2024 Open Enrollment Guide - The HR SOURCE : simplebooklet.com

Page 3 of 49 2024 Open Enrollment Guide Home December 4, 2023 Dear Employee: It is that time of year - Open Enrollment season for the 2024 plan year is underway! We are delighted to present you with a comprehensive suite of benefits, including healthcare, travel, and entertainment options. Essential details and costs are summarized below, with additional information provided in this benefit guide. ** URGENT: Medical transition to AETNA – Action Required by 12/7/2023 ** We are making a transition to Aetna for medical coverage, offering more comprehensive and cost-effective plans. All full-time employees must elect or waive all lines of coverage by December 7, 2023. MEDICAL: You have a choice of three plans. All plans cover Preventive Care at 100%, has been expanded to include $0 cost Preventive Meds, such as Generic Birth Control and Smoking Cessation treatment. Pediatric Dental & Vision is also included for children Under Age 19. All plans have copays for specific services, not subject to the deductible and offer $0 Convenience Care at CVS Minute Clinics! NETWORKS: All 3 plans are available if you live in MD/DC/VA/DE/PA/NJ/NY/CT. If you live outside these 8 states, you can choose one of the two OAEPO plans. Providers can be found on aetna.com. To find a doctor, choose Find a doctor from the menu at the top of the site; under Guests, choose the Plan from an employer option; Enter Zip (for doctor), then choose 2024 Small Group Under 51 Employees. Maryland HMO – Silver HMO plan or MD Elect Choice Open Access (OAEPO) for Silver/Gold EPO. Aetna Silver HMO 2500 100% There are services not subject to $2500 Ind/$5000 non-single deductible including $25 Primary; $0 CVS Minute Clinic and $75 Urgent Care. Generic prescriptions are $15 (Deductible Waived); Brand name subject to medical deductible. *This plan requires you choose aprimary care provider and referralsare required to specialists. *Aetna Silver OAEPO 2500 100% There are many services not subject to the $2500 Single/$2500 non-single deductible including: $25 Primary; $0 CVS Minute Clinic, $100 Specialists and Urgent Care; $350 Imaging. $15 Generic Prescriptions. Brand name subject to medical deducible Aetna Gold OAEPO 1500 80% There are services not subject to the $1500 Single/$3000 non-single deductible including: $5 Primary; $0 CVS Minute Clinic, $50 Specialist; $75 Urgent Care. No RX Deductible: $15 Generics/$65 Brand formulary; $100 Brand Non-formulary AETNA VALUE ADDS: For those who elect medical, you will be sent an Aetna Virtual Kit after your enrollment. In addition to $0 CVS Minute Clinic visits, there is a 24-hour Nurse Hotline; Teladoc Virtual Visits for general medicine, dermatology, and mental health visits, and other discounts and programs. Once you have your card, please register on aetna.com to view these, as well as view your claims and benefits. HEALTHCARE RATES: Please see the rate sheet on page 7 showing monthly deduction amounts based on your age. The HR SOURCE will contribute $175.00 per month towards this cost. Medical costs vary under the Affordable Care Act (ACA), based on age and family demographics.

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Page 4 of 49 2024 Open Enrollment Guide Home PRE-TAX DEDUCTIONS: Medical, Dental & Vision payroll deductions are pre-taxed, so your “net” cost is less. Please advise if you do NOT want your deductions on a pre-tax basis. The stated premiums do not reflect your pre-tax savings, which are based on your income. The ability to pre-tax your premium is a major advantage to having a group health plan over individual coverage. Our health care options are summarized below. More detailed information is contained in this package. DENTAL AND VISION: Our dental benefit will remain with Delta Dental with no increase; Our vision remains with Superior Vision with no increase. Delta Dental provides 100% Preventive Care: 80% Basic and 50% Major Services, up to $1500 of benefit/calendar year. Superior Vision offers a $10 annual eye exam and discounts on contacts/lenses/frames and laser vision correction. COST PER PAY PERIOD: COST PER PAY PERIOD: Employee: Employee +1: Family: $7.21 $23.26 $35.25 Employee Employee + Children Hus & Wife Family $1.38 $3.76 $3.66 $7.69 The HR Source is pleased to offer the following VOLUNTARY BENEFITS! Ally Health/ Telemedicine | This is an extremely popular benefit giving you access to board certified doctors 24/7 by video phone or email for routine type services such as allergies, colds & flu, rashes, sinus infections, etc. Average call back time is 10 minutes, for a $0 copay. If you wish to enroll, your cost is $5/pay period. Please follow the links in the enclosed Ally Health flyer. Travel Perks | You and your family members are entitled to travel discounts and services through Company Travel Perks. There is no cost to participate. For more information see the attached flyer or visit Travel Perks.com. The password to enter the site is: hrsource. You may also contact Perfect Travel directly on 541-349-0036 Tickets At Work | Through TicketsatWork, employees can receive discounts and exclusive access to theme parks and attractions throughout the United States including, Disney World, Disney Land, SeaWorld, Six Flags and Cirque Du Soliel. TicketsatWork also offers savings on car rentals, hotels, and tours. To access this benefit, go to ticketsatwork.com and enter the password hrsource or call 800-331-6483. Discounted Movie Tickets | Regal and AMC Theaters tickets can be purchased for a discounted amount of $11. Tickets can be ordered by emailing hr@thehrsource.com. Tickets will be mailed promptly, and the cost deducted from your next paycheck. Our insurance agent will be happy to assist you with making your plan selections and assist you throughout the year with any claims or enrollment issues. Lisa Jolles can be reached now or throughout the year at 410-891-2157 or LJolles@Kellybenefits.com. I will also be available via email anytime or via phone prior to December 7th to answer any questions you may have. Please feel free to contact the office 301-459-3133 or email us at hr@thehrsource.com. As this is a remarkably busy time of year, our agent is asking those electing Aetna medical to schedule routine appointments January 10th or after. If possible, pick-up CareFirst prescriptions by December 31st. Thank you so much for your prompt attention to this request! Administrative Operations Coordinator

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Page 7 of 49 2024 Open Enrollment Guide Home Age Band Monthly Premium Age Band Monthly Premium Age Band Monthly Premium0-14 217.25 0-14 244.18 0-14 282.53 15 - 15 236.56 15 - 15 265.88 15 - 15 307.65 16 - 16 243.94 16 - 16 274.18 16 - 16 317.25 17 - 17 251.33 17 - 17 282.48 17 - 17 326.85 18 - 18 259.28 18 - 18 291.42 18 - 18 337.19 19 - 19 267.23 19 - 19 300.36 19 - 19 347.53 20 - 20 275.47 20 - 20 309.61 20 - 20 358.24 21 - 21 283.99 21 - 21 319.19 21 - 21 369.32 22 - 22 283.99 22 - 22 319.19 22 - 22 369.32 23 - 23 283.99 23 - 23 319.19 23 - 23 369.32 24 - 24 283.99 24 - 24 319.19 24 - 24 369.32 25 - 25 285.12 25 - 25 320.46 25 - 25 370.80 26 - 26 290.80 26 - 26 326.85 26 - 26 378.19 27 - 27 297.62 27 - 27 334.51 27 - 27 387.05 28 - 28 308.69 28 - 28 346.96 28 - 28 401.46 29 - 29 317.78 29 - 29 357.17 29 - 29 413.27 30 - 30 322.32 30 - 30 362.28 30 - 30 419.18 31 - 31 329.14 31 - 31 369.94 31 - 31 428.05 32 - 32 335.95 32 - 32 377.60 32 - 32 436.91 33 - 33 340.21 33 - 33 382.39 33 - 33 442.45 34 - 34 344.76 34 - 34 387.49 34 - 34 448.36 35 - 35 347.03 35 - 35 390.05 35 - 35 451.31 36 - 36 349.30 36 - 36 392.60 36 - 36 454.27 37 - 37 351.57 37 - 37 395.15 37 - 37 457.22 38 - 38 353.85 38 - 38 397.71 38 - 38 460.18 39 - 39 358.39 39 - 39 402.81 39 - 39 466.09 40 - 40 362.93 40 - 40 407.92 40 - 40 472.00 41 - 41 369.75 41 - 41 415.58 41 - 41 480.86 42 - 42 376.28 42 - 42 422.92 42 - 42 489.35 43 - 43 385.37 43 - 43 433.14 43 - 43 501.17 44 - 44 396.73 44 - 44 445.91 44 - 44 515.95 45 - 45 410.07 45 - 45 460.91 45 - 45 533.30 46 - 46 425.98 46 - 46 478.78 46 - 46 553.99 47 - 47 443.87 47 - 47 498.89 47 - 47 577.25 48 - 48 464.32 48 - 48 521.87 48 - 48 603.85 49 - 49 484.48 49 - 49 544.53 49 - 49 630.07 50 - 50 507.20 50 - 50 570.07 50 - 50 659.61 51 - 51 529.63 51 - 51 595.28 51 - 51 688.79 52 - 52 554.34 52 - 52 623.05 52 - 52 720.92 53 - 53 579.33 53 - 53 651.14 53 - 53 753.42 54 - 54 606.31 54 - 54 681.47 54 - 54 788.51 55 - 55 633.29 55 - 55 711.79 55 - 55 823.59 56 - 56 662.54 56 - 56 744.66 56 - 56 861.63 57 - 57 692.07 57 - 57 777.86 57 - 57 900.04 58 - 58 723.59 58 - 58 813.29 58 - 58 941.04 59 - 59 739.21 59 - 59 830.85 59 - 59 961.35 60 - 60 770.74 60 - 60 866.28 60 - 60 1002.35 61 - 61 798.00 61 - 61 896.92 61 - 61 1037.80 62 - 62 815.89 62 - 62 917.03 62 - 62 1061.07 63 - 63 838.32 63 - 63 942.24 63 - 63 1090.2464+ 851.67 64+ 957.24 64+ 1107.60Aetna / MD Silver HMO 2500 100% IntRXAetna / MD Silver OAEPO 2500 100%Aetna / MD Gold OAEPO 1500 80%Carrier / Plan NameCarrier / Plan NameCarrier / Plan NameAetna Medical - Monthly Premium 2024

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Page 11 of 49 2024 Open Enrollment Guide Home Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: Maryland Insurance Administration, Consumer Complaint Investigation, Life and Health/Appeals and Grievances, Phone: (410) 468-2000 or 800-492-6116, TTY: 1-800-735-2258, http://insurance.maryland.gov/Consumer. ● If your group health coverage is subject to ERISA, you may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform. ● For more information on your rights to continue coverage, contact the plan at 1-866-529-2517. ● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.

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Page 12 of 49 2024 Open Enrollment Guide Home ● If your coverage is a church plan, church plans are not covered by the Federal COBRA continuation coverage rules. If the coverage is insured, individuals should contact their State insurance regulator regarding their possible rights to continuation coverage under State law. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596. Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact: ● If your group health coverage is subject to ERISA, you may contact Aetna directly by calling the toll-free number on your Medical ID Card, or by calling our general toll free number at 1-866-529-2517. You may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform. ● Maryland Insurance Administration, Consumer Complaint Investigation, Life and Health/Appeals and Grievances, Phone: (410) 468-2000 or 800-492-6116, TTY: 1-800-735-2258, http://insurance.maryland.gov/Consumer. ● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov. ● Additionally, a consumer assistance program can help you file your appeal. Contact Maryland Office of the Attorney General Health Education and Advocacy Unit, 200 St. Paul Place, Baltimore, MD 21202-2021, 410-528-1840 or (877) 261-8807, https://www.marylandattorneygeneral.gov/Pages/contactus.aspx, heau@oag.state.md.us Does this plan provide Minimum Essential Coverage? Yes. Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit. Does this plan meet Minimum Value Standards? Yes. If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace. To see examples of how this plan might cover costs for a sample medical situation, see the next section.

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Page 17 of 49 2024 Open Enrollment Guide Home Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: Maryland Insurance Administration, Consumer Complaint Investigation, Life and Health/Appeals and Grievances, Phone: (410) 468-2000 or 800-492-6116, TTY: 1-800-735-2258, http://insurance.maryland.gov/Consumer. • If your group health coverage is subject to ERISA, you may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform. • For more information on your rights to continue coverage, contact the plan at 1-888-802-3862. • For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.

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Page 18 of 49 2024 Open Enrollment Guide Home • If your coverage is a church plan, church plans are not covered by the Federal COBRA continuation coverage rules. If the coverage is insured, individuals should contact their State insurance regulator regarding their possible rights to continuation coverage under State law. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596. Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact: • If your group health coverage is subject to ERISA, you may contact Aetna directly by calling the toll-free number on your Medical ID Card, or by calling our general toll free number at 1-888-802-3862. You may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform. • Maryland Insurance Administration, Consumer Complaint Investigation, Life and Health/Appeals and Grievances, Phone: (410) 468-2000 or 800-492-6116, TTY: 1-800-735-2258, http://insurance.maryland.gov/Consumer. • For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov. • Additionally, a consumer assistance program can help you file your appeal. Contact Maryland Office of the Attorney General Health Education and Advocacy Unit, 200 St. Paul Place, Baltimore, MD 21202-2021, 410-528-1840 or (877) 261-8807, https://www.marylandattorneygeneral.gov/Pages/contactus.aspx, heau@oag.state.md.us Does this plan provide Minimum Essential Coverage? Yes. Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit. Does this plan meet Minimum Value Standards? Yes. If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace. To see examples of how this plan might cover costs for a sample medical situation, see the next section.

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Page 23 of 49 2024 Open Enrollment Guide Home Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: Maryland Insurance Administration, Consumer Complaint Investigation, Life and Health/Appeals and Grievances, Phone: (410) 468-2000 or 800-492-6116, TTY: 1-800-735-2258, http://insurance.maryland.gov/Consumer. • If your group health coverage is subject to ERISA, you may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform. • For more information on your rights to continue coverage, contact the plan at 1-888-802-3862. • For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.

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Page 24 of 49 2024 Open Enrollment Guide Home • If your coverage is a church plan, church plans are not covered by the Federal COBRA continuation coverage rules. If the coverage is insured, individuals should contact their State insurance regulator regarding their possible rights to continuation coverage under State law. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596. Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact: • If your group health coverage is subject to ERISA, you may contact Aetna directly by calling the toll-free number on your Medical ID Card, or by calling our general toll free number at 1-888-802-3862. You may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform. • Maryland Insurance Administration, Consumer Complaint Investigation, Life and Health/Appeals and Grievances, Phone: (410) 468-2000 or 800-492-6116, TTY: 1-800-735-2258, http://insurance.maryland.gov/Consumer. • For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov. • Additionally, a consumer assistance program can help you file your appeal. Contact Maryland Office of the Attorney General Health Education and Advocacy Unit, 200 St. Paul Place, Baltimore, MD 21202-2021, 410-528-1840 or (877) 261-8807, https://www.marylandattorneygeneral.gov/Pages/contactus.aspx, heau@oag.state.md.us Does this plan provide Minimum Essential Coverage? Yes. Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit. Does this plan meet Minimum Value Standards? Yes. If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace. To see examples of how this plan might cover costs for a sample medical situation, see the next section.

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Page 26 of 49 2024 Open Enrollment Guide Home Assistive Technology Persons using assistive technology may not be able to fully access the following information. For assistance, please call 1-866-529-2517. Smartphone or Tablet To view documents from your smartphone or tablet, the free WinZip app is required. It may be available from your App Store. Non-Discrimination Aetna complies with applicable Federal civil rights laws and does not unlawfully discriminate, exclude or treat people differently based on their race, color, national origin, sex, age, disability, gender identity or sexual orientation. We provide free aids/services to people with disabilities and to people who need language assistance. If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card. If you believe we have failed to provide these services or otherwise discriminated based on a protected class noted above, you can also file a grievance with the Civil Rights Coordinator by contacting: Civil Rights Coordinator, P.O. Box 14462, Lexington, KY 40512 (CA HMO customers: P.O. Box 24030, Fresno, CA 93779), 1-800-648-7817, TTY: 711, Fax: 859-425-3379 (CA HMO customers: 860-262-7705), CRCoordinator@aetna.com. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, or at 1-800-368-1019, 800-537-7697 (TDD). Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). TTY: 711 Language Assistance: For language assistance in your language call 1-866-529-2517 at no cost.

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Page 35 of 49 2024 Open Enrollment Guide Home Annual Legal Notices for the Employees of The HR Source Contents Important Notice Regarding Your Medicare’s Prescription Drug Program HIPAA Special Enrollment Notice Notice of Availability of Notice of Privacy Practices Women’s Health and Cancer Rights Act Notice Newborns’ and Mothers’ Health Protection Act Notice Patient Protection Disclosure Medicaid and the Children’s Health Insurance Program (CHIP) Your Rights and Protections Against Surprise Medical Bills For More Information Contact: The HR Source, referred to as the “Plan Sponsor” throughout these materials Pat Hall Jaynes 8181 Professional Place, Suite 120 Hyattsville, MD 20785 Phone: 301-459-3122 For Specific Questions About a Surprise Medical Bill Contact: Aetna P.O. Box 981107 El Paso, TX 79998-1107 1-888-702-3862 www.aetna.com

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Page 36 of 49 2024 Open Enrollment Guide Home Important Notice About Your Medicare’s Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the Plan Sponsor 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. The Plan Sponsor has determined that the prescription drug coverage offered by the Company’s medical plan 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 to 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 Are My Choices? If you decide to join a Medicare drug plan, your Plan Sponsor coverage will not be affected. Before choosing whether to enroll in a Medicare prescription drug plan, 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. You could choose to: 1. Keep your medical and prescription drug coverage through the Plan Sponsor, and not enroll in a Medicare prescription drug plan yet. This choice is available to you because the prescription drug coverage that is offered to you as part of the overall package of medical benefits provided by the Plan Sponsor is “creditable”—meaning that, on average, it is at least as good as the standard Medicare prescription drug coverage. 2. Keep your medical and prescription drug coverage through the Plan Sponsor, but also enroll in a Medicare prescription drug plan now.

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Page 37 of 49 2024 Open Enrollment Guide Home Under this choice, you will be paying premiums for both the Medicare prescription drug plan you select and for medical and prescription drug coverage through Plan Sponsor. You will continue to receive medical and prescription drug coverage through Plan Sponsor. The benefits (if any) that you receive for the Medicare prescription drug plan you select will depend on the cost and type of prescription drugs that you use, the covered of the plan you choose, and the prescription drug coverage provided under Plan Sponsor’s plan. If you enroll in a Medicare prescription drug plan, you must notify the Plan Sponsor so that benefits can be coordinated with the benefits you receive through the Medicare prescription drug plan. 3. Enroll in a Medicare prescription drug plan now and drop your medical and prescription drug coverage through Plan Sponsor. Under this choice, you will have prescription drug coverage only through the Medicare prescription drug plan that you have selected. However, you will also be dropping ALL of your medical coverage through Plan Sponsor—not just the prescription drug coverage—any you may not be able to re-enroll or otherwise 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 the Plan Sponsor and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For more information… About this notice or your current prescription drug coverage: Contact the Plan Sponsor. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Plan Sponsor changes. You also may request a copy of this notice at any time. 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. 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.

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Page 39 of 49 2024 Open Enrollment Guide Home HIPAA Special Enrollment Notice After Declining Coverage If you are declining enrollment for yourself or your dependents (including your spouse) because of other medical, dental, or vision insurance coverage, you may be able to enroll yourself and your dependents in the Plan sponsor’s plan(s), if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing towards the other coverage). Example: You waived coverage under this Plan because you were covered under a plan offered by your spouse's employer. Your spouse terminates employment. If you notify your employer within 30 days of the date coverage ends, you and your eligible dependents may apply for coverage under this Plan. Marriage, Birth or Adoption 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. Example: When you were hired, you were single and chose not to elect health insurance benefits. One year later, you marry. You and your eligible dependents are entitled to enroll in this Plan. However, you must apply within 30 days from the date of your marriage. Coordination with Medicaid and CHIP If you or your dependents are covered under a state Medicaid Plan or CHIP, you may be able to enroll yourself and your dependents, if you or your dependents lose eligibility for coverage under Medicaid or CHIP. However, you must request enrollment within 60 days after the Medicaid or CHIP coverage ends. You may also request enrollment within 60 days of becoming eligible for state premium assistance under Medicaid or CHIP. Example: When you were hired, your children received health coverage under CHIP and you did not enroll them in this Plan. Because of changes in your income, your children are no longer eligible for CHIP coverage. You may enroll them in this Plan if you apply within 60 days of the date of their loss of CHIP coverage. For More Information or Assistance To request special enrollment or obtain more information, contact the Plan Sponsor. Contact information is included on the cover of this legal notice package.

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Page 41 of 49 2024 Open Enrollment Guide Home Women’s Health and Cancer Rights Act Notice If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy- related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Please refer to your enrollment guide and/or Summary of Benefits and Coverage for more information on the deductibles and coinsurance that apply under your plan. If you would like more information on WHCRA benefits, contact the Plan Sponsor.

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Page 42 of 49 2024 Open Enrollment Guide Home Newborns’ and Mothers’ Health Protection Act Notice Under federal law, employer health plans and health insurance issuers offering group health insurance coverage generally may not 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 delivery by cesarean section. However, the Plan or issuer may pay for a shorter stay if the attending provider (e.g., your physician, nurse midwife, or physician assistant), after consultation with the mother, discharges the mother or newborn earlier. Also, under federal law, plans and issuers may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay. In addition, a plan or issuer may not, under federal law, require that a physician or other health care provider obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-of-pocket costs, you may be required to obtain pre-certification. For information on pre-certification, contact your Plan Sponsor.

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Page 43 of 49 2024 Open Enrollment Guide Home Patient Protection Disclosure Designation of Primary Care Provider If your medical plan requires or allows the designation of a primary care provider, you have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For children, you may designate a pediatrician as the primary care provider. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Plan Sponsor. OB/GYN Access You do not need prior authorization from 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 the Plan Sponsor.

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Page 44 of 49 2024 Open Enrollment Guide Home Premium Assistance Under Medicaid and the Children’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.gov to 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.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2023. Contact your State for more information on eligibility – ALABAMA – Medicaid ALASKA – Medicaid Website: http://myalhipp.com/ Phone: 1-855-692-5447 The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspx ARKANSAS – Medicaid CALIFORNIA – Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447) Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hipp Phone: 916-445-8322 Fax: 916-440-5676 Email: hipp@dhcs.ca.gov

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Page 45 of 49 2024 Open Enrollment Guide Home COLORADO – 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 711 CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442 Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268 GEORGIA – Medicaid INDIANA – Medicaid GA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party-liability/childrens-health-insurance-program-reauthorization-act-2009-chipra Phone: 678-564-1162, Press 2 Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone: 1-800-457-4584 IOWA – Medicaid and CHIP (Hawki) KANSAS – Medicaid Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp HIPP Phone: 1-888-346-9562 Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 HIPP Phone: 1-800-967-4660 KENTUCKY – Medicaid LOUISIANA – Medicaid Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP) MAINE – Medicaid MASSACHUSETTS – Medicaid and CHIP Enrollment Website: https://www.mymaineconnection.gov/benefits/s/?language=en_US Phone: 1-800-442-6003 TTY: Maine relay 711 Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms Phone: 1-800-977-6740 TTY: Maine relay 711 Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711 Email: masspremassistance@accenture.com

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Page 46 of 49 2024 Open Enrollment Guide Home MINNESOTA – Medicaid MISSOURI – Medicaid Website: https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and-services/other-insurance.jsp Phone: 1-800-657-3739 Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005 MONTANA – Medicaid NEBRASKA – Medicaid Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 Email: HHSHIPPProgram@mt.gov Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178 NEVADA – Medicaid NEW HAMPSHIRE – Medicaid Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900 Website: https://www.dhhs.nh.gov/programs-services/medicaid/health-insurance-premium-program Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext. 5218 NEW JERSEY – Medicaid and CHIP NEW YORK – Medicaid Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA – Medicaid NORTH DAKOTA – Medicaid Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100 Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825 OKLAHOMA – Medicaid and CHIP OREGON – Medicaid Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075 PENNSYLVANIA – Medicaid and CHIP RHODE ISLAND – Medicaid and CHIP Website: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPP-Program.aspx Phone: 1-800-692-7462 CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov) CHIP Phone: 1-800-986-KIDS (5437) Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line) SOUTH CAROLINA – Medicaid SOUTH DAKOTA - Medicaid Website: https://www.scdhhs.gov Phone: 1-888-549-0820 Website: http://dss.sd.gov Phone: 1-888-828-0059 TEXAS – Medicaid UTAH – Medicaid and CHIP Website: Health Insurance Premium Payment (HIPP) Program | Texas Health and Human Services Phone: 1-800-440-0493 Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669

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Page 47 of 49 2024 Open Enrollment Guide Home VERMONT– Medicaid VIRGINIA – Medicaid and CHIP Website: Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health Access Phone: 1-800-250-8427 Website: https://coverva.dmas.virginia.gov/learn/premium-assistance/famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/health-insurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-800-432-5924 WASHINGTON – Medicaid WEST VIRGINIA – Medicaid and CHIP Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022 Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447) WISCONSIN – Medicaid and CHIP WYOMING – Medicaid Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002 Website: https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/ Phone: 1-800-251-1269 To see if any other states have added a premium assistance program since July 31, 2023, or for more information on special enrollment rights, contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/agencies/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565 Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection 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 a collection of information if the collection of information does not display a currently valid OMB control number. See 44 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 of this 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.gov and reference the OMB Control Number 1210-0137. OMB Control Number 1210-0137 (expires 1/31/2026)

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Page 48 of 49 2024 Open Enrollment Guide Home Your Rights and Protections Against Surprise Medical Bills 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. What is “balance billing” (sometimes called “surprise billing”)? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, 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 is involved 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 services If 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 balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. In certain circumstances, state laws governing surprise bills may also apply (or may apply instead of these rules). For more information contact the claims administrator listed on the cover of this legal notice package. Certain services at an in-network hospital or ambulatory surgical center When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers 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. Under the federal rules, 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. In certain circumstances, state laws governing surprise bills may also apply (or may apply instead of these rules). For more information contact the claims administrator listed on the cover of this legal notice package. When balance billing isn’t allowed, you also have the following protections:

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Page 49 of 49 2024 Open Enrollment Guide Home • 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 claims administrator listed on the cover of this legal notice package.