Joe W Fly TX Benefits Guide 112024 : simplebooklet.com

6We’re excited to share some valuable new benefits for the upcoming year that can help you save on healthcare costs! These benefits are designed to support you in managing your healthcare expenses. We encourage you to take the time to learn about each option and see how they can work for you in 2025. All benefits will be offered through TASC, ensuring a smooth and user-friendly experience for managing your accounts. By exploring these options, you can make informed decisions that align with your healthcare needs and financial goals.• Health Savings Account (HSA): This account is available if you enroll in the High Deductible Health Plan (HDHP). The HSA allows you to save money for medical expenses using pre-tax dollars, meaning you don’t pay taxes on the money you set aside. One great feature is that the funds never expire, so you can save for future healthcare needs over the long term.• Flexible Spending Account (FSA): This account lets you use pre-tax dollars to pay for out-of-pocket healthcare expenses like doctor visits, prescriptions, and copays. Unlike the HSA, FSA funds must be used within the plan year, so it’s important to plan your healthcare spending to make the most of it.• Dependent Care FSA: This benefit helps you save on childcare expenses, allowing you to use pre-tax dollars to pay for eligible dependent care services. This includes costs for daycare, preschool, summer camps, and even after-school programs for children. By using the Dependent Care FSA account, you can lower your taxable income and make it more manageable to cover the costs of caring for your children while you work.• Limited Purpose FSA: This account allows you to set aside pre-tax funds specifically for dental and vision expenses. It helps you cover costs related to your eyes and teeth while preserving your HSA funds for other medical expenses.WHAT'S NEW IN 2025?Healthcare Savings Offered Through TASC

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EligibilityIf you are a full-time employee working at least 30 hours per week, you are eligible to participate in medical, dental, vision, life and disability plans, and additional benefits.Joe Fly Company’s benefits are designed to support your unique needs.ELIGIBILITY AND ENROLLMENTOpen Enrollment is your annual chance to choose your benefits, unless you have a qualifying life event (QLE), such as marriage or the birth/adoption of a child.DID YOU KNOW?Coverage DatesYour elections are effective the first day of the month following the date of employment. Benefits cannot be changed until the next enrollment period unless you experience a qualifying life event (QLE).DependentsDependents eligible for coverage include: Your legal spouse (or common-law spouse/domestic partner where recognized). Children up to age 26 (includes biological children, stepchildren, legally adopted children, children placed for adoption, foster children, and children for whom you or your spouse have legal guardianship). Dependent children, age 26 or older, who are unmarried, primarily supported by you, and are incapable of self-sustaining employment by reason of mental or physical disability which arose while the child was covered as a dependent under this plan (periodic recertification may be required).Verification of dependent eligibility may be required upon enrollment.Active EnrollmentThis year we are conducting an Active Enrollment. This means your existing benefits elections from 2024 will not automatically roll over to the next plan year—2025. Which means you do need to act and enroll or decline benefits. You can also use this time to: Change your current benefits, including who in your family is covered. Purchase additional voluntary life insurance for your self, spouse, and/or child(ren).Any new elections you make or those that you reenroll in will remain in place until the following enrollment period (2026) unless you experience a QLE.7

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Update your personal information.If you’ve experienced any life changes since the last Open Enrollment period—such as the birth of a child or a move—you may need to change your elections or update pertinent details.Joe Fly Company covers a significant amount of your benefits costs. Your contributions for medical, dental, and vision benefits are deducted on a pre-tax basis, lessening your tax liability. Employee contributions vary depending on the level of coverage you select. Typically, the more coverage you have, the higher your portion will be.READY FOR OPEN ENROLLMENT?OPEN ENROLLMENT ACTION ITEMSDouble-check covered medications.If you plan on making any changes to your plan, consider how it affects your prescriptions.Review available plans’ deductibles.Foresee a lot of medical needs this year? You might want a lower deductible. If not, you could switch to a higher deductible plan and enjoy lower premiums.Explore your savings options.Consider the benefits of a Health Savings Account (HSA), Flexible Spending Account (FSA), Dependent Care FSA, and Limited Purpose FSA for 2025. An HSA allows tax-free savings for medical expenses, while an FSA lets you use pre-tax dollars for out-of-pocket costs. The Dependent Care FSA helps manage childcare expenses, while the Limited Purpose FSA is designed for dental and vision expenses. Each option can help you effectively manage healthcare costs.Check your networks.Going in-network often saves you money. Check for any plan changes to make sure your go-to providers and pharmacy are still your best bet.9Schedule your one-on-one benefits consultation.We’re here to help you navigate your benefits for 2025! Schedule a one-on-one call to discuss your options, as we answer any questions and assist with the enrollment process. This personalized support will ensure that you understand your benefits and make the best choices for you and your family. Don’t miss this opportunity to get the guidance you need—book your consultation today! (Please see page 33 for a list of contact numbers.

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What may seem like an urgent care center could be a standalone ER. These newer facilities come with a higher price tag, so ask for clarification if the word "emergency“ appears in the business’s name.* This is a sample list of services and may not be all-inclusive.** Costs and time information represent averages only and are not tied to a specific condition or treatment.You’re feeling sick, but your primary care physician (PCP) is booked through the end of the month. You have a question about the side effects of a new prescription, but the pharmacy is closed. So, what do you do? Instead of rushing to the emergency room or relying on questionable information from the internet, consider your site-of-care options, as shown below.TelemedicineWhen to UseYou need care for minor illnesses and ailments but would prefer not to leave home. These services are available by phone and online (via webcam).Types of Care* Cold and flu symptoms Allergies Bronchitis Urinary tract infection Sinus problemsPrimary Care CenterWhen to UseYou need routine care or treatment for a current health issue. Your PCP knows you and your health history, can access your medical records, provide routine care, and manage your medications.Types of Care* Routine checkups Immunizations Preventive services Managing your general healthNurse LineWhen to UseYou need a quick answer to a health issue that does not require immediate medical treatment or a physician visit.Types of Care*Answers to questions regarding: Symptoms Self-care and/or home treatments Medications and side effects When to seek careEmergency RoomWhen to UseYou need immediate treatment for a serious life-threatening condition. If a situation seems life threatening, call 911 or your local emergency number right away.Types of Care* Heavy bleeding Chest pain Major burns Spinal injuries Severe head injury Major broken bonesUrgent Care CenterWhen to UseYou need care quickly, but it is not a true emergency. Urgent care centers offer treatment for non-life-threatening injuries or illnesses.Types of Care* Strains and sprains Minor broken bones (e.g., finger) Minor infections Minor burns X-raysCosts and Time Considerations** Usually a first-time consultation fee and a flat fee or copay for any visit thereafter Usually immediate access to care Prescriptions through telemedicine or virtual visits not allowed in all statesCosts and Time Considerations** Often requires a copay and/or coinsurance Normally requires an appointment Usually little wait time with scheduled appointmentCosts and Time Considerations** Usually available 24 hours a day, 7 days a week Usually free as part of your medical insuranceCosts and Time Considerations** Often requires a much higher copay and/or coinsurance Open 24/7, but waiting periods may be longer because patients with life-threatening emergencies will be treated first Ambulance charges, if applicable, will be separate and may not be in-networkCosts and Time Considerations** Often requires a copay and/or coinsurance which is usually higher than an office visit Walk-in patients welcome, but waiting periods may be longer, as urgency determines order seen for careWHERE TO GO FOR CARE12DID YOU KNOW?

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IN-NETWORK OUT-OF-NETWORKIndividual $5,000 Not CoveredFamily $15,000 Not CoveredCoinsurance (Plan Pays) 80% Not CoveredIndividual $7,900 Not CoveredFamily$15,800 Not CoveredPrevent at ive Care No Charge Not CoveredPrimary Care$40 Not CoveredSpecialist Services$80 Not CoveredUrgent Care$75 Not CoveredEmergency Room$500 plus coinsurance $500 plus coinsuranceIN-NETWORK OUT-OF-NETWORKIndividual $5,000 $10,000Family $10,000 $20,000Coinsurance (Plan Pays) 100% 70%Individual $5,000 UnlimitedFamily$10,000 Unlimit edPrevent at ive Care No Charge CoinsurancePrimary CareNo Charge aft erdeduct ible CoinsuranceSpecialist ServicesNo Charge aft erdeduct ible CoinsuranceUrgent CareNo Charge aft erdeduct ible CoinsuranceEmergency RoomNo Charge aft erdeduct ible No Charge aft er deduct ibleCOPAYS/COINSURANCECALENDAR YEAR DEDUCTIBLECALENDAR YEAR OUT-OF-POCKET MAXIMUM (MAXIMUM INCLUDES DEDUCTIBLE)BCBS 5000 HMO Plan - TX Employees CALENDAR YEAR DEDUCTIBLECALENDAR YEAR OUT-OF-POCKET MAXIMUM (MAXIMUM INCLUDES DEDUCTIBLE)COPAYS/COINSURANCEBCBS 5000 HSA PPOMEDICAL PLAN SUMMARYThis chart summarizes the 2025 medical coverage provided by BCBSTX. All covered services are subject to medical necessity as determined by the plan. Please note that all out-of-network services are subject to Usual, Customary, and Reasonable (UCR) limitations.The individual deductible must be met by each member enrolled under your medical coverage. If you have several covered dependents, all charges applied to a “per individual” deductible will also be applied toward the “per family” deductible. When the family deductible is reached, no further individual deductibles will have to be met for the remainder of that plan year. No member may contribute more than their individual deductible to the “per family” deductible. The same typically applies for the out-of-pocket maximum.14DID YOU KNOW?

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IN-NETWORKOUT-OF-NETWORKGeneric$0 / $10Not CoveredPreferred $50Not CoveredNon-Preferred $100Not CoveredSpecialt y $150 / $250Not CoveredGeneric $0 / $30Not CoveredPreferred $150Not CoveredNon-Preferred$300Not CoveredIN-NETWORK OUT-OF-NETWORKGeneric No Charge aft erdeduct ible No Charge aft erdeduct iblePreferred No Charge aft erdeduct ible No Charge aft erdeduct ibleNon-PreferredNo Charge aft erdeduct ible No Charge aft erdeduct ibleSpecialt y No Charge aft erdeduct ible No Charge aft erdeduct ibleGeneric No Charge aft erdeduct ibleNo Charge aft erdeduct iblePreferred No Charge aft erdeduct ible No Charge aft erdeduct ibleNon-Preferred No Charge aft erdeduct ible No Charge aft erdeduct ibleIN-NETWORK OUT-OF-NETWORKGeneric $0 / $10$10 / $20 Preferred $50$70 Non-Preferred $100$120 Specialt y $150 / $250$150 / $250 Generic $0 / $30 N/APreferred$150 N/ANon-Preferred $300N/AIN-NETWORK OUT-OF-NETWORKGeneric $0 / $10$10 / $20Preferred $50$70 Non-Preferred $100$120 Specialt y $150 / $250 $150 / $251Generic $0 / $30 N/APreferred $150 N/ANon-Preferred $300 N/ARETAIL RX (30 DAY SUPPLY)MAIL ORDER RX (90 DAY SUPPLY)BCBS 5000 HSA PPOBCBS 3500 PPOBCBS 1500 PPORETAIL RX (30 DAY SUPPLY)MAIL ORDER RX (90 DAY SUPPLY)BCBS 5000 HMO Plan - TX Employees RETAIL RX (30 DAY SUPPLY)MAIL ORDER RX (90 DAY SUPPLY)RETAIL RX (30 DAY SUPPLY)MAIL ORDER RX (90 DAY SUPPLY)Prescription Drug Coverage for Medical PlansOur Prescription Drug Program is through BCBSTX which means you’ll only have one ID card for medical care and prescriptions. Information on benefits coverage and a list of network pharmacies is available online at bcbstx.com/member or by calling the Customer Care number on your ID Card. Cost is determined by the tier (Generic, Preferred, Non-Preferred, or Specialty) assigned to the prescription drug product.DID YOU KNOW?Want to save money on meds? Generic drugs are versions of brand-name drugs with the exact same dosage, intended use, side effects, route of administration, risks, safety, and strength. Because they’re the same medicine, generic drugs are just as effective as brand name, and they meet the same strict FDA standards. But generics cost 80% to 85% less on average than the brand-name equivalent. To find out if there’s a generic for your brand-name drug, visit www.fda.gov.So, how do I get discounts? Apps and prescription discount programs like GoodRx, Optum Perks, and Amazon Prime Rx Savings let you compare prices on prescription drugs and find possible discounts. GoodRx is a web- and app-based platform that allows you to search for prescription drug coupons and compare pharmacy prices. The company claims a savings of up to 80%.  Optum Perks provides coupons for medications and a searchable database for drug cost comparison at participating pharmacies. The Optum Perks member card, which can be used at more than 64,000 pharmacies, is free to use and requires no personal data.  Amazon Prime Rx Savings is a discount card, included with an Amazon Prime membership and administered by InsideRx. It provides discounts of up to 80% for generics and up to 40% for brand-name medication at participating pharmacies.How do they work? These discounts can’t be combined with your benefit plan’s coverage, so make sure to check the price against the cost of using your insurance’s prescription drug benefit. Something else to consider: If you choose to use a discount card instead of tapping into your insurance’s prescription drug benefit, the cash amount you pay for the prescription will not count toward your deductible or out-of-pocket maximum under the benefit plan.PHARMACY BENEFITS16Download the GoodRX App

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SAVE MONEY ON HEALTHCARE EXPENSES FOR TODAY AND TOMORROW.HEALTH SAVINGS ACCOUNT (HSA)A Health Savings Account (HSA) works with your High Deductible Health Plan (HDHP) and lets you deposit a portion of your paycheck—before taxes—into an account.Use your HSA funds to help pay for medical expenses that aren’t covered by your HDHP. Any leftover funds can be transferred into the HSA Investment Account year after year for future growth!You own the HSA.» You are the owner of your HSA, not your employer. The account (and its funds) stay with you, even if you change jobs, and remains active even if you’re no longer covered by an HDHP.» Your HSA funds never expire and may be used for expensesincurred in any year beyond enrollment into TASC’s HSAplan.» With an HSA, you have more control, ownership, and stabilitywhen it comes to your healthcare.Individual – $4,300Family – $8,55017A triple tax advantage.The HSA is a tax-advantaged investment vehicle that offers three separate tax benefits:1. Contributions into an HSA are pretax.2. Earned interest on investment funds is tax-free.3. Withdrawals for qualified medical expenses are tax-free.Each $1 you contribute to your HSA reduces your taxable income by $1For a complete list of eligible expenses, see IRS Publications 502 and 969 at irs.govYou can pay for current healthcareexpenses with tax-free money andsave (tax-free!) for future healthcarecosts.Like a Roth IRA, earned interest on an HSA grows tax-free but you also getthe benefit of a current pretaxdeduction.DID YOU KNOW?Note: The contribution limit is the maximum amount that can be contributed to an HSA each year, per the IRS.2025 Contribution LimitHEALTHCARE EXPENSES Deductibles, copays, and coinsurance  Medical care, prescriptions, and vaccinations  Dental and orthodontic care Eye exams and prescription eye wearIt’s simple. It’s smart. It’ll save you money and help you plan for future medical expenses.

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SAVE MONEY WITH FSAPRETAX BENEFIT ACCOUNTS.FLEXIBLE SPENDING ACCOUNT (FSA)A Flexible Spending Account (FSA) helps you save money by reducing your taxable income when you contribute pretax dollars for common expenses. You can contribute up to $3,300 annually for qualified medical expenses, including deductibles, copays, coinsurance, menstrual products, PPE, and over-the-counter medications. By using pretax dollars, you lower your taxable income and increase your take-home pay. Plus, you can pay for eligible expenses with an FSA debit card at the time of service—no waiting for reimbursement!A Limited Purpose Flexible Spending Account (LPFSA) is a special type of account that allows you to set aside tax-free money to pay for eligible dental and vision expenses. What makes the LPFSA unique is that it can be used alongside a Health Savings Account (HSA), so you can use your LPFSA for immediate dental and vision costs while continuing to grow your HSA for other healthcare expenses. 18Increase your take-home pay by reducing your taxable income.» Each $1 you contribute to your FSA reduces your taxable income by $1» With less tax taken, your take-home pay increases!Richard has:•Gross monthlypay of $3,500•$600 per month in eligible expensesWithout FSA($600 spent using post-tax dollars)$1,932Tip: To estimate potential savings based on your income and expenses, use theTax Savings Calculator atwww.tasconline.com/tasc-calculators/tasc-fsa-calculator/With FSA($600 spent using pretax dollars)$2,098Here’s his net monthly take-home pay:Meet Richard…That’s a net increasein take-home pay of$166 every month!Determine your elections based on your estimated out-of-pocket expenses for the yearFor a complete list of eligible expenses, see IRS Publications 502 and 503 at irs.gov2025 Contribution Limit$3,300Note: The contribution limit is the maximum amount that can be contributed to an HSA each year, per the IRS.Simplicity meets smart. Save money today while planning for a healthier tomorrow!

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Note: Medical expenses for your dependent are not eligible for reimbursement under the TASC Dependent Care FSA.DO YOUR DEPENDENT CARE EXPENSES QUALIFY FOR REIMBURSEMENT?DEPENDENT CARE FSAThe TASC Dependent Care FSA allows you to use pretax dollars to pay for eligible expenses related to care for your child, disabled spouse, elderly parent, or other dependent who is physically or mentally incapable of self-care. That way, you (or your spouse) can work, look for work, or attend school full-time.19A. The dependent care expenses must be work-related. The care must be necessary for the employee and/or the employee’s spouse to work, look for work, or attend school full-time, or if they are physically unable to care for their children.B. The dependent care expenses provided during a calendar year cannot exceed $5,000. In the case of a separate tax return by a married individual, the limit is $2,500. This amount may be less if the employee’s earned income or spouse’s earned income is less than $5,000.Eligible and Ineligible Expenses for Dependent Care FSA ReimbursementReimbursement Allowed Fees for licensed day or adult care facilities Before- and after-school care programs fordependents under age 13 Amounts paid for services (includingbabysitters or nursery school) provided in oroutside of your home Nanny expenses attributed to dependent care Nursery school (preschool) fees Summer Day Camp – primarypurpose must be custodial care andnoteducational in nature Late pick-up feesNote: This list is not exhaustive, so be sure to check potential expenses for eligibility.Certain eligibility criteria must be met for the dependent care FSA benefit:Dependent care expenses must be for the care of one or more qualifying persons.A “qualifying person” is defined as one of the following: A dependent child who was under the age of 13 when care was provided and for whom a tax exemption can be claimed. A spouse who was physically or mentally unable to care for themselves and lived with you for more than half the year. A dependent who was physically or mentally unable to care for themselves and for whom an exemption can be claimed and lived with you for more than half the year. Medical expenses Babysitter in or out of your home for reasons other than to enable you towork Activity fees or educational supplies Food, clothing, and entertainment Transportation expenses Child support payments Kindergarten fees Overnight camp Late payment chargesReimbursement NOT Allowed

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TASC CardThe TASC Card is the preferred and most convenient method to access available account funds for all eligible expenses. It automatically pays for and substantiates most eligible expenses at the point-of-purchase, eliminating the need to submit Requests for Reimbursement and waiting for payment.Picture to PayPicture to Pay makes paying for an expense even easier. Open the TASC App, click the menu option called Picture to Pay, and a camera will pop up. Take a picture of the invoice, enter the amount you would like to pay, review it, and then submit. That’s all it takes!Pay the ProviderAccessible from the Overview page and the Benefit Accounts page,the Pay the Provider feature offers another simple and fast way to pay for an eligible expense. Click on Pay the Provider, select who incurred the expense, select the date the expense was incurred, and the expense type. Enter the amount, provider or merchant, address including unit or suite, city, state, and zip code. Attach the bill by clicking on the appropriate box. This will allow you to attach a bill from the bill depository or to browse your computer to locate the appropriate bill. Review and click submit. TASC will send payment from your account directly to your provider.OnlineIf you pay for an eligible expense out-of-pocket without the TASC Card, you can submit a Request for Reimbursement online.1) Sign in to your account at www.tasconline.com 2) From the Overview page select the green box Request a reimbursement.3) Select who the expense was incurred by and the date of the expense.4) Enter the expense amount, the merchant, attach the receipt(s), and a description of the expense.5) Click Next to review your request, and then Submit reimbursement request.6) Reimbursement is deposited into your MyCash account on your TASC Card.7) Spend your MyCash balance using the TASC Card to buy anything!TASC OFFERS MULTIPLE EASY WAYS TO REQUEST A REIMBURSEMENT.REQUEST A REIMBURSEMENT20

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Employee OnlyEmployee + SpouseEmployee + Child(ren)Employee + FamilyIN-NETWORK FREQUENCYCopay $10 Once ev ery 12 monthsSingle Vision $25Bifocal$25Trifocal$25Lenticular $25Fitting and Evaluation**Up to $40 for standardConventional$0 copay, $130 allow ance, 15% off balance ov er $130Disposable$0 copay, $130 allowance, plus balance ov er $130Medically Necessary Cov ered 100%Copay $0Allowance$130 allow ance, 20% off balance ov er $130Laser Vision CorrectionAddit ional pairs benefitAmplifon hearing discountAddit ional discount s20% off non-covered items with limitations** Fitting and Evaluation fee applied to contact lens allowance.Once ev ery 12 monthsADDITIONAL BENEFITS15% off retail price or 5% off promotional price40% off purchase of complete pair of eyeglassesand a 15% off conventional contact lenses once thefunded benefit has been usedFRAMESOnce ev ery 24 months40% off hearing exams and low priceguarantee on discounted hearing aidsEMPLOYEE CONTRIBUTIONSEXAMSLENSESCONTACTS (IN LIEU OF LENSES AND FRAMES)Once ev ery 12 monthsPer Pay Period$3.80$7.22$7.60$11.18At Joe Fly Company, we are committed to your well-being, including the health of your eyes. Vision is an integral part of a productive and fulfilling life. As such, we strongly encourage all members of our valued team to prioritize their eye health. To assist you and your family in maintaining optimal vision, we are pleased to offer a comprehensive vision benefit through our partnership with BCBS.Vision Plan SummaryThis chart summarizes the 2025 vision coverage provided by BCBS.VISION BENEFITS22For a complete list of in-network providers near you, check out these resources.FIND A PROVIDERDownload the EyeMed member app now, register, and easily access your vision beneﬁt information, no matter where you are!Online: member.eyemedvisioncare.com/bcbstxCall: 1.855.556.8796LASIK: 1.877.5LASER6QR:Efficiency on the go…

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Basic Life and Accidental Death & Dismemberment InsuranceNaming a BeneficiaryYour beneficiary is the person you designate to receive your Life insurance benefits in the event of your death. This includes any benefits payable under Basic Life. You receive the benefit payment for a dependent’s death under Unum.Name a primary and contingent beneficiary to make your intentions clear. Indicate their full name, address, Social Security number, relationship, date of birth, and distribution percentage. Please note that in most states, benefit payments cannot be made to a minor. If you elect to designate a minor as beneficiary, all proceeds may be held under the beneficiary’s name and will earn interest until the minor reaches age 18. Contact Human Resources or your own legal counsel with any questions.SURVIVORS BENEFITS23Coverage Amount$10,000 to $500,000Who Pays EmployeeBenefits Payable Loss of life, both hands, both feet, speech, hearing, eyesight, etc.Evidence of Insurability (EOI) Required Yes, for any amount greater than $200,000Coverage Amount $5,000 to $500,000*Who Pays EmployeeBenefits Payable Loss of life, both hands, both feet, speech, hearing, eyesight, etc.Evidence of Insurability (EOI) Required Yes, for any amount greater than $25,000Coverage Amount $10,000**Who Pays EmployeeBenefits Payable Loss of life, both hands, both feet, speech, hearing, eyesight, etc.*Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself. **The maximum benefit for children live birth to 6months is $1,000.VOLUNTARY CHILD LIFE AND AD&DVOLUNTARY EMPLOYEE LIFE AND AD&DVOLUNTARY SPOUSE LIFE AND AD&DIt's difficult to think about, but having a plan in place to support your family in case something happens to you is essential. Survivor benefits provide financial protection in the event of an unexpected occurrence. If you pass away, these funds can help your family cover basic living expenses, final arrangements, tuition, and more. Additionally, Accidental Death and Dismemberment (AD&D) Insurance is available. This insurance pays a benefit if you survive an accident but sustain certain serious injuries, and it offers an additional amount if you die from a covered accident.

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0How does it work?If a covered illness or injury keeps you from working, Short-Term Disability (STD) Insurance replaces part of your income while you recover. As long as you remain disabled, you can receive payments for up to 11 weeks.You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers because of it.Why is this coverage so valuable?You can use the money however you choose. It can help you pay for your rent or mortgage, groceries, out-of-pocket medical expenses and more.What else is included?Cesarean section benefitIf you have a Cesarean section, you will be considered disabled for a minimum period of eight (8) weeks unless you return to work before the end of the time.How much coverage can I get?YouLONG-TERM DISABILITYSHORT-TERM DISABILITYHow much coverage can I get?24Short-Term Disability Insurance pays you a weekly benefit if you have a covered disability that keeps you from working. Are eligible for coverage if you are an active employee in the United States working a minimum of 30 hours per week. Choose from $25 to $1,500 a week (in $10 increments). You can cover up to 60% of your weekly income.If you don’t sign up now but decide to apply later, you may have to answer health questions.DID YOU KNOW?Elimination Period: Maximum Benefit Period:8th day for injury or sickness11 weeks or until long-term disability (LTD) begins, whichever is earlierHow does it work?Long-term disability (LTD) coverage provides a monthly benefit if you have a covered illness or injury, and you can’t work for a few months — or even longer.You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers because of it.Why is this coverage so valuable?You can use the money however you choose. It can help you pay for your rent or mortgage, groceries, out-of-pocket medical expenses, and more.Elimination Period: Maximum Benefit Period:90 daysPayments will last for as long as you are disabled or until you reach your Social Security Normal Retirement Age, whichever is sooner.You Are eligible for coverage if you are an active employee in the United States working a minimum of 30 hours per week. Cover 60% of your monthly income, up to a maximum payment of $10,000.

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Why is this coverage so valuable? The money can help you pay out-of-pocket medical expenses, like deductibles. You can use this coverage more than once. Even after you receive a payout for one illness, you’re still covered for the remaining conditions and for the reoccurrence of any critical illness with the exception of skin cancer. The reoccurrence benefit can pay 100% of your coverage amount. Diagnoses must be at least 180 days apart and/or the conditions can’t be related to each other.What’s covered?Critical Illnesses Heart attack Stroke Major organ failure End-stage kidney failure Sudden cardiac arrestCoronary artery disease Major (50%): Coronary artery bypass graft or valve replacement Minor (10%): Balloon angioplasty or stent placementCancer conditions Invasive cancer; all breast cancer is considered invasive Non-invasive cancer (25%) Skin cancer – $500Progressive diseases Supplemental conditions Amyotrophic lateral sclerosis (ALS) Dementia, including Alzheimer’s disease Multiple sclerosis (MS) Parkinson’s disease Functional loss Huntington’s disease Lupus Muscular dystrophy Myasthenia gravis Systemic sclerosis (Scleroderma) Addison’s disease Loss of sight, hearing, or speech Benign brain tumor Coma Permanent paralysis Occupational HIV andhepatitis B, C, or D Occupational PTSD Paid at 25% Infectious diseases Pulmonary embolism Transient ischemic attack (TIA) Bone marrow and/or stem cell conditionsHow does it work?If you’re diagnosed with an illness that is covered bythis insurance, you can receive a lump sum benefitpayment. You can use the money however you want.Why should I buy coverage now? It’s more accessible when you buy it through your employer and the premiums are conveniently deducted from your paycheck. Coverage is portable. You may take the coverage with you if you leave the Company or retire. You’ll be billed at home.Be Well BenefitEvery year, each family member who has Critical Illness coverage can also receive $50 for getting a covered Be Well Benefit screening test, such as: Annual exams by a physician, including sports physicals, well-child visits, dental and vision exams Screenings for cancer, including pap smear andcolonoscopy Cardiovascular function screenings Screenings for cholesterol and diabetes Imaging studies, including chest X-ray and mammography Immunizations, including HPV, MMR, tetanus, andinfluenzaWho can get coverage?You:If you apply during this enrollment, choose $10,000, $20,000, or $30,000 of coverage with no medical underwriting to qualify.Your spouse:Spouses can only get 100% of the employee coverage amount if you have purchased coverage for yourself.Your children:Children from live birth to age 26 are automatically covered at no extra cost. Their coverage amount is 50% of yours. They are covered for all the same illnesses plus these specific childhood conditions: Cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome, spina bifida, type 1 diabetes, sickle cell anemia, and congenital heart disease. The diagnosis must occur after the child’s coverage effective date.GROUP CRITICAL ILLNESS INSURANCE25

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Who can get coverage?How does it work?Group Accident Insurance provides a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more serious events.Why is this coverage so valuable?It can help you with out-of-pocket costs that your medical plan doesn’t cover, like co-pays and deductibles. You’ll have base coverage without medical underwriting. The cost is conveniently deducted from your paycheck, you can keep your coverage if you change jobs or retire, and you’ll be billed directly.YouIf you’re actively at work.Your spouseCan get coverage as long as you have purchasedcoverage for yourself.Your childrenDependent children from birthuntil their 26th birthday,regardless of marital or studentstatus.What’s included?Be Well BenefitEvery year, each family member who has Accident coverage can receive $50 for getting a covered Be Well Benefit screening test.Organized Sports BenefitEach family member that has Accident coverage is eligible for a 10% increase in payable benefits within the Injury and Treatment schedule of benefit categories. See disclosures and schedule of benefits for more information.GROUP ACCIDENT INSURANCEGROUP HOSPITAL INSURANCEHow does it work?Group Hospital Insurance helps covered employees, and their families, cope with the financial impacts of a hospitalization. You can receive benefits when you’re admitted to the hospital for a covered accident, illness, or childbirth.Why is this coverage so valuable? The money is payable directly to you — not to a hospital or care provider. The money can also help you pay the out-of-pocket expenses your medical plan may not cover, such as co-insurance, co-pays and deductibles. You get accessible rates when you buy this coverage at work. The cost is conveniently deducted from your paycheck. The benefits in this plan are compatible with a Health Savings Account (HSA). You may take the coverage with you if you leave the company or retire. You’ll be billed directly.Be Well BenefitEvery year, each family member who has Accident coverage can receive $50 for getting a covered Be Well Benefit screening test.DID YOU KNOW?Group Hospital Insurance can pay benefits that help you with the costs of a covered hospital visit.26

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GLOSSARYBalance Billing – When you are billed by a provider for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $60, you may be billed by the provider for the remaining $40.Coinsurance – Your share of the cost of a covered healthcare service, calculated as a percent of the allowed amount for the service, typically after you meet your deductible.Copay – The fixed amount you pay for healthcare services received, as determined by your insurance plan.Deductible – The amount you owe for healthcare services before your insurance begins to pay its portion. For example, if your deductible is $1,000, your plan does not pay anything until you’ve paid $1,000 for covered services. This deductible may not apply to all services, including preventive care. Explanation of Benefits (EOB) – A statement from your insurance carrier that explains which services were provided, their cost, what portion of the claim was paid by the plan, and what portion is your liability, in addition to how you can appeal the insurer’s decision.Flexible Spending Accounts (FSAs) – A special tax-free account you put money into that you use to pay for certain out-of-pocket healthcare costs. You’ll save an amount equal to the taxes you would have paid on the money you set aside. FSAs are “use it or lose it,” so funds not used by the end of the plan year will be lost. Some Healthcare FSAs do allow for a grace period or rollover into the next plan year. Healthcare FSA – A pre-tax benefit account used to pay for eligible medical, dental, and vision care expenses that aren’t covered by your insurance plan. All expenses must be qualified as defined in Section 213(d) of the Internal Revenue Code.  Dependent Care FSA – A pre-tax benefit account used to pay for dependent care services. For additional information on eligible expenses, refer to Publication 503 on the IRS website. High Deductible Health Plan (HDHP) – A plan option that provides choice, flexibility, and control when it comes to healthcare spending. Most preventive care is covered at 100% with in-network providers, and all qualified employee-paid medical expenses count toward your deductible and out-of-pocket maximum.Network – A group of physicians, hospitals, and healthcare providers that have agreed to provide medical services to a health insurance plan’s members at discounted costs.  In-Network – Providers that contract with your insurance company to provide healthcare services at the negotiated carrier discounted rates. Out-of-Network – Providers that are not contracted with your insurance company. If you choose an out-of-network provider, services will not be covered at the in-network negotiated carrier discounted rates.  Non-Participating – Providers that have declined entering into a contract with your insurance provider. They may not accept any insurance, and you could pay for all costs out of pocket.Open Enrollment – The period set by the employer during which employees and dependents may enroll for coverage.28

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Out-of-Pocket Maximum – The most you pay during the plan year before your health insurance begins to pay 100% of the allowed amount. This does not include your premium, out-of-network provider charges beyond the Reasonable and Customary, or healthcare your plan doesn’t cover. Check with your carrier to confirm what applies to the maximum.Over-the-Counter (OTC) Medications – Medications available without a prescription.Prescription Medications – Medications prescribed by a doctor. Cost of these medications is determined by their assigned tier: generic, preferred, non-preferred, or specialty. Generic Drugs – Drugs approved by the U.S. Food and Drug Administration (FDA) to be chemically identical to corresponding preferred or non-preferred versions. Usually the most cost-effective version of any medication. Preferred Drugs – Brand-name drugs on your provider’s approved list (available online). Non-Preferred Drugs – Brand-name drugs not on your provider’s list of approved drugs. These drugs are typically newer and have higher copayments. Specialty Drugs – Prescription medications used to treat complex, chronic, and often costly conditions. Because of the high cost, many insurers require that specific criteria be met before a drug is covered. Prior Authorization – A requirement that your physician obtain approval from your health insurance plan to prescribe a specific medication for you. Step Therapy – The goal of a Step Therapy Program is to steer employees to less expensive, yet equally effective, medications while keeping member and physician disruption to a minimum. You must typically try a generic or preferred-brand medication before “stepping up” to a non-preferred brand.Reasonable and Customary Allowance (R&C) – The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The R&C amount is sometimes used to determine the allowed amount. Also known as the UCR (Usual, Customary, and Reasonable) amount.Summary of Benefits and Coverage (SBC) – Mandated by healthcare reform, you are provided with a summary of your benefits and plan coverage.Summary Plan Description (SPD) – The document(s) that outline the rights, obligations, and material provisions of the plan(s) to all participants and their beneficiaries.29

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REQUIRED NOTICESImportant Notice About Your Prescription Drug Coverage and Medicare Under the Joe W. Fly Co., Inc. Medical Plan(s)Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Joe W. Fly Co., 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 at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. Joe W. Fly Co., Inc. has determined that the prescription drug coverage offered by the Joe W. Fly Co., Inc. Medical plan(s) is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.When Can You Join a Medicare Drug Plan?You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.What 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 Joe W. Fly Co., Inc. coverage may not be affected. For most persons covered under the Plan, the Plan will pay prescription drug benefits first, and Medicare will determine its payments second. For more information about this issue of what program pays first and what program pays second, see the Plan’s summary plan description (SPD) or contact Medicare at the telephone number or web address listed.If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents may not be able to get this coverage back.When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan?You should also know that if you drop or lose your current coverage with Joe W. Fly Co., 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. And you may have to wait until the following October to join.30For More Information About This Notice or Your Current Prescription Drug CoverageContact the person listed at the end of these notices for further information. You will get this notice each year; before the next period you can join a Medicare drug plan; and if this coverage through Joe W. Fly Co., Inc. changes. You also may request a copy of this notice at any time.For More Information About Your Options Under Medicare Prescription Drug CoverageMore 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 1-877-486-2048If 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 at 1-800-325-0778).Remember: Keep this Medicare Part D 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:Name of Entity / Sender:Contact: Position / Office:Address:Email:January 1, 2025Joe W. Fly Co., Inc. Human Resources3412 McCall Lane., Austin, TX 78744mckenna@joeflyco.comWomen’s Health and Cancer Rights ActIf you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for: All stages of reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and Treatment of physical complications of the mastectomy, including lymphedema.These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. For deductibles and coinsurance information applicable to the plan in which you enroll, please refer to the summary plan description (SPD). If you would like more information on WHCRA benefits, please contact Human Resources at mckenna@joeflyco.com.

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31COBRA General NoticeThe 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 SPD or contact the Plan Administrator.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 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 their gross misconduct; Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or You become divorced or legally separated from your spouse.Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: The parent-employee dies; The parent-employee’s hours of employment are reduced; The parent-employee’s employment ends for any reason other than their 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).Important: For all other qualifying events (divorce or legal separation of the employee and spouse, or a dependent child losing eligibility for coverage as a dependent), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to: Joe W. Fly Co., Inc. Documentation of the qualifying event may be requested.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. COBRA continuation coverage can be extended up to an 18-month period by either the Disability extension or the Second qualifying event extensionIf you have questionsQuestions 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 (ACA), 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.HIPAA Privacy and SecurityThe Health Insurance Portability and Accountability Act of 1996 (HIPAA) deals with how an employer can enforce eligibility and enrollment for healthcare benefits, as well as ensuring that protected health information which identifies you is kept private. You have the right to inspect and copy protected health information that is maintained by and for the plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask your benefits administrator to amend the information. For a full copy of the Notice of Privacy Practices, describing how protected health information about you may be used and disclosed and how you can get access to the information, contact Human Resources at mckenna@joeflyco.com. HIPAA Special Enrollment RightsIf you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may later 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 towards your or your dependents’ other coverage).Loss of eligibility includes, but is not limited to: Loss of eligibility for coverage because of ceasing to meet the plan’s eligibility requirements (i.e., legal separation, divorce, cessation of dependent status, death of an employee, termination of employment, and/or reduction in the number of hours of employment); Loss of HMO coverage because the person no longer resides or works in the HMO service area and no other coverage option is available through the HMO plan sponsor; Elimination of the coverage option a person was enrolled in, and another option is not offered in its place; Failing to return from an FMLA leave of absence; and Loss of coverage under Medicaid or the Children’s Health Insurance Program (CHIP).Unless the event giving rise to your special enrollment right is a loss of coverage under Medicaid or CHIP, you must request enrollment within 31 days after your or your dependent’s(s’) other coverage ends (or after the employer that sponsors that coverage stops contributing the coverage).If the event giving rise to your special enrollment right is a loss of coverage under Medicaid or CHIP, you may request enrollment under this plan within 60 days of the date you or your dependent(s) lose such coverage under Medicaid or CHIP. Similarly, if you or your dependent(s) become eligible for a state-granted premium subsidy towards this plan, you may request enrollment under this plan within 60 days after the date Medicaid or CHIP determines that you or the dependent(s) qualify for the subsidy.In addition, if you have a new dependent because of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.To request special enrollment or obtain more information, contact Human Resources at Joe W. Fly Co., Inc.

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32Premium 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 that 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).TEXAS – Medicaid / Texas Health and Human Services | Health Insurance Premium Payment (HIPP) Program Website: https://www.hhs.texas.gov/services/financial/health-insurance-premium-payment-hipp-program  Phone: 1-800-440-0493To see if any other states have added a premium assistance program since January 31, 2024, or for more information on special enrollment rights, contact:U.S. Department of Labor – Employee Benefits Security Administration  Website: www.dol.gov/agencies/ebsa Phone: 1-866-444-EBSA (3272)U.S. Department of Health and Human Services – Centers for Medicare & Medicaid Services Website: www.cms.hhs.gov Phone: 1-877-267-2323, Menu Option 4, Ext. 61565Paperwork Reduction Act StatementAccording to the Paperwork Reduction Act of 1995 (Pub. L. 104–13) (PRA), no persons are required to respond to 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, D.C. 20210, or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.Patient Protection Choice of ProvidersIn cases where the Joe W. Fly Co., Inc. Group Health Plan allows or requires a participant to designate a primary care provider (PCP), the participant has the right to designate any PCP who participates in the network and who is available to accept the participant or participant’s family members. Until you make this designation, Joe W. Fly Co., Inc. Group Health may designate a PCP automatically. For information on how to select a PCP, and for a list of participating PCPs, you can contact your Employer Representative. For children, you may designate a pediatrician as the PCP. You do not need prior authorization from the Joe W. Fly Co., Inc. Group Health Plan or from any other person (including a PCP) to obtain access to obstetrical or gynecological care from a healthcare professional in our network who specializes in obstetrics or gynecology. The healthcare 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 healthcare professionals who specialize in obstetrics or gynecology, contact your Employer Representative.Patient Protection Against Surprise Medical BillsWhat is “balance billing” (sometimes called “surprise billing”)?When you see a doctor or other healthcare 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 healthcare 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 servicesIf you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balance billed for these post-stabilization services. Certain services at an in-network hospital or ambulatory surgical centerWhen you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.Important: 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: Cover emergency services without requiring you to get approval for services in advance (prior authorization). Cover emergency services by out-of-network providers. 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 (EOB). 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 Phone: 800-985-3059 Website: https://www.cms.gov/nosurprises/consumersYour state agency Website:https://www.cms.gov/CCIIO/Resources/Consumer-Assistance-GrantsWhen 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.”

Joe W Fly TX Benefits Guide 112024

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