XCL Resources 2024 Benefits Guide : simplebooklet.com

This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.For the 2024 plan year, XCL Resources has worked hard to offer a competitive total rewards package that includes valuable and comprehensive benefits plans. These programs reflect our commitment to keeping our staff healthy and secure. We understand that your situation is unique, and XCL Resources is offering an overall benefits package with many possible choices - one that can be shaped and molded by you, to fit your needs.As an employee at XCL Resources, enjoying your work and making valuable contributions to the company are equally vital. The health, satisfaction and security of you and your family are important to your well-being and ultimately, achieving the goals of our organization.This enrollment booklet is a summary description of XCL Resources’ benefit plans. If there is a discrepancy between these summaries and the written legal plan documents, the legal plan documents shall prevail. This booklet and plan summaries do not constitute a contract of employment.We hope this enrollment booklet, along with our additional communication and decision-making tools, will help you make the best health care choices for you and your family.2Introduction

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The benefits plan year runsJanuary 1st through December 31st. Unless you have a qualified change-in-status event that impacts your eligibility and the change is allowed under the terms of the insurance contract or plan document, you cannot make changes to your benefits until the next Open Enrollment period.Benefit changes must be consistent with your qualified change-in-status event.Mid year changes must be submitted to Human Resources within 30 days of the event; documentation supporting the change will be required.Who is eligible for benefits?All full-time employees who work a minimum of 30 hours per week are eligible for benefits. For new hires, benefits are effective on the first of the month following your date of hire. In addition to enrolling yourself, you may also enroll any eligible dependents. Eligible dependents are defined below:• Spouse: a person to whom you are legally married by ceremony• Domestic Partners: same and opposite sex • Child(ren): Your biological, adopted, or legal dependents up to age 26 regardless of student, financial, and marital status; coverage for a dependent child will terminate at the end of the month in which the child turns age 26Change-in-Status EventsUnless you have a qualified change-in-status event that impacts your eligibility and the change is allowed under the terms of the insurance contract or plan document, you cannot make changes to the benefits you elect until the next Open Enrollment period. Some examples of qualified change-in-status events are highlighted below:Marriage or divorceBirth, adoption, or deathChange in employment, or employment status for you, your spouse, or your dependent childChange in coverage under another employer plan, such as a change made during your spouse’s Open EnrollmentXCL Resources takes pride in providing a comprehensive employee benefits program, and we recognize the important role employee benefits play as a critical component of your overall compensation. We strive to maintain a benefits program that is rewarding and competitive.WHAT’S INSIDEBenefits Overview Medical Health Savings Account (HSA) Flexible Spending Account (FSA) Dental Vision Life/AD&D Disability EAP & Additional Programs Vendor Contact Information3

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsOverview of Benefit ProgramsXCL Resources provides an array of benefits that can help you enjoy increased well-being, deal with an unexpected illness or accident, build and protect your financial security, balance your personal and professional life and meet everyday needs. These benefits are affordable, comprehensive and competitive. The table below summarizes the benefits available to eligible staff and their dependents. These benefits are described in greater detail in this booklet.Benefits At-A-Glance4Benefits Funding Carrier Medical & Prescription DrugsEmployee + DependentsShared funding BlueCross BlueShield of TexasHealth Savings Account (HSA)Employee OnlyEmployee ContributionsHSA Bank Dental PPO PlanEmployee + DependentsShared funding Principal Vision PlanEmployee + DependentsShared funding PrincipalFlexible Spending AccountsHealth / Dependent Care / Limited PurposeEmployee + DependentsEmployee ContributionsWEXGroup Life / AD&DEmployee Only100% Employer paidPrincipalVoluntary Life/AD&DEmployee + DependentsEmployee PaidPrincipalShort-Term DisabilityEmployee Only100% Employer paidPrincipalLong-Term Disability Employee Only100% Employer paidPrincipal Employee Assistance Program (EAP)Employee + Dependents100% Employer paidPrincipal Travel Assistance Program Employee + Dependents100% Employer PaidPrincipal

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsKEY TERMS TO REMEMBER & PLAN DETAILSANNUAL DEDUCTIBLEThe amount you must pay each year before the plan starts paying a portion of medical expenses. All family members’ expenses that count toward a health plan deductible accumulate together in the aggregate; however, each person also has a limit on their own individual accumulated expenses (the amount varies by plan).OUT-OF-POCKET MAXIMUMThis is the total amount you can pay out of pocket each calendar year before the plan pays 100 percent of covered expenses for the rest of the calendar year. Most expenses that meet provider network requirements count toward the annual out-of-pocket maximum, including expenses paid to the annual deductible, copays, and coinsurance. COPAYS AND COINSURANCEThese expenses are your share of cost paid for covered health care services. Copays are a fixed dollar amount and are usually due at the time you receive care. Coinsurance is your share of the allowed amount charged for a service and is generally billed to you after the health insurance company reconciles the bill with the provider.Medical5PLAN TYPESPPO – A network of doctors, hospitals, and other healthcare providers. You have coverage in and out of network.HDHP – A plan that has higher deductibles in exchange for lower premiums. HDHPs are compatible with Health Savings Accounts (HSA).

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsSummary of CoverageMedical Coverage6Plan Features Blue Cross Blue Shield of Texas, Policy# 242528IN-NETWORKMTBCP418H $3,200 HDHP-HSA PlanMTBCP014 $1,500 Deductible PlanMTBCP002 $500 Deductible PlanProvider Network BlueChoice PPO BlueChoice PPO BlueChoice PPOHSA Compatible? YES NO NOMedical Deductible (Individual / Family)$3,200 / $6,400 $1,500 / $4,500 $500 / $1,500Coinsurance (Member Responsibility)0% after deductible 20% after deductible 0% after deductibleMedical Out-of-Pocket Maximum (Individual / Family)$3,200 / $6,400 $4,500 / $13,500 $1,500 / $4,500Preventive Care No Charge No Charge No ChargePrimary Care Visit 0% after deductible $35 copay $30 copayVirtual Visits 0% after deductible $0 copay $0 copaySpecialist Visit 0% after deductible $70 copay $60 copayDiagnostic Lab & X-Ray 0% after deductibleNo Charge; deductible does not applyNo Charge; deductible does not applyComplex ImagingPreauthorization may be required0% after deductible 20% after deductible 0% after deductibleOutpatient Procedure 0% after deductible 20% after deductible 0% after deductibleInpatient Stay 0% after deductible 20% after deductible 0% after deductibleUrgent Care 0% after deductible $75 copay $75 copayEmergency Room 0% after deductible$500 copay per visit + 20% coinsurance after deductible$500 copay per visitRetail Pharmacy (30-day supply) -Preferred Generic -Non-Preferred Generic -Preferred Brand -Non-Preferred Brand -Preferred Specialty -Non-Preferred Specialty 0% after deductible(Preferred/Non-Preferred Pharmacy)$0 / $10$10 / $20$50 / $70$100 / $120$150 $250(Preferred/Non-Preferred Pharmacy)$0 / $10 $10 / $20 $50 / $70 $100 / $120$150$250Mail Order Pharmacy (90-day supply) *Excludes Specialty drugs0% after deductible $0 / $30 / $150 / $300 $0 / $30 / $150 / $300OUT-OF-NETWORKMedical Deductible(Individual / Family)$6,400 / $12,800 $3,000 / $9,000 $10,000 / $20,000Coinsurance (Member Responsibility)0% after deductible 40% after deductible 50% after deductibleMedical Out-of-Pocket Max (Individual / Family)Unlimited Unlimited UnlimitedCost Per Pay Period (26)Employee Only$24.55 $25.04 $31.61Employee + Spouse$59.07 $60.26 $76.07Employee + Child(ren)$69.05 $70.44 $88.92Employee + Family$103.57 $105.65 $133.38

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsHealth SavingsAccountWho Is Eligible?* All three criteria must be met:• Enrolled in an IRS “qualified” High Deductible Health Plan• Not covered by another medical plan unless the other plans is also a “qualified” HDHP• Not enrolled in Medicare coverage*It is the employee’s responsibility to notify HR if you are not eligible for HSA.How does it work? The HDHP allows employees to set aside money on a pre-tax basis into a Health Savings Account (HSA). The HSA is an account established exclusively for the purpose of paying for qualified medical expenses for you and your eligible dependents on a tax-free basis. Contributions to the HSA are funded with pre-tax deductions withheld from your paycheck. The funds are deposited into an interest-bearing account in your name. The money in the HSA can be used to reimburse eligible expenses not covered by your insurance plan, including the deductible, coinsurance, and copays. Any money not used for medical reimbursement remains in the account. In the event you leave XCL Resources, you own the account and the money therein. For a complete list of “qualified” medical expenses, please refer to Publication 502 at www.irs.gov. How much can I contribute?
IRS ANNUAL LIMITS2024 Maximum Contribution(Employer + Employee)Annual EmployerContributionHow much YOU can contribute in 2024Single Only $4,150 $1,500 $2,650Employee + Dependents $8,300 $3,000 $5,300Catch-Up Contribution Employees age 55+ may be eligible to contribute an additional $1,000You are responsible for tracking your contributions to ensureyou do not exceed the maximum allowable contribution. 7

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsDental CoverageSummary of CoveragePlan Features Principal Financial, Policy# 1121735Provider Network Dental Contracted NetworkIN-NETWORKCalendar Year Maximum $1,500Annual Deductible (Individual / Family) $50 / $150Preventive Care• Routine Exam (2 per calendar year)• Routine Cleanings (2 per calendar year)• Bitewing X-rays (1 per calendar year)No ChargeBasic Procedures• Space Maintainers (dependent children <14)• Fillings & stainless-steel crowns• Periodontics & Endodontics20% after deductible Major Procedures • General Anesthesia • Simple & complex oral surgery • Complete or partial dentures50% after deductibleOrthodontia (Dependent Children to age 19) 50% after deductible Orthodontia Lifetime Maximum $2,000Maximum Accumulation (Rollover Benefit)*Threshold** $1,000Carryover*** $500 annually up to $2,000*Allows for a portion of unused maximum benefit to carry over to the next year’s maximum benefit amount. To qualify, you must have had a dental service performed within the Calendar year and used less than the maximum threshold. **The threshold is equal to the lesser of 50% of the maximum, or $1,000. If the qualification is met, 50% of the threshold is carried over to the next year’s maximum benefit. ***You can accumulate no more than four times the carry over amount. The entire accumulation will be forfeited if no dental service is submitted within a calendar year. OUT-OF-NETWORKOut-of-Network Claim Payment Basis 90th UCRCost Per Pay Period (26) Bi-weekly (26)Employee Only$1.90Employee + Spouse$3.79Employee + Child(ren)$4.49Employee + Family$6.488

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsVision CoverageSummary of Coverage9Plan FeaturesPrincipal Financial, Policy# 1121735In-Network Out-of-Network ReimbursementProvider Network VSP Choice NetworkVision Exam $10 copay Up to $45Prescription LensesSingle Vision $25 copay Up to $30Lined Bifocal $25 copay Up to $50Lined Trifocal $25 copay Up to $65Lenticular $25 copay Up to $100Frames*$130 allowance + 20% discount of amount over allowanceUp to $70Elective Contacts*Fitting and Evaluation: Up to $60 copay$130 allowance Up to $105Medically Necessary Contacts$25 copay; covered in full for members with specific conditionsUp to $210Frequency (from date of last service)Exam Every 12 MonthsLenses Every 12 MonthsContacts Every 12 MonthsFrames Every 12 MonthsYour Per Pay Period Cost Bi-Weekly (26)Employee $0.31Employee + Spouse $0.62Employee + Child(ren) $0.68Employee + Family $1.00*Benefit includes coverage for contacts or glasses, not both.

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsFlexible Savings Accounts10What is a Flexible Spending Account (FSA)?FSAs provide you with an important tax advantage account that can help you pay health care and dependent care expenses on a pre-tax basis. By anticipating your family’s health care and dependent care costs for the next plan year, you can lower your taxable income.Eligible ExpensesEligible health care expenses for the Health Care FSA include more than just your deductible and copayments. The IRS publishes a detailed annual list of qualified eligible expenses. Please see the FSA enrollment kit for a sample of eligible expenses. You can also visit the website www.irs.gov/publications/p502/index.html.“Use it or Lose it”According to IRS regulations, the money you contribute to the FSA must be used for expenses incurred during the plan year in which you make the election. Our plan has a grace period through March 15, 2025, during which you can continue to use funds set aside in the 2024 plan year. Any money not used after this time will be forfeited. Please visit www.irs.gov for additional information about Flexible Spending Accounts.The Health Care FSA lets you pay for certain IRS-approved medical care expenses not covered by your insurance plan with pre-tax dollars. For example, cash that you now spend on deductibles, copayments, or other out-of-pocket medical expenses can instead be placed in the Health Care FSA, to pay for these expenses. The annual maximum contribution for 2024 to the Health Care FSA is $3,200. Funds contributed towards the Healthcare FSA are front-loaded. Eligible dependent care expenses include the cost of licensed childcare facility, nursery or preschool, and the cost of an adult dependent’s care inside or outside of your household. Funds contributed towards Dependent Care FSAs are not front-loaded. Keep these things in mind: • $5,000 annual maximum per household or $2,500 if married and filing separate tax returns.• To qualify, you and your spouse must be employed, or your spouse must be a full-time student.• Record expenses for dependent children under age 13 who you claim on your taxes or a disabled spouse/dependent of any age.• If dependent care expenses are reimbursed from your Dependent Care FSA, these expenses cannot be claimed as a dependent care tax credit on your federal tax return.Healthcare FSADependent Care FSALimited Purpose FSAEmployees are not allowed to contribute to both a health savings account (HSA) at the same time as a standard (non-limited) health flexible spending account (FSA). They are, however, eligible for an HSA if they use a limited-purpose FSA for their dental and vision care needs. This will allow you to maximize your savings and tax benefits. Funds contributed towards Limited Purpose FSAs are front-loaded.

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsGroup Term Life and AD&D InsuranceSummary of Coverage11Group Term Life and AD&D (Employer Paid), Policy# 1121735Plan FeaturesEmployee Life Benefit $50,000Employee AD&D Benefit $50,000Included BenefitsAccelerated Death Benefit, Conversion &Waiver of PremiumThe following benefit reduction schedule shows how much benefits are reduced at certain ages:Age Benefit reduces by:65 35%70 50%Accelerated Benefit – If you become terminally ill, you may be able to receive a portion of your life coverage benefit as a lump sum.Conversion – If you retire, reduce your hours or leave XCL Resources, you may be eligible to convert coverage to an individual policy. You will be required to apply to Principal within 31-days of your termination if you wish to continue your coverage. Contact Principal or review the summary plan description for details.Waiver of Premium – If you become disabled before age 60, coverage will continue, and premium may be waived.Who Is Eligible:• All Active, full-time, regular employees working at least 30 hours per week Benefits You Receive:• XCL Resources provides every eligible employee with group term life and AD&D insurance equal to $50,000 at no cost to you. Coverage is automatic and does not require an election though beneficiary designation is required. Designating a Beneficiary: You must name a person(s) or entity to receive benefits in the event of your death. The beneficiary designation applies to your group term life and AD&D and voluntary life AD&D insurance. Contact Human Resources to update your beneficiary information. You can update your life insurance beneficiary at any time throughout the year and as many times as needed.

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsVoluntary Life and AD&D InsuranceSummary of Coverage12*Guarantee Issue is for newly eligible employees only. Late enrollments, employees increasing current elections, or employees who decide to enroll over the guaranteed issue, must complete an evidence of insurability (EOI) for enrolled amounts. Guarantee Issue is subject to carrier restrictions and guidelines. You, as the employee, must elect coverage for yourself in order to elect for your spouse and/or child(ren). Designating a Beneficiary: You must name a person(s) or entity to receive benefits in the event of your death. The beneficiary designation applies to your group term life and AD&D and voluntary life AD&D insurance. Contact Human Resources to update your beneficiary information. You can update your life insurance beneficiary at any time throughout the year and as many times as needed. Coverage Provided ForVoluntary Term Life and AD&D (Employee Paid), Policy# 1121735Guaranteed Issue Amount*(new hires underage 70 only)Minimum Maximum Increment AvailableEmployee $10,000 $300,000 Units of $10,000Under age 70: $70,000Age 70+: $10,000Spouse $5,000100% of employee’s benefit up to $100,000Units of $5,000Under age 70: $20,000Age 70+: $10,000Child(ren)14 Days and older$5,000 100% of employee’s benefit up to $10,000N/A All amountsIncluded Benefits Annual Benefit Increase Option, Accelerated Death Benefit, Conversion, & Waiver of PremiumThe following benefit reduction schedule shows how much benefits are reduced at certain ages:Age Benefit reduces by:65 35%70 50%Why do you need Voluntary Life and AD&D Insurance? Voluntary life insurance is a financial protection plan that provides a cash benefit for your beneficiary(ies) upon the death of the insured. In addition to providing this benefit to your beneficiary(ies), there is also a living benefit that provides cash in the event you become terminally ill. Because you are purchasing this benefit through XCL Resources, you have the added benefit of receiving a group discount! Annual Benefit Increase – If you are enrolled in coverage, you may increase existing life insurance coverage for you and your eligible dependents by two increments without providing proof of good health, not to exceed the maximum life insurance benefit allowed.Accelerated Benefit – If you become terminally ill, you may be able to receive a portion of your life coverage benefit as a lump sum.Conversion – If you retire, reduce your hours or leave XCL Resources, you may be eligible to convert coverage to an individual policy. You will be required to apply to Principal within 31-days of your termination if you wish to continue your coverage. Contact Principal or review the summary plan description for details.Waiver of Premium – If you become totally disabled under the terms of the contract prior to age 60, coverage will be continued, and your premium may be waived.

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsVoluntary Life / AD&D Insurance Premiums: EmployeesNote: This is an estimate of premium cost. Actual deductions may vary slightly due to rounding.13To determine your bi-weekly deduction for Employee coverage, use the chart below. First, locate the benefit amount you want. Second, find your age bracket. The premium amount is found in the box where the row (age bracket) and column (election amount) intersect. Example: Benefit Amount = $70,000 Age = 36 Premium = $5.01Benefit*29 & under 30-34 35-39 40-44 45-49 50-54 55-59 60-64amount$10,000 $0.53 $0.56 $0.71 $0.96 $1.50 $2.38 $3.61 $4.70 $20,000 $1.07 $1.14 $1.43 $1.92 $3.00 $4.77 $7.22 $9.40 $30,000 $1.59 $1.70 $2.15 $2.88 $4.50 $7.15 $10.83 $14.10 $40,000 $2.12 $2.27 $2.86 $3.84 $6.00 $9.52 $14.43 $18.79 $50,000 $2.66 $2.84 $3.58 $4.80 $7.50 $11.91 $18.05 $23.50 $60,000 $3.19 $3.41 $4.29 $5.76 $9.00 $14.29 $21.66 $28.19 $70,000 $3.71 $3.97 $5.01 $6.72 $10.50 $16.67 $25.26 $32.89 $80,000 $4.24 $4.54 $5.72 $7.68 $12.00 $19.05 $28.87 $37.58 $90,000 $4.78 $5.11 $6.44 $8.64 $13.50 $21.44 $32.49 $42.29 $100,000 $5.31 $5.68 $7.15 $9.60 $15.00 $23.81 $36.09 $46.98 $110,000 $5.83 $6.24 $7.87 $10.56 $16.50 $26.19 $39.70 $51.68 $120,000 $6.37 $6.82 $8.59 $11.52 $18.00 $28.58 $43.31 $56.38 $130,000 $6.90 $7.38 $9.30 $12.48 $19.50 $30.96 $46.92 $61.08 $140,000 $7.43 $7.94 $10.01 $13.44 $21.00 $33.34 $50.53 $65.78$150,000 $7.97 $8.52 $10.73 $14.40 $22.50 $35.73 $54.14 $70.48 $160,000 $8.49 $9.08 $11.45 $15.36 $24.00 $38.11 $57.75 $75.18 $170,000 $9.02 $9.65 $12.16 $16.32 $25.50 $40.48 $61.35 $79.87 $180,000 $9.56 $10.22 $12.88 $17.28 $27.00 $42.87 $64.97 $84.58 $190,000 $10.09 $10.79 $13.59 $18.24 $28.50 $45.25 $68.58 $89.27 $200,000 $10.61 $11.35 $14.31 $19.20 $30.00 $47.63 $72.18 $93.97 $210,000 $11.14 $11.92 $15.02 $20.16 $31.50 $50.01 $75.79 $98.66 $220,000 $11.68 $12.49 $15.74 $21.12 $33.00 $52.40 $79.41 $103.37 $230,000 $12.21 $13.06 $16.45 $22.08 $34.50 $54.77 $83.01 $108.06 $240,000 $12.73 $13.62 $17.17 $23.04 $36.00 $57.15 $86.62 $112.76 $250,000 $13.27 $14.20 $17.89 $24.00 $37.50 $59.54 $90.23 $117.46 $260,000 $13.80 $14.76 $18.60 $24.96 $39.00 $61.92 $93.84 $122.16 $270,000 $14.33 $15.32 $19.31 $25.92 $40.50 $64.30 $97.45 $126.86 $280,000 $14.87 $15.90 $20.03 $26.88 $42.00 $66.69 $101.06 $131.56 $290,000$15.39 $16.46 $20.75 $27.84 $43.50 $69.07 $104.67 $136.26$300,000 $15.92 $17.03 $21.46 $28.80 $45.00 $71.44 $108.27 $140.95 *Proof of good health/evidence of insurability is required to apply for benefit amounts greater than $70,000.

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsVoluntary Life / AD&D Insurance Premiums: DependentsTo determine your bi-weekly deduction for Spousal coverage, use the chart below. First, locate the benefit amount you want. Second, find your age bracket (based on Spouse’s age). The premium amount is found in the box where the row (age bracket) and column (election amount) intersect. Example: Benefit Amount = $20,000 Spouse’s Age = 31 Premium = $1.14Note: This is an estimate of premium cost. Actual deductions may vary slightly due to rounding.14Regardless of how many children you have, they are included in the “All Children” premium amounts listed. ALL CHILDREN (to age 26) LIFE PREMIUM TABLE (26 PAYROLL DEDUCTIONS PER YEAR)$5,000 $0.46$10,000 $0.92Benefit29 & under 30-34 35-39 40-44 45-49 50-54 55-59 60-64amount$5,000 $0.26 $0.28 $0.36 $0.48 $0.75 $1.19 $1.80 $2.35 $10,000 $0.53 $0.56 $0.71 $0.96 $1.50 $2.38 $3.61 $4.70 $15,000 $0.79 $0.85 $1.07 $1.44 $2.25 $3.57 $5.41 $7.04 $20,000 $1.07 $1.14 $1.43 $1.92 $3.00 $4.77 $7.22 $9.40 $25,000 $1.33 $1.42 $1.79 $2.40 $3.75 $5.96 $9.03 $11.75 $30,000 $1.59 $1.70 $2.15 $2.88 $4.50 $7.15 $10.83 $14.10 $35,000 $1.86 $1.99 $2.50 $3.36 $5.25 $8.33 $12.63 $16.44 $40,000 $2.12 $2.27 $2.86 $3.84 $6.00 $9.52 $14.43 $18.79 $45,000 $2.38 $2.55 $3.22 $4.32 $6.75 $10.71 $16.24 $21.14 $50,000 $2.66 $2.84 $3.58 $4.80 $7.50 $11.91 $18.05 $23.50 $55,000 $2.92 $3.13 $3.94 $5.28 $8.25 $13.10 $19.85 $25.84 $60,000 $3.19 $3.41 $4.29 $5.76 $9.00 $14.29 $21.66 $28.19 $65,000 $3.45 $3.69 $4.65 $6.24 $9.75 $15.48 $23.46 $30.54 $70,000 $3.71 $3.97 $5.01 $6.72 $10.50 $16.67 $25.26 $32.89$75,000 $3.98 $4.25 $5.36 $7.20 $11.25 $17.86 $27.07 $35.24 $80,000 $4.24 $4.54 $5.72 $7.68 $12.00 $19.05 $28.87 $37.58 $85,000 $4.52 $4.83 $6.08 $8.16 $12.75 $20.25 $30.68 $39.94 $90,000 $4.78 $5.11 $6.44 $8.64 $13.50 $21.44 $32.49 $42.29 $95,000 $5.04 $5.39 $6.80 $9.12 $14.25 $22.63 $34.29 $44.64 $100,000 $5.31 $5.68 $7.15 $9.60 $15.00 $23.81 $36.09 $46.98 *Proof of good health/evidence of insurability is required to apply for benefit amounts greater than $20,000.

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsDisability Insurance15Plan FeaturesShort-Term Disability (Employer Paid)Policy# 1121735Employee Benefit Amount 60% of weekly earningsMaximum Benefit Amount Up to $2,300 per week Elimination Period (Waiting Period) 7 DaysBenefit Duration 12 weeksPre-Existing Condition Exclusion NoneWhy do you need Short-Term Disability? How will you pay your bills if you are sick or injured temporarily? Even a short illness or injury could seriously impact your paycheck. What happens when your sick time runs out? STD replaces part of your income if you are unable to work due to an accident, illness, or if you are expecting a new addition to your family. Maternity Leave is one of the most common short-term disability claims. As an active, full-time employee of XCL Resources working at least 30 hours per week, you are automatically enrolled for Short-Term Disability through Principal at no cost. Plan FeaturesLong-Term Disability (Employer Paid)Policy# 1121735Employee Benefit Amount 60% of monthly earningsMaximum Benefit Amount Up to $10,000 per monthElimination Period 90 days Own Occupation Period 2 YearsBenefit Duration Social Security Normal Retirement Age (SSNRA)Pre-Existing Condition Exclusion 3 / 12*Why do you need Long-Term Disability? A lengthy disability can be devastating and is more common than you may think. Long-term disability may lead to a loss of income, independence, and financial security. A disability insurance policy can help provide security when you need it most and it pays you cash benefits when you’re sick or hurt and cannot work.As an active, full-time employee of XCL Resources working at least 30 hours per week, you are automatically enrolled for Long-Term Disability through Principal at no cost. *A pre-existing condition is one for which you have received medical treatment, consultation, care or services including diagnostic measures, or if you were prescribed or took prescription medications in the predetermined time frame prior to your effective date of coverage. The pre-existing condition under this plan is 3/12 which means any condition (including pregnancy) that you receive medical attention for in the 3 months prior to your effective date of coverage that results in a disability during the first 12 months of coverage would not be covered.

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee Benefits16Will & Legal Document Center Additional ProgramsWhether you’re traveling right here in the United States or leaving the country, you can rely on AXA to help your travel experience go off without a hitch. You have access to many travel assistance services for free — no matter if you’re traveling for business or pleasure. when traveling 100+ miles away from home, for up to 120 consecutive days, you, your spouse and dependent children are covered. AXA Travel AssistanceCreating legal documents is an important investment in your future. You and your spouse can create, print and store essential legal documents—such as a will, living will, healthcare power of attorney, durable power of attorney, and medical treatment authorization for minors. Plus, you can access estate planning tools and a personal information organizer provided by ARAG.Here’s how it works: 1. Visit www.aragwills.com/principal2. Register using your group policy number (1100465)3. You’re in! Complete the forms or download the materials you need. Employee Assistance Program (EAP) Our EAP is a comprehensive resource providing access to professional assistance for a wide range of personal and work-related issues. The service is available to you and your immediate family members twenty-four hours a day, 365 days a year, and provides resources to help employees find solutions to everyday issues. Services include unlimited phone counseling with licensed medical health professionals to help with more serious issues, and online resources. Participation is voluntary and strictly confidential. The Employee Assistance Program can help with:  Emotional well-being Self-care mobile apps to help with insomnia, anxiety, depression, substance use, and more Online assistance with elder care, childcare, and other family life resources Health and wellness articles, guides, webinars, and podcasts Legal assistance Grief, loss, and life adjustments Relationship/martial conflicts Divorce, adoption, family law, trusts Help with teen adolescent issues, including eating disorders and relationships  Tips on parenting and grandparenting  24/7 phone consultation with licensed mental health professionals You have options! To speak to a counselor, or to learn more about your EAP plan, simply:Call: (800) 450-1327, or go online: www.MagellanAscend.com Sample services include: Emergency medical transportation Transportation for family member to join you  Repatriation  Multilingual translation assistance Lost or stolen items Medical and Dental needsARAG provides the following FREE documents:  Last Will and Testament Medical Treatment authorization for minors Healthcare Power of Attorney Living Will Here’s how it works: 1. Call 888-647-2611 (inside the US)2. Call 630-766-7696 (outside the US)3. Or go online www.principal.com/travelassistance

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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.Benefits for 20242024 Employee BenefitsContact Information17Carrier Name Group # Website Phone NumberMedical/RXBlueCross Blue Shield of Texas 242528Find a doctor or hospital1. Visit www.Bcbstx.com (best to register)2. Select your state3. Select Network: BlueChoice PPO 4. Enter search criteriaFind a Preferred Pharmacy1. Visit www.MyPrime.com 2. Select Health Plan Type “Other BCBSTX Plans”3. On Find a Pharmacy page, select “Preferred Network”4. Enter additional search criteria; filter by “preferred pharmacies” (800) 521-2227Health Savings AccountHSA Bankwww.hsabank.com (800) 357-6246DentalPrincipal Financial Group1121735www.principal.com/dentist1. Select a state where you’d like to find a provider2. Select Network: Principal Plan Dental Network3. Enter additional search criteria, if desired(800) 247-4695VisionPrincipal Financial Group 1121735www.principal.com/vsp1. Enter zip code2. Enter additional search criteria(800) 877-7195Flexible Spending Accounts Wex44100 www.benefitslogin.wexhealth.com (866) 451-3399Group Life and AD&DPrincipal Financial Group1121735www.principal.com (800) 986-3343Voluntary Life and AD&DPrincipal Financial Group1121735www.principal.com (800) 986-3343DisabilityPrincipal Financial Group1121735www.principal.com (800) 245-1522Employee Assistance Program (EAP)www.magellanascend.comEnter: Principal Core for company name(800) 450-1327Will & Legal Document Center 1100465www.ARAGwills.com/PrincipalEnter: 1100465 as the policy numberAXA Travel Assistance www.principal.com/travelassistance Inside US: (888) 647-2611Outside US: (630) 766-7696

XCL Resources 2024 Benefits Guide

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