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Message EmployeeBenefits Guide

At Hill Country Christian School of Austin, we are committed to supporting the well-being of our employees through a comprehensive benefits program. Our goal is to help you stay healthy, feel secure, and maintain a balanced work and personal life. Eligible employees of Hill Country Christian School of Austin and their dependents, may elect benefits in the following areas: Medical, Dental, Vision, Worksite and Voluntary Life. Employees may also choose from Voluntary Short Term and/or Voluntary Long-Term Disability.This booklet outlines some of the most important features of your employee benefits. It’s part of our commitment to helping you make the most of the resources available to you—so you can live a life that’s informed, balanced, and free of unexpected surprises.We encourage you to take the time to review your options carefully. By understanding your benefits, you can make confident, informed choices that support your health, your goals, and your family’s well-being.Stay Healthy• Medical• Dental• VisionFeeling Secure• Disability Insurance• Voluntary Life and Accidental Death & Dismemberment• Worksite Benefits (Accident, Hospital Indemnity & Critical Illness)• Health Savings Account• Flexible Spending AccountHill Country Christian School of Austin2025-2026 Benefits Guide Page 2WELCOME TO YOUR EMPLOYEE BENEFITS!

2025-2026 Benefits Guide Page 3TABLE OF CONTENTSIMPORTANT CONTACTS …………………………………………………………………………….4WHO IS ELIGIBLE? …………………………………………………………………………………….5HOW TO ENROLL ……………………………………………………………………………………..5EMPLOYEE NAVIGATOR …………………………………………………………………………….6-7MID YEAR CHANGES ……………………………………………………………………………….. 8ABOUT UMR AND YOUR MEDICAL PLANS ………………………………………………………9MEDICAL PLAN OVERVIEW …………………………………………………………………..........10PREVENTIVE CARE ………………………………………………………………………….............. 11-13UMR MEMBER PORTAL & APP ………………………………………………………………..........14-15YOUR NEW UMR ID CARD …………………………………………………………………….........16HOW TO FIND A PARTICIPATING PROVIDER …………………………………………………….. 17-18ISBC HEALTH HUB ………………………………………………………………………………......... 19-25o TELEMEDICINE/VIRTUAL VISITSo AT HOME DIAGNOSTICSo REGENEXX BENEFITo MEMBER ADVOCACYo ONE PASS SELECTo INDIVIDUAL HEALTH—MEDICAREHSA (HEALTH SAVINGS ACCOUNT) ……………………………………………………............... 27-28HSA ELIGIBLE EXPENSES …………………………………………………………………………….. 29FSA (FLEXIBLE SPENDING ACCOUNT) …………………………………………………………….30FSA ELIGIBLE EXPENSES ………………………………………………………………………..........31DENTAL PLANS ……………………………………………………………………………................32VISION PLANS …………………………………………………………………………………..........33HOW TO FIND A PARTICIPATING DENTAL PROVIDER ………………………………………….34HOW TO FIND A PARTICIPATING VISION PROVIDER …………………………………….........34VOLUNTARY LIFE/AD&D ……………………………………………………………………...........35SHORT TERM AND LONG TERM DISABILITY ………………………………………………………36PAYROLL DEDUCTIONS PER 24 PERIODS …………………………………………………..........3738-58COLONIAL WORKSITE BENEFITS ……………………………………………………………..........(ACCIDENT, HOSPITAL INDEMNITY, CRITICAL ILLNESS)PRE-TAX AUTHORIZATION (PREMIUM ONLY PLAN-POP) ……………………………….......... 60DISCLOSURES & NOTICES …………………………………………………………………….........61

Benefit Carrier Contact InformationMedical and Prescription DrugsPolicy #76-4501121-800-826-9781www.umr.comISBC Health HubVirtual Visits1-800-686-8048Recuro MemberSuicide and Crisis Lifeline988www.988lifeline.orgDental, Vision, Life, and Disability MetLife Policy # 59398291-800-942-0854www.metlife.comFlexible Spending AccountBenefit Management AdministratorsGroup # BMA080071-800-934-6302www.bmatpa.comHealth Savings Bank Account Administration1-866-234-8913www.optumbank.comVoluntary Products1-800-325-4368www.coloniallife.com2025-2026 Benefits Guide Page 4IMPORTANT CONTACTSRefer to this list if you need to contact any of your benefit vendors.For general information, please contact Human Resources.

Who is Eligible?If you are a full-time employee (working 30 or more hours per week) youare eligible to enroll in the benefits described in this guide. Benefits areavailable based on the new hire waiting period, which is first of the monthfollowing your date of full-time employment.Your dependents are eligible for coverage if they fall into one of these categories:• Your legal spouse.• Children, including natural children, stepchildren, legally adopted children, and other children for whom you have legal custody or are the legal guardian. Other eligibility provisions for children include:• Children up to age 26, regardless of marital or student status. Benefits terminate at the end of their birthday month.• Children up to age 26 who are not actively serving in the military, regardless of student or marital status.• Children over the age of 26 who are incapable of self-sustaining employment because of mental or physical disability. You may be required to provide proof of the child’s disability and dependence upon you for support.How to EnrollThe first step is to review the benefit information provided to you. You will receive an email with instructions to register for Employee Navigator (ENav). Important: You must register with the link provided in this email as it will be under a different broker’s office, the prior ENav will not be up to date for the 2025-2026 plans.Once you register and log in to the ENav portal you will see a button to begin your Open Enrollment elections. See following page for detailed instructions.When to EnrollYour time to enroll for this plan year, 2025 – 2026 is now!Please ensure that you elect all needed benefits for this plan year, which begins August 1, 2025 (or if recently hired, 1stof the following month from your date hire), as you will not be allowed to make changes until the next open enrollment period in 2026 - unless you have a qualified change in status.Terminations: If you terminate your employment with Hill Country Christian School of Austin, your medical, dental and vision coverage will end on the last day of the month of your termination. All other benefits will terminate on last day of employment.BENEFITS ENROLLMENT & ELIGIBILITY2025-2026 Benefits Guide Page 5

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QUALIFYING LIFE EVENTS & SPECIAL ENROLLMENT RIGHTSWhile you are generally only allowed to change your benefits elections during the open enrollment period each year, certain life events provide an exception. Those life events allow you to change your benefits elections in the middle of the plan year if certain requirements are met. The following are examples of types of life events that may allow you to change your benefit elections during a plan year:• Birth/Adoption• Change in Insurance Coverage • Change of Address• Change in Employment Status• Death in the Family• Dependent Child Reaches Limiting Age• Divorce/Annulment• FMLA-related Leave• Legal Separation• Marriage• Spouse Loss of Other CoveragePlease notify Human Resources immediately if you experience any life event changes so that we can ensure there is no interruption or error in your benefits. You have 30 days after the event (60 days if loss of Medicaid or CHIP coverage). Please contact Human Resources with additional questions.2025-2026 Benefits Guide Page 8

Benefits You Receive:Hill Country Christian School of Austin has joined the Independent School Benefits Consortium (ISBC), a program specifically designed for schools like ours. As part of this transition, UMR, a UnitedHealthcare company, will serve as our new medical insurance carrier. UMR offers access to the Choice Plus Network, providing a wide range of providers and facilities. You’ll find helpful instructions in this guide on how to locate network providers through UMR.You will continue to have three medical plan options, now with enhanced benefits designed to better meet your needs.Additionally, ISBC offers valuable tools and services through Recuro Health, also referred to as the Health Hub:• Call Health Hub and speak with a Health Advocate for assistance or questions 1-800-686-8048• Take steps to maintain good health with annual wellness checkups and screenings and other preventive care measures that are covered in-network at no additional cost to you• Have access to Emergency Care 24 hours a day, in- or out-of-networkThese plans provide coverage for medical care, including visits to your doctor’s office, hospital stays, mentalhealth and substance abuse services, chiropractic treatment, physical therapy, and other services. Withhealth coverage, you pay a predetermined fee (copay) for certain covered health care expenses, and theplan pays the rest. For other services, you pay a deductible then a percentage of the cost (coinsurance).Once you reach the pre-determined annual limit on your payments (out-of-pocket maximum), the healthplan pays your covered health care costs at 100%.All three plans utilize the UnitedHealthcare Choice Plus Network. When contacting providers directly tosee if they will accept your insurance plan, please ask them if they are “In-Network” to ensure you avoid any unnecessary out-of-pocket expenses. For benefit verification, it is also recommended you present your UMRInsurance ID Card at the time of service. Providers should contact UMR to verify your medical benefits.In addition to having access to physicians through your health plan, you have access to Virtual Visits for non-emergency medical issues and behavioral health needs, through Health Hub provided by ISBC. You willhave access to board-certified physicians 24 hours a day, whether you’re at home, at work or travelling.Additional information on the Health Hub program is included in this handbook (page 19).2025-2026 Benefits Guide Page 9

Medical benefits at-a-glance:Plan Overview Buy-Up PPO Plan Base PPO Plan HSA PlanNetworkIn-NetworkOut of NetworkN/AIn-Network Out of NetworkN/AIn-NetworkOut of NetworkN/ADeductible• Individual• Family$ 1,500$ 4,500$ 3,000$ 9,000$ 2,500$ 7,500$ 5,000$15,000$ 3,500$ 7,000$ 7,000$14,000Coinsurance • Plan Pays after Deductible• Member Pays after Deductible80%20%60%40%70%30%50%50%80% 20%60% 40%Out-of-Pocket Maximum• Individual• Family$ 4,500$ 13,500UnlimitedUnlimited$ 5,500$ 14,700UnlimitedUnlimited$ 4,000 $ 8,000UnlimitedUnlimitedPhysician Office Visits• Preventive• Primary Care Visit• Specialist Visit• Urgent Care Visit100% Covered$25 copay$50 copay$75 copay40% after Ded40% after Ded40% after Ded40% after Ded100% Covered$25 copay$50 copay$75 copay50% after Ded50% after Ded50% after Ded50% after Ded100% Covered20% after Ded20% after Ded20% after Ded40% after Ded40% after Ded40% after Ded40% after DedOther ServicesDiagnostic Lab & X-Ray (billed with Office Visit)Complex Imaging (MRI/CT/PET Scans)Office Visit20% after Ded40% after Ded0% after DedOffice Visit30% after Ded50% after Ded50% after Ded20% after Ded20% after Ded40% after Ded40% after DedHospitalization• Inpatient• Outpatient20% after Ded20% after Ded40% after Ded40% after Ded30% after Ded30% after Ded50% after Ded50% after Ded20% after Ded20% after Ded40% after Ded40% after DedEmergency Room• Facility Charge• ER Physician Charges$500 + 20% after Ded20% after Ded$500 + 20% after Ded20% after Ded$500 + 30% after Ded30% after Ded$500 + 30% after Ded30% after Ded20% after Ded20% after Ded40% after Ded40% after DedPharmacy:Generic/Pref Brand/Non-Pref BrandSpecialty$5/$10/$50$100/$150/$250Reimbursed contracted rate minus copay$5/$10/$50$100/$150/$250Reimbursed contracted rate minus copayAfter Ded:10%/10%/20%30%/40%/50% to $300 maxReimbursed contracted rate minus copayAdditional Notes:With this plan employees can open a Health Savings Account. HCCSA will contribute $100/month into employee’s HSACost Per Pay Period Employer Pays You Pay Employer Pays You Pay Employer Pays You PayEmployee Only $394.60 $31.17 $392.10 $0.00 $338.47 $0.00Employee & Spouse $340.48 $465.49 $334.80 $407.41 $289.14 $351.56Employee & Child(ren) $412.87 $401.49 $407.22 $342.71 $351.52 $295.84Employee & Family $396.58 $797.99 $387.84 $712.22 $335.34 $614.26Below is a summary of the medical plans available. The plans below do offer out of network benefits, however you will incur higher out-of-pocket costs going out of network and could be balance billed by provider; see your plan documents for details.*See your official plan documents for further details. If a discrepancy is found between this overview and your plan document, the plan document will govern.2025-2026 Benefits Guide Page 10

Wellness and Health ManagementUnderstanding the full value of covered benefits allows you to take responsibility for maintaining good health and incorporating healthy habits into your lifestyle. Some examples include getting regular physical examinations, mammograms and immunizations. Through the plans offered by Hill Country Christian School of Austin, all covered individuals and family members are eligible to receive routine wellness services like these, at no cost; all copays, coinsurance, and deductibles are waived.Which preventative care services are covered?The US Preventive Services Task Force maintains a regular list of recommended services that all Affordable Care Act (i.e. Health Care Reform) compliant insurance plans should cover at 100% for in-network providers. The following pages provide a list of adult screenings and immunizations.You can also go to Preventive health services | HealthCare.gov for a full list.PREVENTIVE CARE2025-2026 Benefits Guide Page 11

General screening guidelinesHeart disease and cancer are the two leading causes of death in the United States, and the risks of developing a significant health condition rise significantly with age.Your family health history can also make you predisposed to certain diseases. So it’s important to understand your risk factors and receive appropriate screenings to head off potential problems when they are most treatable. Early detection could save your life.Recommended tests are based on your age, gender and overall risk factors. The guidelines here are a general reference only. Always discuss your particular health care needs with your physician.Tests for women* The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the additional benefits andharms of clinical breast examination (CBE) beyond screening mammography in women age 40 and older.© 2022 United HealthCare Services, Inc. UM0206 1122 UANo part of this document may be reproduced without permission.The information provided in this document is for general educational purposes only. It is not intended as medicaladvice and cannot replace or substitute for individualized medical care and advice from a personal physician.Individuals should always consult with their physicians regarding any health questions or concerns.Adult screenings andimmunizationsAge range18-39 40-49 50-64 65 +Mammogram*Discuss with yourdoctor or nurseEvery two years through age 74; talk to your health care provider about need for screening after age 74Cervical cancer(Pelvic exam/pap smear)At least every three years afterage 21 or if you have been sexually active for three yearsAt least every three yearsAsk your health care providerif you need testingBone mineral density (osteoporosis)Ask your health care provider if you are at riskfor osteoporosisReceive test after age 65; talkto your health care provider about repeat testingBlood pressureAt least every two years; or annually if your blood pressure is higher than 120/80CholesterolRegular screenings 40-75 years. Ask your health care provider for recommended frequencyObesity/BMIRegular screenings; a BMI of 25 to 29.9 is considered overweight, and a BMI of 30 and above is considered obeseDiabetes(fasting plasma glucosetest recommended)Screening for pre-diabetes and type 2 diabetes for adults ages 35 to 70 years who are overweight orobese with no symptoms of diabetesColorectal cancerFecal occult blood testing, sigmoidoscopy, or colonoscopy beginning at age 45 and continuing until age 752025-2026 Benefits Guide Page 12PREVENTIVE CARE

Tests for men* The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefitsand harms of prostate cancer screening in men younger than age 75. Given the uncertainties and controversy surrounding prostatecancer screening in men younger than 75, a clinician should not order the PSA test without first discussing with the patient.Immunization guidelinesVaccinations work to help your body learn to fight off disease and build immunity to future exposure. Traditional vaccines mimic a natural infection by introducing dead or weakened versions of the germs that trigger a specific illness. Your immune system can clear these germs fromyour body, without experiencing common symptoms and complications, and it will “remember” how to protect your body from germs it has encountered before. For additional information on immunizations, visit cdc.gov/vaccines.Sources: Recommended Adult Immunization Schedule 2018, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; The Guide to Clinical Preventive Services 2010-2014,Recommendations of the U.S. Preventive Services Task Force; U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.Age range18-39 40-49 50-6465+Blood pressureAt least every two years; or annually if your blood pressure is higher than 120/80CholesterolRegular screenings 40-75 years. Ask your health care provider for recommended frequencyObesity/BMIRegular screenings; a BMI of 25 to 29.9 is considered overweight, and a BMI of 30 and above is considered obeseDiabetes(fasting plasma glucosetest recommended)Screening for pre-diabetes and type 2 diabetes for adults ages 35 to 70 years who are overweight orobese with no symptoms of diabetesColorectal cancerFecal occult blood testing, sigmoidoscopy, or colonoscopy beginning at age 45 and continuing until age 75Prostate cancerTalk to your doctor about the risks andbenefits of screening*2025-2026 Benefits Guide Page 13PREVENTIVE CARE

Get all your answers quickand easy @ umr.comMake umr.com your first stopYou want managing your health care to be fast and easy, right? You got it. At umr.com, you’ll find everything youwant to know – and need to do – as soon as you log in.No hassles. No waiting. Just the answers you’re looking for anytime, night or day!Log in now to:• View Things to do, your personalized benefits to-do list• Check your benefits and see what’s covered• Look up what you owe and how much you’ve paid• Find a doctor in your network• Learn about medical conditions and your treatmentoptions• Access tools and trusted resources to help you live ahealthier lifeNote: The images shown reflect available features within our desktop site. These features may or may not be available to all users, depending on your individual and/or company benefits.Fictionalized dataThe UMR app is another way we’re reimagining health care to work for you.We have a smarter, simpler, faster way to manage your health care benefits, right from the palm of your hand.With just a tap, you can:• Access your digital ID card• View your plan details on-demand – anytime, anywhere• Find out if there is aco-pay for your upcoming appointment• Chat, call or message UMR’s member support teamStay connected to your health care and download the UMR app today!Simply scan the QR code to the leftor visit your app store to get started.MEMBER PORTAL & APP2025-2026 Benefits Guide Page 14

You don’t need a Ph.D. to understand your benefitsWe’ve made it easy to find the top things people want to know. Choose Benefits & coverage from myMenu to find out:• What health care services are covered?• What’s the cost difference between an in-network and out-of-network service?• What’s your deductible, and are you close to reaching it?• Is there a co-payment for your office visit? If so, how much?Buried in paperwork?A single click lets you track all your claimsCheck in at your convenience to see if a claim hasbeen processed and what you might owe. To get more details on a specific claim, click view claim detailsor view EOB. This will tell you the type of services provided, the amount billed and the amount paid, if any, and whether there’s any action that needs to be taken before the claim can be processed.You can choose to receive a secure e-mail any time you have a new EOB. If you’re not ready to give up paper completely, you can print out copies from our claims center.Don’t be surprised by unexpected costs• Know the price you’ll pay ahead of time. Search treatments or procedures in the Health cost estimator.• Get your in-network discount. Use Find aproviderto look up doctors and facilities near you.©2023 United HealthCare Services, Inc. UM0106-2PG 0123 UA (FS0737)This content is provided for information only and is not to be considered medical advice.All decisions about medical care should be made by the doctor and patient. Always refer tothe plan document for specific benefit coverage or call the toll-free member phone numberon the back of your health plan ID card. UMR operates in accordance with medical privacystandards established by applicable federal and state laws. The screen shots shown are forillustrative purposes and use fictional data only.MEMBER PORTAL & APP2025-2026 Benefits Guide Page 15

YOUR NEW UMR ID CARD2025-2026 Benefits Guide Page 16

Finding a network provider on umr.com or the UMR app has never been easierFind a provider1Go to umr.com and select Find aprovider2Search for UnitedHealthcare Choice Plus Network usingour alphabet navigation or type UnitedHealthcare Choice Plus into the search box3For medical providers, choose View providers. For behavioral health providers (including counseling and substance abuse), select Behavioral health directory(Continued)2025-2026 Benefits Guide Page 17

UnitedHealthcare Choice PlusThe UnitedHealthcare online provider directories include network hospitals, primary physicians and specialists. The following information is available:• Provider name, address and phone number• Hospital affiliation• Board certification• UnitedHealth Premium® Quality & Cost Efficiency designations that highlight physicians by quality of care and cost standards in their specialty• Average costs for care in your area and how different providers compare to the local average• Provider ID number• Office language capabilities (English, Spanish, etc.)• Map and directions to each officeRememberGet the most from your benefit plan –use participating network health careproviders whenever possible.Find a provider on the go. Sign in to the UMR app and select Find care© 2023 United HealthCare Services, Inc. UM0135-CP 1023 UANo part of this document may be reproduced without permission.2025-2026 Benefits Guide Page 18

Introducing theISBC Health HUBThe ISBC Health Hub is a central place to accessVirtual careAt-Home Diagnostics Member Advocacy Individual Health InsuranceWellness & Personal Health Profile Gym Membership & Home Food DeliveryContact the ISBC Health Hub by calling800-686-80482025-2026 Benefits Guide Page 19

Virtual Care – Primary, Urgent,Behavioral HealthPrimary Care Dedicated primary care physician Comprehensive risk assessment enabling targeted care interventions At-home screening tests Care teams identify and manage chronic conditionsUrgent Care 24/7 access to board-certified doctors for common medical conditions Live video, phone and instant messaging options to meet each persons need Prescriptions are automaticallydelivered to the patient’s preferred pharmacyBehavioral Health Psychiatry and medication management Therapy and counseling Depression and Anxiety screeners to deliver rapid treatment to those who need it most Integrated Prescriptions sent to the patients preferredpharmacy Family behavioral health provides highly specialized pediatric behavioral health clinical services Self-guided and coach-supported skills training is available for parents and caregivers Personalized treatment from expert therapists and coaches provide help for conditions like anxiety, depression, ADHD, and disruptive behaviorPrimary care, urgent care and behavioral health counseling available at the low cost of $15 for high deductible health plan members. $0 cost share for all other plans.Members who need psychiatric visits will have a $240 copay.ISBC Health Hub call 800.686.8048 or login at member.recurohealth.com2025-2026 Benefits Guide Page 20

2025-2026 Benefits Guide Page 21SCREENING FOR MULTIPLE CANCERSIntroducing the Galleri testThe test looks for a signal shared by 50+ cancer types through a simple blood draw.Galleri screens your blood sample for cell-free DNA and identifies whether it comes fromhealthy or cancer cells. DNA from cancer cells has specific methylation patterns that canidentify it as cancer.The Galleri test is being offered to ISBC members and their dependents aged 50 years orolder, or 40-49 with certain risk factors. It is not recommended if are you pregnant orundergoing active cancer treatment.Understanding the resultsThe Galleri test looks for a signal in your bloodthat could indicate cancer. Results are available inabout two weeks and there are two possibleresults:- No Cancer Signal DetectedThis means that no cancer signal was found in yourblood drawn. This does not rule out cancer. TheGalleri test does not detect all cancers. Continuewith routine cancer screening tests your healthcareprovider recommends.+ Cancer Signal DetectedThis means a cancer signal was detected in yourblood drawn. This result is not a cancer diagnosis.Your healthcare provider will discuss next steps toconfirm if cancer is present.ISBC Health Hub call 800.686.8048 or login at member.recurohealth.comAt Home Diagnostics

2025-2026 Benefits Guide Page 22THERE’S STILL TIME TO AVOIDSURGERYIf you’re considering an elective orthopedicsurgery you’ve been putting off, you mayhave another option. Regenexx treats a broad range of elective orthopedic injurieswith minimally invasive, needle-basedprocedures that use your body’s own natural healing agents to regeneratedamaged tissue.We can help to avoid as many as70 percent of elective orthopedicsurgeries.ISBC Health Hub call 800.686.8048 or login at member.recurohealth.com

2025-2026 Benefits Guide Page 23Member Advocacy• Talk to a nurse about managing diabetes• Explain your benefits and clarifycopays and deductibles• Answer questions about yourdiagnosis and research treatmentoptions• Locate and make appointments within-network doctors and specialists• Arrange second opinions, includingtransferring medical records• Research and resolve medical claimsand billing issuesWork with a personal Wellness Coach to reach your health goals and completeyour wellness incentives. Your Coach can:• Schedule one-on-one coaching sessions at times that work for you• Help you develop and follow a personal wellness plan• Keep you motivated along your journey to better healthISBC Health Hub call 800.686.8048 or login at member.recurohealth.comHealth Advocates are standing by to support you with a wide range of healthcareand insurance-related issues.

2025-2026 Benefits Guide Page 24One Pass Select No long-term contracts or annual gym registration fees Flexible fitness options and theability to use locations nationwide(not limited to 1 gym) The ability to add family members(ages 18+) at a 10% monthly discount The option to change tiers monthly A grocery delivery subscriptionand additional member perksIn the kitchenWe make it easy to plan for everything you need to enjoy healthy, delicious, nutritiousmeals. Get access to home grocery delivery to make it even more convenient to become a better you. Get groceries and household essentials delivered to your home.At homeWork out at home with live or on-demand online fitness classes. Try our workout builderto get routines created just for you, no matter what your fitness level and interests.One Pass Select is a subscription-based fitness and well-being programthat supports a healthier lifestyle. Employees can have access tothousands of gyms and online classes with:Being healthy shouldn’t be a grind. Itshould involve trying new things,exploring new foods and pushingyourself to be slightly better than youwere the day before. Get everythingyou need for whole body health in oneeasy, affordable plan

2025-2026 Benefits Guide Page 25Individual Health InsuranceISBC Health Hub call 800.686.8048 or login at member.recurohealth.com

2025-2026 Benefits Guide Page 26Individual Health InsuranceISBC Health Hub call 800.686.8048 or login at member.recurohealth.com

What is a health savings account? A health savings account (HSA) is a health care account and savings account in one. The main purpose of this account is to offset the cost of a qualifying high-deductible health plan (HDHP) and provide savings for your out-of-pocket eligible health care expenses which are funded by your and/or your employer’s tax-exempt contributions. HSA funds roll over from year to year and accumulate in your account. There is no "use-it-or-lose-it" rule with HSAs, and you decide how and when to use your HSA funds, which may be used for eligible expenses you have now, in the future, or during retirement. HSA Contribution Limits 2025 2026Individual $4,300 $4,400Family $8,550 $8,750Additional “Catch Up” for 55 or older $1,000 $1,000HEALTH SAVINGS ACCOUNT (HSA)Why is it a good idea to have an HSA? HSAs benefit everyone who is eligible to have this account, including single individuals, families and soon-to-be retirees. Four reasons to contribute:o Tax-free deposits - The money you contribute to your HSA isn't taxed (up to the IRS annual limit).o Tax-free earnings - Your interest and any investment earnings grow tax-free plus any balances of $1,000 or more can be invested, just like a 401(k).o Tax-free withdrawals - The money used toward eligible health care expenses isn't taxed - now or in the future.o Fund are yours - The account and money is yours to keep, even if you change jobs or retire.Refer to your HSA documentation for additional information.2025-2026 Benefits Guide Page 27Who is eligible to have an HSA? o Covered by a High Deductible Health Plan (HDHP), the plan eligible with UMR is the HSA Plano Not covered under another medical plan that is not an HDHPo Not entitled to Medicare benefits; oro Not eligible to be claimed on another person’s tax returnHow much can I contribute to an HSA? As noted by federal law, the annual contrition limits are:o Hill Country Christian School of Austin will contribute $100/month into an employee’s Health Savings bank accounto The annual contribution limits include any funds contributed by the employer.o The contribution limits are based on the calendar year, not the insurance plan year.

When do I use my HSA? After visiting a physician, facility or pharmacy, your medical claim will be submitted to your HDHP for payment. Your HSA dollars can be used to pay your out-of-pocket expenses (deductibles and coinsurance) billed by the physician, facility or pharmacy, or you can choose to save your HSA dollars for a future medical expense.Health insurance may not be purchased with HSA Funds. However, HSA funds can be used to pay for:1. Health plan premiums during any period of continuation coverage required under any Federal Law (COBRA).2. A qualified long-term care insurance contract.3. A health plan during a period in which the individual is receiving unemployment compensation under any Federal or State Law.4. For individuals over age 65, premiums for Medicare Part A or B, a Medicare HMO and/or the employee share of premiums for employer-sponsored health insurance, including premiums for employer-sponsored retiree health insurance.What if I enroll in an HSA in the middle of the year?If you enroll in an HSA mid-year, you are allowed to make a full year’s contribution, provide that you remain covered by the HSA for at least the 12-month period following that year.Why should I elect an HSA?HEALTH SAVINGS ACCOUNT (HSA)Refer to your HSA documentation for additional information.2025-2026 Benefits Guide Page 281. Cost SavingsTax Benefits:• HSA contributions are excluded from federal income tax.• Interest earnings are tax-deferred.• Withdrawals for eligible expenses are exempt from federal income tax.Reduction in medical plan contributionUnused money is held in an interest-bearing savings or investment account.Note: Many states have not passed legislation toprovide favorable state tax treatment for HSAs.Therefore, amounts contributed to HSAs and interestearned on HSA accounts may be included on theemployee’s W-2 for state income tax purposes.2. Long-Term Financial BenefitsSave for future medical expenses. Funds roll over from year to year.This is your account – you take it with you.3. ChoiceYou control and manage your health care expenses.You choose when to use your HSA dollars to pay your health care expenses.You choose when to save your HSA dollars and pay health care expenses out-of-pocket.*Investment accounts are not FDIC insured and they are not bank guaranteed. Investment accounts are not a deposit account, or anobligation of HSA Bank, and they may lose value. They are not guaranteed by any federal government agency.

HEALTH SAVINGS ACCOUNT (HSA)Refer to your HSA documentation for additional information.2025-2026 Benefits Guide Page 29The products and services listed below are examples of medical expenses eligible forpayment under your HSA, when such services are not covered by your high-deductible health plan. To be an expense for medical care, the expense has to be primarily for theprevention or alleviation of a physical or mental defect or illness.Effective Jan. 1, 2020, the Coronavirus Aid, Relief and Economic Security Act (CARES Act) allows certain over-the-counter medications and products—including cold and flu medicine, allergy medication and menstrual products—to be treated as qualified expenses. This list is not all-inclusive, and the items listed below are subject to change in accordance with IRS regulations. For more information or clarification on individual list items, refer to Publication502 or consult a tax professional.Keep a copy of all your receipts. Review your HSA bank account and member FAQ carefully.Eligible Medical Expenses• Abdominal supports• Acupuncture• Air conditioner (when necessary forrelief from difficulty in breathing)• Alcoholism treatment• Ambulance• Anesthetist• Arch supports• Artificial limbs• Autoette (when used for relief ofsickness/disability)• Birth Control Pills(by prescription)• Blood tests• Blood transfusions• Braces• Cardiographs• Chiropractor• Childbirth/Delivery• Christian Science Practitioner• Contact Lenses• Contraceptive devices(by prescription)• Convalescent home(for medical treatment only)• Crutches• Dental Treatment• Dental X-rays• Dentures• Dermatologist• Diagnostic fees• Drug addiction therapy• Drugs (prescription)• Elastic hosiery (prescription)• Eyeglasses• Fees paid to health instituteprescribed by a doctor• FICA and FUTA tax paid formedical care service• Fluoridation unit• Guide dog• Gum treatment• Gynecologist• Hearing aids and batteries• Hospital bills• Hydrotherapy• Insulin treatment• Lab tests• Lead paint removal• Legal fees• Lodging (away from home foroutpatient care)• Metabolism tests• Neurologist• Nursing (including board and meals)• Obstetrician• Operating room costs• Ophthalmologist• Optician• Optometrist• Oral surgery• Organ transplant (including donor’sexpenses)• Orthopedic shoes• Orthopedist• Osteopath• Oxygen and oxygen equipment• Pediatrician• Physician• Physiotherapist• Podiatrist• Postnatal treatments• Practical nurse for medical services• Prenatal care• Prescription medicine• Psychiatrist• Psychoanalyst• Psychologist• Psychotherapy• Radium Therapy• Registered nurse• Special school costs for thehandicapped• Spinal fluid test• Splints• Sterilization• Surgeon• Telephone or TV equipment toassist the hard-of-hearing• Therapy equipment• Transportation expenses(relative to health care)• Ultra-violet ray treatment• Vaccines• Vasectomy• Vitamins (if prescribed)• Wheelchair• X-raysOver-the-Counter Drugs• Antacids• Allergy medications• Pain relievers• Cold medicine• Anti-diarrhea medicine• Cough drops and throat lozenges• Sinus medications and nasal sprays• Nicotine medications and nasalsprays• Pedialyte• First aid creams• Calamine lotion• Stop-smoking programs• Wart removal medication• Antibiotic ointments• Suppositories and creams forhemorrhoids• Sleep Aids• Motion sickness pillsIneligible Medical Expenses• Advancement payment for servicesto be rendered next year• Athletic Club membership• Automobile insurance premiumallocable to medical cover age• Boarding school fees• Bottled Water• Commuting expenses of a disabledperson• Cosmetic surgery and procedures• Cosmetics, hygiene products andsimilar items• Funeral, cremation, or burialexpenses• Health programs offered by resorthotels, health clubs, and gyms• Illegal operations and treatments• Illegally procured drugs• Maternity clothes• Non-prescription medication• Premiums for life insurance, incomeprotection, disability, lossof limbs, sight or similar benefits• Scientology counseling• Social activities• Special foods and beverages• Specially designed car for thehandicapped other than an autoetteor special equipment• Swimming pool• Travel for general healthimprovement• Tuition and travel expenses aproblem child to a particular school• Weight loss programsOver-the-Counter Drugs• Toiletries (including toothpaste)• Acne treatments• Lip balm (including chapstick orcarmex)• Suntan lotion• Medicated shampoos and soaps• Vitamins (daily)• Fiber supplements• Dietary supplements• Weight loss drugs for general wellbeing• Herbs

FLEXIBLE SPENDING ACCOUNT (FSA)What is a health savings account? Flexible Spending Accounts, or FSAs, provide you with an important tax advantage that can help you pay health care and dependent care expenses on a pre-tax basis. By anticipating your family’s health care and dependent care costs for the next plan year, you can lower your taxable income.This is how an FSA works:If you decide to enroll in one or both of the accounts, your contributions are taken out of each paycheck—before taxes—in equal installments throughout the plan year. These dollars are then placed into your FSA. When you have an eligible health care or dependent care expense, you must submit a claim form along with an itemized receipt to be reimbursed from your account.The health care reimbursement FSA will reimburse you for the full amount of your annual election (less any reimbursement already received), at any time during the plan year, regardless of the amount in your account. The dependent care FSA will only reimburse you for the amount that is in your account at the time you make a claim.Advantages and Disadvantages of an FSA:o It saves you money. An FSA is an employer-sponsored savings account that allows you to put aside money tax-free that can be used to pay for qualified medical expenses.o It is a tax-saver. Contributions to your FSA are made with pre-tax dollars. Since your taxable income is decreased by your contributions, you pay less in taxes.o It is flexible. You can withdraw health FSA funds at any time for qualified medical expenses, even if it’s only the beginning of the year and you haven’t contributed the entire yearly amount yet.o It requires careful planning. FSAs operate under a use-or-lose rule, meaning that if you don’t use the money in your FSA by the end of the plan year, you lose it. Some employers, however, may offer a grace period or allow you to carry over.o It is not portable. If you change jobs, you typically forfeit the funds left in your FSA.o It requires proof. You must fill out all the necessary forms and show receipts for FSA-eligible purchases to be reimbursed.How much can I contribute to an FSAAs noted by federal law, the annual contrition limits are:FSA Contribution Limits 2025Health FSA $3,300Dependent Care FSA$5,000 ($2,500 if married filing separately)Refer to your FSA documentation for more information.2025-2026 Benefits Guide Page 30 You are eligible to rollover $660 into the next plan year with your healthcare FSA. You are only eligible to participate in the healthcare FSA if you are not enrolled for an HSA. You cannot make active contributions to an FSA and HSA at the same time. You are eligible to participate in the dependent care (childcare) FSA regardless of what plan is chosen.

FLEXIBLE SPENDING ACCOUNT (FSA)Refer to your FSA documentation for more information.2025-2026 Benefits Guide Page 31Eligible health care expenses for the health care reimbursement FSA include more than just your deductible and copayments. You can also reimburse items such as prescription drugs, dental expenses, eyeglasses and contacts, certain medical equipment and many more items. For more information about eligible medical expenses, please refer to IRS Publication 502, Medical and Dental Expenses, available at www.irs.gov/publications/p502/index.html.Effective Jan. 1, 2020, the Coronavirus Aid, Relief and Economic Security Act (CARES Act) allows certain over-the-counter medications and products—including cold and flu medicine, allergy medication and menstrual products—to be treatedas qualified expenses.Keep a copy of all your receipts. Review your FSA member account and FAQ carefully.Examples of Healthcare FSA Eligible Expenses• Acupuncture• Alcoholism treatment• Ambulance• Annual physical examination• Artificial limb• Artificial teeth• Bandages• Birth control pills• Body scan• Braille books and magazines• Breast pumps and supplies• Breast reconstruction surgery• Capital expenses (improvementsor special equipment installed to ahome, if meant to accommodate adisabled condition)• Car modifications or specialequipment installed for a personwith a disability• Chiropractor• Christian Science practitioner• Contact lenses• Crutches• Dental treatment (not includingteeth whitening)• Diagnostic devices• Disabled dependent care expenses• Drug addiction treatment• Eye exam• Eyeglasses• Eye surgery• Fertility enhancement (in vitrofertilization or surgery)• Guide dog or other service animal• Health institute fees (if treatmentis prescribed by a physician)• Certain health insurancepremiums (not premiums for anemployer-sponsored plan, butcertain other medical premiums)• Intellectually or developmentallydisabled care, treatment or specialhome• Laboratory fees• Lactation expenses• Lead-based paint removal (if achild in the home has leadpoisoning)• Learning disability care ortreatment• Legal fees associated with medicaltreatment• Lifetime care, advance paymentsor “founder’s fee”• Lodging at a hospital or similarinstitution• Long-term care• Medical conference expenses, ifthe conference concerns a chronicillness of yourself, your spouse oryour dependent• Medical information plan• Medications, if prescribed• Nursing home fees• Nursing services• Operations• Osteopath• Oxygen• Physical examination• Pregnancy test kit• Prosthesis• Psychiatric care• Psychologist• Special education• Sterilization• Stop-smoking programs• Surgery• Special telephone for hearing-impaired individual• Television for hearing-impairedindividuals• Therapy received as medicaltreatment• Transplants• Transportation for medical care• Tuition for special education• Vasectomy• Vision correction surgery• Weight-loss program if it is atreatment for a specific disease• Wheelchair• Wig• X-rayIn order for dependent care services to be eligible, they must be for the care of a tax-dependent child under age 13 who lives with you, or a tax-dependent parent, spouse or child who lives with you and is incapable of caring for himself or herself. The care must be needed so that you and your spouse (if applicable) can go to work. Care must be given during normal working hours (instances such as Saturday night babysitting does not qualify) and cannot be provided by another of your dependents.Examples of Dependent (Child Care) FSA Eligible Expenses• Day Camp -- primary purpose must be custodial care and not educational innature• Dependent care expenses that are necessary for you (and your spouse) towork, actively look for work, or attend school full-time• Dependent care for a child under age 13• FICA/FUTA taxes of day care provider• Late pick up fees• Nanny expenses attributed to dependent care• Nursery school (Pre-School)• Registration fees -- when allocated to dependent care services that have beenprovided

Hill Country Christian School of Austin will continue to offer dental coverage through MetLife. You may choosebetween either the Base or Buy-Up Dental plans. The Base Plan option only provides In-Network benefits, no out-of-network benefits, you must elect a Primary Care dentist and receive a referral to see a Specialist. The Buy-Up Plan option does provide out-of-network benefits; however, you will pay more out-of-pocket since those providers do not have negotiated rates with MetLife. Dental benefits at-a-glance:METLIFE DENTAL Buy-Up PlanVoluntary DPPOBase PlanVoluntary Copay DHMONetwork PDP PlusHMO/Managed Care (Plan Name – MET290)Benefit Period Maximum $1,500 No MaximumDeductible – Individual / FamilyWaived on Preventive?$50 / $150YesNoneYesPreventive ServicesExams, Cleanings, Bitewing X-rays100% Fixed CopaysBasic Restorative ServicesExtractions, Fillings80% Fixed CopaysEndodontics (root canals)Periodontics (gum disease)50%50%Fixed CopaysFixed CopaysMajor Restorative ServicesCrowns, Bridges, Dentures50%50%Fixed CopaysOrthodontic ServicesLifetime Maximum50% - Child(ren) to age 19$1,000Adult & Child(ren)Fixed CopaysCost Per Pay PeriodEmployee OnlyEmployee & SpouseEmployee & Child(ren)Employee & FamilyWhat You Pay$18.74$37.00$45.63$68.87What You Pay$6.63$12.60$13.26$20.55DENTAL 2025-2026 Benefits Guide Page 32*See your official plan documents for further details. If a discrepancy is found between this overview and your plan document, the plan document will govern.

Benefits You Receive:Hill Country Christian School of Austin will continue to offer vision coverage through MetLife which utilizes the MetLife Vision PPOnetwork. This Plan option does provide out-of-network benefits; however, you will pay more out-of-pocket since those providers do not have negotiated rates with MetLife.Vision benefits at-a-glance:MetLifeVoluntary Vision M130DCoverage In-Network Copay Frequency PeriodEye Exam Benefit $10 Once every 12 monthsEyeglass Lenses Allowances: (one pair per frequency period) Single VisionLined BifocalLined TrifocalLenticular$25$25$25$25Once every 12 monthsContact Lenses Allowances:(in lieu of lenses and frames)ElectiveTherapeutic (Medically Necessary)$130 allowanceCovered – copay waivedOnce every 12 monthsFrame Retail Allowance (oneper frequency period)$130 allowanceOnce every 24 monthsCost Per Pay PeriodEmployee OnlyEmployee & SpouseEmployee & Child(ren)Employee & FamilyWhat You Pay$4.23$8.47$7.17$11.83VISION2025-2026 Benefits Guide Page 33*See your official plan documents for further details. If a discrepancy is found between this overview and your plan document, the plan document will govern.

2025-2026 Benefits Guide Page 34

Employees who wish to help secure their family’s future, may purchase Voluntary Life Insurance coveragethrough MetLife. When you enroll yourself and your dependents in this benefit, you pay the full cost through payroll deductions. See the following pages for costs.VOLUNTARY LIFE AND AD&D2025-2026 Benefits Guide Page 35Employee Spouse Child(ren)Election Increments $10,000 $5,000•$100 (Birth to 15 days) •$500 (15 days to 6 months) • $1,000, $2,000, $4,000, $5,000, or $10,000 (6 months to age 25)Maximum BenefitLess of 5x annual salary up to $500,000$100,000, not to exceed 50% of employee coverage$10,000Guarantee Issue $100,000$25,000, not to exceed 50% of employee coverage$10,000Accidental Death & Dismemberment (AD&D)Benefit amount equal to the Life benefitAdditional Information:Evidence of InsurabilityEvidence of Insurability (EOI) will be required for late entrants for any amount and requests exceeding the guaranteed issue.CoverageIf a person is covered as an Employee under this policy, they cannot be covered as a Spouse or Dependent Child under another Employee’s policy through this company. Additionally, if both parents have a policy through this company, only one may insure eligible dependent children.Features available Grief counseling for you and your dependents – Access by calling 1-1-888-319-7819 or long on to www.metlifegc.lifeworks.com(Username: metlifeassist, Password: support) Funeral Discounts and Planning Services – Dignity Memorial provides discounts and planning services. Access by phone 1-866-853-0954 or online www.finalwishesplanning.com Will Preparation & Estate Resolution Services through Hyatt Legal Plans’ network of 14,000+ participating attorneys. Contact MetLife for toll free number.*See your official plan documents for further details. If a discrepancy is found between this overview and your plan document, the plan document will govern.

You will continue to have the opportunity to purchase Short-Term and/or Long-Term Disability (STD/LTD) coverage through MetLife. In the event you becomedisabled from a non-work-related injury or sickness, disability income benefitsare a source of income for you and your family. You are not eligible to receiveshort- term disability benefits if you are receiving workers’ compensationbenefits.Voluntary Long-Term DisabilityBenefits Begin 180 days after the onset of your Accident or Sickness or until the end of the STD maximum benefit period ends to SSNRABenefit Percentage 60%Maximum Monthly Benefit $5,000Pre-existing Limitation 12 months prior to effective date / 12 months after effective dateVoluntary Short-Term DisabilityBenefits Begin On the 15thday from your Accident or SicknessBenefit Percentage Minimum of $100 to a max of the greater of $1,000 or 60% of weekly earnings. Can only increase by an increment of $50 each year.Maximum Weekly Benefit $1,000Benefit Duration Available for up to 24 weeksPre-existing Limitation 3 months prior to effective date / 12 months after effective dateVOLUNTARY DISABILITY2025-2026 Benefits Guide Page 36Benefits at-a-glance:Enrollment in the STD or LTD plans after your initial eligibility period,will require a health statement form. See Employee Navigator for costs.*See your official plan documents for further details. If a discrepancy is found between this overview and your plan document, the plan document will govern.

PAYROLL DEDUCTIONS PER 24 PAY PERIODSMedical Buy-Up PPO Plan Employer Cost Employee CostEmployee Only $394.60 $31.17Employee + Spouse $340.48 $465.49Employee + Child(ren) $412.87 $401.49Employee + Family $396.58 $797.99Medical Base PPO Plan Employer Cost Employee CostEmployee Only $392.10 $0.00Employee + Spouse $334.80 $407.41Employee + Child(ren) $407.22 $342.71Employee + Family $387.84 $712.22Medical HSA Plan Employer Cost Employee CostEmployee Only $338.47 $0.00Employee + Spouse $289.14 $351.56Employee + Child(ren) $351.52 $295.84Employee + Family $335.34 $614.26Voluntary Dental PPO Plan Employee CostEmployee Only $18.74Employee + Spouse $37.00Employee + Child(ren) $45.63Employee + Family $68.87Voluntary Dental DHMO Plan Employee CostEmployee Only $6.63Employee + Spouse $12.60Employee + Child(ren) $13.26Employee + Family $20.55Voluntary Vision Plan Employee CostEmployee Only $4.23Employee + Spouse $8.47Employee + Child(ren) $7.17Employee + Family $11.83STD Plan Employee CostEmployee Only Age Rated: See EnavLTD Plan Employee CostEmployee Only Age Rated: See EnavVoluntary Dependent Life Employee CostSpouse / Child(ren) Insurance Age Rated: See ENav2025-2026 Benefits Guide Page 37

Group Accident InsurancePreferred PlanIf you are in an accident, your focus should be on recovery, not how you’re going to pay your bills. Colonial Life accident insurance can pay benefits directly to you to use howeveryou like —from medical costs to everyday expenses. Whether you’ve had a fall or a car accident, these benefits can offer financial support when you need it.Our coverage includes:• Benefits payable directly to you• No medical questions to qualify for coverage• Coverage for simple and complex injuries• Benefits payable regardless of other insurance• Worldwide coverage• Works alongside your Health Savings Account (HSA)BENEFITS STORYMilo was working in his yard when he tripped and injured his hand.With Colonial Life accident benefits, Milo was able to pay theannualdeductible and co-payments for his health insuranceplanwithout using his savings or taking on debt.MILO’S ACCIDENT BENEFITSMilo went to an urgent care facility and received immediate care.Treatment in a physician’s office or urgent care facility$100The doctor ordered an X-ray and discovered Milo had fractured his hand.• X-ray• Fracture (hand)$60$1,200The doctor also found that Milo had a cut on his hand but did not require stitches.Laceration (no repair) $50Milo was discharged with a splint. Durable medical equipment $50Over the next several weeks, Milo had two follow-up appointments with his doctor.Physician follow-up visits (2 visits)$50 x2 =$100For illustrative purposes only. Benefit amounts may vary and may not cover all expenses.Total $1,560GROUP ACCIDENT (GAC4100) —PREFERRED PLAN

Give your benefits a boostWe know that more complicated or severe accidents result in more expensive medical bills and more disruption in your life.Group Accident includes a Benefit Booster* to provide additional financial support for serious accidents. If you have more than $5,000 in payable benefits for a covered accident, we will give you a $500 boost to your benefits to help you with whatever expenses you have.*Payable once per Insured per covered accidentBENEFITS STORYOlivia was driving to the store when she got into a car accident.Olivia’s benefits helped her cover her medical expenseswhenshe was injured in a car accident, helping her tofocuson her recovery.OLIVIA’S ACCIDENT BENEFITSOlivia arrived by ambulance at the nearest emergency room and received immediate care.• Ambulance• Emergency department visit• Injury due to auto accident$300$200$250The doctor ordered an X-ray and discovered Oliviahad fractured her thigh (femur). He also ordered aCT scan of her head to check for brain injury.• X-ray• Medical imaging• Fracture (thigh)$60$200$3,150Olivia required surgery for her leg.• Surgical repair (thigh fracture)• General anesthesia$3,150$250Olivia boarded her pet for two nights after her surgery.Pet boarding (2 days) $20 x2 =$40Olivia had eight sessions of physical therapyto help regain the strength in her leg and twofollow-up appointments with her doctor.• Therapy services (8 sessions)• Physician follow-up visits (2 visits)$45 x8=$360$50 x2 =$100Olivia’s benefits for this accident totaled more than $5,000.Benefit Booster $500Forillustrative purposes only. Benefit amounts may vary and may not coverall expenses.Total $8,560Benefits are per covered person per covered accident unless stated otherwiseInjury benefits•Burns (based on size and degree) ............. $500–$15,000•Concussion ........................................ .$375•Connective tissue damage ...................... $100–$200•Eye injury .......................................... $300•Hearing loss injuries .................................. $120(Maximum once per lifetime per ear per insured)•Injury due to auto accident ........................... $250•Internal injuries ..................................... $200•Knee cartilage (meniscus) injury ....................... $150•Lacerations .................................... $50–$600•Loss of a digit —partial ......................... $300–$600•Loss of a digit ............................... $750–$2,000•Ruptured or herniated disc ...................... $150–$300

Fracture benefits•Injury .......................................$200–$3,750Examples: finger: $200 | wrist: $1,200 | hip: $3,150•Surgical repair of fracture . . . . .. . . . . . . . . . .. . . . . . . . . . .. 100%(Payable as an additional %of the applicable fractures benefit)•Chip fracture ........................................ 25%(Payable as a %of the applicable fractures benefit)Dislocation benefits•Injury ...................................... .$200–$3,000Examples: elbow: $450 | ankle: $1,200 | hip: $3,000•Surgical repair of dislocation . .. . . . . . . . . . .. . . . . . . . . . ... 100%(Payable as an additional %of the applicable dislocations benefit)•Incomplete dislocation . . . . . . . . . . .. . . . . . . . .. . . . .. . . . . ..25%(Payable as a % of the applicable dislocations benefit)Treatment benefits•Air ambulance ..................................... $1,500•Ambulance (ground or water) ......................... $300•Durable medical equipment ...................... $50–$200•Emergency dental repair ........................ $100–$300•Emergency department .............................. $200(Maximum 4 per year)•Family care ................................... $50 per day(Maximum of one benefit per day for all Insureds combined, up to a maximum of three days per covered accident, regardless of the number of children)•Injections to prevent or limit infection .................. .$50•Lodging ..................................... $200 per day(Maximum 30 days)•Medical imaging..................................... $200•Pain management injections ..........................$100•Pet boarding.................................. $20 per day(Maximum of one benefit per day for all insureds combined, up to a maximum of three days per coveredaccident, regardless of the number of pets that are boarded)•Prosthetic device or artificial limb ............ $1,250–$2,500•Skin grafts (due to burns) ............................. 50%(Payable as a %of the applicable burn benefit)•Skin grafts (not due to burns) .................... $250–$500•Transfusions........................................ $400•Transportation ............................... .$150 per trip(Maximum 6 one-way trips)•Treatment in a physician’s office or urgent care facility ... $100(Maximum 4 per year)•X-ray or ultrasound ................................... .$60Surgery benefits•Anesthesia .................................... $150–$250•Connective tissue surgery..................... .$125–$1,600•Eye surgery......................................... $300•General surgery–Abdominal, thoracic, or cranial ................... .$1,500–Exploratory surgery ............................... $225•Hernia surgery ...................................... $300•Knee cartilage (meniscus) surgery ............... $100–$600•Outpatient surgical facility . . . . . . .. . . . . . . . .. . . . .. . . . . ..$300•Ruptured or herniated disc surgery ............ .$125–$1,500Recovery care benefits•At-home care ................................ $100 per day(Maximum 5 days)•Benefit Booster ..................................... $500•Physician follow-up visits ............................. $50(Maximum 4 days per covered accident and 16 days per calendar year)•Rehabilitation or sub-acute rehabilitationunit confinement............................. $150 per day(Maximum 15 days per covered accident and 30 days per calendar year)•Therapy services (speech, physical therapy,occupational therapy) ......................... .$45 per day(Maximum 15 days)Recovery Plus package•Behavioral health therapy .................. $45 per day(Maximum 15 days)•Post-traumatic stress disorder (PTSD) ............ $200•Prescription drug ................................ .$25•Additional therapy services(chiropractic, acupuncture, alternative therapy) ..... .$45 (Existing therapy services benefit maximum appliesto additional therapy services, maximum 15 days)•Injury due to felonious act of violenceor sexual assault ................................ $250(Maximum once per insured per calendar year, with an accompanying police report)

Contact your Colonial Life benefits counselor to learn more.CT: We will pay the air ambulance or ambulance benefits directly tothe licensed professional ambulance company. CT includes a benefit for “outpatient emergency medical care for accidental ingestion of acontrolled substance.” The at-home care benefit maximum is 80 days.KS: Chiropractic therapy is not available.NH: NH includes a burn benefit for 2nd degree burns under 5% ofskin surface. The minimum benefit for the loss or partial loss of a digit is $1,000.MD: The prescription drug benefit is not available.PA: The pet boarding benefit is not available.TN: The therapy services benefit includes chiropractic.TX: The concussion benefit is replaced by the “concussion and acquired brain injuries” benefit. The therapy services benefit includes the following services: cognitive communication therapy; cognitive rehabilitation therapy; community reintegration services; neurobehavioral; neurocognitive therapy and rehabilitation; neurofeedback therapy; neurophysiological; neuropsychological; post-acute transition services; psychophysiological testing or treatment; and remediation.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate.It may also be offered to employees who do not have HSAs.THIS INSURANCE PROVIDES LIMITED BENEFITS .This coverage is a supplement to health insurance. It is not a substitutefor essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.EXCLUSIONSWe will not pay benefits for claims that are caused by, contributed to by, or resulting from elective procedures, felonies or illegal occupations, hazardous avocations, impaired driving, incarceration, racing, semi-professional or professional sports, sickness, suicide or self-inflicted injuries, war, or armed conflict.ID: ”Semi-professional sports or professional sports” exclusion is replaced by “professional sports” exclusion.IL: We will not pay benefits for claims that are caused by or resulting from Exclusions.MD: Includes an exclusion for “Prohibited referrals.” The “felonies or illegal occupations” and “impaired driving” exclusions apply only to Accidental Death and Dismemberment benefits.MI: “Impaired driving” and “suicide or self-inflicted injuries” exclusions do not apply.MN: “Suicide or self-inflicted injuries” exclusion does not apply.NH: “Incarceration” and “racing” exclusions do not apply.UT: We will not pay benefits for claims that are caused by or resulting from Exclusions.VT: “Impaired driving” exclusion does not apply.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable topolicy form GAC4100-P and certificate form GAC4100-C (including state abbreviations where used, for example: GAC4100-P-TX and GAC4100-C-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.FOR EMPLOYEES 3-23 | 1212757ColonialLife.com

Group Accident InsuranceAccident Hospital BenefitsThese benefits can help with medical costs related to a hospital stay for a covered accident, including costs that your health insurance may not cover, like co-pays and deductibles.Accident hospital benefits are available to you with group accident coverage, as well as all your covered family members Talk with your benefits counselor about the level of accident hospital benefits available to you.Benefits are per covered person per covered accident unless stated otherwise.Economy Basic Preferred Premier  Hospital Admission $500$750$1,000$1,500Hospital Admission –ICU $1,250 $1,500 $1,750 $2,500Hospital Confinement –Daily StayMax. of 365 days per insured per covered accident$100 $200 $250 $350Hospital ICU Confinement –Daily StayMax. of 15 days per insured per covered accident$150 $250 $350 $500Hospital Sub-Acute ICU Confinement –Daily StayMax. of 30 days per insured per covered accident$200 $300 $400 $600Short StayMin. of 8 hours up to 20 hours$200 $200 $200 $200To learn more, talk with your Colonial Life benefits counselor.GROUP ACCIDENT (GAC4100) – ACCIDENT HOSPITAL BENEFITS

STATE VARIATIONS FOR BENEFITSMD includes a second opinion benefit.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs.THIS INSURANCE PROVIDES LIMITED BENEFITS.This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.EXCLUSIONS AND LIMITATIONSWe will not pay benefits for claims that are caused by, contributed to by, or resulting from elective procedures, feloniesor illegal occupations, hazardous avocations, impaired driving, incarceration, racing, semi-professional or professionalsports, sickness, suicide or self-inflicted injuries, war, or armed conflict.STATE VARIATIONS FOR EXCLUSIONS AND LIMITATIONSID: “Semi-professional sports or professional sports” exclusion is replaced by “professional sports” exclusion.IL: We will not pay benefits for claims that are caused by or resulting from Exclusions.MD: Includes an exclusion for “Prohibited referrals.” The “felonies or illegal occupations” and “impaired driving” exclusions apply only to Accidental Death and Dismemberment benefits.MI: “Impaired driving” and “suicide or self-inflicted injuries” exclusions do not apply.MN: “Suicide or self-inflicted injuries” exclusion does not apply.NH: “Incarceration” and “racing” exclusions do not apply.UT: We will not pay benefits for claims that are caused by or resulting from Exclusions.VT: “Impaired driving” exclusion does not apply.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GAC4100-P and certificate form GAC4100-C (including state abbreviations where used, for example, GAC4100-P-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.FOR EMPLOYEES 2-23 | 1284160ColonialLife.com

Group Accident InsuranceAccidental Death & DismembermentBenefitsThese benefits can help pay for expenses related to an accidental death. They can also help pay costs related to recovery and rehabilitation from an accidental dismemberment, including costs that your medical plan doesn’t cover, like co-pays and deductibles.Accidental death & dismemberment (AD&D) benefitsAccidental death and dismemberment benefits are available to you with group accident coverage, as well as all your covered family members. Talk with your benefits counselor about the level of AD&D benefits available to you.Benefits are per covered person per covered accident unless stated otherwise.Economy Basic Preferred Premier   Accidental death  • Named insured $25,000 $25,000 $50,000 $50,000• Spouse1$25,000 $25,000 $50,000 $50,000• Children $5,000 $5,000 $10,000 $10,000Accidental death –Common carrier• Named insured $100,000 $100,000 $200,000 $200,000• Spouse1$100,000 $100,000 $200,000 $200,000• Children $20,000 $20,000 $40,000 $40,000Accidental dismemberment• Both feet $25,000 $50,000 $75,000 $100,000• Both hands $25,000 $50,000 $75,000 $100,000• One foot $6,000 $7,500 $9,000 $15,000• One hand $6,000 $7,500 $9,000 $15,000• Thumb and index finger of the same hand $3,000 $3,750 $4,500 $7,500Coma (7 or more consecutive days) $5,000 $7,500 $10,000 $20,000Home alterations and automobile modifications $500 $1,000 $1,500 $2,000GROUP ACCIDENT (GAC4100) – AD&D BENEFITS

Accidental death & dismemberment benefits (continued)Economy Basic Preferred Premier   Loss of use• Hearing (one ear) $6,000 $7,500 $9,000 $15,000• Hearing (both ears) $25,000 $50,000 $75,000 $100,000• Sight of one eye $6,000 $7,500 $9,000 $15,000• Sight of both eyes $25,000 $50,000 $75,000 $100,000• Speech $25,000 $50,000 $75,000 $100,000Paralysis• Uniplegia $6,000 $7,500 $9,000 $15,000• Hemiplegia $25,000 $50,000 $75,000 $100,000• Paraplegia $25,000 $50,000 $75,000 $100,000• Triplegia $25,000 $50,000 $75,000 $100,000• Quadriplegia $25,000 $50,000 $75,000 $100,000To learn more, talk with your Colonial Life benefits counselor.1. Or domestic partner where permitted by law.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs.THIS INSURANCE PROVIDES LIMITED BENEFITS.This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage asdefined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.EXCLUSIONS AND LIMITATIONSWe will not pay benefits for claims that are caused by, contributedto by, or resulting from elective procedures, felonies or illegal occupations, hazardous avocations, impaired driving, incarceration,racing, semi-professional or professional sports, sickness, suicide or self-inflicted injuries, war, or armed conflict.STATE VARIATIONS FOR EXCLUSIONS AND LIMITATIONSID: “Semi-professional sports or professional sports” exclusion is replaced by “professional sports” exclusion.IL: We will not pay benefits for claims that are caused by or resulting from Exclusions.MD: Includes an exclusion for “Prohibited referrals.” The “felonies or illegal occupations” and “impaired driving” exclusions apply only to Accidental Death and Dismemberment benefits.MI: “Impaired driving” and “suicide or self-inflicted injuries” exclusions do not apply.MN: “Suicide or self-inflicted injuries” exclusion does not apply.NH: “Incarceration” and “racing” exclusions do not apply.UT: We will not pay benefits for claims that are caused by or resulting from Exclusions.VT: “Impaired driving” exclusion does not apply.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable topolicy form GAC4100-P and certificate form GAC4100-C (including state abbreviations where used, for example, GAC4100-P-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.FOR EMPLOYEES 2-23 | 1284100ColonialLife.com

Group Accident InsuranceWellbeing Assistance Benefit –MaxThis benefit can help reduce the risk of serious illness through early detection of disease or other risk factors, giving you more protection from the unexpected.The wellbeing assistance benefit is available to you with group accident coverage, as well as all your covered family members.Wellbeing assistance benefit .. ............ ... .$ 100.00payable once per covered person per calendar year; subject to a 30-day waiting period.• Annual physical, including annualexams, sports physicals and wellchild visits• Blood test for triglycerides• Bone marrow testing• BRCA1 or BRCA2 testing• Breast ultrasound• CA 15-3 (blood test forbreast cancer)• CA 125 (blood test forovarian cancer)• Carotid Doppler• CEA (blood test for colon cancer)• Chest X-ray• Colonoscopy• Echocardiogram (ECHO)• Electrocardiogram (EKG, ECG)• Fasting blood glucose test• Flexible sigmoidoscopy• Hemoccult stool analysis• Immunizations• Mammography• Pap smear• Physical• PSA (blood test for prostate cancer)• Serum cholesterol test for HDL andLDL levels• Serum protein electrophoresis(blood test for myeloma)• Skin cancer biopsy• Stress test on a bicycle or treadmill• Thermography• ThinPrep pap test• Virtual colonoscopyTo learn more, talk with your Colonial Life benefits counselor.GROUP ACCIDENT (GAC4100) – WELLBEING ASSISTANCE BENEFIT - MAX

STATE VARIATIONS FOR BENEFITSMD: Waiting period does not applyWV: Includes human papillomavirus screening testHEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs.THIS INSURANCE PROVIDES LIMITED BENEFITS.This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.EXCLUSIONS AND LIMITATIONSWe will not pay benefits for claims that are caused by, contributed to by, or resulting from elective procedures, feloniesor illegal occupations, hazardous avocations, impaired driving, incarceration, racing, semi-professional or professionalsports, sickness, suicide or self-inflicted injuries, war, or armed conflict.STATE VARIATIONS FOR EXCLUSIONS AND LIMITATIONSIL: We will not pay benefits for claims that are caused by or resulting from Exclusions.MD: Includes an exclusion for “Prohibited referrals.” The “felonies or illegal occupations” and “impaired driving” exclusions apply only to Accidental Death and Dismemberment benefits.MN: “Suicide or self-inflicted injuries” exclusion does not apply.UT: We will not pay benefits for claims that are caused by or resulting from Exclusions.VT: “Impaired driving” exclusion does not apply.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GAC4100-P and certificate form GAC4100-C (including state abbreviations where used, for example, GAC4100-P-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.FOR EMPLOYEES 2-23 | 1345452ColonialLife.com

Group Accident InsuranceActive Lifestyles BenefitThis benefit increases the amount you receive by 20% for your covered eligible benefits, giving you more financial protection for the unexpected.The active lifestyles benefit is available to you with group accident coverage, as well as all your covered family members.Eligible benefits1• Concussion• Connective tissue damage• Dislocations• Emergency dental repair• Eye injury• Fractures• Knee cartilage (meniscus) injury• Lacerations• Medical imaging• Ruptured or herniated disc• Surgery‐ Connective tissue surgery‐ Dislocations —surgical repair‐ Eye surgery‐ Fractures —surgical repair‐ General surgery —abdominal, thoracic, cranial, exploratory‐ Knee cartilage (meniscus) surgery‐ Ruptured or herniated disc surgery• X-ray or ultrasoundTo learn more, talk with your Colonial Lifebenefits counselor.BENEFITS STORYOlivia slipped off the stair climber at the gym …And hit her head on the floor. She had a concussion and fractured her ankle.Olivia’s payable claim added up to $2,500 in accident benefits. Her claim included benefits that were eligible for a 20% active lifestyles benefit.$2,500Eligible benefits$2,500x 20%$500Eligible benefit amount Active lifestyles benefitActive lifestyles benefit calculation$2,500+$500$3,000Eligible benefit amount Active lifestyles benefitTotalFor illustrative purposes only.GROUP ACCIDENT (GAC4100) - ACTIVE LIFESTYLES BENEFIT

1. Active lifestyles benefit applies to any combination of these injuries or services due to a covered accident.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs.THIS INSURANCE PROVIDES LIMITED BENEFITS.This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.EXCLUSIONS AND LIMITATIONSWe will not pay benefits for claims that are caused by, contributed to by, or resulting from elective procedures, feloniesor illegal occupations, hazardous avocations, impaired driving, incarceration, racing, semi-professional or professionalsports, sickness, suicide or self-inflicted injuries, war, or armed conflict.STATE VARIATIONS FOR EXCLUSIONS AND LIMITATIONSID: “Semi-professional sports or professional sports” exclusion is replaced by “professional sports” exclusion.IL: We will not pay benefits for claims that are caused by or resulting from Exclusions.MD: Includes an exclusion for “Prohibited referrals.” The “felonies or illegal occupations” and “impaired driving” exclusions apply only to Accidental Death and Dismemberment benefits.MI: “Impaired driving” and “suicide or self-inflicted injuries” exclusions do not apply.MN: “Suicide or self-inflicted injuries” exclusion does not apply.NH: “Incarceration” and “racing” exclusions do not apply.UT: We will not pay benefits for claims that are caused by or resulting from Exclusions.VT: “Impaired driving” exclusion does not apply.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GAC4100-P and certificate form GAC4100-C (including state abbreviations where used, for example, GAC4100-P-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.FOR EMPLOYEES 3-23 | 1335475ColonialLife.com

Group Accident InsuranceBuilding BenefitThis benefit can increase the value of your accident coverage the longer you keep it by increasing the amount you receive for covered eligible benefits, giving you more financial protection for the unexpected.The building benefit is available to you with group accident coverage, as well as all your covered family members.The building benefit applies to benefits for injury, fractures and dislocations, treatment, surgery, and recovery caredue to a covered accident, as described in the certificateof coverage. Additional benefits may be eligible for the building benefit to apply. Refer to the certificate of coverage for a complete list of covered benefits.1How your benefits may increase in valueContinuous coverage Percentage increase13 to 36 months 5%37 to 60 months 10%61+ months 15%To learn more, talk with your Colonial Life benefits counselor.BENEFITS STORYNoah had a bicycle accident and fractured his wrist and forearm.His payable claim added up to $2,500 in eligible accident benefits. Noah had been continuously covered under his accident coverage for 14 months. He was eligible for a 5% building benefit.$2,500Coverage time:14 monthsEligible benefits5% Building benefit$2,500x 5%$125Eligible benefit amount Building benefitBuilding benefit calculation$2,500+$125$2,625Eligible benefit amount Building benefitTotalFor illustrative purposes only.GROUP ACCIDENT (GAC4100) - BUILDING BENEFIT

1. Building benefit applies to any combination of these injuries or services due to a covered accident. This benefit is payable once per insured per covered accident.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be offered to employees who do not have HSAs.THIS INSURANCE PROVIDES LIMITED BENEFITS.This coverage is a supplement to health insurance. It is not a substitute for essential health benefits or minimum essential coverage as defined in federal law. Insureds in some states must be covered by comprehensive health insurance before applying for this insurance.EXCLUSIONS AND LIMITATIONSWe will not pay benefits for claims that are caused by, contributed to by, or resulting from elective procedures, feloniesor illegal occupations, hazardous avocations, impaired driving, incarceration, racing, semi-professional or professionalsports, sickness, suicide or self-inflicted injuries, war, or armed conflict.STATE VARIATIONS FOR EXCLUSIONS AND LIMITATIONSID: “Semi-professional sports or professional sports” exclusion is replaced by “professional sports” exclusion.IL: We will not pay benefits for claims that are caused by or resulting from Exclusions.MD: Includes an exclusion for “Prohibited referrals.” The “felonies or illegal occupations” and “impaired driving” exclusions apply only to Accidental Death and Dismemberment benefits.MI: “Impaired driving” and “suicide or self-inflicted injuries” exclusions do not apply.MN: “Suicide or self-inflicted injuries” exclusion does not apply.NH: “Incarceration” and “racing” exclusions do not apply.UT: We will not pay benefits for claims that are caused by or resulting from Exclusions.VT: “Impaired driving” exclusion does not apply.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect any benefits payable. Applicable to policy form GAC4100-P and certificate form GAC4100-C (including state abbreviations where used, for example, GAC4100-P-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.© 2023 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.FOR EMPLOYEES 3-23 | 1285095ColonialLife.com

For more information, talk with yourbenefits counselor.Group Hospital IndemnityInsurancePlan 2ColonialLife.comGroup Medical BridgeTMinsurance can help with medical costs associated with a hospital stay that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children.Hospital confinement............................................................... $ per dayMaximum of one day per covered person per calendar yearWaiver of premiumAvailable after 30 continuous days of a covered confinement of the named insuredDaily hospital confinement ................................................................... $100 per dayMaximum of 365 days per covered person per confinement. Re-confinement for the same or relatedcondition within 90 days of discharge is considered a continuation of a previous confinement.Outpatient surgical procedure Tier 1 .................................................................................... $ per day Tier 2 .................................................................................... $ per dayMaximum of $per covered person per calendar year for Tier 1 and 2 combinedMaximum of one day per outpatient surgical procedureGMB7000 – PLAN 2

ColonialLife.comKS: "Surgical Procedure" benefit replaces "Outpatient Surgical Procedure." Diagnostic Procedures must be performed in ahospital or an ambulatory surgical center.PA: "Hospital Confinement Admission" benefit replaces the "Hospital Confinement" benefit*Colonoscopy must result in polyp removal or be recommended by a physician for the purposes of treatingor diagnosing a sickness.If a covered family member has a qualified high deductible health plan (HDHP) and actively contributes to a healthsavings account (HSA), their HSA can be disqualified with this coverage.THIS INSURANCE PROVIDES LIMITED BENEFITS.EXCLUSIONSWe will not pay any benefits for injuries received in accidents or for sicknesses which are caused by, contributed to by or occuras a result of the following exclusions and limitations. (a) alcoholism or drug addiction; (b) dental procedures; (c) electiveprocedures and cosmetic surgery; (d) felonies or illegal occupations; (e) mental or nervous disorders; (f) pregnancy of adependent child; (g) suicide or injuries which any covered person intentionally does to himself or herself; (h) war or armedforces service. Wewill not pay benefits for hospital confinement (i) due to giving birth within the first nine months after theeffective date of the policy or (j) for a newborn who is neither injured nor sick.(k) The policy may have additional exclusionsand limitations which may affect any benefits payable.PRE-EXISTING CONDITION LIMITATIONS(l) We will not pay benefits for loss during the first 12 months after the certificate effective date due to a pre-existingcondition. (m) A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a coveredperson was treated, had medical testing, received medical advice or had taken medication within the 12 months beforethe certificate effective date. (n) This limitation applies to the following benefits, if applicable: Hospital Confinement, DailyHospital Confinement, Inpatient Mental and Nervous, Rehabilitation Unit Confinement, Specified Critical Illness, DiagnosticProcedure, and Outpatient Surgical Procedure.This information is not intended to be a complete description of the insurance coverage available. The insurance or itsprovisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may affect anybenefits payable. Applicable to policy form GMB7000-P and certificate form GMB7000-C (including state abbreviationswhere used, for example: GMB7000-C-TX). For cost and complete details of coverage, call or write your Colonial Lifebenefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is aregistered trademark and marketing brand of Colonial Life & Accident Insurance Company. 11-21 | 101918-2■ Breast– Breast reconstruction– Breast reduction■ Cardiac– Angioplasty– Cardiac catheterization■ Digestive– Exploratory laparoscopy– Laparoscopic appendectomy– Laparoscopic cholecystectomy■ Ear, nose, throat, mouth– Ethmoidectomy– Mastoidectomy– Septoplasty– Stapedectomy– Tympanoplasty■ Eye– Cataract surgery– Corneal surgery (penetrating keratoplasty)– Glaucoma surgery (trabeculectomy)– Vitrectomy■ Gynecological– Hysterectomy– Myomectomy■ Musculoskeletal system– Arthroscopic knee surgery with meniscectomy(knee cartilage repair)– Arthroscopic shoulder surgery– Clavicle resection– Dislocations (open reduction with internal fixation)– Fracture (open reduction with internal fixation)– Removal or implantation of cartilage– Tendon/ligament repairThe procedures listed below are only a sampling of the procedures that may be covered if the outpatientsurgical procedure benefit is selected. Procedures must be performed by a doctor in a hospital or ambulatorysurgical center. For complete details and definitions, refer to your certificate.Tier 1 outpatient surgical procedures■ Breast– Axillary node dissection– Breast capsulotomy– Lumpectomy■ Cardiac– Pacemaker insertion■ Digestive– Colonoscopy*– Fistulotomy– Hemorrhoidectomy– Lysis of adhesions■ Ear, nose, throat, mouth– Adenoidectomy– Removal of oral lesions– Myringotomy– Tonsillectomy– Tracheostomy– TympanotomyTier 2 outpatient surgical procedures■ Gynecological– Dilation and curettage (D&C)– Endometrial ablation– Lysis of adhesions■ Liver– Paracentesis■ Musculoskeletal system– Carpal/cubital repair or release– Foot surgery (bunionectomy, exostectomy,arthroplasty, hammertoe repair)– Removal of orthopedic hardware– Removal of tendon lesion■ Skin– Laparoscopic hernia repair– Skin grafting■ Thyroid– Excision of a mass■ Urologic– Lithotripsy

For more information, talk with yourbenefits counselor.Group Hospital Confinement Indemnity InsuranceHealth Screening BenefitColonialLife.comHealth screening benefit............................................................................ $100 per dayMaximum of one day per covered person per calendar year■ Blood test for triglycerides■ Bone marrow testing■ Breast ultrasound■ CA 15-3 (blood test for breast cancer)■ CA 125 (blood test for ovarian cancer)■ Carotid Doppler■ CEA (blood test for colon cancer)■ Chest X-ray■ Colonoscopy■ Echocardiogram (ECHO)■ Electrocardiogram (EKG, ECG)■ Fasting blood glucose test■ Flexible sigmoidoscopy■ Hemoccult stool analysis■ Mammography■ Pap smear■ PSA (blood test for prostate cancer)■ Serum cholesterol test for HDL and LDL levels■ Serum protein electrophoresis (blood test for myeloma)■ Skin cancer biopsy■ Stress test on a bicycle or treadmill■ Thermography■ ThinPrep pap test■ Virtual colonoscopyGroup Medical BridgeSMinsurance’s health screening benefit can help pay for health and wellness tests you have each year.For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy form GMB1.0-P-R andcertificate form GMB1.0-C-R. Coverage may vary by state and may not be available in all states. This is not an insurancecontract and only the actual policy provisions will control.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is aregistered trademark and marketing brand of Colonial Life & Accident Insurance Company.GROUP MEDICAL BRIDGE HEALTH SCREENING BENEFIT | 5-18 | 100029-4

Group Critical Illness InsurancePlan 2GCI6000 – PLAN 2 – CRITICAL ILLNESS AND CANCERWhen life takes an unexpected turn, your focus should be on recovery —not finances. Colonial Life’s group critical illness insurance helps relieve financial worries by providing a lump-sum benefit payable directly to you to use as needed.Coverage amount:COVERED CRITICAL ILLNESS CONDITION¹PERCENTAGE OF APPLICABLECOVERAGE AMOUNTBenign brain tumor100%Coma100%End stage renal (kidney) failure100%Heart attack (myocardial infarction)100%Loss of hearing100%Loss of sight100%Loss of speech100%Major organ failure requiring transplant100%Occupational infectious HIV or occupational infectious hepatitis B, C or D100%Stroke100%Sudden cardiac arrest100%Coronary artery disease25%COVERED CANCER CONDITION¹PERCENTAGE OF APPLICABLECOVERAGE AMOUNTInvasive cancer (including all breast cancer)100%Non-invasive cancer25%Skin cancer initial diagnosis............................................................ $400 per lifetimeCritical illness and cancer benefitsA hospital stayand treatmentfor correctiveheart surgeryPhysical therapyto build musclestrengthSpecial needsdaycareFor illustrative purposes only.Preparing for a lifelong journeyRebecca was born with Down syndrome.Her parents’ critical illness coverageprovided a benefit that can help coverexpenses related to Rebecca’s care andher changing needs.HOW THEIR COVERAGE HELPEDThe lump-sum amount from thefamily coverage benefit helped pay for:

ColonialLife.com1. Refer to the certificate for complete definitions of covered conditions.2. Dates of diagnoses of a covered critical illness must be separated by more than 180 days.3. Critical illnesses that do not qualify include: coronary artery disease, loss of hearing, loss of sight, loss of speech,and occupational infectious HIV or occupational infectious hepatitis B, C or D.THIS INSURANCE PROVIDES LIMITED BENEFITS.EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESSWe will not pay the Critical Illness Benefit, Benefits Payable Upon Subsequent Diagnosis of a Critical Illness orAdditional Critical Illness Benefit for Dependent Children that occurs as a result of a covered person’s: doctoror physician relationship; felonies or illegal occupations; intoxicants and narcotics; suicide or injuring oneselfintentionally, whether sane or not; war or armed conflict; or pre-existing condition, unless the covered person hassatisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered personis diagnosed with a critical illness.EXCLUSIONS AND LIMITATIONS FOR CANCERWe will not pay the Invasive Cancer (including all Breast Cancer) Benefit, Non-Invasive Cancer Benefit, Benefit PayableUpon Reoccurrence of Invasive Cancer (including all Breast Cancer) or Skin Cancer Initial Diagnosis Benefit for acovered person’s invasive cancer or non-invasive cancer that: is diagnosed or treated outside the territorial limits of theUnited States, its possessions, or the countries of Canada and Mexico; is a pre-existing condition, unless the coveredperson has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date thecovered person is initially diagnosed as having invasive or non-invasive cancer. No pre-existing condition limitation willbe applied for dependent children who are born or adopted while the named insured is covered under the certificate,and who are continuously covered from the date of birth or adoption.PRE-EXISTING CONDITION LIMITATIONWe will not pay a benefit for a pre-existing condition that occurs during the 12-month period after the coverage effectivedate. Pre-existing condition means a sickness or physical condition for which a covered person received medical advice ortreatment within 12 monthsbefore the coverage effective date.This information is not intended to be a complete description of the insurance coverage available. The insurancehas exclusions and limitations which may affect any benefits payable. Applicable to policy forms GCI6000-P-EE-TXand GCI6000-P-AU-TX and certificate forms GCI6000-C-EE-TX and GCI6000-C-AU-TX. For cost and complete details ofcoverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademarkand marketing brand of Colonial Life & Accident Insurance Company. 6-20 | 387100-TXCOVERED CONDITION¹PERCENTAGE OF APPLICABLECOVERAGE AMOUNTCerebral palsy 100%Cleft lip or palate 100%Cystic fibrosis 100%Down syndrome 100%Spina bifida 100%KEY BENEFITS■ Available coverage for spouse and eligible dependent childrenat 50% of your coverage amount■ Cover your eligible dependent children at no additional cost■ Receive coverage regardless of medical history, within specified limits■ Works alongside your health savings account (HSA)■ Benefits payable regardless of other insuranceAdditional covered conditions for dependent childrenSubsequent diagnosis of a different critical illness2If you receive a benefit for a critical illness and are later diagnosed with a different critical illness, 100% of the coverage amount may be payable for that particular critical illness.Subsequent diagnosis of the same critical illness2If you receive a benefit for a critical illness and are later diagnosed with the same critical illness,325% of the coverage amount is payable for that critical illness.Reoccurrence of invasive cancer (including all breast cancer)If you receive a benefit for invasive cancer and are later diagnosed with a reoccurrence of invasive cancer, 25% of the coverage amount is payable if treatment-free for at least 12 months and incomplete remission prior to the date of reoccurrence; excludes non-invasive or skin cancer.For more information, talk with yourbenefits counselor.Preparing for the unexpected is simpler than you think. With Colonial Life, youʼll have the support you need to face lifeʼs toughest challenges.

Group Critical Illness InsuranceWellbeing Assistance BenefitThe wellbeing assistance benefit can help reduce the risk of serious illness through early detection of disease or risk factors.Wellbeing assistance benefit ......... .................................. .................. $100.00Maximum of one test per covered person per calendar year; subject to a 30-day waiting period beforethe benefit is payable. The test must be performed after the waiting period.■ Blood test for triglycerides■ Bone marrow testing■ BRCA1 or BRCA2 testing(genetic test for breast cancer)■ Breast ultrasound■ CA 15-3 (blood test for ovarian cancer)■ CA 125 (blood test for breast cancer)■ Carotid Doppler■ CEA (blood test for colon cancer)■ Chest x-ray■ Colonoscopy■ Echocardiogram (ECHO)■ Electrocardiogram (EKG, ECG)■ Fasting blood glucose test■ Flexible sigmoidoscopy■ Hemoccult stool analysis■ Mammography■ Pap smear■ PSA (blood test for prostate cancer)■ Serum cholesterol test for HDL and LDL levels■ Serum protein electrophoresis(blood test for myeloma)■ Skin cancer biopsy■ Stress test on a bicycle or treadmill■ Thermography■ ThinPrep pap test■ Virtual colonoscopyFor more information, talk with yourbenefits counselor.ColonialLife.comTHIS INSURANCE PROVIDES LIMITED BENEFITS.This information is not intended to be a complete description of the insurance coverage available. The insurance orits provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which mayaffect any benefits payable. Applicable to policy form GCI6000-P and certificate form GCI6000-C (including stateabbreviations where used, for example: GCI6000-C-TX). For cost and complete details of coverage, call or write yourColonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademarkand marketing brand of Colonial Life & Accident Insurance Company.GCI6000 – WELLBEING ASSISTANCE BENEFIT | 5-20 | 387307

Deductions per year: 24Group Accident (GAC4100) for TXApplicable to policy forms GAC4100-P,GAC4100-C Additional Benefits: Accident Hospital Benefits Preferred, Recovery Plus Package, Active Lifestyles, Wellbeing Assistance Max - $100, Building BenefitOn/Off-Job Accident CoverageBENEFIT LEVEL AD&D BENEFIT LEVEL ISSUE AGE EMPLOYEE EMPLOYEEANDSPOUSEEMPLOYEE ANDDEPENDENTCHILD(REN)EMPLOYEE, SPOUSEAND DEPENDENTCHILD(REN)Preferred Preferred 17-99 $9.52 $15.69 $19.11 $25.38Group Medical Bridge (GMB7000) for TX CompositeApplicable to Policy Forms GMB7000–P & GMB7000-CWellbeing Assistance: Standard - $100, Outpatient Surgical Procedure: Option 2 - ($750 / $1500 / $2500), Daily Hospital ConfinementHOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 4: $200017-99 $22.17 $47.13 $30.80 $55.77HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 6: $300017-99 $30.92 $65.88$42.75 $77.72Applicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDGroup Critical Illness (GCI6000) for TXPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $100 BenefitUni-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$10,000 17-24 $5.48 $8.28 $5.48 $8.2825-29 $6.43 $9.68 $6.43 $9.6830-34 $7.38 $11.13 $7.38 $11.1335-39 $9.58 $14.38 $9.58 $14.3840-44 $11.78 $17.68 $11.78 $17.6845-49 $15.28 $23.23 $15.28 $23.2350-54 $18.83 $28.73 $18.83 $28.7355-59 $23.73 $36.18 $23.73 $36.1860-64 $31.18 $47.48 $31.18 $47.4865-69 $37.48 $57.13 $37.48 $57.1370-74 $37.48 $57.13 $37.48 $57.13Hill Country Christian School Dean & DraperPage 1 of 2Underwritten by Colonial Life & Accident Insurance CompanySee page 2 for Important Notice

Group Critical Illness (GCI6000) for TXPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $100 BenefitUni-Tobacco RatesApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$20,000 17-24 $7.63 $11.38 $7.63 $11.3825-29 $9.53 $14.18 $9.53 $14.1830-34 $11.43 $17.08 $11.43 $17.0835-39 $15.83 $23.58 $15.83 $23.5840-44 $20.23 $30.18 $20.23 $30.1845-49 $27.23 $41.28 $27.23 $41.2850-54 $34.33 $52.28 $34.33 $52.2855-59 $44.13 $67.18 $44.13 $67.1860-64 $59.03 $89.78 $59.03 $89.7865-69 $71.63 $109.08 $71.63 $109.0870-74 $71.63 $109.08 $71.63 $109.08$30,000 17-24 $9.78 $14.48 $9.78 $14.4825-29 $12.63 $18.68 $12.63 $18.6830-34 $15.48 $23.03 $15.48 $23.0335-39 $22.08 $32.78 $22.08 $32.7840-44 $28.68 $42.68 $28.68 $42.6845-49 $39.18 $59.33 $39.18 $59.3350-54 $49.83 $75.83 $49.83 $75.8355-59 $64.53 $98.18 $64.53 $98.1860-64 $86.88 $132.08 $86.88 $132.0865-69 $105.78 $161.03 $105.78 $161.0370-74 $105.78 $161.03 $105.78 $161.03Important NoticeInsurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to anoutline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage maynot be available in all states. Rates provided are illustrative and your actual premium may be different depending on your particular situation and plan choices.Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand.© 2025 Colonial Life & Accident Insurance Company"Colonial Life," and the Colonial Life logo, separately and in combination, are service marks of Colonial Life & Accident Insurance Company. All rights reserved.Houston Hamilton |Hill Country Christian School Dean & Draper(Continued...)Page 2 of 2Underwritten by Colonial Life & Accident Insurance CompanySee page 2 for Important Notice

PRE-TAX AUTHORIZATION (PREMIUM ONLY PLAN – POP)How Does the Plan Work?When insurance premiums are deducted from a paycheck, the deductions are normally made after FICA and federalincome taxes are taken out. This means premiums are paid with “after tax dollars.” With this plan, the eligible premiumsare deducted before any tax or Social Security (FICA) deductions are made. The premiums are paid for with “pre-taxdollars.” The income reported on your annual W-2 form is reduced by the amount of the insurance premiums and thetaxable income is therefore lower. This is permitted under special sections of the Internal Revenue Code. Per IRSregulations, domestic partners are not recognized for tax benefit purposes. Therefore, the portion of deductions for thedomestic partner is not eligible for tax favored status.Commonly Asked QuestionsIf I Waive Coverage, Can I Enroll Later?Not until the next annual POP enrollment period. Late enrollments are not permitted under IRS regulations.When Can I Change my POP Enrollment?Within 31 days after your family status has changed. This includes marriage, divorce, birth of a child, the death of yourspouse or a dependent, your spouse’s ending or beginning employment, when you or your spouse switch from part-timeto full-time employment or full-time to part-time, or when you or your spouse take an unpaid leave of absence whichimpacts your medical, dental, and/or vision enrollment.What if I Want to Change or Discontinue my Insurance Coverage During the Year and Have Not Had a Change in Family Status?According to IRS guidelines, once you are enrolled in POP you may not change your deduction until the end of the POPplan year.As I Participate in POP, Can I Use my Medical, Dental, and/or Vision Premiums as a Deduction on my Individual Income Taxes?No. You will already have received your tax savings by participating in this plan.Can I Have Just Part of my Premium Paid Through POP?No. Only your full eligible premiums can be paid through this plan.2025-2026 Benefits Guide Page 60

IMPORTANT PATIENT PROTECTION AND AFFORDABLE CARE ACT NOTICES, ERISA NOTICES AND CONTACTS FOR MORE INFORMATIONHill Country Christian School of Austin is providing these important notices to you at no fee. The notices in this package describe important rights that you have under the terms of Hill Country Christian School of Austin Group Health Plan. If you have any questions or need additional information regarding these notices you can contact:Your Employer RepresentativeCharina Fenton 512-331-2210cfenton@hccsa.orgor by mail at 12124 RR 620 NAustin, TX 78750The following notices are included in this communication in this order:• WHCRA Notice (Women’s Health and Cancer Rights Act)• Newborns’ and Mothers’ Health Protection Act• CHIPRA Notice (Children’s Health Insurance Program Reauthorization Act)• Paperwork Reduction Act Statement• HIPAA Special Enrollment Rights Notice• Patient Protection Choice of Providers• Patient Protections Against Surprise Medical Bills• Fixed Hospital Indemnity Notice – Colonial Hospital Policy• Medicare Creditable/Non-Creditable Notices – (Provided post open enrollment by UMR)DISCLOSURES & NOTICES2025-2026 Benefits Guide Page 61

NOTICE OF RIGHTS UNDER THE WOMEN’S HEALTH AND CANCER RIGHTS ACT(WHCRA)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? Contact your Employer Representative for more information.If you have had or are going to have a mastectomy, you may be entitled to certain benefits, underthe 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 lymphedemas.These benefits will be provided subject to the same deductible and co-insurance particulars that are applicable to other medical and surgical benefits provided under this Plan. Hill Country Christian School of Austin has provided the detailed information regarding deductible and co-insurance for Hill Country Christian School of Austin Group Health Plan. For more information or to get a copy of the Summary Plan Description containing these details contact your Employer Representative.NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACTGroup 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).

Premium Assistance Under Medicaid and theChildren’s Health Insurance Program (CHIP)If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.govto find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.govor call 1-866-444-EBSA (3272).If you live in one of the following states, you may be eligible for assistance paying your employerhealth plan premiums. The following list of states is current as of March 17, 2025. Contact your State for more information on eligibility –ALABAMA – Medicaid ALASKA – MedicaidWebsite: http://myalhipp.com/Phone: 1-855-692-5447The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/Phone: 1-866-251-4861Email: CustomerService@MyAKHIPP.comMedicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspxARKANSAS – Medicaid CALIFORNIA – MedicaidWebsite: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hippPhone: 916-445-8322Fax: 916-440-5676Email: hipp@dhcs.ca.govCOLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)FLORIDA – Medicaid

Health First Colorado Website: https://www.healthfirstcolorado.com/Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711CHP+:https://hcpf.colorado.gov/child-health-plan-plusCHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program(HIBI): https://www.mycohibi.com/HIBI Customer Service: 1-855-692-6442Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.htmlPhone: 1-877-357-3268GEORGIA – Medicaid INDIANA – MedicaidGA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hippPhone: 678-564-1162, Press 1GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party-liability/childrens-health-insurance-program-reauthorization-act-2009-chipraPhone: 678-564-1162, Press 2Health Insurance Premium Payment Program All other MedicaidWebsite: https://www.in.gov/medicaid/http://www.in.gov/fssa/dfr/Family and Social Services Administration Phone: 1-800-403-0864Member Services Phone: 1-800-457-4584IOWA – Medicaid and CHIP (Hawki) KANSAS – MedicaidMedicaid Website:IowaMedicaid | Health & Human ServicesMedicaid Phone: 1-800-338-8366Hawki Website:Hawki- Healthy and Well Kids in Iowa | Health & HumanServicesHawki Phone: 1-800-257-8563HIPP Website: HealthInsurance Premium Payment (HIPP) |Health& Human Services (iowa.gov)HIPP Phone: 1-888-346-9562Website: https://www.kancare.ks.gov/Phone: 1-800-792-4884HIPP Phone: 1-800-967-4660KENTUCKY – Medicaid LOUISIANA – MedicaidKentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspxPhone: 1-855-459-6328Email: KIHIPP.PROGRAM@ky.govKCHIP Website: https://kynect.ky.govPhone: 1-877-524-4718Kentucky Medicaid Website:https://chfs.ky.gov/agencies/dmsWebsite: www.medicaid.la.gov or www.ldh.la.gov/lahippPhone: 1-888-342-6207 (Medicaid hotline) or1-855-618-5488 (LaHIPP)MAINE – Medicaid MASSACHUSETTS – Medicaid and CHIPEnrollment Website: https://www.mymaineconnection.gov/benefits/s/?language=en_USPhone: 1-800-442-6003TTY: Maine relay 711Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-formsPhone: 1-800-977-6740TTY: Maine relay 711Website: https://www.mass.gov/masshealth/paPhone: 1-800-862-4840TTY: 711Email: masspremassistance@accenture.comMINNESOTA – Medicaid MISSOURI – Medicaid

Website:https://mn.gov/dhs/health-care-coverage/Phone: 1-800-657-3672Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 573-751-2005MONTANA – Medicaid NEBRASKA – MedicaidWebsite: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084Email: HHSHIPPProgram@mt.govWebsite: http://www.ACCESSNebraska.ne.govPhone: 1-855-632-7633Lincoln: 402-473-7000Omaha: 402-595-1178NEVADA – Medicaid NEW HAMPSHIRE – MedicaidMedicaid Website: http://dhcfp.nv.govMedicaid Phone: 1-800-992-0900Website:https://www.dhhs.nh.gov/programs-services/medicaid/health-insurance-premium-programPhone: 603-271-5218Toll free number for the HIPP program: 1-800-852-3345, ext. 15218Email: DHHS.ThirdPartyLiabi@dhhs.nh.govNEW JERSEY – Medicaid and CHIP NEW YORK – MedicaidMedicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Phone: 1-800-356-1561CHIP Premium Assistance Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710 (TTY: 711)Website: https://www.health.ny.gov/health_care/medicaid/Phone: 1-800-541-2831NORTH CAROLINA – Medicaid NORTH DAKOTA – MedicaidWebsite: https://medicaid.ncdhhs.gov/Phone: 919-855-4100Website: https://www.hhs.nd.gov/healthcarePhone: 1-844-854-4825OKLAHOMA – Medicaid and CHIP OREGON – Medicaid and CHIPWebsite: http://www.insureoklahoma.orgPhone: 1-888-365-3742Website: http://healthcare.oregon.gov/Pages/index.aspxPhone: 1-800-699-9075PENNSYLVANIA – Medicaid and CHIP RHODE ISLAND – Medicaid and CHIPWebsite: https://www.pa.gov/en/services/dhs/apply-for-medicaid-health-insurance-premium-payment-program-hipp.htmlPhone: 1-800-692-7462CHIP Website: Children'sHealth Insurance Program (CHIP)(pa.gov)CHIP Phone: 1-800-986-KIDS (5437)Website: http://www.eohhs.ri.gov/Phone: 1-855-697-4347, or401-462-0311 (Direct RIte Share Line)SOUTH CAROLINA – Medicaid SOUTH DAKOTA - MedicaidWebsite: https://www.scdhhs.govPhone: 1-888-549-0820Website: http://dss.sd.govPhone: 1-888-828-0059TEXAS – Medicaid UTAH – Medicaid and CHIP

Website: Health Insurance Premium Payment (HIPP)Program| Texas Health and Human ServicesPhone: 1-800-440-0493Utah’s Premium Partnership for Health Insurance (UPP)Website: https://medicaid.utah.gov/upp/Email: upp@utah.govPhone: 1-888-222-2542Adult Expansion Website: https://medicaid.utah.gov/expansion/Utah Medicaid Buyout Program Website:https://medicaid.utah.gov/buyout-program/CHIP Website: https://chip.utah.gov/VERMONT– Medicaid VIRGINIA – Medicaid and CHIPWebsite: Health Insurance Premium Payment (HIPP) Program|Department of Vermont Health AccessPhone: 1-800-250-8427Website:https://coverva.dmas.virginia.gov/learn/premium-assistance/famis-selecthttps://coverva.dmas.virginia.gov/learn/premium-assistance/health-insurance-premium-payment-hipp-programsMedicaid/CHIP Phone: 1-800-432-5924WASHINGTON – Medicaid WEST VIRGINIA – Medicaid and CHIPWebsite: https://www.hca.wa.gov/Phone: 1-800-562-3022Website: https://dhhr.wv.gov/bms/http://mywvhipp.com/Medicaid Phone: 304-558-1700CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)WISCONSIN – Medicaid and CHIP WYOMING – MedicaidWebsite:https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htmPhone: 1-800-362-3002Website: https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/Phone: 1-800-251-1269To see if any other states have added a premium assistance program since March 17, 2025, or for more information on special enrollment rights, contact either:U.S. Department of LaborEmployee Benefits Security Administrationwww.dol.gov/agencies/ebsa1-866-444-EBSA (3272)U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov1-877-267-2323, Menu Option 4, Ext. 61565Paperwork Reduction Act StatementAccording to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to acollection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with acollection of information if the collection of information does not display a currently valid OMB control number. See44 U.S.C. 3512.The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect ofthis collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.govand reference the OMB Control Number 1210-0137.OMB Control Number 1210-0137 (expires 1/31/2026)

HIPAA SPECIAL ENROLLMENT RIGHTS NOTICEIf 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 you 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.To request special enrollment or obtain more information, contact your Employer Representative.PATIENT PROTECTION CHOICE OF PROVIDERSIn cases where Hill Country Christian School of Austin Group Health Plan allows or requires a participant to designate a primary care provider, the participant has the right to designate any primary care provider who participates in the network and who is available to accept the participant or participant’s family members.Until you make this designation, Hill Country Christian School of Austin Group Health may designate a primary care provider automatically. For information on how to select a primary care provider, and for a list of the participating primary care providers, you can contact your Employer Representative.For children, you may designate a pediatrician as the primary care provider.You do not need prior authorization from Hill Country Christian School of Austin Group Health Plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact your Employer Representative.

PATIENT PROTECTIONS AGAINST SURPRISE MEDICAL BILLSWhatis “balance billing” (sometimes called “surprise billing”)?When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other 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” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay 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 annual out-of-pocket limit.“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who isinvolved in your care – like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.You are protected from balance billing for:Emergency servicesIf you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balanced 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.There are some states that have surprise bill or balance billing laws. These laws apply to fully insured plans and may impact self-funded plans, including state or municipal government plans and church group plans. Please check with your plan administrator and/or insurance certificate/booklet to see if state law applies to your coverage.Certain services at an in-network hospital or ambulatory surgical centerWhen 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 may bill you is your plan’s in-network 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 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.When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.There are some states that have surprise bill or balance billing laws. These laws apply to fully insured plans and may impact self-funded plans, including state or municipal government plans and church group plans. Please check with your plan administrator and/or insurance certificate/booklet to see if state law applies to your coverage.When balance billing isn’t allowed, you also have the following protections:• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.• Your health plan generally must:o Cover emergency services without requiring you to get approval for services in advance (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 deductible and out-of-pocket limit.If you believe you’ve been wrongly billed, you may contact:• The US Department of Health and Human Services at: Phone: 800-985-3059Website: https://www.cms.gov/nosurprises/consumers• Your state agency, which can be found at: https://www.cms.gov/CCIIO/Resources/Consumer-Assistance-Grants

IMPORTANT: This is a fixed indemnity policy, NOT health insuranceThis fixed indemnity policy may pay you a limited dollar amount if you're sick or hospitalized. You're still responsible for paying the cost of your care.• The payment you get isn't based on the size of your medical bill.• There might be a limit on how much this policy will pay each year.• This policy isn't a substitute for comprehensive health insurance.• Since this policy isn't health insurance, it doesn't have to include most Federal consumer protections that apply to health insurance.Looking for comprehensive health insurance?• Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.• To find out if you can get health insurance through your job, or a family member's job, contact the employer.Questions about this policy?• For questions or complaints about this policy, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners' website (naic.org) under "Insurance Departments."If you have this policy through your job, or a family member's job, contact the employer.Hospital Indemnity Notice

Credible Notice Important Notice from Hill Country Christian School of Austin about Your Prescription Drug Coverage and Medicare UMR / Base, Buy-Up PPO & HDHP Plans Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage under Hill Country Christian School of Austin Sponsored Health Plan 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. Hill Country Christian School of Austin has determined that the prescription drug coverage offered 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 while you are covered under Hill Country Christian School of Austin Sponsored Health Plan, your Hill Country Christian School of Austin Sponsored Health Plan may be affected. Your employer sponsored coverage cannot be cancelled due to your Medicare enrollment (See the COBRA Note below.). Medicare and your employer sponsored coverage will coordinate benefits so that you will not receive duplicate benefits. The Medicare, Who Pays First handbook available from your Medicare representative or online https://www.medicare.gov/publications/02179-how-medicare-works-with-other-insurance.pdf, has detail on how Medicare coordinates benefits.

Credible Notice Typically, your employer sponsored coverage will pay its benefits without regard to payments that may be made by Medicare. In these cases, your employer sponsored coverage is considered ‘primary’ and Medicare is ‘secondary’ coverage. Medicare will only pay after the primary employer sponsored coverage has paid its benefits. Your Medicare coverage will have no effect on your employer sponsored coverage cost sharing such as copayments, deductibles, exclusions or other plan limits. HOWEVER, there are three instances where Medicare is primary and your employer sponsored coverage is secondary. In these cases Medicare will pay its benefits without regard to payments that may be made under the employer sponsored coverage. The employer sponsored coverage will coordinate benefits so that it does not duplicate benefits paid by Medicare. This will reduce the benefits paid by your employer sponsored coverage. These three instances are when: • your employer employs less than 20 employees • your coverage is from a former employer, a retiree plan or COBRA coverage • you are disabled and the employer sponsored coverage is due to another person working for the employer (examples when allowed – the coverage is under your spouse, your domestic partner, your dependent or grandchild), and the employer has less than 100 employees. When the employer has 100 or more employees then Medicare is secondary. Notes: 1. If you have end stage renal disease then the employer sponsored coverage is primary for the first 30 months and Medicare is primary after that 30 month period has expired.) 2. If you are enrolled in Medicare prior to electing COBRA, then your Medicare enrollment cannot be used to limit or deny COBRA. If you enroll in Medicare after you elect COBRA then the Medicare enrollment is a terminating event for your COBRA coverage. If you do decide to join a Medicare drug plan and drop your current Hill Country Christian School of Austin Sponsored Health Plan, be aware that you and your dependents will have to wait for the next Open Enrollment period, if any are offered by your Employer, or HIPAA Special Enrollment Right be able to get this coverage back. 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 coverage with Hill Country Christian School of Austin 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.

Credible Notice For More Information About This Notice Or Your Current Prescription Drug Coverage Contact the person listed below at the bottom of this Notice for further information or to receive the contact information for someone at the insurance company, third party administrator or service provider who administers the prescription drug program for Hill Country Christian School of Austin Sponsored Health Plan. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Hill Country Christian School of Austin changes. You also may request a copy of this notice at any time. For More Information About Your Options Under Medicare Prescription Drug Coverage 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 maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: July 2, 2025 Name of Entity/Sender: Charina Fenton Contact - Position/Office: Director of Human Resources Address: 12124 RR 620 N Austin, TX 78750 Phone Number: 512-331-2210

The information in this Benefits Summary is presented for illustrative purposes and is based on information providedby various carriers. The text contained in this Summary was taken from various summary plan descriptions andbenefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are alwayspossible. In case of a discrepancy between the Benefits Summary and the actual plan documents, the actual plandocuments will prevail. All information is confidential, pursuant to the Health Insurance Portability and AccountabilityAct of 1996. If you have any questions about this summary, please contact Human Resources.Presented by: