Helpful Resources
Important Contacts
Employee Response Center
Employee benefits can be complicated. The Higginbotham Employee Response Center can assist you with the following:
Enrollment
Benefits information
Claims or billing questions
Eligibility issues
Call 866-419-3518 to speak with a representative Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you leave a voice mail message after 3:00 p.m. CT, your call will be returned the next business day. You can also email questions or requests to helpline@higginbotham.net
Bilingual representatives are available.
Welcome
We are pleased to offer a comprehensive benefits package intended to protect your well-being and financial health. This guide is your opportunity to learn more about the benefits available to you and your eligible dependents beginning January 1, 2026.
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 December 31, 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 for you and/or your family. After Open Enrollment, you may make changes to your benefit elections only when you have a Qualifying Life Event.
Availability of Summary Health Information
Your benefits program offers three medical plan coverage options. To help you make an informed choice and compare your options, Summary of Benefits and Coverage (SBC) documents are available in
in Hand, or by contacting Human
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices about your prescription drug coverage. Please see page 24 for more details.
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 the same plans for your dependents as you select for yourself.
Eligible Dependents Include
Your legal spouse
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
Renew Home Health requires a spousal affidavit if you are enrolling your spouse in one of our medical plans. This means that if your spouse is eligible for coverage through her/his employer, she/he is not eligible to be enrolled in a Renew Home Health medical plan.
Qualifying Life Events
Your benefit elections remain in effect for the entire plan year until the following Open Enrollment. You may only change coverage during the plan year if you have a Qualifying Life Event, and you must do so within 30 days of the event.
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 request a midyear change, you must notify Human Resources and complete your election changes within 30 days following the event. Be prepared to provide documentation supporting the Qualifying Life Event.
How to Enroll
To begin your enrollment, go to www.benefitsinhand.com
First-time users, follow steps 1-4. Returning users, log in and start at step 5.
1. If this is your first time to log in, click on the New User Registration link. Once you register, you will use your username and password to log in.
2. Enter your personal information and company identifier of maxushealth and click Next
3. Create a username (work email address recommended) and password, then check the I agree to terms and conditions box before you click Finish
4. If you used an email address as your username, you will receive a validation email to that address. You may now log in to the system.
5. Click the Start Enrollment button to begin the enrollment process.
6. Confirm or update your personal information and click Save & Continue
7. Edit or add dependents who need to be covered on your benefits. Once all dependents are listed, click Save & Continue.
8. Follow the steps on the screen for each benefit to make your selection. Please notice there is an option to decline coverage. If you wish to decline, click the Don’t want this benefit? button and select the reason for declining.
9. Once you have elected or declined all benefits, you will see a summary of your selections. Click the Click to Sign button. Your enrollment will not be complete until you click the Click to Sign button.
Have questions about your benefits or need help enrolling? Call the Employee Response Center at 866-419-3518. Benefits experts are available to take your call Monday through Friday from 7:00 a.m. to 6:00 p.m. CT.
Medical Coverage
The medical plan options through Gravie protect you and your family from major financial hardship in the event of illness or injury. You have a choice of three plans:
Base Plan (Traditional 5000) – This plan is an OAP, with a $5,000 Individual and a $10,000 Family in-network deductible.
Buy-Up Plan (ComfortFit 6350) – This plan is an OAP, with a $6,350 Individual and a $12,700 Family in-network deductible.
HDHP (HSA 6350) – This plan is an HDHP, with a $6,350 Individual and a $12,700 Family ($6,350 per family member) in-network deductible.
Open Access Plus (OAP) Plan
An OAP plan, named after the Open Access Plus network of providers, makes it easy to get quality, in-network care through a large, national network of providers. Choosing a primary care physician to coordinate your care is an option, but you do not need a referral to see a specialist. OAP plans can steer you through different tiers of in-network providers for the best specialized care. Prior authorization may be required for hospitalizations and some types of outpatient services.
Find an In-Network Provider
• Visit https://member.gravie.com
• Call 866-863-6232
• Download the Gravie app.
High Deductible Health Plan (HDHP)
An HDHP also allows you to see any provider when you need care, but you will pay less for care when you go to Cigna in-network providers. In exchange for a lower per-paycheck cost for medical benefits, you must satisfy a higher plan deductible that applies to almost all health care expenses, including prescription drugs. If you enroll in the HDHP, you may be eligible to open a Health Savings Account (see page 12 for details).
$0 Cost Services
If you are enrolled in the ComfortFit 6350 plan, there are no costs for the following non-hospital services:
Preventive care
Specialist visit
Urgent care visit
Generic prescriptions
Online care
Mental health care
Physical therapy
Occupational therapy
Speech therapy
Chiropractic care
For hospital services, you must first meet your deductible (which also satisfies your out-of-pocket maximum). Once you meet your deductible, there is no further charge for services.
Note: If you are enrolled in the Gravie HSA 6350 plan, you must meet your deductible before accessing these free services.
Medical Benefits Summary
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1
Gravie Resources
Member Website and Mobile App
Access your Gravie account anytime to find a provider, check your benefits, check claims status, and more.
Visit https://member.gravie.com.
Download the Gravie app
Gravie Member ID Card
Your Gravie member ID card shows your ID number, your group number, and your plan’s effective date. It also shows how to submit claims, links you to your member website, and lists support contact information.
Always show your new ID card to your provider, including the Cigna network logo.
Review your network (top right) and make sure your provider is in-network.
If your providers have questions, have them call 877-684-3984
Questions about Your Coverage?
Gravie Care representatives can help evaluate plan options, verify network coverage, locate providers, decipher Explanation of Benefits statements (EOBs) and bills, and more.
• Call 866-863-6232
• Email help@gravie.com.
Gravie Pay
Gravie Pay is an interest-free, pay-over-time option to pay for out-of-pocket medical expenses. Most non-hospital services have no cost, so out-of-pocket expenses should be infrequent. But when they do come up, you have access to Gravie Pay to manage payments over time.
Sword
Sword is a clinical-grade digital physical therapy program that helps members (age 13+) overcome back, joint, and muscle pain through personalized care from licensed physical therapists and innovative sensor-based technology. Unlike traditional physical therapy, members can access treatment wherever and whenever it is convenient.
FitOn
FitOn has a free library of over 30,000 virtual classes, including cardio, HIIT, yoga, Pilates, meditation, dance, and barre. The library also includes nutrition guides, meal plans, fitness courses and challenges, and more. In-person fitness perks are available as well.
Prescription Drugs
Your medical coverage includes prescription benefits for retail, mail order (home delivery), and specialty drugs.
Prescription Drug List
Your medical carrier controls prescription drug costs by negotiating discounts on medications. Covered drugs are listed in the Prescription Drug List. If you take maintenance medications, review the list with your doctor to see which ones are covered and available. If your medication is not listed, call the phone number on your member ID card.
Retail
Use any participating retail pharmacy to fill short-term, nonspecialty medications. Retail pharmacies often fill or refill 30to 90-day supplies.
Get More Information
• Visit www.gravie.com/gravie-care.
• Call 877-608-0355
• Download the Express Scripts app
• Send a secure message at https://member.gravie.com/contact
Home Delivery
If you take medication on a daily basis, consider using home delivery. It is a convenient, low-cost option that delivers up to a 90-day supply right to your home. You will need to set up an online pharmacy account and/or download the app to easily manage your prescriptions.
Sign Up for Home Delivery
Call the phone number on the back of your ID card.
Save Money. Buy Generic Drugs!
Generic drugs are a safe and effective option to brand name drugs – and they cost much less! They have the same active ingredients, strength, and dosage as brandname drugs, and they also meet the same rigorous quality and safety standards set by the Food and Drug Administration.
Specialty
Specialty medications treat complex or chronic conditions. You must enroll in the specialty drug program through Accredo to access support, home delivery, and cost-saving programs. The program provides 24/7 access to pharmacists and nurses, helps with prior authorizations, and coordinates co-pay assistance through SaveOnSP
Smart90 – Get three-month supplies of maintenance medications via home delivery or select retail pharmacies for the cost of two copays.
SaveOnSP – Helps lower out-of-pocket costs for eligible specialty medications. You must speak with SaveOnSP before you fill your first prescription to enroll.
Prior Authorization – Some medications need approval before coverage. Your provider or you can check the formulary and submit requests:
Visit www.express-scripts.com/pa
Call 800-417-1764
Fax 800-417-1829.
Sign Up for Specialty Pharmacy
• Accredo Specialty Pharmacy – Call 877-605-2001
• SaveOnSP – Call 800-683-1074
Telemedicine
Teladoc Health virtual visits are included with your Gravie medical benefits. Virtual visits offer convenience by letting you see and talk to a doctor from your mobile phone or computer without having to go to a doctor’s office for care. During your virtual visit, you will be able to talk to a doctor about your health concerns, symptoms, and treatment options. If needed, a Teladoc Health doctor can also write prescriptions. Use Teladoc Health when:
Your doctor is unavailable
You become ill while traveling
You are considering visiting an emergency room for a nonemergency health condition
Doctors can diagnose and treat a wide range of non-emergency medical conditions, including:
Bladder/urinary tract infections
Bronchitis
Cold/flu/fever
Diarrhea/stomachache
Migraine/headaches
Sinus problems/sore throat
Rash/pink eye
And more!
Register with Teladoc Health
Register for an account so you can get on-demand medical care.
Visit www.teladochealth.com
Call 800-835-2362
Download the Teladoc Health app.
Health Care Options
Becoming familiar with your options for medical care can save you time and money.
CARE
Access to care via phone, online video or mobile app whether you are home, work or traveling; medications can be prescribed
TELEMEDICINE
DOCTOR’S OFFICE
RETAIL CLINIC
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
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
• Allergies
• Cough/cold/flu
• Rash
• Stomachache
URGENT CARE
EMERGENCY CARE
When you need immediate attention; walk-in basis is usually accepted
Generally includes evening, weekend and holiday hours
• Infections
• Sore and strep throat
• Vaccinations
• Minor injuries/sprains/ strains
• Common infections
• Minor injuries
• Pregnancy tests
• Vaccinations
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility
• Sprains and strains
• Minor broken bones
• Small cuts that may require stitches
• Minor burns and infections
2-5 minutes
15-20 minutes
15 minutes
15-30 minutes
• Chest pain
• Difficulty breathing
• Severe bleeding
• Blurred or sudden loss of vision
HOSPITAL 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
FREESTANDING ER
24 hours a day, 7 days a week
• Major broken bones
• Most major injuries except trauma
• Severe pain
4+ hours
Minimal
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.
Health Savings Account
A Health Savings Account (HSA) through Optum Bank is more than a way to help you and your family cover health care costs — it is also a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows taxfree and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
Enrolled in our HDHP (HSA 6350)
Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
Not enrolled in a Health Care Flexible Spending Account
Not eligible to be claimed as a dependent on someone else’s tax return
Not enrolled in Medicare or TRICARE
Not receiving Veterans Administration benefits
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP.
Important Enrollment Information
You must enroll in the HDHP medical plan to be eligible for the HSA.
Maximum Contributions
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximums for 2026 are based on the coverage option you elect:
Individual – $4,400
Family – $8,750
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are age 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 anytime during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
Opening an HSA
If you meet the eligibility requirements, you may open an HSA administered by Optum Bank. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. To open an account, go to www.optumbank.com
Important HSA Information
Always ask your health care provider to file claims with your medical provider so network discounts can be applied. 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 may open an HSA at the financial institution of your choice, but only accounts opened through Optum Bank are eligible for automatic payroll deductions.
Flexible Spending Accounts
One way to plan ahead and save money over the course of a year is to participate in our Flexible Spending Account (FSA) programs. FSAs allow you to pay for certain health, dental, vision, and dependent care expenses with pretax dollars that reduce your taxable income and save you money. There are two kinds of accounts: one for health care expenses and one for dependent care expenses. When you enroll, you must decide how much money to set aside from your paycheck for each account. Be sure to estimate your expenses conservatively as the IRS requires that you use the money in your account during the plan year and applicable grace period (the “use it or lose it” rule). 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 out-of-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 to pay doctor visit 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 either online or via fax or email:
Fax – 866-419-3516
Email – flexclaims@higginbotham.net
Online – https://flexservices.higginbotham.net
Dependent Care FSA
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents in order for you or your spouse to work or attend school full-time. The dependent child must be under age 13 and claimed as a dependent on your federal income tax return, or a disabled dependent of any age incapable of self-care and who spends at least eight hours a day in your home.
Reimbursement from your Dependent Care FSA is limited to the total amount that is deposited in your account at that time. In order to be reimbursed, you must provide the tax identification or Social Security number of the party providing care, and that provider cannot be anyone considered your dependent for income tax purposes.
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.
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 Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).
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.
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. Any unused FSA medical spending dollars up to $680 will automatically carry over to the end of your plan year (December 31, 2026). The carryover rule does not apply to your Dependent Care FSA.
FSAstore.com
FSAstore.com offers thousands of FSA-eligible products and services that can be purchased with your Higginbotham Benefits Card or any major credit card. With FSAstore.com’s competitive pricing and free shipping on orders over $50, you could save more than 40% using your FSA pretax dollars.
You can shop directly at www.FSAstore.com using your debit card, or have your physician submit prescriptions directly (some products will require a current prescription). FSAstore.com will also contact your physician to obtain a prescription for you.
The FSAstore.com Services Channel allows you to search a database of more than 300,000 health care providers for nearby eligible services, such as acupuncture and chiropractic care. The FSAstore.com Learning Center is focused on answering common questions about your FSAs and keeping you informed about changes to your FSA benefits.
Higginbotham Portal
The Higginbotham Portal has everything you need to manage your FSAs:
24/7 access to plan documents, letters and notices, forms, account balances, contributions, and other plan information
Update your personal information
Access Section 125 tax calculators
Look up qualified expenses
Submit claims
Request a new or replacement Benefits Debit Card
Register on the Higginbotham Portal
Go to https://flexservices.higginbotham.net and click Register Follow the instructions and scroll down to enter your information.
Enter your Employee ID, which is your Social Security number with no dashes or spaces.
Follow the prompts to navigate the site.
If you have any questions or concerns, contact Higginbotham:
Phone – 866-419-3519
Email – flexclaims@higginbotham.net
Fax – 866-419-3516
Dental Coverage
Our dental plans help you maintain good dental health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions for dental will be deducted from your paycheck on a pretax basis. The plan you choose will determine your premium. Dental coverage is provided through Mutual of Omaha
DPPO Plans
If you enroll in one of the DHMO plans, you and all eligible dependents must select a primary care dentist from the DHMO network directory to manage your care. Dental services are unlimited and have fixed copays. There are no deductibles or claim forms to file. Out-of-network care is not covered.
Find an In-Network Dentist
Visit www.mutualofomaha.com/dental
Dental Benefits Summary
1 Payment for covered services received from an out-of-network dentist is based on the 90th percentile of Usual, Customary, and Reasonable (UCR) charges.
2 The amount you pay after the deductible has been met.
Vision Coverage
Our vision plan provides quality care to help preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes and high cholesterol. You may seek care from any licensed optometrist, ophthalmologist, or optician, but plan benefits are better if you use an in-network provider. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Mutual of Omaha using the EyeMed network of providers.
Find an In-Network Vision Provider
Visit www.mutualofomaha.com/vision or call 866-289-0614 to find an in-network vision provider.
Vision Benefits Summary
Lenses
• Single vision
• Lined bifocals
• Lined trifocals
• Lenticular
Contacts
In lieu of frames/lenses
• Elective
• Medically
Exams
Lenses
Once every 12 months
Once every 12 months
Frames Once every 24 months
Contacts
Once every 12 months
Life and AD&D Insurance
Life and Accidental Death and Dismemberment (AD&D) insurance through Mutual of Omaha are important parts of your financial security, especially if others depend on you for support. With Life insurance, your beneficiary(ies) can use the coverage to pay off your debts, such as credit cards, mortgages, and other final expenses. AD&D coverage provides specified benefits for a covered accidental bodily injury that causes dismemberment (e.g., the loss of a hand, foot, or eye). In the event that death occurs from an accident, 100% of the AD&D benefit would be payable to your beneficiary(ies). As you grow older, your Life and AD&D coverage amounts reduce to 65% at age 65, and to 50% at age 70.
Basic Life and AD&D
Basic Life and AD&D coverages are provided at no cost to you. Employees are automatically covered up to $25,000.
Voluntary Life and AD&D
You may purchase additional Life and AD&D insurance for you and your eligible dependents. If you decline Voluntary 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 — proof of good health — may be required before coverage is approved. You must elect Voluntary coverage for yourself in order to elect coverage for your spouse or children.
If you leave Renew Home Health, you may take the insurance with you by paying premiums directly to Mutual of Omaha
1 Spouse rate is based on Employee’s age.
Annual Benefit Amount Increase
If you enroll in at least the minimum coverage when you first become eligible, you may increase your coverage by up to $10,000 at your next enrollment, as long as you stay within your maximum benefit amount. Any amount above the Guaranteed Issue requires proof of good health.
Living Care / Accelerated Death Benefit
If you are diagnosed with a terminal illness, you may request up to 80 percent of your life insurance benefit while you are still living, up to $250,000.
Designating a Beneficiary
A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
Disability Insurance
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. We offer Short Term Disability (STD) and Long Term Disability (LTD) insurance for you to purchase through Mutual of Omaha
Voluntary Short Term Disability
STD coverage pays a percentage of your weekly salary for up to 13 weeks if you are temporarily disabled and unable to work due to an illness, non-work-related injury, or pregnancy. STD benefits are not payable if the disability is due to a job-related injury or illness.
SHORT TERM DISABILITY
Voluntary Long Term Disability
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for more than 90 days. Benefits begin at the end of an elimination period and continue while you are disabled up to Social Security Normal Retirement Age (SSNRA) or two years.
Submit and Track Disability Claims
Sign in to www.mutualofomaha.com and go to the Claims section to get 24/7 access to submit, link, review, track, and correspond to your claims.
You can also call 800-775-8805 for assistance.
Supplemental Insurance
For an additional layer of protection, Renew Home Health offers the following voluntary benefits through Mutual of Omaha. The premiums for these benefits are deducted from your paycheck on a post-tax basis.
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. You may enroll yourself, your spouse, and your dependent children. If you suffer from a fracture, dislocation, or other covered accidental injury, Accident insurance can help offset unexpected medical expenses, such as emergency room fees, deductibles, and copays. Please refer to the benefit summary for details.
ACCIDENT INSURANCE
Confinement $400 per day up to 365 days
Care Unit $800 per day up to 15 days
Specific Sum Injuries Concussions, dislocations, eye injuries, fractures, lacerations, ruptured discs, and more
Accidental Death & Dismemberment1
•
1 Percentage of benefit paid for dismemberment is dependent on type of
Supplemental Insurance
Critical Illness Insurance
Critical Illness insurance complements your major medical coverage by providing a lump-sum cash benefit if you or a covered family member is diagnosed with a critical illness or event such as cancer, heart attack, stroke, end-stage renal kidney failure, etc. These benefits are paid in addition to what is covered under your medical insurance. This coverage helps with the costs such as lost income, meals, childcare, travel to and from treatment, high deductibles, copays, and out-of-network or alternative treatments. It also includes access to a personal health advocate who can assist you in managing health care services for you and your entire family. Please see the benefit summary for full policy information and requirements.
CRITICAL ILLNESS INSURANCE
Hospital Indemnity Insurance
The Hospital Indemnity plan helps you with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance which pays a benefit to the hospital or doctor, this plan pays a lump-sum cash benefit to help you take care of unexpected expenses. You can spend the money on childcare, meals, bills, etc. The benefit you receive is based on the service provided. The table below lists only a few of the covered services. See the plan document for full details.
Advanced multiple sclerosis; advanced Parkinson’s disease; ALS (aka Lou Gehrig’s disease); Alzheimer’s disease; benign brain tumor; coma/brain injury; dementia; end-stage renal failure; heart attack; heart, kidney, or organ failure; invasive cancer; loss of sight, speech, or hearing; major burns; occupational HIV; paralysis; stroke
Acute respiratory distress; carcinoma in situ; coronary artery disease; COVID-19; inflammatory bowel disease; skin cancer; transient ischemic attack
Employee Assistance Program
Mutual of Omaha provides an Employee Assistance Program (EAP) to help you and your family members cope with personal issues. Your EAP offers 24/7/365 counseling and support in the following areas.
EMPLOYEE ASSISTANCE PROGRAM
PERSONAL MATTERS LEGAL OR FINANCIAL MATTERS RESOURCES
Get in-person help for short-term issues
(up to five sessions per person, per issue, per year)
• Relationships
• Work/life balance
• Stress
• Grief and loss
• Childcare and eldercare
• Addiction
Get one free 30-minute meeting per legal issue and 25% off follow-up meetings
• College planning
• Estate planning
• Wills
• Legal counsel
• Home or car buying
• Moving
• Budgeting
Get a wide range of information, tools, and resources
• Articles and courses
• Videos
• Online tools
Don’t wait to ease your mind – experts are ready to give you 24/7/365 support.
Get Help Now
• Visit www.mutualofomaha.com/eap
• Call 800-316-2796.
Additional Benefits
Mutual of Omaha provides the following programs and services at no cost to you.
Worldwide Travel Assistance
AXA Assistance USA provides travel assistance for you and your dependents if you are traveling on any single trip more than 100 miles from home. Contact a representative to get trip planning assistance; translation, interpreter, or legal services; lost baggage assistance; identity theft recovery assistance; emergency funds; document replacement; medical emergency help; and more. Services are available for business and personal travel.
For inquiries within the USA, call 800-856-9947
From outside the USA, call 312-935-3658
Will Preparation
Creating a will is an important investment in your future. In just minutes, you can create a personalized will that keeps your information safe and secure. The services provided by Epoq offer a secure account space to prepare wills and other legal documents. Log in at www.willprepservices.com and use the code MUTUALWILLS to register.
Hearing Discount
You have access to a hearing discount program at no additional cost through Amplifon. This program provides free hearing testing, a low-price guarantee, a 60-day risk-free trial period, and two years of batteries with purchase. To activate your benefit, call 888-534-1747. Learn more at www.amplifonusa.com/mutualofomaha
Z Sonic Toothbrush Exclusive Offer
You may purchase Z Sonic toothbrushes at special discounted pricing as a Mutual of Omaha dental customer. These brushes remove more plaque, reduce gingivitis, whiten better than manual brushing, and deliver up to 41,000 sonic pulses per minute. Discounted replacement brush heads are available in four-count packs.
Z Sonic Pulse: $59.95 (regularly $99.95)
Z Sonic Mini: $14.50 (regularly $19.95)
To order, visit https://myzsonic.com/moo or call 888-228-7706 and mention the Mutual of Omaha member special.
Employee Benefit Cost Worksheet
The table below summarizes all the decisions you will need to make for enrollment. This is not an enrollment form. Review each decision carefully when completing this worksheet. Remember, your elections are permanent until next year’s enrollment period. This worksheet will help you prepare to complete your enrollment form. To determine the total of your per-pay-period deduction, simply add up the totals on each elected line of coverage. See the Wellness Program notice on page 27 for important information about rates.
Employee Only
• $15/hr
• $15.01-$20.99/hr
• $21-$30.99/hr
• $31-$40.99/hr
• > $41/hr
• $15/hr
• $15.01-$20.99/hr •
Required Notices
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998
In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully.
As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:
All stages of reconstruction of the breast on which the mastectomy was performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
Prostheses and treatment of physical complications of the mastectomy, including lymphedema.
Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
SPECIAL ENROLLMENT RIGHTS
This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.
Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP)
If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage).
If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance.
Marriage, Birth or Adoption
If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption.
For More Information or Assistance
To request special enrollment or obtain more information, contact:
Renew Home Health Human Resources 1021 Washington Avenue Fort Worth, TX 76104 817-921-6400
YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Renew Home Health and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Renew Home Health has determined that the prescription drug coverage offered by the Renew Home Health medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is not considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Renew Home Health 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 Renew Home Health 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
Required Notices
example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.
For more information about this notice or your current prescription drug coverage: Contact the Human Resources Department at 817-921-6400
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
Call 1-800-MEDICARE (1-800-633-4227) TTY users should call 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www. socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
January 1, 2026
Renew Home Health Human Resources 1021 Washington Avenue Fort Worth, TX 76104 817-921-6400
NOTICE OF HIPAA PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan – whether received in writing, in an electronic medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by Renew Home Health, hereinafter referred to as the plan sponsor.
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer.
You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask the Human Resources Department to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources Department.
Complaints: If you believe your privacy rights have been violated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer.
Renew Home Health Human Resources
1021 Washington Avenue Fort Worth, TX 76104
817-921-6400
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.
Required Notices
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444EBSA (3272)
If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, 2025. Contact your State for more information on eligibility.
TEXAS – MEDICAID
Website: https://www.hhs.texas.gov/ services/financial/health-insurancepremium-payment-hipp-program
Phone: 1-800-440-0493
To see if any other States have added a premium assistance program since July 31, 2025, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565
CONTINUATION OF COVERAGE RIGHTS UNDER COBRA
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the Renew Home Health group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Renew Home Health 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
Renew Home Health Human Resources 1021 Washington Avenue Fort Worth, TX 76104 817-921-6400
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
When you get emergency care or get treated by an out-of-network provider at an innetwork hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/ or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual 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-of-network provider.
You are protected from balance billing for:
Emergency services – If you have an emergency medical condition and get emergency services from an out-ofnetwork provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these poststabilization services.
Certain services at an in-network hospital or ambulatory surgical center – When you get services from an innetwork hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network 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-of-network. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by outof-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-ofnetwork services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/nosurprises for more information about your rights under federal law.
Required Notices
NOTICE REGARDING WELLNESS PROGRAM
The employee wellness program is a voluntary program administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness program you may be asked to complete a voluntary health risk assessment or “HRA” that asks a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease). You may also be asked to complete a biometric screening, which could include a blood test for certain medical conditions such as diabetes, heart disease, etc. You are not required to complete the HRA or to participate in the blood test or other medical examinations.
However, employees who choose to participate in the wellness program may qualify for an incentive. Although you are not required to complete a HRA or biometric screening, the wellness program may specify that only employees who do so will qualify for the incentive. Additional incentives may be available for employees who participate in certain health-related activities or achieve certain health outcomes.
If you are unable to participate in any of the health-related activities or achieve any of the health outcomes required to earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accommodation or an alternative standard by contacting Human Resources.
If you choose to participate in a HRA and/ or biometric screening, information from your HRA and results from your biometric screening will be used to provide you with information to help you understand your current health and potential risks and may also be used to offer you services through the wellness program. You also are encouraged to share your results or concerns with your own doctor.
Protections from Disclosure of Medical Information
We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program may use aggregate information it collects to design a program based on identified health risks in the workplace, the wellness program will never disclose any of your personal information either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.
Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements.
In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately.
You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.
If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact Human Resources.
This guide highlights the main features of the Renew Home Health employee benefits program. It is intended to help you choose the benefits that are best for you. This guide does not include all plan rules and details.
The terms of your benefit plans are governed by legal documents including insurance contracts. Should there be any inconsistency between this guide and the legal plan documents, the plan documents are the final authority. Renew Home Health reserves the right to change or discontinue benefit plans anytime.