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2023 EMPLOYEE BENEFITS Benefits Summary Guide 2024

Welcome to your 2024 Benefits We consider our employee benefits program to be one of our most important investments Because we recognize the value our employees bring to our company we are committed to providing you with a complete benefits program as part of your total compensation Your benefit needs are unique and our program is designed to be comprehensive and flexible so you are able choose the benefits that make the most sense for you and your family This summary describes your employee benefits available to you This guide is meant only to cover major points of each benefit and does not contain all the details of each plan or policy including limitations and exclusions If there is ever a question about one of these plans or policies or if there is a conflict between the information in this summary and the official carrier supplied plan or policy documents the formal wordings in those documents will govern These benefits may be changed at any time and do not represent a contractual obligation on the part of your employer ELIGIBILITY Employees All full time employees working at least 30 hours per week are eligible for group benefits All benefits are effective on the first of the month following 30 days of employment For example if you start January 1st your benefits are effective February 1st Eligible Dependents Your eligible dependents include your legally married spouse and children including stepchildren and adopted children until age 26 for all benefits Coverage may be available for a mentally or physically disabled child who is age 26 or older Please contact your human resource department WHEN CAN YOU ENROLL MAKE CHANGES New Hires Newly Eligible for Benefits The portal for open enrollment will be available in Paycom after 30 days of employment You have until the end of the month at that point to enroll If you do not enroll within that time you will not be eligible for benefits until the next Open Enrollment unless you have a Qualifying Life Event Open Enrollment During Open Enrollment you will have the opportunity to make changes to your benefit elections You must enroll online by the Open Enrollment deadline for your benefits to be effective January 1st Except for a Qualifying Life Event you will not be able to change your elections until the next year s Open Enrollment Qualifying Life Event If you have a Qualifying Life Event you may be able to change your benefits before the next Open Enrollment You must notify Human Resources within 30 days of the change Some examples of Qualifying Life Events include Marriage Divorce Birth of a child adoption or placement for adoption Loss of other coverage Court Order 2

Medical Prescription Drug Benefits Because we recognize how important medical coverage is for you and your family you have the opportunity to enroll into a major medical plan sponsored by CIGNA Although you may have coverage outside of the network it is beneficial for you to stay within the network To help save money always ask your physician if they have a contract with the CIGNA Open Access Plus Network To locate a physician or facility within the network simply go to www mycigna com From there you can request physicians or facilities in a specific area by zip code or by a specific name BENEFIT what you pay Network Calendar Year Deductible Individual Family copays do not count toward deductible Co Insurance Calendar Year Out of Pocket Max Individual Family includes deductible coinsurance copays Preventative Care Physicians Office Visit Specialist Office Visit MDLive Virtual Visit Diagnostic Lab X ray except for Complex imaging Complex Imaging MRI PET CTscans Outpatient Hospitalization Inpatient Hospitalization Emergency Room Urgent Care Facility Retail Prescription Drugs 30 daysupply Generic Brand Formulary Preferred Brand Non formulary Non preferred Specialty Drugs Mail Order Prescription 90 day supply Generic Brand Formulary Preferred Brand Non formulary Non preferred Specialty Drugs Pharmacy Information C I G N A MEDICAL BASE PLAN HDHP HSA In Network Benefits Shown Open Access Plus Network MIDDLE PLAN PPO In Network Benefits Shown Open Access Plus Network 5 000 10 000 3 500 10 500 20 30 6 500 13 000 Covered at 100 no deductible 20 after deductible 20 after deductible 20 after deductible 20 after deductible 20 after deductible 20 after deductible 20 after deductible 20 after deductible 20 after deductible 6 500 13 000 Covered at 100 no deductible 40 copay 60 copay No Charge No Charge 30 after deductible 30 after deductible 30 after deductible 200 copay then 30 50 copay 20 after deductible 20 after deductible 20 after deductible 20 after deductible 25 copay 50 copay 70 copay 25 50 70 copay 20 after deductible 20 after deductible 20 after deductible 20 after deductible 75 copay 150 copay 210 copay 75 150 210 copay Pharmacy Network Cigna 90 Now Network Drug List available at cigna com druglist BUY PLAN PPO In Network Benefits Shown Open Access Plus Network 2 000 6 000 30 6 500 13 000 Covered at 100 no deductible 30 copay 50 copay No Charge No Charge 30 after deductible 30 after deductible 30 after deductible 200 copay then 30 50 copay 25 copay 45 copay 60 copay 25 45 60 copay 75 copay 135 copay 180 copay 75 135 180 copay Payment of the difference between the cost of a brand name drug and a generic may be required if a generic drug is available 3

Health Savings Account ELIGIBILITY CONTRIBUTIONS A Health Savings Account is a tax advantaged medical savings account available to individuals enrolled in a qualified High Deductible Health Plan HDHP Please note this is a voluntary benefit HDHP PLAN HDHP HSA is a qualified HDHP which allows you to open an HSA account If you elect this plan option you can have funds deducted from your paycheck on a pre tax basis to be deposited directly into your HSA account The HSA funds may only be used to pay for qualified medical dental or vision expenses otherwise federal tax liability and or penalties will apply Any unused funds will rollover and accumulate year to year if not spent Since HSA accounts are owned by the individual if you leave employment you take the funds with you If you later choose to enroll in a non qualified HSA plan you can no longer contribute to your HSA account however you can continue to access the funds to pay for qualified expenses In order to contribute into the Health Savings Account HSA you must be enrolled in the HDHP Plan HDHP HSA for 2024 This is a voluntary benefit and you do not have to contribute The IRS has set limits on the total amount that can be contributed into your HSA account For 2024 the limits are as follows MAXIMUM CONTRIBUTION LIMITS IN 2024 Individual Account Family Account Over age 55 4 150 year 8 300 year Optional 1 000 year additional contribution HEALTHCARE EXPENSES For ease of utilizing the Health Savings Account you will receive a bank account and a debit card You may simply use the debit card for any medical dental and vision expense as your form of payment and the amount will be deducted from your balance It is best to save all your expense receipts should you be asked to submit them in the future Examples of eligible healthcare expenses include Doctor s office visit and Prescription copays Deductibles Co Insurance Over the Counter Medication with a prescription Eyeglasses Eye Surgery Contact Lenses Braces and other dental services Birth Control Pills Chiropractor Once your bank account has been set up you can visit www hsabank com to view your account 4

Dental Benefits Staying healthy includes obtaining quality dental care for you and your family Although your dental plan allows out of network benefits it is in your best interest to stay within the network to benefit from the contracted discounts applied to their services The Dental Network is the UNUM Dental Network To locate a participating dentist in your area you can go to www unumdentalcare com Remember using a network provider can potentially save you money BENEFIT Calendar Year Deductible Basic and Major Services Individual Family Calendar Year Maximum Preventive Basic and Major Services Type 1 Diagnostic Preventative Services Oral Exams Prophylaxis twice every 12 months Full Mouth X Rays once every 36 months Space Maintainers Fluoride Treatment to age 16 once every 12 months Sealants to age 16 permanent molars once every 36 months Type 2 Basic Services Fillings benefit allowed for amalgam restorations on posterior teeth Simple Extractions Endodontics eg Root Canal Periodontal maintenance in combination with Prophylaxis Non surgical periodontics Surgical periodontics gum treatments Anesthesia subject to review covered with complex oral surgery Type 3 Major Services Inlays Onlays Crown bridges dentures and implants Repairs crowns denture and bridges Waiting Periods Timely Applicants Preventive Services Basic Services Major Services Criteria Annual Carryover Amount Maximum Carryover Limit Claims Claims Paid IN NETWORK OUT OF NETWORK 50 150 1 000 0 deductible waived 0 deductible waived 20 after deductible 20 after deductible 50 after deductible 50 after deductible None None None None None None Must be enrolled in the plan for 12 months then rollover is added at the next anniversary date 250 1 000 Fee Schedule In Network Fee Schedule 5

Vision Benefits Vision care is also an important part of you and your family s healthcare therefore you will be given the opportunity to enroll with UNUM Although you have out of network benefits it is again best for you to stay within the network to receive less out of pocket expenses for you and your family UNUM Vision Care Plan utilizes the EyeMed Vision Care Network which has an extensive network of providers who offer co payments and or reimbursements for eye exams lenses and frames To locate a participating provider in your area you can go www EyeMedVisionCare com UNUM BENEFIT Eye Exam once every 12 months Eyeglass Lenses once every 12 months Single Vision Bifocal Vision Trifocal Vision Lenticular Vision Eyeglass Frames once every 12 months Contact Lenses Medically Necessary in lieu of eyeglasses once every 12 months Contact Lenses Elective in lieu of eyeglasses once every 12 months Lasik Vision Discount IN NETWORK 10 copay 10 copay 10 copay 10 copay 10 copay 130 Allowance Covered in full 130 Allowance Nationwide access to discounts on LASIK surgery through partnership with TLC Vision Discounts are also available with participating local providers OUT OF NETWORK Up to 40 Up to 30 Up to 50 Up to 70 Up to 70 Up to 91 Up to 210 Up to 130 N A 6

Group Life AD D Insurance Life insurance is an important part of your financial well being especially if others depend on you for support Accidental Death Dismemberment AD D coverage is also important in the event you are involved in an accident resulting in your death or suffer a dismemberment Your employer will provide basic term life AD D insurance at NO COST to all eligible employees who enroll in one of the three medical plans offered This benefit is available only to active full time employees GROUP LIFE AND AD D BENEFIT COMPANY PAID FOR EMPLOYEES ENROLLED IN MEDICAL Life Benefit Amount 25 000 AD D Benefit Amount 25 000 Benefit Reduction 35 at the age 65 and 50 at age 70 Voluntary Life AD D Insurance You may elect Voluntary Life and AD D insurance for yourself spouse and legal dependents up to the Guarantee Issue Amount This is the amount of coverage you can qualify without providing Evidence of Insurability EOI Also any amount over the Guarantee Issue Amount will require Evidence of Insurability EOI Why is this coverage so valuable If you buy a minimum of 10 000 of coverage now you can increase your coverage in the future up to 100 000 to meet your growing needs There would be no medical underwriting to qualify for coverage Premiums are based on age and the amount of approved coverage Per pay deductions will be displayed when you enroll through Paycom COVERAGE Minimum Maximum Increments Guarantee Issue U N U M VOLUNTARY LIFE AND AD D BENEFIT EMPLOYEE You may elect a max of 500 000 up to 5x annual earnings 10 000 SPOUSE You may elect up to 150 000 not to exceed 100 of employees amount 5 000 CHILDREN You may elect up to 10 000 Max benefit for children live birth to 6 months is 1 000 2 000 500 000 150 000 10 000 10 000 100 000 5 000 25 000 2 000 10 000 Employee and Spouse rates are calculated based on the current age of the Employee as of the effective date and the amount of coverage Age Reduction 65 at age 65 50 at age 70 Employee and spouse rates are adjusted once each year on the plan anniversary date for employees advancing to the next age band Additional information EOI s and claim forms are available at www paycom com under Benefits Benefit Forms and Links Beneficiary Designation By receiving Group Life and AD D and or electing into Voluntary Life and AD D you are given the opportunity to select a beneficiary of your choice should this benefit ever have to pay out It is your responsibility to update your records each time a change in beneficiary may occur To update this information please see your Human Resource Department 7

Voluntary Disability Insurance Disability insurance is an added financial security and can help protect you and your family for a set period of time and can replace part of your income if disability keeps you out of work It is an important part of your financial well being especially if others depend on you for support All employees can enroll during this enrollment and do not have to complete Evidence of Insurability EOI V O L U N T A R Y S H O R T TERM DISABILITY Coverage Amount Elimination Period Accident Sickness Benefit Duration 60 of basic weekly earnings up to 1 500 7 days 7 days 25 weeks Pre Existing Conditions 3 months prior 12 months insured Voluntary Short Term Disability Premiums are based on age per 10 of weekly benefit Per pay deductions will be displayed when you enroll through Paycom V O L U N T A R Y L O N G TERM DISABILITY Coverage Amount 60 of your monthly income up to 6 000 Elimination Period Accident Sickness Benefit Duration Pre Existing Conditions 180 days You can receive benefits up to the Social Security SS normal retirement age Not Covered Voluntary Long Term Disability Premiums are based on age per 100 of monthly benefit Per pay deductions will be displayed when you enroll through Paycom 8

Worksite Products You may also apply for any worksite coverages below for you and your family if you are an eligible employee Benefits are paid directly to you and you are free to use them to cover expenses you deem fit ACCIDENT INSURANCE How does it work Accident Insurance provides a set benefit amount based on the type of injury you have and the type of treatment you need It covers accidents that occur on and off the job And it includes a range of incident from common injuries to more serious events BENEFIT Accident Coverage Death Benefit employee spouse children Ambulance Ground Air Emergency Room Urgent Care Follow up Visit Doctor Hospital Admission Hospital Confinement Wellness Benefit On and off the job 50 000 25 000 12 500 200 1 500 150 150 75 visit up to 2 visits 1 200 250 up to 365 days 50 CRITICAL ILLNESS How does it work If you re diagnosed with an illness that is covered by this insurance you can receive a lump sum benefit payment You can use the money however you want BENEFIT Employee Critical Illness Benefit Employee Critical Illness Guarantee Issue Spouse Critical Illness Benefit Spouse Critical Illness Guarantee Issue Child Critical Illness Benefit Pre Existing Conditions Limitation Wellness Benefit Covered Conditions 10 000 10 000 50 of the employee benefit amount 50 of the employee benefit amount Children from live birth to age 26 are automatically covered at no extra cost 50 of the employee benefit amount 12 month look back 12 month exclusion period 50 per calendar year for each family member Cancer Heart Attack Stroke Coma etc 9

Worksite Products cont GROUP HOSPITAL INSURANCE How does it work Group Hospital Insurance helps covered employees and their families cope with the financial impacts of a hospitalization You can receive benefits when you re admitted to the hospital for a covered accident illness or childbirth BENEFIT Hospital Admission ICU Admission Hospital Daily Stay ICU Daily Stay Short Stay Payable for a maximum of 1 day per year Payable for a maximum of 1 day per year Payable per day up to 365 days Payable per day up to 30 days Payable for a maximum of 1 day per year 1 000 1 000 100 100 250 10

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Medical Monthly Deductions BASE PLAN HDHP HSA EMPLOYEE ONLY 30 00 MIDDLE PLAN PPO EMPLOYEE SPOUSE 452 11 EMPLOYEE CHILD REN 346 58 EMPLOYEE FAMILY 768 70 EMPLOYEE ONLY 101 92 EMPLOYEE SPOUSE 568 19 BUY UP PLAN PPO EMPLOYEE ONLY 114 26 EMPLOYEE SPOUSE 589 90 Your premiums will be deducted on a pre tax basis EMPLOYEE CHILD REN 440 53 EMPLOYEE CHILD REN 459 30 EMPLOYEE FAMILY 951 17 EMPLOYEE FAMILY 981 79 Dental Vision Monthly Deductions DENTAL PLAN EMPLOYEE ONLY 6 33 EMPLOYEE SPOUSE 37 27 EMPLOYEE CHILD REN 44 29 EMPLOYEE FAMILY 68 16 VISION PLAN EMPLOYEE ONLY 1 68 EMPLOYEE SPOUSE 7 70 Your premiums will be deducted on a pre tax basis EMPLOYEE CHILD REN 8 39 EMPLOYEE FAMILY 14 68 COBRA Coverage for employees and their covered dependents terminates on the last day worked or the last day of the month in which the termination occurs with no carry over time or grace period Employees leaving the Company will be notified in writing of their rights and options to continue medical dental and vision insurance under COBRA COBRA payments and procedures are handled between the exemployee and the Plan Claims Administrator 13

Voluntary Short Term Disability Deductions VOLUNTARY SHORT TERM DISABILITY RATES 80 per 10 of coverage Example Employee with 40 000 annual salary and weekly benefit of 461 54 60 of weekly salary 461 54 10 x 80 36 92 per month or 8 52 weekly Your premiums will be deducted on a post tax basis Voluntary Long Term Disability Deductions Age Band 25 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 Rates per 100 of Monthly Covered Payroll 0 12 0 17 0 30 0 51 0 83 1 14 1 34 1 79 1 68 1 49 1 00 Your premiums will be deducted on a post tax basis 14

Voluntary Life AD D Monthly Deductions Age Band 15 24 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 75 Employee Life Monthly Rates Per 1 000 0 080 0 080 0 100 0 150 0 210 0 350 0 540 0 780 1 030 1 320 2 420 8 140 Spouse Life Monthly Rates Per 1 000 0 080 0 080 0 100 0 150 0 210 0 350 0 540 0 780 1 030 1 320 2 420 8 140 Child Life Monthly Rate Per 1 000 0 200 Note The premium paid for child coverage is based on the cost of coverage for one child regardless of how many children you have Children are eligible up to age 26 15

Accident Monthly Deductions EMPLOYEE ONLY 14 83 EMPLOYEE SPOUSE EMPLOYEE CHILD 26 13 30 20 Your premiums will be deducted on a pre tax basis EMPLOYEE FAMILY 41 50 Hospital Monthly Deductions EMPLOYEE ONLY 11 07 EMPLOYEE SPOUSE 26 57 EMPLOYEE CHILD 17 89 Your premiums will be deducted on a pre tax basis EMPLOYEE FAMILY 33 39 Critical Illness Monthly Deductions Full Time Employees Critical Illness Attained Age Costs 10 000 Employee and 5 000 Spouse 50 Be Well Benefit Age 25 4 16 3 01 25 29 4 96 3 41 30 34 5 86 3 86 35 39 7 06 4 46 40 44 9 26 5 56 45 49 12 96 7 41 50 54 19 16 10 51 55 59 26 16 14 01 60 64 45 56 23 71 65 69 61 56 31 71 70 74 83 66 42 76 75 79 112 56 57 21 80 84 149 16 75 51 85 215 66 108 76 Your premiums will be deducted on a post tax basis Attained age rates and costs are based on the insured s age each year on the policy anniversary date and increase as the insured ages and moves into new age bands 16

BENEFIT Group Medical Health Savings Account MDLive Virtual Visits Dental Vision Life and AD D Voluntary Term Life Voluntary Short Term Long Term Disability Voluntary Accident Voluntary Critical Illness Voluntary Hospital Insurance Numbers You Need to Know INSURANCE CARRIER CONTACT INFORMATION CARRIER CIGNA HSA Bank CIGNA UNUM GROUP NUMBER CUSTOMER SERVICE NUMBER 00652128 N A 00652128 1 888 806 5094 English 1 800 357 6246 Spanish 1 866 357 6232 1 888 726 3171 958270 1 888 400 9304 UNUM 958270 1 888 400 9304 UNUM 958267 1 800 421 0344 UNUM 958268 1 800 421 0344 UNUM 958269 1 800 421 0344 UNUM 958271 1 800 635 5597 UNUM 958272 1 800 635 5597 UNUM 958273 1 800 635 5597 WEBSITE www mycigna com www hsabank com www mycigna com www unumdentalcare com www unumvisioncare com www unum com employees www unum com employees www unum com employees www unum com employees www unum com employees www unum com employees 17

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Notices Health Plan Compliance Notices Disclaimer This document contains many of the required Health and Welfare Plan model notice templates provided by the Department of Labor and other Federal agencies Most employers prefer to include required notices in their open enrollment materials for ease of distribution Some of these notices may require distribution outside of the open enrollment period or to both employees as well as dependent participants For example the General COBRA Notice must be provided to not only participating employees but also to participating spouses In addition some notices may require further customization based on the specific terms of your plan For example if you offer a fully insured plan and any state mandated billing requirements apply to your plan a state summary or state developed model language may need to be added to your Surprise Medical Bills Notice Employers may also be subject to additional State laws and Federal disclosures not outlined in these materials For example the ACA requires that employers distribute a Marketplace Notice to all employees within 14 days of the employee s start date because this notice is required to be distributed to all employees upon hire and not on an annual basis and must be highly customized this notice is not included in this packet Similarly if you offer a wellness program that asks participants health related questions e g a health risk assessment or involves a medical examination e g biometric testing then an additional ADA Notice will be required that contains customized information relating to your specific wellness plan For a more detailed overview of commonly required health plan compliance notices ask your McGriff Account Team for our annual Employee Benefit Plan Reporting and Disclosure Guide If you have questions about or need additional clarity on the notices provided herein please reach out to your McGriff Account Team You are also encouraged to retain ERISA counsel to review all notices for proper customization and accuracy and to determine which additional disclosures you may be required to provide to your employees and plan participants 25

Notices Medicare Part D Creditable Coverage Notice Important Notice from FABco LLC About your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it This notice has information about your current prescription drug coverage offered by the HDHPQ OAP OAP Base OAP Buy Up through FABco LLC and about your options under Medicare s prescription drug coverage This information can help you decide whether or not you want to join a Medicare drug plan If you are considering joining you should compare your current coverage including which drugs are covered at what cost with the coverage and costs of the plans offering Medicare prescription drug coverage in your area Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice There are two important things you need to know about your current coverage and Medicare s prescription drug coverage 1 Medicare prescription drug coverage became available in 2006 to everyone with Medicare You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan like an HMO or PPO that offers prescription drug coverage All Medicare drug plans provide at least a standard level of coverage set by Medicare Some plans may also offer more coverage for a higher monthly premium 2 FABco LLC has determined that the prescription drug coverage offered by the HDHPQ OAP OAP Base OAP Buy Up is on average for all plan participants expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage Because your existing coverage is Creditable Coverage you can keep this coverage and not pay a higher premium a penalty if you later decide to join a Medicare drug plan When Can You Join A Medicare Drug Plan You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th However if you lose your current creditable prescription drug coverage through no fault of your own you will also be eligible for a two 2 month Special Enrollment Period SEP to join a Medicare drug plan What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan If you decide to join a Medicare drug plan your current coverage through FABco LLC will not be affected You can keep this coverage if you elect Part D and this plan will coordinate with Part D coverage If you decide to join a Medicare drug plan and drop your current group health coverage through FABco LLC be aware that you and your dependents will be able to get this coverage back If you are able to get this coverage back reentry into the plan is subject to the underlying terms of the Plan When Will You Pay A Higher Premium Penalty To Join A Medicare Drug Plan You should also know that if you drop or lose your current group health coverage through FABco LLC and don t join a Medicare drug plan within 63 continuous days after your current coverage ends you may pay a higher premium a penalty to join a Medicare drug plan later If you go 63 continuous days or longer without creditable prescription drug coverage your monthly premium may go up by at least 1 of the Medicare base beneficiary premium per month for every month that you did not have that coverage For example if you go nineteen months without creditable coverage your premium may consistently be at least 19 higher than the Medicare base beneficiary premium You may have to pay this higher premium a penalty as long as you have Medicare prescription drug coverage In addition you may have to wait until the following October to join For More Information About This Notice Or Your Current Prescription Drug Coverage Contact the Plan Administrator listed below for further information NOTE You ll get this notice each year or if the creditable coverage status of this plan through FABco LLC changes You may request a copy of this notice at any time For More Information About Your Options Under Medicare Prescription Drug Coverage 26

Notices More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare You handbook You ll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plans For more information about Medicare prescription drug coverage Visit www medicare gov Call your State Health Insurance Assistance Program see the inside back cover of your copy of the Medicare You handbook for their telephone number for personalized help Call 1 800 MEDICARE 1 800 633 4227 TTY users should call 1 877 486 2048 If you have limited income and resources extra help paying for Medicare prescription drug coverage is available For information about this extra help visit Social Security on the web at www socialsecurity gov or call them at 1 800 772 1213 TTY 1 800 325 0778 Remember Keep this Creditable Coverage notice If you decide to join one of the Medicare drug plans you may be required to provide a copy of this notice when you join to show whether or not you have Fomr pauinrtpaoisneesdocfrethdiistanbolteicceo vtehreaPglea naAnddmthineirsetfroatroer wis hether or not you are required to pay a higher premium a penalty Laura Butler 713 633 6500 27

Notices Wellness Program Disclosure Your health plan is committed to helping you achieve your best health Rewards for participating in a wellness program are available to all employees If you think you might be unable to meet a standard for a reward under this wellness program you might qualify for an opportunity to earn the same reward by different means Contact us at 713 633 6500 and we will work with you and if you wish with your doctor to find a wellness program with the same reward that is right for you in light of your health status 28

Notices WHCRA Enrollment Annual Notice Enrollment Notice If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Women s Health and Cancer Rights Act of 1998 WHCRA For individuals receiving mastectomy related benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for All stages of reconstruction of the breast on which the mastectomy was performed Surgery and reconstruction of the other breast to produce a symmetrical appearance Prostheses and Treatment of physical complications of the mastectomy including lymphedema These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you would like more information on WHCRA benefits call your plan administrator as identified at the end of these notices Annual Notice Do you know that your plan as required by the Women s Health and Cancer Rights Act of 1998 provides benefits for mastectomy related services including all stages of reconstruction and surgery to achieve symmetry between the breasts prostheses and complications resulting from a mastectomy including lymphedema Call your plan administrator at 713 633 6500 for more information For purposes of this notice the plan administrator is Laura Butler 713 633 6500 29

Notices Newborns Act Disclosure Group health plans and health insurance issuers generally may not under Federal law restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery or less than 96 hours following a cesarean section However Federal law generally does not prohibit the mother s or newborn s attending provider after consulting with the mother from discharging the mother or her newborn earlier than 48 hours or 96 hours as applicable In any case plans and issuers may not under Federal law require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours or 96 hours 30

Notices General Notice of COBRA Continuation Coverage Rights For use by single employer group health plans Continuation Coverage Rights Under COBRA Introduction You re getting this notice because you recently gained coverage under a group health plan the Plan This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 COBRA COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federal law you should review the Plan s Summary Plan Description or contact the Plan Administrator You may have other options available to you when you lose group health coverage For example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out of pocket costs Additionally you may qualify for a 30 day special enrollment period for another group health plan for which you are eligible such as a spouse s plan even if that plan generally does not accept late enrollees What is COBRA continuation coverage COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a qualifying event Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a qualified beneficiary You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If you re an employee you ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events Your hours of employment are reduced or Your employment ends for any reason other than your gross misconduct If you re the spouse of an employee you ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events Your spouse dies Your spouse s hours of employment are reduced Your spouse s employment ends for any reason other than his or her gross misconduct Your spouse becomes entitled to Medicare benefits under Part A Part B or both or You become divorced or legally separated from your spouse Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events 31

Notices The parent employee dies The parent employee s hours of employment are reduced The parent employee s employment ends for any reason other than his or her gross misconduct The parent employee becomes entitled to Medicare benefits Part A Part B or both The parents become divorced or legally separated or The child stops being eligible for coverage under the Plan as a dependent child If the Plan provides retiree health coverage sometimes filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event If a proceeding in a bankruptcy is filed with respect to FABco LLC and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan the retired employee will become a qualified beneficiary The retired employee s spouse surviving spouse and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of coverage under the Plan When is COBRA continuation coverage available The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying events The end of employment or reduction of hours of employment Death of the employee If the Plan provides retiree health coverage commencement of a proceeding in bankruptcy with respect to the employer or The employee s becoming entitled to Medicare benefits under Part A Part B or both For all qualifying events divorce or legal separation of the employee and spouse or a dependent child s losing eligibility for coverage as a dependent child you must notify the Plan Administrator in writing within 60 days You must provide this written notice to Laura Butler at 13835 Beaumont Hwy Houston TX 77049 How is COBRA continuation coverage provided Once the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offered to each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage There are also ways in which this 18 month period of COBRA continuation coverage can be extended Disability extension of 18 month period of COBRA continuation coverage If you or anyone in your family covered under the Plan is determined by the Social Security Administration SSA to be disabled and you timely notify the Plan Administrator in writing you and your covered 32

Notices dependents may be entitled to receive up to an additional 11 months of COBRA continuation coverage for a total maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18 month period of COBRA continuation coverage In order for this disability extension to apply you must timely notify the Plan Administrator in writing of the SSA disability determination before the end of the 18 month period of continuation coverage and within 60 days after the later of i the date of the initial qualifying event ii the date on which coverage would be lost because of the initial qualifying event or iii the date of the SSA disability determination This notice must be mailed to Laura Butler at 13835 Beaumont Hwy Houston TX 77049 Oral notice including notice by telephone is not acceptable The written notice must include the name and address of the employee covered under the plan the name of the disabled qualified beneficiary the date that the qualified beneficiary became disabled and the date that the SSA made its determination of disability Your notice must also include a copy of the SSA disability determination If these procedures are not followed or if written notice is not provided to the Plan Administrator within the required time period there will be no disability extension of COBRA continuation coverage You must also notify the Plan Administrator within 30 days of any revocation of Social Security disability benefits Second qualifying event extension of 18 month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits under Part A Part B or both gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred Are there other coverage options besides COBRA Continuation Coverage Yes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid Children s Health Insurance Program CHIP or other group health plan coverage options such as a spouse s plan through what is called a special enrollment period Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at www healthcare gov Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends In general if you don t enroll in Medicare Part A or B when you are first eligible because you are still employed after the Medicare initial enrollment period you have an 8 month special enrollment period to sign up for Medicare Part A or B beginning on the earlier of The month after your employment ends or The month after group health plan coverage based on current employment ends see https www medicare gov sign up change plans how do i get parts a b part a part b sign up periods If you don t enroll in Medicare and elect COBRA continuation coverage instead you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends the Plan may terminate your continuation coverage However if Medicare Part A or B is 33

Notices effective on or before the date of the COBRA election COBRA coverage may not be discontinued on account of Medicare entitlement even if you enroll in the other part of Medicare after the date of the election of COBRA coverage If you are enrolled in both COBRA continuation coverage and Medicare Medicare will generally pay first primary payer and COBRA continuation coverage will pay second Certain plans may pay as if secondary to Medicare even if you are not enrolled in Medicare For more information visit https www medicare gov medicare and you If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act ERISA including COBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the U S Department of Labor s Employee Benefits Security Administration EBSA in your area or visit www dol gov ebsa Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA s website For more information about the Marketplace visit www HealthCare gov Keep your Plan informed of address changes To protect your family s rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan Administrator Plan Contact Information CIGNA Group 00652128 HDHPQ OAP OAP Base and OAP Buy Up FABco LLC 13835 Beaumont Hwy Houston TX 77049 713 633 6500 34

Notices Special Enrollment Notice If you are declining enrollment for yourself or your dependents including your spouse because of other health insurance or group health plan coverage you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage or if the employer stops contributing toward your or your dependents other coverage However you must request enrollment within 30 days after your or your dependents other coverage ends or after the employer stops contributing toward the other coverage In addition if you have a new dependent as a result of marriage birth adoption or placement for adoption you may be able to enroll yourself and your dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption Finally if you or an eligible dependent has coverage under a state Medicaid or child health insurance program and that coverage is terminated due to a loss of eligibility or if you or an eligible dependent become eligible for state premium assistance under one of these programs you may be able to enroll yourself and your eligible family members in the Plan However you must request enrollment no later than 60 days after the date the state Medicaid or child health insurance program coverage is terminated or the date you or an eligible dependent is determined to be eligible for state premium assistance To request special enrollment or obtain more information contact the plan administrator listed below Laura Butler 713 633 6500 35

Notices Notice of Privacy Practices Plan Sponsor FABco LLC 13835 Beaumont Hwy Houston TX 77049 713 633 6500 Privacy Official Laura Butler 713 633 6500 Laura Butler fabcous com Effective Date 01 01 2024 Your Information Your Rights Our Responsibilities This notice describes how medical information about you may be used and disclosed and how you can get access to this information Please review it carefully Your Rights You have the right to Get a copy of your health and claims records Correct your health and claims records Request confidential communication Ask us to limit the information we share Get a list of those with whom we ve shared your information Get a copy of this privacy notice Choose someone to act for you File a complaint if you believe your privacy rights have been violated Your Choices You have some choices in the way that we use and share information as we Answer coverage questions from your family and friends Provide disaster relief Market our services and sell your information Our Uses and Disclosures We may use and share your information as we Help manage the health care treatment you receive Run our organization Pay for your health services Administer your health plan Help with public health and safety issues Do research Comply with the law Respond to organ and tissue donation requests and work with a medical examiner or funeral director Address workers compensation law enforcement and other government requests Respond to lawsuits and legal actions Your Rights When it comes to your health information you have certain rights This section explains your rights and some of our responsibilities to help you Get a copy of health and claims records 36

Notices You can ask to see or get a copy of your health and claims records and other health information we have about you Ask us how to do this We will provide a copy or a summary of your health and claims records usually within 30 days of your request We may charge a reasonable cost based fee Ask us to correct health and claims records You can ask us to correct your health and claims records if you think they are incorrect or incomplete Ask us how to do this We may say no to your request but we ll tell you why in writing within 60 days Request confidential communications You can ask us to contact you in a specific way for example home or office phone or to send mail to a different address We will consider all reasonable requests and must say yes if you tell us you would be in danger if we do not Ask us to limit what we use or share You can ask us not to use or share certain health information for treatment payment or our operations We are not required to agree to your request and we may say no if it would affect your care Get a list of those with whom we ve shared information You can ask for a list accounting of the times we ve shared your health information for six years prior to the date you ask who we shared it with and why We will include all the disclosures except for those about treatment payment and health care operations and certain other disclosures such as any you asked us to make We ll provide one accounting a year for free but will charge a reasonable cost based fee if you ask for another one within 12 months Get a copy of this privacy notice You can ask for a paper copy of this notice at any time even if you have agreed to receive the notice electronically We will provide you with a paper copy promptly Choose someone to act for you If you have given someone medical power of attorney or if someone is your legal guardian that person can exercise your rights and make choices about your health information We will make sure the person has this authority and can act for you before we take any action File a complaint if you feel your rights are violated You can complain if you feel we have violated your rights by contacting us using the information on page 1 You can file a complaint with the U S Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue S W Washington D C 20201 calling 1 877696 6775 or visiting www hhs gov ocr privacy hipaa complaints We will not retaliate against you for filing a complaint Your Choices 37

Notices For certain health information you can tell us your choices about what we share If you have a clear preference for how we share your information in the situations described below talk to us Tell us what you want us to do and we will follow your instructions In these cases you have both the right and choice to tell us to Share information with your family close friends or others involved in payment for your care Share information in a disaster relief situation If you are not able to tell us your preference for example if you are unconscious we may go ahead and share your information if we believe it is in your best interest We may also share your information when needed to lessen a serious and imminent threat to health or safety In these cases we never share your information unless you give us written permission Marketing purposes Sale of your information Our Uses and Disclosures How do we typically use or share your health information We typically use or share your health information in the following ways Help manage the health care treatment you receive We can use your health information and share it with professionals who are treating you Example A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services Run our organization We can use and disclose your information to run our organization and contact you when necessary We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage This does not apply to long term care plans Example We use health information about you to develop better services for you Pay for your health services We can use and disclose your health information as we pay for your health services Example We share information about you with your dental plan to coordinate payment for your dental work Administer your plan We may disclose your health information to your health plan sponsor for plan administration Example Your company contracts with us to provide a health plan and we provide your company with certain statistics to explain the premiums we charge How else can we use or share your health information We are allowed or required to share your information in other ways usually in ways that contribute to the public good such as public health and research We have to meet many conditions in the law before we can share your information for these purposes For more information see www hhs gov ocr privacy hipaa understanding consumers index html Help with public health and safety issues 38

Notices We can share health information about you for certain situations such as Preventing disease Helping with product recalls Reporting adverse reactions to medications Reporting suspected abuse neglect or domestic violence Preventing or reducing a serious threat to anyone s health or safety Do research We can use or share your information for health research Comply with the law We will share information about you if state or federal laws require it including with the Department of Health and Human Services if it wants to see that we re complying with federal privacy law Respond to organ and tissue donation requests and work with a medical examiner or funeral director We can share health information about you with organ procurement organizations We can share health information with a coroner medical examiner or funeral director when an individual dies Address workers compensation law enforcement and other government requests We can use or share health information about you For workers compensation claims For law enforcement purposes or with a law enforcement official With health oversight agencies for activities authorized by law For special government functions such as military national security and presidential protective services Respond to lawsuits and legal actions We can share health information about you in response to a court or administrative order or in response to a subpoena Our Responsibilities We are required by law to maintain the privacy and security of your protected health information We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information We must follow the duties and privacy practices described in this notice and give you a copy of it We will not use or share your information other than as described here unless you tell us we can in writing If you tell us we can you may change your mind at any time Let us know in writing if you change your mind For more information see www hhs gov ocr privacy hipaa understanding consumers noticepp html Changes to the Terms of this Notice We can change the terms of this notice and the changes will apply to all information we have about you The new notice will be available upon request on our web site and we will mail a copy to you 39

Notices Your Rights and Protections Against Surprise Medical Bills When youget emergency care or are treatedbyan out of network providerat an in network hospital or ambulatory surgical center you are protected from balance billing In these cases you shouldn t be charged more than your plan s copayments coinsurance and ordeductible What is balance billing sometimes called surprise billing When you see a doctor or other health care provider you may owe certain out of pocket costs like a copayment coinsurance or deductible You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn t in your health plan s network Out of network means providers and facilities that haven t signed a contract with your health plan to provide services Out of network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service This is called balance billing This amount is likely more than in network costs for the same service and might not count toward your plan s deductible or annual out of pocket limit Surprise billing is an unexpected balance bill This can happen when you can t control who is involved in your care like when you have an emergency or when you schedule a visit at an innetwork facility but are unexpectedly treated by an out of network provider Surprise medical bills could cost thousands of dollars depending on the procedure or service You re protected from balance billing for Emergency services If you have an emergency medical condition and get emergency services from an out of network provider or facility the most they can bill you is your plan s in network cost sharing amount such as copayments coinsurance and deductibles You can t be balance billed for these emergency services This includes services you may get after you re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post stabilization services Certain services at an in network hospital or ambulatory surgical center When you get services from an in network hospital or ambulatory surgical center certain providers there may be out of network In these cases the most those providers can bill you is your plan s innetwork cost sharing amount This applies to emergency medicine anesthesia pathology radiology laboratory neonatology assistant surgeon hospitalist or intensivist services These providers can t balance bill you and may not ask you to give up your protections not to be balance billed If you get other types of services at these in network facilities out of network providers can t balance bill you unless you give written consent and give up your protections You renever required to give up yourprotections frombalance billing You also aren trequired to get outof networkcare You canchooseaproviderorfacility in your plan snetwork 40

Notices When balance billing isn t allowed you also have these protections You re only responsible for paying your share of the cost like the copayments coinsurance and deductible that you would pay if the provider or facility was in network Your health plan will pay any additional costs to out of network providers and facilities directly Generally your health plan must o Cover emergency services without requiring you to get approval for services in advance also known as prior authorization o Cover emergency services by out of network providers o Base what you owe the provider or facility cost sharing on what it would pay an in network provider or facility and show that amount in your explanation of benefits o Count any amount you pay for emergency services or out of network services toward your in network deductible and out of pocket limit If you think you ve been wrongly billed contact the No Surprises Helpdesk operated by the U S Department of Health and Human Services at 1 800 985 3059 Visit www cms gov nosurprises consumers for more information about your rights under federal law 41

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13835 Beaumont Hwy Houston TX 77049 713 633 6500 www FABcous com