,64544276018

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JOIN FOR FREEYour Free Welcome Kit Is Waiting!Livongo gives you tools and support to help make living with diabetes easier. Join today and unlock your full beneﬁts! You’ll get a Welcome Kit with an advanced blood glucose meter, plus unlimited strips, personalized insights, and 24/7 expert support. The program is provided to you and your family members with diabetes and coverage through Blue Cross and Blue Shield of Texas(BCBSTX).LEARN MOREUse Registration Code: BCBSTXIt’s All In The Meter And On The HousePersonalizedtips for you4G blood sugar meterOptional family alertsEasily order strips from your appReadings upload automaticallyShareable reports with your Doctor Members must have primary insurance coverage through the Blue Cross and Blue Shield of Texas (BCBSTX) plan offering the Livongo program. For Administrative Services Only (ASO) and Preferred Provider Organizations (PPO) only. Not available for Fully Insured (FI) or Health Maintenance Organizations (HMO).Program includes trends and support on your secure Livongo account and app, but does not include a phone, tablet, or smartwatch.UnsubscribeLivongo. 150 W. Evelyn Ave., Suite 150, Mountain View, CA 94041 2020 © Livongo. All rights reserved.PM07452.A PM08174.A PM08175.A PM08176.A PM07609.A PM07484.A PM07485.B749605.0720Las comunicaciones del programa Livongo están disponibles en español.Al inscribirse, podrá conﬁgurar el idioma que preﬁera para las comunicaciones provenientes del medidor y del programa. Para inscribirse en español, llame al (800) 945-4355 o visite bienvenido.livongo.com/BCBSTXGetting started is easy.JOIN NOWNEED HELP? CALL LIVONGO MEMBER SUPPORT AT (800) 945-4355 AND USE YOUR REGISTRATION CODE BCBSTX.749605.0720

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756318.0621Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield AssociationFor Standard 2-150 MembersAs part of the Wellbeing Management and Health Advocacy Solutions packaging, Blue Cross and Blue Shield of Texas oers an exciting coaching option, with no extra charge to members. Your employees could benet from digital educational opportunities for reducing the risk of type 2 diabetes and heart disease with Omada. This supplemental remote care can be done in the comfort of the member’s own home.Omada – Diabetes Prevention SolutionOmada, a behavioral medicine program, inspires and enables people who are at risk for chronic conditions like type 2 diabetes and heart disease to change the habits that put them most at risk. The program combines data-powered human coaching, connected devices and a tailored curriculum to eectively improve overall health and reduce the risk of diabetes and cardiovascular disease. Features include:• Professional health coach to provide ongoing digitalsupport and guidance• Weekly lessons to empower healthier habits aroundfood, activity, sleep and stress• Cellular-connected scale that automatically uploadsreadings to a member’s account• Small online group for real-time motivation froma community of peers• Simple employer reporting for enrollment,engagement and outcomesEligibilityTo support the program, Omada will receive a weekly le of eligible members. Because all risks for diabetes and cardiovascular disease are not identiable through a claims screen, BCBSTX provides Omada with the entire membership eligibility. On enrollment, members complete a brief health assessment to determine full eligibility for the program. In addition, for groups that also implement Omada’s Hypertension program, BCBSTX screens prior claims to identify members with hypertension (HTN) and identies those members within Omada’s eligibility le. Omada will only outreach for HTN program to identied members. Members without prior claims can self-identify as having HTN when they enroll in that program.Omada is an independent company that provides a Diabetes Prevention Solution and Hypertension programs for Blue Cross and Blue Shield of Texas. Omada is solely responsible for the products and services that it provides. Blue Cross and Blue Shield of Texas makes no endorsement, representations or warranties regarding third-party vendors and the products and services oered by them.Omada®Coach-Led Digital Program for Diabetes Prevention for Wellbeing Management and Health Advocacy Solutions

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Clinically-proven weight loss without counting caloriesNow you can lose weight, gain energy, sleep better, and improve your mind and body—all while eating your favorite foods. Questions? Visit support.wondrhealth.com“I love the whole idea of the psychology of things. I like to look in the why’s and how it works. You can eat whatever you want. You just need to retrain your brain into thinking about how you need to eat your food.”—Brad M.WONDR PARTICIPANTlbsConfidence70GAINEDLOST84% 62%LOST WEIGHTFEEL MORE CONFIDENT68%ARE MORE PHYSICALLY ACTIVE85%57%FEEL MORE IN CONTROL OF THEIR WEIGHTFEEL THEIRMOOD HAS IMPROVED61%HAVE MORE ENERGY© 2021 WONDR | W3016What is Wondr? No points, plans, or counting calories. Forget eating kale salads 24/7; Wondr is a skills-based digital weight loss program that teaches you how to enjoy the foods you love to improve your overall health. Our behavioral science-based program was created by a team of doctors and clinicians (which is why we left out the “e” in Wondr) and is clinically-proven for lasting results.LET’S TALK RESULTSIn as little as 10 weeks:*Based on Wondr Health Book of BusinessYour employer has partnered with Wondr Health™ to help youimprove your health at no cost to you.*wondrhealth.com/BCBSTX*To learn more and join the waitlist,visit: wondrhealth.com/BCBSTXGo toFile: NSWondr-Generic-OE-Guide-Short---No-scheduled-classes-Wondr-Open-Enrollment-BCBS-Fully-Insured--BCBSTX-07-06-21.pdf Date:07/06/2021Powered by TCPDF (www.tcpdf.org)756947.0821

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Member ResourcesMaximize Your Benefits: Rx Apps • 100% free to use• Provides significant savings on certainprescription drugs (can be hundreds of dollars ormore)• Provides manufacturer discount coupons• Gives prices at nearby pharmacies• You do not need prior-authorizations• Since you are not using insurance, you do not have to abide by any step-therapy orquantity limitations that may be in force by your pharmacy benefit manager• Tells you if there are cheaper alternative drugs available• Informs you if the drug is a combination drug:• Combination drugs cost more. Ex. Duexis costs $2,500 per script and it is just acombination of ibuprofen and famotidine (Pepcid) (which can be bought OTC forless than $30 per month.• Can be used for pets as well!• 100% free to use• Provides significant savings on certain prescription drugs(can be hundreds of dollars or more)• Compares discount coupon price to your insurance price• Since you are not using insurance, you do not have toabide by any step-therapy or quantity limitations thatmay be in force by your pharmacy benefit manager*GoodRx utilizes manufacturer discounts and do not go toward your Maximum Out of Pocket – If you hit your Maximum Out of Pocket this is not a good tool for you.

2024 Cook Parker Benefit Booklet

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