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Teal Energi 2024 Benefits Guide

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ThebenefitsplanyearrunsJanuary1stthroughDecember31st.Unlessyouhaveaqualifiedchange-in-statuseventthatimpactsyoureligibilityandthechangeisallowedunderthetermsoftheinsurancecontractorplandocument,youcannotmakechangestoyourbenefitsuntilthenextOpenEnrollmentperiod.Benefitchangesmustbeconsistentwithyourqualifiedchange-in-statusevent.ChangesmustbesubmittedtoHumanResourceswithin30daysoftheevent;documentationsupportingthechangewillberequired.Whoiseligibleforbenefits?Allfull-timeemployeeswhoworkaminimumof30hoursperweekareeligibleforbenefits. For new hires, benefits are effective on the first of the month followingyourdateofhire.In addition to enrolling yourself, you may also enroll any eligible dependents.Eligibledependentsaredefinedbelow:• Spouse:apersontowhomyouarelegallymarriedbyceremony• Child(ren):Yourbiological,adopted,orlegaldependentsuptoage26regardlessof student, financial, and marital status; coverage for a dependent child willterminateattheendofthemonthinwhichthechildturnsage26Change-in-StatusEventsUnlessyou have aqualifiedchange-in-statuseventthat impactsyoureligibilityandthechangeisallowedunderthetermsoftheinsurancecontractorplandocument,youcannot make changes to the benefitsyouelectuntilthenext Open Enrollmentperiod.Someexamplesofqualifiedchange-in-statuseventsarehighlightedbelow:MarriageordivorceBirth,adoption,ordeathChangeinemployment,oremploymentstatusforyou,yourspouse,oryourdependentchildChangeincoverageunderanotheremployerplan,suchasachangemadeduringyourspouse’sOpenEnrollmentTeal Energi takesprideinproviding acomprehensiveemployee benefits program, and we recognize theimportant role employee benefits play as a criticalcomponent of your overall compensation. We striveto maintain a benefits program that is rewarding andcompetitive.WHAT’SINSIDEEmployeeResourcesEmployeeContributionsMedicalDentalVisionPlanHighlightsLife/AD&DDisabilityEmployeeAssistanceProgramTravelAssistanceProgram2

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EMPLOYEERESOURCESPlan PolicyNumber PhoneNumberandWebsite/EmailMedicalBlueCrossBlueShield359914(800) 521-2227 www.bcbstx.comDentalPrincipalFinancial1163013-10001(800) 247-4695www.principal.com/dentistVisionPrincipalFinancial1163013-10001(800) 877-7195www.principal.com/vsp LifeandDisabilityPrincipalFinancial1163013-10001(800) 245-1522www.principal.comEmployeeAssistanceProgram(EAP)PrincipalFinancial1163013-10001(800) 450-1327www.magellanhealth.com/memberTravelAssistanceProgramPrincipalFinancial1163013-10001(888) 647-2611www.principal.com/travelassistanceManyofourprovidershavemobileappsthatprovidepersonalizedaccesstoyourbenefitswhenandwhereyouneedthem!TherearealsoavarietyofFREEhealthandfitnessrelatedappsavailable.BrowseanddownloadappstoyoursmartphoneortabletfromtheAppStoreorGooglePlay.THERE’SANAPPFORTHAT!3

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4WeofferthreePPOplansforyoutochoosefrom.To locateaparticipating,in-networkprovider,visitwww.bcbstx.com.Thischartisintendedforsummarypurposesonly.Ifthereareanydiscrepancies,theofficialplandocumentswillalwaysgovern.Pre-certificationmayberequiredforcertainservices.MEDICAL&PRESCRIPTIONPLANHIGHLIGHTSPPOPLANS(InandOut-of-Network;NoPCPRequired)PlanFeaturesPlanOption1 PlanOption2 PlanOption3$6,350HDHP $4,000HDHP $1,500PPO(B660CHC) (G656CHC) (G653CHC)IN-NETWORKProviderNetwork BlueChoicePPO BlueChoicePPO BlueChoicePPOHSACompatible? YES YES NOAnnualDeductibleAmountyoumustpaybeforetheplanwillbegintopayforcertainservices$6,500individual$13,000family$4,000individual$12,000family$1,500individual$4,500familyAnnualOut-of-PocketMaximumMaximumamountyoupayperyearforcoveredexpenses$7,250individual$14,500family$4,000individual$12,000family$6,000individual$12,000familyPREVENTIVESERVICESWell-childvisitsandimmunizations,routineGYNvisit,annualadultphysical,andotherappropriatescreeningsasoutlinedintheACANocharge Nocharge NochargeOFFICEVISITS,LABS,ANDTESTINGPCP&SpecialistOfficeVisits 30%afterdeductible 0%afterdeductible $40Copay/$80CopayDiagnosticTest(x-ray,bloodwork) 30%afterdeductible 0%afterdeductibleLab:20%afterdeductibleX-Rays:$50pertest+ 20%afterdeductibleImaging(CT/PETscans,MRIs)(pre-authorizationmayberequired)30%afterdeductible 0%afterdeductible$100copaypertest+ 20%afterdeductibleHOSPITALInpatient/Outpatient 30%afterdeductible 0%afterdeductible 20%afterdeductibleURGENTANDEMERGENCYCAREUrgentCare 30%afterdeductible 0%afterdeductible $75copayEmergencyRoom$650pervisit+30%afterdeductible0%afterdeductible$500copaypervisit+ 20%afterdeductiblePRESCRIPTIONDRUGSRetailPharmacy(30-daysupply)GenericNon-PreferredGenericBrandNameNon-PreferredBrandNamePreferredSpecialtyNon-PreferredSpecialty10%-50%afterdeductible(refertoSBCpharmacytiers)0%afterdeductiblePreferred/Non-PreferredPharmacy$0/$10$10/$20$50/$70$100/$120$150$250MailOrder(90-daysupply)SpecialtyRXnotcovered10%-50%afterdeductible 0%afterdeductible $0/$30/$150/$300 OUT-OF-NETWORKAnnualDeductible$13,000individual$26,000family$8,000individual$24,000family$3,000individual$9,000familyAnnualOut-of-PocketMaximum Unlimited$8,000individual$24,000familyUnlimited

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5HEALTHSAVINGSACCOUNTWhoIsEligible?*Allthreecriteriamustbemet:• EnrolledinanIRS“qualified”HighDeductibleHealthPlan• Notcoveredbyanothermedicalplanunlesstheotherplanisalsoa“qualified”HDHP• NotenrolledinMedicarecoverage*Itistheemployee’sresponsibilitytonotifyHRifyouarenoteligibleforHSA.Howdoesitwork?The HDHP allows employees to set aside money on a pre-tax basis into a Health Savings Account (HSA).TheHSAisanaccountestablishedexclusivelyforthepurposeof payingforqualifiedmedicalexpensesforyouandyoureligibledependentsonatax-freebasis.ContributionstotheHSAarefundedwithpre-taxdeductionswithheldfromyourpaycheck.Thefundsaredeposited into an interest-bearingaccount in your name. The money in the HSA can be used to pay foreligible expenses not covered by your insurance plan, including the deductible, coinsurance, and copays.Any money not used for qualified medical expenses remains in the account. In the event you leave TealEnergi,youowntheaccountandthemoneytherein.Foracomplete listof“qualified” medical expenses,pleaserefertoPublication502atwww.irs.gov.HowmuchcanIcontribute?IRSANNUALLIMITS 2024MaximumContributionSingleOnly $4,150Employee+Dependents $8,300Catch-UpContribution Employeesage55+maybeeligibletocontributeanadditional$1,000

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Dental-PrincipalWearepleasedtoofferyouacomprehensivedentalPPOplan.Youcanvisitanylicenseddentist,butyourcostsareusuallylowestwithanin-networkdentist.In-networkdentistsacceptreducedfeesforcovered services;out-of-network dentistsmaybalancebillyouthedifferencebetweentheirusualfeeandwhattheplanpays.Limitationsorwaitingperiodsmayapplyforsomebenefits;someservicesmaybeexcludedfrom your plan.Thesechartsareintendedforsummarypurposesonly.Ifthereareanydiscrepancies,theplandocumentwillalways govern. Dental Reimbursement for out-of-network services is based on the maximum contractallowancesandnotnecessarilyeachdentist’ssubmittedfees.Youwillpaylessmoneywhenyoustaywithinthenetwork.Needtolocateaparticipating,in-networkprovider?Visitwww.principal.com/vspDENTAL&VISIONPLANHIGHLIGHTSPreventionfirst!Make sure you take advantage of yourpreventive dental visits. Preventive careservicesarenotsubjecttothedeductibleandthe plan covers100%of the cost ifyouvisitanin-networkprovider!6Vision-PrincipalYour vision coverage provides a full range of vision care services. You may receive care from any provider you choose, but yourbenefitsaregreaterwhenyouseeaparticipatingproviderinthenetwork.Ifyouchoosetoreceiveservicesfromanout-of-networkprovider, youwillberequiredtopaythatprovideratthetimeofserviceandsubmitaclaimformforreimbursement.MaximumAccumulation(RolloverBenefit)1Threshold2$750Carry-over350%ofthresholdtoamaximumof$3751. This allows for a portion of unusedmaximumbenefittocarryovertonextyear'smaximum benefit amount. To qualify, youmust have had a dental service performedwithin the Calendar year and used less thanthemaximumthreshold.2. Thethresholdisequaltothelesserof50%ofthemax benefit or$1,000.Ifqualificationismet,50%ofthethresholdwillcarryovertonextyear’smaxbenefit.3. You can accumulate no more than 4Xcarryoveramount.PlanFeaturesIn-Network&Out-of-NetworkNetworkPrincipalDentalPPOCalendarYearDeductibleAmountyoumustpaypercalendaryearbeforetheplanbeginstopaybenefits.Thedeductibleiswaivedforpreventiveservices.$50individual$150familyPreventiveandDiagnosticServicesNocharge—nodeductibleBasicServicesDeductible,then20%MajorServicesDeductible,then50%AnnualBenefitMaximum$1,500perpersonpercalendaryear,plus,anymaximumrolloverbenefitMaximumamounttheplanwillpaypercalendaryearOrthodontiaNotCoveredOutofNetworkProcessing90thPercentilePlanFeatures In-NetworkOut-of-NetworkReimbursementVisionExam(Onceevery12months)$10copay Upto$45EyeglassFrames(Onceevery12months)$130planallowance+ 20%offbalanceUpto$70EyeglassLenses(Onceevery12months)Single$25copay Upto$30LinedBifocal$25copay Upto$50LinedTrifocal$25copay Upto$65Lenticular$25copay Upto$100ContactLenses Elective:$130allowance Upto$105(Onceevery12months)Necessary:$25copay Upto$210* Benefitallowanceincludescoverageforglassesframesorcontactlenses,notboth.

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BasicTermLifeandAD&DInsurance(CompanyPaid)Allfull-timeemployeesworking30ormorehoursperweekareautomaticallyenrolledinthebasiclifebenefit.Whilecoverageisautomatic,iscriticalthatyoudesignateabeneficiarywhenfirstenrollinginbenefits.Youcanchangeyourbeneficiaryatanytimeandasfrequentlyasneeded.LIFEINSURANCEDuringyourbenefitsenrollment,don’tforgettodesignateabeneficiary!7Lifeinsurancehelpsprotectyourfamilyfromfinancialriskandsuddenlossofincomeintheeventofyourdeath.Accidentaldeathanddismemberment (AD&D)insurance provides an additionalbenefit ifyoulose your life, sight, hearing, speech, orlimbsin anaccident.CompanyPaidSummaryLifeBenefitFlat$50,000AccidentalDeathBenefitFlat$50,000ReductionScheduleBy35%@65;50%@70AdditionalBenefitsConversion,AcceleratedDeathBenefit,WaiverofPremiumVoluntarySummaryLife/AD&DBenefit- Employee- Spouse- Child(ren)[TermLifeOnly]$10,000-$300,000$5,000-$100,000(cannotexceed100%ofemployeeamount)$5,000or$10,000GuaranteedIssueCoverage(nomedicalquestions)- Employee(Underage70)- Spouse(Underage70)$100,000$20,000ReductionScheduleBy35%@65;50%@70AdditionalBenefitsConversion,AcceleratedDeathBenefit,WaiverofPremiumVoluntaryTermLifeandAD&D Insurance(EmployeePaid)Allfull-timeemployeesworking30ormorehoursperweekareeligibletoenrollinadditionalvoluntarylifeinsuranceaboveandbeyondtheemployerpaidbenefits.Voluntarytermliferatesareofferedatheavilydiscountedgrouprates.Solongasyouenrollwhenfirsteligible,guaranteedcoverageisalsoavailabletoyou,regardlessofyourcurrenthealthstatus.

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DISABILITYINSURANCE8EmployerpaidShort-TermDisabilityPlanFeaturesPrincipalLifeInsuranceCompanyEmployeeBenefitAmount 60%MaximumBenefitAmount $2,000perweekEliminationPeriod(WaitingPeriod) 14DaysBenefitDuration 11WeeksPre-ExistingConditionExclusion NoneVoluntaryLong-TermDisabilityPlanFeaturesPrincipalLifeInsuranceCompanyEmployeeBenefitAmount 60%MaximumBenefitAmount $10,000permonthOwnOccupationPeriod 2YearsEliminationPeriod(WaitingPeriod) 90DaysBenefitDuration SocialSecurityNormalRetirementAgePre-ExistingConditionExclusion 3/12*WhydoyouneedVoluntaryLong-TermDisability?(EmployeePaid)Alengthydisabilitycanbedevastatingandismorecommonthanyoumaythink.Long-termdisabilitymayleadtoalossofincome,independence,andfinancialsecurity.Adisabilityinsurancepolicycanhelpprovidesecuritywhenyouneeditmost,anditpaysyoucashbenefitswhenyou’resickorhurtandcan’twork.Asanactive,full-timeemployee,youareeligibletoelectLTDandtakeadvantageofthegrouprate.WhydoyouneedShort-TermDisability?(CompanyPaid)Howwillyou payyourbillsifyouwere sickorinjured? Evenashort illnessorinjurycould seriouslyimpactyourpaycheck.What happens when yoursick time runsout?  Disabilityreplaces part of your income ifyou are unableto work due to anaccident,illness,orifyouareexpectinganewadditiontoyourfamily. MaternityLeaveisoneofthemostcommonusesfordisabilityinsurance.Fortunately, allfull-timeemployeeswhoworkaminimumof30hoursperweekareautomaticallyenrolledinShort-Termdisability.*Apre-existingconditionisoneforwhichyouhavereceivedmedicaltreatment,consultation,careorservicesincludingdiagnosticmeasures,orifyouwereprescribedortookprescriptionmedicationsinthepredeterminedtimeframepriortoyoureffectivedateofcoverage.Thepre-existingconditionunderthisplanis3/12whichmeansanycondition(includingpregnancy)thatyoureceivemedicalattentionforinthe3monthspriortoyoureffectivedateofcoveragethatresultsinadisabilityduringthefirst12monthsofcoveragewouldnotbecovered.

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ADDITIONALBENEFITS9EmployeeAssistanceProgram-100%CompanyPaidLifecanbeunpredictable.Andit’snotalwayseasy. Thereishelpavailablewhenyouneedit.Thatiswhattheemployeeassistanceprogram(EAP),providedbyMagellanHealthcare,isallabout.WithanEAP, youandyourfamilyhaveaccess tofree,confidentialresources tohelphandle life’s everyday- and notsoeveryday-challenges.You might use your EAPtohelp:manage stress,handlerelationshipissues,balance workandlife, workthroughgrief,copewithanxiety,andmore.Sampleservicesinclude:ü In-personorvirtualcounselingü Legal,financial,andidentitytheftservicesü Work-lifewebservicesTravelAssistanceProgram-100%CompanyPaidWhetheryou’retravelingrighthereintheUnitedStatesorleavingthecountry,youcanrelyonAXAtohelpyourtravelexperiencegooff without a hitch. And because you’re covered by group term life insurance from Principal®, you have access to many travelassistanceservicesforfree—nomatterifyou’retravelingforbusinessorpleasure.Sampletopicsinclude:ü Lostorstolenitemsü Medicalassistanceü Telephonictranslation/interpreterservicesü Prescriptionreplacementassistanceü Emergencymedicalevacuation

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2022BENEFITSENROLLMENTBOOKLETBookletDevelopedinPartnershipWith