Angleton ER Proposal : simplebooklet.com

Account Name: Account Number: 253158 Renewal Effective Date: Dec 1, 2023ANGLETON ER PLLC Agent: DANG, PHUC HAO Rating Area: 25Renewal at a GlanceCurrent and Renewal Medical Plans and PremiumsYour group’s current Medical plan(s) and suggested plans for the upcoming year are listed below.If these plans aren’t a good fit for the new year, don’t worry, you’ve got more plans to choose from in the Medical Plans section.Current Plan Renewal PlanPlan ID S663CHC S663CHCMetallic Silver SilverNetwork Name Blue Choice PPO Blue Choice PPO DeductibleIn-Network // Out-of-Network$3000//$6000 $3000//$6000Primary Care/Virtual Visit $40/$40 $45/$45CoinsuranceIn-Network // Out-of-Network70%//50% 70%//50%Out-of-Pocket MaxIn-Network // Out-of-Network$8550//Unlimited $9000//UnlimitedSpecialist Office Visit $80 $90Non Preferred Pharmacy Copays $10/$20/$70/$120/$150/$250 $10/$20/$70/$120/$150/$250Current Plan Renewal PlanPlan ID G652CHC G652CHCMetallic Gold GoldNetwork Name Blue Choice PPO Blue Choice PPO DeductibleIn-Network // Out-of-Network$1500//$3000 $1500//$3000Primary Care/Virtual Visit $40/$40 $45/$45CoinsuranceIn-Network // Out-of-Network80%//60% 80%//60%Out-of-Pocket MaxIn-Network // Out-of-Network$5000//Unlimited $5250//UnlimitedSpecialist Office Visit $80 $90Non Preferred Pharmacy Copays $10/$20/$70/$120/$150/$250 $10/$20/$70/$120/$150/$250

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Account Name: Account Number: 253158 Renewal Effective Date: Dec 1, 2023ANGLETON ER PLLC Agent: DANG, PHUC HAO Rating Area: 25Renewal at a GlanceCurrent Plan Renewal PlanPlan ID B662CHC B662CHCMetallic Bronze BronzeNetwork Name Blue Choice PPO Blue Choice PPO DeductibleIn-Network // Out-of-Network$8550//$17100 $8550//$17100Primary Care/Virtual Visit DC/DC DC/DCCoinsuranceIn-Network // Out-of-Network100%//100% 100%//100%Out-of-Pocket MaxIn-Network // Out-of-Network$8550//$17100 $8550//$17100Specialist Office Visit DC DCNon Preferred Pharmacy Copays 100% 100%Current Plan Renewal PlanPlan ID S662CHC S662CHCMetallic Silver SilverNetwork Name Blue Choice PPO Blue Choice PPO DeductibleIn-Network // Out-of-Network$5000//$10000 $5000//$10000Primary Care/Virtual Visit DC/DC DC/DCCoinsuranceIn-Network // Out-of-Network100%//100% 100%//100%Out-of-Pocket MaxIn-Network // Out-of-Network$5000//$10000 $5000//$10000Specialist Office Visit DC DCNon Preferred Pharmacy Copays 100% 100%More information on rates is available in the Appendix – Monthly Medical Premiums section. To view other plans, see the Medical Plans section.Current and Renewal Metallic Medical Plans and Premium - Composite Rates

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Account Name: Account Number: 253158 Renewal Effective Date: Dec 1, 2023ANGLETON ER PLLC Agent: DANG, PHUC HAO Rating Area: 25Renewal at a GlanceEnrolled Count Current Plan Renewal PlanPlan IDS663CHC S663CHCComposite Rates - Medical3 EO: $788.21 EO: $903.010 ES: $1,576.42 ES: $1,806.021 EC: $1,576.42 EC: $1,806.020 EF: $2,364.63 EF: $2,709.03Total Monthly Medical Premium$3,941.05 $4,515.05Enrolled Count Current Plan Renewal PlanPlan IDG652CHC G652CHCComposite Rates - Medical10 EO: $898.35 EO: $1,024.954 ES: $1,796.70 ES: $2,049.902 EC: $1,796.70 EC: $2,049.905 EF: $2,695.05 EF: $3,074.85Total Monthly Medical Premium$33,238.95 $37,923.15Enrolled Count Current Plan Renewal PlanPlan IDB662CHC B662CHCComposite Rates - Medical3 EO: $649.13 EO: $782.071 ES: $1,298.26 ES: $1,564.140 EC: $1,298.26 EC: $1,564.140 EF: $1,947.39 EF: $2,346.21Total Monthly Medical Premium$3,245.65 $3,910.35Enrolled Count Current Plan Renewal PlanPlan IDS662CHC S662CHCComposite Rates - Medical1 EO: $779.30 EO: $900.820 ES: $1,558.60 ES: $1,801.640 EC: $1,558.60 EC: $1,801.640 EF: $2,337.90 EF: $2,702.46Total Monthly Medical Premium$779.30 $900.82

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Account Name: Account Number: 253158 Renewal Effective Date: Dec 1, 2023ANGLETON ER PLLC Agent: DANG, PHUC HAO Rating Area: 25Appendix - Medical CensusThis census represents enrollment at the time the renewal was prepared. It may not reflect current enrollment.Name Relationship DOB Age Coverage Type **State1ALBADRI, ZAINAB Employee 04/21/1989 34 EOTX2 AMRO, MOATH Employee 11/18/1985 38 EO TX3 ARDUINI, JACKIE Employee 09/24/1985 38 EO TX4 ARMSTRONG, CERNICE Employee 02/08/1964 59 ES TX4.1 ARMSTRONG, CHARLES, LADALE Spouse 12/28/1962 60 TX5 BELL, LOIS, MICHELLE Employee 11/10/1986 37 EO TX6 BROWN, AMY Employee 08/15/1985 38 EO TX7 CANDAL, NOEMI Employee 11/20/1979 44 EC TX7.1 GARCIA, ALEXANDRA Dependent 10/21/1998 25 TX7.2 GARCIA, ADAM Dependent 08/11/2000 23 TX7.3 GARCIA, MATTHEW Dependent 03/23/2004 19 TX8 CARRIER, NEDRA Employee 10/05/1963 60 EO TX9 CURNUTT, THOMAS Employee 11/01/1962 61 ES TX9.1 CURNUTT, LAURA Spouse 05/17/1964 59 TX10 DARBONNE, CASSIE Employee 06/09/1961 62 EO TX11 FLETCHER, TAMMY Employee 07/18/1969 54 ES TX11.1 FLETCHER, DARREN Spouse 12/13/1966 56 TX12 GOMEZ, ALICE Employee 02/02/1992 31 EO TX13 HANSON, STEPHAN Employee 04/24/1965 58 ES TX13.1 NGUYEN, TOM Spouse 10/20/1969 54 TX14 HOGAN, STACEY Employee 12/17/1967 55 EO TX15 JANNISE, AUDRA Employee 01/17/1967 56 EO TX16 JAOUHARI, JAMEL Employee 01/01/1974 49 EO TX17 KEITH, NICHOLAS Employee 01/08/1980 43 EF TX17.1 KEITH, ANGELENE Spouse 12/09/1982 40 TX17.2 CASTILLO, SAMUEL Dependent 07/15/2001 22 TX17.3 CASTILLO, CHRISTIAN Dependent 09/27/2002 21 TX17.4 CASTILLO, LARISSA Dependent 06/01/2005 18 TX17.5 KEITH, GABRIEL Dependent 01/13/2006 17 TX17.6 KEITH, KAYLEE Dependent 08/16/2008 15 TX17.7 KEITH, LAILA Dependent 06/14/2012 11 TX

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Account Name: Account Number: 253158 Renewal Effective Date: Dec 1, 2023ANGLETON ER PLLC Agent: DANG, PHUC HAO Rating Area: 25Appendix - Medical CensusThis census represents enrollment at the time the renewal was prepared. It may not reflect current enrollment.Name Relationship DOB Age Coverage Type **State17.8KEITH, NICHOLAS Dependent 03/10/2014 9TX18 KUDRATH, ABDULLA Employee 10/11/1984 39 EO TX19 LABAY, WADE Employee 02/09/1994 29 EO TX20 LEZA, AUGUSTIN Employee 10/24/1969 54 EF TX20.1 LEZA, DONNA Spouse 10/21/1969 54 TX20.2 LEZA, ISABELL Dependent 01/03/2005 18 TX21 LYLES, AMANDA Employee 04/29/1981 42 EO TX22 MASSEY, KEEGAN Employee 10/16/1984 39 EO TX23 METREJEAN, TROY Employee 01/13/1973 50 EC TX23.1 METREJEAN, LANDON Dependent 03/09/2005 18 TX24 REEDY, PRENTIS Employee 11/02/1979 44 ES TX24.1 KING, FELICIA Spouse 07/14/1980 43 TX25 SAEED, BILAL, AHMAD Employee 09/09/1972 51 EF TX25.1 SAEED, SAMIYA Spouse 10/30/1975 48 TX25.2 SAEED, HAMZA, AHMAD Dependent 05/17/2004 19 TX25.3 SAEED, ESHAN, AHMAD Dependent 03/28/2008 15 TX25.4 SAEED, SHAYAAN Dependent 07/11/2014 9 TX26 SALDIVAR, JUAN Employee 02/08/1979 44 EF TX26.1 SALDIVAR, CLAUDIA Spouse 07/10/1983 40 TX26.2 SALDIVAR, CARLOS Dependent 07/23/2014 9 TX26.3 SALDIVAR, SANTIAGO Dependent 02/01/2017 6 TX27 SEM, EMILY Employee 11/08/1975 48 EF TX27.1 NEVAREZ, FRANCISCO Spouse 05/08/1961 62 TX27.2 LAM, ETHAN Dependent 07/17/1998 25 TX27.3 NEVAREZ, SOFIA Dependent 01/23/2015 8 TX28 WEYRICK, MARGARET Employee 07/22/1967 56 EO TX29 WEYRICK-HERBERT, LISA Employee 12/16/1968 54 EC TX29.1 HERBERT, ROBERT Dependent 10/02/2000 23 TX30 WHITE, SHELLEY Employee 12/24/1975 47 EO TX**Coverage Type: EO = Employee Only; ES = Employee+Spouse/Domestic Partner; EC = Employee + Child(ren); EF = Go Back to Renewal Contents

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Plan 1 Plan 2 Plan 3Plan NameTraditional Traditional TraditionalPlan TypeSELF-FUNDED PPO COPAYPLANSELF-FUNDED PPO COPAYPLANSELF-FUNDED PPO COPAYPLANMedical Plan Design$3,000 In-network/$6,000 Out-of-network$1,500 In-network/$3,000 Out-of-network$8,550 In-network/$17,100 Out-of-networkIndividual Deductible$6,000 In-network/$12,000 Out-of-network$3,000 In-network/$6,000 Out-of-network$17,100 In-network/$34,200Out-of-networkFamily Deductible80% In-network/50% Out-of-network80% In-network/50% Out-of-network100% In-network/70% Out-of-networkCoinsurance$8,550 In-network/$25,650 Out-of-network$5,000 In-network/$15,000 Out-of-network$8,550 In-network/$29,150 Out-of-networkTotal Ind Plan OOP Maximum$17,100 In-network/$51,300Out-of-network$10,000 In-network/$30,000Out-of-network$17,100 In-network/$58,300Out-of-networkTotal Fam Plan OOP MaximumIndividual/Family deductible Individual/Family deductible Individual/Family deductibleFamily Deductible AccumulationMethod$40/$60 copay, then covered at100%$40/$60 copay, then covered at100%Deductible and coinsurancePCP/Specialist VisitWalmart Health Virtual Care Walmart Health Virtual Care Walmart Health Virtual CareTelemedicine Vendor(s)$0 per visit for Urgent Care orTalk Therapy visitsUp to three Walmart HealthVirtual Care Urgent Care visitsper individual and five WalmartHealth Virtual Care Talk Therapyvisits per individual are includedper month.$0 per visit for Urgent Care orTalk Therapy visitsUp to three Walmart HealthVirtual Care Urgent Care visitsper individual and five WalmartHealth Virtual Care Talk Therapyvisits per individual are includedper month.$0 per visit for Urgent Care orTalk Therapy visitsUp to three Walmart HealthVirtual Care Urgent Care visitsper individual and five WalmartHealth Virtual Care Talk Therapyvisits per individual are includedper month.Walmart Health Virtual CareTelemedicine$75 copay, then covered at100%$75 copay, then covered at100%Deductible and coinsuranceUrgent Care VisitCigna LocalPlus Cigna LocalPlus Cigna LocalPlusMedical NetworkDeductible and coinsurance Deductible and coinsurance Deductible and coinsuranceOP SurgeryCIGNA PBM CIGNA PBM CIGNA PBMPharmacy Benefit Manager$20/$50/$75 $20/$50/$75 50%/50%Rx Coverage (Generic/Brand/Non-preferred brand)Deductible and coinsurance Deductible and coinsurance Deductible and coinsuranceDXLDeductible and coinsurance Deductible and coinsurance Deductible and coinsuranceER TreatmentN/A N/A N/AAMECalendar Year, deductible creditincludedCalendar Year, deductible creditincludedCalendar Year, deductible creditincludedDeductible and OOP AccrualPeriod6 months 6 months 6 monthsRun Out Period50% 50% 50%Delayed Administration FeeNo No NoHSA EligibleNo No NoWellness Program10 hours per employee percalendar year10 hours per employee percalendar year10 hours per employee percalendar yearPapa CaregiverIncluded Included IncludedCancer Coach by Osara HealthGroup Name: Angleton ER PLLCEffective Date: 12/01/2023SIC Code: 81100Plan/Rate SummaryPlease review this proposal. If you are ready to move forward, contact your Licensed Agent or Sales Representative to discuss the next steps.Plans quoted in this proposal: 4Location Name: Location 1 Zip Code: 75036Location Type: MainPlan / Rate Summary Page 1 of 4Version V20.0 Quote Number: 6244160 Quote ID: 3651903 Print ID: 1The Self-Funded Program through Allstate Benefits provides tools for employers owning small to mid-sized businesses to establish a self-funded health benefitplan for their employees. The benefit plan is established by the employer and is not an insurance product. For employers in the Self-Funded Program, stop-lossinsurance is underwritten by: Integon National Insurance Company in CT, NY and VT; Integon Indemnity Corporation in FL; and National Health InsuranceCompany in WA, CO, and all other states where offered.

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Group Name: Angleton ER PLLCEffective Date: 12/01/2023SIC Code: 81100Plan/Rate SummaryPlease review this proposal. If you are ready to move forward, contact your Licensed Agent or Sales Representative to discuss the next steps.Plans quoted in this proposal: 4Location Name: Location 1 Zip Code: 75036Location Type: MainPlan 4Plan NameTraditionalPlan TypeSELF-FUNDED HSA PPO PLANMedical Plan Design$3,500 In-network/$7,000 Out-of-networkIndividual Deductible$7,000 In-network/$14,000 Out-of-networkFamily Deductible70% In-network/40% Out-of-networkCoinsurance$5,000 In-network/$15,000 Out-of-networkTotal Ind Plan OOP Maximum$10,000 In-network/$30,000 Out-of-networkTotal Fam Plan OOP MaximumIndividual/Family deductibleFamily Deductible AccumulationMethodDeductible and coinsurancePCP/Specialist VisitWalmart Health Virtual CareTelemedicine Vendor(s)$38 per visit for Urgent Care or Talk TherapyWalmart Health Virtual CareTelemedicineDeductible and coinsuranceUrgent Care VisitCigna LocalPlusMedical NetworkDeductible and coinsuranceOP SurgeryCIGNA PBMPharmacy Benefit ManagerDeductible and70% for generic70% for brand50% for non-preferred brandRx Coverage (Generic/Brand/Non-preferred brand)Deductible and coinsuranceDXLDeductible and coinsuranceER TreatmentN/AAMECalendar Year, deductible credit includedDeductible and OOP AccrualPeriod6 monthsRun Out Period50%Delayed Administration FeeYesHSA EligibleNoWellness Program10 hours per employee per calendar yearPapa CaregiverIncludedCancer Coach by Osara HealthNoDentalNoVision$25,987.33Total CostPlan Selection Notes:Total plan out-of-pocket maximum includes deductible, coinsurance and any Rx or Medical copayments.This self-funded health benefit plan template meets Minimum Value.Plan includes Terminal Liability coverage for 24 months after the end of the plan year. A terminal liability coverage reserve fee willbe taken at the end of the run-out, calculated as 3% of any remaining claim account surplus prior to any claim account refund.Terminal Liability coverage is not provided in cases of early termination.Walmart Health Virtual Care consultation fees will be submitted to the plan as claims at the then current contracted rate.

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Stop-Loss Insurance and Financial DetailsStop-Loss Insurance and Financial DetailsAnnual Aggregate Attachment PointSpecific Attachment PointMonthly Bill MedicalEmployeeEmployee + SpouseEmployee + ChildFamilyStop-loss PremiumAdmin, Sales and General ExpensesClaims AccountTotal$105,951.24Plan 1$50,000.00$556.17$1,418.19$1,084.51$1,835.31$13,442.58$6,704.07$8,829.27$28,975.92$154,729.56Plan 2$100,000.00$717.61$1,829.89$1,399.33$2,368.09$15,889.44$8,603.69$12,894.13$37,387.26$21,540.72Plan 3$20,000.00$399.04$1,017.54$778.11$1,316.81$14,139.46$4,855.24$1,795.06$20,789.76Annual Aggregate Attachment PointSpecific Attachment PointMonthly Bill MedicalEmployeeEmployee + SpouseEmployee + ChildFamilyStop-loss PremiumAdmin, Sales and General ExpensesClaims AccountTotal$87,025.68Plan 4$50,000.00$498.80$1,271.93$972.66$1,646.02$12,706.12$6,029.07$7,252.14$25,987.33Group Name: Angleton ER PLLCEffective Date: 12/01/2023SIC Code: 81100Location Name: Location 1 Zip Code: 75036Location Type: Main

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17$556.17 17$717.61 17$399.04 17$498.80Rate Enrollment Rate Enrollment Rate RateEmployee (EE)Employee + Spouse (EE+SP)Employee + Child (EE+CH)Employee + Family (EE+FM)Enrollment Enrollment5$1,418.19 5$1,829.89 5$1,017.54 5$1,271.933$1,084.51 3$1,399.33 3$778.11 3$972.665$1,835.31 5$2,368.09 5$1,316.81 5$1,646.02Medical Plan 1 Plan 2 Plan 3 Plan 4Plan 1 Cost Plan 2 Cost Plan 3 Cost Plan 4 CostMember NameMonthly Rate Breakdown by EmployeeMedical TierZAINAB ALBADRI M(34) $556.17 $399.04$717.61 $498.80EEMOATH AMRO M(38) $556.17 $399.04$717.61 $498.80EEJACKIE ARDUINI F(38) $556.17 $399.04$717.61 $498.80EECERNICE ARMSTRONG F(59), SP M(60) $1,418.19 $1,017.54$1,829.89 $1,271.93ESLOIS BELL F(37) $556.17 $399.04$717.61 $498.80EEAMY BROWN F(38) $556.17 $399.04$717.61 $498.80EENOEMI CANDAL F(44), CH: 3 $1,084.51 $778.11$1,399.33 $972.66ECNEDRA CARRIER F(60) $556.17 $399.04$717.61 $498.80EETHOMAS CURNUTT M(61), SP F(59) $1,418.19 $1,017.54$1,829.89 $1,271.93ESCASSIE DARBONNE F(62) $556.17 $399.04$717.61 $498.80EETAMMY FLETCHER F(54), SP M(56) $1,418.19 $1,017.54$1,829.89 $1,271.93ESALICE GOMEZ F(31) $556.17 $399.04$717.61 $498.80EESTEPHAN HANSON M(58), SP M(54) $1,418.19 $1,017.54$1,829.89 $1,271.93ESSTACEY HOGAN F(55) $556.17 $399.04$717.61 $498.80EEAUDRA JANNISE F(56) $556.17 $399.04$717.61 $498.80EEJAMEL JAOUHARI M(49) $556.17 $399.04$717.61 $498.80EENICHOLAS KEITH M(43), SP F(40), CH: 7 $1,835.31 $1,316.81$2,368.09 $1,646.02EFABDULLA KUDRATH M(39) $556.17 $399.04$717.61 $498.80EEWADE LABAY M(29) $556.17 $399.04$717.61 $498.80EEAUGUSTIN LEZA M(54), SP F(54), CH: 1 $1,835.31 $1,316.81$2,368.09 $1,646.02EFAMANDA LYLES F(42) $556.17 $399.04$717.61 $498.80EEKEEGAN MASSEY M(39) $556.17 $399.04$717.61 $498.80EETROY METREJEAN M(50), CH: 1 $1,084.51 $778.11$1,399.33 $972.66ECPRENTIS REEDY M(44), SP F(43) $1,418.19 $1,017.54$1,829.89 $1,271.93ESBILAL SAEED M(51), SP F(48), CH: 3 $1,835.31 $1,316.81$2,368.09 $1,646.02EFJUAN SALDIVAR M(44), SP F(40), CH: 2 $1,835.31 $1,316.81$2,368.09 $1,646.02EFEmployee Census30Total Employees: Total Employees Eligible: 30 Total Employees Enrolling: 30Agent Phone:Business Name:Proposal Creation Date:Robert Levy(713) 575-3722Angleton ER PLLC10/03/2023HCR Indicator:ZIPCounty:Proposed Effective Date:State:Location Name:Location Type:SIC Code:75036DENTON Location 1MainTX12/01/2023 81100SSize Category:Agent:

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Prepared for: Angleton ER PLLC Prepared on: 2023-10-09Quote ID: 66616 Effective Date: 12-01-2023 Product:MedicalComposite Premiums – Hybrid PlansPlan Plan DescriptionEm ployeeOnlyEm ployee/SpouseEm ployee/Child(ren)Fam ily Prem ium1Select 7500 HMO - Memorial HermannSelect Netw ork 382.57 765.13 765.13 1147.70 18363.232Select 6850 HMO - Memorial HermannSelect Netw ork 391.51 783.03 783.03 1174.54 18792.613Select 6350 HSA HMO - MemorialHermann Select Netw ork 399.48 798.95 798.95 1198.43 19174.914Select 5000 HSA HMO - MemorialHermann Select Netw ork 429.00 858.01 858.01 1287.01 20592.135Select 4000 HSA HMO - MemorialHermann Select Netw ork 436.48 872.95 872.95 1309.43 20950.916Select 002 HMO - Memorial HermannSelect Netw ork 447.87 895.74 895.74 1343.61 21497.767Select 3000 HMO - Memorial HermannSelect Netw ork 448.99 897.97 897.97 1346.96 21551.398Select 5000 HMO - Memorial HermannSelect Netw ork 479.49 958.99 958.99 1438.48 23015.659Select 3000 HSA HMO - MemorialHermann Select Netw ork 485.29 970.58 970.58 1455.86 23293.8710Select 1000 HMO - Memorial HermannSelect Netw ork 514.10 1028.19 1028.19 1542.29 24676.6711Select 1500 HMO - Memorial HermannSelect Netw ork 515.21 1030.43 1030.43 1545.64 24730.2112Select 001 HMO - Memorial HermannSelect Netw ork 516.70 1033.40 1033.40 1550.11 24801.6513Select 2350 HMO - Memorial HermannSelect Netw ork 523.03 1046.05 1046.05 1569.08 25105.3114Select 3000-100 HMO - MemorialHermann Select Netw ork 526.00 1052.01 1052.01 1578.01 25248.1315Select 1500-100 HMO - MemorialHermann Select Netw ork 547.96 1095.91 1095.91 1643.87 26301.9516Select 500 HMO - Memorial HermannSelect Netw ork 585.16 1170.32 1170.32 1755.49 28087.7317Select 7500 PPO - Memorial HermannSelect Netw ork 528.60 1057.20 1057.20 1585.80 25372.8018Select 6350 HSA PPO - MemorialHermann Select Netw ork 573.60 1147.20 1147.20 1720.80 27532.8019Select 5000 HSA PPO - MemorialHermann Select Netw ork 586.63 1173.25 1173.25 1759.88 28158.1120Select 002 PPO - Memorial HermannSelect Netw ork 598.86 1197.73 1197.73 1796.59 28745.4121Select 3000 PPO - Memorial HermannSelect Netw ork 639.52 1279.04 1279.04 1918.56 30696.9622Select 2350 PPO - Memorial HermannSelect Netw ork 663.99 1327.99 1327.99 1991.98 31871.6523Select 1500 PPO - Memorial HermannSelect Netw ork 684.52 1369.04 1369.04 2053.56 32856.96

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Prepared for: Angleton ER PLLC Prepared on: 2023-10-09Quote ID: 66616 Effective Date: 12-01-2023 Product:MedicalPlan Designs – Hybrid PlansSelect 7500 PPO (H30609TX0030200) Participating Providers Non-Participating ProvidersEMPLOYEE’S RESPONSIBILITYAnnual Deductible $7,500 Individual / $15,000 Family $15,000 Individual / $30,000 FamilyAnnual Out-of-Pocket Maximum(1) $7,900 Individual / $15,800 Family $20,000 Individual / $40,000 FamilyOffice Visits $40 PCP / $70 Specialist 30% Coinsurance, Deductible appliesfirst PCP / 30% Coinsurance,Deductible applies first SpecialistAnnual Office Visit Limitations No Limit No LimitInpatient Services No Charge, Deductible applies first 30% Coinsurance, Deductible appliesfirstEmergency Room No Charge, Deductible applies first No Charge, Deductible applies firstRetail Rx (Up to 30 Day Supply)Generic $4 - Preferred; $10 - Non preferred 50% Coinsurance, Deductible appliesfirstBrand Name Formulary After Deductible: $160 - Preferred;$170 - Non preferred50% Coinsurance, Deductible appliesfirstBrand Name Non-Formulary After Deductible: $250 - Preferred;$260 - Non preferred50% Coinsurance, Deductible appliesfirstSpecialty 45% Coinsurance, Deductible appliesfirst45% Coinsurance, Deductible appliesfirst(1) Out-of- pocket maximums include deductibles. NAThis represents a brief description of some of the plan provisions. The Group Policy and certificates of coverage provide amore complete description of the plan design and provisions. If there is any conflict, these contractual documents prevail. List Bill Prem ium Prem ium Pre m iumAge Male Fem ale Age Male Fem ale Age M ale Fem ale0 580.49 580.49 34 201.08 460.09 50 534.98 634.691 580.49 580.49 35 247.01 450.16 51 534.98 634.692-6 137.37 137.37 36 247.01 450.16 52 534.98 634.697-17 159.71 159.71 37 247.01 450.16 53 534.98 634.6918 159.71 159.71 38 247.01 450.16 54 534.98 634.6919 140.26 311.55 39 247.01 450.16 55 678.14 728.2020-24 140.26 311.55 40 306.18 470.85 56 678.14 728.2025 165.09 407.96 41 306.18 470.85 57 678.14 728.2026 165.09 407.96 42 306.18 470.85 58 678.14 728.2027 165.09 407.96 43 306.18 470.85 59 678.14 728.2028 165.09 407.96 44 306.18 470.85 60 882.53 861.8429 165.09 407.96 45 386.44 537.46 61 882.53 861.8430 201.08 460.09 46 386.44 537.46 62 882.53 861.8431 201.08 460.09 47 386.44 537.46 63 882.53 861.8432 201.08 460.09 48 386.44 537.46 64 882.53 861.8433 201.08 460.09 49 386.44 537.46 65 + 1221.81 1037.69PlaceholderOut-of-area rates are 125% of those listed above

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Prepared for: Angleton ER PLLC Prepared on: 2023-10-09Quote ID: 66616 Effective Date: 12-01-2023 Product:MedicalPlan Designs – Hybrid PlansSelect 002 PPO (H30609TX0030203) Participating Providers Non-Participating ProvidersEMPLOYEE’S RESPONSIBILITYAnnual Deductible $3,000 Individual / $6,000 Family $6,000 Individual / $12,000 FamilyAnnual Out-of-Pocket Maximum(1) $6,200 Individual / $12,400 Family $15,000 Individual / $30,000 FamilyOffice Visits $5 PCP / $10 Specialist 50% Coinsurance, Deductible appliesfirst PCP / 50% Coinsurance,Deductible applies first SpecialistAnnual Office Visit Limitations No Limit No LimitInpatient Services 50% Coinsurance, Deductible appliesfirst50% Coinsurance, Deductible appliesfirstEmergency Room 50% Coinsurance, Deductible appliesfirst50% Coinsurance, Deductible appliesfirstRetail Rx (Up to 30 Day Supply)Generic $4 - Preferred; $10 - Non preferred 50% coinsurance, Deductible appliesfirstBrand Name Formulary $50 - Preferred; $60 - Non preferred 50% coinsurance, Deductible appliesfirstBrand Name Non-Formulary $100 - Preferred; $110 - Non preferred 50% coinsurance, Deductible appliesfirstSpecialty 45% coinsurance, Deductible appliesfirst45% coinsurance, Deductible appliesfirst(1) Out-of- pocket maximums include deductibles. NAThis represents a brief description of some of the plan provisions. The Group Policy and certificates of coverage provide amore complete description of the plan design and provisions. If there is any conflict, these contractual documents prevail. List Bill Prem ium Prem ium Pre m iumAge Male Fem ale Age Male Fem ale Age M ale Fem ale0 657.65 657.65 34 227.81 521.25 50 606.09 719.061 657.65 657.65 35 279.84 510.00 51 606.09 719.062-6 155.62 155.62 36 279.84 510.00 52 606.09 719.067-17 180.94 180.94 37 279.84 510.00 53 606.09 719.0618 180.94 180.94 38 279.84 510.00 54 606.09 719.0619 158.91 352.97 39 279.84 510.00 55 768.28 824.9920-24 158.91 352.97 40 346.87 533.43 56 768.28 824.9925 187.03 462.18 41 346.87 533.43 57 768.28 824.9926 187.03 462.18 42 346.87 533.43 58 768.28 824.9927 187.03 462.18 43 346.87 533.43 59 768.28 824.9928 187.03 462.18 44 346.87 533.43 60 999.84 976.4029 187.03 462.18 45 437.81 608.90 61 999.84 976.4030 227.81 521.25 46 437.81 608.90 62 999.84 976.4031 227.81 521.25 47 437.81 608.90 63 999.84 976.4032 227.81 521.25 48 437.81 608.90 64 999.84 976.4033 227.81 521.25 49 437.81 608.90 65 + 1384.21 1175.62PlaceholderOut-of-area rates are 125% of those listed above

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Prepared for: Angleton ER PLLC Prepared on: 2023-10-09Quote ID: 66616 Effective Date: 12-01-2023 Product:MedicalPlan Designs – Hybrid PlansSelect 3000 PPO (H30609TX0030031) Participating Providers Non-Participating ProvidersEMPLOYEE’S RESPONSIBILITYAnnual Deductible $3,000 Individual / $6,000 Family $6,000 Individual / $12,000 FamilyAnnual Out-of-Pocket Maximum(1) $6,850 Individual / $13,700 Family $15,000 Individual / $30,000 FamilyOffice Visits $35 Copay, No Deductible PCP / $70Copay, No Deductible Specialist30% Coinsurance, Deductible appliesfirst PCP / 30% Coinsurance,Deductible applies first SpecialistAnnual Office Visit Limitations No Limit No LimitInpatient Services No Charge, Deductible applies first 30% Coinsurance, Deductible appliesfirstEmergency Room $400 Copay, No Deductible $400 Copay, No DeductibleRetail Rx (Up to 30 Day Supply)Generic $4 - Preferred; $10 - Non preferred 50% Coinsurance; Deductible appliesfirstBrand Name Formulary $50 - Preferred: $60 - Non preferred 50% Coinsurance, Deductible appliesfirstBrand Name Non-Formulary $100 - Preferred; $110 - Non preferred 50% Coinsurance, Deductible appliesfirstSpecialty 45% Coinsurance, Deductible appliesfirst45% Coinsurance, Deductible appliesfirst(1) Out-of- pocket maximums include deductibles. NAThis represents a brief description of some of the plan provisions. The Group Policy and certificates of coverage provide amore complete description of the plan design and provisions. If there is any conflict, these contractual documents prevail. List Bill Prem ium Prem ium Pre m iumAge Male Fem ale Age Male Fem ale Age M ale Fem ale0 702.30 702.30 34 243.28 556.63 50 647.24 767.881 702.30 702.30 35 298.84 544.62 51 647.24 767.882-6 166.19 166.19 36 298.84 544.62 52 647.24 767.887-17 193.22 193.22 37 298.84 544.62 53 647.24 767.8818 193.22 193.22 38 298.84 544.62 54 647.24 767.8819 169.69 376.93 39 298.84 544.62 55 820.44 881.0020-24 169.69 376.93 40 370.42 569.65 56 820.44 881.0025 199.73 493.56 41 370.42 569.65 57 820.44 881.0026 199.73 493.56 42 370.42 569.65 58 820.44 881.0027 199.73 493.56 43 370.42 569.65 59 820.44 881.0028 199.73 493.56 44 370.42 569.65 60 1067.72 1042.6929 199.73 493.56 45 467.53 650.24 61 1067.72 1042.6930 243.28 556.63 46 467.53 650.24 62 1067.72 1042.6931 243.28 556.63 47 467.53 650.24 63 1067.72 1042.6932 243.28 556.63 48 467.53 650.24 64 1067.72 1042.6933 243.28 556.63 49 467.53 650.24 65 + 1478.19 1255.43PlaceholderOut-of-area rates are 125% of those listed above

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Prepared for: Angleton ER PLLC Prepared on: 2023-10-09Quote ID: 66616 Effective Date: 12-01-2023 Product:MedicalPlan Designs – Hybrid PlansSelect 1500 PPO (H30609TX0030204) Participating Providers Non-Participating ProvidersEMPLOYEE’S RESPONSIBILITYAnnual Deductible $1,500 Individual / $3,000 Family $3,000 Individual / $6,000 FamilyAnnual Out-of-Pocket Maximum(1) $4,500 Individual / $9,000 Family $15,000 Individual / $30,000 FamilyOffice Visits $25 PCP / $50 Specialist 30% Coinsurance, Deductible appliesfirst PCP / 30% Coinsurance,Deductible applies first SpecialistAnnual Office Visit Limitations No Limit No LimitInpatient Services 25% Coinsurance, Deductible appliesfirst30% Coinsurance, Deductible appliesfirstEmergency Room $400 then 25% Coinsurance $400 then 25% CoinsuranceRetail Rx (Up to 30 Day Supply)Generic $4 - Preferred; $10 - Non preferred 50% Coinsurance, Deductible appliesfirstBrand Name Formulary $30 - Preferred; $40 - Non preferred 50% Coinsurance, Deductible appliesfirstBrand Name Non-Formulary $60 - Preferred; $70 - Non preferred 50% Coinsurance, Deductible appliesfirstSpecialty 45% Coinsurance, Deductible appliesfirst45% Coinsurance, Deductible appliesfirst(1) Out-of- pocket maximums include deductibles. NAThis represents a brief description of some of the plan provisions. The Group Policy and certificates of coverage provide amore complete description of the plan design and provisions. If there is any conflict, these contractual documents prevail. List Bill Prem ium Prem ium Pre m iumAge Male Fem ale Age Male Fem ale Age M ale Fem ale0 751.72 751.72 34 260.40 595.80 50 692.78 821.911 751.72 751.72 35 319.87 582.94 51 692.78 821.912-6 177.88 177.88 36 319.87 582.94 52 692.78 821.917-17 206.82 206.82 37 319.87 582.94 53 692.78 821.9118 206.82 206.82 38 319.87 582.94 54 692.78 821.9119 181.63 403.45 39 319.87 582.94 55 878.16 943.0020-24 181.63 403.45 40 396.49 609.73 56 878.16 943.0025 213.78 528.29 41 396.49 609.73 57 878.16 943.0026 213.78 528.29 42 396.49 609.73 58 878.16 943.0027 213.78 528.29 43 396.49 609.73 59 878.16 943.0028 213.78 528.29 44 396.49 609.73 60 1142.85 1116.0629 213.78 528.29 45 500.43 696.00 61 1142.85 1116.0630 260.40 595.80 46 500.43 696.00 62 1142.85 1116.0631 260.40 595.80 47 500.43 696.00 63 1142.85 1116.0632 260.40 595.80 48 500.43 696.00 64 1142.85 1116.0633 260.40 595.80 49 500.43 696.00 65 + 1582.20 1343.77PlaceholderOut-of-area rates are 125% of those listed above

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Angleton ER PLLC 000022074Multi-Quote SummaryProposed effective date: 12/01/2023 Number of employees: 30 Industry/SIC code: 7389 Number of employees applying: 30Location 1: ZIP code:77065County: Harris State: TXHealth Benefit Plan DesignTrustmark HealthyChoicesSMTrustmark HealthyEdgeSMPPOLocation 1 Network Not ApplicableAetna SignatureAdministratorsDeductibleIndividual (in-network/out-of-network)$1,500$3,000/$7,500Familytwo times individualtwo times individualDeductible TypeEmbeddedEmbeddedBenefit PeriodCalendar YearCalendar YearCoinsurance(in-network/out-of-network)50%70%/50%Out-of-Pocket LimitIndividual (in-network/out-of-network)$4,000$9,000/$25,000Familytwo times individualtwo times individualTeladoc®Telemedicine Services - General Medical$0 per consult$0 per consultPhysician/Specialist Office Visit$50 copay$40 copayUrgent Care Center$50 copay$125 copayEmergency Room$750 copay$750 copayTherapies$50 copay$40 copayAlternative Medicinedeductible & coinsurancedeductible & coinsuranceOutpatient Diagnostic X-Raydeductible & coinsurancedeductible & coinsuranceOutpatient Diagnostic Labdeductible & coinsurancedeductible & coinsuranceOutpatient Advanced Imagingdeductible & coinsurance$300 copayInpatient Admission/Outpatient Surgery$1,500 access fees$2,000 access feesPrescription Drug Benefit (copays, deductible)$0/$50/$80/$0^, $500$20/$65/$95/$0^, $500MaternityYesYesSpecific Deductible$20,000$20,000Annual Aggregate Attachment Point*$72,780$62,299Runout Period15 Months15 MonthsSurplus Option1/2 Adm Fee Credit1/2 Adm Fee CreditSurplus Determination Period16th month16th monthHealth - Composite Monthly Costs**Family StatusNumber of EmployeesEmployee17$343.09$328.82Employee and Spouse5$926.36$887.82Employee and Child3$552.27$541.12Full Family5$1,135.54$1,100.12Coverage Cost TotalsHealth - Total Monthly Cost$17,798.84$17,153.00Total Monthly Cost for all Coverages$17,798.84$17,153.00Total Annual Cost for all Coverages $213,586.08 $205,836.00*The annual aggregate attachment point is equal to the sum of the 12 monthly claim prefunding amounts due during the contract period.**The monthly costs includes stop-loss premium, administrative fees and claim prefunding.^See product brochure for more details.If the employer offers multiple plans, the total monthly cost will increase by 4%. Impact to stop-loss insurance rates may vary by plan design to comply with state regulations. For an updated proposal, contact your sales contact.This document is not intended to be a proposal. The proposal will reflect the plan design actually chosen and only the actual plan provisions will prevail. Refer to your product brochure for a description of coverages and options. Coverage is not effective without written notification. Any existing coverage should remain in force until such written notification is received. The document presented is valid only for the proposed effective date. Costs may be adjusted based on the health status of employees and dependents of the group for which a final proposal will be generated. An agent who is licensed in the state where the Participating Employer Application and Agreement is signed and where the stop-loss insurance contract is issued must present this document.Quote Name: Initial Quote

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Angleton ER PLLC 000022074Multi-Quote SummaryNumber of employees: 30 Industry/SIC code: 7389 Number of employees applying: 30Proposed effective date: 12/01/2023Location 1: ZIP code:77065County: Harris State: TXHealth Benefit Plan DesignLocation 1 NetworkDeductibleDeductible TypeBenefit PeriodCoinsuranceIndividual (in-network/out-of-network)Family(in-network/out-of-network)Out-of-Pocket Limit Individual (in-network/out-of-network)FamilyTeladoc®Telemedicine Services - General MedicalPhysician/Specialist Office VisitUrgent Care CenterEmergency RoomTherapiesAlternative MedicineOutpatient Diagnostic X-RayOutpatient Diagnostic LabOutpatient Advanced ImagingInpatient Admission/Outpatient SurgeryPrescription Drug Benefit (copays, deductible)MaternityTrustmark HealthyEdgeSMPPOAetna SignatureAdministrators$3,000/$7,500two times individualEmbeddedCalendar Year70%/50%$7,500/$20,000two times individual$0 per consult$35 copay$75 copay$500 copay$35 copaydeductible & coinsurance100% up to $250100% up to $250$300 copay$2,000 access fees$20/$65/$95/$0^, $0YesTrustmark HealthyEdgeSMPPOAetna SignatureAdministrators$1,500/$5,000two times individualEmbeddedCalendar Year70%/50%$5,000/$15,000two times individual$0 per consult$30 copay$60 copay$500 copay$30 copaydeductible & coinsurance100% up to $250100% up to $250$300 copay$2,000 access fees$15/$50/$80/$0^, $0YesSpecific DeductibleAnnual Aggregate Attachment Point*Runout PeriodSurplus OptionSurplus Determination Period$20,000$73,28515 Months1/2 Adm Fee Credit16th month$20,000$94,05715 Months1/2 Adm Fee Credit16th monthHealth - Composite Monthly Costs**Number of Employees$390.49 $473.69$1,054.32 $1,278.97$640.08 $771.26Family StatusEmployeeEmployee and SpouseEmployee and ChildFull Family17535 $1,303.91 $1,576.54Coverage Cost TotalsHealth - Total Monthly Cost $20,349.72 $24,644.06$20,349.72 $24,644.06Total Monthly Cost for all CoveragesTotal Annual Cost for all Coverages $244,196.64 $295,728.72

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DENTALDental insurance can help preserve your smile with easy-to-use coverage that promotes overall wellness.Benefits can help with a variety of dental costs, from routine cleanings to more advanced procedures. Coverage is available for you, your spouse and dependent children.The benefit year maximum for this plan is $2,000 per person.Class A, B and C services apply toward the benefit year maximum.Plan detailsThis plan has a deductible of $50 per person.Families only pay the deductible for a maximum of three people. Applies only to class B and C services.www.elitebenefitsgroup.comCLASS TYPE OF SERVICEINSURANCE PAYSNetworkOur national dental network offers more than 323,000 access points. Members may choose any dentist but may receive additional savings by choosing an in-network dentist. Plus, services not covered by this plan may also still be eligible for in-network savings. Out-of-network benefits are paid at the network negotiated rate.The co-insurance for this plan is:INSURANCE(Network: UNUM) $2,000, 100% 80% 50%Class AClass BClass CPreventive ServiceBasic ServiceMajor Service100%80%50%

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Covered Procedures& waiting periodsRoutine exams and cleanings (twice every 12 months) One additional cleaning per 12 months if member is in second or third trimester of pregnancy4X-raysBitewing X-rays (up to four films; once every 12 months)Full mouth/panoramic x-rays(once every five years)Children’s services(up to age 14) Fluoride treatment (once every 12 months) Sealants (once every 36 months) Space maintainers (up to age 14; once every 24 months)Adjunctive pre-diagnostic oral cancer screening (for age 40 or older; once every 12 months).Simple restorative services(fillings)Simple extractionsEmergency treatmentRepair of crown, denture or bridgeOral surgery (extractions and impacted teeth)Anesthesia (subject to review; covered with complex oral surgery)Periodontics (gum treatments)Endodontics (root canals)Inlays and onlaysCrownsBridgesDenturesEndosteal implants (in lieu of an approved three-unit bridge)Preventive services (Class A): No waiting periodBasic services (Class B): No waiting periodMajor services (Class C): 12 - month waiting periodMonthly PremiumEmployeeEmployee and SpouseEmployee and Child (ren)Employee and Family$33.62$63.53$79.67$117.95www.elitebenefitsgroup.com

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Dental insurance offers an optional vision rider to help pay for eye exams and materials, such as glasses and contact lenses. This coverage can help you maintain healthy vision and overall wellness, as well as provide valuable financial protection for you, your spouse and dependent children.www.elitebenefitsgroup.comVISION BENEFITSIN-NETWORKS OUT OF NETWORK ALLOWANCECO-PAYSSTANDARD PLASTIC LENSES 1 (once per 12 months)FRAMES 1 (once per 12 months)CONTACT LENSES (once per 12 months) (Includes fit, follow-up and materials) in lieu of eyeglass lenses and framesExam (once per 12 months)Materials$10$25Up to $35See belowSingle visionBifocalTrifocalLenticularProgressivePolycarbonate lenses (for children to age 19)Covered by co-payCovered by co-payCovered by co-payCovered by co-pay$80 allowance$70 allowanceUp to $25Up to $40Up to $50Up to $50Up to $40N/Achoose any frame avaiable at provider locations$120 allowanceUp to $50ElectiveMedically NecessaryUp to $120 allowanceUp to $210 allowanceUp to $100 allowanceUp to $210 allowanceVISION

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Voluntary Benefits 101What are voluntary benefits?Sometimes called “supplemental insurance,” voluntary benefits are policies you buy to add to the health and life insurance your employer may already provide. These benefits can help you pay for things your other insurance won’t, such as lost wages, out-of-pocket expenses and household bills.Advantages*Flexibility Use claim payments however you like – pay deductibles, co-payments and other expenses not covered by your health or life insurancePortability Take coverage with you if you leave your job or retireStability Maintain coverage whether or not you’re employedConvenience Pay premiums using your choice of payroll deduction, bank dra or direct billingTo learn more about voluntary benefits, contact us at 713-575-3722ColonialLife.comUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.Policies Accident insurance Helps cover out-of-pocket expenses in the event of a covered accidentCancer and critical illness insurance Helps with the high cost of cancer or critical illness diagnosis and treatmentDental insurance Helps pay for dental procedures, like routine cleanings, crowns and root canalsDisability insurance Helps replace part of your regular income if you are unable to work because of a covered injury or illnessHospital confinement indemnity insurance Helps pay for covered hospital-related expenses, such as outpatient surgery and diagnostic proceduresLife insurance Protects the people who depend on you by helping cover final expenses and loss of income*Advantages may not apply to all products. See your Colonial Life benefits counselor forcomplete details.

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Offer 24/7 health care access for your employeesThere’s a simple way to expand your benefits package and give your employees better access to medical care. In association with Recuro Health, Colonial Life can help you provide an easier form of doctor visits for your employees — virtual care. This service is available at no direct cost to you or them for the first year following the enrollment.Our service solutionWhile not intended to replace a primary care doctor, Recuro Health gives your employees 24/7 access to board-certified doctors, where it’s most convenient for them. With more than 20 million members, Recuro Health is one of the nation’s largest virtual care networks with state-licensed physicians averaging 15 years of practice experience.Aer registering, your employees can have a virtual consult to diagnose non-emergency medical issues over the phone or through secure video on their computer, tablet or the Recuro Health Mobile App. When a medical condition calls for a prescription, Recuro Health doctors can send an e-prescription straight to the patient’s local pharmacy of choice (restrictions apply).Improving employee care just got easierMaking Recuro Health part of your overall benefits oering is an easy way to show your employees you care about their access to medical care. It can also help decrease employee absenteeism and increase productivity — while helping lower health care costs for your business. Colonial Life will only fund this program for the first year. Following the first year, you have the opportunity to fund the program at a discounted rate so that your employees can continue their coverage.To learn more, talk with your Colonial Life representative.10-22 | 101765-4ColonialLife.comHere are some of the common conditions that can be treated:Recuro Health also oers pediatric care.By accessing, using, or registering with the Recuro Health Application, you agree that you have read and understood, and, as a condition to your use of the app, you agree to be bound by, these terms of use. You do not have permission to use the Application if you do not agree to these terms of use. The Application is intended to facilitate the provision of services to registered users. Recuro Health is the operator of this Application and does not provide healthcare services. Recuro’s digital health tools do not provide medical diagnosis, advice, or treatment. You should discuss with your physician before making any medical decisions, including starting, stopping or modifying any medication or other treatment or care plan. Services facilitated through the Application can range from health risk assessments, to diagnostic and genomic testing, to visits with healthcare providers, to prescription of medication by healthcare providers, to other healthcare tracking and navigation tools. The Application enables Healthcare Providers to oer an online telehealth service that, when clinically appropriate, allows patients to obtain a limited range of health care from participating Healthcare Providers. Based on the information you provide, a Healthcare Provider will provide a diagnosis and a treatment plan for you. If you register to receive health care services from Healthcare Providers through the Application, we will rely on you to provide accurate and complete information throughout both the clinical interview and the registration process, in order to ensure you receive appropriate care.For complete terms & conditions, visit: www.recurohealth.com/terms-conditions/ Allergies Asthma Bronchitis Cold and flu Ear infections Fever Headache Joint aches Respiratory infections Sinus infections Skin infections Urinary tract infectionsInsurance products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

Angleton ER Proposal

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