2026
(Short plan year: February 1 – May 31, 2026)
Employee Benefits
Benefits Helpline with Higginbotham 866-419-3518
HELPFUL RESOURCES BENEFITS HELPLINE WITH HIGGINBOTHAM Call 866-419-3518 Employee benefits can be complicated and Higginbotham can help. Call the Benefits Helpline for help with: • Enrollment
• Claims or billing questions
• Benefits information
• Eligibility issues
Support is available Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you leave a voicemail after 3:00 p.m. CT, your call will be returned the next business day. You can also email helpline@higginbotham.net. Bilingual representatives are available.
FIND A PROVIDER AND REQUEST AN ID CARD • Online – www.bcbstx.com • Call – 800-521-2227 • Download – BCBSTX app • Policy Numbers • HDHP: 383754 • PPO: 383753
IMPORTANT CONTACTS COVERAGE
PROVIDER
POLICY #
WEBSITE/EMAIL
PHONE
Benefits/Enrollment
Higginbotham
N/A
helpline@higginbotham.net
866-419-3518
Medical/Pharmacy
Blue Cross Blue Shield of Texas
HDHP: 383754 PPO: 383753
www.bcbstx.com
800-521-2227 Pre-enrollment: 866-231-5581
MDLIVE
N/A
www.mdlive.com/bcbstx
888-680-8646
Health Reimbursement Arrangement
Higginbotham
N/A
https://flexservices.higginbotham.net
866-419-3519
Health Savings Account
Bank of America
N/A
https://myhealth.bankofamerica.com
800-718-6710
Flexible Spending Accounts
Higginbotham
N/A
https://flexservices.higginbotham.net
866-419-3519
Dental
Blue Cross Blue Shield of Texas
286209
www.bcbstx.com
800-521-2227
Vision
Blue Cross Blue Shield of Texas
F025331
www.eyemedvisioncare.com/bcbstxvis
855-556-8796
Disability, Life, AD&D, Accident, Critical Illness Insurance
Blue Cross Blue Shield of Texas
F025331
www.bcbstx.com/ancillary
877-442-4207
Transamerica
518081-00000
https://transamerica.com/portal
800-401-8726
Employee Assistance Program
ComPsych GuidanceResources
N/A
www.guidanceresources.com web ID: DLEAP
888-628-4844
Human Resources
Meritum Energy
N/A
hr@meritumenergy.com
210-876-3560
Telemedicine
401(k)
2 Meritum Energy Holdings
WELCOME We are pleased to offer you a comprehensive benefits package intended to protect your well-being and financial health. This guide is your opportunity to learn more about the benefits available to you and your eligible dependents beginning February 1, 2026. To get the best value from your benefits program, please take the time to evaluate your coverage options and determine which plans best meet the health care and financial needs of you and your family. By being a wise consumer, you can support your health and maximize your health care dollars. Each year during Open Enrollment, you have the opportunity to make changes to your benefit plans. The enrollment decisions you make this year will remain in effect through May 31, 2026. After Open Enrollment, you may make changes to your benefit elections only when you have a Qualifying Life Event. You will have 30 days to make your benefit elections and submit supporting documentation to Human Resources. If you do not make your changes during the 30-day period, your changes cannot be made until the next Open Enrollment period.
WHAT’S INSIDE Helpful Resources...................................... 2 Eligibility..................................................... 4 How to Enroll............................................. 5 Medical Coverage...................................... 6 Pharmacy Benefits..................................... 8 BCBSTX Resources..................................... 9 Telemedicine............................................ 10 Health Care Options................................ 11 Health Reimbursement Arrangement..... 12 Health Savings Account........................... 13 Flexible Spending Accounts..................... 14 Dental Coverage...................................... 16 Vision Coverage....................................... 17 Disability Insurance................................. 18 Life and AD&D Insurance......................... 19 Supplemental Insurance.......................... 20 Employee Contributions.......................... 22 Retirement Plan....................................... 23 Employee Assistance Program................ 24 Benefit Extras.......................................... 25 Important Notices................................... 26
See page 26 for important information concerning Medicare Part D coverage.
This plan year runs from February 1, 2026, through May 31, 2026. Open Enrollment for the new plan year – June 1, 2026 through May 31, 2027 – will be held prior to June 1, 2026.
2026 Employee Benefits 3
ELIGIBILITY You are eligible for benefits if you are a regular, full-time employee working an average of 30 hours per week. Your coverage is effective the first of the month after you have completed 30 days of full-time employment. You may also enroll eligible dependents for benefits coverage. The cost to you for dependent coverage depends on the number of dependents you enroll and the particular plans you choose. When covering dependents, you must select and be on the same plans.
ELIGIBLE DEPENDENTS INCLUDE • Your legal spouse or domestic partner • Children under the age of 26 regardless of student, dependency, or marital status • Children over the age of 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
QUALIFYING LIFE EVENTS Once you elect your benefit options, they remain in effect for the entire plan year until the following Open Enrollment. You may only change coverage during the plan year if you have a Qualifying Life Event, some of which include: • Marriage, divorce, legal separation, or annulment • Birth, adoption, or placement for adoption of an eligible child • Death of your spouse or child • Change in your spouse’s employment status that affects benefits eligibility • Change in your child’s eligibility for benefits • Significant change in benefit plan coverage for you, your spouse, or your child • FMLA leave, COBRA event, court judgment, or decree • Becoming eligible for Medicare, Medicaid, or TRICARE • Receiving a Qualified Medical Child Support Order If you have a Qualifying Life Event and want to change your elections, you must notify Human Resources and complete your changes within 30 days of the event. You may be asked to provide documentation to support the change. Contact Human Resources for details.
AVAILABILITY OF SUMMARY HEALTH INFORMATION Our employee benefits program offers two medical plan options. To help you make an informed choice and compare your options, a Summary of Benefits and Coverage (SBC) for each plan is available online in the Documents section of Paycom.
4 Meritum Energy Holdings
HOW TO ENROLL To enroll for or make changes to your benefits, visit www.paycom.com and log in. You must log in to select or modify your benefits or to decline coverage. • Select Employee. • Enter your username, password, and the last four digits of your Social Security number, and then select Login. • Select Benefit Enrollment under My Benefits. • Select Start Enrollment. • Update your personal information and add your dependents.
Note: Enrollment is passive. If you do not log in to make elections, your current benefits will automatically roll over for the short plan year (February 1–May 31, 2026). Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) do not roll over and require new elections.
NEED ENROLLMENT HELP?
• Make your benefit elections and click Enroll or Decline. • The Benefit Plan Selection Review screen will appear. Please review your benefit elections. Once you are satisfied with your elections, check Complete Enrollment, then confirm by clicking OK. • When you are ready to complete your enrollment, click Sign and Submit.
Contact the Higginbotham Benefit Helpline: • Call 866-419-3518 • Email helpline@higginbotham.net
HELPFUL APPS TO DOWNLOAD APP
APPLE APP STORE IPHONE/IPAD
GOOGLE PLAY ANDROID
Blue Cross Blue Shield of Texas Search for in-network providers and facilities, and see what procedures may cost. See claims details and access your ID card.
https://apps.apple.com/us/app/find-doctorsfind-provider/id573016251
https://play.google.com/store/ apps/details?id=com.hcsc.android. providerfindertx&hl=en_US
MDLIVE Access telemedicine services, including online medical consultations, recommendations, and prescription savings.
https://apps.apple.com/us/app/mdlive/ id839671393?ls=1
https://play.google.com/store/apps/ details?id=com.mdlive.mobile&hl=en_US
Higginbotham Check your account summary, available balances, claims requiring receipts, statements, and notifications.
https://apps.apple.com/us/app/higginbothamfsa/id1558901680
https://play.google.com/store/apps/ details?id=com.dpath.higg&hl=en_US
2026 Employee Benefits 5
MEDICAL COVERAGE The medical plan options through BCBSTX using the BlueChoice PPO network of providers are designed to protect you and your family from major financial hardship in the event of illness or injury. You have a choice of two plans:
BLUE ACCESS FOR MEMBERS
• HDHP Base Plan
Blue Access for Members (BAM) is the secure BCBSTX member website where you can:
• PPO Plan
HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
PREFERRED PROVIDER ORGANIZATION (PPO)
The HDHP Base Plan option allows you the freedom to see any provider when you need care, although you will pay less if you use in-network providers. In exchange for a lower per-paycheck cost, however, you must satisfy a higher deductible that applies to almost all health care expenses, including those for prescription drugs. In-network preventive care is covered at 100%. Once your deductible is met, you will continue to pay 20% coinsurance until you reach your out-of-pocket maximum. The plan then pays 100% for services. If you enroll in the HDHP, you may be eligible to open an HSA (see page 13).
The PPO Plan also allows you the freedom to see any provider when you need care. When you use in-network providers, you receive benefits at a discounted network cost. You may pay more for services if you use outof-network providers. In-network preventive care is covered at 100%. In-network office visits, urgent care visits, and prescription medications are covered with a copay. Most other in-network services are covered at the coinsurance level after you have met your deductible.
FIND AN IN-NETWORK BCBSTX PROVIDER • Online – www.bcbstx.com • Call – 800-521-2227
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• Check the status of your claims and claim history • Confirm which family members are covered under your plan • View and print Explanation of Benefits (EOB) claims statements • Locate in-network providers • Request or print a member ID card To get started, log in at www.bcbstx.com. Use the information on your BCBSTX ID card to complete the registration process.
MEDICAL COVERAGE MEDICAL BENEFITS SUMMARY HDHP BASE PLAN
PPO PLAN
IN-NETWORK
OUT-OF-NETWORK
IN-NETWORK
OUT-OF-NETWORK
Plan Year Deductible • Individual • Family
$3,500 $7,000
$7,000 $14,000
$5,000 $10,000
$10,000 $20,000
Plan Year Out-of-Pocket Maximum Includes deductible and copayments • Individual • Family • Lifetime Maximum
$5,000 $10,000 Unlimited
$10,000 $20,000 Unlimited
$5,600 $10,200 Unlimited
$20,000 $60,000 Unlimited
Health Reimbursement Arrangement Meritum Energy Contribution Health Savings Account Meritum Energy Contribution
N/A
Up to $2,500 each for employee and one dependent after in-network deductible is met
Up to $1,000
N/A
YOU PAY Preventive Care
$0
Telemedicine
YOU PAY 40%
$0
1
50%1
$48 consult fee
N/A
$40 copay
N/A
Primary Care Physician
20%1
40%1
$40 copay
50%1
Specialist
20%1
40%1
$40 copay
50%1
Diagnostics X-ray and Lab
20%1
40%1
$0
50%1
Complex Imaging
20%1
40%1
30%1
50%1
Urgent Care
20%1
40%1
$65 copay
50%1
Emergency Room True emergency covered in-network
20%1
40%1
$100 copay + 30%1
50%1
Inpatient Hospital Care
20%1
40%1
30%1
50%1
Outpatient Surgery
20%
40%
30%
50%1
Retail Pharmacy Up to 30-day supply • Generic • Preferred Brand • Non-preferred Brand • Specialty
20%1 20%1 20%1 20%1
20%1, 2 20%1, 2 20%1, 2 20%1, 2
$20 copay $40 copay $60 copay $150 copay
$20 copay + 20%2 $40 copay + 20%2 $60 copay + 20%2 $150 copay + 20%2
Mail Order Pharmacy Up to 90-day supply • Generic • Preferred Brand • Non-preferred Brand • Specialty
20%1 20%1 20%1 20%1,3
N/A N/A N/A N/A
$60 copay $120 copay $180 copay $150 copay3
N/A N/A N/A N/A
1
What you will pay after your deductible is met.
2
Plus amount over allowable.
3
Specialty drugs are limited to a 30-day supply.
1
1
1
2026 Employee Benefits 7
PHARMACY BENEFITS Your BCBSTX medical coverage includes pharmacy benefits through Prime Therapeutics, a pharmacy benefit manager that administers our prescription drug plan through a network of pharmacies that offer affordable medications. Visit www.myprime.com to get the most out of your prescription benefits.
FIND A PHARMACY
MAIL ORDER PRESCRIPTIONS
To find an in-network pharmacy:
• 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.
• Visit www.myprime.com. • Click on Find a Pharmacy > Continue without sign in > BCBS Texas. • Answer No for Medicare Part D and select Other BCBSTX Plans for the health plan type. • Click Continue, then choose Traditional Select Network from the drop-down menu and Submit. • Start a search for all in-network pharmacies near you.
PAY THE DIFFERENCE BENEFIT Your prescription drug benefit uses a Member Pay the Difference pharmacy benefit designed to encourage you to use medications that have been shown to be safe and cost-effective. When you fill a prescription through a contracting pharmacy for a covered brand name drug where a generic equivalent is available, you may pay more. A generic equivalent is made with the same active ingredient(s) at the same dose as the brand drug. You will pay the copay/coinsurance amount plus the difference in cost between the brand drug and its generic equivalent. This may apply even if your doctor writes “do not substitute” on your prescription. Go to www.bcbstx.com and log in to BAM for full details.
8 Meritum Energy Holdings
• Phone – Call 833-715-0942 and have your member ID card, your doctor’s information, and prescription information ready. • Home Delivery (for long-term or maintenance medications) – Visit www.bcbstx.com and log in to BAM. Complete the mail order form and send it with your prescription and payment to Express Scripts. • Doctor – Ask your doctor to fax, call, or email your prescription to Express Scripts for you.
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 so visit https:// www.accredo.com for details.
Questions? Visit www.bcbstx.com or call the number on your member ID card.
BCBSTX RESOURCES LIVONGO
BLUE365
OMADA
Livongo offers digital solution programs to help you manage chronic diabetes and high blood pressure. Participation is FREE and available to you and your family members with diabetes and/or hypertension.
With Blue365, you and your family can save money on health care products and services that are most often not covered by your health plan. You also have access to a full range of savings from top national and local retailers, including:
Omada is a personalized program to help you lose weight and lower your blood pressure. You get one-on-one coaching, support, tools, and resources to help reduce your risk for chronic health conditions. If you are at risk for type 2 diabetes or heart disease or are living with high blood pressure, the Omada program is included in your benefits at $0 cost to you.
Diabetes Management Program Livongo can help you manage type 1 and type 2 diabetes by using:
• Dental, vision, and hearing products and services
• A connected blood sugar monitor
• Fitness gear and apparel
• Unlimited strips and lancets at NO COST
• Gym memberships
• Personalized insights and support
• Healthy eating options
Blood Pressure Management
• And more!
Livongo offers personal support by monitoring your blood pressure using:
HINGE HEALTH
• A connected monitor • One-on-one coaching • Real-time tips and more
Learn More and Join • Text – GO WELL-BCBSTX to 85240 • Online – https://get.livongo.com/ well-bcbstx/register • Call – 800-945-4355 and use registration code: WELL-BCBSTX
24/7 NURSELINE BCBSTX provides free, around-the-clock access to registered nurses by calling 800-581-0368.
• Family activities
If you suffer from constant back and joint pain, Hinge Health can help you without drugs or surgery! Get personal therapy, unlimited support, and a free computer tablet and wearable sensors — all for free! Average results show 60% pain reduction and two out of three surgeries avoided. Learn more and apply at www.hingehealth.com/bcbstx.
WONDR 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. Learn more at https://support.wondrhealth.com.
Apply for Omada online at www.omadahealth.com/bcbstx.
WELL ONTARGET FITNESS PROGRAM As a BCBSTX member, the Fitness Program is available exclusively for you and your covered dependents (age 16 or older). Access a nationwide network of fitness locations and enjoy other program perks such as: • Flexible gym network for a choice of gyms and preferences • Studio class network for boutique-style classes and specialty gyms • Family friendly gyms • Convenient payment Digital 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, yoga, and more. Digital access comes with some packages, or you can select it by itself if you just want digital classes.
Sign Up Today! • Online – Go to www.bcbstx.com and log in to BAM. Under the Wellness tab, choose Fitness Program, then select Learn More. • Call – 888-762-2583 (BLUE)
2026 Employee Benefits 9
TELEMEDICINE If you enroll in one of the BCBSTX medical plan options, you have access to telemedicine services through MDLIVE. Connect anytime day or night with a board-certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
WHEN TO USE MDLIVE MDLIVE services should only be used for minor, non-life-threatening conditions such as: • Sore throat
• Have a non-emergency issue and are considering a convenient care clinic, urgent care clinic, or emergency room for treatment
• Headache
• Are on a business trip, vacation, or away from home
• Cold
• Are unable to see your primary care physician
• Flu
Using MDLIVE is Easy
• Allergies
Register with MDLIVE so you are ready to use this valuable service when and where you need it.
• Fever
• Online – www.mdlive.com/bcbstx • Call – 888-680-8646
• Stomachache
• Urinary tract infections Do not use telemedicine for serious or lifethreatening emergencies.
• Download – MDLIVE app
YOUR COST PER VISIT HDHP Base Plan • $48 general service fee • Up to a $250 service fee for mental health PPO Plan • $40 copay
DOWNLOAD THE MOBILE APP Scan the QR code to download the MDLIVE app to your mobile device.
Apple App Store iPhone/iPad
10 Meritum Energy Holdings
Google Play Android
HEALTH CARE OPTIONS Becoming familiar with your options for medical care can save you time and money.
HEALTH CARE PROVIDER
SYMPTOMS
AVERAGE COST AVERAGE WAIT
NON-EMERGENCY CARE
TELEMEDICINE
DOCTOR’S OFFICE
RETAIL CLINIC
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 Generally, the best place for routine preventive care; established relationship; able to treat based on medical history
Allergies Cough/cold/flu Rash Stomachache
$
2-5 minutes
• • • •
Infections Sore and strep throat Vaccinations Minor injuries, sprains and strains
$
15-20 minutes
• • • •
Common infections Minor injuries Pregnancy tests Vaccinations
$
15 minutes
$$
15-30 minutes
Chest pain Difficulty breathing Severe bleeding Blurred or sudden loss of vision • Major broken bones
$$$$
4+ hours
• Most major injuries except trauma • Severe pain
$$$$$$
Minimal
Office hours vary 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 When you need immediate attention; walk-in basis is usually accepted
URGENT CARE
• • • •
Generally includes evening, weekend and holiday hours
• Sprains and strains • Minor broken bones • Small cuts that may require stitches • Minor burns and infections
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility
• • • •
EMERGENCY CARE
HOSPITAL ER
FREESTANDING ER
24 hours a day, 7 days a week
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
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.
2026 Employee Benefits 11
HEALTH REIMBURSEMENT ARRANGEMENT A Health Reimbursement Arrangement (HRA) is an employer-funded health care account from which you can be reimbursed – tax free – for qualified medical expenses. When you elect coverage under the PPO Plan, Meritum Energy will establish an HRA in your name and reimburse you and one dependent for up to $2,500 each once you meet your deductibles. You can use your HRA to pay for: • Qualified medical expenses for you and your covered dependents • Any combination of deductible, coinsurance, or copay expenses Our HRA is administered by Higginbotham.
SUBMITTING A CLAIM Submit your EOB and claim forms to Higginbotham for reimbursement from your HRA: • Fax – 866-419-3516 • Email – flexclaims@higginbotham.net • Online – https://flexservices.higginbotham.net
12 Meritum Energy Holdings
HEALTH SAVINGS ACCOUNT If you enroll in the HDHP Base medical plan, you may be eligible to open a Health Savings Account (HSA). An HSA is a personal savings account you can use to pay qualified out-of-pocket medical expenses with pretax dollars. You own and control the money in your HSA. The money in your account (including interest and investment earnings) grows tax-free, and if the funds are used to pay for qualified medical expenses, they are spent tax-free. 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 and, since it is an individual account, the balance is yours to keep even if you change health plans or jobs. Our HSA is administered by Bank of America.
HSA ELIGIBILITY You are eligible to open and contribute to an HSA if you: • Are enrolled in an HSA-eligible HDHP (the HDHP Base medical plan) • Are not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan • Are not enrolled in a Health Care Flexible Spending Account • Are not eligible to be claimed as a dependent on someone else’s tax return • Are not enrolled in Medicare or TRICARE • Have not received Veterans Administration benefits You can use the money in your HSA to pay for qualified medical expenses now or in the future. Your HSA can be used for your expenses and those of your spouse and dependents, even if they are not covered by the HDHP.
MAXIMUM CONTRIBUTIONS
OPENING AN HSA
Your contributions to your HSA, when combined with Meritum Energy contributions, may not exceed the annual maximum amount established by the Internal Revenue Service. Meritum Energy will contribute up to $1,000 to your HSA. The annual contribution maximums for 2026 are based on the coverage option you elect:
HSA MAXIMUM CONTRIBUTIONS You
INDIVIDUAL
FAMILY
$3,400
$7,750
Company
$1,000
$1,000
Total
$4,400
$8,750
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future expenses. 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 age 55 at anytime during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
If you meet the eligibility requirements, you may open an HSA administered by Bank of America. 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 https://myhealth.bankofamerica.com. Always ask your health care provider to file your claims with your medical provider so network discounts can be applied. Then you can pay the provider with your HSA debit card based on the balance due after discount. You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit. You can access the Employee User Guide through https://healthaccounts. bankofamerica.com. NOTE: You may open an HSA at any financial institution of your choice, but only accounts opened through Bank of America are eligible for automatic payroll deduction and company contributions.
2026 Employee Benefits 13
FLEXIBLE SPENDING ACCOUNTS An FSA allows you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer two different FSAs: one for health care expenses and one for dependent care expenses. Our FSAs are administered by Higginbotham.
HEALTH CARE FSA From each paycheck, you may set aside pretax dollars that can then be used to pay outof-pocket health care expenses. A complete list of qualified expenses can be found in Publication 502 on the IRS website. When you incur the expense, you will be reimbursed the full amount at that time. You can contribute up to $3,400 annually to the Health Care FSA. You cannot contribute to a Health Care FSA if you have a Health Savings Account (HSA). Higginbotham will issue you a debit card to pay for eligible expenses directly from your FSA.
How the Health Care FSA Works When you incur a medical, dental, vision, or hearing expense, you will be reimbursed the full amount of the expense at that time (up to your annual election amount). You are entitled to the full election amount from day one of your plan year. When you incur a qualified health care expense, you can choose one of two reimbursement methods: • Use your FSA debit card (see below for information) to pay doctor visits and prescription copays. Your FSA will be charged for the amount, and you will not need to submit a request for reimbursement. • You can pay out-of-pocket, then submit your receipts to Higginbotham: • Fax – 866-419-3516 • Email – flexclaims@higginbotham.net • Online – https://flexservices.higginbotham.net
HIGGINBOTHAM BENEFITS DEBIT CARD The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an 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).
14 Meritum Energy Holdings
This plan year runs from February 1, 2026, through May 31, 2026. Only expenses incurred during this time period should be submitted. Open Enrollment for the new plan year – June 1, 2026 through May 31, 2027 – will be held prior to June 1, 2026.
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 fulltime. 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.
Things to Consider Regarding the Dependent Care FSA • Overnight camps are not eligible for reimbursement (only day camps can be considered). • If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13. • You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
FLEXIBLE SPENDING ACCOUNTS IMPORTANT FSA RULES • The maximum per plan year you can contribute to a 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. • Expenses for services received during the four-month period (or from the date you became covered) can be reimbursed from the money set aside from your pay during the 2026 plan year. You can continue to file claims incurred during the plan year for another 90 days (up until August 30, 2026). • Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses. • The IRS has amended the “use it or lose it” rule to allow you to carry over up to $680 in your Health Care FSA into the next plan year. The carryover rule does not apply to your Dependent Care FSA.
HIGGINBOTHAM PORTAL The Higginbotham Portal provides information and resources to help manage your FSAs: • Access plan documents, letters and notices, forms, account balances, contributions, and other plan information. • Update your personal information. • Utilize Section 125 tax calculators. • Look up qualified expenses. • Submit claims. • Request a new or replacement Benefits Debit Card.
Register on the Higginbotham Portal Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information. • Enter your Employee ID, which is your Social Security number with no dashes or spaces. • Follow the prompts to navigate the site. • If you have any questions or concerns, contact Higginbotham: • Call – 866-419-3519 • Email – flexclaims@higginbotham.net • Fax – 866-419-3516
HIGGINBOTHAM FLEX MOBILE APP Your Health Care FSA can be easily accessed on your smartphone or tablet with the Higginbotham mobile app. To locate and load the app, search for Higginbotham 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 you 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 Higginbotham Portal. If you have not registered on the Higginbotham Portal, you can register on the mobile app.
2026 Employee Benefits 15
DENTAL COVERAGE Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions for dental coverage will be deducted from your paycheck on a pretax basis. Coverage is provided through BCBSTX using the BlueCare Dental network.
FIND AN IN-NETWORK PROVIDER AND VIEW OR REQUEST AN ID CARD
DPPO PLAN
• Online – www.bcbstx.com
Two levels of benefits are available with the DPPO plan: in-network and out-ofnetwork. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. Using an in-network provider will provide you with the highest level of benefits and the deepest discounts the plan offers.
• Call – 800-521-2227
Out-of-network services are paid up to the Maximum Allowable Charge (MAC) in your area as determined by BCBSTX. If you use an out-of-network provider, you will be responsible for any amount over the MAC amount.
DENTAL BENEFITS SUMMARY BLUECARE DPPO PLAN Calendar Year Deductible • Individual • Family
IN-NETWORK
OUT-OF-NETWORK1
$50 $150
$50 $150
Calendar Year Benefit Maximum Per Individual
$1,500
YOU PAY
YOU PAY
$0
$0
Basic Care Fillings, simple extractions, periodontics, anesthesia
20% after deductible
20% after deductible
Major Restorative Care Endodontics, oral surgery, crowns, dentures, bridges
50% after deductible
50% after deductible
Preventive and Diagnostic Care Exams, cleanings, X-rays, fluoride treatments, sealants, space maintainers
Orthodontics Adults and children
50% ($1,000 lifetime maximum)
Out-of-network providers: When you use out-of-network providers, your services will be paid based on the MAC, a set amount for each type of service that is determined by BCBSTX. If your dentist’s fee is lower than the MAC, the plan will pay benefits based on the actual fee. If the fee is higher, the plan will pay benefits based only on the MAC amount, and you are responsible for the difference. 1
When the course of treatment will be in excess of $300, a predetermination request should be submitted to BCBSTX in advance of treatment.
16 Meritum Energy Holdings
• Download – BCBSTX app • Policy Number – 286209
VISION COVERAGE Our vision plan through BCBSTX is designed to provide your basic eyewear needs and preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes or high cholesterol. You may seek care from any licensed optometrist, ophthalmologist, or optician, but plan benefits are better if you use an in-network provider. The vision plan uses the EyeMed vision network of providers.
VISION BENEFITS SUMMARY VISION PLAN IN-NETWORK YOU PAY
OUT-OF-NETWORK REIMBURSEMENT
Exam
$10 copay
Up to $30
Lenses • Single Vision • Bifocals • Trifocals • Lenticular • Standard Progressives
$25 copay $25 copay $25 copay $25 copay $90 copay
Up to $25 Up to $40 Up to $55 Up to $55 Up to $40
$150 allowance; 20% off balance over allowance
Up to $75
Frames Contacts • Fit and Follow-up • Elective • Medically Necessary
Up to $40 for standard; 10% off retail for premium $150 allowance; 15% of balance over allowance $0
N/A Up to $120 Up to $210
BENEFIT FREQUENCY Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
FIND AN IN-NETWORK PROVIDER AND VIEW OR REQUEST AN ID CARD • Online – www.eyemedvisioncare.com/bcbstxvis • Call – 855-556-8796 • Download – EyeMed Members app • Policy Number – F025331
GLASSES OR CONTACTS? If you purchase contacts using the $150 allowance, you can also purchase a pair of glasses using the $150 frame allowance plus 20% discount over the allowance, and you can receive 20% off the spectacle lenses.
2026 Employee Benefits 17
DISABILITY INSURANCE Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness while insured. Meritum Energy offers Short Term Disability (STD) and Long Term Disability (LTD) insurance for you to purchase.
VOLUNTARY SHORT TERM VOLUNTARY LONG TERM DISABILITY DISABILITY STD coverage through BCBSTX pays a percentage of your weekly salary for up to 24 weeks if you are temporarily disabled and unable to work due to an illness, injury, or pregnancy. STD benefits are NOT payable if the disability is due to a jobrelated injury or illness.
LTD insurance through BCBSTX pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for more than 180 days. Benefits begin at the end of an elimination period and continue while you are disabled up to a maximum benefit period.
VOLUNTARY SHORT TERM DISABILITY
VOLUNTARY LONG TERM DISABILITY
Benefits Begin
15th day
Benefits Begin
181st day
Percentage of Earnings You Will Receive
60%
Percentage of Earnings You Will Receive
Maximum Weekly Benefit
$2,500
Maximum Monthly Benefit
$10,000
Maximum Benefit Period
24 weeks
Maximum Benefit Period
Social Security Normal Retirement Age
Pre-existing Condition
3/121
MONTHLY RATES PER $10 OF WEEKLY BENEFIT
Pre-existing Condition
60%
12/121
MONTHLY RATES PER $100 OF MONTHLY BENEFIT
AGE
RATE
AGE
RATE
<30
$0.450
<25
$0.113
30-34
$0.440
25-29
$0.175
35-39
$0.440
30-34
$0.318
40-44
$0.480
35-39
$0.491
45-49
$0.580
40-44
$0.818
50-54
$0.690
45-49
$1.105
55-59
$0.900
50-54
$1.401
60-64
$1.110
55-59
$1.658
65+
$1.510
60+
$1.718
Benefits may not be paid for conditions for which you have been treated within the three months prior to your effective date until you have been covered under this plan for 12 months. 1
18 Meritum Energy Holdings
Benefits may not be paid for conditions for which you have been treated within the 12 months prior to your effective date until you have been covered under this plan for 12 months. 1
PREMIUM CALCULATIONS Calculate your monthly premiums for Voluntary Disability insurance using these formulas:
Voluntary STD Annual Salary ÷ 52 = Weekly Earnings × $.60 = Weekly Benefit ÷ 10 × STD Rate = Monthly Premium
Voluntary LTD Monthly Earnings × LTD Rate = Amount ÷ 100 = Monthly Premium
LIFE AND AD&D INSURANCE Life insurance is an important part of your financial security, especially if others depend on you for support. Even if you are single, your beneficiary can use your Life insurance to pay off your debts, such as credit cards, mortgages, and other final expenses. Accidental Death and Dismemberment (AD&D) coverage provides specified benefits for a covered accidental bodily injury that directly causes dismemberment (e.g., the loss of a hand, foot, or eye). In the event that death occurs from an accident, 100% of the AD&D benefit would be payable to your beneficiary(ies).
BASIC LIFE AND AD&D COVERAGE Basic Life and AD&D insurance are provided by Meritum Energy at no cost to you through BCBSTX. You are automatically covered at $50,000 for each benefit. Benefits reduce by 35% at age 70, and by 50% at age 75.
DESIGNATING A BENEFICIARY A beneficiary is the person or entity you designate to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary and you can change beneficiaries at anytime. If you name more than one beneficiary, you must identify the share for each.
SUPPLEMENTAL LIFE AND AD&D COVERAGE You may purchase additional Life and AD&D insurance for you and your eligible dependents. If you decline Supplemental Life and AD&D insurance when first eligible, or if you elect coverage and wish to increase your benefit amount at a later date, evidence of insurability (EOI) — proof of good health — may be required before coverage is approved. Benefits reduce by 35% at age 70 and by 50% at age 75. You must elect Supplemental Life and AD&D coverage for yourself in order to elect coverage for your spouse or children. Coverage is provided through BCBSTX. If you leave Meritum Energy, you may be able to take the insurance with you.
SUPPLEMENTAL LIFE AND AD&D AVAILABLE COVERAGE Employee
• Increments of $10,000 up to $500,000 • Guaranteed Issue $150,000 for each benefit
Spouse
• Increments of $5,000 up to $250,000 not to exceed 50% of employee coverage • Guaranteed Issue $25,000
Unmarried, Dependent Child(ren)
• $1,000 for children under six months • $10,000 for children six months to age 26 • Guaranteed Issue $10,000
MONTHLY SUPPLEMENTAL LIFE AND AD&D RATES PER $1,000 EMPLOYEE/SPOUSE AGE
RATE
AGE
RATE
<30
$0.120
50-54
$0.540
30-34
$0.140
55-59
$0.860
35-39
$0.180
60-64
$1.240
40-44
$0.240
65-69
$2.120
45-49
$0.350
70+
$3.720
CHILDREN To age 26
$0.230
2026 Employee Benefits 19
SUPPLEMENTAL INSURANCE IMPORTANT: THESE ARE FIXED INDEMNITY POLICIES, NOT HEALTH INSURANCE. These fixed indemnity policies may pay you a limited dollar amount if you are sick or hospitalized. You are still responsible for paying the cost of your care. • The payment you get is not based on the size of your medical bill. • There might be a limit on how much a policy will pay each year. • These fixed indemnity policies are not a substitute for comprehensive health insurance. • Since these fixed indemnity policies are not health insurance, they do not have to include most Federal consumer protections that apply to health insurance. Looking for comprehensive health insurance? • Visit www.healthcare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options. • To find out if you can get health insurance through your job, or a family member’s job, contact the employer. Questions about this policy? • For questions or complaints about these are fixed indemnity policies, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners’ website (www.naic.org) under Insurance Departments. • If you have these fixed indemnity policies through your job, or a family member’s job, contact the employer.
20 Meritum Energy Holdings
We offer the opportunity to enroll in additional coverage that complements the traditional health care programs. These plans are all offered through BCBSTX and are portable. This means if you leave your employment, you can take these policies with you.
ACCIDENT INSURANCE Accident insurance pays a fixed benefit directly to you in the event of an accident, regardless of any other coverage you may have. Benefits are paid according to a fixed schedule for accident-related expenses including hospitalizations, fractures and dislocations, emergency room visits, major diagnostic exams, and physical therapy. Please refer to the Summary of Benefits and Coverage for benefit details.
ACCIDENT INSURANCE SERVICE
BENEFIT
Emergency • ER or urgent care • Physician
$150 $50
Ambulance • Ground • Air
$200 $1,500
Initial Hospitalization
$1,200
Hospital Confinement
$250 per day
Intensive Care Unit Admission Intensive Care Unit
$2,000 $500 per day
Specific Sum Injuries Dislocations, ruptured discs, eye injuries, fractures, lacerations, concussions, etc. 1
Wellness Benefit
$50 - $12,500 $50
Accidental Death & Dismemberment • Employee • Spouse • Child
$40,000 $40,000 $12,500
MONTHLY RATE Employee Only
$10.76
Employee + Spouse
$17.87
Employee + Child(ren)
$20.62
Employee + Family
$32.40
1
Amount of benefit paid is dependent on type of loss.
SUPPLEMENTAL 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 upon first and second diagnosis of any covered critical illness or cancer to help cover expenses such as lost income, out-of-town treatments, special diets, daily living, and household upkeep costs.
VOLUNTARY CRITICAL ILLNESS INSURANCE LUMP-SUM BENEFIT AMOUNTS AVAILABLE Employee
$5,000 to $20,000 in $5,000 increments
Spouse
$2,500 to $10,000 in increments of $2,500 not to exceed 50% of employee benefit
Child(ren)
$2,500 to $5,000 in increments of $2,500 not to exceed 50% of employee benefit
CONDITION1
FIRST OCCURRENCE BENEFIT
Full Benefit Invasive Cancer, Heart Attack, Stroke, Major Organ Transplant, Major Burns, Coma, Advanced Alzheimer’s Disease, Advanced Multiple Sclerosis, End-stage Renal Failure, Paralysis, Benign Brain Tumor, Loss of Sight/Speech/Hearing, Advanced Parkinson’s Disease, Amyotrophic Lateral Sclerosis (ALS)
100% of benefit amount
Partial Benefit Carcinoma in Situ, Major Heart Surgery
25% of benefit amount
MONTHLY RATE PER BENEFIT AMOUNT EMPLOYEE AGE
$5,000
$10,000
$15,000
$20,000
<30
$2.56
$5.12
$7.68
$10.24
30-39
$3.70
$7.40
$11.10
$14.80
40-49
$7.51
$15.02
$22.53
$30.04
50-59
$15.46
$30.91
$46.37
$61.82
60-64
$26.44
$52.87
$79.31
$105.74
65+
$40.68
$81.35
$122.03
$162.70
SPOUSE AGE
$2,500
$5,000
$7,500
$10,000
<30
$1.97
$3.94
$5.90
$7.87
30-39
$2.58
$5.16
$7.74
$10.32
40-49
$4.59
$9.18
$13.76
$18.35
50-59
$8.61
$17.22
$25.83
$34.44
60-64
$14.11
$28.22
$42.32
$56.43
65+
$21.81
$43.62
$65.42
$87.23
CHILD(REN) $2,500
$5,000
$0.68
$1.35
A 6/12 pre-existing condition exclusion applies. Benefits may not be paid for a condition for which you have been treated within the six months prior to your effective date until you have been covered under this plan for 12 months. 1
2026 Employee Benefits 21
EMPLOYEE CONTRIBUTIONS YOUR 2026 MONTHLY COST MEDICAL HDHP BASE PLAN
PPO PLAN
Employee Only
$173.17
$310.32
Employee + Spouse
$688.86
$970.53
Employee + Child(ren)
$548.62
$754.75
Employee + Family
$1,052.25
$1,383.15
$
TELEMEDICINE MDLIVE
Paid by Meritum Energy for all employees enrolled in either of the BCBSTX medical plans
$0
HEALTH SAVINGS ACCOUNT Individual
$358.33 maximum monthly contribution1
Family
$712.50 maximum monthly contribution1
$
FLEXIBLE SPENDING ACCOUNTS Health Care FSA
$275.00 maximum monthly contribution
$
Dependent Care FSA
$416.67 maximum monthly contribution
$
DENTAL Employee Only
$0.00
Employee + Spouse
$19.64
Employee + Child(ren)
$30.47
Employee + Family
$58.04
$
VISION Employee Only
$8.25
Employee + Spouse
$15.67
Employee + Child(ren)
$16.49
Employee + Family
$24.25
$
DISABILITY INSURANCE Short Term Disability
See page 18 for rates
$
Long Term Disability
See page 18 for rates
$
Basic Life and AD&D
Paid by Meritum Energy
$0
Voluntary Life and AD&D
See page 19 for rates
$
Accident
See page 20 for rates
$
Critical Illness
See page 21 for rates
$
LIFE AND AD&D INSURANCE
VOLUNTARY SUPPLEMENTAL INSURANCE
YOUR TOTAL MONTHLY BENEFIT COST
$
Meritum Energy will contribute up to $1,000 to your HSA. If you receive less than the full $1,000 company contribution, your maximum monthly contribution will differ from the amounts listed above. 1
22 Meritum Energy Holdings
RETIREMENT PLAN A consistent savings plan throughout your career is the foundation for security during your retirement years. A 401(k) plan can be a powerful tool in promoting financial security in retirement. Our 401(k) plan through Transamerica is designed to help you reach your investment goals.
How the Retirement Plan Works You are eligible to participate in the plan on the first of the month following 60 days of service and the attainment of age 18. You may contribute up to the 2026 IRS limit of $24,500. If you are age 50 or older, you may make an additional contribution based on your age:
VESTING You are always 100% vested in your own contributions. You are 100% vested in matching company contributions after two years of service.
• $8,000 age 50-59 • $11,250 age 60-63 • $8,000 age 64+ You may change the amount of your contributions anytime. All changes become effective as soon as administratively feasible and remain in effect until modified or terminated by you. You also decide how to invest the assets in your account, and you may change your investment choices anytime. Meritum Energy will make a dollar-for-dollar matching contribution up to 6% of your contribution. For more details, refer to your 401(k) Enrollment Guide or contact Transamerica at 800-401-8726.
SET UP YOUR ACCOUNT ONLINE Get online access to review and manage your account. • Online – https://transamerica.com/portal • Call – 800-401-8726 • Download – Transamerica Retirement app
2026 Employee Benefits 23
EMPLOYEE ASSISTANCE PROGRAM Meritum Energy provides an Employee Assistance Program (EAP) to help you and family members cope with a variety of personal or work-related issues. Available to all employees and their eligible dependents, ComPsych GuidanceResources provides confidential counseling and support services. This program is made available at no additional cost to you. This 24/7 service, staffed by experienced clinicians, is available by calling 888-628-4824 or visiting www.guidanceresources.com (use web ID DLEAP). You also have up to three virtual sessions with a counselor per person, per issue, per year.
CONFIDENTIAL EMOTIONAL SUPPORT Trained clinicians will listen to your concerns and help you or your family members with any issues, including: • Stress and anxiety • Grief and loss • Relationships and marital conflicts
WORK-LIFE BALANCE Specialists can provide qualified referrals and resources to help you balance your daily personal and work life, including: • Finding childcare and eldercare
• Planning events
• Hiring movers or home repair contractors
• Locating pet care
LEGAL GUIDANCE Talk to an attorney for assistance on pressing legal issues, including: • Divorce
• Family law
• Adoption
• Wills and trusts
FINANCIAL RESOURCES Speak to financial experts for help with a wide range of issues, such as: • Retirement planning
• Debt management and budgeting
• Taxes
• Bankruptcy
Online Support GuidanceResources Online is your 24/7 link to vital information, tools, and support. Log in at www.guidanceresources.com anytime for: • Articles, podcasts, videos, and slideshows • On-demand training
24 Meritum Energy Holdings
CONTACT THE EAP Contact GuidanceResources anytime you need help. • Call – 888-628-4844 • TTY – 800-697-0353 • Online – use web ID DLEAP www.guidanceresources.com • Download – GuidanceNow app
BENEFIT EXTRAS Included with your BCBSTX coverage are the following value-added programs available to you and your eligible dependents at no additional cost.
BENEFICIARY RESOURCE SERVICES
DISABILITY RESOURCE SERVICES
Beneficiary Resource Services through The following services are available if you Morneau Shepell combines family wellness are enrolled in our LTD plan: and security at the most difficult times. • In-person Consultations – Three faceServices include grief and financial to-face sessions to address behavioral counseling, funeral planning, legal support, issues. and online will preparation. • Assistance by Phone – 24/7 unlimited Services for you and your family telephone counseling with master’sdegree-level counselors to identify • Online Will Preparation – Create a concerns, assess needs, and refer to a will in just minutes that keeps your specialist to help resolve the issue. information safe and secure. Log in at www.beneficiaryresources.com • Web-based Services – and enter the username beneficiary. GuidanceResources provides a Answer some simple questions and secure website where you can download or print documents instantly. access self-assessments, content on • Online Funeral Planning – Download a funeral planning guide. There are also calculators to estimate and compare funeral expenses, along with information on funeral requirements and various religious customs.
Services for your beneficiaries and their families • Unlimited phone contact for up to one year with a grief counselor, legal advisor, or financial planner.
personal health, and tools to help with personal, relationship, legal, health, and financial concerns. Go to www.guidanceresources.com and log in using company ID DISRES. Call 866-899-1363 for additional information.
WORLDWIDE TRAVEL ASSISTANCE AND IDENTITY THEFT Generali Global Assistance provides travel assistance for you and your dependents if you are traveling more than 100 miles from home. Representatives can help with trip planning or assist in an emergency while traveling. Services include: • Medical search and referral • Medical monitoring • Medical evacuation/return home • Traveling companion assistance • Dependent children assistance • Visit by family member/friend • Return of mortal remains • Replacement of medications and eyeglasses • Locating lost or stolen items • Legal assistance/bail • Interpretation/translation Access this service by calling 877-715-2593 or sending an email to ops@ us.generaliglobalassistance.com.
• Up to five face-to-face working sessions that can be split between different counselors depending on need. • Morneau Shepell maintains a comprehensive directory of qualified and accessible counselors who will initiate follow-up calls when necessary for up to one full year from the date of initial contact. To access services, in at to www.beneficiaryresources.com and use beneficiary as your username, or call 800-769-9187 for more information. 2026 Employee Benefits 25
IMPORTANT NOTICES WOMEN’S HEALTH AND SPECIAL ENROLLMENT RIGHTS YOUR PRESCRIPTION DRUG CANCER RIGHTS ACT OF 1998 This notice is being provided to ensure COVERAGE AND MEDICARE 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: z All stages of reconstruction of the breast on which the mastectomy was performed; z Surgery and reconstruction of the other breast to produce a symmetrical appearance; and z 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.
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
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Meritum Energy Holdings 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.
If you have a new dependent as a result of a marriage, birth, adoption, or placement 2. Meritum Energy Holdings has for adoption, you may be able to enroll determined that the prescription drug yourself and your dependents. However, coverage offered by the Meritum you must enroll within 31 days after the Energy Holdings medical plan is, on marriage, birth, or placement for adoption. average for all plan participants, For More Information or Assistance expected to pay out as much as the standard Medicare prescription drug To request special enrollment or obtain coverage pays and is considered more information, contact: Creditable Coverage. Meritum Energy Holdings Human Resources 19206 Huebner Suite 100 San Antonio TX 78258 210-876-3560
26 Meritum Energy Holdings
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 Meritum Energy Holdings 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 Meritum Energy Holdings 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.
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 800325-0778.
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.
February 1, 2026 Meritum Energy Holdings Human Resources 19206 Huebner Suite 100 San Antonio TX 78258 210-876-3560
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 For more information about this notice required to provide a copy of this notice or your current prescription drug when you join to show whether or not you coverage: have maintained creditable coverage and Contact the Human Resources Department whether or not you are required to pay a higher premium (a penalty). at 210-876-3560.
For more information about your options NOTICE OF HIPAA PRIVACY under Medicare prescription drug PRACTICES coverage: This notice describes how medical More detailed information about Medicare information about you may be used and plans that offer prescription drug coverage disclosed and how you can get access is in the “Medicare & You” handbook. to this information. Please review it You will get a copy of the handbook in the carefully. mail every year from Medicare. You may Effective Date of Notice: September 23, also be contacted directly by Medicare 2013 prescription drug plans. For more Meritum Energy Holdings’s Plan is required information about Medicare prescription by law to take reasonable steps to ensure drug coverage: the privacy of your personally identifiable z Visit www.medicare.gov. health information and to inform you z Call your State Health Insurance about: Assistance Program (see the inside back 1. the Plan’s uses and disclosures of cover of your copy of the “Medicare Protected Health Information (PHI); & You” handbook for their telephone 2. your privacy rights with respect to number) for personalized help. your PHI; z Call 1-800-MEDICARE (1-800-6333. the Plan’s duties with respect to your 4227). TTY users should call 877-486PHI; 2048.
2026 Employee Benefits 27
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.
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.
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.
The Plan and its business associates will 3. use PHI without your authorization to carry out treatment, payment and health care operations. The Plan and its business 4. associates (and any health insurers providing benefits to Plan participants) 5. 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); For example, the Plan may use information (2) summary health information for to project future benefit costs or audit the purposes of health or stop loss insurance underwriting or for purposes of modifying accuracy of its claims processing functions. 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.
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Summary health information can be provided to the Trustees for the purposes designated above. When required by law. 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.
7.
8.
When required by law to report 9. 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. 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). 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.
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.
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.
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 Section 2 – Rights of Individuals directors, consistent with applicable law, as necessary to carry out their Right to Request Restrictions on Uses duties with respect to the decedent. and Disclosures of PHI 11. When consistent with applicable law You may request the Plan to restrict the and standards of ethical conduct if the uses and disclosures of your PHI. However, Plan, in good faith, believes the use or the Plan is not required to agree to your disclosure is necessary to prevent or request (except that the Plan must comply lessen a serious and imminent threat with your request to restrict a disclosure of to the health or safety of a person or your confidential information for payment the public and the disclosure is to a or health care operations if you paid for person reasonably able to prevent or the services to which the information lessen the threat, including the target relates in full, out of pocket). of the threat. You or your personal representative will 12. When authorized by and to the extent be required to submit a written request to necessary to comply with workers’ exercise this right. Such requests should be compensation or other similar made to the Plan’s Privacy Official. programs established by law.
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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.
30 Meritum Energy Holdings
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).
Minimum Necessary Standard
When using or disclosing PHI or when requesting PHI from another covered entity, the Plan will make reasonable The Plan retains discretion to deny access efforts not to use, disclose or request to your PHI by a personal representative more than the minimum amount of PHI to provide protection to those vulnerable necessary to accomplish the intended people who depend on others to exercise purpose of the use, disclosure or request, their rights under these rules and who may taking into consideration practical and be subject to abuse or neglect. technological limitations. When required by law, the Plan will restrict disclosures Section 3 – The Plan’s Duties to the limited data set, or otherwise as The Plan is required by law to maintain the necessary, to the minimum necessary privacy of PHI and to provide individuals information to accomplish the intended (participants and beneficiaries) with notice purpose. of the Plan’s legal duties and privacy However, the minimum necessary practices. standard will not apply in the following This Notice is effective September 23, situations: 2013, and the Plan is required to comply 1. disclosures to or requests by a health with the terms of this Notice. However, care provider for treatment; the Plan reserves the right to change its privacy practices and to apply the changes 2. uses or disclosures made to the to any PHI received or maintained by the individual; Plan prior to that date. If a privacy practice 3. disclosures made to the Secretary of is changed, a revised version of this Notice the U.S. Department of Health and will be provided to all participants for Human Services; whom the Plan still maintains PHI. The 4. uses or disclosures that are required revised Notice will be distributed in the by law; and same manner as the initial Notice was provided or in any other permissible 5. uses or disclosures that are required manner. for the Plan’s compliance with legal regulations. If the revised version of this Notice is posted, you will also receive a copy of the De-Identified Information Notice or information about any material This notice does not apply to information change and how to receive a copy of the that has been de-identified. De-identified Notice in the Plan’s next annual mailing. information is information that does not Otherwise, the revised version of this identify an individual and with respect Notice will be distributed within 60 days of to which there is no reasonable basis to the effective date of any material change believe that the information can be used to the Plan’s policies regarding the uses or to identify an individual. disclosures of PHI, the individual’s privacy rights, the duties of the Plan or other privacy practices stated in this Notice.
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: Meritum Energy Holdings Human Resources 19206 Huebner Suite 100 San Antonio TX 78258 210-876-3560
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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.
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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. ALABAMA – MEDICAID Website: http://www.myalhipp.com/ Phone: 1-855-692-5447 ALASKA – MEDICAID The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/ dpa/Pages/default.aspx ARKANSAS – MEDICAID Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447) CALIFORNIA– MEDICAID Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hipp Phone: 916-445-8322 Fax: 916-440-5676 Email: hipp@dhcs.ca.gov
COLORADO – HEALTH FIRST COLORADO (COLORADO’S MEDICAID PROGRAM) AND CHILD HEALTH PLAN PLUS (CHP+) Health First Colorado website: https://www. healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711 CHP+: https://hcpf.colorado.gov/child-healthplan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https:// www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442 FLORIDA – MEDICAID Website: https://www.flmedicaidtplrecovery. com/flmedicaidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268 GEORGIA – MEDICAID GA HIPP Website: https://medicaid.georgia.gov/ health-insurance-premium-payment-programhipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia. gov/programs/third-party-liability/childrenshealth-insurance-program-reauthorization-act2009-chipra Phone: 678-564-1162, Press 2 INDIANA – MEDICAID Health Insurance Premium Payment Program All other Medicaid Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr/ Family and Social Services Administration Phone: 1-800-403-0864 Member Services Phone: 1-800-457-4584 IOWA – MEDICAID AND CHIP (HAWKI) Medicaid Website: https://hhs.iowa.gov/ programs/welcome-iowa-medicaid Medicaid Phone: 1-800-338-8366 Hawki Website: https://hhs.iowa.gov/programs/ welcome-iowa-medicaid/iowa-health-link/hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://hhs.iowa.gov/programs/ welcome-iowa-medicaid/fee-service/hipp HIPP Phone: 1-888-346-9562 KANSAS – MEDICAID Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 HIPP Phone: 1-800-967-4660
KENTUCKY – MEDICAID Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs. ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kynect.ky.gov Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov/ agencies/dms LOUISIANA – MEDICAID Website: www.medicaid.la.gov or www.ldh. la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP) MAINE – MEDICAID Enrollment Website: https://www. mymaineconnection.gov/benefits/ s/?language=en_US Phone: 1-800-442-6003 TTY: Maine relay 711 Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applicationsforms Phone: 1-800-977-6740 TTY: Maine Relay 711 MASSACHUSETTS – MEDICAID AND CHIP Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711 Email: masspremassistance@accenture.com MINNESOTA – MEDICAID Website: https://mn.gov/dhs/health-carecoverage/ Phone: 1-800-657-3672 MISSOURI – MEDICAID Website: http://www.dss.mo.gov/mhd/ participants/pages/hipp.htm Phone: 573-751-2005 MONTANA – MEDICAID Website: https://dphhs.mt.gov/ MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 Email: HHSHIPPProgram@mt.gov NEBRASKA – MEDICAID Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178
NEVADA – MEDICAID Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900 NEW HAMPSHIRE – MEDICAID Website: https://www.dhhs.nh.gov/programsservices/medicaid/health-insurance-premiumprogram Phone: 603-271-5218 Toll free number for the HIPP program: 1-800852-3345, ext. 15218 Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov NEW JERSEY – MEDICAID AND CHIP Medicaid Website: http://www.state.nj.us/ humanservices/dmahs/clients/medicaid/ Phone: 1-800-356-1561 CHIP Premium Assistance Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/ index.html CHIP Phone: 1-800-701-0710 (TTY: 711) NEW YORK – MEDICAID Website: https://www.health.ny.gov/health_care/ medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA – MEDICAID Website: https://medicaid.ncdhhs.gov Phone: 919-855-4100 NORTH DAKOTA – MEDICAID Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825 OKLAHOMA – MEDICAID AND CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 OREGON – MEDICAID Website: https://healthcare.oregon.gov/Pages/ index.aspx Phone: 1-800-699-9075 PENNSYLVANIA – MEDICAID AND CHIP Website: https://www.pa.gov/en/services/dhs/ apply-for-medicaid-health-insurance-premiumpayment-program-hipp.html Phone: 1-800-692-7462 CHIP Website: https://www.dhs.pa.gov/CHIP/ Pages/CHIP.aspx CHIP Phone: 1-800-986-KIDS (5437) RHODE ISLAND – MEDICAID AND CHIP Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347 or 401-462-0311 (Direct RIte Share Line)
SOUTH CAROLINA – MEDICAID Website: https://www.scdhhs.gov Phone: 1-888-549-0820 SOUTH DAKOTA - MEDICAID Website: https://dss.sd.gov Phone: 1-888-828-0059 TEXAS – MEDICAID Website: https://www.hhs.texas.gov/services/ financial/health-insurance-premium-paymenthipp-program Phone: 1-800-440-0493 UTAH – MEDICAID AND CHIP Utah’s Premium Partnership for Health Insurance (UPP) Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov Phone: 1-888-222-2542 Adult Expansion Website: https://medicaid.utah. gov/expansion/ Utah Medicaid Buyout Program Website: https:// medicaid.utah.gov/buyout-program/ CHIP Website: https://chip.utah.gov/ VERMONT– MEDICAID Website: https://dvha.vermont.gov/members/ medicaid/hipp-program Phone: 1-800-250-8427 VIRGINIA – MEDICAID AND CHIP Website: https://coverva.dmas.virginia.gov/learn/ premium-assistance/famis-select https://coverva.dmas.virginia.gov/learn/premiumassistance/health-insurance-premium-paymenthipp-programs Medicaid/CHIP Phone: 1-800-432-5924 WASHINGTON – MEDICAID Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022 WEST VIRGINIA – MEDICAID AND CHIP Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855699- 8447) WISCONSIN – MEDICAID AND CHIP Website: https://www.dhs.wisconsin.gov/ badgercareplus/p-10095.htm Phone: 1-800-362-3002 WYOMING – MEDICAID Website: https://health.wyo.gov/healthcarefin/ medicaid/programs-and-eligibility/ Phone: 1-800-251-1269
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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 Meritum Energy Holdings group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Meritum Energy Holdings 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 Meritum Energy Holdings Human Resources 19206 Huebner Suite 100 San Antonio TX 78258 210-876-3560
34 Meritum Energy Holdings
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 outof-pocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-ofnetwork provider.
You are protected from balance billing for: z 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 post-stabilization services. z Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these 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:
If you believe you have been wrongly billed, you may contact your insurance z You are only responsible for paying your provider. Visit www.cms.gov/nosurprises share of the cost (like the copayments, for more information about your rights under federal law. 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. z 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.
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This brochure highlights the main features of the Meritum Energy Holdings 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. Meritum Energy Holdings reserves the right to change or discontinue its employee benefits plans anytime.