WoodsEdge Community Church 2024 Benefit Guide : simplebooklet.com

ELIGIBILITY WHO IS ELIGIBLE All full-time employees working an average of at least 30 hours per week throughout the calendar year are eligible for a full range of benefits provided by WoodsEdge Community Church. You may also enroll your eligible dependents. WHEN TO ENROLL Benefit eligible employees initially have the two following opportunities to enroll in the benefits program: NEW HIRE ENROLLMENT: New hires have until the first of the month following or concurrent with your date of hire to enroll in WoodsEdge’s benefit coverages. Employees not enrolling during this period must wait until the next open enrollment in November 2024 to elect coverage. OPEN ENROLLMENT: Open enrollment is November 14 – 30, 2023 for the 2024 plan year. At this time employees can change their elections or enroll for the first time. WHEN YOU CAN MAKE CHANGES WoodsEdge’s benefits plan year is from January 1 to December 31. Generally, you can only change your benefit choices during the annual Benefits Enrollment period or if you have an IRS “Qualifying Event” during the year, which includes: •Marriage or Divorce•Birth, adoption or placement for adoption of an eligible child•Death of your spouse or covered child•Change in your spouse’s work status that results in cancellation of your benefits•Your dependent child is no longer eligible•Becoming eligible for Medicare or Medicaid during the yearIf you have a life event change, you must submit notification to your Human Resources department within 30 days of the qualifying event. Depending on the type of change, you may need to provide proof documentation (for example, a marriage license or birth certificate). If you do not submit notification within 30 days, you will have to wait until the next annual Open Enrollment period to make benefit changes. WHEN COVERAGE ENDS Benefits end on the last day of the month in which your employment with WoodsEdge Community Church ends, or when you cease to meet eligibility guidelines. COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985) continuation of coverage is available for eligible terminations for medical, dental and vision coverages.

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Help is at your ﬁngertips Contact informationMedical, Dental & Vision For personalized claim and plan information: Aetna: Login to your personalized site https://www.aetna.com click “member log-in” Guardian: Guardian Anytime site: www.Guardianlife.com Life and LTD For Disability or Life claims, please contact Human Resources. Find your providers Online Provider DirectoriesAetna Medical - https://www.aetna.com Click on “Find a Doctor” and follow the prompts. Select the “Aetna Choice® POS II (Open Access)” network OR Log into your personalized Aetna member site Guardian Dental & Vision: Dental: https://www.guardianlife.com/ﬁnd-a-dentist Vision: https://www.vsp.com/eye-doctor OR Login to your personalized GuardianAnytime site (best). YOUR BENEFIT PLANS EFFECTIVE JANUARY 1, 2025 - DECEMBER 31, 2025 MEDICAL PLANS - AetnaWoodsEdge Community Church offers three medical plan choices through Aetna. You are eligible for this plan the 1st of the month following your date of hire. WoodsEdge will pay a portion of the employee and dependent cost. The balance of the premium cost will be deducted from your paycheck on a pre-tax basis..Aetna CPOSII 1500 Premier PPOAetna CPOSII 3000 100/50 PPOAetna CPOSII 3500 HSA PPOIf you choose to enroll in the Aetna CPOSII 3500 HSA plan, WoodsEdge will contribute $500 each year into your Health Savings Bank account ($500 enrolling yourself only, $1,000 if enrolling yourself and dependents). This annual amount will be divided into monthly deposits. Please see the Aetna Summary of Beneﬁts and Coverage for more details on these plans.DENTAL PLAN - GuardianWoodsEdge Community Church offers a dental plan administered by Guardian. Should you wish to enroll, WoodsEdge will pay a portion of the total premium for both employee and dependent. The balance of the premium cost will be deducted from your paycheck on a pre-tax basis. Refer to the Guardian dental beneﬁt summary for details.VISION PLAN - GuardianWoodsEdge Community Church offers a vision plan administered by Guardian. Should you wish to enroll, WoodsEdge will pay a portion of the total premium for both employee and dependent. The balance of the premium cost will be deducted from your paycheck on a pre-tax basis. For more plan information, please refer to the Guardian vision beneﬁt summary.LIFE AND VOLUNTARY LIFE - Guardian WoodsEdge provides a $20,000 life insurance beneﬁt at no cost to you. The life plan includes coverage for Accidental Death and Dismemberment. In addition to your basic life, you may purchase additional term life insurance through payroll deduction. Employees can choose amounts in increments of $10,000, to a maximum of $300,000. Spouses can choose amounts up to 50% of your voluntary life amount. You may also elect a $10,000 beneﬁt for children. The Guarantee Issue life insurance amount for employees is up to $50,000; for Spouse it is up to $25,000. See Guardian’s Voluntary Life Summary for details and costLONG TERM DISABILITY - GuardianWoodsEdge provides a long term disability plan from Guardian. This beneﬁt is provided at no cost to you. Should you become disabled, after 90 days from the date of disability the plan will pay 60% of your pre-disability earnings, to a maximum of $5,000 a month. The beneﬁt is paid until your Social Security Normal Retirement Age or until you are no longer disabled. Please refer to the Guardian’s beneﬁt summary and contract for exact coverage details.VOLUNTARY PLANS - Colonial Life You have the opportunity to purchase voluntary plans through Colonial Life on a pre-tax or post-tax basis, where applicable. There are several plans to choose from: Accident, Critical Illness, and Hospital Conﬁnement. Enrollment counselors are available to review these plans with you.

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Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered ServicesCoverage Period: 01/01/2025 - 12/31/2025 : AFA CPOSII Premier 1500 80/50 CY V24Coverage for: Employee + Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, www.HealthReformPlanSBC.com or by calling 1-888-982-3862. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary/ or call 1-888-982-3862 to request a copy.Important Questions Answers Why This Matters:What is the overall deductible?In-Network: Individual $1,500 / Family $3,000. Out-of-Network: Individual $3,000 / Family $9,000.Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.Are there servicescovered before you meetyour deductible?Yes. Certain office visits, preventive care, emergency care, urgent care and prescription drugs in-network.This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.Are there otherdeductibles for specificservices?No.You don’t have to meet deductibles for specific services.What is the out-of-pocketlimit for this plan?In-Network: Individual $5,500 / Family $11,000. Out-of-Network: Individual $13,000 / Family $39,000.The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.What is not included inthe out-of-pocket limit?Premiums, balance-billing charges, penalties for failure to obtain pre-authorization for services, and health care this plan doesn't cover.Even though you pay these expenses, they don’t count toward the out-of-pocket limit.Will you pay less if youuse a network provider?Yes. See http://www.aetna.com/docfind or call 1-888-982-3862 for a list of in-network providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider's charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.Do you need a referral tosee a specialist?No.You can see the specialist you choose without a referral.083000-040020-042466 Page 1 of 6

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All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness$20 copay/visit, deductible does not apply50% coinsuranceNo charge for in-network Virtual Primary Care telemedicine provider visits for certain services.Specialist visit$40 copay/visit, deductible does not apply50% coinsuranceNonePreventive care /screening /immunizationNo charge 50% coinsuranceYou may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.If you have a test Diagnostic test (x-ray, blood work) No charge 50% coinsuranceNoneImaging (CT/PET scans, MRIs)$250 copay/visit, deductible does not apply50% coinsurance NoneIf you need drugs to treat your illness or conditionMore information about prescription drug coverage is available at www.aetnapharmacy.com/advancedcontrolaetnaPreferred generic drugsTier 1A: $3 copay/ prescription (retail), $6 copay/ prescription (mail order); Tier 1: $10 copay/ prescription (retail), $20 copay/ prescription (mail order), deductible does not apply50% coinsurance (retail), deductible does not applyCovers up to a 30 day supply (retail prescription), 31-90 day supply (mail order prescription). Your cost will be higher for choosing Brand over Generics unless prescribed Dispense as Written; cost difference penalty doesn’t apply to out-of-pocket limit. No charge for preferred generic FDA-approved women's contraceptives in-network. Review your formulary for prescriptions requiring precertification or step therapy for coverage. No coverage for mail order prescriptions out-of-network. Maintenance drugs- after two retail fills, you are required to fill a 90-day supply at a participating mail service pharmacy or at selected participating retail providers.Preferred brand drugs$35 copay/ prescription (retail), $70 copay/ prescription (mail order), deductible does not apply50% coinsurance (retail), deductible does not applyNon-preferred generic/brand drugs$50 copay/ prescription (retail), $100 copay/ prescription (mail order), deductible does not apply50% coinsurance (retail), deductible does not applySpecialty drugsPreferred: 20% coinsurance up to a $250 maximum/ prescription for up to a 30 day supply; Non-preferred: 40% Not coveredAll specialty prescription drug fills on initial fill must be filled at a network specialty pharmacy except for urgent situations. Your plan may include access to selected participating retail pharmacies for certain specialty drugs.083000-040020-042466 Page 2 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)coinsurance up to a $500 maximum/ prescription for up to a 30 day supply, deductible does not applyIf you have outpatient surgeryFacility fee (e.g., ambulatory surgery center)20% coinsurance 50% coinsuranceNonePhysician/surgeon fees 20% coinsurance 50% coinsurance NoneIf you need immediate medical attentionEmergency room care$500 copay/visit, deductible does not apply$500 copay/visit, deductible does not applyCopay waived if admitted. Out-of-network emergency room care cost-share same as in-network. No coverage for non-emergency care.Emergency medical transportation No charge No chargeOut-of-network cost-share same as in-network.Urgent care$50 copay/visit, deductible does not apply50% coinsurance No coverage for non-urgent use.If you have a hospital stayFacility fee (e.g., hospital room) 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.Physician/surgeon fees 20% coinsurance 50% coinsurance NoneIf you need mental health, behavioral health, or substance abuse servicesOutpatient servicesOffice visits and all other outpatient services: No chargeOffice visits and all other outpatient services: 50% coinsuranceNoneInpatient services 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If you are pregnantOffice visitsNo charge 50% coinsuranceCost sharing does not apply for preventive services. Maternity care may include tests and services described elsewhere in the SBC (i.e., ultrasound).Childbirth/delivery professional services20% coinsurance 50% coinsurance NoneChildbirth/delivery facility services 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.083000-040020-042466 Page 3 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you need help recovering or have other special health needsHome health care$40 copay/visit, deductible does not apply50% coinsuranceCoverage is limited to 60 visits per year. Out-of-network precertification required or $400 penalty applies per occurrence.Rehabilitation services$40 copay/visit, deductible does not apply50% coinsuranceCoverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.Habilitation services No charge 50% coinsuranceNoneSkilled nursing care 20% coinsurance 50% coinsuranceCoverage is limited to 60 days per year. Out-of-network precertification required or $400 penalty applies per occurrence.Durable medical equipment 20% coinsurance 50% coinsuranceCoverage is limited to 1 durable medical equipment for same/similar purpose. Excludes repairs for misuse/abuse.Hospice services 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If your child needs dental or eye careChildren's eye exam No charge50% coinsuranceCoverage is limited to 1 exam every 12 months.Children's glasses Not coveredNot coveredNot covered.Children's dental check-up Not covered Not covered Not covered.Excluded Services & Other Covered Services:Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) • Bariatric surgery• Cosmetic surgery• Dental care (Adult & Child)• Glasses (Child)• Hearing aids• Long-term care• Non-emergency care when traveling outside the U.S.• Private-duty nursing• Routine foot care• Weight loss programsOther Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.) • Acupuncture - Coverage is limited to 10 visits per year.• Chiropractic care - Coverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.• Infertility treatment - Limited to the diagnosis & treatment of underlying medical condition, including artificial insemination.• Routine eye care (Adult) - Coverage is limited to 1 exam every 12 months.083000-040020-042466 Page 4 of 6

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Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: ● For more information on your rights to continue coverage, contact the plan at 1-888-982-3862.● If your group health coverage is subject to ERISA, you may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.● If your coverage is a church plan, church plans are not covered by the Federal COBRA continuation coverage rules. If the coverage is insured, individuals should contact their State insurance regulator regarding their possible rights to continuation coverage under State law.Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596.Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact:● If your group health coverage is subject to ERISA, you may contact Aetna directly by calling the toll-free number on your Medical ID Card, or by calling our general toll free number at 1-888-982-3862. You may also contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.● For non-federal governmental group health plans, you may also contact the Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov.● Additionally, a consumer assistance program can help you file your appeal. Contact information is at: http://www.aetna.com/individuals-families-health-insurance/rights-resources/complaints-grievances-appeals/index.html.Does this plan provide Minimum Essential Coverage? Yes.Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit.Does this plan meet Minimum Value Standards? Yes. If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.To see examples of how this plan might cover costs for a sample medical situation, see the next section.083000-040020-042466 Page 5 of 6

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About these Coverage Examples:This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) ■ The plan’s overall deductible $1,500■ Specialist copayment $40■ Hospital (facility) coinsurance 20%■ Other coinsurance 20%This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)Total Example Cost $12,700In this example, Peg would pay:Cost SharingDeductibles $1,500Copayments $10Coinsurance $1,700What isn't coveredLimits or exclusions $60The total Peg would pay is $3,270 Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well-controlled condition)■ The plan’s overall deductible $1,500■ Specialist copayment $40■ Hospital (facility) coinsurance 20%■ Other coinsurance 20%This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Diabetic supplies (glucose meter)Total Example Cost $5,600In this example, Joe would pay:Cost SharingDeductibles $0Copayments $900Coinsurance $0What isn't coveredLimits or exclusions $20The total Joe would pay is $920 Mia’s Simple Fracture (in-network emergency room visit and follow up care)■ The plan’s overall deductible $1,500■ Specialist copayment $40■ Hospital (facility) coinsurance 20%■ Other coinsurance 20%This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray)Durable medical equipment (crutches) Rehabilitation services (physical therapy)Total Example Cost $2,800In this example, Mia would pay:Cost SharingDeductibles $0Copayments $700Coinsurance $0What isn't coveredLimits or exclusions $0The total Mia would pay is $700Note: These numbers assume the patient does not participate in the plan's wellness program. If you participate in the plan's wellness program, you may be able to reduce your costs. For more information about the wellness program, please contact: 1-888-982-3862.The plan would be responsible for the other costs of these EXAMPLE covered services.083000-040020-042466 Page 6 of 6

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Assistive TechnologyPersons using assistive technology may not be able to fully access the following information. For assistance, please call 1-888-982-3862.Smartphone or TabletTo view documents from your smartphone or tablet, the free WinZip app is required. It may be available from your App Store.Non-DiscriminationAetna complies with applicable Federal civil rights laws and does not unlawfully discriminate, exclude or treat people differently based on their race, color, national origin, sex, age, disability, gender identity or sexual orientation.We provide free aids/services to people with disabilities and to people who need language assistance.If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card.If you believe we have failed to provide these services or otherwise discriminated based on a protected class noted above, you can also file a grievance with the Civil Rights Coordinator by contacting: Civil Rights Coordinator, P.O. Box 14462, Lexington, KY 40512 (CA HMO customers: P.O. Box 24030, Fresno, CA 93779), 1-800-648-7817, TTY: 711, Fax: 859-425-3379 (CA HMO customers: 860-262-7705), CRCoordinator@aetna.com.You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, or at 1-800-368-1019, 800-537-7697 (TDD).Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

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AFA CPOSII Premier 1500 80/50 CY V24Supplemental InformationCoverage for: Employee + Family | Plan Type: POSProfessional Services: 105% of Medicare Facility Services: 140% of Medicare How is the overall deductible or out-of-pocket limit met?Individual deductible and out-of-pocket limit payments apply to the family deductible and out-of-pocket limit.The family deductible and family out-of-pocket limit are cumulative for all family members. The family deductible and out-of-pocket limit can be met by a combination of family members; however no single individual within the family will be subject to more than the individual deductible or out-of-pocket limit amount.How your out-of-network care is reimbursed:We cover the cost of services based on whether doctors are “in-network” or “out-of-network.” We want to help you understand how much Aetna pays for your out-of-network care. At the same time, we want to make it clear how much more you will need to pay for this "out-of-network" care.You may choose a provider (doctor or hospital) in our network. You may choose to visit an out-of-network provider. If you choose a doctor who is out-of-network, your Aetna health plan may pay some of that doctor's bill. Most of the time, you will pay a lot more money out of your own pocket if you choose to use an out-of-network doctor or hospital. When you choose out-of-network care, Aetna limits the amount it will pay.This limit is called the "recognized" or "allowed" amount. Your doctor sets his or her own rate to charge you. It may be higher -- sometimes much higher -- than what your Aetna plan "recognizes." Your doctor may bill you for the dollar amount that your plan doesn't "recognize." You must also pay any copayments, coinsurance and deductibles under your plan. No dollar amount above the "recognized charge" counts toward your deductible or out-of-pocket limit. To learn more about how we pay out-of-network benefits, visit Aetna.com. Type “how Aetna pays” in the search box.You can avoid these extra costs by getting your care from Aetna’s network of health care providers. Go to Aetna.com and click on “Find a Doctor” on the left side of the page. If you are already a member, sign on to your Aetna member site.This applies when you choose to get care out-of-network. When you have no choice (for example: emergency room visit after a car accident or for other emergency services), we will pay the bill as if you got care in-network. You pay cost sharing and deductibles for your in-network level of benefits. Contact Aetna if your health care provider asks you to pay more. You are not responsible for any outstanding balance billed by your providers for emergency services beyond your cost sharing and deductibles.Other important information about your plan:This plan does not cover all health care expenses and includes exclusions and limitations. Members should refer to their plan documents to determine which Questions: Call the toll free number on your ID card (1-888-982-3862 for prospective members), TDD 1-800-628-3323 (hearing impaired only), or visit us at HealthReformPlanSBC.com 083000-040020-042457 1 of 3

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AFA CPOSII Premier 1500 80/50 CY V24Coverage for: Employee + Family | Plan Type: POSSupplemental Informationhealth care services are covered and to what extent.Additional information regarding your plan is available in the Disclosure Document on Aetna.com. Information includes:● “Knowing what is covered” which describes how we review a request for coverage for a service or supply● “Prescription drug benefit” which describes procedures we use to manage prescription drug benefits. These procedures include how to obtain a list of covered drugs and the exception policy for receiving coverage of a drug that is not on a closed formularyPlans are provided by: Aetna Life Insurance Company. While this material is believed to be accurate as of the production date, it is subject to change.Health benefits and health insurance plans contain exclusions and limitations. Not all health services are covered.See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. You may be responsible for the health care provider's full charges for any non-covered services, including circumstances where you have exceeded a benefit limit contained in the plan. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. We do not provide care or guarantee access to health services.The following is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on state mandates or the plan design or rider(s) purchased by you or your employer. ● All medical and hospital services not specifically covered in, or which are limited or excluded by your plan documents● Donor egg retrieval● Experimental and investigational procedures, except for coverage for medically necessary routine patient care costs for members participating in a cancer clinical trial with respect to the treatment of cancer or other life-threatening disease or condition● Home births● Immunizations for travel or work except where medically necessary or indicated● Implantable drugs and certain injectable drugs including injectable infertility drugs● Long-term rehabilitation therapy● Non-medically necessary services or supplies● Orthotics except diabetic orthotics● Outpatient prescription drugs (except for treatment of diabetes), unless covered by a prescription plan rider and over-the-counter medications (except as provided in a hospital) and supplies● Radial keratotomy or related procedures● Reversal of sterilization● Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies, counseling or prescription drugs● Therapy or rehabilitation other than those listed as covered 083000-040020-042457 2 of 3Questions: Call the toll free number on your ID card (1-888-982-3862 for prospective members), TDD 1-800-628-3323 (hearing impaired only), or visit us at HealthReformPlanSBC.com

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Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered ServicesCoverage Period: 01/01/2025 - 12/31/2025 : AFA CPOSII 3000 100/50 $0LXR CY V24Coverage for: Employee + Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, www.HealthReformPlanSBC.com or by calling 1-888-982-3862. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary/ or call 1-888-982-3862 to request a copy.Important Questions Answers Why This Matters:What is the overall deductible?In-Network: Individual $3,000 / Family $6,000. Out-of-Network: Individual $6,000 / Family $18,000.Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.Are there servicescovered before you meetyour deductible?Yes. Certain office visits, preventive care, urgent care and prescription drugs in-network.This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.Are there otherdeductibles for specificservices?No.You don’t have to meet deductibles for specific services.What is the out-of-pocketlimit for this plan?In-Network: Individual $6,500 / Family $13,000. Out-of-Network: Individual $16,000 / Family $48,000.The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.What is not included inthe out-of-pocket limit?Premiums, balance-billing charges, penalties for failure to obtain pre-authorization for services, and health care this plan doesn't cover.Even though you pay these expenses, they don’t count toward the out-of-pocket limit.Will you pay less if youuse a network provider?Yes. See http://www.aetna.com/docfind or call 1-888-982-3862 for a list of in-network providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider's charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.Do you need a referral tosee a specialist?No.You can see the specialist you choose without a referral.081700-050020-062430 Page 1 of 6

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All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness$35 copay/visit, deductible does not apply50% coinsuranceNo charge for in-network Virtual Primary Care telemedicine provider visits for certain services.Specialist visit$75 copay/visit, deductible does not apply50% coinsuranceNonePreventive care /screening /immunizationNo charge 50% coinsuranceYou may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.If you have a test Diagnostic test (x-ray, blood work) No charge 50% coinsuranceNoneImaging (CT/PET scans, MRIs) 0% coinsurance 50% coinsurance NoneIf you need drugs to treat your illness or conditionMore information about prescription drug coverage is available at www.aetnapharmacy.com/advancedcontrolaetnaPreferred generic drugsTier 1A: $3 copay/ prescription (retail), $6 copay/ prescription (mail order); Tier 1: $10 copay/ prescription (retail), $20 copay/ prescription (mail order), deductible does not apply50% coinsurance (retail), deductible does not applyCovers up to a 30 day supply (retail prescription), 31-90 day supply (mail order prescription). Your cost will be higher for choosing Brand over Generics unless prescribed Dispense as Written; cost difference penalty doesn’t apply to out-of-pocket limit. No charge for preferred generic FDA-approved women's contraceptives in-network. Review your formulary for prescriptions requiring precertification or step therapy for coverage. No coverage for mail order prescriptions out-of-network. Maintenance drugs- after two retail fills, you are required to fill a 90-day supply at a participating mail service pharmacy or at selected participating retail providers.Preferred brand drugs$45 copay/ prescription (retail), $90 copay/ prescription (mail order), deductible does not apply50% coinsurance (retail), deductible does not applyNon-preferred generic/brand drugs$75 copay/ prescription (retail), $150 copay/ prescription (mail order), deductible does not apply50% coinsurance (retail), deductible does not applySpecialty drugsPreferred: 20% coinsurance up to a $250 maximum/ prescription for up to a 30 day supply; Non-preferred: 40% coinsurance up to a $500 Not coveredAll specialty prescription drug fills on initial fill must be filled at a network specialty pharmacy except for urgent situations. Your plan may include access to selected participating retail pharmacies for certain specialty drugs.081700-050020-062430 Page 2 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)maximum/ prescription for up to a 30 day supply, deductible does not applyIf you have outpatient surgeryFacility fee (e.g., ambulatory surgery center)0% coinsurance 50% coinsuranceNonePhysician/surgeon fees 0% coinsurance 50% coinsurance NoneIf you need immediate medical attentionEmergency room care $300 copay/visit $300 copay/visitCopay waived if admitted. Out-of-network emergency room care cost-share same as in-network. No coverage for non-emergency care.Emergency medical transportation 0% coinsurance 0% coinsuranceOut-of-network cost-share same as in-network.Urgent care$75 copay/visit, deductible does not apply50% coinsurance No coverage for non-urgent use.If you have a hospital stayFacility fee (e.g., hospital room) 0% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.Physician/surgeon fees 0% coinsurance 50% coinsurance NoneIf you need mental health, behavioral health, or substance abuse servicesOutpatient servicesOffice visits and all other outpatient services: No chargeOffice visits and all other outpatient services: 50% coinsuranceNoneInpatient services 0% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If you are pregnantOffice visitsNo charge 50% coinsuranceCost sharing does not apply for preventive services. Maternity care may include tests and services described elsewhere in the SBC (i.e., ultrasound).Childbirth/delivery professional services0% coinsurance 50% coinsurance NoneChildbirth/delivery facility services 0% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.081700-050020-062430 Page 3 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you need help recovering or have other special health needsHome health care 0% coinsurance 50% coinsuranceCoverage is limited to 60 visits per year. Out-of-network precertification required or $400 penalty applies per occurrence.Rehabilitation services$75 copay/visit 50% coinsuranceCoverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.Habilitation services No charge 50% coinsuranceNoneSkilled nursing care 0% coinsurance 50% coinsuranceCoverage is limited to 60 days per year. Out-of-network precertification required or $400 penalty applies per occurrence.Durable medical equipment 50% coinsurance 50% coinsuranceCoverage is limited to 1 durable medical equipment for same/similar purpose. Excludes repairs for misuse/abuse.Hospice services 0% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If your child needs dental or eye careChildren's eye exam No charge50% coinsuranceCoverage is limited to 1 exam every 12 months.Children's glasses Not coveredNot coveredNot covered.Children's dental check-up Not covered Not covered Not covered.Excluded Services & Other Covered Services:Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) • Bariatric surgery• Cosmetic surgery• Dental care (Adult & Child)• Glasses (Child)• Hearing aids• Long-term care• Non-emergency care when traveling outside the U.S.• Private-duty nursing• Routine foot care• Weight loss programsOther Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.) • Acupuncture - Coverage is limited to 10 visits per year.• Chiropractic care - Coverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.• Infertility treatment - Limited to the diagnosis & treatment of underlying medical condition, including artificial insemination.• Routine eye care (Adult) - Coverage is limited to 1 exam every 12 months.081700-050020-062430 Page 4 of 6

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About these Coverage Examples:This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) ■ The plan’s overall deductible $3,000■ Specialist copayment $75■ Hospital (facility) coinsurance 0%■ Other coinsurance 0%This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)Total Example Cost $12,700In this example, Peg would pay:Cost SharingDeductibles $3,000Copayments $10Coinsurance $0What isn't coveredLimits or exclusions $60The total Peg would pay is $3,070 Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well-controlled condition)■ The plan’s overall deductible $3,000■ Specialist copayment $75■ Hospital (facility) coinsurance 0%■ Other coinsurance 0%This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Diabetic supplies (glucose meter)Total Example Cost $5,600In this example, Joe would pay:Cost SharingDeductibles $0Copayments $1,200Coinsurance $0What isn't coveredLimits or exclusions $20The total Joe would pay is $1,220 Mia’s Simple Fracture (in-network emergency room visit and follow up care)■ The plan’s overall deductible $3,000■ Specialist copayment $75■ Hospital (facility) coinsurance 0%■ Other coinsurance 0%This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray)Durable medical equipment (crutches) Rehabilitation services (physical therapy)Total Example Cost $2,800In this example, Mia would pay:Cost SharingDeductibles $2,300Copayments $200Coinsurance $0What isn't coveredLimits or exclusions $0The total Mia would pay is $2,500Note: These numbers assume the patient does not participate in the plan's wellness program. If you participate in the plan's wellness program, you may be able to reduce your costs. For more information about the wellness program, please contact: 1-888-982-3862.The plan would be responsible for the other costs of these EXAMPLE covered services.081700-050020-062430 Page 6 of 6

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AFA CPOSII 3000 100/50 $0LXR CY V24Supplemental InformationCoverage for: Employee + Family | Plan Type: POSProfessional Services: 105% of Medicare Facility Services: 140% of Medicare How is the overall deductible or out-of-pocket limit met?Individual deductible and out-of-pocket limit payments apply to the family deductible and out-of-pocket limit.The family deductible and family out-of-pocket limit are cumulative for all family members. The family deductible and out-of-pocket limit can be met by a combination of family members; however no single individual within the family will be subject to more than the individual deductible or out-of-pocket limit amount.How your out-of-network care is reimbursed:We cover the cost of services based on whether doctors are “in-network” or “out-of-network.” We want to help you understand how much Aetna pays for your out-of-network care. At the same time, we want to make it clear how much more you will need to pay for this "out-of-network" care.You may choose a provider (doctor or hospital) in our network. You may choose to visit an out-of-network provider. If you choose a doctor who is out-of-network, your Aetna health plan may pay some of that doctor's bill. Most of the time, you will pay a lot more money out of your own pocket if you choose to use an out-of-network doctor or hospital. When you choose out-of-network care, Aetna limits the amount it will pay.This limit is called the "recognized" or "allowed" amount. Your doctor sets his or her own rate to charge you. It may be higher -- sometimes much higher -- than what your Aetna plan "recognizes." Your doctor may bill you for the dollar amount that your plan doesn't "recognize." You must also pay any copayments, coinsurance and deductibles under your plan. No dollar amount above the "recognized charge" counts toward your deductible or out-of-pocket limit. To learn more about how we pay out-of-network benefits, visit Aetna.com. Type “how Aetna pays” in the search box.You can avoid these extra costs by getting your care from Aetna’s network of health care providers. Go to Aetna.com and click on “Find a Doctor” on the left side of the page. If you are already a member, sign on to your Aetna member site.This applies when you choose to get care out-of-network. When you have no choice (for example: emergency room visit after a car accident or for other emergency services), we will pay the bill as if you got care in-network. You pay cost sharing and deductibles for your in-network level of benefits. Contact Aetna if your health care provider asks you to pay more. You are not responsible for any outstanding balance billed by your providers for emergency services beyond your cost sharing and deductibles.Other important information about your plan:This plan does not cover all health care expenses and includes exclusions and limitations. Members should refer to their plan documents to determine which Questions: Call the toll free number on your ID card (1-888-982-3862 for prospective members), TDD 1-800-628-3323 (hearing impaired only), or visit us at HealthReformPlanSBC.com 081700-050020-062415 1 of 3

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AFA CPOSII 3000 100/50 $0LXR CY V24Coverage for: Employee + Family | Plan Type: POSSupplemental Informationhealth care services are covered and to what extent.Additional information regarding your plan is available in the Disclosure Document on Aetna.com. Information includes:● “Knowing what is covered” which describes how we review a request for coverage for a service or supply● “Prescription drug benefit” which describes procedures we use to manage prescription drug benefits. These procedures include how to obtain a list of covered drugs and the exception policy for receiving coverage of a drug that is not on a closed formularyPlans are provided by: Aetna Life Insurance Company. While this material is believed to be accurate as of the production date, it is subject to change.Health benefits and health insurance plans contain exclusions and limitations. Not all health services are covered.See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. You may be responsible for the health care provider's full charges for any non-covered services, including circumstances where you have exceeded a benefit limit contained in the plan. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. We do not provide care or guarantee access to health services.The following is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on state mandates or the plan design or rider(s) purchased by you or your employer. ● All medical and hospital services not specifically covered in, or which are limited or excluded by your plan documents● Donor egg retrieval● Experimental and investigational procedures, except for coverage for medically necessary routine patient care costs for members participating in a cancer clinical trial with respect to the treatment of cancer or other life-threatening disease or condition● Home births● Immunizations for travel or work except where medically necessary or indicated● Implantable drugs and certain injectable drugs including injectable infertility drugs● Long-term rehabilitation therapy● Non-medically necessary services or supplies● Orthotics except diabetic orthotics● Outpatient prescription drugs (except for treatment of diabetes), unless covered by a prescription plan rider and over-the-counter medications (except as provided in a hospital) and supplies● Radial keratotomy or related procedures● Reversal of sterilization● Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies, counseling or prescription drugs● Therapy or rehabilitation other than those listed as covered 081700-050020-062415 2 of 3Questions: Call the toll free number on your ID card (1-888-982-3862 for prospective members), TDD 1-800-628-3323 (hearing impaired only), or visit us at HealthReformPlanSBC.com

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Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered ServicesCoverage Period: 01/01/2025 - 12/31/2025 : AFA CPOSII 3500 HSA 80/50 E CY V24Coverage for: Employee + Family | Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, www.HealthReformPlanSBC.com or by calling 1-888-982-3862. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary/ or call 1-888-982-3862 to request a copy.Important Questions Answers Why This Matters:What is the overall deductible?In-Network: Individual $3,500 / Family $7,000. Out-of-Network: Individual $10,000 / Family $30,000.Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.Are there servicescovered before you meetyour deductible?Yes. Preventive care in-network.This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.Are there otherdeductibles for specificservices?No.You don’t have to meet deductibles for specific services.What is the out-of-pocketlimit for this plan?In-Network: Individual $6,000 / Family $12,000. Out-of-Network: Individual $20,000 / Family $60,000.The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.What is not included inthe out-of-pocket limit?Premiums, balance-billing charges, penalties for failure to obtain pre-authorization for services, and health care this plan doesn't cover.Even though you pay these expenses, they don’t count toward the out-of-pocket limit.Will you pay less if youuse a network provider?Yes. See http://www.aetna.com/docfind or call 1-888-982-3862 for a list of in-network providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider's charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.Do you need a referral tosee a specialist?No.You can see the specialist you choose without a referral.083000-040020-022485 Page 1 of 6

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All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness$35 copay/visit 50% coinsurance0% coinsurance after deductible for in-network Virtual Primary Care telemedicine provider visits for certain services.Specialist visit $75 copay/visit 50% coinsuranceNonePreventive care /screening /immunizationNo charge 50% coinsuranceYou may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.If you have a test Diagnostic test (x-ray, blood work) 20% coinsurance 50% coinsuranceNoneImaging (CT/PET scans, MRIs) 20% coinsurance 50% coinsurance NoneIf you need drugs to treat your illness or conditionMore information about prescription drug coverage is available at www.aetnapharmacy.com/advancedcontrolaetnaPreferred generic drugsTier 1A: $3 copay/ prescription (retail), $6 copay/ prescription (mail order); Tier 1: $10 copay/ prescription (retail), $20 copay/ prescription (mail order)50% coinsurance (retail)Covers up to a 30 day supply (retail prescription), 31-90 day supply (mail order prescription). Your cost will be higher for choosing Brand over Generics unless prescribed Dispense as Written; cost difference penalty doesn’t apply to overall deductible or out-of-pocket limit. No charge for preferred generic FDA-approved women's contraceptives in-network. Review your formulary for prescriptions requiring precertification or step therapy for coverage. No coverage for mail order prescriptions out-of-network. Maintenance drugs- after two retail fills, you are required to fill a 90-day supply at a participating mail service pharmacy or at selected participating retail providers. Deductible doesn't apply to certain preventive medications.Preferred brand drugs$50 copay/ prescription (retail), $100 copay/ prescription (mail order)50% coinsurance (retail)Non-preferred generic/brand drugs$100 copay/ prescription (retail), $200 copay/ prescription (mail order)50% coinsurance (retail)Specialty drugsPreferred: 20% coinsurance up to a $250 maximum/ prescription for up to a 30 day supply; Non-preferred: 40% Not coveredAll specialty prescription drug fills on initial fill must be filled at a network specialty pharmacy except for urgent situations. Your plan may include access to selected participating retail pharmacies for certain specialty drugs.083000-040020-022485 Page 2 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)coinsurance up to a $500 maximum/ prescription for up to a 30 day supplyIf you have outpatient surgeryFacility fee (e.g., ambulatory surgery center)20% coinsurance 50% coinsuranceNonePhysician/surgeon fees 20% coinsurance 50% coinsurance NoneIf you need immediate medical attentionEmergency room care 20% coinsurance 20% coinsuranceOut-of-network emergency room care cost-share same as in-network. No coverage for non-emergency care.Emergency medical transportation 20% coinsurance 20% coinsuranceOut-of-network cost-share same as in-network.Urgent care 20% coinsurance 50% coinsurance No coverage for non-urgent use.If you have a hospital stayFacility fee (e.g., hospital room) 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.Physician/surgeon fees 20% coinsurance 50% coinsurance NoneIf you need mental health, behavioral health, or substance abuse servicesOutpatient servicesOutpatient office visits: 0% coinsurance; All other outpatient services: 20% coinsuranceOffice visits and all other outpatient services: 50% coinsuranceNoneInpatient services 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If you are pregnantOffice visitsNo charge 50% coinsuranceCost sharing does not apply for preventive services. Maternity care may include tests and services described elsewhere in the SBC (i.e., ultrasound).Childbirth/delivery professional services20% coinsurance 50% coinsurance NoneChildbirth/delivery facility services 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.083000-040020-022485 Page 3 of 6

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CommonMedical EventServices You May NeedWhat You Will PayLimitations, Exceptions, & Other Important InformationIn-Network Provider (You will pay the least)Out–of–Network Provider (You will pay the most)If you need help recovering or have other special health needsHome health care 20% coinsurance 50% coinsuranceCoverage is limited to 60 visits per year. Out-of-network precertification required or $400 penalty applies per occurrence.Rehabilitation services$75 copay/visit 50% coinsuranceCoverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.Habilitation services 20% coinsurance 50% coinsuranceNoneSkilled nursing care 20% coinsurance 50% coinsuranceCoverage is limited to 60 days per year. Out-of-network precertification required or $400 penalty applies per occurrence.Durable medical equipment 50% coinsurance 50% coinsuranceCoverage is limited to 1 durable medical equipment for same/similar purpose. Excludes repairs for misuse/abuse.Hospice services 20% coinsurance 50% coinsuranceOut-of-network precertification required or $400 penalty applies per occurrence.If your child needs dental or eye careChildren's eye exam No charge50% coinsuranceCoverage is limited to 1 exam every 12 months.Children's glasses Not coveredNot coveredNot covered.Children's dental check-up Not covered Not covered Not covered.Excluded Services & Other Covered Services:Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) • Bariatric surgery• Cosmetic surgery• Dental care (Adult & Child)• Glasses (Child)• Hearing aids• Long-term care• Non-emergency care when traveling outside the U.S.• Private-duty nursing• Routine foot care• Weight loss programsOther Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.) • Acupuncture - Coverage is limited to 10 visits per year.• Chiropractic care - Coverage is limited to 60 visits per year for Physical Therapy, Occupational Therapy, Speech Therapy & Chiropractic care combined.• Infertility treatment - Limited to the diagnosis & treatment of underlying medical condition, including artificial insemination.• Routine eye care (Adult) - Coverage is limited to 1 exam every 12 months.083000-040020-022485 Page 4 of 6

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About these Coverage Examples:This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) ■ The plan’s overall deductible $3,500■ Specialist copayment $75■ Hospital (facility) coinsurance 20%■ Other coinsurance 20%This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)Total Example Cost $12,700In this example, Peg would pay:Cost SharingDeductibles $3,500Copayments $10Coinsurance $1,600What isn't coveredLimits or exclusions $60The total Peg would pay is $5,170 Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well-controlled condition)■ The plan’s overall deductible $3,500■ Specialist copayment $75■ Hospital (facility) coinsurance 20%■ Other coinsurance 20%This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Diabetic supplies (glucose meter)Total Example Cost $5,600In this example, Joe would pay:Cost SharingDeductibles $3,500Copayments $400Coinsurance $0What isn't coveredLimits or exclusions $20The total Joe would pay is $3,920 Mia’s Simple Fracture (in-network emergency room visit and follow up care)■ The plan’s overall deductible $3,500■ Specialist copayment $75■ Hospital (facility) coinsurance 20%■ Other coinsurance 20%This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray)Durable medical equipment (crutches) Rehabilitation services (physical therapy)Total Example Cost $2,800In this example, Mia would pay:Cost SharingDeductibles $2,800Copayments $0Coinsurance $0What isn't coveredLimits or exclusions $0The total Mia would pay is $2,800Note: These numbers assume the patient does not participate in the plan's wellness program. If you participate in the plan's wellness program, you may be able to reduce your costs. For more information about the wellness program, please contact: 1-888-982-3862.The plan would be responsible for the other costs of these EXAMPLE covered services.083000-040020-022485 Page 6 of 6

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AFA CPOSII 3500 HSA 80/50 E CY V24Supplemental InformationCoverage for: Employee + Family | Plan Type: POSProfessional Services: 105% of Medicare Facility Services: 140% of Medicare Is a Health Savings Account (HSA) available under this plan option?YesAn HSA is an account that may be set up by you or your employer to help you plan for current and future health care costs. You may make contributions to the HSA up to a maximum amount set by the IRS. Any earnings on your contributions grow tax free and any withdrawals you make for eligible medical expenses are also tax free. Contact your employer or call the Customer Service number on your ID Card for more information.How is the overall deductible or out-of-pocket limit met?Individual deductible and out-of-pocket limit payments apply to the family deductible and out-of-pocket limit.The family deductible and family out-of-pocket limit are cumulative for all family members. The family deductible and out-of-pocket limit can be met by a combination of family members; however no single individual within the family will be subject to more than the individual deductible or out-of-pocket limit amount.How your out-of-network care is reimbursed:We cover the cost of services based on whether doctors are “in-network” or “out-of-network.” We want to help you understand how much Aetna pays for your out-of-network care. At the same time, we want to make it clear how much more you will need to pay for this "out-of-network" care.You may choose a provider (doctor or hospital) in our network. You may choose to visit an out-of-network provider. If you choose a doctor who is out-of-network, your Aetna health plan may pay some of that doctor's bill. Most of the time, you will pay a lot more money out of your own pocket if you choose to use an out-of-network doctor or hospital. When you choose out-of-network care, Aetna limits the amount it will pay.This limit is called the "recognized" or "allowed" amount. Your doctor sets his or her own rate to charge you. It may be higher -- sometimes much higher -- than what your Aetna plan "recognizes." Your doctor may bill you for the dollar amount that your plan doesn't "recognize." You must also pay any copayments, coinsurance and deductibles under your plan. No dollar amount above the "recognized charge" counts toward your deductible or out-of-pocket limit. To learn more about how we pay out-of-network benefits, visit Aetna.com. Type “how Aetna pays” in the search box.You can avoid these extra costs by getting your care from Aetna’s network of health care providers. Go to Aetna.com and click on “Find a Doctor” on the left side of the page. If you are already a member, sign on to your Aetna member site.This applies when you choose to get care out-of-network. When you have no choice (for example: emergency room visit after a car accident or for other emergency services), we will pay the bill as if you got care in-network. You pay cost sharing and deductibles for your in-network level of benefits. Questions: Call the toll free number on your ID card (1-888-982-3862 for prospective members), TDD 1-800-628-3323 (hearing impaired only), or visit us at HealthReformPlanSBC.com 083000-040020-022479 1 of 3

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AFA CPOSII 3500 HSA 80/50 E CY V24Coverage for: Employee + Family | Plan Type: POSSupplemental InformationContact Aetna if your health care provider asks you to pay more. You are not responsible for any outstanding balance billed by your providers for emergency services beyond your cost sharing and deductibles.Other important information about your plan:This plan does not cover all health care expenses and includes exclusions and limitations. Members should refer to their plan documents to determine which health care services are covered and to what extent.Additional information regarding your plan is available in the Disclosure Document on Aetna.com. Information includes:● “Knowing what is covered” which describes how we review a request for coverage for a service or supply● “Prescription drug benefit” which describes procedures we use to manage prescription drug benefits. These procedures include how to obtain a list of covered drugs and the exception policy for receiving coverage of a drug that is not on a closed formularyPlans are provided by: Aetna Life Insurance Company. While this material is believed to be accurate as of the production date, it is subject to change.When offered, investment services are independently offered by the HSA Administrator.HSAs are currently not available to HMO members in California and Illinois.Health benefits and health insurance plans contain exclusions and limitations. Not all health services are covered.See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. You may be responsible for the health care provider's full charges for any non-covered services, including circumstances where you have exceeded a benefit limit contained in the plan. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. We do not provide care or guarantee access to health services.The following is a partial list of services and supplies that are generally not covered. However, your plan documents may contain exceptions to this list based on state mandates or the plan design or rider(s) purchased by you or your employer. 083000-040020-022479 2 of 3Questions: Call the toll free number on your ID card (1-888-982-3862 for prospective members), TDD 1-800-628-3323 (hearing impaired only), or visit us at HealthReformPlanSBC.com

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AFA CPOSII 3500 HSA 80/50 E CY V24Coverage for: Employee + Family | Plan Type: POSSupplemental Information● All medical and hospital services not specifically covered in, or which are limited or excluded by your plan documents● Donor egg retrieval● Experimental and investigational procedures, except for coverage for medically necessary routine patient care costs for members participating in a cancer clinical trial with respect to the treatment of cancer or other life-threatening disease or condition● Home births● Immunizations for travel or work except where medically necessary or indicated● Implantable drugs and certain injectable drugs including injectable infertility drugs● Long-term rehabilitation therapy● Non-medically necessary services or supplies● Orthotics except diabetic orthotics● Outpatient prescription drugs (except for treatment of diabetes), unless covered by a prescription plan rider and over-the-counter medications (except as provided in a hospital) and supplies● Radial keratotomy or related procedures● Reversal of sterilization● Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies, counseling or prescription drugs● Therapy or rehabilitation other than those listed as covered In case of emergency, call 911 or your local emergency hotline, or go directly to an emergency care facility.We consider your personal information to be private. We have policies and procedures in place to protect your personal information from unlawful use and disclosure. For a summary of our policy, go to Aetna.com. You’ll find the Privacy Notices link at the bottom of the page. Plan features and availability may vary by location and group size.© 2014 Aetna Inc.083000-040020-022479 3 of 3Questions: Call the toll free number on your ID card (1-888-982-3862 for prospective members), TDD 1-800-628-3323 (hearing impaired only), or visit us at HealthReformPlanSBC.com

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ACCESS TO CARE Aetna Smart Compare® Choosing the right physician or specialist can be tough. That’s why we’re making it easier for you. Aetna Smart Compare will provide the best matches prioritized at the top of your search. The “Quality & Effective Care” designation identifies local providers who provide a higher quality of care* that you can trust. Plus, these providers can help you save on medical costs and are already in your network. Log in to your member web site at Aet.na/Health-Login. Go to “Find Care and Pricing” to search for providers, such as primary care physicians or specialists. MinuteClinic® Your plan gives you access to covered MinuteClinic services at no or a lower cost to you.* They’re located inside select CVS Pharmacy® locations. They’re open every day, even evenings and weekends. If your plan is eligible for a health savings account, you can get preventive care at no extra cost. You’ll also get care for covered minor illnesses and injuries at a lower cost than available to the public. And once you meet your deductible, you can get all covered services at no extra cost. Find a clinic near you at CVS.com/MinuteClinic. Or log in to your Aetna Health℠ app at Aet.na/Health-App.For a list of other in-network providers, log in to Aet.na/Health-Login and use our search tool. Virtual care options CVS Health Virtual Care™* lets you get care for minor injuries, illnesses, skin conditions, select women’s services and mental health services, like talk therapy and medication support. CVS Health Virtual Primary Care™* gives you access to a dedicated virtual provider for preventive services, sick and wellness visits, medicine reviews and disease management. Teladoc Health You can connect directly with a board-certified doctor by phone or video. This is best for general medical, dermatology or mental health visits — and all at no or low cost to you. You can easily access these low- or no-cost virtual primary care services. Just go to Aet.na/Health-Login to log in to your member website. Call 1-855-TELADOC (835-2362) Visit Aet.na /AFA-Tdoc *FOR AETNA SMART COMPARE: Visit Aetna.com/SmartCompare for more information. Not available to groups located inCalifornia, joint ventures and local network plans.*FOR COST OF MINUTECLINIC SERVICES: Includes select MinuteClinic® services. Not all MinuteClinic services are covered.Please consult benefit documents to confirm what services are included. Members enrolled in qualified high-deductible healthplans must meet their deductible before receiving covered non-preventive MinuteClinic services at no cost share. However,such services are covered at negotiated contract rates. This benefit is not available in all states and on indemnity plans. VisitMinuteClinic.com for age and service restrictions. This is for informational purposes only and is intended to be used only inconnection with self-funded plans. It is not medical advice and is not intended to be a substitute for proper medical careprovided by a physician.*FOR CVSH VIRTUAL CARE PROVIDERS: For a complete list of other participating providers, log in to your member site at Aetna.com and use our provider search tool. *FOR CVSH VIRTUAL CARE RESTRICTIONS: Members will be able to access CVS Health Virtual Primary Care™ and CVS HealthVirtual Care™ in addition to current virtual services. CVS Health Virtual Primary Care and CVS Health Virtual Care are not availableto joint ventures and indemnity plans.Teladoc® is not available to all members. Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. Visit Teladoc.com/Aetna for a complete description of the limitations of Teladoc services. Teladoc, Teladoc Health and the Teladoc Health logo are registered trademarks of Teladoc Health, Inc.

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WELLNESS INCENTIVE PROGRAMS Aetna Health Your Way™ - Engage Get personalized resources and challenges to help you earn rewards of up to $100 per year. You’ll start with a well-being assessment, and then interact with recommended resources to earn points and improve your health.* This way, you can stay on track and reach your goals. Just log in to you member website at Aet.na/Health-Login. OTC Health Solutions® Enjoy $25 every three months to shop hundreds of CVS® products Every three months, you’ll get $25 to spend on select over-the-counter health and wellness products at CVS®. This can help you take care of minor illnesses, have fewer doctor visits and save money. 3 ways to save In store Visit any CVS store that participates in OTC Health Solutions. Go to www.CVS. com/otchs/aetcommercialotc /storelocator to find one near you. Online Visit www.CVS.com/ otchs/aetcommercialotc for the fastest and easiest way to order anytime. Over the phone Call 1-888-628-2770 (TTY: 711) Monday to Friday, from 9 AM to 8 PM local time. Discount programThe Aetna Discount Program helps you save on many health products and services. You’ll save money on eyewear, hearing exams, healthy lifestyle services, natural health offerings and more. Watch the savings add up. Simply visit Aet.na/Health-Login to log in to your member website. MENTAL WELL-BEINGEmployee Assistance Program (Aetna Resources For Living℠) Through this program, you’ll get support for stress management, work/life balance, depression and anxiety. Plus, we’ll connect you with legal and financial help. This benefit is available to you and your eligible household members. Find log in instructions at aet.na/afa-eap or by scanning this QR code: Behavioral telehealth virtual providers and services These services offer another way to get help from a licensed therapist or psychiatrist. And you can choose from a large network of providers. Check out virtual providers here. Or visit Aetna.com to find another network provider. *FOR EARN POINTS NOTE: Not all recommended actions result in earning rewards.

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MANAGING HEALTH Aetna One® Essentials Your physical and mental health is everything. Whether you’re taking care of a minor issue or dealing with bigger health challenges, we can help. If you can benefit from care management, one of our nurses will work with you to set up a plan, help you understand your benefits and answer any questions. To get started, go to Aet.na/Health-Login to log in to your member website. Or call the number on your member ID card. Enhanced Maternity Program Going through a maternity journey is unique for each person. So whether you need support for family planning or postpartum care, we’ll be right there as a trusted, reliable resource throughout your entire experience. To learn more and sign up, call us at 1-800-272-3531 (TTY: 711) weekdays from 8 AM to 7 PM ET. Or log in to Aet.na/Health-Login and look under “Stay Healthy.” Taking care of diabetes health Diabetic meter program If you have diabetes, you know it’s important to check your blood glucose levels regularly. And we want to help — with a new blood glucose meter. It’s part of your prescription plan, and ordering one is easy! To order, simply: Visit Aetna.com/ManagingDiabetes If you have questions, call the number on your Aetna® member ID card. $0 preferred diabetic benefit* For another way to save, enjoy a new pharmacy benefit. You’ll have no deductible and $0 cost-share for preferred insulin and diabetic supplies. Call the number on your Aetna member ID card to find out which insulins and diabetic supplies are included. *Not available in Oklahoma. HSA, IntRx, and Value plans: Preventive deductible waiver and $0 preferred diabetic offering bothwaive the deductible. $0 preferred diabetic benefit also waives copay/coinsurance on preferred insulin/diabetic supplies. The $0 preferred diabetic benefit does not include diabetic drugs. Policies and plans are insured and/or administered by Aetna Life Insurance Company or its affiliates (Aetna). Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Refer to Aetna.com for more information about Aetna® plans. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a health care professional. Aetna, CVS Pharmacy® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies. For your best health, we encourage you to have a relationship with a primary care physician or other doctor. Tell them about your visit to MinuteClinic, or MinuteClinic can send a summary of your visit directly to them. DISCOUNT OFFERS ARE NOT INSURANCE. They are not benefits under your insurance plan. You get access to discounts off the regular charge on products and services offered by third-party vendors and providers. Aetna makes no payment to the third parties — you are responsible for the full cost. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. Aetna Resources For Living℠ is the brand name used for products and services offered through the Aetna group of companies. The EAP is administered by Aetna Behavioral Health, LLC; and in California for Knox-Keene plans, and Health and Human Resources Center, Inc. All EAP calls are confidential, except as required by law. EAP instructors, educators and network participating providers are independent contractors and are neither agents nor employees of Aetna. Aetna does not direct, manage, oversee or control the individual services provided by these persons and does not assume any responsibility or liability for the services they provide and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. ©2024 Aetna Inc. 3468990-01-01 (6/24)

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Page of 1 2Aetna CPOSII $1500 PremierAetna CPOSII 3000 100/50Aetna CPOSII $3500 HSA PlanNetworkCPOSII PPOCPOSII PPOCPOSII PPOHSA or FSA?FSAFSAHSANetwork Deductible$1,500 individual $3,000 family$3,000 individual $6,000 family$3,500 individual $7,000 familyNetwork Out of Pocket$5,500 individual $11,000 family$6,500 individual $13,000 family$6,000 individual $12,000 familyNon-network Deductible$3,000 individual $9,000 family$6,000 individual $18,000 family$10,000 individual $30,000 familyNon-Network Out of Pocket Max $13,000 individual $39,000 family$16,000 individual $48,000 family$20,000 individual $60,000 familyCoinsurance80% in-network 50% Out-of-network100% in-network 50% Out-of-network80% in-network 50% Out-of-networkNetwork Office Visit$20 GP; $40 Specialist $0 Lab/X-ray $250 copay CT/PET/MRI$35 GP; $75 Specialist$35 GP; $75 Specialist After plan deductibleNon-Network Office Visit50% after deductible50% after deductible50% after plan deductiblePreventive Care/Well child care (in-network)100% no deductible100% no deductible100% no deductibleEmergency ServicesER - $500 visit plus 20% coinsurance $50 Urgent CareER - $300/visit plus deductible $75 Urgent Care100% after plan deductibleHospital & Outpatient Surgery80% in-network 50% non-network after plan deductibles100% in-network 50% non-network after plan deductibles100% in-network 70% non-network after plan deductiblesPrescriptions$3/$10/$35/$50/20%$3/$10/$45/$75/20%$3/$10/$50/$100/20% after plan deductible2025 Per Pay Period (24) Medical Plan CostEmployee Only$53.92$49.49$43.66Employee + Spouse$141.42$127.24$110.16Employee + Child(ren)$111.98$101.09$87.79Employee + Family $195.80$175.57$151.49WoodsEdge Community Church Benefit Plans At-a-Glance Effective Date: January 1, 2025

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FLEXIBLE SPENDING ACCOUNTS FLEXIBLE SPENDING ACCOUNTS (FSA) Using a flexible spending account (FSA) saves you money by allowing you to pay for eligible expenses on a tax-free basis. When you contribute to an FSA, you save approximately 30%* on eligible expenses, making a $100 eligible purchase cost you about $70. You get these savings because the contributions you make to an FSA are exempt from Federal, State, and FICA payroll taxes. *This tax example is a broad approximation of tax liability. Your specific savings depend on your tax bracket. Further, your contributions may be subject to state income tax in some states. You should consult a tax advisor for help with your own situation. Current IRS tax laws control all pre-tax payment and contribution matters and are subject to change. FSA Options You may participate in any FSA available under your employer’s plan design, as long as you’re eligible to participate. Health Care FSA: allows you to pay for eligible medical, vision, and dental expenses that are not covered by another health plan. As long as you (or a covered spouse) are not contributing to a health saving account (HSA), you can use a health care FSA to supplement out-of-pocket costs. Limited Health FSA*: allows you to pay for eligible vision and dental expenses that are not covered by another health plan. This is a great option if you (or your spouse) contribute to a health savings account (HSA) because you can maximize savings by participating in both plans at the same time. Dependent Care FSA: allows you to set aside pre-tax funds to pay for daycare expenses for eligible children or other eligible dependents. You (and your spouse if you’re married) must be working, looking for work, or be a full-time student to use this account. *Note: to be eligible for the Limited Health FSA, you must enroll in the Health Saver 5000 HSA plan. Next Steps 1. Attend the Upcoming Benefit Meeting Learn more about the value of an FSA by attending the upcoming benefit meeting on November 14th at 10AM. This will help you understand your options and determine which FSA to enroll in. 2. View Eligible Expenses

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HEALTH SAVINGS ACCOUNT (HSA) Information for those enrolling in the AETNA’s CPOSII 3500 HSA plan HEALTH SAVINGS ACCOUNT (HSA) To be eligible for an HSA, you must enroll in the Health Saver 5000 HSA plan. A health savings account (HSA) is a savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. With an HSA, you save approximately 30%* on your eligible expenses, making a $1,000 expense cost you about $700. You get these savings because the contributions you make to your HSA are exempt from Federal, State, and FICA payroll taxes. *This tax example is a broad approximation of tax liability. Your specific savings depend on your tax bracket. Further, your contributions may be subject to state income tax in some states. You should consult a tax advisor for help with your own situation. Current IRS tax laws control all pre-tax payment and contribution matters and are subject to change. HSA Options HSAs offer flexibility and planning beyond what you get with other benefits. Spend your HSA dollars when you need them, save your HSA dollars when you don’t have an immediate need, and invest some of your savings as your balance grows to see your money grow even faster. Spend Use funds on a tax-free basis to pay for eligible purchases as they come up. Save Put funds away for future expenses. Take advantage of a high-yield HSA, which gives you the potential of a higher interest rate. Invest Help support your financial wellness by investing funds for health emergencies or health costs incurred during retirement. Next Steps 1. Consider Your Interest Options At EBC, there are two interest options for your HSA—a traditional interest option or a high-yield interest option. When you first enroll in your HSA, your HSA cash balance will automatically start out with the traditional HSA interest option, but you have the ability to transition your HSA cash balance to a high-yield HSA option at any time. The high-yield HSA gives you the opportunity to earn higher interest on your HSA funds by having your HSA held in a non-FDIC-insured account that is backed by a highly rated insurance company, Pacific Life. You can change your interest option preference anytime through your online account. Learn more at www.ebcflex.com/highyieldhsa.

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HEALTH SAVINGS ACCOUNT (HSA) Information for those enrolling in the AETNA’s CPOSII 3500 HSA plan 2. Learn More About Investing Once your HSA reaches a $1,000 cash balance, you can start investing your HSA funds. There are three investment models to choose from based on your expertise—Managed, Self-Directed, and Brokerage. Whether you’re new to investing and are looking for a guided experience or are a seasoned investor looking to research and trade stocks and ETFs, you will have an investment model that best fits your needs. If your investment needs ever change, you can switch your investment model at any time. You can also transfer funds between your HSA cash balance and investment balance at any time. 3. View Eligible Expenses Consider which eligible expenses you can use your HSA funds on to help inform your contribution amount. For a full list of eligible HSA expenses, visit www.ebcflex.com/eligibleexpenses. 4. Choose Your Contribution Amount After considering the eligible expenses, decide how much you would like to contribute to the HSA. For 2024, you can elect to contribute up to the established limit: Self-Only Health Plan Family Health Plan $4,300* $8,550* *Limits are based on the assumption that an individual is HSA eligible for the full plan year. Limits may be prorated based on the duration of HSA eligibility. 5. Complete the Enrollment Process After determining that an HSA is right for you, if you are eligible for an HSA, and determining your election amount, you should now have a better understanding of your available options and be prepared to complete the enrollment process. STILL HAVE QUESTIONS? Review the HSA Frequently Asked Questions (FAQs) at: https://www.ebcflex.com/simplyhsafaqs/

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

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

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

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ColonialLife.com11-21 | 101861-1HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be oered to employees who do not have HSAs.THIS INSURANCE PROVIDES LIMITED BENEFITS.EXCLUSIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of a covered personʼs felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness, suicide or injuries which any covered person intentionally does to himself, war or armed conflict. In addition, we will not pay Catastrophic Accident benefits for injuries a child received during birth, or for injuries that are the result of being intoxicated or under the influence of any narcotics.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form GACC1.0-P and certificate form GACC1.0-C (including state abbreviations where used, for example: GACC1.0-C-EE-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2021 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

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For more information, talk with your benefits counselor.Group Accident InsurancePreferred PlanColonialLife.comGAC4000 – PREFERRED PLANGroup accident insurance can help with medical or other costs associated with a covered accident or injury that your health insurance may not cover. With this coverage you may not need to use your savings or secure a loan to help pay those unexpected out-of-pocket expenses. Coverage options are available for you, your spouse and eligible dependent children. Benefits are per covered person per covered accident unless stated otherwiseAccident emergency treatment ................................................................................................ $150 One visit per covered person per covered accident and Up to four visits per covered person per calendar yearAccident follow-up doctor visit ..................................................................................................$50Up to four visits per covered person per covered accident andUp to 16 visits per covered person per calendar yearAccidental death Accidental deathPer covered person Accidental death common carrier¾ Named insured .....................................................................$50,000 .................. $200,000¾ Spouse ...............................................................................$50,000 .................. $200,000¾ Dependent child(ren) .............................................................. $10,000 ....................$40,000Examples of common carriers are mass transit trains, buses and planesAccidental dismembermentLoss or loss of use¾ One hand, arm, foot, leg or sight of an eye ......................................................................... $9,000¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination ................................ $18,000¾ One finger or one toe ................................................................................................... $1,050¾ Two or more fingers; two or more toes; or any combination ................................................... $2,100Air ambulance .................................................................................................................. $1,500 Transportation to or from a hospital or medical facilityAmbulance (ground)..............................................................................................................$300 Transportation to or from a hospital or medical facilityAppliance aid in personal locomotion or mobility .........................................................................$100Walking boot, neck brace, back brace, leg brace, cane, crutches, walker and wheelchairBlood/plasma/platelets .........................................................................................................$400 Required during treatment of a covered accidentBurn¾ 2nd-degree burns (covering at least 36% of the body’s surface) ..................................................$1,000¾ 3rd-degree burns (based on size) ......................................................................... $2,000 – $15,000Burn–skin gra ...................................................................................50% of applicable burn benefitAs a result of 2nd-degree or 3rd-degree burns

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Catastrophic accidentTotal and irrecoverable loss or loss of use¾ Both hands, arms, feet, legs or the sight of both eyes; or any combination; or¾ Loss of hearing in both ears or loss of ability to speak Subject to a 365-day elimination period; payable once per lifetime per covered person¾ Named insured ..................................................................................................................................................$50,000¾ Spouse ..................................................................................................................................................................$50,000 ¾ Dependent child(ren) .......................................................................................................................................$25,000Coma ...............................................................................................................$10,000Lasting for 14 or more consecutive daysConcussion ............................................................................................................ $375Dislocation (separated joint) Non-surgical Surgical¾ Hip ........................................................................................$3,000 $6,000¾ Knee (except patella) ..................................................................$1,500 $3,000¾ Ankle, bone or bones of the foot (other than toes) ...............................$1,200 $2,400¾ Collarbone (sternoclavicular) ..........................................................$800 $1,600¾ Collarbone (acromioclavicular and separation) ....................................$200 $400¾ Lower jaw ..................................................................................$720 $1,440¾ Shoulder (glenohumeral) ............................................................ $1,200 $2,400¾ Elbow ....................................................................................... $450 $900¾ Wrist ........................................................................................$600 $1,200¾ Bone(s) of the hand, (other than fingers) ............................................. $810 $1,620¾ Finger, toe ..................................................................................$200 $400¾ Incomplete dislocation or dislocation reduction.................................. 25% of the applicable without anesthesia non-surgical amountEmergency dental work ¾ Dental crown or denture ....................................................................................$300 ¾ Dental extraction .............................................................................................$100 Eye injury ..............................................................................................................$300 With surgical repair or removal of a foreign objectFracture (broken bone) Non-surgical Surgical¾ Skull, depressed fracture (except face/nose) ......................................$3,750 $7,500¾ Skull, simple non-depressed fracture (except face/nose) .......................$1,800 $3,600¾ Hip, thigh (femur) ......................................................................$3,150 $6,300¾ Body of vertebrae (excluding vertebral processes) ...............................$2,700 $5,400¾ Pelvis .....................................................................................$2,400 $4,800¾ Leg (tibia and/or fibula) ...............................................................$1,800 $3,600¾ Bones of the face or nose (except mandible or maxilla) ...........................$910 $1,820¾ Upper jaw, maxilla, upper arm between .......................................... $1,050 $2,100 elbow and shoulder¾ Lower jaw, mandible ................................................................. $1,200 $2,400¾ Kneecap, ankle, foot .................................................................. $1,200 $2,400¾ Shoulder blade, collarbone ......................................................... $1,200 $2,400¾ Vertebral processes ...................................................................... $630 $1,260¾ Forearm, hand, wrist ................................................................. $1,200 $2,400¾ Rib ..........................................................................................$375 $750¾ Coccyx .....................................................................................$320 $640¾ Finger, toe .................................................................................$200 $400¾ Chip fracture .................................................25% of the applicable non-surgical amountAlex was cleaning out the gutters when he fell. ALEX’S BENEFITS Ambulance $300Emergency room visit $150X-ray $60Hospital admission $1,000Hospital confinement $750Leg fracture (surgical) $3,600Physical therapy $360Appliance (crutches) $100Doctor’s follow-up oice visit $150$6,470EMERGENCY ROOM VISITAlex was taken by ambulance to the nearest emergency room and received immediate care.The doctor ordered an X-ray and discovered Alex had fractured his leg.DIAGNOSTIC PROCEDUREOver the next several weeks, he had three follow-up appointments with his doctor.DOCTORʼS OFFICE VISITAlex had eight sessions of PT to help him regain the strength in his leg.PHYSICAL THERAPYAlex was admitted to the hospital for surgery on his leg. He was confined for three days.HOSPITAL CONFINEMENTFor illustrative purposes only.Benefit amounts may vary and may not cover all expenses. The certificate has exclusions and limitations.ALEXʼS OUT-OF-POCKET EXPENSESWhen Alex totaled up the bills, he had to pay his annual deductible, as well as co-payments for the ambulance, emergency room, hospital, surgery, physical therapy and follow-up visits. Luckily, Alex had accident coverage to help with these expenses.Alex used crutches.APPLIANCE FOR MOBILITY

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For more information, talk with your benefits counselor.GAC4000 – PREFERRED PLANHospital admission .............................................................................................................$1,000Per covered person per covered accidentHospital confinement .................................................................................................. $250 per dayUp to 365 days per covered person per covered accidentHospital intensive care unit admission .................................................................................... $1,750 Per covered person per covered accidentHospital intensive care unit confinement ........................................................................ $400 per day Up to 15 days per covered person per covered accident Knee cartilage (torn) ............................................................................................................. $750 Laceration (no repair, without stitches) ..........................................................................................$50 Laceration (repaired by stitches)¾ Total of all lacerations is less than two inches long ...................................................................$150¾ Total of all lacerations is at least two but less than six inches long ................................................. $300 ¾ Total of all lacerations is six inches or longer ........................................................................... $600 Lodging (companion) ..................................................................................................$200 per day Up to 30 days per covered person per covered accident Medical imaging study (CT, CAT scan, EEG, MR or MRI) .....................................................................$200 One benefit per covered person per covered accident per calendar yearOccupational or physical therapy ....................................................................................$45 per day Up to 10 days per covered person per covered accident Pain management for epidural anesthesia .................................................................................. $150 Prosthetic device/artificial limb One benefit per covered person per covered accident¾ One ....................................................................................................................... $1,250 ¾ More than one ........................................................................................................... $2,500 Rehabilitation unit confinement ....................................................................................$150 per day Immediately aer a period of hospital confinement due to a covered accident; up to 15 days per covered person per covered accident, not to exceed 30 days per covered person per calendar yearRuptured disc with surgical repair ............................................................................................$900 Surgery¾ Cranial, open abdominal and thoracic .............................................................................. $1,500 ¾ Hernia with surgical repair ...............................................................................................$300Surgery (exploratory and arthroscopic) ....................................................................................... $225Tendon/ligament/rotator cu¾ One with surgical repair ..................................................................................................$900 ¾ Two or more with surgical repair ..................................................................................... $1,800 Transportation for hospital confinement ...................................................................$600 per round tripUp to three round trips for more than 50 miles from home per covered person per covered accidentX-ray ...................................................................................................................................$60

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ColonialLife.com4-18 | 101862HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be oered to employees who do not have HSAs.THIS CERTIFICATE PROVIDES LIMITED BENEFITS.EXCLUSIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of a covered personʼs felonies or illegal occupations, hazardous avocations, racing, semi-professional or professional sports, sickness, suicide or injuries which any covered person intentionally does to himself, war or armed conflict. In addition, we will not pay Catastrophic Accident benefits for injuries a child received during birth, or for injuries that are the result of being intoxicated or under the influence of any narcotics.This information is not intended to be a complete description of the insurance coverage available. This coverage has exclusions and limitations that may aect benefits payable. For cost and complete details, see your Colonial Life benefits counselor. This brochure is applicable to policy form GACC1.0-P and certificate form GACC1.0-C (plus state abbreviations where applicable, such as GACC1.0-P-EE-TX and certificate form GACC1.0-C-EE-TX). Coverage may vary by state and may not be available in all states. Premium at the eective date will vary according to the family coverage type.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

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For more information, talk with your benefits counselor.ColonialLife.comGroup Accident InsuranceHealth Screening BenefitTHIS INSURANCE PROVIDES LIMITED BENEFITS.HEALTH SAVINGS ACCOUNT (HSA) COMPATIBLEThis plan is compatible with HSA guidelines and any other HSA plan in which a covered family member may participate. It may also be oered to employees who do not have HSAs.This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy forms GACC1.0-P-EE-TX, certificate form GACC1.0-C-EE-TX and rider form R-GACC1.0-HS-TX. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.GAC4000 - HEALTH SCREENING | 10-20 | 101865-1-TXThis benefit can help pay for routine preventive tests and services.Health screening ................................................................................ $100.00Payable once per covered person per calendar year; subject to a 30-day waiting period Blood test for triglycerides Bone marrow testing Breast ultrasound CA 15-3 (blood test for breast cancer) CA 125 (blood test for ovarian cancer) Carotid Doppler CEA (blood test for colon cancer) Chest X-ray Colonoscopy Echocardiogram (ECHO) Electrocardiogram (EKG, ECG) Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA (blood test for prostate cancer) Serum cholesterol test for HDL and LDL levels Serum protein electrophoresis (blood test for myeloma) Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopyUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

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For more information, talk with your benefits counselor.Group Hospital Confinement Indemnity InsurancePlan 2GROUP MEDICAL BRIDGE – PLAN 2The surgeries listed below are only a sampling of the surgeries that may be covered. Surgeries must be performed by a doctor in a hospital or ambulatory surgical center. For complete details and definitions, please refer to your certificate. Tier 1 outpatient surgical procedures  Breast– Axillary node dissection– Breast capsulotomy– Breast reconstruction– Lumpectomy  Cardiac– Pacemaker insertion  Digestive– Colonoscopy– Fistulotomy– Hemorrhoidectomy (external)– Lysis of adhesions  Skin– Laparoscopic hernia repair– Skin graing  Ear, nose, throat, mouth– Adenoidectomy– Removal of oral lesions– Myringotomy– Tonsillectomy– Tracheostomy  Gynecological– Dilation and curettage (D&C)– Endometrial ablation– Lysis of adhesions  Liver– Paracentesis  Musculoskeletal system– Carpal/cubital repair or release– Dislocation (closed reduction treatment) other than a finger or toe– Foot surgery (bunionectomy, exostectomy, arthroplasty, hammertoe repair)– Fracture (closed reduction treatment) other than a rib, finger or toe– Removal of orthopedic hardware– Removal of tendon lesionGroup Medical BridgeSM insurance can help with medical costs that your health insurance may not cover. These benefits are available for you, your spouse and eligible dependent children. Hospital confinement benefit .......................................................$_______________ per dayMaximum of one day per covered person per calendar yearOutpatient surgical procedure benefit  Tier 1.......................................................................................$_______________ per day  Tier 2.......................................................................................$_______________ per dayMaximum of $________________ per covered person per calendar year for Tier 1 and 2 combined Maximum of one day per outpatient surgical procedure

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THIS POLICY PROVIDES LIMITED BENEFITS. EXCLUSIONS We will not pay benefits for losses which are caused by: dental procedures, elective procedures, cosmetic surgery, felonies or illegal occupations, intoxicants or narcotics, pregnancy of a dependent child, psychiatric or psychological conditions, suicide, intentional injuries, war, armed forces service or giving birth within the first nine months aer the certificate eective date. We will not pay benefits for hospital confinement of a newborn who is neither injured nor sick. We will not pay benefits for loss during the first 12 months aer the eective date due to a pre-existing condition, which means a sickness or physical condition for which a covered person was treated, had medical testing, received medical advice or had taken medication within the 12 months before the certificate eective date.For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy forms GMB1.0-P-AU-TX-R and GMB1.0-P-EE-TX-R and certificate forms GMB1.0-C-AU-TX-R and GMB1.0-C-EE-TX-R. This is not an insurance contract and only the actual certificate provisions will control.ColonialLife.com10-18 | 100025-3-TX  Breast– Breast reduction  Cardiac– Angioplasty– Cardiac catheterization  Digestive– Exploratory laparoscopy– Laparoscopic appendectomy– Laparoscopic cholecystectomy  Ear, nose, throat, mouth– Ethmoidectomy– Mastoidectomy– Septoplasty– Stapedectomy– Tympanoplasty– Tympanotomy  Eye– Cataract surgery– Corneal surgery (penetrating keratoplasty)– Glaucoma surgery (trabeculectomy)– Vitrectomy Tier 2 outpatient surgical procedures  Gynecological– Myomectomy  Musculoskeletal system– Arthroscopic knee surgery with meniscectomy (knee cartilage repair)– Arthroscopic shoulder surgery– Clavicle resection– Dislocations (open reduction with internal fixation)– Fracture (open reduction with internal fixation)– Removal or implantation of cartilage– Tendon/ligament repair  Thyroid– Excision of a massUnderwritten by Colonial Life & Accident Insurance Company, Columbia, SC©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

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For more information, talk with your benefits counselor.Group Hospital Confinement Indemnity InsuranceHealth Screening BenefitFor cost and complete details, see your Colonial Life benefits counselor. Applicable to policy form GMB1.0-P-R and certificate form GMB1.0-C-R. Coverage may vary by state and may not be available in all states. This is not an insurance contract and only the actual policy provisions will control.GROUP MEDICAL BRIDGE HEALTH SCREENING BENEFIT | 5-18 | 100029-4ColonialLife.comHealth screening benefit ............................................................................ $100 per dayMaximum of one day per covered person per calendar year  Blood test for triglycerides  Bone marrow testing  Breast ultrasound  CA 15-3 (blood test for breast cancer)  CA 125 (blood test for ovarian cancer)  Carotid Doppler  CEA (blood test for colon cancer)  Chest X-ray  Colonoscopy  Echocardiogram (ECHO)  Electrocardiogram (EKG, ECG)  Fasting blood glucose test  Flexible sigmoidoscopy  Hemoccult stool analysis  Mammography  Pap smear  PSA (blood test for prostate cancer)  Serum cholesterol test for HDLand LDL levels  Serum protein electrophoresis(blood test for myeloma)  Skin cancer biopsy  Stress test on a bicycleor treadmill  Thermography  ThinPrep pap test  Virtual colonoscopyGroup Medical BridgeSM insurance’s health screening benefit can help pay for health and wellness tests you have each year.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2018 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

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Group Critical Illness InsurancePlan 2GCI6000 – PLAN 2 – CRITICAL ILLNESS AND CANCERWhen life takes an unexpected turn, your focus should be on recovery — not finances. Colonial Life’s group critical illness insurance helps relieve financial worries by providing a lump-sum benefit payable directly to you to use as needed.Coverage amount: ____________________________COVERED CRITICAL ILLNESS CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTBenign brain tumor100%Coma100%End stage renal (kidney) failure100%Heart attack (myocardial infarction)100%Loss of hearing100%Loss of sight100%Loss of speech100%Major organ failure requiring transplant100%Occupational infectious HIV or occupational infectious hepatitis B, C or D100%Stroke100%Sudden cardiac arrest 100%Coronary artery disease25%COVERED CANCER CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTInvasive cancer (including all breast cancer)100%Non-invasive cancer25%Skin cancer initial diagnosis ............................................................ $400 per lifetimeCritical illness and cancer benefitsSpecial needs daycareA hospital stay and treatment for corrective heart surgeryPhysical therapy to build muscle strengthFor illustrative purposes only.Preparing for a lifelong journeyRebecca was born with Down syndrome. Her parents’ critical illness coverage provided a benefit that can help cover expenses related to Rebecca’s care and her changing needs. HOW THEIR COVERAGE HELPEDThe lump-sum amount from the family coverage benefit helped pay for:

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ColonialLife.com6-20 | 387100-TX1. Refer to the certificate for complete definitions of covered conditions. 2. Dates of diagnoses of a covered critical illness must be separated by more than 180 days. 3. Critical illnesses that do not qualify include: coronary artery disease, loss of hearing, loss of sight, loss of speech, and occupational infectious HIV or occupational infectious hepatitis B, C or D.THIS INSURANCE PROVIDES LIMITED BENEFITS.EXCLUSIONS AND LIMITATIONS FOR CRITICAL ILLNESS We will not pay the Critical Illness Benefit, Benefits Payable Upon Subsequent Diagnosis of a Critical Illness or Additional Critical Illness Benefit for Dependent Children that occurs as a result of a covered person’s: doctor or physician relationship; felonies or illegal occupations; intoxicants and narcotics; suicide or injuring oneself intentionally, whether sane or not; war or armed conflict; or pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is diagnosed with a critical illness.EXCLUSIONS AND LIMITATIONS FOR CANCER We will not pay the Invasive Cancer (including all Breast Cancer) Benefit, Non-Invasive Cancer Benefit, Benefit Payable Upon Reoccurrence of Invasive Cancer (including all Breast Cancer) or Skin Cancer Initial Diagnosis Benefit for a covered person’s invasive cancer or non-invasive cancer that: is diagnosed or treated outside the territorial limits of the United States, its possessions, or the countries of Canada and Mexico; is a pre-existing condition, unless the covered person has satisfied the pre-existing condition limitation period shown on the Certificate Schedule on the date the covered person is initially diagnosed as having invasive or non-invasive cancer. No pre-existing condition limitation will be applied for dependent children who are born or adopted while the named insured is covered under the certificate, and who are continuously covered from the date of birth or adoption.PRE-EXISTING CONDITION LIMITATION We will not pay a benefit for a pre-existing condition that occurs during the 12-month period aer the coverage eective date. Pre-existing condition means a sickness or physical condition for which a covered person received medical advice or treatment within 12 months before the coverage eective date.This information is not intended to be a complete description of the insurance coverage available. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy forms GCI6000-P-EE-TX and GCI6000-P-AU-TX and certificate forms GCI6000-C-EE-TX and GCI6000-C-AU-TX. For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.COVERED CONDITIONPERCENTAGE OF APPLICABLE COVERAGE AMOUNTCerebral palsy 100%Cle lip or palate 100%Cystic fibrosis 100%Down syndrome 100%Spina bifida 100%KEY BENEFITSAdditional covered conditions for dependent childrenSubsequent diagnosis of a dierent critical illnessIf you receive a benefit for a critical illness and are later diagnosed with a dierent critical illness, 100% of the coverage amount may be payable for that particular critical illness.Subsequent diagnosis of the same critical illnessIf you receive a benefit for a critical illness and are later diagnosed with the same critical illness,3 25% of the coverage amount is payable for that critical illness.Reoccurrence of invasive cancer (including all breast cancer)If you receive a benefit for invasive cancer and are later diagnosed with a reoccurrence of invasive cancer, 25% of the coverage amount is payable if treatment-free for at least 12 months and in complete remission prior to the date of reoccurrence; excludes non-invasive or skin cancer.For more information, talk with your benefits counselor.Preparing for the unexpected is simpler than you think. With Colonial Life, youʼll have the support you need to face lifeʼs toughest challenges.  Available coverage for spouse and eligible dependent children at 50% of your coverage amount  Cover your eligible dependent children at no additional cost  Receive coverage regardless of medical history, within specified limits  Works alongside your health savings account (HSA)  Benefits payable regardless of other insurance

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Group Critical Illness InsuranceWellbeing Assistance BeneﬁtThe wellbeing assistance benefit can help reduce the risk of serious illness through early detection of disease or risk factors.Wellbeing assistance benefit ............................................................. $100.00Maximum of one test per covered person per calendar year; subject to a 30-day waiting period before the benefit is payable. The test must be performed aer the waiting period. Blood test for triglycerides Bone marrow testing BRCA1 or BRCA2 testing (genetic test for breast cancer) Breast ultrasound CA 15-3 (blood test for ovarian cancer) CA 125 (blood test for breast cancer) Carotid Doppler CEA (blood test for colon cancer) Chest x-ray Colonoscopy Echocardiogram (ECHO) Electrocardiogram (EKG, ECG) Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA (blood test for prostate cancer) Serum cholesterol test for HDL and LDL levels Serum protein electrophoresis (blood test for myeloma) Skin cancer biopsy Stress test on a bicycle or treadmill Thermography ThinPrep pap test Virtual colonoscopyFor more information, talk with your benefits counselor.ColonialLife.comGCI6000 – WELLBEING ASSISTANCE BENEFIT | 5-20 | 387307Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC.©2020 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.THIS INSURANCE PROVIDES LIMITED BENEFITS.This information is not intended to be a complete description of the insurance coverage available. The insurance or its provisions may vary or be unavailable in some states. The insurance has exclusions and limitations which may aect any benefits payable. Applicable to policy form GCI6000-P and certificate form GCI6000-C (including state abbreviations where used, for example: GCI6000-C-TX). For cost and complete details of coverage, call or write your Colonial Life benefits counselor or the company.

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Group Disability InsuranceGROUP DISABILITY BASEYou never know when a disability could impact your way of life. Fortunately, there’s a way to help protect your income. If a covered accident or sickness prevents you from earning a paycheck, disability insurance can provide a monthly benefit to help you cover your ongoing expenses.Can you aord to not protect your income? You don’t have the same lifestyle expenses as the next person. That’s why you need disability coverage that can be customized to fit your specific needs.Aer calculating your monthly expenses, your benefits counselor can help you complete the benefits worksheet.ColonialLife.comMONTHLY EXPENSESRound to the nearest hundred.1 Rent or mortgage $2 Transportation $3 Utilities (phone, internet, electricity/gas, water, etc.) $4 Food and necessities $5 Other expenses $ Total monthly expenses (add lines 1-5 together) $Benefits worksheetHow much coverage do I need?Monthly benefit amount for o-job accident and o-job sickness: ______________Choose a monthly benefit amount between $400 and $7,500.*If your plan includes on-job accident/sickness benefits, the benefit is 50% of the o-job amount.What is the benefit period?Benefit period: _______ monthsThe partial disability benefit period is three months.When may my total disability benefits start?Aer an accident: _______ days Aer a sickness: _______ days*Subject to income requirements

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EXCLUSIONS AND LIMITATIONS We will not pay benefits for losses that are caused by, contributed to by or occur as the result of: alcoholism or drug addiction, felonies or illegal occupations, flying, hazardous avocations, intoxicants and narcotics, psychiatric or psychological conditions, racing, semi-professional or professional sports, suicide or injuries which you intentionally do to yourself, war or armed conflict. We will not pay for losses due to you giving birth within the first nine months aer the coverage eective date of the certificate. We will not pay for loss when the disability is a pre-existing condition as described in the certificate.Pre-Existing Condition means a sickness or physical condition, whether diagnosed or not, for which you were treated, had medical testing, received medical advice or had taken medication within 12 months before the coverage eective date.We will not pay for loss when the disability is a pre-existing condition as defined in this certificate, unless you have satisfied the pre-existing condition limitation period (typically 12 months) shown on the Certificate Schedule on the date you suer a loss due to a covered accident or covered sickness.For cost and complete details, see your Colonial Life benefits counselor. Applicable to policy form GDIS-P-EE-TX and certificate form GDIS-C-EE-TX. This is not an insurance contract and only the actual policy and certificate provisions will control.Product information and features Total disabilityTotally disabled or total disability means you are: unable to perform the material and substantial duties of your regular occupation, not working at any occupation, and under the regular and appropriate care of a doctor.Partial disabilityIf you are able to return to work part-time aer at least 14 days of being paid for a total disability, you may be able to still receive 50% of your total disability benefit.Waiver of premiumWe will waive your premium payments aer 90 consecutive days of a covered disability.Geographical limitationsIf you are disabled while outside of the United States, Mexico or Canada, you may receive benefits for up to 60 days before you have to return to the U.S. Issue ageCoverage is available from ages 17 to 74.PortabilityYou may be able to keep your coverage even if you change jobs.For more information, talk with your benefits counselor.10-17 | 101296-2Underwritten 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.

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Your cost will vary based on the level of coverage you select. Whole Life InsuranceYou can’t predict your family’s future, but you can be prepared for it.You like to think that you’ll be there for your family in the years to come. But if something happened to you, would your family have the income they need?It’s not easy to think about such serious circumstances, but it’s important to make sure your family is financially protected. You can gain peace of mind with whole life insurance from Colonial Life.Advantages of whole life insurance  Permanent coverage that stays the same throughout the life of the policy  Guaranteed level premiums that do not increase because of changes in health or age  Access to the policy’s cash value through a policy loan for emergencies  Benefit for the beneficiary that is typically tax-freeBenefits and features  Two plan options to choose what age your premium payments will end – Paid-Up at Age 70 or Paid-Up at Age 100  Stand-alone spouse policy available whether or not you buy a policy for yourself  Flexibility to keep the policy if you change jobs or retire  Built-in terminal illness accelerated death benefit that provides up to 75% of the policy’s death benefit (up to $150,000) if you’re diagnosed with a terminal illness  Immediate $3,000 claim payment that can help your designated beneficiary pay for funeral costs or other expenses  Pays cash surrender value at age 100 (when the policy endows)WHOLE LIFE (IWL5000)HealthAairs.org, End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported, July 2017.Talk with your benefits counselor for information about what level of coverage would work best for you.In the U.S., medical spending in the last 12 months of life is nearly $80,000 per person.$

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£ YOU $ ___________________ Select the option:£ Paid-Up at Age 70£ Paid-Up at Age 100£ SPOUSE $ _______________ Select the option:£ Paid-Up at Age 70£ Paid-Up at Age 100EXCLUSIONS AND LIMITATIONSIf the insured dies by suicide, whether sane or insane, within two years (one year in ND) from the coverage eective date or the date of reinstatement, we will not pay the death benefit. We will terminate this policy and return the premiums paid without interest, minus any loans and loan interest to you. Product may vary by state. For costs and complete details of the coverage, call or write your Colonial Life benefits counselor or the company.This brochure is applicable to policy forms ICC19-IWL5000-70/IWL5000-70, ICC19-IWL5000-100/IWL5000-100, ICC19-IWL5000J/IWL5000J and rider forms ICC19-R-IWL5000-STR/R-IWL5000-STR, ICC19-R-IWL5000-CTR/R-IWL5000-CTR, ICC19-R-IWL5000-WP/R-IWL5000-WP, ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD, ICC19-R-IWL5000-CI/R-IWL5000-CI, ICC19-R-IWL5000-CC/R-IWL5000-CC, ICC19-R-IWL5000-GPO/R-IWL5000-GPO and applicable state variations.Additional coverage optionsSpouse term life riderCover your spouse up to a maximum death benefit of $50,000; 10-year and 20-year spouse term riders are available.Juvenile whole life policyYou can purchase a policy while children are young and premiums are low – whether or not you buy a policy on yourself. You may also increase the coverage when the child is 18, 21 and 24 without providing proof of good health. The plan is paid-up at age 70.Children’s term life riderYou may purchase up to $20,000 in term life coverage for all of your eligible dependent children and pay one premium. The children’s term life rider may be added to either your policy or your spouse’s policy – not both.Accidental death benefit riderThe beneficiary may receive an additional benefit if the covered person dies as a result of an accident before age 70. The benefit doubles if the accidental bodily injury occurs while riding as a fare-paying passenger using public transportation, such as ride-sharing services. An additional 25% will be payable if the injury is sustained while driving or riding in a private passenger vehicle and wearing a seatbelt.Chronic care accelerated death benefit riderIf a licensed health care practitioner certifies that you have a chronic illness, you may receive an advance on all or a portion of the death benefit, available in a one-time lump sum or monthly payments. A chronic illness means you require substantial supervision due to a severe cognitive impairment or you may be unable to perform at least two of the six Activities of Daily Living (bathing, continence, dressing, eating, toileting and transferring). Premiums are waived during the benefit period.Critical illness accelerated death benefit riderIf you suer a heart attack (myocardial infarction), stroke or end-stage renal (kidney) failure, a $5,000 benefit is payable. A subsequent diagnosis benefit is included.Guaranteed purchase option riderIf you are age 50 or younger when you purchase the policy, you can add the rider, which allows you to purchase additional whole life coverage – without having to answer health questions – at three dierent points in the future. You may purchase up to your initial face amount, not to exceed a total combined maximum of $100,000 for all options.Waiver of premium benefit riderPremiums are waived (for the policy and riders) if you become totally disabled before the policy anniversary following your 65th birthday and you satisfy the six-month elimination period. Once you are no longer disabled, premium payments will resume.Benefits worksheetFor use with your benefits counselorSelect any optional riders:£ Spouse term life rider $ _____________ face amount for ________-year term period£ Children’s term life rider $ _____________ face amount£ Accidental death benefit rider£ Chronic care accelerated death benefit rider£ Critical illness accelerated death benefit rider£ Guaranteed purchase option rider£ Waiver of premium benefit riderHOW MUCH COVERAGE DO YOU NEED?To learn more, talk with your benefits counselor.ColonialLife.com6-19 | 101935£ DEPENDENT STUDENT $____________£ Paid-Up at Age 70 £ Paid-Up at Age 100 1 Loan should be repaid to protect the policy’s value. 2 Any payout would reduce the death benefit. Benefits may be taxable as income. Individuals should consult with their legal or tax counsel when deciding to apply for accelerated benefits.Underwritten 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.

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Deductions per year: 24Group Accident for TXApplicable to policy forms GACC1.0-P & GACC1.0-ClOn/Off-Job Accident Coverage, Health Screening Benefit ($100 Benefit)BasicISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY17-99 $7.84 $12.55 $12.01 $16.73Group Accident for TXApplicable to policy forms GACC1.0-P & GACC1.0-ClOn/Off-Job Accident Coverage, Health Screening Benefit ($100 Benefit)PreferredISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY17-99 $10.47 $16.92 $17.28 $23.74Group Medical Bridge (GMB7000) for TXCompositeApplicable to Policy Forms GMB7000–P & GMB7000-ClWellbeing Assistance: Standard - $100, Outpatient Surgical Procedure: Option 2 - ($750 / $1500 / $2500)HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 4: $200017-99 $19.42 $40.58 $26.70 $47.87HOSPITAL CONFINEMENT LEVEL ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE PARENT FAMILY TWO PARENT FAMILYLevel 6: $300017-99 $28.17 $59.33 $38.65 $69.82WoodsEdge Community Church SB&K BenefitsPage 1 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice

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Group Critical Illness (GCI6000) for TXApplicable to policy forms GCI6000-P, GCI6000-C,R-GCI6000-CB, R-GCI6000-BB, R-GCI6000-HB,R-GCI6000-INF, R-GCI6000-PDlPlan 2 - Critical Illness & Cancer, Wellbeing Assistance Benefit - $100 BenefitUni-Tobacco RatesISSUE AGE NAMED INSURED NAMED INSURED ANDSPOUSENAMED INSURED ANDDEPENDENT CHILD(REN)NAMED INSURED, SPOUSEAND DEPENDENT CHILD(REN)$10,000 17-24 $5.48 $8.28 $5.48 $8.2825-29 $6.43 $9.68 $6.43 $9.6830-34 $7.38 $11.13 $7.38 $11.1335-39 $9.58 $14.38 $9.58 $14.3840-44 $11.78 $17.68 $11.78 $17.6845-49 $15.28 $23.23 $15.28 $23.2350-54 $18.83 $28.73 $18.83 $28.7355-59 $23.73 $36.18 $23.73 $36.1860-64 $31.18 $47.48 $31.18 $47.4865-69 $37.48 $57.13 $37.48 $57.1370-74 $37.48 $57.13 $37.48 $57.13$20,000 17-24 $7.63 $11.38 $7.63 $11.3825-29 $9.53 $14.18 $9.53 $14.1830-34 $11.43 $17.08 $11.43 $17.0835-39 $15.83 $23.58 $15.83 $23.5840-44 $20.23 $30.18 $20.23 $30.1845-49 $27.23 $41.28 $27.23 $41.2850-54 $34.33 $52.28 $34.33 $52.2855-59 $44.13 $67.18 $44.13 $67.1860-64 $59.03 $89.78 $59.03 $89.7865-69 $71.63 $109.08 $71.63 $109.0870-74 $71.63 $109.08 $71.63 $109.08$30,000 17-24 $9.78 $14.48 $9.78 $14.4825-29 $12.63 $18.68 $12.63 $18.6830-34 $15.48 $23.03 $15.48 $23.0335-39 $22.08 $32.78 $22.08 $32.7840-44 $28.68 $42.68 $28.68 $42.6845-49 $39.18 $59.33 $39.18 $59.3350-54 $49.83 $75.83 $49.83 $75.8355-59 $64.53 $98.18 $64.53 $98.1860-64 $86.88 $132.08 $86.88 $132.0865-69 $105.78 $161.03 $105.78 $161.0370-74 $105.78 $161.03 $105.78 $161.03WoodsEdge Community Church SB&K Benefits(Continued...)Page 2 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 4 for Important Notice

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Group Disability for TX AAA Risk ClassApplicable to policy forms GDIS-P & GDIS-ClOn/Off-Job Accident and Sickness3 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $2,000* $2,500* $3,000* $4,000**monthly benefit amount0 days Accident/7 days Sickness 17-49 $28.70 $35.88 $43.05 N/A50-64 $33.30 $41.63 $49.95 N/A65-74 $41.40 $51.75 $62.10 N/A7 days Accident/7 days Sickness 17-49 $27.30 $34.13 $40.95 N/A50-64 $33.00 $41.25 $49.50 N/A65-74 $39.10 $48.88 $58.65 N/A6 Month Benefit PeriodELIMINATION PERIOD ISSUE AGE $2,000* $2,500* $3,000* $4,000**monthly benefit amount0 days Accident/7 days Sickness 17-49 $38.50 $48.13 $57.75 N/A50-64 $48.00 $60.00 $72.00 N/A65-74 $68.20 $85.25 $102.30 N/A7 days Accident/7 days Sickness 17-49 $35.50 $44.38 $53.25 N/A50-64 $47.00 $58.75 $70.50 N/A65-74 $64.10 $80.13 $96.15 N/AWhole Life Plus (IWL5000) for TXApplicable to policy forms ICC19-IWL5000-70/IWL5000-70,ICC19-IWL5000-100/IWL5000-100,ICC19-IWL5000J/IWL5000J and rider formsICC19-R-IWL5000-STR/R-IWL5000-STR,ICC19-R-IWL5000-CTR/R-IWL5000-CTR,ICC19-R-IWL5000-WP/R-IWL5000-WP,ICC19-R-IWL5000-ACCD/R-IWL5000-ACCD,ICC19-R-IWL5000-CI/R-IWL5000-CI,ICC19-R-IWL5000-CC/R-IWL5000-CC,ICC19-R-IWL5000-GPO/R-IWL5000-GPO,ICC23-IWL5000-LTC/IWL5000-LTClAdult Base Plan Paid-Up at Age 100Non-Tobacco RatesISSUE AGE $10,000 $15,000 $20,000 $25,00025 $4.60 $6.90 $9.20 $11.5035 $6.26 $9.39 $12.52 $15.6545 $9.94 $14.91 $19.89 $24.8655 $16.23 $24.34 $32.45 $40.5665 $28.88 $43.31 $57.75 $72.19Tobacco RatesISSUE AGE $10,000 $15,000 $20,000 $25,00025 $8.04 $12.05 $16.07 $20.0935 $9.78 $14.66 $19.55 $24.4445 $14.56 $21.83 $29.11 $36.3955 $24.53 $36.80 $49.07 $61.3365 $41.96 $62.94 $83.92 $104.89WoodsEdge Community Church SB&K Benefits(Continued...)Page 3 of 4Underwritten by Colonial Life & Accident Insurance CompanySee page 3 for Important Notice

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Getting startedThe easiest way to manage your business with us is through ColonialLife.com. To sign up for the website, click Register at the top right of the home page and follow the instructions. Consider your optionsAt Colonial Life, our goal is to give you an excellent customer experience that is simple, modern and personal. For your convenience, you can choose how you interact with us. For the quickest service, we recommend using our website, which lets you do the following:  Review, print or download a copy of your policy/certificate by clicking on the My Correspondence tab.  Update contact information or add family member profile information for use when filing online claims.  Access service forms to make changes to your policy, such as a beneficiary change.  Submit your claim using our eClaims system.  Check the status of your claim and view claims correspondence.  Access claim forms.Policyholder Service GuideeClaims are quick and easyWith the eClaims feature on ColonialLife.com, you can file most claims online by simply answering a few questions and uploading your supporting documentation. You’re able to spend less time on paperwork, and we’re able to process your claim faster.  From Colonial Life.com, file claims from any device. It’s fast, easy and 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 and service 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.

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CHIPRA REQUIRED NOTICE FOR YOUR EMPLOYEESPresident Obama signed into law the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) to extend and expand the State Children’s Health Insurance Program (CHIP).GuideStone® modied its procedures effective April 1, 2009, to comply with CHIPRA’s requirement to add special enrollment rights for participants and their children when:• There is a loss of coverage under Medicaid or CHIP or• The employee or dependents become eligible under Medicaid or CHIP for state premium assistance to purchase coverage under the employer’s group health plan.Premium assistance programs use federal and state CHIP and Medicaid funds to help subsidize the purchase of group health coverage for children (and, in some circumstances, family members) who have access to employer-sponsored coverage but may need assistance in paying for their premiums.What does this mean to employers?CHIPRA requires that employers maintaining group health plans in states that provide medical assistance through either Medicaid or a CHIP program must provide a notice to employees to inform them of the potential opportunities for premium assistance in their state.The attached notice is provided by the U.S. Department of Labor’s Employee Benets Security Administration. You should also check with your state Medicaid or CHIP program ofce to determine whether the additional state program information must be included in the notice.Because your health plans renew each January 1, your notice must be provided with the annual re-enrollment materials for the next plan year.This information was compiled on July 31, 2023. It will be updated as new information becomes available.Continued on other side© 2023 GuideStone® 1125353 08/23 87105005 LBJ Freeway, Ste. 2200, Dallas, TX 75244-61521-844-INS-GUIDE • GuideStone.org

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Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2023. Contact your State for more information on eligibility – ALABAMA – Medicaid ALASKA – Medicaid Website: http://myalhipp.com/ Phone: 1-855-692-5447 The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspx ARKANSAS – Medicaid CALIFORNIA – Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447) Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hipp Phone: 916-445-8322 Fax: 916-440-5676 Email: hipp@dhcs.ca.gov COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) FLORIDA – Medicaid Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711 CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/HIBI Customer Service: 1-855-692-6442 Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.htmlPhone: 1-877-357-3268

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GEORGIA – Medicaid INDIANA – Medicaid GA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party-liability/childrens-health-insurance-program-reauthorization-act-2009-chipra Phone: 678-564-1162, Press 2 Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone: 1-800-457-4584 IOWA – Medicaid and CHIP (Hawki) KANSAS – Medicaid Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp HIPP Phone: 1-888-346-9562 Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 HIPP Phone: 1-800-967-4660 KENTUCKY – Medicaid LOUISIANA – Medicaid Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP) MAINE – Medicaid MASSACHUSETTS – Medicaid and CHIP Enrollment Website: https://www.mymaineconnection.gov/benefits/s/?language=en_US Phone: 1-800-442-6003 TTY: Maine relay 711 Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms Phone: 1-800-977-6740 TTY: Maine relay 711 Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711 Email: masspremassistance@accenture.com MINNESOTA – Medicaid MISSOURI – Medicaid Website: https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and-services/other-insurance.jsp Phone: 1-800-657-3739 Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005 MONTANA – Medicaid NEBRASKA – Medicaid Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 Email: HHSHIPPProgram@mt.gov Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178

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NEVADA – Medicaid NEW HAMPSHIRE – Medicaid Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900 Website: https://www.dhhs.nh.gov/programs-services/medicaid/health-insurance-premium-program Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext. 5218 NEW JERSEY – Medicaid and CHIP NEW YORK – Medicaid Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA – Medicaid NORTH DAKOTA – Medicaid Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100 Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825 OKLAHOMA – Medicaid and CHIP OREGON – Medicaid Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075 PENNSYLVANIA – Medicaid and CHIP RHODE ISLAND – Medicaid and CHIP Website: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPP-Program.aspx Phone: 1-800-692-7462 CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov) CHIP Phone: 1-800-986-KIDS (5437) Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line) SOUTH CAROLINA – Medicaid SOUTH DAKOTA - Medicaid Website: https://www.scdhhs.gov Phone: 1-888-549-0820 Website: http://dss.sd.gov Phone: 1-888-828-0059 TEXAS – Medicaid UTAH – Medicaid and CHIP Website: Health Insurance Premium Payment (HIPP) Program | Texas Health and Human Services Phone: 1-800-440-0493 Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669 VERMONT– Medicaid VIRGINIA – Medicaid and CHIP Website: Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health Access Phone: 1-800-250-8427 Website: https://coverva.dmas.virginia.gov/learn/premium-assistance/famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/health-insurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-800-432-5924 WASHINGTON – Medicaid WEST VIRGINIA – Medicaid and CHIP Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022 Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

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WISCONSIN – Medicaid and CHIP WYOMING – Medicaid Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002 Website: https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/ Phone: 1-800-251-1269 To see if any other states have added a premium assistance program since July 31, 2023, or for more information on special enrollment rights, contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov1-877-267-2323, Menu Option 4, Ext. 61565 Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137. OMB Control Number 1210-0137 (expires 1/31/2026) © 2023 GuideStone® 1125353 08/23 8710

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1HIPAA Notice of Privacy Practices for Protected Health InformationTHIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.Dear GuideStone® Plan Participant:GuideStone Financial Resources of the Southern Baptist Convention® (“GuideStone”) is the Plan Sponsor of your Group and Personal Health Plans (“Plans”), and the Plans are subject to the Health Insurance Portability and Accountability Act (“HIPAA”). You have received this Notice because of your health coverage with GuideStone. This Notice describes how the Plans protect the personal health information they have about you which relates to your health coverage (“Protected Health Information” or “PHI”) and how the Plans may use and disclose this information. PHI includes individually identifiable information which is created, received, maintained or transmitted by the Plans and which relates to your past, present or future health, treatment or payment for health care services. This Notice also describes your rights with respect to PHI and how you can exercise those rights. This Notice does not apply to PHI maintained in your employment records by your employer for employ-ment or other non-health plan purposes.You may contact the following person for more information about the Plans’ privacy practices, to exercise your rights or to complain about how the Plans are handling your PHI:HIPAA Privacy Contact GuideStone Financial Resources 5005 LBJ Freeway, Ste. 2200, Dallas, TX 75244-6152HIPAAPrivacyContact@GuideStone.org1-844-INS-GUIDE (1-844-467-4843)

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2NOTICE SUMMARYThe following is a brief summary of the topics covered in this Notice. Please refer to the full Notice below for details:As allowed by law, the Plans may use and disclose PHI to:n Make, receive or collect payments;n Conduct health care operations;n Business associates that provide a service or function for the Plans; orn Provide your employer with summary health information.In addition, the Plans may use or disclose PHI to:n Help with public health and safety issues;n Do research;n Comply with the law;n Respond to organ and tissue donation requests and work with a medical examiner or funeral director;n Address workers’ compensation, law enforcement and other government requests;n Respond to lawsuits and legal actions;n Individuals involved in your care;n Communicate to you about health-related benefits or services; orn Provide other uses of PHI that require authorization.You have the right to:n Receive a copy of this Notice;n Inspect and copy your PHI, or a right to access your PHI;n Amend your PHI if you believe the information is incorrect;n Obtain a list of disclosures the Plans made about you (except for treatment, payment or health care operations), or a right to an accounting;n Ask the Plans to restrict the information that they share for treatment, payment or health care operations; n Request that the Plans communicate with you in a confidential manner and that your information is sent to an alternative location or by alternative means; andn Complain to the HIPAA Privacy Contact or the U.S. Department of Health and Human Services if you believe your privacy rights have been violated.The Plans are required by law to:n Maintain the privacy of PHI;n Provide this Notice of the Plans’ legal duties and privacy practices with respect to PHI;n Notify affected individuals following a breach of PHI; andn Follow the terms of this Notice.NOTICE DETAILSThe Plans may use and disclose PHI to evaluate and process any requests for coverage and claims for benefits. The following describe these and other uses and disclosures:n Treatment: The Plans may disclose PHI to your providers for treatment, including the provision of care (diagnosis, cure, etc.) or the coordination or management of that care.n For payment: The Plans may use and disclose your PHI for enrollment, to receive payment for coverage and to pay benefits. Payment activities include receiving claims or bills from your health care providers, processing payments, sending Explanations of Benefits (“EOBs”) to you, reviewing the medical necessity of the services rendered, conducting claims appeals and coordinating the payment of benefits between multiple medical plans.n For health care operations: The Plans may use and disclose your PHI for activities compatible with, and directly related to, treatment and payment. For example, the Plans may use or disclose your PHI for the Plans’ administration activi-ties, such as verification of enrollment, payment of costs of coverage, information systems controls, underwriting and actuarial evaluations, network development, selecting vendors, third-party liability, quality assessments, case management, disease-management programs and other Plan-related activities, including compliance and financial audits of claims. Subject to 26 U.S.C. § 9802(f), the Plans may not use or disclose PHI that is genetic information for underwriting purposes. n To business associates: The Plans may disclose PHI to business associates if providing a service to the Plans or per-forming a function on their behalf. In order to release PHI to a business associate, the Plans require a business associate

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3agreement where the business associate agrees in writing to contract terms designed to appropriately safeguard your information. n To your employer: The Plans may provide to your employer summary health information (as defined by HIPAA to be health information for which there is no reasonable basis to believe the information can be used to identify the individual) for (a) obtaining premium bids for providing health coverage under the group health plan or (b) modifying, amending or terminating the group health plan. The Plans may also tell your employer whether you are enrolled or disenrolled from the Plans. Under no circumstances will the Plans disclose your PHI to your employer for the purpose of employment-related actions or decisions.n Help with public health and safety issues: The Plans may disclose PHI for certain situations such as preventing disease; helping with product recalls; reporting adverse reactions to medications; reporting suspected abuse, neglect or domestic violence; and preventing or reducing a serious threat to anyone’s health or safety.n Do research: The Plans may disclose PHI for health research.n Comply with the law: The Plans may disclose PHI if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.n Respond to organ and tissue donation requests and work with a medical examiner or funeral director: The Plans may disclose PHI with organ procurement organizations, a coroner, medical examiner or funeral director when an individual dies.n Address workers’ compensation, law enforcement and other government requests: The Plans may share PHI in response to a court or administrative order or in response to a subpoena.n Respond to lawsuits and legal actions: The Plans may disclose PHI in response to a court or administrative order or in response to a subpoena.n To individuals involved in your care: The Plans may dis-close your PHI to a family member or other individual who is involved in your health care. For example, the Plans may disclose PHI to a covered family member whom you have authorized the Plans to contact regarding payment of a claim.n For health-related benefits or services: The Plans may use your PHI to provide you with information about benefits available to you under your current coverage or policy and, in limited situations, about health-related products or ser-vices that may be of interest to you. However, the Plans will not send marketing communications to you in exchange for financial remuneration from a third party without your authorization.n Other uses of PHI: Other uses and disclosures of PHI not covered by this Notice and permitted by the laws that apply to the Plans will be made only with your written authorization or that of your legal representative. If the Plans are authorized to use or disclose PHI about you, you or your legally authorized representative may revoke that authorization in writing at any time, except to the extent that the Plans have taken action relying on the authoriza-tion or if the authorization was obtained as a condition of obtaining your coverage. You should understand that the Plans will not be able to take back any disclosures they have already made with authorization.Your Rights Regarding PHI that the Plans Maintain About YouThe following are your rights under HIPAA concerning your PHI:n Right to accounting: You have a right to an accounting of certain disclosures of your PHI that are for reasons other than for treatment, payment or health care operations in the six years prior to the date of the request. n Right to access: You have a right to inspect and obtain a copy of the PHI in a designated record set. Generally, a designated record set contains medical and billing records, as well as other records that are used to make decisions about your health care benefits. Access to psychotherapy notes and information compiled in reasonable anticipation of or for use in legal proceedings may be denied. A reasonable, cost-based fee may be imposed for copying and mailing the requested information.n Right to request amendment: If you believe that your PHI is incorrect or incomplete, you have the right to request that we amend your PHI. n Right to request restrictions: You have the right to request restrictions on how your PHI is used and/or disclosed 1) for treatment, payment or health care operations 2) to persons

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involved in your health care or payment for health care or 3) to notify family members or others about your generalcondition, location or death. The Plans may agree to your request if required by law.n Right to request confidential communications: You have the right to request that the Plans communicate with you about PHI at alternative locations or by alternative means. For example, you may ask that we send all EOBs to your office rather than your home address. The Plans are not required to accommodate your request unless the request is reasonable and you state that the Plans’ ordinary communication process could endanger you.n Right to request and obtain a paper copy of this Notice: You have the right to request and obtain a paper copy of this Notice at any time, even if you have agreed to receive it electronically.n Right to receive notification in the event the Plans discover a breach: You have a right to receive notification in the event the Plans discover a breach of your unsecured PHI and determine notification is required under HIPAA.n Right to file a complaint: If you believe your privacy rights have been violated, you may file a written complaint with the HIPAA Privacy Contact or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.To exercise any of these rights, please write to the HIPAA Privacy Contact. The Plans are allowed to deny or limit your requests. You may have the right to object and obtain a review of the decision. The Plans will provide you with further information about the decision. Contact HIPAA Privacy Contact at: GuideStone Financial Resources5005 LBJ Freeway, Ste. 2200, Dallas, TX 75244-6152HIPAAPrivacyContact@GuideStone.org1-844-INS-GUIDE (1-844-467-4843)Contact the Secretary of Health and Human Services at: U.S. Department of Health and Human Services 200 Independence Avenue, S.W., Washington, D.C. 202011-877-696-6775 Additional InformationChanges to this Notice: The Plans reserve the right to change the terms of this Notice and its information prac-tices and to make the new provisions effective for all PHI it maintains. Any amended Notice will be made available on GuideStone.org or, if applicable, by your employer.5005 LBJ Freeway, Ste. 2200, Dallas, TX 75244-61521-844-INS-GUIDE • GuideStone.org© 2023 GuideStone® 1088353 09/23 8008

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9731 9/23 Page 1 of 5 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2024 - 12/31/2024 Health Choice 1500 : GuideStone The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, www.GuideStone.org/PlanBooklets. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at www.HealthCare.Gov/sbc-glossary or call 1-844-467-4843 to request a copy. Important Questions Answers Why This Matters: What is the overall deductible? In-network: $1,500 Individual /$3,000 family. Out-of-network: $3,000 Individual /$6,000 family. Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet thier own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible. Are there services covered before you meet your deductible? Yes. Preventive care and insulin are covered before you meet your deductible. This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. Are there other deductibles for specific services? No. You don't have to meet deductible for specific services. What is the out-of-pocket limit for this plan? For network providers $5,500 individual / $11,000 family; for out-of-network providers $23,000 individual / $26,000 family. The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met. Premiums, balance-billing charges, health care this plan doesn’t cover, and penalties do not count toward the out-of-pocket limit. What is not included in the out-of-pocket limit? Premiums, balance billed charges, costs of health care drugs this plan doesn’t cover, and out-of-network copayments. Even though you pay these expenses, they don’t count toward the out-of-pocket limit. Will you pay less if you use a network provider? Yes. See www.guidestonehealth.org or call 1-855-497-1230 for a list of participating providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Do you need a referral to see a specialist? No. You can see the specialist you choose without a referral. Coverage for: Ind/Fam | Plan Type Choice

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[* For more information about limitations and exceptions, see the plan or policy document at www.GuideStone.org/PlanBooklets.] Page 2 of 5 All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies. Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) If you visit a health care provider’s office or clinic Primary care visit to treat an injury or illness $25 copay 50% coinsurance ----------None---------- Specialist visit $45 copay 50% coinsurance ----------None---------- Preventive care/screening/ immunization No charge for covered services Not covered You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay. If you have a test Diagnostic test (x-ray, blood work) 20% coinsurance 50% coinsurance ----------None---------- Imaging (CT/PET scans, MRIs) 20% coinsurance 50% coinsurance Prior authorization required for non-emergency advanced imaging procedures (e.g., MRI, CT, PET) performed in an outpatient setting. If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.GuideStone.org Generic drugs (Retail/Mail Order) $15 copay / $30 copay 100% of drug cost. Upon manual claim form submission, you will be reimbursed based on plan benefits and allowable charges for covered drugs. Brand over generic costs will be a noncovered penalty. Maintenance drugs require 90 day fills (mail order or approved retail) to be covered. Penalties do not apply to annual accumulators. Certain contraceptives are not covered. Please see plan booklet for additional details on your prescription benefits. Preferred brand drugs (Retail/Mail Order) $50 copay / $100 copay Non-preferred brand drugs (Retail/Mail Order) $75 copay / $150 copay Diabetic Supplies (Generic, Preferred, Non-preferred) $20 copay Covers up to a 90-day supply. Deductible does not apply. Participating Insulin $75 copay /prescription mail Covers up to a 90-day supply. Deductible does not apply. Specialty drugs (Generic/Preferred) $50 copay / $75 copay / $100 copay Covers up to a 30-day supply. Please see plan booklet for additional details on your prescription benefits. If you have outpatient surgery Facility fee (e.g., ambulatory surgery center) 20% coinsurance 50% coinsurance ----------None---------- Physician/surgeon fees 20% coinsurance 50% coinsurance ----------None----------

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[* For more information about limitations and exceptions, see the plan or policy document at www.GuideStone.org/PlanBooklets.] Page 3 of 5 Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) If you need immediate medical attention Emergency room care 20% coinsurance after $250 copay 20% coinsurance after $250 copay ----------None---------- Emergency medical transportation 20% coinsurance 50% coinsurance Air ambulance always pays at in network level. Other emergency transportation pays at in-network level and waives deductible. Urgent care $50 copay 50% coinsurance Waive copay for MHSA diagnosis if copay would otherwise apply. If you have a hospital stay Facility fee (e.g., hospital room) 20% coinsurance 50% coinsurance after $500 copay Precertification may be required. Physician/surgeon fees 20% coinsurance 50% coinsurance ----------None---------- If you need mental health, behavioral health, or substance abuse services Outpatient services Office Visit:$25 copay Other:20% coinsurance 50% coinsurance ----------None---------- Inpatient services 20% coinsurance 50% coinsurance after $500 copay Precertification may be required. If you are pregnant Office visits $25 copay 50% coinsurance ----------None---------- Childbirth/delivery professional services 20% coinsurance 50% coinsurance ----------None---------- Childbirth/delivery facility services 20% coinsurance 50% coinsurance after $500 copay ----------None---------- If you need help recovering or have other special health needs Home health care 20% coinsurance 50% coinsurance Maximum 120 visits per year. Rehabilitation services 20% coinsurance 50% coinsurance See plan booklet. Limits may apply. PT/OT/ST take Specialist copay if applicable. Habilitation services 20% coinsurance 50% coinsurance Skilled nursing care 20% coinsurance 50% coinsurance Maximum 30 days per year. Durable medical equipment 20% coinsurance 50% coinsurance Rental or purchase option determined by the claims administrator. Rental costs cannot exceed the total cost of purchase. Hospice services 20% coinsurance 50% coinsurance ----------None---------- If your child needs dental or eye care Children’s eye exam $25 coinsurance Not covered See Preventive Care Schedule for age limits on child vision screening. Children’s glasses Not covered Not covered ----------None---------- Children’s dental check-up Not covered Not covered See Preventive Care Schedule for exceptions

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[* For more information about limitations and exceptions, see the plan or policy document at www.GuideStone.org/PlanBooklets.] Page 4 of 5 Excluded Services & Other Covered Services: Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) • Abortion • Acupuncture • Certain Contraceptives • Cosmetic Surgery • • Dental Care (Adult) • Experimental or investigational treatment • Infertility treatment • Long-term care • Private-duty nursing • Private hospital room • Routine foot care • Weight loss program Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.) • Bariatric Surgery • Hearing Aids • Routine Eye Care (Adult) • Non-emergency care when traveling outside the U.S. • Chiropractic Care - Limited to 12 visits per coverage period. Your Rights to Continue Coverage: Church plans are not covered by the federal COBRA continuation coverage rules. Other coverage options may be available to you, too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318- 2596. Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact: MyQHealth Care Coordinators at 1-855-497-1230 or visit www.guidestonehealth.org Does this plan provide Minimum Essential Coverage? True Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit. Does this plan meet the Minimum Value Standards? True If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace. Language Access Services: [Spanish (Español): Para obtener asistencia en Español, llame al 1-844-INS-GUIDE (1-844-467-4843).] [Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 1-844-INS-GUIDE (1-844-467-4843).] [Chinese (中文): 如果需要中文的帮助, 请拨打这个号码1-844-INS-GUIDE (1-844-467-4843).] [Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 1-844-INS-GUIDE (1-844-467-4843).] To see examples of how this plan might cover costs for a sample medical situation, see the next section.

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Page 5 of 5 About these Coverage Examples: This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage. ◼ The plan’s overall deductible $1,500 ◼ Specialist copay $45 ◼ Hospital (facility) coinsurance 20% ◼ Other coinsurance 20% This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia) Total Example Cost $12,700 In this example, Peg would pay: Cost Sharing Deductibles $1,500 Copayments $70 Coinsurance $2,200 What isn’t covered Limits or exclusions $0 The total Peg would pay is $3,770 ◼ The plan’s overall deductible $1,500 ◼ Specialist copay $45 ◼ Hospital (facility) coinsurance 20% ◼ Other coinsurance 20% This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter) Total Example Cost $5,600 In this example, Joe would pay: Cost Sharing Deductibles $100 Copayments $1,000 Coinsurance $0 What isn’t covered Limits or exclusions $0 The total Joe would pay is $1,100 ◼ The plan’s overall deductible $1,500 ◼ Specialist copay $45 ◼ Hospital (facility) coinsurance 20% ◼ Other coinsurance 20% This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy) Total Example Cost $2,800 In this example, Mia would pay: Cost Sharing Deductibles $1,500 Copayments $600 Coinsurance $100 What isn’t covered Limits or exclusions $0 The total Mia would pay is $2,200 The plan would be responsible for the other costs of these EXAMPLE covered services. Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) Total Example Cost {{PlanCoverageExamples.Pregnancy.ExampleCost}} In this example, Peg would pay: Cost Sharing Deductibles {{PlanCoverageExamples.Pregnancy.CostSharingDeductible}} $ Copayments {{PlanCoverageExamples.Pregnancy.CostSharingCopayments}} Coinsurance {{PlanCoverageExamples.Pregnancy.CostSharingCoinsurance}} What isn’t covered Limits or exclusions {{PlanCoverageExamples.Pregnancy.Exclusions}} The total Peg would pay is {{PlanCoverageExamples.Pregnancy.Total}} (9 months of in-network pre-natal care and a hospital delivery) Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well- controlled condition) Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well- controlled condition) Mia’s Simple Fracture (in-network emergency room visit and follow up care) Mia’s Simple Fracture (in-network emergency room visit and follow up care)

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9755 9/23 Page 1 of 5 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2024 - 12/31/2024 Health Choice 4000 : GuideStone The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, www.GuideStone.org/PlanBooklets. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at www.HealthCare.Gov/sbc-glossary or call 1-844-467-4843 to request a copy. Important Questions Answers Why This Matters: What is the overall deductible? In-network: $4,000 Individual /$7,000 family. Out-of-network: $8,000 Individual /$16,000 family. Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet thier own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible. Are there services covered before you meet your deductible? Yes. Preventive care and insulin are covered before you meet your deductible. This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. Are there other deductibles for specific services? No. You don't have to meet deductible for specific services. What is the out-of-pocket limit for this plan? For network providers $6,350 individual / $12,700 family; for out-of-network providers $36,000 individual / $44,000 family. The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met. Premiums, balance-billing charges, health care this plan doesn’t cover, and penalties do not count toward the out-of-pocket limit. What is not included in the out-of-pocket limit? Premiums, balance billed charges, costs of health care drugs this plan doesn’t cover, and out-of-network copayments. Even though you pay these expenses, they don’t count toward the out-of-pocket limit. Will you pay less if you use a network provider? Yes. See www.guidestonehealth.org or call 1-855-497-1230 for a list of participating providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Do you need a referral to see a specialist? No. You can see the specialist you choose without a referral. Coverage for: Ind/Fam | Plan Type Choice

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Page 5 of 5 About these Coverage Examples: This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage. ◼ The plan’s overall deductible $4,000 ◼ Specialist copay $45 ◼ Hospital (facility) coinsurance 20% ◼ Other coinsurance 20% This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia) Total Example Cost $12,700 In this example, Peg would pay: Cost Sharing Deductibles $4,000 Copayments $70 Coinsurance $1,700 What isn’t covered Limits or exclusions $0 The total Peg would pay is $5,770 ◼ The plan’s overall deductible $4,000 ◼ Specialist copay $45 ◼ Hospital (facility) coinsurance 20% ◼ Other coinsurance 20% This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter) Total Example Cost $5,600 In this example, Joe would pay: Cost Sharing Deductibles $100 Copayments $1,000 Coinsurance $0 What isn’t covered Limits or exclusions $0 The total Joe would pay is $1,100 ◼ The plan’s overall deductible $4,000 ◼ Specialist copay $45 ◼ Hospital (facility) coinsurance 20% ◼ Other coinsurance 20% This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy) Total Example Cost $2,800 In this example, Mia would pay: Cost Sharing Deductibles $1,700 Copayments $600 Coinsurance $70 What isn’t covered Limits or exclusions $0 The total Mia would pay is $2,370 The plan would be responsible for the other costs of these EXAMPLE covered services. Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) Total Example Cost {{PlanCoverageExamples.Pregnancy.ExampleCost}} In this example, Peg would pay: Cost Sharing Deductibles {{PlanCoverageExamples.Pregnancy.CostSharingDeductible}} $ Copayments {{PlanCoverageExamples.Pregnancy.CostSharingCopayments}} Coinsurance {{PlanCoverageExamples.Pregnancy.CostSharingCoinsurance}} What isn’t covered Limits or exclusions {{PlanCoverageExamples.Pregnancy.Exclusions}} The total Peg would pay is {{PlanCoverageExamples.Pregnancy.Total}} (9 months of in-network pre-natal care and a hospital delivery) Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well- controlled condition) Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well- controlled condition) Mia’s Simple Fracture (in-network emergency room visit and follow up care) Mia’s Simple Fracture (in-network emergency room visit and follow up care)

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9965 9/23 Page 1 of 5 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2024 - 12/31/2024 BlueHPN 5000 : GuideStone The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, www.GuideStone.org/PlanBooklets. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at www.HealthCare.Gov/sbc-glossary or call 1-844-467-4843 to request a copy. Important Questions Answers Why This Matters: What is the overall deductible? In-network: $5,000 Individual /$10,000 family. Out-of-network: Not Covered Individual /Not Covered family. Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet thier own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible. Are there services covered before you meet your deductible? Yes. Preventive care and insulin are covered before you meet your deductible. This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. Are there other deductibles for specific services? No. You don't have to meet deductible for specific services. What is the out-of-pocket limit for this plan? For network providers $6,500 individual / $12,700 family; for out-of-network providers Not Covered / Not Covered. The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met. Premiums, balance-billing charges, health care this plan doesn’t cover, and penalties do not count toward the out-of-pocket limit. What is not included in the out-of-pocket limit? Premiums, balance billed charges, costs of health care drugs this plan doesn’t cover, and out-of-network copayments. Even though you pay these expenses, they don’t count toward the out-of-pocket limit. Will you pay less if you use a network provider? Yes. See www.guidestonehealth.org or call 1-855-497-1230 for a list of participating providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Do you need a referral to see a specialist? No. You can see the specialist you choose without a referral. Coverage for: Ind/Fam | Plan Type Choice

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[* For more information about limitations and exceptions, see the plan or policy document at www.GuideStone.org/PlanBooklets.] Page 2 of 5 All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies. Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) If you visit a health care provider’s office or clinic Primary care visit to treat an injury or illness $25 copay Not Covered ----------None---------- Specialist visit $45 copay Not Covered ----------None---------- Preventive care/screening/ immunization No charge for covered services Not covered You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay. If you have a test Diagnostic test (x-ray, blood work) 20% coinsurance Not Covered ----------None---------- Imaging (CT/PET scans, MRIs) 20% coinsurance Not Covered Prior authorization required for non-emergency advanced imaging procedures (e.g., MRI, CT, PET) performed in an outpatient setting. If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.GuideStone.org Generic drugs (Retail/Mail Order) $15 copay / $30 copay 100% of drug cost. Upon manual claim form submission, you will be reimbursed based on plan benefits and allowable charges for covered drugs. Brand over generic costs will be a noncovered penalty. Maintenance drugs require 90 day fills (mail order or approved retail) to be covered. Penalties do not apply to annual accumulators. Certain contraceptives are not covered. Please see plan booklet for additional details on your prescription benefits. Preferred brand drugs (Retail/Mail Order) $50 copay / $100 copay Non-preferred brand drugs (Retail/Mail Order) $75 copay / $150 copay Diabetic Supplies (Generic, Preferred, Non-preferred) $20 copay Covers up to a 90-day supply. Deductible does not apply. Participating Insulin $75 copay /prescription mail Covers up to a 90-day supply. Deductible does not apply. Specialty drugs (Generic/Preferred) $50 copay / $75 copay / $100 copay Covers up to a 30-day supply. Please see plan booklet for additional details on your prescription benefits. If you have outpatient surgery Facility fee (e.g., ambulatory surgery center) 20% coinsurance Not Covered ----------None---------- Physician/surgeon fees 20% coinsurance Not Covered ----------None----------

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[* For more information about limitations and exceptions, see the plan or policy document at www.GuideStone.org/PlanBooklets.] Page 3 of 5 Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) If you need immediate medical attention Emergency room care 20% coinsurance after $250 copay 20% coinsurance after $250 copay ----------None---------- Emergency medical transportation 20% coinsurance Not Covered Air ambulance always pays at in network level. Other emergency transportation pays at in-network level and waives deductible. Urgent care $50 copay Not Covered Waive copay for MHSA diagnosis if copay would otherwise apply. If you have a hospital stay Facility fee (e.g., hospital room) 20% coinsurance Not Covered Precertification may be required. Physician/surgeon fees 20% coinsurance Not Covered ----------None---------- If you need mental health, behavioral health, or substance abuse services Outpatient services Office Visit:$25 copay Other:20% coinsurance Not Covered ----------None---------- Inpatient services 20% coinsurance Not Covered Precertification may be required. If you are pregnant Office visits $25 copay Not Covered ----------None---------- Childbirth/delivery professional services 20% coinsurance Not Covered ----------None---------- Childbirth/delivery facility services 20% coinsurance Not Covered ----------None---------- If you need help recovering or have other special health needs Home health care 20% coinsurance Not Covered Maximum 120 visits per year. Rehabilitation services 20% coinsurance Not Covered See plan booklet. Limits may apply. PT/OT/ST take Specialist copay if applicable. Habilitation services 20% coinsurance Not Covered Skilled nursing care 20% coinsurance Not Covered Maximum 30 days per year. Durable medical equipment 20% coinsurance Not Covered Rental or purchase option determined by the claims administrator. Rental costs cannot exceed the total cost of purchase. Hospice services 20% coinsurance Not Covered ----------None---------- If your child needs dental or eye care Children’s eye exam $25 coinsurance Not covered See Preventive Care Schedule for age limits on child vision screening. Children’s glasses Not covered Not covered ----------None---------- Children’s dental check-up Not covered Not covered See Preventive Care Schedule for exceptions

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Page 5 of 5 About these Coverage Examples: This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage. ◼ The plan’s overall deductible $5,000 ◼ Specialist copay $45 ◼ Hospital (facility) coinsurance 20% ◼ Other coinsurance 20% This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia) Total Example Cost $12,700 In this example, Peg would pay: Cost Sharing Deductibles $5,000 Copayments $50 Coinsurance $1,500 What isn’t covered Limits or exclusions $0 The total Peg would pay is $6,500 ◼ The plan’s overall deductible $5,000 ◼ Specialist copay $45 ◼ Hospital (facility) coinsurance 20% ◼ Other coinsurance 20% This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter) Total Example Cost $5,600 In this example, Joe would pay: Cost Sharing Deductibles $100 Copayments $1,000 Coinsurance $0 What isn’t covered Limits or exclusions $0 The total Joe would pay is $1,100 ◼ The plan’s overall deductible $5,000 ◼ Specialist copay $45 ◼ Hospital (facility) coinsurance 20% ◼ Other coinsurance 20% This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy) Total Example Cost $2,800 In this example, Mia would pay: Cost Sharing Deductibles $1,700 Copayments $600 Coinsurance $100 What isn’t covered Limits or exclusions $0 The total Mia would pay is $2,400 The plan would be responsible for the other costs of these EXAMPLE covered services. Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) Total Example Cost {{PlanCoverageExamples.Pregnancy.ExampleCost}} In this example, Peg would pay: Cost Sharing Deductibles {{PlanCoverageExamples.Pregnancy.CostSharingDeductible}} $ Copayments {{PlanCoverageExamples.Pregnancy.CostSharingCopayments}} Coinsurance {{PlanCoverageExamples.Pregnancy.CostSharingCoinsurance}} What isn’t covered Limits or exclusions {{PlanCoverageExamples.Pregnancy.Exclusions}} The total Peg would pay is {{PlanCoverageExamples.Pregnancy.Total}} (9 months of in-network pre-natal care and a hospital delivery) Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well- controlled condition) Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well- controlled condition) Mia’s Simple Fracture (in-network emergency room visit and follow up care) Mia’s Simple Fracture (in-network emergency room visit and follow up care)

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8850 9/23 Page 1 of 5 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2024 - 12/31/2024 Health Saver 5000 : GuideStone The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, www.GuideStone.org/PlanBooklets. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at www.HealthCare.Gov/sbc-glossary or call 1-844-467-4843 to request a copy. Important Questions Answers Why This Matters: What is the overall deductible? In-network: $5,000 Individual /$10,000 family. Out-of-network: $15,000 Individual /$30,000 family. Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet thier own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible. Are there services covered before you meet your deductible? Yes. Preventive care and insulin are covered before you meet your deductible. This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. Are there other deductibles for specific services? No. You don't have to meet deductible for specific services. What is the out-of-pocket limit for this plan? For network providers $5,000 individual / $10,000 family; for out-of-network providers $25,000 individual / $50,000 family. The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met. Premiums, balance-billing charges, health care this plan doesn’t cover, and penalties do not count toward the out-of-pocket limit. What is not included in the out-of-pocket limit? Premiums, balance billed charges, costs of health care drugs this plan doesn’t cover, and out-of-network copayments. Even though you pay these expenses, they don’t count toward the out-of-pocket limit. Will you pay less if you use a network provider? Yes. See www.guidestonehealth.org or call 1-855-497-1230 for a list of participating providers. This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Do you need a referral to see a specialist? No. You can see the specialist you choose without a referral. Coverage for: Ind/Fam | Plan Type HDHP

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[* For more information about limitations and exceptions, see the plan or policy document at www.GuideStone.org/PlanBooklets.] Page 2 of 5 All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies. Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) If you visit a health care provider’s office or clinic Primary care visit to treat an injury or illness 0% coinsurance 30% coinsurance ----------None---------- Specialist visit 0% coinsurance 30% coinsurance ----------None---------- Preventive care/screening/ immunization No charge for covered services Not covered You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay. If you have a test Diagnostic test (x-ray, blood work) 0% coinsurance 30% coinsurance ----------None---------- Imaging (CT/PET scans, MRIs) 0% coinsurance 30% coinsurance Prior authorization required for non-emergency advanced imaging procedures (e.g., MRI, CT, PET) performed in an outpatient setting. If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.GuideStone.org Generic drugs 0% coinsurance 100% of drug cost. Upon manual claim form submission, you will be reimbursed based on plan benefits and allowable charges for covered drugs. Brand over generic costs will be a noncovered penalty. Maintenance drugs require 90 day fills (mail order or approved retail) to be covered. Penalties do not apply to annual accumulators. Certain contraceptives are not covered. Please see plan booklet for additional details on your prescription benefits. Preferred brand drugs 0% coinsurance Non-preferred brand drugs 0% coinsurance Diabetic Supplies (Generic, Preferred, Non-preferred) 0% coinsurance Covers up to a 90-day supply. Deductible does not apply. Participating Insulin $75 /prescription mail Covers up to a 90-day supply. Deductible does not apply. Specialty drugs 0% coinsurance Covers up to a 30-day supply. Please see plan booklet for additional details on your prescription benefits. If you have outpatient surgery Facility fee (e.g., ambulatory surgery center) 0% coinsurance 30% coinsurance ----------None---------- Physician/surgeon fees 0% coinsurance 30% coinsurance ----------None----------

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[* For more information about limitations and exceptions, see the plan or policy document at www.GuideStone.org/PlanBooklets.] Page 3 of 5 Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) If you need immediate medical attention Emergency room care $0 copay $0 copay ----------None---------- Emergency medical transportation 0% coinsurance 30% coinsurance Air ambulance always pays at in network level. Other emergency transportation pays at in-network level and waives deductible. Urgent care 0% coinsurance 30% coinsurance Waive copay for MHSA diagnosis if copay would otherwise apply. If you have a hospital stay Facility fee (e.g., hospital room) 0% coinsurance 30% coinsurance after $500 copay Precertification may be required. Physician/surgeon fees 0% coinsurance 30% coinsurance ----------None---------- If you need mental health, behavioral health, or substance abuse services Outpatient services 0% coinsurance 30% coinsurance ----------None---------- Inpatient services 0% coinsurance 30% coinsurance after $500 copay Precertification may be required. If you are pregnant Office visits 0% coinsurance 30% coinsurance ----------None---------- Childbirth/delivery professional services 0% coinsurance 30% coinsurance ----------None---------- Childbirth/delivery facility services 0% coinsurance 30% coinsurance after $500 copay ----------None---------- If you need help recovering or have other special health needs Home health care 0% coinsurance 30% coinsurance Maximum 120 visits per year. Rehabilitation services 0% coinsurance 30% coinsurance See plan booklet. Limits may apply. PT/OT/ST take Specialist copay if applicable. Habilitation services 0% coinsurance 30% coinsurance Skilled nursing care 0% coinsurance 30% coinsurance Maximum 30 days per year. Durable medical equipment 0% coinsurance 30% coinsurance Rental or purchase option determined by the claims administrator. Rental costs cannot exceed the total cost of purchase. Hospice services 0% coinsurance 30% coinsurance ----------None---------- If your child needs dental or eye care Children’s eye exam 0% coinsurance Not covered See Preventive Care Schedule for age limits on child vision screening. Children’s glasses Not covered Not covered ----------None---------- Children’s dental check-up Not covered Not covered See Preventive Care Schedule for exceptions

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Page 5 of 5 About these Coverage Examples: This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage. ◼ The plan’s overall deductible $5,000 ◼ Specialist coinsurance 0% ◼ Hospital (facility) coinsurance 0% ◼ Other coinsurance 0% This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia) Total Example Cost $12,700 In this example, Peg would pay: Cost Sharing Deductibles $5,000 Copayments $0 Coinsurance $0 What isn’t covered Limits or exclusions $0 The total Peg would pay is $5,000 ◼ The plan’s overall deductible $5,000 ◼ Specialist coinsurance 0% ◼ Hospital (facility) coinsurance 0% ◼ Other coinsurance 0% This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter) Total Example Cost $5,600 In this example, Joe would pay: Cost Sharing Deductibles $1,500 Copayments $300 Coinsurance $0 What isn’t covered Limits or exclusions $0 The total Joe would pay is $1,800 ◼ The plan’s overall deductible $5,000 ◼ Specialist coinsurance 0% ◼ Hospital (facility) coinsurance 0% ◼ Other coinsurance 0% This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy) Total Example Cost $2,800 In this example, Mia would pay: Cost Sharing Deductibles $2,800 Copayments $0 Coinsurance $0 What isn’t covered Limits or exclusions $0 The total Mia would pay is $2,800 The plan would be responsible for the other costs of these EXAMPLE covered services. Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) Total Example Cost {{PlanCoverageExamples.Pregnancy.ExampleCost}} In this example, Peg would pay: Cost Sharing Deductibles {{PlanCoverageExamples.Pregnancy.CostSharingDeductible}} $ Copayments {{PlanCoverageExamples.Pregnancy.CostSharingCopayments}} Coinsurance {{PlanCoverageExamples.Pregnancy.CostSharingCoinsurance}} What isn’t covered Limits or exclusions {{PlanCoverageExamples.Pregnancy.Exclusions}} The total Peg would pay is {{PlanCoverageExamples.Pregnancy.Total}} (9 months of in-network pre-natal care and a hospital delivery) Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well- controlled condition) Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well- controlled condition) Mia’s Simple Fracture (in-network emergency room visit and follow up care) Mia’s Simple Fracture (in-network emergency room visit and follow up care)