We are pleased to offer you a full benefits package. These benefits will help you and your family save money on your health care and stay healthy. Read this guide to learn about the benefits starting January 1, 2026. Each year during Open Enrollment, you can make changes to your benefit plans. The choices you make this year will stay in effect through December 31, 2026. Take time to review these benefits and pick the plans that best meet your needs. After Open Enrollment – during the rest of the year – you can only make changes to your benefits if you have a Qualifying Life Event.
Availability Of Summary Health Information
Your benefits program offers medical plan coverage options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage (SBC) available from Human Resources or at www.paycom.com. welcome!
why do i need insurance?
When you’re hurt or sick, the last thing you want to worry about is the doctor bill. Paying a little money from each paycheck for insurance can save you a lot of money at the hospital and doctor’s office. Having a smaller paycheck is no fun, but a huge medical bill you can’t pay is much worse. Insurance can help.
How Insurance Works
Insurance makes a way for a group of people to pool their money together. That way, if one person in the group has a large doctor or hospital bill, there’s always enough money to pay for it.
If you sign up for one of our benefit plans, Haven for Hope pays a large part of the cost for you You will pay a set rate from your paycheck.
PAYING A LITTLE NOW MEANS SAVING A LOT LATER The HMO Base Plan is FREE (Texas only) There is no fee for the medical HMO Base Plan. pay less
things to remember
Make sure you enroll in benefits.
Read this book and then go to www.paycom.com to sign up.
The HMO medical plan is FREE!
The HMO Base Plan has no regular fee to pay –it is free! So make sure at least to pick that plan. You can also choose one of the other plans. Just choose something. This plan is only in Texas.
The FSA can save you money!
Take the time to learn about the Flexible Spending Account (FSA). It can help you have more money on hand to spend on health care as well as child and eldercare. It is definitely worth it.
Questions? Call the Employee Response Center
Get healthy and earn points to spend.
Sign up for Well onTarget — the Blue Cross Blue Shield of Texas (BCBSTX) Wellness program — to get healthy and earn points to spend.
If you have questions about signing up or getting benefits, you can call the Employee Resource Center (ERC) at 844-643-HOPE (4673) or email havenforhopebenefits@higginbotham.net . They can help!
getting benefits
If you’re reading this book, you probably can get these benefits. Check below to see the rules for you and your family. Be sure to note when you need to sign up and when your benefits start.
new hire
Who Can Get Benefits
You can get benefits if you are a regular, full-time employee working an average of 30 hours per week.
When To Sign Up
Sign up by the deadline set by Human Resources
When Benefits Start
The first day of the month after the day you got hired
employee
Who Can Get Benefits
A regular, full-time employee working an average of 30 hours per week
When To Sign Up
You can sign up during Open Enrollment or when you have a Qualifying Life Event
When Benefits Start
• If you sign up at Open Enrollment: January 1
• If you have a Qualifying Life Event: Ask Human Resources
dependents
Who Can Get Benefits
• Your legal spouse
• Children under age 26 regardless of student, dependency, or marital status
• Children over age 26 who fully depend on you because of a mental or physical disability and who are listed as dependents on your federal tax return
When To Sign Up
Normally, you must sign up at Open Enrollment. You and your family must sign up together and be on the same plans.
The only time you can sign up outside Open Enrollment is if you have a Qualifying Life Event.
When Benefits Start
Based on 2026 effective dates
open enrollment
The normal time to sign up for benefits is during Open Enrollment. It happens every fall and lasts about two weeks.
YOUR OPEN ENROLLMENT DATES FOR 2025
December 1-14, 2025
After you sign up, your benefits start January 1, 2026.
Changing Health Plans Outside of Open Enrollment
You may only change coverage during the plan year if you have a Qualifying Life Event, such as:
Marriage
Divorce
Legal separation
Annulment
Death of a Spouse
Birth
Adoption/placement for adoption
Change in benefits eligibility
Death of a Child
FMLA event, 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 employment status affecting benefits
Significant change in cost of spouse’s coverage
You have 30 days from the event to notify Human Resources and complete your changes. You may need to provide documents to verify the change. If you miss the deadline, you will not be able to make changes. You may need to provide proof of the event. If you still have questions, ask Human Resources.
1
Start Enrollment
From the Notifications Center, tap the current year’s Benefits Enrollment, review the instructions, then tap Next.
2 Review Your Information
Check your personal details. Tap Edit to correct anything, then tap Next.
3 Answer Pre-Enrollment Questions
Complete the pre-enrollment questions and tap Next. 4
Update Dependents & Beneficiaries
Add or edit dependents and beneficiaries, then tap Next.
• Tap the blue link to edit.
• Tap the + to add someone new.
Make Your Elections
5
6
For each plan, choose to enroll or decline, then tap Next and continue through all benefit options.
Review & Finalize
Review your elections, sign where indicated, and tap Finalize to submit.
The BCBSTX medical plans can protect you and your family from major financial hardship if you get sick or hurt in an accident. You can pick one of these three plans:
HMO Base Plan (Texas only) PPO Mid Plan PPO Buy-up Plan
This plan is an HMO, with a $5,000 deductible for you if you stay in-network and a $15,000 deductible for you and your family if you stay in-network.
Health Maintenance Organization
This plan is a PPO, with a $3,000 deductible for you if you stay in-network and a $6,000 deductible for you and your family if you stay in-network.
With a Health Maintenance Organization (HMO) plan:
1. You must seek care from doctors and dentists in the Blue Essentials HMO network .
2. You must pick a main doctor (also called a “primary care physician”).
3. Your main doctor must give you a referral before you can see a specialist.
4. Always check first to see if your doctor or specialist is in-network .
5. Stay in-network. The HMO does not help you pay out-of-network medical costs.
This plan is a PPO, with a $2,000 deductible for you if you stay in-network and a $4,000 deductible for you and your family if you stay in-network.
Preferred Provider Organization
With a Preferred Provider Organization (PPO) plan:
1. You can see any doctor or dentist you want when you need care.
2. When you see BlueChoice PPO network doctors and dentists, you will pay less for care.
3. When you see a doctor out-of-network , you will pay more for care.
Words to Know
What is a deductible?
A deductible is what you have to pay for health care bills before your health insurance pays anything.
Example: If your deductible is $1,000, this means your plan does not pay anything until you meet your $1,000 deductible.
What is a copay?
A copay is the small, fixed price you have to pay for each health care service.
Example: You must pay a $25 copay before seeing your main doctor.
What is coinsurance?
Coinsurance is a percent (for example, 20%) that you have to pay for a health care service after you pay your deductible.
Example: If you go to the hospital, you may have to pay the rest of your deductible and then a 20% coinsurance of the rest of the bill.
free
PREVENTIVE CARE
Preventive care helps keep you healthy. All three BCBSTX medical plans give you free preventive care with in-network doctors. Preventive care can include office visits, lab work, screenings, and other services. Women, men, and children of all ages can get preventive care. Ask your doctor what preventive care services may be best for you and your family.
Nurseline
Call 800-581-0368 to talk right away with a registered nurse. Nurses can:
• Answer general health questions.
• Set up a doctor visit.
• Tell you where to go for quick help or emergencies.
You also can listen to more than 1,000 health topics in both English and Spanish.
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•
medical plan comparison
Which medical plan is right for me?
Look at these examples to see how each plan might play out for you.
• The Base HMO Plan is FREE !
• If you don’t plan on going to the doctor much, you will pay less overall.
• Your main doctor can help you save by keeping you in-network and managing your health care. You will need a referral to see a specialist.
Sonja and her three young children are all in good health and rarely go to the doctor other than annual physicals. She can save money when she does go to the Doctor with this free medical plan. But they can also feel secure that their main doctor is helping to manage costs and if someone does get very sick or has an accident, they are covered.
• This plan has a lower deductible – $3,000 for one person and $6,000 for the family.
• Cost per paycheck payments are higher on this plan, but you might pay less out-of-pocket
• In-network doctor will cost less, but you can see any doctor you want.
Lilly has high blood pressure and gets frequent checkups at the doctor. She also takes a couple of regular medications. She pays a little out of her paycheck, but her payment is not as high as it could be. It works for her because she saves on her out-of-pocket costs and gets to see the doctors she wants to without asking for permission first.
• This plan has the lowest deductible – only $2,000 for one person and $4,000 for the family.
• Cost per paycheck payments are the highest on this plan, but you might pay the least out-of-pocket .
• In-network doctor will cost less, but you can see any doctor you want.
Michael has Type 2 diabetes and takes medication to help control his insulin levels. He also needs a diagnostic X-ray of his gallbladder. Michael expects to pay copays for his doctor visits and prescriptions and also coinsurance for his X-ray. Even though he will pay more each paycheck, this plan will help him save on all the out-of-pocket costs.
pharmacy coverage
If you are enrolled in a BCBSTX medical plan, your pharmacy coverage uses Prime Therapeutics
You can keep your prescription drug costs down if you:
• Fill your prescriptions at an in-network pharmacy
• Ask your doctor if a generic drug is an option
• Get up to a 90-day supply of covered drugs used regularly through Express Scripts
• Use the Accredo specialty pharmacy service for specialty drugs.
Pharmacy Websites and Apps
Go to www.myprime.com or www.bcbstx.com –or download the PrescriptionHub app or BCBSTX app – to:
• Find nearby network drug stores
• Look up drugs and costs
Home Delivery Pharmacy Service
Express Scripts is a convenient, cost-effective way to receive up to a 90-day supply of prescription drugs. Set up home delivery and have your prescriptions delivered right to where you are.
Ordering Options
• Online – Sign up at www.express-scripts.com/rx . You can also log in to www.myprime.com and follow the links to Express Scripts Pharmacy.
• Mobile – Download the Express Scripts app or the PrescriptionHub app.
• Phone – Call 833-715-0942 and have your member ID card and your Rx ready.
• Mail – Visit www.bcbstx.com and log in to Blue Access for Members (BAM). 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.
Home Delivery Refills
Refill dates are shown on each prescription label. You can choose to have Express Scripts Pharmacy remind you by phone or email when a refill is due. Choose the reminder option that best suits you.
Questions?
Visit www.bcbstx.com or call the phone number listed on your member ID card.
Specialty Pharmacy Services
If you have a chronic condition and give yourself your own medications, Accredo can help you with your specialty prescriptions. Accredo offers free home delivery, online delivery tracking, and 24/7 support with your specialty prescription order.
How to Order
1. Call 833-721-1619 to register. A representative will work with your doctor on the rest.
2. After you register, go to www.accredo.com or download the Accredo app.
3. Before your scheduled fill date, someone will contact you to:
» Confirm your drugs, dose and the delivery location.
» Check any prescription changes your doctor may have ordered.
» Talk about any changes in your condition or answer any questions about your health.
Specialty Pharmacy Support
Accredo gives one-on-one counseling to help you with your treatment goals, manage any side effects, help you stick to your regimen, and monitor your progress. They can also help with any financial or insurance concerns you may have. Visit www.accredo.com or call 833-721-1619.
Help with Prescriptions
The BCBSTX Pharmacy Care Management team reviews prescription claims. If they think a drug you’re using is complicated, they may call to talk you about:
• Harmful drug interactions
• Specific drug requirements
• Cost concerns
You don’t have to talk to them, but it is free and it will help you understand your prescriptions better.
Remember : Always ask your doctor about your prescriptions. If you have benefits questions, log in to www.bcbstx.com or call the number on the back of your ID card.
Your regular doctor may also offer telemedicine services during or after normal office hours. It is best to ask if this is available, so you know what your options are before you need care. But the cost for care may be different since you are not using an MDLIVE provider.
telemedicine
FOR CONVENIENT, 24/7 CARE
Your medical health plan offers telemedicine through MDLIVE. Meet anytime day or night with a board-certified doctor on your phone, tablet, or computer for FREE !
When to Use MDLIVE
Telemedicine doesn’t replace your main doctor, but it’s easier and cheaper when you need care and:
• Have a nonemergency and are thinking about going to an after-hours health care clinic, urgent care clinic, or emergency room for treatment.
• Are on a business trip, vacation, or away from home.
• Can’t see your main doctor.
Use telemedicine services for minor conditions such as:
• Sore throat
• Headache
• Stomachache
• Cold/Flu
• Mental health issues
• Allergies
• Fever
• Urinary tract infections
Speak with a licensed counselor, therapist or psychiatrist for support with virtual visits, available by appointment. Get virtual care for:
• Anxiety
• Depression
• Stress management
• Trauma and loss
• Relationship problems
Don’t use telemedicine for serious or life-threatening emergencies.
Registration is Easy
Sign up for MDLIVE so you can have it ready to meet with a doctor when and where you need it.
Visit www.mdlive.com/bcbstx
Call 888-680-8646
Text BCBSTX to 635-483 to chat with MDLIVE Health Assistant
Download the MDLIVE app
Note: When registering, your coverage provider is BCBSTX Virtual Visits
health care options
Becoming familiar with your options for medical care can save you time and money.
Nonemergency Care
Telemedicine
Get care by phone, online video, or mobile app no matter if you are home, work, or traveling; doctors can prescribe medicine.
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.
Generally includes evening, weekend, and holiday hours
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
Sore and strep throat
and strains
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.
medical plan resources
With BAM , you can:
• Check the status or history of a claim
• View or print Explanation of Benefits (EOB) statements
• Find a doctor or hospital in your plan’s network
• Find Spanish-speaking providers
• Request a new ID card – or print a temporary one
• See how much money you owe
• Get ID card info
• Find in-network doctors,
and drug stores with Provider Finder
wellness resources
If you are enrolled in a BCBSTX medical plan, take advantage of any of the following free programs to help manage or solve your health condition.
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.
Lose Weight
Wondr is a free 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. Enroll at https://wondrhealth.com/BCBSTX or get the Wondr app.
Manage Your Diabetes or Lower Your Blood Pressure
Omada helps with Type 2 diabetes as well as high blood pressure. Apply online at https://omadahealth.com/bcbstx
• Smart scale to see how habit changes impact your weight
• Professional coaches
• Engaging weekly lessons
• Supportive peer group
Teladoc helps track your blood sugar and blood pressure levels and develop healthier lifestyle habits. Visit www.teladochealth.com/go/well-bcbstx or call 800-835-2362 . Use registration code: WELL-BCBSTX .
• Blood glucose meter
• Unlimited strips and lancets
• Blood pressure monitor
• Tips, action plans, and one-on-one coaching
• Real-time support for out-of-range readings
Reduce Back and Joint Pain
Hinge Health can help your back and joint pain – 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 12week intensive phase, followed by an ongoing program that builds on what you have learned. Learn more and apply at www.hingehealth.com/bcbstx .
Get a FREE Blood Glucose Meter
BCBSTX is offering you a choice of a FREE blood glucose meter until December 31, 2026. Ask your doctor which meter is best for you, shop for the meter at your local drug store, and give them the info below:
• CONTOUR NEXT GEN or CONTOUR NEXT EZ glucose monitoring system
» RxBin #: 018844
» PCN #: 3F
» Group #: MGDCARE
» ID #: CNMC7246982
• LifeScan OneTouch Verio Reflect or Verio Flex Meter
» RxBin #: 601341
» PCN #: OHS
» Group #: OH6504201
» ID #: NOCHARGEMETR
Well onTarget
Want to get healthy and stay healthy? If you sign up for a medical plan, you can use the BCBSTX wellness program – Well onTarget . When you are healthy, you spend less on doctors and hospitals, you feel better, and you tend to live longer. The wellness program can help you set and reach your health goals.
Wellness Portal
Start here. The Wellness Portal connects you with the entire Wellness program – including a digital library with articles, podcasts and videos on health topics and over 30 challenges for conquering stress, sleep, physical activity, and more.
1. Go to www.bcbstx.com to sign up or log in.
2. Click the Wellness tab.
3. After you sign up, you can go directly to www.wellontarget.com
AlwaysOn
DOWNLOAD THE ALWAYSON APP TO CONNECT
Take your Health Assessment
Set personal health and wellness goals and track your progress
Take an online educational course
View your Blue Points balance
Track data synced from fitness devices and apps
Blue Points Program
Get Blue Points for getting healthy and staying healthy. Go to www.wellontarget.com to see all the things – DVDs, electronics, sporting goods, clothes and charity donations –you can buy with your points.
Blue Points Program
Points
10 points per day (up to 70 points per week)
55 points per day
250 points per month
300 points each week
1,000 points per quarter
2,500 points every six months
2,500 points
2,675 points
Activities
Track your progress toward your goals in the Wellness Portal
Track your progress using a synced fitness device or app
Completing any selfmanagement program progress check-ins
Adding weekly fitness program gym visits to your routine
Complete a self-management program
Complete your Health Assessment
Enroll in the Fitness Program
Connect a compatible fitness device to the portal
questions
Call 877-806-9380 with questions about the Well onTarget wellness program.
Health Assessment
Take the Health Assessment and earn 2,500 points. You will answer questions about diet, physical activity, tobacco use, emotional health, and health at work and on the road. You can complete it all at once or over time.
Health Assessment Steps
1. Answer personalized questions – You will begin by answering a few basic questions, and then more detailed questions based on your answers.
2. Get a wellness report – The report will show you how you are doing and give you healthy tips. You can even print a report to share with your doctor.
3. Start you personalized wellness program – Your answers will help tailor the wellness programs to reach your health goals. You can check your progress and earn Blue Points
Log in at www.wellontarget.com and click Start in the Health Assessment box.
Digital Self-Management Programs
Get easy-to-learn tips and resources. Choose between educational content and six-week interactive programs that focus on health conditions and how to improve them. Earn 1,000 Blue Point s every three months for completing a program. Visit www.wellontarget.com or use the AlwaysOn app to get started.
Fitness Program
Get a discounted gym membership for you and your family (ages 16 and older) from a nationwide network of 9,000 fitness locations.
• $25 per month per member — with a one-time enrollment fee of $25 per member.
• No long-term contract — membership is month to month.
• Get 2,500 Blue points for joining — and more points for weekly visits.
• Get discounts — on massage therapists, personal trainers, nutrition counselors, and more.
Digital Home Fitness is also available if you prefer to work out at home. Access thousands of digital fitness videos and live classes such as cardio, boot camp, barre, and more.
• Log in to www.bcbstx.com and select Fitness Program, then Enroll Now
• Call 888-762-2583 (BLUE).
Wellness Coaching
You can get one-one-one coaching from health experts – including dietitians, nurses, and personal trainers – to help you set and achieve your goals. Message or call a coach from www.wellontarget.com or the AlwaysOn app Coaches can:
• Help you quit tobacco or stay tobacco free.
• Help you improve your physical fitness, nutrition, blood pressure, or cholesterol.
• Put you in touch with a registered dietitian.
• Share ideas for making healthy eating choices.
• Design a health and wellness plan that’s right for you.
Tools and Trackers
Get integrated trackers can help you monitor your health and well-being. You can sync them to popular healthtracking apps and wearable devices. Trackers include:
• Stress
• Oral health
• Weight
• Blood pressure
• Tobacco use
• Cholesterol
• Water intake
• Physical activity
• Sleep
• Nutrition
emotional and mental health care
Our medical plans cover mental health. Get help with mental health concerns including:
• Alcohol and drug use issues
• Anger management
• Anxiety
• Bipolar disorder
• Depression
• Domestic violence
• Grief
• Post-traumatic stress disorder (PTSD)
• Schizophrenia and schizoaffective disorder
• Suicidal thinking
• Stress
Start with Your Main Doctor
Talk about your mental health with your doctor. Your doctor can help you make a plan to get the help you need and find a specialist near you. You will pay the same as you do for your other doctor and specialists visits.
Mental Health Counseling
A counselor can talk with you to help solve a problem over one – or several visits.
Substance Use Counseling
Substance use counselors help people who suffer from addiction to alcohol or drugs.
Psychiatric Therapy
A psychiatrist is a medical doctor who can diagnose mental health disorders and prescribe medications.
Find a Mental Health Provider
Sign up for MDLIVE so you can have it ready to meet with a doctor when and where you need it.
Visit www.bcbstx.com
Call 800-521-2227
Download the BCBSTX app
FREE Digital Mental Health
Get free online help dealing with, stress, worry, depression, insomnia, social anxiety, substance use, panic, and resiliency. Learn to Live’s online program helps you break through bad thinking patterns with:
• Quick and easy lessons
• One-on-one coaching
To sign up, go to www.bcbstx.com, click Wellness and then Digital Mental Health. Or, tap Digital Mental Health in the BCBSTX App. You can also register minors (ages 13-17).
FREE Telemedicine for Mental Health
Schedule a free video or phone visit with a board-certified therapist or psychiatrist with MDLIVE
• Visit www.mdlive.com/bcbstx
• Call 888-680-8646
• Download the MDLIVE app
FREE Counseling with the Employee Assistance Program
Talk to a counselor in person or by phone 24/7 for free with the programs below.
Alliance Work Partners
Get six free counseling sessions per problem per year. Call 800-343-3822 or 800-334-TEEN (8336). Or visit www.awpnow.com select Access Your Benefits . Use code AWP-HFH-3953
maternity benefits
Our medical plans cover pregnancy and maternity care including lab tests, sonograms, delivery, hospital stay, and more.
FREE Services and Screenings
Preventive check-ups and screenings – before and after birth – can help find illnesses and medical problems early and help keep you and your baby healthy. There’s no copay, deductible or coinsurance, even if your deductible or out-of-pocket maximum hasn’t been met.
Ask your doctor what free screenings are available and best for you.
Maternity Support
Special Beginnings supports you from early pregnancy until six weeks after delivery, including:
• Online prenatal classes
• Service Coordinator before and after your baby is born
• 24 Hour Nurse Advice Line: 844-971-8906
It is free, easy, and confidential.
Call 888-421-7781 to enroll or get more details
FREE Breast Pumps and Supplies
Our medical plans cover a free manual or electric breast pump (one per pregnancy), along with free supplies, including breast milk storage supplies.
1. Ask your doctor for a prescription for a breast pump.
2. Call the number on your ID card to learn how and where to rent or buy a pump in network.
• Manual Breast Pumps (to buy)
• Electric Breast Pumps (to buy)
• Medical Grade Breast Pumps (to rent)
3. You may have to pay first and then submit a claim to BCBSTX with the prescription and receipt.
Need Breast Pump Supplies?
If your pump needs a part replaced, most breastfeeding pump supplies are also free. Call the number on your member ID card to ask for what you need.
Need Free Breastfeeding Counseling or Support?
1. Talk to your doctor or other provider if you have questions.
2. Make sure the doctor or other provider offering counseling and support is in network.
3. Set up an appointment.
FOR YOUR PEARLY WHITES
Did you know that when you get regular dental checkups you can spot other health problems, too?
The BCBSTX Dental PPO offers preventive, basic, and major dental care to help keep you smiling and healthy.
You can see any dental provider for care, but you’ll pay less and get the best care when you see dentists in the BlueCare Dental PPO network. You may pay more for care if you see dentists out of the network.
Regular dental checkups and cleanings can save you from a lot of pain.
• Get rid of plaque and tartar
• Stop cavities and gum disease
• Let your dentist check for any major problems
• Fix problems sooner
• Prevent future visits to the dentist
GET YOUR TEETH CHECKED AND CLEANED EVERY six months
Find an In-Network Dentist
Search for a dentist in the BlueCare Dental PPO network:
2 Payment for covered services received from an out-of-network dentist is based on the 90th percentile of UCR.
Additional Dental Benefit
Do you have heart disease or diabetes – or are you pregnant – and need extra dental work? Pick one of the following services in addition to your regular dental benefits:
vision plan comparison
Lenses
• Single Vision
• Bifocal
• Trifocal
•
Add on to bifocal copay
• Tier I
• Tier II
• Tier III
• Tier IV
Lenses
In lieu of eyeglasses
• Standard Fitting and Evaluation
• Elective
Get additional discounts!
• 20% off any remaining frame balance
• 15% off any remaining conventional contact lens balance
Save on other items!
• 40% off additional pairs of glasses
• 20% off non-prescription sunglasses and other accessories
• 15% off the standard price or 5% off any sale price of LASIK or PRK services
flexible spending accounts
Why do I need a Flexible Spending Account?
Eye glasses, cavity fillings, prescription drugs, and other medical costs — all these can get expensive. An FSA can help you pay for them. If you put a little money from each paycheck into your FSA, you get two big benefits.
use the funds now
You can use all your FSA money you are going to pay through the whole year right away to pay for health care costs. It’s like having a credit card with no interest!
pay less in taxes
The money that goes in your FSA gets taken out before taxes. This means you get fewer taxes taken from your salary – putting more money in your pocket!
Types of FSAs
Haven for Hope offers two different FSAs. Higginbotham manages both.
health care
helps pay for most medical, dental, and eye care costs
How to Check on Your FSAs
Go online or use the mobile app to:
• See how much money you have in your FSA.
• File or check on a claim.
• Send in your receipts and get paid back.
• Check what you can buy.
• Set up email notifications.
Use it or lose it!
You need to use your FSA money by the end of the year – December 31, 2026.
• Health Care FSA: You can carry over up to $680 into the new year – no more.
dependent care
helps pay for child and eldercare costs like daycare and after-school programs
Online
• Go to the Higginbotham Portal at https://flexservices. higginbotham.net
• Enter your Employee ID, which is your Social Security number with no dashes or spaces.
• Follow the prompts to navigate the site.
Mobile App
• Dependent Care FSA: You cannot carry over anything. Use it or lose it.
Need to file a 2026 claim in 2027?
You can still file claims from the 2026 plan year for another 90 days (up until April 1, 2027).
Questions?
Call 866-419-3519
• Download the Higginbotham Flex Mobile App at Google Play or the Apple Store.
• Log in using the same username and password you use to log in to the Higginbotham Portal. Note: You must register on the Higginbotham Portal to use the mobile app.
GET PAID BACK BY YOUR FSA
To get paid back from your FSAs, save your receipts and upload them:
• Online in the Higginbotham Portal (above) or
• On the Higginbotham Flex Mobile App.
You can also email or fax your receipts to:
Email flexclaims@higginbotham.net
Fax 866-419-3516
health care
flexible spending account
The Health Care FSA helps pay for most medical, dental, and eye care costs. You can use it to help pay for doctor’s visits. You can also use it to buy eyeglasses, over-the-counter medicine, and more.
Decide how much money to put into your Health Care FSA. You can put in up to $3,400 each plan year. The money will be taken out of each of your paychecks.
How much can I put in?
• $3,400
What can I buy?
• Breast pumps
• Chiropractor visits
• Dental work and braces
• Doctor and hospital visits
• Drug and alcohol addiction help
• Eyeglasses
• Hearing aids and batteries
• Insulin
• Prescription drugs
• Therapy
• Wheelchair or crutches
• Vaccines
Go to www.irs.gov for a full list.
What can’t I buy?
• CBD products
• Vitamins (unless they’re prenatal)
• Cosmetic surgery
Use the money as soon as you want. You don’t have to wait.
Choose how to pay with your FSA. You have two choices:
• Use your Health Care FSA debit card.
• Pay cash and send in your receipts to get paid back with your FSA money.
HOW TO USE YOUR FUNDS
Use the Health Care FSA Debit Card
The Higginbotham Benefits Debit Card works like a regular debit card — but it’s tied to your Health Care FSA account . You can use this debit card to pay for approved health care costs. When you use the card, you don’t have to file a claim for reimbursement.
Keep your receipts
You must send in your receipts — or an Explanation of Benefits — for most things you buy with your card. If you don’t send in your receipts, you’ll get a “request for substantiation,” asking for them. After that, you’ll have 60 days to send in the receipts or else your card will stop working. Note: You don’t have to send in receipts for copays.
Your card will expire
Check the expiration date on your card to see when you need to order a new card.
Note: You can’t use this card for dependent care expenses.
dependent care flexible spending account
The Dependent Care FSA helps pay for child care and eldercare costs while you and your spouse work or go to school full time. It can also help pay for the care of a family members of any age who spend at least eight hours a day in your home and can’t take care of themselves.
Decide how much money to put in your Dependent Care FSA. Part of that money will come out of each paycheck over the year.
How much can I put in?
• $7,500 if filing jointly or as head of household
• $3,750 if married and filing separate tax returns
What can I buy?
• Adult daycare center
• Babysitting that’s work related
• Before- or afterschool program
• Child care
• Day camp
Go to www.irs.gov for a full list.
What can’t I buy?
• Activity fees
• Childcare or eldercare that’s not work related
• Babysitting for your own children
• Dance lessons
• Day nursing care
Use the money that’s in your Dependent Care FSA right now — no more.
Submit your receipts to get reimbursed. Note: You cannot use the debit card for dependent care. Use the money as soon as you want. You don’t have to wait.
Use Cash and Get Paid Back
You can only get reimbursed for what is in your Dependent Care FSA right now
To be able to get paid back, you (and your spouse, if married) must be gainfully employed, looking for work, a full-time student, or not able to take care of yourself.
You cannot get reimbursed for overnight camps.
This FSA only pays for the following dependents:
• Children under age 13.
• A spouse or anyone who depends on you and who spends at least eight hours a day in your home and is mentally or physically not able to take care of themselves.
• The caretaker you hire cannot be your child under age 19 or anyone you claim as a dependent on your income taxes.
abbreviated list of qualified FSA expenses
The products and services listed below are examples of medical expenses eligible for payment under your Health Care FSA. 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.
• Abdominal supports
• Acupuncture
• Air conditioner (when necessary for relief from difficulty in breathing)
• Alcoholism treatment
• Ambulance
• Anesthetist
• Arch supports
• Artificial limbs
• Autoette (when used for relief of sickness/disability)
• Blood tests
• Blood transfusions
• Braces
• Cardiographs
• Chiropractor
• Contact lenses
• Convalescent home (for medical treatment only)
• Crutches
• Dental treatment
• Dental X-rays
• Dentures
• Dermatologist
• Diagnostic fees
• Diathermy
• Drug addiction therapy
• Drugs (prescription)
• Elastic hosiery (prescription)
• Eyeglasses
• Fees paid to health institute prescribed by a doctor
• FICA and FUTA tax paid for medical care service
• Fluoridation unit
• Guide dog
• Gum treatment
• Gynecologist
• Healing services
• Hearing aids and batteries
• Hospital bills
• Hydrotherapy
• Insulin treatment
• Lab tests
• Lead paint removal
• Legal fees
• Lodging (away from home for outpatient care)
• Metabolism tests
• Neurologist
• Nursing (including board and meals)
• Obstetrician
• Operating room costs
• Ophthalmologist
• Optician
• Optometrist
• Oral surgery
• Organ transplant (including donor’s expenses)
• Orthopedic shoes
• Orthopedist
• Osteopath
• Oxygen and oxygen equipment
• Pediatrician
• Physician
• Physiotherapist
• Podiatrist
• Postnatal treatments
• Practical nurse for medical services
• Prenatal care
• Prescription medicines
• Psychiatrist
• Psychoanalyst
• Psychologist
• Psychotherapy
• Radium therapy
• Registered nurse
• Special school costs for the handicapped
• Spinal fluid test
• Splints
• Surgeon
• Telephone or TV equipment to assist the hard-of-hearing
• Therapy equipment
• Transportation expenses (relative to health care)
• Ultraviolet ray treatment
• Vaccines
• Vitamins (if prescribed)
• Wheelchair
• X-rays
life and ad&d
If your family depends on you, you need Life and Accidental Death and Dismemberment (AD&D) insurance through BCBSTX/ Dearborn, which can help pay off debts (e.g., car, home, bills, etc.) and protect your savings. AD&D insurance pays out money to you and your family if an accident causes bodily harm or loss (e.g., hand, foot, or eye). You or your loved ones get 100% of the AD&D benefit if your death occurs by accident.
Insurance We Buy For You
Basic Life and AD&D
Basic Life and AD&D insurance are free for you . You are automatically covered at $10,000 for each benefit.
Pick Who Gets the Money
You need to pick a beneficiary – someone who gets the money from your Life and AD&D insurance if something happens to you.
More than one person can be a beneficiary and get the money from your policy. Also, you can change your mind about who gets the money at any time. But if you name more than one person, you have to say how much each person will get (for example, 50% or 25%).
You Get Less as You Get Older
Your Life and AD&D insurance pays out less as you get older
• Age 65 – Amount reduces to 65%
• Age 70 – Amount reduces to 50%
Carry It With You
If you leave your job at Haven for Hope, you might be able to take your Life and AD&D insurance with you. Call BCBSTX to find out.
Insurance You Can Buy For Yourself
Voluntary Life and AD&D
You can buy more Life and AD&D insurance if you want. You may need to show proof of good health if:
• You do not buy Voluntary Life and AD&D insurance when you first get a chance
• You want to add to the insurance later
You must buy Life and AD&D insurance for yourself before you can buy any for your spouse or children.
You
• Buy $10,000 of insurance at a time up to $500,000 or 5 times your pay for the year
• New Hire: You can buy up to $200,000 without medical questions or exams
Your Spouse
• Buy $5,000 at a time up to $250,000, as long as it’s not more than the amount of insurance you buy for yourself
• New Hire: You can buy up to $50,000 for your spouse without medical questions or exams
Your Children
• 6 months to age 26 - Increments of $5,000 up to $20,000
• Birth to 6 months - $100
• New hire Guaranteed Issue $20,000
Age 26
1Spouse rate is based on employee’s age.
disability
FOR WHEN YOU CANNOT WORK DUE TO ACCIDENT OR ILLNESS
Disability insurance pays you part of your salary if you can’t work because of an accident or sickness that’s covered by your policy. We give you Short Term Disability (STD) and Long Term Disability (LTD) insurance for FREE through BCBSTX/Dearborn.
Short Term Disability
STD insurance pays you a percent of your weekly salary if you’re disabled from a sickness, pregnancy, or non-workrelated injury and can’t work for a little while. You don’t get STD benefits if your disability is from getting hurt or sick at work. If a medical condition is job-related, it’s considered workers’ compensation, not STD.
Short Term Disability Benefits
Long Term Disability
LTD insurance pays you a percent of your monthly salary for a covered disability or injury that keeps you from work for more than 90 days. Your benefits will start at the end of an elimination period and keep going while you’re disabled until you reach the Social Security Normal Retirement Age (SSNRA).
Long Term Disability Benefits
Maximum
Pre-existing Condition Exclusion 3/122
1Social Security Normal Retirement Age
2Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months.
employee assistance program
FOR WHEN YOU NEED A HELPING HAND
The EAP from Alliance Work Partners and BCBSTX help you and family members cope with a variety of personal and work-related issues.
These programs provide confidential 24/7 counseling and support services at little or no cost to you to help with:
• Relationships
• Work-life balance
• Stress and anxiety
• Interpersonal skills
• Will preparation and estate resolution
Alliance Work Partners
Get six free counseling sessions per problem per year.
Visit www.awpnow.com and select Access Your Benefits. Use code AWP-HFH-3953
Call 800-343-3822 or 800-334-TEEN ( 8336)
BCBSTX
Get three free calls per year (per household) with an in-house master’s level EAP professional.
Get a free emergency ride, if you feel you can’t drive yourself.
1. Call a local cab, UBER, Lyft, or other rideshare.
2. Get a ride up for to 50 miles.
3. Keep your receipt.
4. Mail in your receipt to AWP at www.awpnow.com.
5. Get paid back up to $50 for fares (but not extra fees) within 30 days.
additional benefits
The following discounts and services are available through your group benefits with Blue Cross Blue Shield of Texas (BCBSTX) at no extra cost to you.
Beneficiary Resource Services
Beneficiary Resource Services through Morneau Shepell provides wellness and security at the most difficult times.
Services for You and Your Family
• Online Will Preparation – Create a personalized will and keep your information safe and secure. Log in at www.beneficiaryresource.com and enter username beneficiary
• Online Funeral Planning – Download a funeral planning guide and access helpful information such as funeral cost comparisons, funeral requirements, and various religious customs.
Services for Your Beneficiaries
• Get unlimited phone contact for up to one year with a grief counselor, legal advisor, or financial planner.
• Up to five face-to-face working sessions can be split between different counselors. Counselors will initiate follow-up calls, when necessary, for up to one full year from the date of initial contact.
Call 800-769-9187 for details.
Worldwide Travel Assistance and Identity Theft
Get travel assistance from Generali Global Assistance if you are traveling more than 100 miles from home. Representatives can assist with trip planning and with a medical emergency while traveling. Other services include:
• Medical evacuation/return home
• Replacement of medication and eyeglasses
• Locating lost or stolen items
• Legal assistance/bail
• Interpreter/translation services
• Return of mortal remains
• And more
Services must be coordinated through Generali Global Assistance to be covered.
• Email medservices@assistamerica.com
• Call 800-872-1414 (Toll Free within the U.S.)
• Group Number: 01-AA-TRS-12201
Exclusive Hearing Aid Discounts
If you’re enrolled in BCBSTX vision coverage, you also receive special savings on hearing aids through Amplifon, the nation’s largest independent hearing discount network. Covered vision members receive:
• Up to 64% off retail pricing
• A wide selection of top hearing aid brands
• A 60-day risk-free trial, follow-up care
• Battery support
• A 3-year warranty for loss, damage, or repair
• Financing options may also be available for those who qualify. It’s an easy way to support both your vision and hearing health.
Visit www.eyemedvisioncare.com/bcbstx
employee perks and discounts
Haven for Hope offers a variety of employee perks designed to help you save on fitness, family activities, entertainment, apparel, and more. Explore the discounts below to make the most of your benefits.
Gold’s Gym
Stay active with exclusive discounted Gold’s Gym memberships for Haven for Hope employees — plus savings you can share with up to four household members. Enjoy strength training, group classes, and full-service wellness resources at participating locations.
You can join, update, or cancel anytime during the plan year, giving you total flexibility.
Per-Pay-Period Membership Rates
1Gym locations: Babcock, Bandera Trails, Bulverde, Crossroads, New Braunfels, Tezel, Culebra, Fiesta Trails, Goliad, Legacy Trails, Live Oak, Quarry, Valley Hi, Walzem, Alamo Heights, Rogers Ranch, Medical Center
2Gym locations: Alamo Heights, Roger’s Ranch
3Gym location: Medical Center
(Membership pricing subject to change per Gold’s Gym.)
YMCA Membership
Employees receive discounted YMCA memberships that cover up to two adults and dependent children (up to age 26) living in the same household (proof of residency required).
Enjoy access to fitness centers, pools, group classes, youth and family activities, and wellness programs—plus a convenient mobile app for schedules and workouts.
Per-Pay-Period Rate
• Employee: $17.50
• Family (2 adults + children up to 26): $35.00
Membership updates can be made at any time during the plan year.
Recognize: Employee Appreciation Platform
Recognition matters, and with Recognize, it’s easy to celebrate outstanding work, milestones, and everyday wins. Employees can send appreciation to coworkers at any time and earn points redeemable for gift cards or Haven for Hope swag.
Scan the app or web QR codes to get started.
Apparel Now – Haven for Hope Gear
Show your Haven pride! Visit the Apparel Now online store to shop branded shirts, jackets, vests, mugs, beanies, and more. Items are shipped directly to your home for fast, easy ordering.
Visit www.apparelnow.com/haven-for-hope-apparel
Working Advantage (Tickets at Work)
Enjoy exclusive employee discounts on entertainment, travel, theme parks, movie tickets, dining, events, electronics, and online shopping through Working Advantage.
Visit www.workingadvantage.com
Use company code: H4HPERKS App code Web code
Benefits Assistance
Higginbotham Employee Response Center
844-643-HOPE (4673)
email:
havenforhopebenefits@higginbotham.net
Medical
BCBSTX
800-521-2227
www.bcbstx.com
Telemedicine
BCBSTX/MDLIVE
888-680-8646
www.mdlive.com/bcbstx Dental
BCBSTX
877-442-4207
www.bcbstx.com Vision
BCBSTX
855-556-8796
www.member.eyemedvisioncare.com/bcbstx
Flexible Spending Accounts
Higginbotham 866-419-3519
https://flexservices.higginbotham.net Basic and Voluntary Life and AD&D
BCBSTX/Dearborn 800-521-2227
www.bcbstx.com Short and Long Term Disability
BCBSTX/Dearborn 800-521-2227
www.bcbstx.com
important 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:
Haven for Hope of Bexar County Human Resources
1 Haven for Hope Way San Antonio, TX 78207 human.resources@havenforhope.org
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 Haven for Hope of Bexar County 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. Haven for Hope of Bexar County has determined that the prescription drug coverage offered by the Haven for Hope of Bexar County 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 Haven for Hope of Bexar County 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 Haven for Hope of Bexar County 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 210-220-2150
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 (1-800-6334227). TTY users should call 877-4862048
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
Haven for Hope of Bexar County Human Resources
1 Haven for Hope Way San Antonio, TX 78207 human.resources@havenforhope.org
Notice of HIPAA Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Effective Date of Notice: September 23, 2013
Haven for Hope of Bexar County’s Plan is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information and to inform you about:
1. the Plan’s uses and disclosures of Protected Health Information (PHI);
2. your privacy rights with respect to your PHI;
3. the Plan’s duties with respect to your PHI;
4. your right to file a complaint with the Plan and to the Secretary of the U.S. Department of Health and Human Services; and
5. the person or office to contact for further information about the Plan’s privacy practices.
The term “Protected Health Information” (PHI) includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form (oral, written, electronic).
Section 1 – Notice of PHI Uses and Disclosures
Required PHI Uses and Disclosures
Upon your request, the Plan is required to give you access to your PHI in order to inspect and copy it.
Use and disclosure of your PHI may be required by the Secretary of the Department of Health and Human Services to investigate or determine the Plan’s compliance with the privacy regulations. Uses and disclosures to carry out treatment, payment and health care operations.
The Plan and its business associates will use PHI without your authorization to carry out treatment, payment and health care operations. The Plan and its business associates (and any health insurers providing benefits to Plan participants) may also disclose the following to the Plan’s Board of Trustees: (1) PHI for purposes related to Plan administration (payment and health care operations); (2) summary health information for purposes of health or stop loss insurance underwriting or for purposes of modifying the Plan; and (3) enrollment information (whether an individual is eligible for benefits under the Plan). The Trustees have amended the Plan to protect your PHI as required by federal law.
Treatment is the provision, coordination or management of health care and related services. It also includes but is not limited to consultations and referrals between one or more of your providers.
For example, the Plan may disclose to a treating physician the name of your treating radiologist so that the physician may ask for your X-rays from the treating radiologist.
Payment includes but is not limited to actions to make coverage determinations and payment (including billing, claims processing, subrogation, reviews for medical necessity and appropriateness of care, utilization review and preauthorizations).
For example, the Plan may tell a treating doctor whether you are eligible for coverage or what percentage of the bill will be paid by the Plan.
Health care operations include but are not limited to quality assessment and improvement, reviewing competence or qualifications of health care professionals, underwriting, premium rating and other insurance activities relating to creating or renewing insurance contracts. It also includes case management, conducting or arranging for medical review, legal services and auditing functions including fraud and abuse compliance programs, business planning and development, business management and general administrative activities. However, no genetic information can be used or disclosed for underwriting purposes.
For example, the Plan may use information to project future benefit costs or audit the accuracy of its claims processing functions.
Uses and disclosures that require that you be given an opportunity to agree or disagree prior to the use or release.
Unless you object, the Plan may provide relevant portions of your protected health information to a family member, friend or other person you indicate is involved in your health care or in helping you receive payment for your health care. Also, if you are not capable of agreeing or objecting to these disclosures because of, for instance, an emergency situation, the Plan will disclose protected health information (as the Plan determines) in your best interest. After the emergency, the Plan will give you the opportunity to object to future disclosures to family and friends.
Uses and disclosures for which your consent, authorization or opportunity to object is not required.
The Plan is allowed to use and disclose your PHI without your authorization under the following circumstances:
1. For treatment, payment and health care operations.
2. Enrollment information can be provided to the Trustees.
3. Summary health information can be provided to the Trustees for the purposes designated above.
4. When required by law.
5. When permitted for purposes of public health activities, including when necessary to report product defects and to permit product recalls. PHI may
also be disclosed if you have been exposed to a communicable disease or are at risk of spreading a disease or condition, if required by law.
6. When required by law to report information about abuse, neglect or domestic violence to public authorities if there exists a reasonable belief that you may be a victim of abuse, neglect or domestic violence. In which case, the Plan will promptly inform you that such a disclosure has been or will be made unless that notice would cause a risk of serious harm. For the purpose of reporting child abuse or neglect, it is not necessary to inform the minor that such a disclosure has been or will be made. Disclosure may generally be made to the minor’s parents or other representatives although there may be circumstances under federal or state law when the parents or other representatives may not be given access to the minor’s PHI.
7. The Plan may disclose your PHI to a public health oversight agency for oversight activities required by law. This includes uses or disclosures in civil, administrative or criminal investigations; inspections; licensure or disciplinary actions (for example, to investigate complaints against providers); and other activities necessary for appropriate oversight of government benefit programs (for example, to investigate Medicare or Medicaid fraud).
8. The Plan may disclose your PHI when required for judicial or administrative proceedings. For example, your PHI may be disclosed in response to a subpoena or discovery request.
9. When required for law enforcement purposes, including for the purpose of identifying or locating a suspect, fugitive, material witness or missing person. Also, when disclosing information about an individual who is or is suspected to be a victim of a crime but only if the individual agrees to the disclosure or the Plan is unable to obtain the individual’s agreement because of emergency circumstances. Furthermore, the law enforcement official must represent that the information is not intended to be used against the individual, the
immediate law enforcement activity would be materially and adversely affected by waiting to obtain the individual’s agreement and disclosure is in the best interest of the individual as determined by the exercise of the Plan’s best judgment.
10. When required to be given to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as authorized by law. Also, disclosure is permitted to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent.
11. When consistent with applicable law and standards of ethical conduct if the Plan, in good faith, believes the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to a person reasonably able to prevent or lessen the threat, including the target of the threat.
12. When authorized by and to the extent necessary to comply with workers’ compensation or other similar programs established by law.
Except as otherwise indicated in this notice, uses and disclosures will be made only with your written authorization subject to your right to revoke such authorization.
Uses and disclosures that require your written authorization.
Other uses or disclosures of your protected health information not described above will only be made with your written authorization. For example, in general and subject to specific conditions, the Plan will not use or disclose your psychiatric notes; the Plan will not use or disclose your protected health information for marketing; and the Plan will not sell your protected health information, unless you provide a written authorization to do so. You may revoke written authorizations at any time, so long as the revocation is in writing. Once the Plan receives your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.
Section 2 – Rights of Individuals
Right to Request Restrictions on Uses and Disclosures of PHI
You may request the Plan to restrict the uses and disclosures of your PHI. However, the Plan is not required to agree to your request (except that the Plan must comply with your request to restrict a disclosure of your confidential information for payment or health care operations if you paid for the services to which the information relates in full, out of pocket).
You or your personal representative will be required to submit a written request to exercise this right. Such requests should be made to the Plan’s Privacy Official.
Right to Request Confidential Communications
The Plan will accommodate reasonable requests to receive communications of PHI by alternative means or at alternative locations if necessary to prevent a disclosure that could endanger you.
You or your personal representative will be required to submit a written request to exercise this right.
Such requests should be made to the Plan’s Privacy Official.
Right to Inspect and Copy PHI
You have a right to inspect and obtain a copy of your PHI contained in a “designated record set,” for as long as the Plan maintains the PHI. If the information you request is in an electronic designated record set, you may request that these records be transmitted electronically to yourself or a designated individual.
Protected Health Information (PHI)
Includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form.
Designated Record Set
Includes the medical records and billing records about individuals maintained by or for a covered health care provider; enrollment, payment, billing, claims adjudication and case or medical management record systems maintained by or for the Plan; or other information used in whole or in part by or for the Plan to make decisions about individuals. Information used for quality control or peer review analyses and not used to make decisions about individuals is not in the designated record set.
The requested information will be provided within 30 days if the information is maintained on site or within 60 days if the information is maintained off site. A single 30-day extension is allowed if the Plan is unable to comply with the deadline.
You or your personal representative will be required to submit a written request to request access to the PHI in your designated record set. Such requests should be made to the Plan’s Privacy Official.
If access is denied, you or your personal representative will be provided with a written denial, setting forth the basis for the denial, a description of how you may appeal the Plan’s decision and a description of how you may complain to the Secretary of the U.S. Department of Health and Human Services.
The Plan may charge a reasonable, costbased fee for copying records at your request.
Right to Amend PHI
You have the right to request the Plan to amend your PHI or a record about you in your designated record set for as long as the PHI is maintained in the designated record set.
The Plan has 60 days after the request is made to act on the request. A single 30-day extension is allowed if the Plan is unable to comply with the deadline. If the request is denied in whole or part, the Plan must provide you with a written denial that explains the basis for the denial. You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of your PHI.
Such requests should be made to the Plan’s Privacy Official.
You or your personal representative will be required to submit a written request to request amendment of the PHI in your designated record set.
Right to Receive an Accounting of PHI Disclosures
At your request, the Plan will also provide you an accounting of disclosures by the Plan of your PHI during the six years prior to the date of your request. However, such accounting will not include PHI disclosures made: (1) to carry out treatment, payment
or health care operations; (2) to individuals about their own PHI; (3) pursuant to your authorization; (4) prior to April 14, 2003; and (5) where otherwise permissible under the law and the Plan’s privacy practices. In addition, the Plan need not account for certain incidental disclosures.
If the accounting cannot be provided within 60 days, an additional 30 days is allowed if the individual is given a written statement of the reasons for the delay and the date by which the accounting will be provided.
If you request more than one accounting within a 12-month period, the Plan will charge a reasonable, cost-based fee for each subsequent accounting.
Such requests should be made to the Plan’s Privacy Official.
Right to Receive a Paper Copy of This Notice Upon Request
You have the right to obtain a paper copy of this Notice. Such requests should be made to the Plan’s Privacy Official.
A Note About Personal Representatives
You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your PHI or allowed to take any action for you. Proof of such authority may take one of the following forms:
1. a power of attorney for health care purposes;
2. a court order of appointment of the person as the conservator or guardian of the individual; or
3. an individual who is the parent of an unemancipated minor child may generally act as the child’s personal representative (subject to state law).
The Plan retains discretion to deny access to your PHI by a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect.
Section 3 – The Plan’s Duties
The Plan is required by law to maintain the privacy of PHI and to provide individuals (participants and beneficiaries) with notice of the Plan’s legal duties and privacy practices.
This Notice is effective September 23, 2013, and the Plan is required to comply with the terms of this Notice. However, the Plan reserves the right to change its privacy practices and to apply the changes to any PHI received or maintained by the Plan prior to that date. If a privacy practice is changed, a revised version of this Notice will be provided to all participants for whom the Plan still maintains PHI. The revised Notice will be distributed in the same manner as the initial Notice was provided or in any other permissible manner.
If the revised version of this Notice is posted, you will also receive a copy of the Notice or information about any material change and how to receive a copy of the Notice in the Plan’s next annual mailing. Otherwise, the revised version of this Notice will be distributed within 60 days of the effective date of any material change to the Plan’s policies regarding the uses or disclosures of PHI, the individual’s privacy rights, the duties of the Plan or other privacy practices stated in this Notice.
Minimum Necessary Standard
When using or disclosing PHI or when requesting PHI from another covered entity, the Plan will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations. When required by law, the Plan will restrict disclosures to the limited data set, or otherwise as necessary, to the minimum necessary information to accomplish the intended purpose.
However, the minimum necessary standard will not apply in the following situations:
1. disclosures to or requests by a health care provider for treatment;
2. uses or disclosures made to the individual;
3. disclosures made to the Secretary of the U.S. Department of Health and Human Services;
4. uses or disclosures that are required by law; and
5. uses or disclosures that are required for the Plan’s compliance with legal regulations.
De-Identified Information
This notice does not apply to information that has been de-identified. De-identified information is information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual.
Summary Health Information
The Plan may disclose “summary health information” to the Trustees for obtaining insurance premium bids or modifying, amending or terminating the Plan. “Summary health information” summarizes the claims history, claims expenses or type of claims experienced by participants and excludes identifying information in accordance with HIPAA.
Notification of Breach
The Plan is required by law to maintain the privacy of participants’ PHI and to provide individuals with notice of its legal duties and privacy practices. In the event of a breach of unsecured PHI, the Plan will notify affected individuals of the breach.
Section 4 – Your Right to File a Complaint With the Plan or the HHS Secretary
If you believe that your privacy rights have been violated, you may complain to the Plan. Such complaints should be made to the Plan’s Privacy Official.
You may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, D.C. 20201. The Plan will not retaliate against you for filing a complaint.
Section 5 – Whom to Contact at the Plan for More Information
If you have any questions regarding this notice or the subjects addressed in it, you may contact the Plan’s Privacy Official. Such questions should be directed to the Plan’s Privacy Official at:
Haven for Hope of Bexar County Human Resources
1 Haven for Hope Way San Antonio, TX 78207 human.resources@havenforhope.org 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 employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa. dol.gov or call 1-866-444-EBSA (3272)
If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums.
The following list of States is current as of July 31, 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 Haven for Hope of Bexar County group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Haven for Hope of Bexar County 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
Haven for Hope of Bexar County Human Resources 1 Haven for Hope Way San Antonio, TX 78207 human.resources@havenforhope.org
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 outof-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-ofpocket 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-ofnetwork provider.
You are protected from balance billing for:
• Emergency services – If you have an emergency medical condition and get emergency services from an out-ofnetwork 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 poststabilization services.
• Certain services at an in-network hospital or ambulatory surgical center – When you get services from an innetwork 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 innetwork facilities, out-of-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 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 outof-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 Haven for Hope 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. Haven for Hope reserves the right to change or discontinue its employee benefits plans anytime.
