We are pleased to offer a full benefits package to you and your eligible dependents. Read this guide to know what benefits are available to you. You may only enroll for or make changes to your benefits during Open Enrollment or when you have a Qualifying Life Event.
Availability of Summary Health Information
Your benefits program offers three medical plan coverage options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage (SBC), available at www.paycom.com and from the People Department.
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 for your prescription drug coverage. Please see page 33 for more details.
• A regular, full-time employee working an average of 30 hours per week
When to Enroll
• Enroll by the deadline given by the People Department
When Coverage Starts
• First of the month following your date of hire
EMPLOYEE
Who is Eligible
• A regular, full-time employee working an average of 30 hours per week
When to Enroll
• Enroll during Open Enrollment or when you have a Qualifying Life Event
When Coverage Starts
• Open Enrollment: Start of the plan year
• Qualifying Life Event: Ask the People Department
DEPENDENT(S)
Who is Eligible
• Your legal spouse
• Child(ren) under age 26, regardless of student, dependency, or marital status
• Child(ren) over age 26 who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return
When to Enroll
• You must enroll the dependent(s) at Open Enrollment or for a Qualifying Life Event
• When covering dependents, you must enroll for and be on the same plans
When Coverage Starts
• Ask the People Department, if needed
Qualifying Life Events
You may only change coverage during the plan year if you have a Qualifying Life Event, such as:
in benefits eligibility
FMLA, COBRA event, court judgment, or decree Becoming eligible for Medicare, Medicaid, or TRICARE
Receiving a Qualified Medical Child Support Order Gain or loss of benefits coverage
Change in employment status affecting benefits
Significant change in cost of spouse’s coverage
You have 30 days from the event to notify the People Department and complete your changes. You may need to provide documents to verify the change.
How To Enroll
ONLINE WITH PAYCOM
To begin the enrollment process, log in to the employee portal at www.paycom.com.
1 Select the current year’s benefits enrollment and click on Start Enrollment
2 Review your information. Click Edit to make changes, or Next to continue.
3 Complete the pre-enrollment questions and click Save and Next. You can also edit dependent and beneficiary info on this screen.
4
Choose to enroll or decline by clicking the appropriate option, and add dependents as needed. When finished, click Enroll and continue this for each plan.
5 When you are finished, review your enrollment and click Finalize. Then, tap Sign and Submit in the pop-up window.
Call or text with a bilingual representative at 888-386-2572 , Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you leave a message after 3:00 p.m. CT, your call or text will be returned the next business day. Email questions or requests to barcelusa@higginbotham.net
Medical Coverage
The medical plan options through Blue Cross Blue Shield of Texas (BCBSTX) protect you and your family from major financial hardship in the event of illness or injury. You have a choice of three plans:
PPO $2,000
This PPO plan has a $2,000 Individual and a $4,000 Family in-network deductible.
PPO $4,000
This PPO plan has a $4,000 Individual and an $8,000 Family in-network deductible.
HDHP $3,400
This HDHP plan has a $3,400 Individual and a $6,800 Family in-network deductible.
Preferred Provider Organization
A Preferred Provider Organization (PPO) plan allows you to see any provider when you need care. When you see in-network providers for care, you will pay less and get the highest level of benefits. You will pay more for care if you use out-of-network providers. When you see innetwork providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other network services are covered at the deductible and coinsurance level.
High Deductible Health Plan
A High Deductible Health Plan (HDHP) allows you to see any provider when you need care, and you will pay less for care when you go to in-network providers. In exchange for a lower per-paycheck cost for medical benefits, you must satisfy a higher plan deductible that applies to almost all health care expenses, including prescription drugs. If you enroll in the HDHP, you may be eligible to open a Health Savings Account (HSA) (see page 18).
Medical Plan Comparison FOR
PREVENTIVE TO CHRONIC CARE
Prescription Drug Coverage
Your prescription drug coverage is provided through Prime Therapeutics. To save money on long-term or maintenance prescriptions, use the Express Scripts mail order or Accredo specialty drug programs.
Mail Order Prescriptions
Express Scripts delivers your long-term (or maintenance) medications to the address of your choice.
New Prescriptions
• Mail your prescription to Express Scripts, or have your doctor fax or e-prescribe.
• Ask your doctor to write a prescription for a 90-day supply for each of your long-term medicines. Or, ask your doctor to fax or e-prescribe your order.
• To print a new prescription order form, go to www.express-scripts.com/rx or call 833-715-0942
• Mail your prescription, completed form, and payment to Express Scripts.
Medications take about five days to deliver after receipt of your order.
Refill or Transfer Prescriptions
• Online – Visit www.express-scripts.com/rx to register and create a profile, or log in to www.myprime.com and follow the links to Express Scripts Pharmacy.
• Phone – Call 833-715-0942 and have your member ID card and your doctor’s and Rx information ready.
• Mail – Visit www.bcbstx.com and log in to Blue Access for Members. Complete the mail order form and send it with your Rx and payment to Express Scripts.
• Doctor – Ask your doctor to fax, call, or email your Rx to Express Scripts for you.
Questions?
Visit www.bcbstx.com or call the number on your member ID card.
Step Therapy
Some prescription drugs require step therapy, meaning you may need to try a proven, cost-effective medication before receiving coverage for a more expensive one. Treatment decisions remain between you and your doctor. Step therapy typically applies to high-cost medications for conditions like high cholesterol, depression, rheumatoid arthritis, and more.
If you are already taking a drug in the step therapy program, you may not be affected. For details or to check if your medication requires step therapy, visit www.bcbstx.com/ member/rx_drugs or call the number on your ID card. Your doctor can also call 800-289-1525 with questions.
Specialty Medications
If you need specialty drugs to treat complex or chronic conditions, use Accredo for new or transfer orders. Call 833-721-1619 to speak to a representative and place your order. Certain exclusions and limitations apply. Visit www.accredo.com for details.
Telemedicine
Your medical coverage offers HealthiestYou telemedicine services through Teladoc . Connect anytime day or night with a board-certified doctor via your mobile device or computer at no additional cost to you if you enroll in one of the three medical plans
While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
• Have a non-emergency issue and are considering an afterhours health care clinic, urgent care clinic, or emergency room for treatment
• Are on a business trip, vacation, or away from home
• Are unable to see your primary care physician
When to Use Teladoc
Use telemedicine for minor conditions such as:
• Colds
• Flu symptoms
• Allergies
• Bronchitis
• Urinary tract infection
• Respiratory infection
• Sinus problems
• Back problems
• Dermatology issues
• Behavioral health care
• Counseling
• Nutrition
• Mental Health
Do not use telemedicine for serious or life-threatening emergencies.
Expert Medical Services
Get expert advice from a clinical team to help understand and manage your medical diagnosis and treatment plans. Services include:
• Expert Medical Opinion – request a second opinion on an existing diagnosis or course of treatment
• Ask the Expert – get answers to questions about medical conditions, treatment options, or symptoms
• Find the Best Doctor – get help locating a specialist in your area
• Critical Case Support – a clinical team assigned during the crucial hours after an emergency to work with on-site medical teams
• Treatment Decision Support – receive guidance and education on treatment options
• Medical Records eSummary – collect and organize your medical records in a single secure place
Health Care Options
Becoming familiar with your options for medical care can save you time and money.
Non-emergency Care
Telemedicine
Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed.
24 hours a day, 7 days a week
Doctor’s Office
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history.
Office hours vary
Retail Clinic
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies.
Hours vary based on store hours
Urgent Care
When you need immediate attention; walk-in basis is usually accepted.
and strep throat
Generally includes evening, weekend, and holiday hours Sprains and strains
Emergency Care
Hospital ER
Life-threatening or critical conditions; trauma treatment ; multiple bills for doctor and facility.
24 hours a day, 7 days a week
Freestanding ER
Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher
24 hours a day, 7 days a week
Chest pain
Difficulty breathing Severe bleeding Blurred or sudden loss of vision Major broken bones
Most major injuries except trauma Severe pain
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only estimates. This information is not intended as medical advice. If you have questions, please call the phone number on the back of your medical ID card.
BCBSTX Resources
FOR GETTING THE MOST OUT OF YOUR MEDICAL COVERAGE
BCBSTX Member Portal
Blue Access for Members (BAM) is the secure BCBSTX member website where you can:
• Check claim status or history
• Confirm dependent eligibility
• Sign up for electronic Explanation of Benefits statements
• Locate in-network providers
• Print or request an ID card
• Review your benefits
• Get tips to live and eat healthier Register for an account at www.bcbstx.com
Mobile App
The BCBSTX mobile app can help you stay organized and in control of your health anytime, anywhere. Log in from your mobile device to access your BAM account to:
• Track account balances and deductibles
• Access ID card information
• Find doctors, dentists, and pharmacies
Nurseline
Call 800-581-0368 for immediate access to registered nurses who can answer general health questions, make appointments with your doctor, and help determine where to go for immediate or emergency health care services. You can also access an audio library of more than 1,000 healthrelated topics in both English and Spanish.
Blue365 Discounts
Blue365 can help you save money on health and wellness products and services not covered by insurance. There are no claims to file, and you do not need a referral or preauthorization. Visit www.blue365deals.com/bcbstx to sign up and receive weekly featured deals by email. Discount categories include:
• Apparel and footwear
• Fitness
• Hearing and vision
• Home and family
• Nutrition
• Personal care
Well onTarget
Well onTarget provides the support you need to make healthy choices and rewards you for your hard work. Use the online wellness portal and mobile app to access a suite of personalized tools and resources.
• Biometric screenings
• Health assessment
• Blue Points program
• Fitness tracking
• Fitness program
• And more
Visit www.wellontarget.com to access the Well onTarget member portal. If you have already registered on BAM, use the same log-in information. If not, you can register on this site. Get the Well onTarget mobile app, AlwaysOn, to take a health assessment, check your Blue Points balance, and track wellness information.
BCBSTX Resources
FOR GETTING THE MOST OUT OF YOUR MEDICAL COVERAGE
Well onTarget Fitness Program
As a BCBSTX member, you and your covered dependents (age 16 and older) have exclusive access to the Fitness Program . This program offers a nationwide network of fitness centers. You can choose a location near your home, one close to work, or even visit locations while traveling. The Fitness Program offers flexibility and convenience with a range of gym networks to suit your budget and preferences. You can also enjoy boutique-style studio classes and specialty gyms with a pay-as-you-go option, plus 30% off every 10th class. The program is family-friendly, providing discounted access for your covered dependents through bundled pricing. You can easily manage monthly fees with automatic withdrawals from your credit card or bank account.
The Fitness Program offers a variety of tools, discounts, and incentives to help you stay active and maintain your wellbeing. From a user-friendly mobile app to complementary and alternative medicine discounts, the program is designed to provide flexibility and savings. Plus, you can earn points and rewards just by staying committed to your fitness routine.
• Mobile App: Access location search, studio class registration, check-ins, and activity history.
• Real-Time Data: Accessible via the app and Well onTarget portals.
• CAM Discounts: Save on services like acupuncture and massage therapy through the Whole Health Living Choices Program.
• Blue Points: Earn 2,500 points for joining and additional points for weekly visits.
• Web Resources: Track fitness visits and find locations online.
For more information, or to sign up, use any of the options below.
Visit www.bcbstx.com (log in and select Fitness Program under Quick Links to enroll) Call 888-762-BLUE (2583), Monday through Friday, 7 a.m. to 7 p.m. CT.
VirtualCheckup
Catapult Health offers an in-home VirtualCheckup program for your preventive care. It is fast, free, and easy to do! Simply order your kit for home delivery, follow the directions, and complete your VirtualCheckup with a Catapult nurse practitioner. Everything you need to collect vital information is included in the kit and is yours to keep (including a blood pressure monitor). Visit www.virtualcheckup.com/BCBSTX for details and to order.
Back and Joint Pain
If you suffer from constant back and joint pain, Hinge Health can help without drugs or surgery. Get personal therapy, unlimited support, a computer tablet, and wearable sensors — all for free! Average results show 60% pain reduction and two out of three surgeries avoided. Your remote care may be done in the comfort of your own home. You will begin with a 12-week intensive phase, followed by an ongoing program that builds on what you have learned. Learn more and apply at www.hingehealth.com/bcbstx or by calling 888-762-BLUE (2583)
Diabetes/High Blood Pressure
If you are at risk of diabetes and/or high blood pressure, Omada helps you change the habits that put you most at risk for developing a chronic condition. A virtual care team will work with you to create a program to reduce your risk and build healthy habits. You will receive weekly support and connect with a small group of peers, all from the comfort of your own home. If you have any health claims that show you may be at risk for diabetes or high blood pressure, Omada will reach out to you directly. Visit www.omadahealth.com/bcbstx for details or by calling 888-762-BLUE (2583)
Digital Weight Loss
If you would like to lose weight and change how your body stores and uses energy, Wondr may be right for you. Wondr is a 100% digital weight loss program that teaches you how to eat your favorite foods and still lose weight, have energy, stress less, and sleep better. Wondr is not a diet plan. There are no points, plans, or calories to count. It teaches you skills to know how and when you eat and improve your long-term health. Learn more and enroll at https://wondrhealth.com/ bcbstx or by calling 888-762-BLUE (2583)
Quit Smoking
Tobacco cessation services are available for free as long as you visit an in-network provider. There are no out-of-pocket costs, even if you have not met your deductible. Call the Customer Service number on the back of your member ID card or log in to www.bcbstx.com to learn more or by calling 888-762-BLUE (2583)
Chronic Disease Digital Management
Livongo offers digital solution programs to help you manage chronic diabetes and high blood pressure (hypertension). Participation is FREE and available to you and your family members.
Diabetes Management Program
Manage Type 1 and Type 2 diabetes by using:
• Livongo’s advanced blood glucose meter – Get immediate feedback and alert loved ones in real time (using a cellular connection) when your blood glucose is too high or low
• Unlimited strips and lancets – Livongo ships supplies to you at NO COST
• Real-time tips and support – Get 24/7 support if your glucose is not in range or if you want tips on diabetes management
High Blood Pressure Management Program
Livongo offers personal support by monitoring your blood pressure using:
• A wireless, connected blood pressure cuff
• Support and coaching with licensed professionals 24/7
• Notifications and reminders for high blood pressure readings
• Blood pressure reading reports
Get started today at www.bcbstx.com or by calling 888-762-BLUE (2583).
Digital Mental Health Program
BCBSTX offers Learn to Live, a confidential, digital mental health program designed to help you manage stress, anxiety, depression, and insomnia. With personalized programs based on proven Cognitive Behavioral Therapy techniques, you can access interactive tools, resources, and support at your own pace. Available anytime, anywhere, Learn to Live empowers you to improve your emotional well-being.
For more information, log in to your BCBSTX member portal at www.bcbstx.com and explore the Learn to Live program today or by calling 888-762-BLUE (2583)
Special Beginnings
BCBSTX’s Special Beginnings program offers personalized support and resources for a healthy pregnancy. From your first trimester to delivery, this program provides guidance on prenatal care, planning with your doctor, and managing highrisk conditions like gestational diabetes or preeclampsia. Start early to give your baby the best start in life.
Get started today at www.bcbstx.com or by calling 888-762-BLUE (2583)
Dental Insurance
including regular checkups and other dental work. Coverage is provided through BCBSTX
DPPO Plans
Two DPPO plans are available: the Low Plan and the High Plan. The Low Plan is ideal if your dentist is in the BCBSTX dental network or you are open to switching dentists. Out-of-network services are reimbursed on a Maximum Allowable Charge basis. The High Plan suits those who want to keep their out-of-network dentist, with out-ofnetwork services reimbursed at the 90th percentile of local charges.
Vision Insurance
FOR YOUR PEEPERS
Our vision plan offers quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems. You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see in-network providers. Coverage is provided through BCBSTX using the EyeMed Insight vision network.
Health Savings Account
FOR CURRENT OR FUTURE EXPENSES
An HSA is a tax-exempt tool to supplement your retirement savings and to cover current and future health costs.
As a type of personal savings account that 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 current or future 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.
YOU DECIDE HOW TO USE YOUR HSA FUNDS
Use it Now
Make annual HSA contributions. Pay for eligible medical costs. Keep HSA funds in cash.
Let it Grow
Make annual HSA contributions. Pay for medical costs with other funds. Invest HSA funds.
Health Savings Account
FOR CURRENT OR FUTURE EXPENSES
Tax Benefits
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible HDHP plan
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
• Not enrolled in a Health Care Flexible Spending Account
• Not eligible to be claimed as a dependent on someone else’s tax return
• Not enrolled in Medicare, Medicaid, or TRICARE
• Not receiving Veterans Administration benefits
Contributions
If you enroll in the HDHP medical plan, Barcel will contribute a dollar-fordollar match up to $1,500 to your HSA when you first open your account.
HSA Contributions
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 age 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 anytime during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
Open an HSA
If you meet the eligibility requirements, you may open an HSA administered by ThrivePass. 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. To open an account, go to www.thrivepass.com
Important HSA Information
• Always ask your network doctor to file claims with your medical, dental, or vision carrier so you will get the highest level of benefits. You can pay the doctor with your HSA debit card for any balance due.
• You, not your employer, are responsible for maintaining ALL records and 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 ThrivePass are eligible for automatic payroll deduction and company contributions. No Qualifying Life Event is required to make changes throughout the year
Flexible Spending Accounts
FOR HEALTH AND DEPENDENT CARE EXPENSES
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 three different FSAs: two for health care expenses and one for dependent care expenses. ThrivePass 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 $3,400 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 and coinsurance
Prescription copays
Hearing aids and batteries
You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).
Limited Purpose Health Care FSA
A Limited Purpose Health Care FSA is available if you enrolled in the HDHP medical plan and contribute to an HSA. You can use a Limited Purpose Health Care FSA to pay for eligible out-of-pocket dental and vision expenses only, such as:
Dental and orthodontia care (e.g., fillings, X-rays, and braces)
Vision care (e.g., eyeglasses, contact lenses, and LASIK surgery)
Important FSA Rules
How the Health Care and Limited Purpose Health Care FSAs Work
You can access the funds in your FSA two different ways:
• Use your FSA debit card to pay for qualified expenses, doctor visits, and prescription copays.
• Pay out-of-pocket and submit your receipts for reimbursement:
» Email – support@thrivepass.com
» Online – www.thrivepass.com
ThrivePass Benefits Debit Card
The ThrivePass Benefits Debit Card gives you immediate access to funds in your Health Care or Limited Purpose Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay for 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).
• The maximum per plan year you can contribute to a Health Care or Limited Purpose Health Care FSA is $3,400. The maximum per plan year you can contribute to a Dependent Care FSA is $7,500 when filing jointly or head of household and $3,750 when married filing separately.
• You cannot change your election during the year unless you experience a Qualifying Life Event.
• Your Health Care or Limited Purpose Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
• You can continue to file claims incurred during the plan year for another 31 days (up until January 31, 2027).
• The IRS has amended the “use it or lose it” rule to allow you to carry over up to $680 in your Health Care FSA into the next plan year ($680 from the 2025 to the 2026 plan year). The carryover rule does not apply to your Dependent Care FSA.
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 or attend school full time. You can use the account to pay for daycare 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 (and your spouse, if married) must be gainfully employed, looking for work, a full-time student, or incapable of self-care.
Dependent Care FSA Considerations
Overnight camps are not eligible for reimbursement (but day camps are).
If your child turns age 13 midyear, you may only be reimbursed for the time the child was under age 13. You may be reimbursed 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 a dependent claimed on your income taxes.
Limited Purpose Health Care FSA
Dependent Care
FSA (cannot be used to pay for dependent health care)
Most medical, dental, and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses, and doctorprescribed over-the-counter medications)
Dental and vision care expenses that are not covered by your health plan (such as eyeglasses, contacts, LASIK eye surgery, fillings, X-rays, and braces). Available only if you have an HSA account.
Dependent care expenses (such as daycare, afterschool, or eldercare programs) so you and your spouse can work or attend school full-time
ThrivePass Pre-Tax Accounts Mobile App
ThrivePass Member Portal
The ThrivePass Member portal provides information and resources to help you manage your FSAs. You can:
• Access plan documents, letters and notices, forms, account balances, contributions, and other plan information
• Update your personal information
• Look up qualified expenses
• Submit claims
Register on the ThrivePass Portal
Visit https://app.thrivepass.com and click Set Up an Account. Follow the instructions and scroll down to enter your information.
• Enter your registration code from the welcome letter.
• Create password.
• If you have any questions or concerns, contact ThrivePass:
» Phone – 866-855-2844
» Email – tpa@thrivepass.com
$3,400
$7,500 (filing jointly or head of household)
$3,750 (married and filing separate tax returns)
Saves on eligible expenses not covered by insurance, reduces your taxable income
Reduces your taxable income
Easily access your Health Care FSA on your smartphone or tablet with the ThrivePass mobile app. Search for ThrivePass in your mobile device’s app store and download as you would any other app.
• View Accounts – See detailed account and balance information.
• Card Activity – View debit card activity.
• SnapClaim – File a claim and upload receipt photos directly from your smartphone.
• Manage Subscriptions – Set up email notifications to keep up-to-date on all account and Health Care FSA debit card activity. Log in using the same username and password you use to log in to the ThrivePass portal.
List of Qualified HSA and FSA Expenses
The products and services listed below are examples of medical expenses eligible for payment using your Health Savings Account and Flexible Spending Account. This list is not all-inclusive; additional expenses may qualify, and the items listed are subject to change in accordance with IRS regulations. Please refer to IRS Publication 502 Medical and Dental Expenses at www.irs.gov for a complete description of eligible medical and dental expenses.
Dental
• Dental X-rays
• Dentures and bridges
• Exams and teeth cleaning
• Extractions and fillings
• Oral surgery
• Orthodontia
• Periodontal services Eyes
• Eye exams
• Eyeglasses and contact lenses
• Laser eye surgeries
• Prescription sunglasses
• Radial keratotomy Hearing
• Hearing aids and batteries
• Hearing exams
Lab Exams/Tests
• Blood and metabolism tests
• Body scans
• Cardiograms
• Laboratory fees
• X-rays
Medications
• Insulin
• Prescription drugs
• Medical equipment/ supplies
• Air purification equipment
• Arches and orthotic inserts
• Contraceptive devices
• Crutches, walkers, and wheelchairs
• Exercise equipment
• Hospital beds
• Mattresses
• Medic alert bracelet or necklace
• Nebulizers
• Orthopedic shoes
• Oxygen
• Post-mastectomy clothing
• Prosthetics
• Syringes
Medical Procedures/ Services
• Acupuncture
• Alcohol and drug/ substance abuse
• Ambulance
• Fertility enhancement and treatment
• Hair loss treatment
• Hospital services
• Immunization
• In vitro fertilization
• Physical examination
• Service animals
• Sterilization/sterilization reversal
• Transplants (to include donor)
• Transportation
Obstetrics
• Lamaze class
• OB/GYN exams
• OB/GYN maternity fees
• Pre- and postnatal
Practitioners
• Allergist
• Chiropractor
• Christian Science practitioner
• Dermatologist
• Homeopath
• Naturopath
• Optometrist
• Osteopath
• Physician
• Psychiatrist or psychologist Therapy
• Alcohol and drug addiction
• Counseling
• Exercise programs
• Hypnosis
• Massage (medically necessary)
• Occupational
• Physical
• Smoking cessation programs
• Speech
Life and AD&D Insurance
FOR FINANCIAL SECURITY AFTER DEATH OR LOSS
Life and Accidental Death and Dismemberment (AD&D) insurance through Mutual of Omaha are important to your financial security, especially if others depend on you for support or vice versa. With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies). Life and AD&D coverage amounts reduce to 65% at age 65, and 50% at age 70.
Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at one times your annual salary, up to a maximum of $500,000 for each benefit.
Voluntary Life and AD&D
If you need more coverage than Basic Life and AD&D, you may buy Voluntary Life and AD&D for yourself and your dependent(s). If you do not elect Voluntary Life and AD&D insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health. You must elect Voluntary Life and AD&D coverage for yourself before covering your spouse and/or child(ren).
Employee
• Increments of $10,000 up to the lesser of five times your annual salary or $500,000
• Guaranteed issue: $100,000 Spouse
Designating a Beneficiary
A beneficiary is the person or entity you elect 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 anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
• Increments of $5,000 up to $250,000 (not exceeding 100% of associate amount)
• Guaranteed issue: $30,000
Child(ren)
• Increments of $1,000 up to $10,000
• All amounts are guaranteed
What is Guaranteed Issue and Evidence of Insurability?
Guaranteed issue is the amount of insurance applied for without answering any health questions (or which does not require evidence of insurability).
Guaranteed issue is available to new hires only. For new hires, coverage amounts over the Guaranteed Issue Amount will require a health application/evidence of insurability. For late entrants, all coverage amounts will require a health application/evidence of insurability.
Evidence of Insurability — or proof of good health — may be required if you are a late entrant and/or your request any additional coverage above your guarantee issue amount.
Evidence of Insurability
Visit www.mutualofomaha.com/eoi/#/home to submit your evidence of insurability to Mutual of Omaha. You will need your group number available, which is G000CGDN
Conversion – Portability – Waiver of Premium
Upon termination of employment, you have the option to continue your company-paid Life and AD&D insurance and pay premiums directly to Mutual of Omaha. Your company-paid Life and AD&D insurance may be converted to an individual policy. Portability is available for Life coverage if you are enrolled in additional Life coverage. Portability is not available for AD&D. If you are disabled at the time your employment is terminated, you may be eligible for a Waiver of Premium while you are disabled. Contact the People Department for a Conversion, Portability, or Waiver of Premium application.
Disability Insurance
FOR WHEN YOU CANNOT WORK DUE TO ACCIDENT OR ILLNESS
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. We provide Short Term Disability (STD) and Long Term Disability (LTD) for you to purchase through Mutual of Omaha.
Voluntary Short Term Disability
STD coverage pays a percentage of your weekly salary if you are temporarily disabled and unable to work due to an illness, pregnancy, or non-work-related injury. STD benefits are not payable if the disability is due to a job-related injury or illness. If a medical condition is job-related, it is considered Workers’ Compensation, not STD.
Short Term Disability may cover a variety of conditions and injuries, including:
• Maternity • Musculoskeletal • Mental health
Voluntary Long Term Disability
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for more than 90 days. Benefits begin at the end of an elimination period and continue while you are disabled up to Social Security Normal Retirement Age (SSNRA).
1
Evidence of Insurability
Visit www.mutualofomaha.com/eoi/#/home to submit your evidence of insurability to Mutual of Omaha . You will need your group number available, which is listed in Paycom
LTD Rate and Premium Calculation (Monthly)
California Associates
As a California employee, you have state-mandated disability insurance provided by the state at no cost to you . The state disability plan will pay primary and will offset/reduce the benefit from Mutual of Omaha.
Claims Support
Mutual of Omaha makes filing all types of claims easier for you. File claims 24/7/365 in a way that works best for you. Call 800-775-1000 or file online at www.mutualofomaha.com/support .
Supplemental Benefits
Accident Insurance
Accident insurance provides affordable protection against a sudden, unforeseen accident. The Accident plan helps offset the direct and indirect expenses resulting from an accident such as copayments, deductibles, ambulance, physical therapy, childcare, rent, and other costs not covered by traditional health plans. See the plan document for full details.
Insurance
•
Critical Illness Insurance
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. See the plan document for full details.
Critical Illness Insurance
• Increments of 5,000 up to $50,000
• Guaranteed issue $40,000
• Increments of $1,000 up to $50,000 (not exceeding 100% of employee’s CI principal sum)
• Guaranteed issue $40,000 Children
• 50% of employee’s CI principal sum, up to $10,000
1 Percentage of benefit paid for dismemberment is dependent on type of loss.
Claims Support
Mutual of Omaha makes filing all types of claims easier for you. File claims 24/7/365 in a way that works best for you. Call 800-775-1000 or file online at www.mutualofomaha.com/support
Designating a Beneficiary
A beneficiary is the person or entity you elect 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 anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
ID Theft
Allstate Identity Protection gives you powerful tools to defend against identity theft, fraud, and online threats, helping protect your finances, your privacy, and your peace of mind.
With Allstate Identity Protection, you get:
• Comprehensive Coverage: Identity, privacy, and device protection combined in one plan.
• Family Protection: Includes your spouse, children, elderly parents, and even in-laws.
• Device Security : Protect up to 10 devices per household from online threats.
• 24/7 Fraud Restoration: Work one-on-one with certified Restoration Specialists to recover your identity and financial accounts.
• Educational Tools: Get alerts, personalized risk tips, and insights through your Allstate Digital Footprint® and Identity Health Status.
• Elder Fraud and Child Safety Support : Monitor seniors and children for scams, cyberbullying, and social media risks.
• Award-winning Service: 96% post-restoration satisfaction and Best-in-Class identity protection.
If fraud occurs, Allstate handles the details, restoring your identity, reimbursing expenses up to $1 million, and providing step-by-step updates through your Fraud Resolution Tracker.
Visit www.allstateidentityprotection.com
Pet Partners
You may buy PetPartners medical insurance for your pet(s) with after-tax payroll deductions.
The My Pet Protection (MPP) plan covers cats and dogs only. The MPP plan offers a choice of reimbursement options (80%) so you can find coverage that best fits your budget. All plans have a $300 deductible and $5,000 maximum annual benefit.
See any veterinary professional for care and get discounts for multiple pets. Coverage includes:
• Accidents
• Illnesses
• Surgeries and hospitalization
• Hereditary and congenital conditions
• Cancer
• Dental diseases
• Behavioral treatments
• Therapeutic diets
• And more
Every policy includes 24/7 access to veterinary experts by phone, chat, and email, and unlimited help for general to urgent care needs via VetHelpline. PetRXExpress is also included to save money on your pet’s prescriptions. Preexisting conditions are not covered.
How To Enroll
You may enroll for pet coverage anytime during the year. Once registered and logged in, you can access deductible, limits, and more within the portal.
Per-Pay-Period Cost (26 deductions)
Visit https://portal.independenceamerican.com
Call 800-956-2495
Email mypolicy@petpartners.com
Accidents, including poisonings and allergic reactions
Injuries, including cuts, sprains, and broken bones
Common illnesses, including ear infections, vomiting, and diarrhea
Serious/chronic illnesses, including cancer and diabetes
Hereditary and congenital conditions
Surgeries and hospitalization
X-rays, MRIs, and CT scans
Prescription medications and therapeutic diets
Wellness exams
Vaccinations
Spay/neuter
Flea and tick prevention
Heart worm testing and prevention
Routine blood tests
Retirement Plan
A 401(k) plan can be a powerful tool to help you be financially secure in retirement. Our 401(k) plan through Empower Retirement can help you reach your investment goals.
How the Retirement Plan Works
You are eligible to participate in the plan if you are 18 years of age and have 60 days of service with the company. You may contribute up to the IRS limit.
You decide how much you want to contribute and can change your contribution amount anytime. All changes are effective as soon as administratively feasible and remain in effect until you update or stop your contributions. You also decide how to invest the assets in your account and may change your investment choices anytime. For more details, refer to your 401(k) Enrollment Guide or contact Empower Retirement at 877-778-2100.
Enrollment
You must enroll through Empower Retirement at www.empowermyretirement.com or by calling 877-778-2100.
• Log on and select Register.
• Choose the I do not have a PIN tab.
• Follow the prompts to create your username and password.
Vesting
You are always 100% vested in your own contributions. You are 100% vested in matching company contributions after six years of service.
Vesting Schedule
<2 years of service – 0%
2-3 years of service – 20%
3-4 years of service – 40%
4-5 years of service – 60%
5-6 years of service – 80%
6 years or more of service – 100%
Investment Options
You may direct your contributions to any of the investments offered within the company 401(k) plan. Changes to your investments can be made by calling 800-338-4015 or visiting www.empowermyretirement.com .
2026 IRS Contribution Limits
• $24,500
• $8,000 additional contribution if age 50 or older
Legal Protection
FOR ADDITIONAL PEACE OF MIND
Legal Services
LegalShield is a group legal services plan providing a low cost benefit designed to make legal services available and affordable to you when the need arises. Plan benefits emphasize preventive legal care to help keep minor legal problems from becoming serious or financially devastating. This plan offers assistance with a wide range of legal matters covering everyday situations when legal advice is helpful.
Assistance includes:
Preventive Legal Services
• Telephone consultations on unlimited personal matters
• Legal correspondence or phone call per subject matter on member’s behalf
• Legal document review
• 25% discount on will preparation with yearly updates
Motor Vehicle Legal Services
• Moving violation representation
• Defense of criminal charges
• Driver’s license services
• Personal injury collection assistance
Identity Theft Shield
Identity theft victims spend countless hours and an average of $1,200 in the quest to clear their names. With Identity Theft Shield , experienced professionals can assist if you or your spouse are a victim of identity theft.
Credit Report
After you enroll, you will receive an up-to-date credit report as well as a detailed analysis of your personal credit score.
Trial Defense Services
• Defense of civil actions and job-related criminal actions
• Pretrial and trial assistance
• Coverage increases each year
IRS Audit Legal Services
• Consultation
• Representation at audit
• Representation at trial
Preferred Member Discount
25% discount from the provider law firm’s standard hourly rate for legal services not otherwise covered by the plan, including pre-existing conditions.
Continuous Credit Monitoring
Your credit files will be regularly monitored and suspicious activity brought to your attention, providing you with early detection and the opportunity to question any discrepancies before your credit is damaged.
Identity Restoration
Restoring your name and credit can be overwhelming and costly. With Identity Theft Shield, a trained expert will take the steps to restore your name and credit for you.
If you wish to speak to a representative regarding plan benefits, call 800-654-7757
Additional Benefits
Mutual of Omaha provides the following programs and services at no cost to you.
Employee Assistance Program
The Employee Assistance Program (EAP) is a confidential program to help you find solutions for personal or workplace issues. Benefits for you and your eligible dependents include unlimited telephone access to EAP professionals and up to three face-to-face sessions with a counselor. Professionals are available 24/7 to help with the following:
• Stress or depression
• Financial issues
• Family and relationship issues
• Addiction
• Grief issues
• Parenting and eldercare
• Legal services
• Financial services
• Other personal concerns
For assistance, call 800-316-2796 or visit www.mutualofomaha.com/eap. More online resources are available on the website.
Worldwide Travel Assistance
AXA Assistance USA provides travel assistance for you and your dependents if you are traveling on any single trip more than 100 miles from home. Contact a representative to get trip planning assistance; translation, interpreter, or legal services; lost baggage assistance; emergency funds; document replacement; medical emergency help; and more. Services are available for business and personal travel.
For inquiries within the U.S.: 800-856-9947 Outside the U.S.: 312-935-3658
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: Barcel People Department
301 Northpoint Dr #100 Coppell, TX 75019 972-607-4500
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 Barcel 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. Barcel has determined that the prescription drug coverage offered by the Barcel 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. The HSA plan 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.
Legal Notices
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 Barcel 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 Barcel 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 People Department at 972-607-4500
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).
January 1, 2026 Barcel People Department 301 Northpoint Dr #100 Coppell, TX 75019 972-607-4500
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 Barcel, hereinafter referred to as the plan sponsor.
Legal Notices
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 People 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 People 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.
Barcel People Department
301 Northpoint Dr #100 Coppell, TX 75019
972-607-4500
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 1-877-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 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 1-866-444EBSA (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, 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 Barcel group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Barcel plan after you have left employment with the company. If you wish to elect COBRA coverage, contact your People Department for the applicable deadlines to elect coverage and pay the initial premium.
Plan Contact Information
Barcel People Department 301 Northpoint Dr #100 Coppell, TX 75019 972-607-4500
Legal Notices
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network 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-of-network 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 innetwork 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 in-network 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 outof-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, out-ofnetwork 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-of-network. 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 out-of-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 (cost-sharing) 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-ofnetwork 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.
This brochure highlights the main features of the Barcel employee benefits program. It does not include all plan rules, details, limitations, and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be an inconsistency between this brochure and the legal plan documents, the plan documents are the final authority. Barcel reserves the right to change or discontinue its employee benefits plans anytime.
