J-Kraft, Inc. English Benefit Guide 2023-2024 : simplebooklet.com

Contact Information for Benefit Vendors Health Insurance ....................................................................................................................... 5 Blue Cross Blue Shield of Texas 800-521-2227www.bcbstx.comDental Insurance .................................................................................................................... 13 Unum 888-400-9304www.unumdentalcare.comVision Insurance ...................................................................................................................... 14 Unum 855-652-8686www.EyeMedVisionCare.com/UnumLife and AD&D Insurance ....................................................................................................... 15 Unum 888-400-9304www.unum.com/myunumShort- and Long-Term Disability Insurance ............................................................................ 17 Unum 888-400-9304www.unum.com/myunumGroup Accident Insurance .................................................................................................... 19 Colonial Life 800-325-4368www.coloniallife.comHospital Indemnity Insurance ................................................................................................ 25 Colonial Life 800-325-4368www.coloniallife.comCritical Illness Insurance.......................................................................................................... 26 Colonial Life 800-325-4368www.coloniallife.comIf you have any questions regarding your benefit options or how to enroll in coverage, please contact Human Resources. Debbie Segura, Human Resources debbie@jkraftinc.com 281-876-2535 ext. 319Contacts 2

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This is why J-Kraft, Inc. is committed to a comprehensive employee benefit program that helps employees stay healthy, feel secure and maintain a work/life balance. Your family members may reap the rewards of the plans also. Eligible employees of J-Kraft, Inc. may elect Medical provided by Blue Cross Blue Shield of Texas and Dental, Vision, Voluntary Life and AD&D, Short- and Long-Term Disability Benefits that will be provided by Unum, along with Supplemental Worksite benefits with Colonial Life beginning November 1, 2023. As a J-Kraft, Inc. employee, you are provided with $15,000 in life insurance paid 100% by your employer. We encourage you to take the time to educate yourself about your options and choose the best coverage for yourself and your family. In this way, you can make the changes you want in your health and in your life. The following sections in this booklet describe some of the most important provisions of your benefits. It’s another way we’re working with you to help you get the most from your benefits, so you can live a life that’s balanced and informed, with no “surprises”. Stay Healthy • Medical, Dental, and VisionFeel Secure • J-Kraft, Inc. provides full-time employees with $15,000 of Group Life and Accidental Deathand Dismemberment (AD&D) insurance and pays the full cost of this benefit.• Voluntary Life and AD&D• Short- and Long-Term Disability• Supplemental Worksite BenefitsPlease remember to update your beneficiary information.Our employees are our most valuable asset.3

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Who is Eligible and When: An employee who regularly works thirty (30) or more hours per week will be eligible to enroll in these Benefits. If you are a new hire, you are eligible for benefits the 1st day of the month following 60 days. Your deadline to elect benefits is the 15th of the month prior to the effective date. An Eligible Dependent is a covered employee's spouse and dependent child/ren, until the end of the month in which the child/ren attains the age twenty-six (26). The term “Dependent Child” shall mean a Covered Employee’s natural born son or daughter; stepson or stepdaughter; legally adopted child (from the date of placement with the employee for the purpose of legal adoption); or a child for whom the employee is the legal guardian (coverage will remain in effect until the date the child no longer meets the age and support and maintenance requirements of an Eligible Dependent under the terms of this Plan, regardless of whether or not such child has attained age 18 (or any other applicable age of emancipation of minors) and therefore the employee is no longer considered such child’s Legal Guardian). The term “legal guardian” means a person recognized by a court of law as having the duty of taking care of the person and managing the property and rights of an individual that is placed with such person by judgment, decree, or other order of any court of competent jurisdiction. When You or Your Dependents are no Longer Eligible for Benefits: If you are an Employee, you and/or your covered dependents will be qualified beneficiaries for COBRA if you lose your coverage under the Plan if any of the following qualifying events occur: • Your hours of employment are reduced below 30 hours; or • Your employment ends for any reason other than your gross misconduct; or • Employee dies; or • Employee enrolls in Medicare benefits (under Part A, Part B, or both); or • Employee becomes divorced or legally separated; or • The child stops being eligible for coverage under the Plan as a “dependent child” Important Notice – Special Enrollment Requirements: If you are declining enrollment for yourself or your dependents (including your spouse) because you have 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. However, you must request enrollment within 30 days after you or your dependents’ other coverage ends. 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. Please contact your Human Resources department within 10 days. Failure to do so will result in no change in coverage until open enrollment. Eligibility 4

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J-Kraft, Inc. will offer four medical options through BlueCross BlueShield of Texas. Two HMO plans and two PPO plans. You’ll find that the BlueCross BlueShield of Texas health plans offer so much more than coverage for just basic medical needs. You will be able to: • Call customer service 24 hours a day, seven days a week and talk to a live representative at 1-800-521-2227 • Get prescriptions filled at one of more than 57,000 national and local pharmacies • 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-network All four plans provide coverage for medical care, including visits to your doctor’s office, hospital stays, mental health and substance abuse services, chiropractic treatment, physical therapy, and other services. For some services, you pay a deductible then a percentage of the cost (coinsurance), while for other services you pay a predetermined fee (copay) and the health plan pays the negotiated balance. Once you reach an annual limit on your payments (out-of-pocket maximum), the health plan pays your covered health care costs at 100%. If you elect either one of the two Base or Buy-Up HMO plans, you must select an in-network primary care physician to help guide and direct your care, and you will require a referral to see a specialist. If you elect the Base HMO plan, please select from the Blue Advantage network selection of licensed health professionals; there are no out of network benefits. With the Buy-Up HMO plan, you will need to select from the Blue Essentials network selection of licensed health professionals; there are no out of network benefits. If you elect either one the two Basic or Buy-UP PPO plans, you will be able to see any licensed health care processional, either in or out-of-network, but your cost will be lowest when you use a contracted BlueCross BlueShield healthcare provider. When contacting providers directly to see if they will accept your insurance plan, you will need to verify that they are in your network to ensure that you avoid any unnecessary out-of-pocket expenses. It is also recommended you present your BlueCross BlueShield Insurance ID Card at the time of service, when visiting a Provider, you have not seen before. Employees who enroll in one of the medical plan options will have additional access to physicians, by way of virtual visits. BlueCross BlueShield has partnered with MD LIVE to provide access for non-emergency medical issues. You will have access to board-certified physicians 24 hours a day, whether you’re at home, at work or traveling. Additional information on the Virtual Visit program is included in this guide. For their Pharmacy Program, BlueCross BlueShield of Texas utilizes Prime Therapeutics, LLC as their pharmacy benefit manager. Prime Therapeutics, LLC administers certain core services, such as developing and maintaining the drug formulary and contracting with pharmacy networks, which help to contain rising drug costs and maintain and improve the quality of care delivered to members. Please ensure that you’ve reviewed your plan options, and verified your physician’s availability, before making your final decision. Medical 5

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Annual Physicals and Preventive Care: One of the benefits of Health Care Reform is that when the primary purpose of your visit is for preventive care you will not have a charge. Preventive Care Physicals are covered under the group health plans at 100% so your annual physical, routine gynecological visits, and well-child exams, are free of charge if you see a contracted provider. This means no copayment, no coinsurance, and you will not have to first meet your deductible, when using an in-network provider. Important: Services will not be considered preventive and WILL NOT BE COVERED at 100% if they are part of a visit to diagnose, monitor or treat an already existing symptom, illness or injury; or if you utilize an out-of-network provider and/or facility for part of the visit or tests. If you discuss existing symptoms or issues during your preventive visit, the physician might file the claim as diagnostic services, resulting in your having out-of-pocket cost. To help you make sure that your preventive visit is covered at 100% we have provided the following tips which you may use when scheduling your next preventive care visit and/or while you are at the physician’s office. Preventive Care Tips: 1. When you schedule your appointment, explain that you are coming in for your annual preventive carephysical and that it should be covered at 100% by your insurance. Remember, not all screenings andtests are considered medically necessary, and some have age limits before they are recommended aspreventive care and covered at 100%.2. Members are allowed one preventive annual physical based on the calendar year.3. While at your visit, if you mention to your physician that you are experiencing specific symptoms orissues, the purpose of your visit could change from preventive to one for diagnosing a symptom and/orillness. You may need to schedule a separate appointment for symptoms you are already experiencingto ensure the testing during your annual physical is coded as preventive care and covered at 100%. DONOT ignore current symptoms or issues. Schedule your follow-up appointment as soon as possible.4. Confirm that your physician is in-network with the health plan.5. If the physician sends you to a separate facility to have a preventive procedure or test performed,make sure that the facility is in-network and always ask them if the procedure will be covered at 100%.Ensure that the laboratory being used for blood work is also in network with the health plan – DO NOTassume that since it is in the physician’s office that it is also in-network.Preventive Care6

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BlueCross BlueShield of Texas www.bcbstx.com Refer to Summary of Benefit Coverage for plan details. MTBAB036 Base HMO MBEE039 Buy-Up HMO Services Network Name: In-Network Only Blue Advantage HMO In-Network Only Blue Essentials Medical (In-Network) Physician Visit Copay Primary Care: Specialist: $35 PCP Required $70 Specialist Referral Required $40 PCP Required $80 Specialist Referral Required Preventative Care Covered at 100% Covered at 100% Virtual Visits with MDLIVE $0 $0 Lab Testing – Outpatient 30% after Deductible No Charge after Deductible X-Rays - Outpatient30% after Deductible No Charge after Deductible Complex Imaging 30% after Deductible No Charge after Deductible Coinsurance 70% 100% Deductible (Individual/Family) $4,000 $12,000 $5,000 $15,000 Out-of-pocket Maximum (Individual/Family) $7,900 $15,800 $7,900 $15,800 In-Patient/Out-Patient 30% after Deductible No Charge after Deductible Urgent Care Copay $75 Some services may apply to Ded+30% $75 Some services may apply to Ded Emergency Room $500 Copay + Deductible + 30% $500 Copay + Deductible Prescription Drugs Preferred Pharmacy: Non-Preferred Pharmacy: Tiers: $0/ $10/ $50/ $100/ $150/$250 $10/ $20/ $70/ $120/ $150/$250 Excludes CVS Pharmacy Tiers: $0/ $10/ $50/ $100/ $150/$250 $10/ $20/ $70/ $120/ $150/$250 Excludes CVS Pharmacy Medical Options7

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BlueCross BlueShield of Texas www.bcbstx.com Refer to Summary of Benefit Coverage for plan details. MTBCB036 Basic PPO MTBCP028 Buy-Up PPO Services Network Name: Blue Choice PPO Blue Choice PPO Medical (In-Network) Benefits Illustrated are In Network Benefits Illustrated are In Network Physician Visit Copay Primary Care: Specialist: $35 $70 $35 $70 Preventative Care Covered at 100% Covered at 100% Virtual Visits with MDLIVE $0 $0 Lab Testing - Outpatient 30% after Deductible No Charge X-Rays – Outpatient 30% after Deductible No Charge Complex Imaging 30% after Deductible 20% after Deductible Coinsurance 70% 80% Deductible (Individual/Family) $4,000 $12,000 $3,000 $9,000 Out-of-pocket Maximum (Individual/Family) $8,150 $16,300 $8,150 $16,300 In-Patient/Out-Patient 30% after Deductible 20% after Deductible Urgent Care Copay $75 Some services may apply to Ded + 30% $75 Some services may apply to Ded + 20% Emergency Room $500 Copay + Deductible + 30% $500 Copay + Deductible + 20% Prescription Drugs Preferred Pharmacy: Non-Preferred Pharmacy: Tiers: $0/ $10/ $50/ $100/ $150/$250 $10/ $20/ $70/ $120/ $150/$250 Excludes CVS Pharmacy Tiers: $0/ $10/ $50/ $100/ $150/$250 $10/ $20/ $70/ $120/ $150/$250 Excludes CVS Pharmacy Out of Network Benefits: 50% - $10,000/$20,000 Ded Out of Pocket: Unlimited 60% - $10,000 / $20,000 Ded Out of Pocket: Unlimited Medical Options 8

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9100009.1222Virtual Visits may be limited by plan. For providers licensed in New Mexico and the District of Columbia, Urgent Care service is limited to interactive online video; Behavioral Health service requires video for the initial visit but may use video or audio for follow-up visits, based on the provider’s clinical judgment. Behavioral Health is not available on all plans. MDLIVE is a separate company that operates and administers Virtual Visits for Blue Cross and Blue Shield of Texas. MDLIVE is solely responsible for its operations and for those of its contracted providers. MDLIVE® and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without permission. Blue Cross® , Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.• Call 888-680-8646• Go to MDLIVE.com/bcbstx• Text BCBSTX to 635-483 • Download the appActivate your VirtualVisits account today:First, call your doctor’s office; they may also offer telehealth consultations by phone or online video.If you have any questions about this or any other BCBSTX benefit, please call the number on the back ofyour ID card.Virtual Visits sessions with licensed behavioral health therapists are available by appointment. Get virtual care for:• Depression• Eating disorders• ADHD• Substance use disorders• Trauma and PTSD• Autism spectrum disorder• Allergies• Cold/Flu• FeverThe Virtual Visits benefit is a convenient alternative for treatment of more than 80 health conditions, including:• Headaches• Nausea• Sinus infectionsWhy Virtual Visits?• 24/7 access to an independently contracted, board-certified doctor or therapist• Access via phone, online video or mobile app from almost anywhere• Average wait time of less than20 minutes• Doctors can send e-prescriptions to your local pharmacy10

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Dental Insuran Unum dental plan provides the flexibility to visit your dentist or any licensed dentist, in or out-of-network but your costs will be lowest when you use contracted Unum providers. Anytime you want to check coverage, claim status, or get an estimate, you or your dentist can get a quick answer by phone or online. When you enroll in this benefit, you pay the full cost through payroll deductions. Refer to the additional information on the following page for details of the plan. The chart below outlines how the plan works and what types of services are covered. Unum PPO Dental Benefits At-a-Glance: www.unum.com Type of Service Passive MAC Deductible (Individual/Family) $50 / $150 Annual Max $1,500 Preventive Services 100% Basic Services 80% Major Services 50% Endodontics Covered under Basic Periodontics Covered under Basic Orthodontics Included Orthodontia Lifetime Max $1,500 Children & Adults Orthodontia Coinsurance 50% Out-of-Network Services are reimbursed from the In Network schedule Features: Carryover Benefit $700 / $350 / $1,250 Threshold Limit / Carryover Benefit / Carryover Account Limit Refer to Benefit Summary for plan details. Dental Option 13

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Unum vision plan (EyeMed Insight Network) provides the flexibility to visit your vision care provider, in or out-of-network but your costs will be lowest when you use contracted Unum providers. Anytime you want to check coverage, claim status, or get an estimate, you or your provider can get a quick answer by phone or online. When you enroll in this benefit, you pay the full cost through payroll deductions. Refer to the additional information on the following page for details of the plan. The chart below outlines how the plan works and what types of services are covered. Unum Vision Benefits At-a-Glance: www.unum.com Type of Service In-Network EyeMed Insight Network Out-of-Network Reimbursement Exam / Material Copays $10 copay / $10 copay Up to $40 Frames Up to $130 retail allowance Up to $91 Lenses (Standard per pair) Single Vision Bifocal Trifocal Lenticular Standard Progressive $10 Copay $10 Copay $10 Copay $10 Copay $75 Copay Up to $30 Up to $50 Up to $70 Up to $70 Up to $50 Contact Lenses (Elective) Contact Lenses (Medically Necessary) In lieu of eyeglass lenses Up to $130 allowance Covered at 100% Up to $130 Up to $210 Standard Contact Fitting Exam Fee Up to $40 Copay Not Covered Frequency of Services Exams /Lenses /Frames 1 per 12 months Refer to Benefit Summary for plan details. Vision Option 14

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J-Kraft Inc. provides Basic Life and Accidental Death & Dismemberment at no cost to you.Unum Basic Life and AD&D Benefits At-a-Glance:www.unum.com Employees who want to supplement their group life insurance benefits may purchase additional coverage from Unum. When you enroll yourself and/or your dependents in this benefit, you pay your premium cost through payroll deductions. Unum Voluntary Life and AD&D Benefits At-a-Glance: www.unum.com Refer to Benefit Summary for plan details. Benefit Description Basic Life & AD&D Benefit Amount $15,000 AD&D Coverage $15,000 Accelerated Death Benefit Yes Travel Assistance Yes Bereavement Counseling Yes Age Reduction: Coverage amounts will reduce to: 65% of original amount when you reach age 65 40% of original amount when you reach age 70 20% of original amount when you reach age 75 Coverage cannot be increased after reduction Retirement Terminates Benefit Description Voluntary Term Life & AD&D Benefit Amount Employee $10,000 - $150,000, not to exceed 5x salary Spouse $5,000 - $150,000, not to exceed 100% of Employee Children $1,000 - 14 days to 6 mo. Old $10,000 - 6 mo. to 26 yrs. Guarantee Issue Amount: Employee $150,000 Spouse $50,000 Child(ren) $10,000 Age Reduction Coverage amounts will reduce to: 65% of original amount when you reach age 65 40% of original amount when you reach age 70 20% of original amount when you reach age 75 Coverage cannot be increased after reduction AD&D Coverage Yes Accelerated Death Benefit Yes Retirement Terminates Basic and Voluntary Life and AD&D 15

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Find clarity and comfort during trying timesLife planning nancial & legal resourcesWhen a loved one is terminally ill, or passes away, you may need help with the personal, financial and legal decisions that need to be made. Support is always available when you are protected by Unum Group Life Insurance.Life Planning Financial & Legal Resources will be thereWith Unum group life coverage, you have automatic access to Life Planning Financial & Legal Resources. This service is included in the cost of your insurance plan for employees, spouses and beneficiaries who need help during a terminal illness, or after the loss of a covered employee.Caring consultants can provide the assistance you needWhen a life claim is submitted and approved, a specially trained consultant will reach out to the employee or beneficiary to provide support. Each consultant holds a Master’s degree in the mental health field, and is highly skilled at assisting those who need help dealing with the emotional challenges of a terminal illness or the loss of a loved one.Life Planning consultants are also able to provide financial and legal support regarding estate settlement, Social Security, cash flow, taxes and investment planning. They can help you develop a customized financial plan to preserve your quality of life, protect resources and build future security.These consultants are available to assist you in your time of need, and their services are designed to coordinate with the efforts of a family attorney, accountant, or broker. Their services are strictly confidential, and they do not work on commission and will not try to sell any product or service.You may have questions like these: • There’s so much paperwork. Where do I begin? • Do I need to pay outstanding bills? • How should I manage retirement accounts? • How should I invest the insurance money? • What do I do with the will? • Do I need to le probate?Answers to these questions and more are available at no charge as part of your life insurance coverage from Unum.Assistance is only a call or click awayTo speak with a Life Planning consultant you can contact: • Call 1-800-422-5142 (multilingual) • Visit members.healthadvocate.com (Enter Unum — Life Planning)16

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Disability programs are designed to replace part of your salary if illness or injury prevents you from working for a period of time. When you enroll in this benefit, you pay the full cost through payroll deductions. Without disability coverage, you and your family may struggle to get by if you miss work due to an injury or illness. In the event that you become disabled from a non-work-related injury or sickness, disability income benefits will provide a partial replacement of lost income benefit. Short and Long-Term Disability Insurance is based on individual rates and salary. Unum Disability Benefits At-a-Glance: www.unum.com Refer to Benefit Summary for plan details. Age Band Short-Term Disability Rates per $10 of Weekly Benefit Long-Term Disability Rates per $100 of Monthly Benefit <25 $0.710 $0.190 25-29 $0.780 $0.300 30-34 $0.810 $0.540 35-39 $0.700 $0.870 40-44 $0.710 $1.490 45-49 $0.850 $1.950 50-54 $1.170 $2.750 55-59 $1.390 $3.550 60-64 $1.540 $2.740 65-69 $1.910 $1.840 70+ $1.910 $1.340 Voluntary Short-Term Disability Long-Term Disability Benefits Begin 8th day Injury / 8th day Sickness 90 days Benefits Payable 12 Weeks Social Security Normal Retirement Age (SSNRA) Percentage of Income Replaced 60% of your weekly covered basic pay 60% of your monthly covered basic pay Maximum Benefit $1,250 $7,500 Pre – Existing 3/12 3/12 Disability 17

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For more information, talk with your benefits counselor.Group Accident InsuranceBasic PlanColonialLife.comGAC4000 – BASIC PLANNobody expects an accident to happen. But if it does, your main focus should be on recovery, not how you’re going to pay your bills. Colonial Life accident insurance provides benefits directly to you to use however you like – from medical costs to everyday expenses. Whether it's a fall or a car accident, your benefits oer support when you need it. Benefits are per covered person per covered accident unless stated otherwiseAccident emergency treatment ................................................................................................ $100 One visit per covered person per covered accident and Up to four visits per covered person per calendar yearAccident follow-up doctor visit ..................................................................................................$50Up to three visits per covered person per covered accident andUp to 12 visits per covered person per calendar yearAccidental death Accidental deathPer covered person Accidental death common carrier¾ Named insured .....................................................................$25,000 .................. $100,000¾ Spouse ...............................................................................$25,000 .................. $100,000¾ Dependent child(ren) ............................................................... $5,000 ....................$20,000Examples of common carriers are mass transit trains, buses and planesAccidental dismembermentLoss or loss of use¾ One hand, arm, foot, leg or sight of an eye ......................................................................... $7,500¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination ................................ $15,000¾ One finger or one toe ................................................................................................... $1,050¾ Two or more fingers; two or more toes; or any combination ................................................... $2,100Air ambulance .................................................................................................................. $1,000 Transportation to or from a hospital or medical facilityAmbulance (ground).............................................................................................................. $200 Transportation to or from a hospital or medical facilityAppliance aid in personal locomotion or mobility ...........................................................................$75Walking boot, neck brace, back brace, leg brace, cane, crutches, walker and wheelchairBlood/plasma/platelets ......................................................................................................... $300 Required during treatment of a covered accidentBurn¾ 2nd-degree burns (covering at least 36% of the body’s surface) .................................................... $750¾ 3rd-degree burns (based on size) ......................................................................... $1,500 – $12,000Burn–skin gra ................................................................................... 50% of applicable burn benefitAs a result of 2nd-degree or 3rd-degree burns 19

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Catastrophic accidentTotal and irrecoverable loss or loss of use¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination; or¾ Loss of hearing in both ears or loss of ability to speak Subject to a 365-day elimination period; payable once per lifetime per covered person¾ Named insured ..................................................................................................................................................$50,000¾ Spouse ..................................................................................................................................................................$50,000 ¾ Dependent child(ren) .......................................................................................................................................$25,000Coma ................................................................................................................ $7,500Lasting for 14 or more consecutive daysConcussion ............................................................................................................ $275Dislocation (separated joint) Non-surgical Surgical¾ Hip ........................................................................................$2,000 $4,000¾ Knee (except patella) ..................................................................$1,000 $2,000¾ Ankle, bone or bones of the foot (other than toes) .................................$960 $1,920¾ Collarbone (sternoclavicular) ..........................................................$500 $1,000¾ Collarbone (acromioclavicular and separation) ....................................$140 $280¾ Lower jaw ..................................................................................$450 $900¾ Shoulder (glenohumeral) ...............................................................$750 $1,500¾ Elbow ....................................................................................... $330 $660¾ Wrist ........................................................................................$390 $780¾ Bone(s) of the hand, (other than fingers) ............................................. $540 $1,080¾ Finger, toe ..................................................................................$140 $280¾ Incomplete dislocation or dislocation reduction.................................. 25% of the applicable without anesthesia non-surgical amountEmergency dental work ¾ Dental crown or denture ....................................................................................$150 ¾ Dental extraction .............................................................................................. $50 Eye injury ..............................................................................................................$200 With surgical repair or removal of a foreign objectFracture (broken bone) Non-surgical Surgical¾ Skull, depressed fracture (except face/nose) ......................................$2,250 $4,500¾ Skull, simple non-depressed fracture (except face/nose) .......................$1,200 $2,400¾ Hip, thigh (femur) ......................................................................$2,100 $4,200¾ Body of vertebrae (excluding vertebral processes) ...............................$1,800 $3,600¾ Pelvis .....................................................................................$1,650 $3,300¾ Leg (tibia and/or fibula) ...............................................................$1,200 $2,400¾ Bones of the face or nose (except mandible or maxilla) ...........................$700 $1,400¾ Upper jaw, maxilla, upper arm between .............................................$700 $1,400 elbow and shoulder¾ Lower jaw, mandible ....................................................................$720 $1,440¾ Kneecap, ankle, foot .................................................................. $1,020 $2,040¾ Shoulder blade, collarbone ............................................................$810 $1,620¾ Vertebral processes ...................................................................... $450 $900¾ Forearm, hand, wrist ................................................................. $1,020 $2,040¾ Rib ..........................................................................................$225 $450¾ Coccyx .....................................................................................$240 $480¾ Finger, toe .................................................................................$200 $400¾ Chip fracture .................................................25% of the applicable non-surgical amountAlex was cleaning out the gutters when he fell. ALEX’S BENEFITS Ambulance $200Emergency room visit $100X-ray $50Hospital admission $750Hospital confinement $525Leg fracture (surgical) $2,400Physical therapy $280Appliance (crutches) $75Doctor’s follow-up oice visit $150$4,530EMERGENCY ROOM VISITAlex was taken by ambulance to the nearest emergency room and received immediate care.The doctor ordered an X-ray and discovered Alex had fractured his leg.DIAGNOSTIC PROCEDUREOver the next several weeks, he had three follow-up appointments with his doctor.DOCTORʼS OFFICE VISITAlex had eight sessions of physical therapy to help him regain the strength in his leg.PHYSICAL THERAPYAlex was admitted to the hospital for surgery on his leg. He was confined for three days.HOSPITAL CONFINEMENTFor illustrative purposes only.Benefit amounts may vary and may not cover all expenses. The certificate has exclusions and limitations.ALEXʼS OUT-OF-POCKET EXPENSESWhen Alex totaled up the bills, he had to pay his annual deductible, as well as co-payments for the ambulance, emergency room, hospital, surgery, physical therapy and follow-up visits. Luckily, Alex had accident coverage to help with these expenses.Alex used crutches.APPLIANCE FOR MOBILITY20

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For more information, talk with your benefits counselor.GAC4000 – BASIC PLANHospital admission ............................................................................................................... $750Per covered person per covered accidentHospital confinement .................................................................................................. $175 per dayUp to 365 days per covered person per covered accidentHospital intensive care unit admission .................................................................................... $1,500 Per covered person per covered accidentHospital intensive care unit confinement......................................................................... $300 per day Up to 15 days per covered person per covered accident Knee cartilage (torn)..............................................................................................................$500 Laceration (no repair, without stitches) ..........................................................................................$50 Laceration (repaired by stitches)¾ Total of all lacerations is less than two inches long .....................................................................$75¾ Total of all lacerations is at least two but less than six inches long ................................................. $300 ¾ Total of all lacerations is six inches or longer ........................................................................... $600 Lodging (companion) ..................................................................................................$150 per day Up to 30 days per covered person per covered accident Medical imaging study (CT, CAT scan, EEG, MR or MRI) ..................................................................... $150 One benefit per covered person per covered accident per calendar yearOccupational or physical therapy ....................................................................................$35 per day Up to 10 days per covered person per covered accident Pain management for epidural anesthesia ....................................................................................$50 Prosthetic device/artificial limb One benefit per covered person per covered accident¾ One .......................................................................................................................... $750 ¾ More than one ........................................................................................................... $1,500 Rehabilitation unit confinement ....................................................................................$100 per day Immediately aer a period of hospital confinement due to a covered accident; up to 15 days per covered person per covered accident, not to exceed 30 days per covered person per calendar yearRuptured disc with surgical repair ............................................................................................ $600 Surgery¾ Cranial, open abdominal and thoracic .............................................................................. $1,000 ¾ Hernia with surgical repair ............................................................................................... $250Surgery (exploratory and arthroscopic) ....................................................................................... $150Tendon/ligament/rotator cu¾ One with surgical repair .................................................................................................. $600 ¾ Two or more with surgical repair ..................................................................................... $1,200 Transportation for hospital confinement ...................................................................$400 per round tripUp to three round trips for more than 50 miles from home per covered person per covered accidentX-ray ...................................................................................................................................$50 21

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For more information, talk with your benefits counselor.Group Accident InsurancePremier PlanColonialLife.comGAC4000 – PREMIER PLANGroup accident insurance can help with medical or other costs associated with a covered accident or injury that your health insurance may not cover. With this coverage you may not need to use your savings or secure a loan to help pay those unexpected out-of-pocket expenses. Coverage options are available for you, your spouse and eligible dependent children. Benefits are per covered person per covered accident unless stated otherwiseAccident emergency treatment ................................................................................................ $200 One visit per covered person per covered accident and Up to four visits per covered person per calendar yearAccident follow-up doctor visit ..................................................................................................$50Up to six visits per covered person per covered accident andUp to 24 visits per covered person per calendar yearAccidental death Accidental deathPer covered person Accidental death common carrier¾ Named insured .....................................................................$50,000 .................. $200,000¾ Spouse ...............................................................................$50,000 .................. $200,000¾ Dependent child(ren) .............................................................. $10,000 ....................$40,000Examples of common carriers are mass transit trains, buses and planesAccidental dismembermentLoss or loss of use¾ One hand, arm, foot, leg or sight of an eye ........................................................................ $15,000¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination ................................ $30,000¾ One finger or one toe ................................................................................................... $1,500¾ Two or more fingers; two or more toes; or any combination ................................................... $3,000Air ambulance .................................................................................................................. $2,000 Transportation to or from a hospital or medical facilityAmbulance (ground).............................................................................................................. $400 Transportation to or from a hospital or medical facilityAppliance aid in personal locomotion or mobility ......................................................................... $200Walking boot, neck brace, back brace, leg brace, cane, crutches, walker and wheelchairBlood/plasma/platelets ......................................................................................................... $500 Required during treatment of a covered accidentBurn¾ 2nd-degree burns (covering at least 36% of the body’s surface) ..................................................$1,500¾ 3rd-degree burns (based on size) ......................................................................... $3,000 – $21,000Burn–skin gra ................................................................................... 50% of applicable burn benefitAs a result of 2nd-degree or 3rd-degree burns 22

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Catastrophic accidentTotal and irrecoverable loss or loss of use¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination; or¾ Loss of hearing in both ears or loss of ability to speak Subject to a 365-day elimination period; payable once per lifetime per covered person¾ Named insured ............................................................................................................................................... $100,000¾ Spouse ............................................................................................................................................................... $100,000 ¾ Dependent child(ren) .......................................................................................................................................$50,000Coma ...............................................................................................................$20,000Lasting for 14 or more consecutive daysConcussion ............................................................................................................ $500Dislocation (separated joint) Non-surgical Surgical¾ Hip ........................................................................................$4,000 $8,000¾ Knee (except patella) ..................................................................$2,000 $4,000¾ Ankle, bone or bones of the foot (other than toes) ...............................$1,600 $3,200¾ Collarbone (sternoclavicular) ........................................................$1,100 $2,200¾ Collarbone (acromioclavicular and separation) ....................................$280 $560¾ Lower jaw ..................................................................................$990 $1,980¾ Shoulder (glenohumeral) ............................................................ $1,200 $2,400¾ Elbow ....................................................................................... $600 $1,200¾ Wrist ........................................................................................$750 $1,500¾ Bone(s) of the hand, (other than fingers) ...........................................$1,050 $2,100¾ Finger, toe ..................................................................................$260 $520¾ Incomplete dislocation or dislocation reduction.................................. 25% of the applicable without anesthesia non-surgical amountEmergency dental work ¾ Dental crown or denture ....................................................................................$600¾ Dental extraction .............................................................................................$200Eye injury ..............................................................................................................$400 With surgical repair or removal of a foreign objectFracture (broken bone) Non-surgical Surgical¾ Skull, depressed fracture (except face/nose) ......................................$5,000 $10,000¾ Skull, simple non-depressed fracture (except face/nose) .......................$2,400 $4,800¾ Hip, thigh (femur) ......................................................................$4,200 $8,400¾ Body of vertebrae (excluding vertebral processes) ...............................$3,600 $7,200¾ Pelvis .....................................................................................$3,225 $6,450¾ Leg (tibia and/or fibula) ...............................................................$2,400 $4,800¾ Bones of the face or nose (except mandible or maxilla) ........................ $1,295 $2,590¾ Upper jaw, maxilla, upper arm between .......................................... $1,400 $2,800 elbow and shoulder¾ Lower jaw, mandible ................................................................. $1,200 $2,400¾ Kneecap, ankle, foot .................................................................. $1,200 $2,400¾ Shoulder blade, collarbone ......................................................... $1,200 $2,400¾ Vertebral processes ...................................................................... $810 $1,620¾ Forearm, hand, wrist ................................................................. $1,200 $2,400¾ Rib ..........................................................................................$500 $1,000¾ Coccyx .....................................................................................$420 $840¾ Finger, toe .................................................................................$200 $400¾ Chip fracture .................................................25% of the applicable non-surgical amountAlex was cleaning out the gutters when he fell. ALEX’S BENEFITS Ambulance $400Emergency room visit $200X-ray $60Hospital admission $1,500Hospital confinement $1,050Leg fracture (surgical) $4,800Physical therapy $440Appliance (crutches) $200Doctor’s follow-up oice visit $150$8,800EMERGENCY ROOM VISITAlex was taken by ambulance to the nearest emergency room and received immediate care.The doctor ordered an X-ray and discovered Alex had fractured his leg.DIAGNOSTIC PROCEDUREOver the next several weeks, he had three follow-up appointments with his doctor.DOCTORʼS OFFICE VISITAlex had eight sessions of PT to help him regain the strength in his leg.PHYSICAL THERAPYAlex was admitted to the hospital for surgery on his leg. He was confined for three days.HOSPITAL CONFINEMENTFor illustrative purposes only.Benefit amounts may vary and may not cover all expenses. The certificate has exclusions and limitations.ALEXʼS OUT-OF-POCKET EXPENSESWhen Alex totaled up the bills, he had to pay his annual deductible, as well as co-payments for the ambulance, emergency room, hospital, surgery, physical therapy and follow-up visits. Luckily, Alex had accident coverage to help with these expenses.Alex used crutches.APPLIANCE FOR MOBILITY23

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For more information, talk with your benefits counselor.GAC4000 – PREMIER PLANHospital admission .............................................................................................................$1,500Per covered person per covered accidentHospital confinement .................................................................................................. $350 per dayUp to 365 days per covered person per covered accidentHospital intensive care unit admission .................................................................................... $2,500 Per covered person per covered accidentHospital intensive care unit confinement ........................................................................ $600 per day Up to 15 days per covered person per covered accident Knee cartilage (torn) .......................................................................................................... $1,250 Laceration (no repair, without stitches) ..........................................................................................$75Laceration (repaired by stitches)¾ Total of all lacerations is less than two inches long ................................................................... $150¾ Total of all lacerations is at least two but less than six inches long ................................................. $600¾ Total of all lacerations is six inches or longer ........................................................................ $1,200 Lodging (companion) ..................................................................................................$250 per day Up to 30 days per covered person per covered accident Medical imaging study (CT, CAT scan, EEG, MR or MRI) ..................................................................... $400One benefit per covered person per covered accident per calendar yearOccupational or physical therapy ....................................................................................$55 per day Up to 10 days per covered person per covered accident Pain management for epidural anesthesia .................................................................................. $150 Prosthetic device/artificial limb One benefit per covered person per covered accident¾ One ........................................................................................................................$1,750 ¾ More than one ........................................................................................................... $3,500 Rehabilitation unit confinement ....................................................................................$200 per day Immediately aer a period of hospital confinement due to a covered accident; up to 15 days per covered person per covered accident, not to exceed 30 days per covered person per calendar yearRuptured disc with surgical repair ......................................................................................... $1,200 Surgery¾ Cranial, open abdominal and thoracic .............................................................................. $2,000 ¾ Hernia with surgical repair ............................................................................................... $400Surgery (exploratory and arthroscopic) ....................................................................................... $275Tendon/ligament/rotator cu¾ One with surgical repair ............................................................................................... $1,200¾ Two or more with surgical repair ..................................................................................... $2,400 Transportation for hospital confinement ...................................................................$700 per round tripUp to three round trips for more than 50 miles from home per covered person per covered accidentX-ray ...................................................................................................................................$60 24

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For more information, talk with your benefits counselor.ColonialLife.comGroup Hospital Indemnity InsurancePlan 1 (HSA-Compliant)PA: “Hospital Confinement Admission” benefit replaces the “Hospital Confinement” benefitTHIS INSURANCE PROVIDES LIMITED BENEFITS.Insureds in California must be covered by comprehensive health insurance before applying for Hospital Confinement Indemnity Insurance.EXCLUSIONSWe will not pay any benefits for injuries received in accidents or for sicknesses which are caused by, contributed to by or occur as a result of the following exclusions and limitations. (a) alcoholism or drug addiction; (b) dental procedures; (c) elective procedures and cosmetic surgery; (d) felonies or illegal occupations; (e) mental or nervous disorders; (f) pregnancy of a dependent child; (g) suicide or injuries which any covered person intentionally does to himself or herself; or (h) war. We will not pay benefits for hospital confinement (i) due to giving birth within the first nine months aer the eective date of the policy or (j) for a newborn who is neither injured nor sick. (k) The policy may have additional exclusions and limitations which may aect any benefits payable.PRE-EXISTING CONDITION LIMITATIONS(l) We will not pay benefits for loss during the first 12 months aer the certificate eective date due to a pre-existing condition.(m) A pre-existing condition is a sickness or physical condition, whether diagnosed or not, for which a covered person was treated, had medical testing, received medical advice or had taken medication within the 12 months before the certificateeective date. (n) This limitation applies to the following benefits, if applicable: Hospital Confinement, Daily Hospital Confinement, Inpatient Mental and Nervous, Rehabilitation Unit Confinement and Specified Critical Illness.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 aect any benefits payable. Applicable to policy formGMB7000-P and certificate form GMB7000-C (including state abbreviations where applicable, such as policy forms GMB7000-P-AU-TX and GMB7000-P-EE-TX, and certificate forms GMB7000-C-AU-TX and GMB7000-C-EE-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company. This form is not complete without form #101733.GMB7000 – PLAN 1 | 6-21 | 101917-2Group Medical BridgeTM insurance 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 aer 30 continuous days of a covered confinement of the named insured Daily hospital confinement .................................................................... $100 per dayMaximum of 365 days per covered person per confinement. Re-confinement for the same or related condition within 90 days of discharge is considered a continuation of a previous confinement.Health savings account (HSA) compatibleThis plan is compatible with HSA guidelines and any other HSA plan that a covered family member may participate in. It may also be oered to employees who do not have HSAs.Colonial Life & Accident Insurance Company’s Group Medical Bridge oers an HSA-compatible plan in most states.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.25

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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 APPLICABLE COVERAGE 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 arrest 100%Coronary artery disease25%COVERED CANCER CONDITION¹PERCENTAGE OF APPLICABLE COVERAGE AMOUNTInvasive cancer (including all breast cancer)100%Non-invasive cancer25%Skin cancer initial diagnosis ............................................................ $400 per lifetimeCritical illness and cancer benefitsSpecial needs daycareA hospital stay and treatment for corrective heart surgeryPhysical therapy to build muscle strengthFor illustrative purposes only.Preparing for a lifelong journeyRebecca was born with Down syndrome. Her parents’ critical illness coverage provided a benefit that can help cover expenses related to Rebecca’s care and her changing needs. HOW THEIR COVERAGE HELPEDThe lump-sum amount from the family coverage benefit helped pay for:26

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ColonialLife.com6-20 | 387100-TX1. 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 ILLNESS We will not pay the Critical Illness Benefit, Benefits Payable Upon Subsequent Diagnosis of a Critical Illness or Additional Critical Illness Benefit for Dependent Children that occurs as a result of a covered person’s: doctor or physician relationship; felonies or illegal occupations; intoxicants and narcotics; suicide or injuring oneself intentionally, whether sane or not; war or armed conflict; or pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a critical illness.EXCLUSIONS AND LIMITATIONS FOR CANCER We will not pay the Invasive Cancer (including all Breast Cancer) Benefit, Non-Invasive Cancer Benefit, Benefit Payable Upon Reoccurrence of Invasive Cancer (including all Breast Cancer) or Skin Cancer Initial Diagnosis Benefit for a covered person’s invasive cancer or non-invasive cancer that: is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexico; is a pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is initially diagnosed as having invasive or non-invasive cancer. No pre-existing condition limitation will be 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 LIMITATION We will not pay a benefit for a pre-existing condition that occurs during the 12-month period aer the coverage eective date. Pre-existing condition means a sickness or physical condition for which a covered person received medical advice or treatment within 12 months before the coverage eective date.This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy forms GCI6000-P-EE-TX and GCI6000-P-AU-TX and certificate forms GCI6000-C-EE-TX and GCI6000-C-AU-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.©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.COVERED CONDITION¹PERCENTAGE OF APPLICABLE COVERAGE AMOUNTCerebral palsy 100%Cle lip or palate 100%Cystic fibrosis 100%Down syndrome 100%Spina bifida 100%KEY BENEFITSAdditional covered conditions for dependent childrenSubsequent diagnosis of a dierent critical illness2If you receive a benefit for a critical illness and are later diagnosed with a dierent 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,3 25% 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 in complete remission prior to the date of reoccurrence; excludes non-invasive or skin cancer.For more information, talk with your benefits counselor.Preparing for the unexpected is simpler than you think. With Colonial Life, youʼll have the support you need to face lifeʼs toughest challenges. Available coverage forspouse and eligibledependent childrenat 50% of yourcoverage amount Cover your eligibledependent children atno additional cost Receive coverageregardless of medicalhistory, withinspecified limits Works alongsideyour health savingsaccount (HSA) Benefits payableregardless of otherinsurance27

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Getting startedThe easiest way to manage your business with us is through ColonialLife.com. To sign up for the website, click Register at the top right of the home page and follow the instructions. Consider your optionsAt Colonial Life, our goal is to give you an excellent customer experience that is simple, modern and personal. For your convenience, you can choose how you interact with us. For the quickest service, we recommend using our website, which lets you do the following:  Review, print or download a copy of your policy/certificate by clicking on the My Correspondence tab.  Update contact information or add family member profile information for use when filing online claims.  Access service forms to make changes to your policy, such as a beneficiary change.  Submit your claim using our eClaims system.  Check the status of your claim and view claims correspondence.  Access claim forms.Policyholder Service GuideeClaims are quick and easyWith the eClaims feature on ColonialLife.com, you can file most claims online by simply answering a few questions and uploading your supporting documentation. You’re able to spend less time on paperwork, and we’re able to process your claim faster.  From Colonial Life.com, file claims from any device. It’s fast, easyand available 24/7.  Select direct deposit to receive your benefit payment faster.  Easily submit additional documents.Paper claims  If you don’t want to file online, download the form you need by visiting the Claims Center page on ColonialLife.com and clicking on claim andservice forms.  You may fax your claim to 1-800-880-9325.  Follow the instructions, tips and videos to complete and submit your claim.ColonialLife.comContact us Online ColonialLife.com Log in and click on Contact UsTelephone 1-800-325-4368Hearing-impaired customers 803-798-4040If you do not have a TDD, call Voiance Telephone Interpretation Services. 844-495-61058-17 | 43233-39Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.32

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Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitUni-Tobacco RatesATTAINEDAGENAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$10,000 17-24 $1.95 $3.00$1.95$3.0025-29 $2.10 $3.25$2.10$3.2530-34 $2.35 $3.60$2.35 $3.6035-39 $3.30 $5.00$3.30 $5.0040-44 $4.40 $6.65$4.40 $6.6545-49 $6.05 $9.10 $6.05 $9.1050-54 $7.95$12.00 $7.95 $12.0055-59 $10.75 $16.15$10.75$16.1560-64 $14.25 $21.45$14.25 $21.4565-69 $17.75 $26.70$17.75 $26.7070-74 $22.45 $35.75$22.45 $35.75$20,000 17-24 $2.45 $3.75$2.45$3.7525-29 $2.75 $4.25$2.75 $4.2530-34 $3.25$4.95 $3.25 $4.9535-39 $5.15 $7.75 $5.15 $7.7540-44 $7.35 $11.05$7.35 $11.0545-49 $10.65 $15.95$10.65 $15.9550-54 $14.45 $21.75$14.45 $21.7555-59 $20.05$30.05 $20.05 $30.0560-64 $27.05 $40.60$27.05 $40.6065-69 $34.05 $51.15$34.05 $51.1570-74 $43.45 $65.25$43.45 $65.25$30,000 17-24 $2.95 $4.50$2.95 $4.5025-29$3.40$5.25$3.40 $5.2530-34 $4.15 $6.30$4.15 $6.3035-39 $7.00 $10.50 $7.00 $10.5040-44$10.30 $15.45 $10.30 $15.4545-49$15.25 $22.80 $15.25 $22.8050-54$20.95 $31.50 $20.95 $31.5055-59$29.35 $43.95 $29.35 $43.9560-64$39.85 $59.85 $39.85 $59.8565-69$50.35 $75.60 $50.35 $75.6070-74$64.45 $96.75 $64.45 $96.75Important 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.© 2023 Colonial Life & Accident Insurance CompanyJ-Kraft, IncSemi-Monthly Rate Table(Continued...)Underwritten by Colonial Life & Accident Insurance CompanySee page 2 for Important Notice 30

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Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitUni-Tobacco RatesATTAINEDAGENAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$10,000 17-24 $1.80 $2.77$1.80 $2.7725-29 $1.94 $3.00$1.94 $3.0030-34 $2.17 $3.32$2.17 $3.3235-39 $3.05 $4.62$3.05 $4.6240-44 $4.06 $6.14$4.06 $6.1445-49 $5.58 $8.40 $5.58 $8.4050-54 $7.34 $11.08$7.34 $11.0855-59 $9.92 $14.91 $9.92 $14.9160-64 $13.15 $19.80$13.15 $19.8065-69 $16.38 $24.65$16.38 $24.6570-74 $20.72 $31.15$20.72 $31.15$20,000 17-24 $2.26 $3.46$2.26 $3.4625-29 $2.54 $3.92$2.54 $3.9230-34 $3.00 $4.57$3.00 $4.5735-39 $4.75 $7.15$4.75 $7.1540-44 $6.78 $10.20$6.78 $10.2045-49 $9.83$14.72 $9.83 $14.7250-54 $13.34 $20.08$13.34 $20.0855-59 $18.51 $27.74$18.51 $27.7460-64 $24.97 $37.52$24.97 $37.5265-69 $31.43$47.22 $31.43 $47.2270-74 $40.11 $60.23$40.11 $60.23$30,000 17-24 $2.72 $4.15$2.72 $4.1525-29 $3.14 $4.85$3.14 $4.8530-34 $3.83 $5.82$3.83 $5.8235-39 $6.46 $9.69 $6.46 $9.6940-44 $9.51$14.26 $9.51 $14.2645-49 $14.08 $21.05$14.08 $21.0550-54 $19.34 $29.08$19.34 $29.0855-59 $27.09 $40.57$27.09 $40.5760-64 $36.78 $55.25$36.78 $55.2565-69 $46.48 $69.78$46.48 $69.7870-74 $59.49 $89.31 $59.49 $89.31Important 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.© 2023 Colonial Life & Accident Insurance CompanyJ-Kraft, IncBi-Weekly Rate Table(Continued...)Underwritten by Colonial Life & Accident Insurance CompanySee page 2 for Important Notice 31

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Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $50 BenefitUni-Tobacco RatesATTAINEDAGENAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$10,000 17-24 $0.90 $1.38$0.90 $1.3825-29 $0.97 $1.50$0.97 $1.5030-34 $1.08 $1.66$1.08 $1.6635-39 $1.52 $2.31$1.52 $2.3140-44 $2.03 $3.07$2.03 $3.0745-49 $2.79 $4.20$2.79 $4.2050-54 $3.67 $5.54$3.67 $5.5455-59 $4.96 $7.45 $4.96 $7.4560-64 $6.58 $9.90 $6.58 $9.9065-69 $8.19$12.32 $8.19 $12.3270-74 $10.36 $15.58$10.36 $15.58$20,000 17-24 $1.13 $1.73$1.13 $1.7325-29 $1.27 $1.96$1.27 $1.9630-34 $1.50 $2.28$1.50 $2.2835-39 $2.38 $3.58$2.38 $3.5840-44 $3.39 $5.10$3.39 $5.1045-49 $4.92 $7.36 $4.92 $7.3650-54 $6.67 $10.04$6.67 $10.0455-59 $9.25$13.87 $9.25 $13.8760-64 $12.48 $18.76$12.48 $18.7665-69 $15.72 $23.61$15.72 $23.6170-74 $20.05 $30.12$20.05 $30.12$30,000 17-24 $1.64 $2.08 $1.64$2.0825-29 $1.99 $2.42 $1.99$2.4230-34 $2.47 $2.91 $2.47$2.9135-39 $4.34 $4.85 $4.34$4.8540-44 $6.49 $7.13 $6.49$7.1345-49 $9.74 $10.52 $9.74$10.5250-54 $13.55 $14.54 $13.55$14.5455-59 $19.02 $20.28 $19.02$20.2860-64 $25.94 $27.62 $25.94$27.6265-69 $32.86 $34.89 $32.86$34.8970-74 $42.21 $44.65 $42.21$44.65Important 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.© 2023 Colonial Life & Accident Insurance CompanyJ-Kraft, IncWeekly Rate Table(Continued...)Underwritten by Colonial Life & Accident Insurance CompanySee page 2 for Important Notice 32

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Dental Plan Coverage Tier Weekly Bi-Weekly Semi-Monthly Employee Only $5.64 $11.29 $12.23 Employee + Spouse $12.24 $24.48 $26.52 Employee + Child(ren) $16.30 $32.60 $35.32 Employee + Family $22.68 $45.35 $49.13 Vision Plan Coverage Tier Weekly Bi-Weekly Semi-Monthly Employee Only $1.39 $2.79 $3.02 Employee + Spouse $2.78 $5.57 $6.03 Employee + Child(ren) $3.17 $6.34 $6.87 Employee + Family $4.93 $9.86 $10.69 Accident: Low Plan / High Plan Coverage Tier Weekly Low/High Bi-Weekly Low/High Semi-Monthly Low/High Employee Only $1.56 / $3.85 $3.11 / $7.71 $3.37 / $8.35 Employee + Spouse $2.54 / $6.24 $5.08 / $12.48 $5.51 / $13.52 Employee + Child(ren) $3.02 / $7.13 $6.05 / $14.26 $6.55 / $15.45 Employee + Family $4.01 / $9.51 $8.01 / $19.03 $8.68 / $20.62 Hospital Indemnity: Low Plan / High Plan Coverage Tier Weekly Low/High Bi-Weekly Low/High Semi-Monthly Low/High Employee Only $2.17 / $5.37 $4.33 / $10.75 $4.70 / $11.65 Employee + Spouse $4.90 / $11.79 $9.81 / $23.58 $10.63 / $25.55 Employee + Child(ren) $3.10 / $7.48 $6.20 / $14.97 $6.72 / $16.22 Employee + Family $5.84 / $13.90 $11.67 / $27.79 $12.65 / $30.11 Critical Illness Insurance - Please speak with a Benefits Counselor for personalized rates. Short- and Long-Term Disability Insurance – Please speak with a Benefits Counselor for personalized rates. Voluntary Life Insurance – Please speak with a Benefits Counselor for personalized rates. Rates 34

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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, 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 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. J-Kraft Inc. has provided the detailed information regarding deductible and co-insurance for the J-Kraft Inc. Group Health Plan. For more information or to get a copy of the Summary Plan Description containing these details contact your Employer Representative. 36

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PATIENT PROTECTION CHOICE OF PROVIDERS In cases where the J-Kraft Inc. Group Health Plan allows or required 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, J-Kraft Inc. 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 the J-Kraft Inc. 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. HIPAA SPECIAL ENROLLMENT RIGHTS NOTICE If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after 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. 37

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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 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.htmlPhone: 1-877-357-3268 38

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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 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 39

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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 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) 40

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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 Employee Benefits Security Administration www.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. 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) 41

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Important Notice from J-Kraft, Inc., about your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with J-Kraft Inc. 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 and 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 can be found 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 minimum level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. J-Kraft Inc. has determined that the prescription drug coverage offered by BCBS of TX (BCBSTX) 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. Read this notice carefully. It explains the options you have under Medicare prescription drug coverage, and it can help you decide whether or not you want to enroll when you become Medicare eligible. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan your current J-Kraft Inc. coverage will not be affected. When you elect for Medicare Part D you can keep the prescription drug coverage offered by J-Kraft Inc. through BCBSTX and this plan will coordinate with Medicare Part D. The table below outlines how prescription drug coverage will be provided. If you are NOT Medicare-eligible and enrolled in one of these options You currently get your prescriptions filled….. You CAN NOT enroll in a Medicare Prescription Drug Plan • PPO • HMO • EPO at retail pharmacies using the retail pharmacy network or via mail order ….you are not eligible to enroll in Medicare Prescription Drug Plan – Nothing Changes. If you ARE Medicare eligible and enrolled in one of these options You currently get your prescriptions filled…. You do NOT have to enroll in a Medicare Prescription Drug Plan • PPO • HMO • EPO at retail pharmacies using the retail pharmacy network or via mail order …you will continue using the retail pharmacy network or the mail order program – Nothing Changes If you do decide to enroll in a Medicare Prescription Drug Plan when you become Medicare-eligible, and you waive coverage under the J-Kraft Inc. Medical Benefit Program, you may re-enroll in the J-Kraft Inc. Medical Benefit Plan during any J-Kraft Inc. Annual Enrollment period, or within 31 days of any Qualified Change in Status. 42

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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 J-Kraft Inc. 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 person listed below for further information. 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 J-Kraft Inc. 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: September 11, 2023 Name of Entity/Sender: J-Kraft Inc. Contact--Position/Office: Debbie Segura, HR Address: 4643 E. Richey Rd., Humble, TX 77338 Phone Number: 281-876-2535 ext.31943

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PATIENT PROTECTIONS AGAINST SURPRISE MEDICAL BILLS 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 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 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. 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. 44

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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: 800-985-3059 Website: https://www.cms.gov/nosurprises/consumers • Your state agency, which can be found at: https://www.cms.gov/CCIIO/Resources/Consumer-Assistance-Grants 45

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General Notice of COBRA Rights (For use by single-employer group health plans) Continuation Coverage Rights Under COBRA Introduction You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your hours of employment are reduced, or • Your employment ends for any reason other than your gross misconduct. If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your spouse dies; • Your spouse’s hours of employment are reduced; • Your spouse’s employment ends for any reason other than his or her gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or 46

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• You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: • The parent-employee dies; • The parent-employee’s hours of employment are reduced; • The parent-employee’s employment ends for any reason other than his or her gross misconduct; • The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the Plan as a “dependent child.” When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events: • The end of employment or reduction of hours of employment; Death of the employee; • The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both). For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to: Debbie Segura 4643 E. Richey Rd. Humble, Texas 77338 How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways in which this 18-month period of COBRA continuation coverage can be extended: 47

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Disability extension of 18-month period of COBRA continuation coverage If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, Children’s Health Insurance Program (CHIP), or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov. Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends? In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period1 to sign up for Medicare Part A or B, beginning on the earlier of • The month after your employment ends; or • The month after group health plan coverage based on current employment ends. If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage. 1 https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods. 48

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If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare. For more information visit https://www.medicare.gov/medicare-and-you. If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.healthcare.gov. Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. Plan contact information 2023 - 2024 Plan Year Debbie Segura 4643 E. Richey Rd. Humble, Texas 7733849

J-Kraft, Inc. English Benefit Guide 2023-2024

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