We are pleased to offer a comprehensive benefits package intended to protect your well-being and financial health. This guide is your opportunity to learn more about the benefits available to you and your eligible dependents beginning November 1, 2025.
Each year during Open Enrollment, you have the opportunity to make changes to your benefit plans. The enrollment decisions you make this year will remain in effect through October 31, 2026.
To get the best value from your health care plan, please take the time to evaluate your coverage options and determine which plans best meet the health care and financial needs of you and your family. After Open Enrollment, you may make changes to your benefit elections only when you have a Qualifying Life Event.
Plan deductibles and annual maximums for medical and dental reset every year on January 1.
Availability of Summary Health Information
Your plan offers three health coverage options. To help you make an informed choice and compare your options, a Summary of Benefits and Coverage (SBC) is available summarizing important information about your health coverage options in a standard format. The SBC is available in the MyPay portal and learnW3, or by contacting Human Resources at hrdept1@livew3.com.
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices about your prescription drug coverage. Please see page 16 for more details.
Eligibility
You are eligible for benefits if you are a regular, fulltime employee working an average of 30 hours per week. You may also enroll eligible dependents for benefits coverage. The cost for coverage depends on the number of dependents you enroll and the benefits you choose. When covering dependents, you must select and be on the same plans.
Qualifying Life Events
Your benefit elections remain in effect for the entire plan year until the following Open Enrollment. You may only change coverage during the plan year if you have a Qualifying Life Event such as marriage, divorce, birth or adoption, loss of other coverage, etc. You must notify HR in a timely manner if any of these events occur. Contact HR for a full list of Qualifying Life Events and the notification timeframes required for requested changes. If you experience a qualifying event, complete the change in the MyPay system, or if you have questions, contact Human Resources at hrdept1@livew3.com
SCHIP Eligibility Special Enrollment Period
W3 Luxury Living provides two additional special enrollment opportunities:
If your or your dependent’s Medicaid or SCHIP (State Children’s Health Insurance Program) coverage is terminated as a result of loss of eligibility.
If you or your dependent becomes eligible for a premium assistance subsidy under Medicaid or SCHIP.
You must request this special enrollment option within 60 days of the loss or eligibility of Medicaid or SCHIP coverage.
How to Enroll
Open Enrollment takes place online through the MyPay portal. You must log in and elect benefits for the 2025-2026 plan year. Your current benefit elections will not roll over. If you do not log in and enroll, you will not have benefits for the coming year. The open enrollment period is October 6-11, 2025. Contact HR or your manager if you have any questions.
Medical Coverage
Our medical plan options through UnitedHealthcare (UHC) protect you and your family from major financial hardship in the event of illness or injury. You have a choice of three plans:
HSA Plan – This plan is an HDHP
Base Plan – This plan is a PPO
Buy-Up Plan – This plan is a PPO
All three plans utilize the Choice Plus network of providers.
High Deductible Health Plan (HDHP)
An HDHP allows you the freedom to see any provider when you need care, however you will pay less if you use in-network providers. In exchange for a lower per-paycheck cost, you must satisfy a higher deductible that applies to almost all health care expenses, including those for prescription drugs. The plan pays 80% for health care expenses and covers prescription costs with a copay once you meet your deductible.
If you enroll in the HDHP, you may be eligible to open a Health Savings Account (see page 7).
Preferred Provider Organization (PPO)
A PPO allows you the freedom to see any provider when you need care. When you use in-network providers, you receive benefits at a discounted network cost. You may pay more for services if you use out-of-network providers.
myuhc.com
Register at www.myuhc.com for easy, anytime access to your benefits:
Locate a provider
Confirm your benefits
You can also download the mobile app for onthe-go access.
Medical Benefits Summary
Calendar Year Deductible
Individual
Family
Out-of-Pocket Maximum
Includes deductible
Individual
Family
Lifetime
Preventive Care
Telemedicine
Primary Care Office Visit
Adult
Child(ren) under age 19
Specialist Office Visit
Premium designated
Non-premium designated
Inpatient Hospital
Emergency Room
Facility
Physician
Urgent Care Facility
Outpatient Services
Surgery, lab, X-ray, complex imaging (CAT, MRI)
Retail Prescriptions
Up to 30-day supply
Tier 1
Tier 2
Tier 3
Mail Order Prescriptions
Up to 90-day supply
Tier 1
Tier 2
Tier 3
1 The amount you pay after the deductible is met.
2 Lower copay applies if you use a UHC Premium Designated physician. Visit www.myuhc.com to
Premium Designated providers.
Telemedicine
Included with your medical coverage is access to UHC’s Virtual Visits — quality 24/7 telemedicine care. While Virtual Visits care does not replace your primary care physician, it is a convenient and costeffective option when you need care and:
Have a non-emergency issue and are considering a convenience care clinic, urgent care, or emergency room for treatment
Are on a business trip, vacation, or away from home
Your primary care physician is unavailable
When to Use Virtual Visits
Use Virtual Visits for minor conditions such as:
Sore throat
Headache
Stomachache
Cold and flu
Allergies
Fever
Do not use telemedicine for serious or lifethreatening emergencies. Register so you are ready to use this valuable service.
Online – www.myuhc.com
Mobile – download the mobile app
Health Care Options
UHC Rewards
Earn up to $300 with UHC Rewards, included in your health plan at no additional cost. With UHC Rewards, a variety of actions — including many things you already do — lead to rewards. The activities you go for are up to you, including ways to spend your earnings. Here are some ways you can earn:
Reach Daily Goals – Track 5,000 steps or 15 active minutes each day (double it for an even bigger reward, track 14 nights of sleep)
Complete One-Time Reward Activities – Go paperless, get a biometric screening, take a healthy survey, connect a tracker
Personalize your experience by selecting activities that are right for you and look for new ways of earning rewards to be added throughout the year.
Get Started
Download the UHC app www.myuhc.com
Call customer service at 866-230-2505
Becoming familiar with your options for medical care can save you time and money.
Non-Emergency Care
Telemedicine – $ – average 2-5 minute wait – Access to care and prescriptions via phone, online video or mobile app whether you are home, work or traveling. Use for allergies, coughs, cold or flu, rashes, stomachaches, and other non-emergency health issues.
Doctor’s Office – $ – average 15-20 minute wait – Generally, the best place for routine preventive care as your doctor can treat based on your medical history.
Retail Clinic – $ – average 15 minute wait – Usually located in stores and pharmacies with a lower out-ofpocket cost than urgent care. Use when your doctor is unavailable for common infections, minor injuries, pregnancy tests, and vaccinations.
Urgent Care – $$ – average 15-30 minute wait – When you need immediate attention for sprains, strains, minor broken bones, small cuts that may need stitches, minor burns, and infections.
Emergency Care
Hospital ER – $$$ – average 4+ hour wait – Life-threatening or critical conditions and trauma treatment such as chest pain, difficulty breathing, severe bleeding, blurred or sudden vision loss, and major broken bones. Expect multiple bills for doctors and facility.
Freestanding ER – $$$$ – minimal wait – Use for most major injuries except trauma care. Facilities can look similar to an urgent care center, but medical bills may be 10 times higher.
Health Savings Account
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs — it is also a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs. HSA Bank is our plan administrator.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends taxfree if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA Eligibility
You are eligible to open and contribute to an HSA if you:
Are enrolled in an HSA-eligible HDHP
Are not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
Are not enrolled in a Health Care Flexible Spending Account
Are not eligible to be claimed as a dependent on someone else’s tax return
Are not eligible for Medicare or TRICARE
Have not received Veterans Administration benefits
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds for your spouse and dependents’ health care expenses, even if they are not covered by the HDHP.
Maximum Contributions
Your HSA contributions may not exceed the annual maximum amount established by the IRS. The annual contribution maximum is based on the coverage option you elect:
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you may make the catch-up contribution for the entire plan year.
Opening an HSA
If you meet the eligibility requirements, you may open an HSA. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. Go to the MyPay portal to open an account.
Important HSA Information
Always ask your health care provider to file claims with your insurance provider so network discounts can be applied.
Use your HSA debit card to pay the provider.
Keep all receipts for HSA reimbursements in the event of an IRS audit.
You may open an HSA at the financial institution of your choice, but only accounts opened through HSA Bank are eligible for automatic payroll deduction.
Non-Tobacco User Incentive Program
W3 Luxury Living rewards employees who do not use tobacco products or who are trying to quit using tobacco products. To be eligible for a non-tobacco user incentive during the 2025-2026 plan year, you must complete one of the following at enrollment:
Declare that you do not use tobacco.
Declare that you use tobacco but intend to complete a company sponsored tobacco cessation program.
Submit a Tobacco Cessation Program
Completion Form to Human Resources within 30 days of completing the program during the 2025-2026 plan year.
If your tobacco status changes mid-year, you must notify Human Resources.
Both online self-directed courses and health coaching by phone are available. A self-paced workbook is also available through Higginbotham If you would like to use a different program, please consult with Human Resources to determine if your quit method is approved for purposes of this program.
If you are interested in learning more about the non-tobacco user incentive program, please refer to the following:
2025 Non-Tobacco User Medical Premium Rate
UHC Rally Flyer
2025 Tobacco Cessation Program Completion Form on MyPay
Contact Human Resources at hrdept1@livew3.com
Important Program Information
Please note that for the purpose of this program, “use of tobacco products” includes any use of cigarettes, e-cigarettes, pipes, cigars, or any other tobacco products regardless of frequency or method of use.
Tobacco users who declare at enrollment that they intend to join and complete a company-sponsored tobacco cessation program during the plan year will qualify for the non-tobacco user incentive upon completion of the program and submission of the Tobacco Cessation Program Completion Form to Human Resources. This includes reimbursement for incentives lost while completing the cessation program.
Tobacco users who do not intend to complete a company-sponsored tobacco cessation program during the plan year will not be eligible for the 2025-2026 non-tobacco incentive and will not have an opportunity to qualify for a non-tobacco incentive until the next enrollment.
If you have a health factor that makes it unreasonably difficult or medically inadvisable for you to achieve the requirements of this program to qualify for the incentives, please contact Human Resources and we will work with you and/or your physician to develop an alternative. The purpose of this program is to promote health and prevent disease by alerting employees to potential health risks. This program is confidential and HIPAA compliant. Protected Health Information will only be collected in aggregate form in order to design programs for the purpose of addressing the company’s overall risks. Any information shared will not be disclosed, except in accordance with HIPAA laws.
Dental Coverage
Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through UHC
Two levels of benefits are available with the DPPO plan: in-network and out-of-network. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an out-ofnetwork provider.
Dental Benefits Summary
Vision Coverage
Our vision plan provides quality care to help preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes and high cholesterol. You may seek care from any licensed optometrist, ophthalmologist, or optician, but plan benefits are better if you use an in-network provider. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through UHC using the Spectera network.
Vision Benefits Summary
1 After deductible.
The plan deductible and annual maximum for the dental plan will reset with the calendar year, January 1.
Covered brands1
Noncovered brands
Frequency Exam Once every 12 months Lenses Once every 12 months
Once every 12 months
Contacts Once every 12 months
1 Maximize your benefits by using brands specified on the MyPay portal.
Flexible Spending Accounts
A Flexible Spending Account (FSA) allows you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer two different FSAs: one for health care expenses and one for dependent care expenses. Higginbotham administers our FSAs.
Health Care FSA
The Health Care FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. You may contribute up to $3,300 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include:
Dental and vision expenses
Medical deductibles, copays, and coinsurance
Prescription copays
Hearing aids and batteries
How the Health Care FSA Works
Access the funds in your Health Care FSA two different ways:
Use your Higginbotham Benefits Debit Card to pay for qualified expenses.
Pay out-of-pocket and submit your receipts for reimbursement:
Fax – 866-419-3516
Email – flexclaims@higginbotham.net
Online –https://flexservices.higginbotham.net
Higginbotham Benefits Debit Card
Dependent Care FSA
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work full-time. You can use the account to pay for day care or babysitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled, or a full-time student.
Things to Consider Regarding the Dependent Care FSA
Overnight camps are not eligible for reimbursement (only day camps can be considered).
If your child turns 13 mid-year, you may only request reimbursement for the part of the year when the child is under age 13.
You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).
Important
FSA Rules
The maximum per plan year you can contribute to a Health Care FSA is $3,300. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately.
You cannot change your election during the year unless you experience a Qualifying Life Event.
You can continue to file claims incurred during the plan year for another 90 days (up until January 29, 2027)
Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
The IRS has amended the “use it or lose it rule” to allow you to carry-over up to $660 from your Health Care FSA into the next plan year. The carry-over rule does not apply to your Dependent Care FSA.
Higginbotham Portal
The Higginbotham Portal provides information and resources to help you manage your FSA.
Access plan documents, letters and notices, forms, account balances, contributions, and other plan information
Update your personal information
Utilize Section 125 tax calculators
Look up qualified expenses
Submit claims
Request a new or replacement Benefits Debit Card
Register on the Higginbotham Portal
Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.
Enter your Employee ID, which is your Social Security number with no dashes or spaces.
Follow the prompts to navigate the site.
If you have any questions or concerns, contact Higginbotham:
Phone – 866-419-3519
Email – flexclaims@higginbotham.net
Fax – 866-419-3516
Life and AD&D Insurance
Life and Accidental Death and Dismemberment (AD&D) insurance are important parts of your financial security, especially if others depend on you for support. With Life insurance, your beneficiary(ies) can use the coverage to pay off your debts, such as credit cards, mortgages, and other final expenses.
AD&D coverage provides specified benefits for a covered accidental bodily injury that causes dismemberment (e.g., the loss of a hand, foot, or eye). In the event that death occurs from an accident, 100% of the AD&D benefit would be payable to your beneficiary(ies).
Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you through Mutual of Omaha. You are automatically covered at one times your base annual salary.
BASIC LIFE AND AD&D
One times your base annual salary to a maximum of $200,000
Voluntary Life and AD&D
You may purchase additional Life and AD&D insurance for you and your eligible dependents through Mutual of Omaha
If you decline Voluntary Life and AD&D insurance when first eligible, an Evidence of Insurability (EOI) — proof of good health — will be required before coverage is approved. If you already have coverage, you may increase your benefit amount by $10,000 during open enrollment without providing EOI.
To elect coverage for your spouse or children, you must first elect Voluntary Life and AD&D for yourself. If you leave the company, you may be able to take the insurance with you.
Increments of $10,000 to a maximum of the lesser of five times annual salary or $500,000
Guarantee Issue $100,000 Spouse
Increments of $5,000 to a maximum of $250,000 not to exceed 100% of employee amount
Guarantee Issue $20,000
Rate is based on employee’s age
Child(ren) 14 days to age 26
Increments of $2,000 to a maximum of $10,000 not to exceed 100% of employee amount
Guarantee Issue $10,000
Rate is for all covered children, regardless of how many
Designating a Beneficiary
A beneficiary is the person or entity you designate to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary and you can change beneficiaries at anytime. If you name more than one beneficiary, you must identify the share for each.
VOLUNTARY
Disability Insurance
Short Term Disability (STD) insurance provides partial income protection if you are unable to work due to a covered accident or illness. We offer STD insurance for you to purchase through Mutual of Omaha
STD coverage pays a percentage of your weekly salary for up to 24 weeks if you are temporarily disabled and unable to work due to an illness, nonwork related injury or pregnancy. STD benefits are not payable if the disability is due to a job-related injury or illness.
Enrollment into the STD plan is available each year at benefit renewal with the plan having a 3/6 preexisting condition clause.
VOLUNTARY SHORT TERM DISABILITY
Elimination Period
Accident
Illness 14 days 14 days
Percentage of Earnings You Receive
Maximum Benefit Period
of
24 weeks
Pre-Existing Condition Exclusion 3/61
1 Benefits may not be paid for any condition treated within the three months prior to your effective date until you have been covered under this plan for six months.
Supplemental Insurance
W3 Luxury Living offers you and your eligible family members the opportunity to enroll in additional coverage that complements our traditional health care programs. Health insurance covers medical bills, but if you have an emergency, you may face unexpected out-of-pocket costs, such as deductibles, coinsurance, travel expenses, and non-medical related expenses. These plans are offered through Mutual of Omaha and are portable. If you leave your employment, you can take these policies with you. All the information to enroll is on the MyPay enrollment site.
Accident Insurance
Benefits are paid direct to you for covered accidental injuries, regardless of any other coverage you may have and you can spend it any way you choose. Benefits are paid according to a fixed schedule that includes benefits for hospitalization, fractures and dislocations, emergency room visits, major diagnostic exams, physical therapy and more. Please refer to the benefit summary for benefit details.
Critical Illness
Critical Illness insurance helps pay the cost of non-medical expenses related to a covered critical illness or cancer. The plan provides a lump sum benefit payment to you upon first and second diagnosis of any covered critical illness or cancer. The benefit can help cover expenses, such as lost income, out-of-town treatments, special diets, daily living, and household upkeep costs.
Hospital Indemnity
The Hospital Indemnity Plan helps with the high cost of medical care by paying a set amount when you have an inpatient hospital stay. Unlike traditional insurance which pays a benefit to the hospital or doctor, this plan pays you direct based on the care or treatment you receive. These costs may include meals and transportation, child care, or time away from work due to a medical issue that requires hospitalization.
Legal Services
LegalShield
LegalShield provides affordable legal services when the need arises. This plan offers help with a wide range of legal matters, including everyday situations when legal advice is helpful. Assistance includes:
Preventive Legal Services – Telephone consultations, legal correspondence, legal document review on an unlimited number of topics
Will Prep Services – Wills/Living Wills prepared at no charge with yearly updates
Motor Vehicle Legal Services – Moving violations, driver’s license services, personal injury collection assistance
Trial Defense Services – Defense of civil actions, 24/7 emergency attorney access, pretrial and trial assistance
IRS Audit Legal Services – Consultation and audit representation
Preferred Member Discount – 25% discount on the provider law firm’s hourly rate for services not otherwise covered by the plan
IDShield
Identity theft victims spend an average of 330 hours repairing an issue. With IDShield, your dedicated, licensed fraud investigator does whatever it takes, as long as it takes, clearing your records for life.
Credit Report – Receive up-to-date credit reports as well as a detailed analysis of your personal credit score.
Continuous Credit Monitoring – Your files will be regularly monitored and suspicious activity brought to your attention.
Identity Restoration – Unlimited restoration done by their licensed private investigators. Call 817-988-6780 for more information about plan benefits.
Additional Benefits
The following programs are available to you and your eligible dependents at no additional cost through your Mutual of Omaha coverage.
Employee Assistance Program (EAP) – This confidential service includes 24/7 unlimited telephone access to professionals for help with stress and depression, financial issues, family and relationship issues, substance abuse, grief, parenting, elder care and other personal concerns. You and your eligible dependents are also entitled to up to three face-to-face sessions with a counselor. Visit www.mutualofomaha. com/eap or call 800-316-2796 for assistance.
Advocacy Services – Advocacy Services provides personalized and confidential problem-solving assistance for any benefit, claim, or provider/ hospital issue or question. Call 866-372-5577 weekdays from 7:00 a.m. to 7:00 p.m. or email customerservice@gilsbar.com
Hearing Discount – Provides access to a free hearing test, low-price guarantee for devices, a 60-day risk free trial period and two years of batteries with purchase. To activate your benefit, call 888 534-1747. Visit www.amplifonusa.com/mutualofomaha to learn more.
Worldwide Travel Assistance – This program provides travel assistance for you and your dependents when traveling more than 100 miles from home for up to 120 days. Representatives can help with trip planning or assist in an emergency, including interpreter or legal services, dealing with lost baggage, emergency funds, document replacement and more. For inquiries within the U.S., call 800-856-9947. If outside the U.S., call 312-935-3658
Employee Per Pay Period Costs
Your costs for benefits will be deducted pretax each paycheck (26 pay periods).
Legal Notices
Women’s Health and Cancer Rights Act of 1998
In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully.
As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:
All stages of reconstruction of the breast on which the mastectomy was performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
Prostheses and treatment of physical complications of the mastectomy, including lymphedema.
Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
Special Enrollment Rights
This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.
Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP)
If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage).
If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance.
Marriage,
Birth or
Adoption
If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption.
For More Information or Assistance
To request special enrollment or obtain more information, contact:
W3 Luxury Living Human Resources
2505 N State Hwy 360 Grand Prairie, TX 75050 972-471-8782
Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with W3 Luxury Living and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. W3 Luxury Living has determined that the prescription drug coverage offered by the W3 Luxury Living medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting W3 Luxury Living at the phone number or address listed at the end of this section.
If you choose to enroll in a Medicare prescription drug plan and cancel your current W3 Luxury Living prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.
If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.
For more information about this notice or your current prescription drug coverage:
Contact the Human Resources Department at 972-4718782 .
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
November 1, 2025
W3 Luxury Living Human Resources
2505 N State Hwy 360 Grand Prairie, TX 75050 972-471-8782
Notice of HIPAA Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan – whether received in writing, in an electronic medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by W3 Luxury Living , hereinafter referred to as the plan sponsor.
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer.
You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask the Human Resources Department to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources Department.
Complaints: If you believe your privacy rights have been violated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer.
W3 Luxury Living Human Resources
2505 N State Hwy 360 Grand Prairie, TX 75050
972-471-8782
Conclusion
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
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 1-877KIDS 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 employersponsored 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, 2025. Contact your State for more information on eligibility.
To see if any other States have added a premium assistance program since July 31, 2025, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
Continuation of Coverage Rights Under COBRA
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the W3 Luxury Living group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the W3 Luxury Living plan after you have left employment with the company. If you wish to elect COBRA coverage, contact your Human Resources Department for the applicable deadlines to elect coverage and pay the initial premium.
Plan Contact Information
W3 Luxury Living Human Resources
2505 N State Hwy 360 Grand Prairie, TX 75050 972-471-8782
Your Rights and Protections against Surprise Medical Bills
When you get emergency care or get treated by an out-ofnetwork provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-ofnetwork providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services – If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most the provider or facility may bill you is your plan’s innetwork cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, outof-network providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care out-ofnetwork. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay outof-network providers and facilities directly.
Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (costsharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/ nosurprises for more information about your rights under federal law.
Notice Regarding Wellness Program
The employee wellness program is a voluntary program administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness program you may be asked to complete a voluntary health risk assessment or “HRA” that asks a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease). You may also be asked to complete a biometric screening, which could include a blood test for certain medical conditions such as diabetes, heart disease, etc. You are not required to complete the HRA or to participate in the blood test or other medical examinations.
However, employees who choose to participate in the wellness program may qualify for an incentive. Although you are not required to complete a HRA or biometric screening, the wellness program may specify that only employees who do so will qualify for the incentive. Additional incentives may be available for employees who participate in certain health-related activities or achieve certain health outcomes.
If you are unable to participate in any of the healthrelated activities or achieve any of the health outcomes required to earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by contacting Human Resources.
If you choose to participate in a HRA and/or biometric screening, information from your HRA and results from your biometric screening will be used to provide you with information to help you understand your current health and potential risks and may also be used to offer you services through the wellness program. You also are encouraged to share your results or concerns with your own doctor.
Protections from Disclosure of Medical Information
We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program may use aggregate information it collects to design a program based on identified health risks in the workplace, the wellness program will never disclose any of your personal information either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.
Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements.
In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately.
You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.
If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact Human Resources.
