Return to flip book view

Texana Bank Benefit Guide.PUB

Page 1

EMPLOYEE BENEFITS GUIDEA comprehensive guide to understanding your employee benefits program.

Page 2

Important Contacts Kerri Moulton Account Manager Phone: 903-434-4752 kmoulton@higginbotham.net Toni Melton Phone: 903-576-0548 tmelton@higginbotham.net Medical, Dental, Basic Life, Short Term Disability, Long Term DisabilityCustomerService(800)521‐2227www.bcbstx.comNEED to file a claim? Have questions on a denied claim or a bill? Gayle Peacock, ACSR Claim Specialist Phone: 903-434-4780 gpeacock@higginbotham.net Vision CustomerService(800)662‐5851www.emihealth.comThis brochure highlights the main features of Texana Bank benefits program and does not include all plan rules and details. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be any inconsistencies between this brochure and the legal plan documents, the plan documents are the final authority. Accident, Crical Care, Medical Bridge, Term Life, Whole Life Phone:(800)325‐4368www.coloniallife.comBailey Murphy SeniorHumanResourcesGeneralistP(903)336‐6751bailey.murphy@texanabank.comLauren Witherspoon DirectorofHumanResourcesP(903)334‐0969lauren.witherspoon@texanabank.com

Page 3

T exana Bank is pleased to provide a variety of insurance benefits. You may select the insurance that best fits your needs. You are eligible for benefits if you are a regular, full-time employee working an average of 30 hours per week. Your coverage is effective the first of the month after you have completed 60 days of full-time employment. Enrollment must be completed within 31 days of the date of eligibility. Once your enrollment is completed, no changes will be allowed until the next annual open enrollment period unless you have a Qualifying Life Event or your hours worked per week drop below the minimum. The policy year runs from January 1, 2024 to December 31, 2024; however, the company reserves the right to make changes to the policies at anytime as well as the right to require appropriate documentation to prove your dependent relationship status including marriage, birth, tax returns and other legal documents. You may also enroll eligible dependents for benefits coverage. The cost to you for dependent coverage will vary depending on the number of dependents you enroll in the plan and the particular plans you choose. When covering dependents, you must select the same plans for your dependents as you select for yourself. Eligible Dependents include:  Your legal spouse Children under the age of 26, regardless ofstudent status, dependency or marital status* Natural Child* Legally Adopted Child* Step child*Child for who you or your spouse are the legalguardian as long as you have the sole legalright and obligation to provide support andmedical care Children who are fully dependent on you forsupport due to a mental or physical disability andwho are indicated as such on your federal taxreturn; may continue coverage past age 26 A child of a child who is dependent for federalincome tax purposes at the time application forcoverage of the child is madeQualifying Life Events Once you elect your benefit options, they will remain in effect for the entire plan year until the following Open Enrollment. You may only change coverage during the plan year if you have a Qualifying Life Event, and you must do so within 30 days of the event. You may NOT drop coverage due to financial hardship or dissatisfaction with the plan. Qualifying Life Events include:  Marriage, divorce, legal separation or annulment Birth, adoption or placement for adoption of aneligible child Death of a spouse or child Change in your spouse’s employment that affectsbenefits eligibility Change in your child’s eligibility for benefits(reaching the age limit) Change in residence that affects your eligibilityfor coverage Significant change in coverage or cost in your,your spouse’s or child’s benefit plans FMLA Leave, COBRA event, Court Judgment orDecree Becoming eligible for Medicare or Medicaid Receiving a Qualified Medical Child SupportOrderIf you have a Qualifying Life Event and want to request a mid-year change, you must notify Human Resources and complete your election changes within 30 days following the event. Be prepared to provide documentation to support the Qualifying Life Event. Eligibility 1

Page 4

Enrollment Instructions ENROLL IN YOUR BENEFITS: One step at a timeStep 1: Log InGo to ǁǁǁ͘ďĞŶĞĨŝƚƐŝŶŚĂŶĚ͘ĐŽŵand click Login• Returning users: Log in with the username and password you selected. ,I\RXKDYHIRUJRWWHQ\RXUSDVVZRUG&OLFN5HVHWDIRUJRWWHQSDVVZRUG• First time users: Click on your Registration Link in the email sent to youby your admin or Register as a new user. Create an account, andcreate your own username and password.ŽŵƉĂŶLJ/ĚĞŶƚŝĨŝĞƌ͗TBANKStep 2: Welcome! After you login click Let’s Begin to complete your required tasks.Step 3: Onboarding (For first time users, if applicable)Complete any assigned onboarding tasks before enrolling in your benefits. Once you’ve completed your tasks click Start Enrollment to begin your enrollments. Step 4: Start EnrollmentsAfter clicking Start Enrollment, you’ll need to complete some personal & dependent information before moving to your benefit elections.Have dependent details handy. To enroll a dependent in coverage you will need their date of birth and Social Security number.T I Pif you hit “Dismiss, complete later” you’ll be taken to your Home Page. You’ll still be able to start enrollments again by clicking “Start Enrollments”T I P2

Page 5

Enrollment Instructions Step 8: HR Tasks (if applicable)To complete any required HR tasks, click Start Tasks. If your HR department has not assigned any tasks, you’re finished! You can login to review your benefits 24/7T I PIf you miss a step you’ll see Enrollment Not Complete in theprogress bar with the incomplete steps highlighted. Click on any incomplete steps to complete them.Click Save & Continue at the bottom of each screen to save your elections.If you do not want a benefit, click Don’t want this benefit? at the bottom of the screen and select a reason from the drop-down menu.Step 6: FormsIf you have elected benefits that require a beneficiary designation, Primary Care Physician, or completion of an Evidence of Insurability form, you will be prompted to add in those details.Step 7: Review & Confirm ElectionsReview the benefits you selected on the enrollment summary page to make sure they are correct then click Sign & Agree to complete your enrollment. You can either print a summary of your elections for your records or login at any point during the year to view your summary online.Step 5: Benefit ElectionsTo enroll dependents in a benefit, click the checkbox next to the dependent’s name under Who am I enrolling? Below your dependents you can view your available plans and the cost per pay. To elect a benefit, click Select Plan underneath the plan cost.3

Page 6

Medical Blue Cross Blue Shield MTBCP007H MTBCB042 MTBCP019 Plan Name HSA Plan Base Plan Buy Up Plan In Network Blue Choice PPO Deducbel‐Ind/Family $5,000/$10,000 $5,000/$14,700 $2,000/$6,000MaxOutofPocket‐Indi/Family $5,000/$10,000 $7,350/$14,700 $5,000/$14,700Coinsurance 100/0 80/20 100/0Physician Services PrimaryCare Deducble $45 $30Specialist Deducble $90 $60SimpleLab&X‐ray Deducble Deducble+20% $0VirtualVisits‐MDLive $48 $45 $30Other Services HospitalAdmission Deducble Deducble+20% Deducble+0%OutpaentSurgery Deducble Deducble+20% Deducble+0%EmergencyRoom Deducble $500+Ded+30% Deducble+0%UrgentCare Deducble $75 $75ComplexImaging Deducble Deducble+20% $0Prescripon Drugs RXDeducble IntergratedwithMedical None NoneTierI Deducble $0 $0TierII Deducble $10 $10TierIII Deducble $50 $50TierIV Deducble $100 $100MailOrder‐90daysupply Deducble 3XCopay 3XCopayOut of Network Deducble $10,000/$20,000 $10,000/$29,400 $4,000/$12,000Maximum Out of Pocket Unlimited Unlimited UnlimitedCoinsurance 70/30 70/30 2%Bi‐Weekly Payroll Rates Employee $37.40 $73.22 $146.27Employee+Spouse $235.60 $315.03 $477.06Employee+Child(ren) $207.84 $274.46 $410.34Employee+Family $378.80 $489.05 $713.92Semi‐Monthly Payroll Rates Employee $40.52 $79.32 $158.46Employee+Spouse $255.25 $341.28$516.82Employee+Child(ren) $225.17 $297.34 $444.54Employee+Family $410.37 $529.80 $773.42This illustraon is presented for comparison purposes only. Please refer to the carrier(s) plan summary for terms, con-dions, limitaons, and exclusions. 4

Page 7

5BCBS Virtual Visits

Page 8

DEN-CB-SOC-LG-2023-TXThe Deductibles, Coinsurance Amount, and Annual Maximum below are subject to change as permitted by applicable law.BlueCare DentalSMDTNHR33Covered ServicesContracting DentistNon-Contracting DentistDiagnostic Evaluations (Deductible waived)100%100%Preventive Services (Deductible waived)100%100%Diagnostic Radiographs (Deductible waived)100%100%Miscellaneous Preventive Services 100%100%Basic Restorative Services80%80%Non-Surgical Extractions80%80%Non-Surgical Periodontal Services80%80%Adjunctive Services80%80%Endodontic Services80%80%Oral Surgery Services80%80%Surgical Periodontal Services 80%80%Major Restorative Services 50%50%Prosthodontic Services 50%50%Miscellaneous Restorative and Prosthodontic Services 50%50%Implants 50%50%Orthodontia50%50%Participants are covered with the exception of Dependent children age 19 and overMaximum Lifetime Benefits per individual for Orthodontia$1,500$1,500Deductible Three-Month Deductible Carryover applies$50 individual / $150 family$50 individual / $150 familyAnnual Maximum$1,500$1,500Dental 6

Page 9

DEN-CB-SOC-LG-2023-TXBenefits for covered services received from a Contracting Dentist are based on the Allowable Amount, and such Dentist cannot balance bill for charges in excess of this Allowable Amount.Benefits for covered services received from a Non-Contracting Dentist will be based upon an Allowable Amount determined by BCBSTX, where non-contracting Allowable Amount will be not less than the amount BCBSTX would have paid, for the same covered service, supply, or procedure if performed or provided by a Contracting Dentist, and it is possible that such Dentist will balance bill for amounts above this.Dental 7

Page 10

Group:Texana Bank (Plan #7699)Plan: VSP Plus 10-1301/1/2024Plan Type: VoluntaryIn-NetworkOut-of-Network$10 Co-pay Up to $65$10 Co-payUp to $30$10 Co-payUp to $50$10 Co-payUp to $65$10 Co-payUp to $100$0 Co-pay$95-$105 Co-pay$150-$175 Co-pay$17 Co-pay$15 Co-pay$75 Co-pay$31 Co-pay SV/$35 Co-Pay Multifocal$0 Copay$17 Co-pay$41 Co-pay$16 Co-payUp to 25% Discount$130 Allowance at any VSP doctor or $70 at Costco, Sam's Club or WalmartUp to $80 Up to 20% Off RetailN/A$130 Allowance Up to $115 Up to $500 in Savings Not CoveredUnderwritten by: Educators Health Plans Life, Accident & HealthEHPL.TX.V.VSP.SCH.DVSP Choice PlusWellVision ExamLenses (Glass or Plastic)Lens OptionsLenticularSingle VisionLined Bifocal Lined Trifocal Premium Progressive OptionsCustom Progressive OptionsPlastic Gradient DyeProgressive (Standard no-line)Solid Plastic DyeNetworkEffective Date:Photochromic LensesPolycarbonate for AdultsPolycarbonate for Children (under 18)The reimbursement outlined under the Lenses section is a total reimbursement for lenses and any lens enhancements elected.CoatingsScratch Resistant CoatingThe reimbursement outlined under the Lenses section is a total reimbursement for lenses and any lens enhancements elected.Anti-Reflective CoatingUV ProtectionAdditional lens enhancements NotesThis is a summary of plan benefits. The actual Policy will detail all plan limitations and exclusions.** 20% discount off unlimited additional pairs of glasses offered through any VSP Choice Providers within 12 months of last covered eye exam.*** Discounts average 15-20% off or 5% off a promotional offer for laser surgery, including PRK, LASIK, Custom LASIK, and IntraLase3 LASIK***Refractive SurgeryFramesAllowance Based on Retail PricingExam, Lenses, Frame or ContactsEvery 12 MonthsAdditional Pairs of Glasses**Elective Contact Lenses In Lieu of Frame & LensesElective contact lens fitting, evaluation services and prescription contact lenses are covered up to plan allowance. 15% discount given off contact lens fitting and evaluation services, excluding materials.Frequency Corporate (801)262-7475 Customer Service (800)662-5851 EMIHealth.comVision8

Page 11

Basic Life and AD&D9

Page 12

Short Term Disability10

Page 13

Long Term Disability11

Page 14

Group Accident 4000 - PreferredYou do everything you can to keep your family safe, but accidents do happen. It's comforting to know you have help to manage the medical costs associated with accidental injuries both on and off the job. Accident insurance is designed to help offset the financial effects of a covered accident with a lump sum benefit, paid directly to the employee. Guarantee Issue.Per pay period rates for on/off Job coverageSee brochure for full list of benefits12

Page 15

Group Critical Care 6000 Plan 4 - Cancer & Cancer BenefitsCancer insurance helps offset the out-of-pocket medical and indirect, non-medical expenses related to cancer that most plans don’t cover. This coverage also provides an initial diagnosis benefit and an annual benefit for wellness screening tests. Guarantee Issue during initial enrollment.13

Page 16

                          Group Critical Care 6000 Plan 4 - Cancer & Cancer Benefits14

Page 17

Critical Illness insurance ihelps supplement major medical coverage by providing a lump-sum benefit the policy holder can use to pay for expenses associated with a covered critical illness. These benefits can help pay for recovery, additional medical procedures or any way you choose. Spouse/child coverage is available at 50% of the employee benefit. Benefit available from $5,000 to $50,000 and is Guarantee Issue during initial enrollment up to $30,000.Group Critical Care - Plan 1Critical Illness BenefitsAnnual Wellness Benefit: $50/yearBenefit Payable upon Subsequent Diagnosis of a Critical Illness - Allows the covered person to use the coverage more than once. Child coverage (up to age 26): If elected, children are covered at no additional cost.Plan 1Included withNon-tobacco Rates per pay period for $10,000Tobacco Rates per pay period for $10,00015

Page 18

Group Medical Bridge 7000Group Hospital Indemnity Insurance is designed to help provide financial protection for covered individuals by paying a benefit due to a hospitalization. Employees can use the benefits to cover out-of-pocket expenses and extra bills that can occur. Indemnity lump sum benefits are paid directly to the employee based on the amount of coverage listed, and regardless of the actual cost of treatment. Cost per pay periodCost per pay period16

Page 19

Life InsuranceRates vary based on issue age and tobacco status. Speak with a counselor for more information and a quote.• Employee age 16 – 50 Up to $75k face amount• Employee age 51 – 60 Up to $50k face amount• Employee age 61 – 75 Up to $25k face amount• Spouse age 16 – 75 $10k face amount Term LifeYou can purchase level term life insurance through Colonial Life to protect you and your family. 10-, 15-, 20-, and 30-year terms available. Rates consistant through the length of the term. Coverage for spouse and dependent children available. Coverage is available in $1,000 increments up to five times your salary to $300,000. Minimum of $10,000. Guarantee Issue during Initial Enrollment:Whole Life Whole Life insurance offers protection beyond an individual’s working years, potentially for your lifetime. With a guaranteed death benefit that will never decrease, level premiums that will never increase, cash value accumulation, living benefits and other options, whole life goes beyond typical term life insurance. Plans available in $1,000 increments from $5,000-$300,000. Policy can cover employee, spouse and or children. Guarantee Issue is available up to $50,000. Rates vary based on issue age and tobacco status. Speak with a counselor for more information and a quote.17

Page 20

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.18

Page 21

If you are a Colonial Life customer and your policy includes a wellness screening benefit or wellness rider, all you have to do is go online or call when you have one of the specified wellness tests:  Online claim filing is fast and easy.Visit ColonialLife.com to set up your personalaccount and submit your wellness screening claim electronically. You can select direct deposit for your claims payment.  Call 1-800-325-4368, Monday through Friday,8 a.m. to 8 p.m. EST. You can speak with acustomer service representative or access our Automated Service Center, which is available 24 hours a day, seven days a week.Take advantage of wellness screening benefitsClaims made easyWhat you’ll need:  Date of screening  Type of wellness screening  Medical provider/facility’s phone number whereyou had the screeningSee your policy/certificate for more information.ColonialLife.comYou can review your policy/certificate for coverage details, including a detailed list of wellness tests (if applicable), under the Policies tab at ColonialLife.com.8-19 | NS-13831-3Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2019 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.Wellness screening means a preventive test or biometric screening. This is separate from a doctor’s oice visit claim. Please refer to your policy/certificate for details.19

Page 22

Additional Information• BCBS Employee Portal and mobile app• Medical HSA Information• Vision Insurance Information• EMI Vision Employee Portal and mobile app• Disability Resources• Will Prep and Funeral Assistance• Required Notices20

Page 23

21

Page 24

Health Savings Account 5 2024 Maximum Annual Contribution Individual $4,150 Family $8,300 22

Page 25

VSP Choice PlusAwesome coverage and easy to use benefits.Give your EMI Health ID number23Choose a VSP? network provider1Choice Plus NetworkNo claim forms. No paperwork. It's that easy!- Costco- Walmart- Sam's Club- VisionworksPlans include Exams & Hardware VSP does the rest!23

Page 26

Extra savings with your vision planHere are some perks on your vision benefits!- All non-covered lens options are cost-controlled, averaging 20-25% off retail prices.- Most popular lens options have fixed co-pay for upgrades like light-reactive, impact-resistant, scratch-resistant, anti-glare coating, UV coatings, and more.- 20% savings on frame cost over the frame allowance.- 20% savings on complete pairs within the last 12 months of exam.- 15% savings on contact lens evaluation & fitting fees.- Laser vision correction.- Average 15% off the regular price or 5% off the promotional prices; only available from contracted facilities.- After surgery, use your frame allowance (if eligible) for sunglasses from any VSP doctor.Provider Level - Assignment of Benefit Option (AoB)- Provider bills VSP for OON reimbursement.- Member pays overage at the time of service.1Member Level - Submitting for Reimbursement- ALL CLAIMS BY MAIL MUST BE SUBMITTED ON A VSP MEMBER REIMBURSEMENT FORM.- To submit a claim, you will need a copy of the itemized receipts or service statements.- To submit a claim by mail, contact VSP Member Services at 800.877.7195 to request a VSP Member Reimbursement Form. The form can be sent to a preferred address or emailed to you. You must complete the form and mail it to the address below. VSPAttention: Claims ServicesPO Box 385018Birmingham, AL 35239-50182Online Submission - VSP.com- Member signs in and completes online form and submits electronically.3Out- of- Network (OON) Claim Submittal OptionsIf you do visit an out- of- network provider, you have options24

Page 27

Let's take a tour of your dashboardMy EMI Health AccountNote: not all of these blocks may appear on your dashboard. This guide covers all that may possibly show up, but they may not apply to the EMI Health plans you are enrolled in. Welcome to the your member dashboard! In less than 30 seconds, you can see everything you need to know.12431View your member ID cardView, download, or print your EMI Health ID card by clicking on ?View Your Member ID Card? button.2See your plan documentsHere are the plans you are currently enrolled in through EMI Health. From here, you can view your plan documents (your coverage grids and/ or fee schedules if applicable) and access your pharmacy tools. 3View and sort your recent claimsUse the toggles to filter and sort your claims by type, covered member, network, and date range. View your Explanation of Benefits (EOBs) documents by clicking on ?View EOB? to the right of each claim. Note: These documents are not mailed, so it's important to check your dashboard regularly for any new EOBs that come into your account.4At- a- glance accumulatorsIn this block, you are able to see your progress towards applicable plan accumulators for medical and dental plans. Use the drop down options at the top to switch between covered members on your plan, time period, and accumulator type.25

Page 28

My EMI Health AccountAll your benefit answers in one place.Getting Started:Find everything related to your benefits from general plan documents to detailed claims information.What you can do:- View your plan documents- View and sort your claims- Download, and print your ID cards- View all your EOBs- See at- a- glance progress towards your accumulators- Review eligibility/ enrollment status- Go to emihealth.com.- Click Sign In and select My EMI Health.- Select Register and choose Member as the type of account.- Enter the data to identify yourself and click Continue.* You will need your Member ID found on your EMI Health ID card. Also, for your security, your password must be at least six characters and include a special character, e.g., !, @, #, $, etc.**Please note that you will only make an EMI Health account for your family through the plan subscriber. Dependents and spouses will not have their own account.26

Page 29

Find in- network providers and facilities.Provider SearchNeed to talk to a person? No problem . Call us from the app.Customer ServiceAccess your ID Card from anywhere at any time.ID CardView your EOBs and search by person, service, date, and more.EOBsView and download your plan grids so you always know the benefits you have.Plan InformationDownload the app and log in using your My EMI Health username and password.If you haven't registered your account, you can do so in the app or online at emihealth.com.Log in/ Register- Access current and past issues of the Hope Health newsletter.- Update your profile information like email address, password, or security questions.Other FeaturesThe EMI Health Mobile AppYour benefits. Anytime. Anywhere.Scan this QR codewith your phoneto download.27

Page 30

28

Page 31

29

Page 32

Life InsuranceServices for Insureds, Beneciaries and Their FamiliesBeneciary Resource Services™ Benets Beyond a CheckWhen a loved one dies, families often face complex issues ranging from estate planning, legal questions, funeral planning and coping with grief and nancial uncertainties. That’s why we oer Beneciary Resource Services, a program that combines family wellness and security at the most dicult of times. Services include grief and nancial counseling, funeral planning, legal support and online will preparation. Beneciary Resource Services is provided by Morneau Shepell.Beneciary Resource Services™Counseling: 800 -769-9187BeneciaryResource.comUsername: beneciaryServices for Insureds and Their FamiliesOnline Will PreparationYou and your family have access to a full legal library with many estate planning documents, including an online will. You can create your own will online in a safe and secure way, right from your home. The will can be saved and updated as family situations change. Creating a will provides security and peace of mind for several reasons:• Appoints a guardian for children• Controls where property and assets go• Provides family securityOnline Funeral PlanningYou have access to an online funeral planning site that features a variety of helpful tools and information, such as:• A downloadable funeral planningguide to document vital informationyour loved ones will need whenmaking nal arrangements• Calculators to estimate and compareexpenses for various types of funeralarrangements• Information on funeral requirementsand various religious customs• Directories to locate funeral homesand cemeteries in your areaInsurance products issued by Dearborn Life Insurance Company, 701 E. 22nd St. Suite 300, Lombard, IL 60148. 30

Page 33

To access these valuable resources, call or visit:800-769-9187BeneciaryResource.comUsername: beneciary*May include face-to-face sessions, over-the-phone sessions or time taken for research or document preparation.Beneciary Resource Services™Counseling: 800-769 -9187BeneciaryResource.comUsername: beneciaryBlue Cross and Blue Shield of Texas is the trade name of Dearborn Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. Services for Beneciaries and Their FamiliesThe following services are available after a life claim or for those who qualify for an accelerated death benet:Face-to-Face Working Sessions*Five face-to-face working sessions are available to you or your beneciaries. All ve sessions may be used with one grief counselor or legal advisor, or they may be split among the two types of counselors or advisors in geographically accessible locations. A one-hour nancial consultation on the phone is also available.Unlimited Phone ContactAvailable for up to one year with a grief counselor, legal advisor or nancial planner.Referrals and Support ServicesMorneau Shepell maintains a comprehensive directory of qualied and accessible grief counselors and legal and nancial consultants.Follow UpCounselors will initiate follow-up calls when necessary for up to one full year from the date of initial contact.Morneau Shepell’s network of experienced professionals can oer counseling for those facing emotional, nancial or legal issues. Morneau Shepell’s counselors are available 24 hours a day, 365 days a year. All calls are completely condential.750109.0919For employee use. Beneciary Resource Services is provided by Morneau Shepell. Morneau Shepell is an independent organization that does not provide Blue Cross and Blue Shield of Texas (BCBSTX) or Dearborn Life Insurance Company products or services. Morneau Shepell is solely responsible for the products and services described in this ier. Legal services will not be provided for court proceedings or for the preparation of briefs for legal appearances or actions or for any action against any party providing Beneciary Resource Services. Legal services provided under Beneciary Resource Services are not intended for adversarial matters. May include face-to-face sessions, over-the-phone sessions or time taken for research or document preparation. Neither Morneau Shepell, BCBSTX nor Dearborn Life Insurance Company are responsible or liable for care or advice rendered by any referral resources.Blue Cross and Blue Shield of Texas is the trade name of Dearborn Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. 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.31

Page 34

Required Notices Women’s Health and Cancer Rights Act of 1998 In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully. As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:  All stages of reconstruction of the breast on which themastectomy was performed; Surgery and reconstruction of the other breast to produce asymmetrical appearance; and Prostheses and treatment of physical complications of themastectomy, including lymphedema.Health plans must determine the manner of coverage in consul-tation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to de-ductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan. Special Enrollment Rights This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time. Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP) If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later 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 enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage). If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is termi-nated from, or determined to be eligible for such assistance. Marriage, Birth or Adoption If youhave anew dependentas a result of a marriage, birth,adopon,orplacementforadopon,youmaybeabletoenrollyourselfandyourdependents.However,youmustenrollwith‐in31daysaerthemarriage,birth,orplacementforadopon.For More Information or Assistance To request special enrollment or obtain more information contact: Texana Bank 1698 Keller Pkwy,Suite 100 Keller, TX 76248 (903)334-0969Your 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 Texana Bank and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice. 1. Medicare prescription drug coverage became available in2006 to everyone with Medicare. You can get this coveragethrough a Medicare Prescription Drug Plan or a MedicareAdvantage Plan that offers prescription drug coverage. AllMedicare prescription drug plans provide at least a standardlevel of coverage set by Medicare. Some plans may alsooffer more coverage for a higher monthly premium.2. Texana Bank has determined that the prescription drugcoverage offered by the BlueCross BlueShield medical planis, on average for all plan participants, expected to pay outas much as the standard Medicare prescription drug cover-age pays and is considered Creditable Coverage. The HSAplan is not considered Creditable Coverage.Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods. You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to en-roll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D, after first becoming eligible to enroll, you may have to pay a higher pre-mium (a penalty). 32

Page 35

Required Notices You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Texana Bank at the phone number or address listed at the end of this section. If you choose to enroll in a Medicare prescription drug plan and cancel your current prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to de-termine if and when you are allowed to add coverage. If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage. For more information about this notice or your current prescription drug coverage: Contact the Higginbotham at 903-334-0969 NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy. For more information about your options under Medicare prescription drug coverage: More detailed information about Medicare plans that offer pre-scription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare pre-scription drug plans. For more information about Medicare pre-scription drug coverage:  Visit www.medicare.gov. Call your State Health Insurance Assistance Program (seethe inside back cover of your copy of the “Medicare &You” handbook for their telephone number) for personal-ized help. Call 1-800-MEDICARE (1-800-633-4227). TTY usersshould call 877-486-2048.If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this help is available from the Social Security Administra-tion (SSA) online at www.socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778. Remember: Keep this Cr editable Coverage notice. If you enroll in one of the new plans approved by Medicare which of-fer prescription drug coverage, 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 whether or not you are required to pay a higher premium (a penalty). Date: 1/1/2024 Texana Bank 1698 Keller Pkwy,Suite 100 Keller, TX 76248 (903)334-0969Notice of HIPAA Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan - whether received in writing, in an electronic medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by Spring Creek Enterprises, hereinafter referred to as the plan sponsor. The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer. You have the right to inspect and copy protected health infor-mation which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protect-ed health information about you is incorrect or incomplete, you may ask the Human Resources Department to amend the infor-mation. For a full copy of the Notice of Privacy Practices de-scribing how protected health information about you may be used and disclosed and how you can get access to the infor-mation, contact the Human Resources Department. Complaints: If you believe your privacy rights have been violat-ed, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for fil-ing a complaint. To file a complaint, please contact the Privacy Officer. Texana Bank 1698 Keller Pkwy,Suite 100 Keller, TX 76248 (903)334-096933

Page 36

Required Notices 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 are 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 and CHIP pro-grams. If you or your children are not eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance pro-grams but you may be able to buy individual 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, you can 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, you can ask the 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 em-ployer plan, your employer must allow you to enroll in your employer plan if you are not already enrolled. This is called a “special enrollment” opportunity, and you must request cover-age within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your em-ployer 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, 2018. Contact your State for further information on eligibility. TEXAS – Medicaid Website: http://www.gethipptexas.com/ Phone: 1-800-440-0493 To see if any more States have added a premium assistance pro-gram since July 31, 2018 or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272)U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu option 4, Ext. 61565Continuation of Coverage Rights Under COBRA 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 cov-erage through the Marketplace, you may qualify for lower 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 cov-erage 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 depend-ent 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 yourgross 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 thanhis or her gross misconduct; Your spouse becomes entitled to Medicare benefits (underPart A, Part B, or both); or You become divorced or legally separated from your spouse.34

Page 37

Required Notices Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qual-ifying events:  The parent-employee dies; The parent-employee’s hours of employment are reduced; The parent-employee’s employment ends for any reasonother 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 thechild stops being eligible for coverage under the Plans 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; 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 Ad-ministrator within 60 days after the qualifying event occurs. How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be of-fered to each of the qualified beneficiaries. Each qualified bene-ficiary will have an independent right to elect COBRA continu-ation coverage. Covered employees may elect COBRA continu-ation coverage on behalf of their spouses, and parents may elect 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 this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of COBRA continu-ation coverage If you or anyone in your family covered under the Plan is deter-mined by Social Security to be disabled and you notify the Plan Administrator timely, you and your entire family may be enti-tled to get up to an additional 11 months of COBRA continua-tion 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 cov-erage 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. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose cov-erage under the Plan had the first qualifying event not oc-curred. Are there other coverage options besides COBRA Continu-ation 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, 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 cover-age. You can learn more about many of these options at www.healthcare.gov. 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 un-der 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: Texana Bank 1698 Keller Pkwy,Suite 100 Keller, TX 76248 35

Page 38

Required Notices New Health Insurance Marketplace Coverage Options and Your Health Coverage PART A: General Information With key parts of the health care law now in effect, there is a new way to buy health insurance: the Health Insurance Marketplace. To assist you in evaluating options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by the employer. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in November for coverage starting as early as January 1. Can I Save Money on my Health Insurance Premiums in the Mar-ketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit. Note: If you purchase a health plan through the Marketplace in-stead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution – as well as your employee contribution to employer-offered coverage-is often excluded from in-come for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or your Human Resources Administrator. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insur-ance Marketplace in your area. PART B: Information About Health Coverage Offered by Your Em-ployer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This infor-mation is numbered to correspond to the Marketplace application. PART B: Information About Health Coverage Offered by Your Em-ployer Continued Here is some basic information about health coverage offered by this employer: As your employer, we offer a health plan to:  Full-time associate who work a minimum of 30 hours per week and are at least 18 years of age are eligible to participate in the benefits program. Enrollment must be completed within 31 days of the date of eligibility.  Once your enrollment is completed, no changes will be allowed until the next annual open enrollment period unless you have Qualifying Life Event or your hours worked per week drop below the minimum.  Additional information regarding Eligibility can be found on pg 3. With respect to dependents:  Your eligible dependents include: —Your legally-married spouse. —Your children from birth to age 26 —Your unmarried dependent children of any age who are men-tally or physically disabled and who are dependent on you for support.  Children include: —Natural children —Legally-adopted children (or children place with you for adoption) —Stepchildren —Children for whom you or your spouse are the legal guardian, as long as you have the sole legal right and obligation to provide support and medical care.  Dependent coverage takes effect on the same date your coverage be-gins. You may be asked to provide evidence that your dependents meet the eligibility requirements, such as birth certificate, adoption or guardianship papers, a marriage license or a federal income tax return.  Additional info regarding Dependents found on pg 3.  This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wag-es. 36

Page 39

Required Notices  Even if your employer intends your coverage to be afforda-ble, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are hourly or you work on a commission basis), if you are newly employed mid-year, or if you have other income loss-es, you may still qualify for a premium discounts. Newborns’ and Mothers’ Health Protection Act (NMHPA): Group health plans & health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s at-tending provider, after consulting the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans & issuers may not, under federal law, require that a provider obtain authorization from the Plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Notice Regarding Wellness Program The employee wellness program is a voluntary program admin-istered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or pre-vent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness program you may be asked to complete a voluntary health risk assessment or "HRA" that asks a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabe-tes, or heart disease). You may also be asked to complete a bio-metric screening, which could include a blood test for certain medical conditions such as diabetes, heart disease, etc. You are not required to complete the HRA or to participate in the blood test or other medical examinations. However, employees who choose to participate in the wellness program may qualify for an incentive. Although you are not required to complete a HRA or biometric screening, the wellness program may specify that only employees who do so will quali-fy for the incentive. Additional incentives may be available for If you are unable to participate in any of the health-related activ-ities or achieve any of the health outcomes required to earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accom-modation or an alternative standard by contacting your HR dept. If you choose to participate in a HRA and/or biometric screen-ing, information from your HRA and results from your bio-metric screening will be used to provide you with information to help you understand your current health & potential risks & may also be used to offer you services through the wellness program. You also are encouraged to share your results or concerns with your own doctor. Protections from Disclosure of Medical Information We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program may use aggregate information it collects to design a program based on identified health risks in the work-place, the wellness program will never disclose any of your per-sonal information publicly or to the employer, except as neces-sary to respond to a request from you for a reasonable accom-modation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you provided in connection with the wellness program will not be provided to your supervisors or managers & may never be used to make decisions regarding your employment. Your health information will not be sold, exchanged, trans-ferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness pro-gram, and you will not be asked or required to waive the confi-dentiality of your health information as a condition of participat-ing in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. In addition, all medical information obtained through the well-ness program will be maintained separate from your personnel records, information stored electronically will be encrypted, & no information you provide as part of the wellness program will be used in making any employment decision. Appropriate pre-cautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in con-nection with the wellness program, we will notify you immedi-ately. You may not be discriminated against in employment because of the medical information you provide as part of par-ticipating in the wellness program, nor may you be subjected to retaliation if you choose not to participate. If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact Human Resources. 3. Employer Name: Texana Bank 4. Employer Idenficaon Number (EIN): 75‐02696105. Employer Address: 1696 Keller Pkwy, Suite 100 6. Employer Phone Number: (903) 334‐09697. City: Keller 8. State: TX 9. Zip Code:7624810. Who can we contact about employee health coverage at this job?: Lauren WitherSpoon11. Phone Number: (903) 334‐0969 12. E‐Mail Address: lauren.witherspoon@texanabank.com1Anemployer–sponsoredhealthplanmeetsthe“minimumvaluestandard”iftheplan’sshareofthetotalallowedbenefitcostscoveredbytheplanisnolessthan60percentofsuchcosts.37

Page 40

Prepared by Higginbotham 1610 Shadywood Ln Mount Pleasant, TX 75455 Phone: (800) 256-1905 www.higginbotham.com This brochure highlights the main features of Texana Bank's employee benefits program. It does not include all plan rules, details, limitations, and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be an inconsistency between this brochure and the legal plan documents, the plan documents are final authority. Texana Bank reserves the right to change or discontinue the employee benefits plans at any time.