2025 Warrior Benefits Guide

WARRIOR

Enabling all Warriors to thrive

The Heart of the Warrior

Our people-focused workplace is built to enable all Warriors to:

THRIVE personally and professionally by securing inclusive, comprehensive, cost-effective and flexible benefits, perks and amenities.

ENRICH their lives through opportunities to learn, grow and enhance our communities.

NOURISH their body to live life to the fullest.

CELEBRATE one another for the Warrioring that we do for our members, providers, clients and each other.

Our Warriors are at the heart of all we do. You work every day to provide an unmatched experience for our members, and we want to provide the same kind of experience for you. That’s the philosophy that our Total Rewards and Wellbeing programs are built on. Our offerings provide security and support that empower you to thrive in all aspects of your life. Our offerings are designed to support your overall health and wellbeing. You can choose from a variety of plans and options which include:

• Medical (4 plan choices)

• Health Savings Account

• Healthcare Flex Spending Account

• Dental

• Vision

• Critical Illness

• Hospital Indemnity

• Accidental Injury

• Supplemental Life and AD&D

• Dependent Care Flex Spending Account

Many of these benefits are provided at no cost to you, and most do not require enrollment in any of the plans above:

• Headspace Employee Assistance Program

• Short & Long-Term Disability

• Basic Life and AD&D

• AndHealth Migraine Reversal*

• Teledoc Services* (General Medicine, Dermatology, Mental Health)

• Omada Complete (for obesity-related chronic disease) *

• Omada Joint & Muscle Health*

• Medicare & Social Security Support

• Identity Theft Protection

*These solutions are 100% paid by Quantum Health and are available to Quantum Health medical plan participants. Refer to plan eligibility requirements.

We also offer a wide range of perks and amenities to support your overall wellbeing:

• Paid Time Off

• Paid Holidays

• Bereavement Leave

• Parental Bonding Leave

• Up to 4% Employer 401(k) Match

• Tobacco-Free Campus

• Adoption Assistance

• Tuition Reimbursement

• On-site Fitness Center

• Live & Virtual Fitness Classes

• Free Snacks & Drinks

• Volunteerism Opportunities

• Employee Resource Groups

• On-site Respite Areas

• Subsidized Food Court & Coffee Shop

Our total rewards program costs over $40 million. The majority of the spend is attributed to healthcare costs. Quantum Health is self-insured, meaning there is no insurance company paying the claims — we do. With healthy habits (diet, exercise and condition management) and good stewardship of plan utilization (using the right channel of care in the right situation), you can play a key role in minimizing the expected rise in 2025 healthcare costs.

Throughout the year, we continually review our total rewards program to ensure we are supporting our growing and diverse workforce in the most comprehensive way possible. We encourage your feedback! Please email suggestions to warrior.feedback@quantum-health.com

Stay well, Warriors!

Total Rewards

What’s New for 2025

Two New Medical Plans

To offer more choice to Warriors, we are introducing two new medical plan options for 2025: the Alternative Copay and Alternative HDHP (HSA) plans, both with reference-based pricing.

Our Alternative Plans are designed to offer:

• Lower cost, meaning you pay less out of your paycheck

• Open access, meaning more options for care in an open network

• Enhanced price protection so you don’t overpay for care. The Warrior Pod is available to assist you in navigating your claims and billing, finding quality providers in the open network, connecting you with point solutions, and more.

Remember: Quantum Health pays 100% of preventive care regardless of the plan you choose.

New Plans:

1. Alternative Copay with reference-based pricing will cost you much less out of every pay (lower premium) compared with the Traditional Copay but offers the same plan design (deductible, copays, out-of-pocket max). Additionally, you are only subject to the in-network limits regardless of where you seek care. Those who choose this plan can also enroll in the Healthcare Flexible Spending Account (HCFSA) (with new debit card!) to help pay for out-of-pocket costs pretax.

2. Alternative HDHP (HSA) with reference-based pricing offers the lowest per paycheck cost (premium) of all plans and is an HSA qualifying High Deductible Health Plan (HDHP) with quarterly contributions from Quantum Health.

Home Delivery with OptumRx for all maintenance medications

Optum Rx Home Delivery Pharmacy will save you time and money in 2025. Action required for all employees using maintenance medications − All maintenance drugs must be filled using our OptumRx Home Delivery service (you will only have access to 2 fills at retail). Best of all, you will save money by only paying 2.5x copays rather than 3x copays for your 90-day supply, and your prescriptions will be delivered right to your door. When ordering your 90-day supply via Home Delivery, you can choose to pay in full at the time of order or pay over time with Optum's Easy Pay program. You can also use your HCFSA or HSA funds to pay for your medications.

Healthcare Flexible Spending Account (HCFSA) Debit Card

In 2025, we are making it easier to spend your Healthcare Flexible Spending Account (HCFSA) dollars by providing you with an HCFSA Debit Card. The new HCFSA Debit Card will be provided to HCFSA account holders to make paying your expenses easier and stress-free. You can conveniently use your card to pay for all eligible out-of-pocket medical, dental, vision, pharmacy and qualified over-the-counter (OTC) expenses that you or your eligible dependents incur during the plan year. HCFSA's are available to any eligible employee enrolled in a copay plan (Traditional Copay (PPO) or Alternative Copay) and those who waive QH coverage for 2025. Your entire 2025 contributions to your HCFSA will be made available to you on your first day of active coverage, meaning you can start using your HCFSA funds before they come out of your paycheck.

Eligibility & Enrollment

FAQs and instructions

When Can I Enroll? When Is Coverage Effective?

• All newly hired or rehired employees can enroll in benefits during their first 30 days of employment. Benefits coverage will become effective the first of the month following the date of hire unless otherwise noted.

• Employees can enroll during the annual Open Enrollment period, November 4-15, 2024. Benefits changes made during Open Enrollment will become effective January 1, 2025.

Who Is Eligible?

• Enrollments can only be made or changed throughout the 2025 plan year if an employee experiences a Qualifying Life Event (QLE).

All full-time regular employees (30+ hours per week) and eligible dependents.

Eligible Dependents Include:

• Spouse or domestic partner (DP), including same-sex partners

• Children, stepchildren and/or children of your DP (if enrolling the DP in coverage). Children are eligible for coverage up to the age of 26

What Is Included as a QLE?

• Marriage or divorce

• Birth or adoption (coverage will take effect immediately)

• Your spouse or domestic partner has an employment status change that results in a loss or gain of coverage

• Dependent children and/or stepchildren of any age who are fully dependent upon you because of a physical or mental disability

• Dependent no longer qualifies as an eligible dependent (child reaching the age of 26)

• Child loses or gains coverage on another plan

• Court order or qualified medical support order

All life events must be entered in UKGPro, with documentation of the event, within 30 days of the event date. If you, your spouse or domestic partner, or eligible child(ren) lose coverage under Medicaid or a state Children’s Health Insurance Program (CHIP) or become eligible for state- provided assistance, you have 60 days to enter your life event in UKGPro and provide documentation. Once approved, all QLE changes will become effective the first of the month following the event date, except for a birth or adoption, in which case the coverage will take effect immediately.

Where Do I Enroll?

All enrollments and life events can be completed by logging into your UKGPro account at https: //ew44.ultipro.com/ and clicking on the Benefits icon.

BENEFIT ELIGIBILITY

Medical, Dental and Vision

Quantum Health offers you the choice of four medical plan designs: Traditional Copay (PPO), Alternative Copay, Traditional Alternative HDHP (HSA). Use this chart and the following scenarios to decide which one is right for you.

* With a reference-based pricing plan, your health coverage determines the allowed amount for medical services based on reference points. In our case consider costs up to this reference price according to the plan coverage, if a provider charges more, you may be responsible for the difference. By choosing If you choose one of these plans, engage the Warrior Pod to assist you in navigating your claims and billing (especially if your EOB does not match your bill)

Traditional HDHP (HSA),

COMPARISON TABLE

well-child checkups, immunizations, flu shots, well-woman exams, mammograms, other cancer screenings and more. healthcare.gov/coverage/preventive-care-benefits/. Certain preventive drugs, including some birth controls, are covered by the plan at 100%. see if yours is covered. Provider Network for Traditional Plans: “UHC Choice Plus”

$133.46 / $651.60

/ $638.52

Service Costs

Open Access In Network Out of Network Open Access

also has a maximum total throughout the year. True Family

The deductible is met by pooling expenses across all family members. One family member could pay toward the entire family deductible.

$30 / $50

(Deductible + Coinsurance) Deductible + Coinsurance Deductible + Coinsurance Deductible + Coinsurance Deductible + Coinsurance

$800 – Single $1,600 – Family

this is a percentage of what Medicare pays for coverage, to determine the value of a specific service. This means that while Quantum Health will choosing providers who accept the reference price, you can minimize or avoid out-of-pocket expenses and help keep your healthcare costs under control. bill) and finding quality healthcare.

OptumRx Home Delivery

For maintenance medications. OptumRx® Home Delivery is convenient and reliable.

Convenience

Medications are delivered to your mailbox, with free standard shipping.

Auto-Refill

Select auto-renewal so you never forget a refill.

Savings

You will pay less for your medication with a 3-month supply.

Easy Payment Plan

Payment for your 3-month supply may be spread over three smaller monthly installments.

24/7 Pharmacist Support

Speak to a pharmacist anytime, from the privacy of your own home.

Personalized Drug Pricing Tool and Reminders

Use the drug pricing tool for cost-saving opportunities. Set up text and email reminders to help you remember to take or refill your medications.

Here’s how to get started with home delivery:

• ePrescribe. Ask your doctor to send an electronic prescription to OptumRx.

• optumrx.com or OptumRx app. Easily find your medications and set up home delivery in just a few steps.

• Phone. Call the toll-free number on your member ID card.

Prescriptions from OptumRx should arrive within 5 business days after your complete order is received. You can check the status of your orders online.

Need Your Medication Right Away?

Ask your doctor for a 1-month supply that can be filled at a participating retail pharmacy. You will have access to two retail-based refills then will need to move to home delivery.

Formulary for 2025: Premium Formulary

Teladoc

Download the app to talk to a doctor anytime, anywhere,* by phone or video.

Your Teladoc Services:

General Medical

Talk to a doctor anytime, anywhere, by phone or video. Set up your account to talk to a U.S.-licensed physician for nonemergency medical conditions like the flu, sinus infections, bronchitis, and much more.

$49 or less / visit

Mental Health

Build a relationship with an experienced therapist or psychiatrist of your choice by phone or video. Our experts provide support for:

• Anxiety, stress, depression

• Mood swings

• Not feeling like yourself

$90 or less / therapist visit

$220 or less / psychiatrist first visit

$100 or less / psychiatrist ongoing visit

Dermatology

• Relationship conflicts

• Trauma & PTSD

• Medication management

Healthy skin made easier. You no longer have to wait weeks for an appointment. Simply use your Teladoc account to upload images of your skin condition and a U.S. board-certified dermatologist will provide a diagnosis and treatment plan customized for your skin condition.

$85 or less / visit

Account Set-Up:

Set up your Teladoc account in 4 easy steps:

1. Download The App. Search for “Teladoc” in the App Store or on Google Play.

2. Set Up Your Account. Once you’ve downloaded the app, select “Set up your account.”

3. Enter Basic Contact Information. Provide some information about yourself to confirm your eligibility. We’ll confirm we found your benefits and you’ll continue creating your account.

4. Create Your Account. Enter your address and phone number, create a username and password, pick security questions, and agree to terms and conditions.

Have Traditional or Alternative Copay plan?

Participants of the copay plans will pay copays of $10 / $10 / $50 when using Teladoc services.

If you enroll in a one of the Alternative plans for 2025 and have used Teladoc in the past, you will have to create a new Teladoc account.

Note: Teladoc benefits listed above are available to Quantum Health employees enrolled in ANY medical plan. *Teladoc is not available internationally.

Making the Best Choice

There are many factors to consider when making a decision on your health coverage. When making a choice:

• Compare all Quantum Health medical plans with other medical plans that you may have access to (e.g., spouse coverage through their employer). Consider the scope of services, networks and any additional perks of each plan (e.g., tax advantaged savings accounts)

• Consider your health and the health of your dependents. If you plan for the care you know you’ll need, you’ll be able to select a plan that offers optimal coverage based on your budget.

• Consider your budget. Assess your current financial state and compare out-of-pocket costs for each plan.

• Consider planned life changes in 2025. Are you expecting any major changes like birth of a child, retirement or any kids aging off of your plan?

Utilize the following scenarios that show examples of how plans compare based on specific needs. Please note this is for educational purposes only and is not meant to offer advice on which plan to choose based on any specific circumstances. As always, the Warrior Pod is here to support you. Reach out with any questions regarding plan options.

CHOOSING A MEDICAL PLAN

It can be hard to choose the right plan for you and your family. Below, there are several scenarios of members with different care needs, and an illustration of the costs they might face under Quantum Health's medical plans, when utilizing in-network providers (for the traditional plans). Katie

Katie is a healthy 24-year-old with no medical issues, enrolled in employee-only coverage. She typically only goes to the doctor when attending her annual health exam and does not meet her deductible in a year.

Steve

Steve is a 45-year-old with controlled diabetes, enrolled in employee + spouse coverage. He has a mail order, generic prescription and uses a continuous glucose monitor to track his glucose levels. All claims below are for Steve.

Mallory

Mallory is a 31-year-old enrolled in family coverage with another baby on the way. She and her family have no medical issues, but because she is pregnant, they expect to hit their out-of-pocket maximum this year.

This is not a cost estimator. Treatments shown are just examples of how these plans might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. This example does not account for any balance bills you may receive under the Alternative Plans due to reference-based pricing (RBP) set-up.

Employee + Spouse / Domestic Partner

(Employee Rate / Quantum Contribution)

Employee + Child(ren)

(Employee Rate / Quantum Contribution) $10.59 / $32.74

Employee + Family

(Employee Rate / Quantum Contribution)

Dental Benefits

Quantum Health is partnered with Delta Dental to provide your dental benefits coverage.

Maximum Benefit

$2,500 per person per calendar year.

Maximum Carryover

$500 can be carried over from one calendar year to the next. This amount can accumulate but will not exceed $1,250.

Deductible

$50 deductible per person per calendar year, limited to a maximum of $150 per family per calendar year. Deductible is waived for diagnostic and preventive services.

ID Cards

ID cards are not issued for dental coverage, but employees can download generic ID cards from deltadentaloh.com or use an electronic ID card through the Delta Dental mobile app.

When you make your appointment, tell them you have Delta Dental of Ohio.

/ Quantum Contribution)

/ $2.63 Employee + 1 (Employee Rate / Quantum Contribution)

Employee + 2+ (Employee Rate / Quantum Contribution)

/ $4.01

Vision Benefits

Quantum Health offers a vision plan through VSP. The VSP Signature plan offers you access to both private practice eye doctors and eye doctors in some of your favorite retail locations.

YOUR COVERAGE WITH A VSP PROVIDER

WellVision Exam

Prescription Glasses

Frame

Lenses

Lens Enhancements

Contacts (instead of glasses)

Primary Eyecare

Extra Savings

Focuses on your eyes and overall wellness

$150 featured frame brands allowance

$130 frame allowance

20% savings on the amount over your allowance

$130 Walmart / Sam’s Club frame allowance

$70 Costco frame allowance

Single vision, lined bifocal & lined trifocal lenses

Impact-resistance lenses for dependent children

Standard progressive lenses

Premium progressive lenses

Custom progressive lenses

Average savings of 40% on other lens enhancements

$130 allowance for contacts; copay does not apply Contact lens exam (fitting and evaluation)

Retinal screening for members with diabetes

Additional exams and services for members with diabetes, glaucoma, or age-related macular degeneration

Treatment and diagnosis of eye conditions, including pink eye, vision loss and cataracts, available for all members

Limitations and coordination with your medical coverage may apply. Ask your VSP doctor for details.

Glasses and Sunglasses

$25 for exam & glasses Every calendar year

Combined with exam Every other calendar year

Combined with exam Every calendar year

$120-$160 Every calendar year

Up to $60 Every calendar year

$0 $20 per exam As needed

Extra $20 to spend on featured frame brands. Go to vsp.com/offers for details.

30% savings on additional glasses and sunglasses, including lens enhancements, from the same VSP provider on the same day as your WellVision Exam.

Or get 20% from any VSP provider within 12 months of your last WellVision Exam.

Routine Retinal Screening

No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam.

Laser Vision Correction

Average 15% off the regular price or 5% off the promotional price; discount only available from contracted facilities. After surgery, use your frame allowance (if eligible) from sunglasses from any VSP doctor.

Your Coverage with Out-of-Network Providers

Get the most out of your benefits and greater savings with a VSP network doctor. Call Member Services for out-ofnetwork plan details.

ID Cards

ID cards are not issued for vision coverage, but employees can download generic ID cards from vsp.com or use an electronic ID card through the VSP mobile app.

Coverage with a retail chain may be different or not apply. Log in to vsp.com to check your benefits for eligibility and to confirm in-network locations based on your plan type. VSP guarantees coverage from VSP network providers only. Coverage information is subject to change. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business.

When you make your appointment, tell them you have VSP.

Tax Advantaged Savings Accounts

Save money while covering out-of-pocket costs. Take full advantage of the tax advantaged savings accounts available to you.

Tax advantaged savings accounts are a great way to save money. The money you contribute to these accounts comes out of your paycheck without being taxed, and you withdraw it tax-free when you pay for eligible healthcare and dependent care expenses.

Question about how to maximize savings? Contact the Warrior Pod.

Eligibility

Annual Contribution from Quantum Health (quarterly installments)

IRS 2025 Annual Total Contribution Limits* (Employee contributions + Quantum’s Contributions)

Those enrolled in an HSA qualifying High Deductible Health Plan (HDHP)

Employee Only - $800

Employee + Spouse, Child(ren), Family - $1,600

For new employees, contributions are prorated based on the effective date of coverage during your first year of coverage only

Employee Only - $4,300 Employee + Spouse, Child(ren), Family - $8,550 Catch-Up Contribution (for employees 55+ years of age) $1,000

When Are Funds Available?

Employee contributions accrue per paycheck. Quantum Health contributes funds quarterly, which are available for use once they’ve been funded to your account.

Debit Card Available? Yes

Eligible Expenses

Use It or Lose It?

Portability

HCFSA funds can be used on any dependent you can claim on your tax return. DCFSA funds can be used on any natural, adopted, and foster children who have not reached age 13 and family members who cannot care for themselves.

Out-of-pocket medical expenses: medications, prescriptions, deductibles, dental care, lab exams, various over-the-counter

No. Funds roll over year to year.

The account belongs to you indefinitely, whether you change jobs or health plans.

*Note: To take full advantage of the IRS limit, set your annual maximum contribution at the IRS limit, minus the company contribution.

SAVINGS ACCOUNTS

HEALTHCARE FLEXIBLE SPENDING ACCOUNT (HCFSA)

Those enrolled in a copay plan (Traditional Copay or Alternative Copay) and those who waive QH medical coverage

Anyone with eligible dependent care expenses N / A N / A

At the time of this publication, IRS contribution limits have not yet been established for 2025

At the time of this publication, IRS contribution limits have not yet been established for 2025 N / A N / A

Quantum Health provides you with access to 100% of your contributions upfront on Jan. 1, meaning you can start spending before the funds come out of your paycheck!

Funds accrue per paycheck and are available for use once they have been funded to your account.

Yes (NEW FOR 2025) No

deductibles, copays, coinsurance, bandages, sunscreen, eyecare, medical devices and supplies, and much more

Yes. Must use all funds within plan year + 2.5-month grace period in the next calendar year.

If you do not use funds within plan year + 2.5 months, you forfeit funds.

If you leave Quantum Health, you forfeit the funds unless you spend them before leaving.

Pay for eligible expenses related to dependent care such as childcare, before-school / afterschool care, day camps, nursery, summer camp, babysitter, homecare for elders, and much more

Yes. Must use all funds within plan year + 2.5-month grace period in the next calendar year.

If you do not use funds within plan year + 2.5 months, you forfeit funds.

If you leave Quantum Health, you forfeit the funds unless you spend them before leaving. Your contributions and withdrawals are all TAX FREE!

Health Savings Account (HSA)

An HSA allows you to save money for qualified medical expenses that you’re expecting, such as contact lenses or monthly prescriptions, as well as unexpected ones − for this year and the future.

Who Is Eligible for an HSA?

You must be enrolled in the HSA Health Plan to participate.

To be eligible and qualify for an HSA, you must be enrolled in our Traditional HDHP (HSA) or our Alternative HDHP (HSA).

Who is ineligible for an HSA plan?

• Those covered by any other health plan except what is permitted (dental, vision, disability, and some other types of additional coverage are permissible).

• Those enrolled in Medicare, TRICARE or TRICARE for Life.

• Those who have received Department of Veterans Affairs (VA) benefits within the past three months, except for preventive care. If you are a veteran with a disability rating from the VA, this exclusion does not apply.

Quantum Health’s Contribution to Your HSA

• Those claimed as a dependent on someone else’s tax return.

• Those who have a healthcare flexible spending account (FSA) or health reimbursement account (HRA). Other plan designs, such as limited-purpose FSA or HRA may be permitted.

• Other restrictions and exceptions also apply. Consult a tax, legal or financial advisor to discuss your personal circumstances.

Quantum Health wants to help you grow your HSA funds. We will make quarterly installments to your HSA on the first pay date of each quarter. For new employees, contributions are prorated based on the effective date of coverage during your first year of coverage only.

Participants in an HSA can increase, decrease, start or stop their own contribution anytime during the calendar year.

Note: To take full advantage of the IRS limit, set your annual maximum contribution at the IRS limit, minus the company contribution.

Flexible Spending Accounts (FSA)

Quantum Offers You the Following FSAs:

Healthcare FSA: Pay for eligible healthcare expenses, including out-of-pocket expenses such as plan deductibles, copayments and coinsurance, but not insurance premiums.

Dependent Care FSA: Pay for eligible expenses relating to dependent care, including daycare, preschool and summer camp.

Estimate Carefully

What’s an Eligible Expense?

Healthcare FSA: Plan deductibles, copays, coinsurance and other healthcare expenses. To learn more, see IRS Publication 502 at www.irs.gov.

Dependent Care FSA: Child day care, babysitters, home care for dependent elders, and related expenses. To learn more, see IRS Publication 503 at www.irs.gov.

Keep in mind, FSAs are “use-it-or-lose-it” accounts. You generally must use all the money in an FSA within the plan year. Quantum Health offers a “grace period” of 2.5 extra months to use the money in your FSA. At the end of the grace period, you forfeit any money left over in your FSA.

Healthcare Flexible Savings Account (HCFSA)

A Few Things to Note About Your Healthcare Account (HCFSA):

By enrolling in a Healthcare Flexible Spending Account, you can set aside pretax dollars to pay for healthcare expenses not covered by your benefits plan. That means more money for you and your family!

• All expenses reimbursed by the HCFSA must be healthcare services received during the plan year.

• When submitting claims for healthcare, you must either include a written statement (bill) from the provider stating the eligible expenses that have been incurred and the amount, or submit an explanation of benefits (EOB) from any primary medical, dental or vision coverage indicating the amount(s) that you are obligated to pay.

Maximum Contribution

• Once you’ve selected the amount to be deducted from your pay, you cannot change the amount during the year unless you experience a permissible qualified change such as marital status, dependent status or employment status.

At the time of this publication, 2025 HCFSA contributions limits have not been set by the IRS. The IRS HCFSA maximum is $3,200 in plan year 2024.

Dependent Care Flexible Spending Account (DCFSA)

If you enroll in a Dependent Care Flexible Spending Account (DCFSA), you can use pretax dollars to cover eligible expenses like:

• Expenses for family members who cannot care for themselves. Expenses must not be attributable to medical services. The dependent must be a qualifying individual that still spends at least eight hours each day in the employee’s household

• Day care for children under 13 by babysitters, day care centers, nursery schools and preschools (if the primary purpose is to care for the child rather than educate)

• Custodial expenses

A Few Things to Note About Your Dependent Care Account (DCFSA):

• Accounts are in the enrollee’s name only, so only the enrollee can register.

• Reimbursement being requested must be for services already incurred. Funds that are available at the time of claim submission will be reimbursed to the member upon processing of the claim

• If there are not sufficient funds in the account at the time of claim submission, the member will be reimbursed up to the available balance. The remainder of the claim will pend until further contributions are made

Maximum Contribution

• If you are uncertain about the eligibility of your childcare expenses, check with your personal tax advisor

• Dependent Care FSA funds must be spent by the participant within the FSA’s plan year. Unused funds will be forfeited

• Eligible expenses must be used to enable the employee and spouse to be gainfully employed and their primary purpose must be to care for children while parents are at work

At the time of this publication, 2025 DCFSA contributions limits have not been set by the IRS.

Know Your Eligible & Ineligible Expenses for Tax Advantaged Savings Accounts

If you have a tax advantaged savings account, pretax dollars may only be used to cover eligible expenses. To better understand what is and isn’t eligible, find a full list of reimbursable expenses at www.hsabank.com/hsabnk/LearningCenter/IRS-Qualified-Medical-Expenses

Eligible Healthcare Expenses are listed in Publication 502 and Dependent Care in Publication 503 at www.irs.gov

Know Where to Go for Care

You have many options for healthcare. The option you choose can make a big difference in how much you pay. See below for a general guide for the most cost-effective, timely care based on your needs.

Remember: Preventive services are covered at 100% in-network with no out-of-pocket expense. This includes annual physicals, well-child checkups, immunizations, flu shots, well-woman exams, mammograms, and other cancer screenings. And more! For a complete listing of covered preventive services, visit https://www.healthcare.gov/coverage/preventive-care-benefits.

EAP / Headspace

Telemedicine

FREE to you (Quantum Health Pays)

Retail Clinics

Primary Care

Urgent Care Clinic

Mental health coaching is immediate In-person therapy – avg of 6 weeks

$ Same day or more

Access to mental health coaching, therapy, psychiatry, hundreds of meditations and other resources for all of life’s needs.

Telemedicine (like Teladoc) is a convenient, affordable option if you need quick help, 24/7.

Stress, anxiety, depression, anger, grief, sleep, family needs, financial needs, etc.

Emergency Room / Department

$ 15 min or less

$ $ 30-60 days

$ $ $ 20-30 minutes

$ $ $ $ 3-12 hours (non-critical cases)

Typically staffed by a nurse practitioner and located in a retail space (grocery stories, pharmacies, etc.).

Can offer you preventive services, personalized treatment plans, and referrals to specialists as needed.

Facility that provides immediate, non-emergency care for illness and injuries that require prompt attention.

Usually housed in hospital (but sometimes listed as "urgent care emergency facility"), and is available 24/7/365.

Allergies, rashes, cold, flu or minor illnesses or injuries.

Allergies, rashes, cold, flu or minor illnesses or injuries, vaccinations, etc.

Routine check-ups, physicals, mgmt. of chronic conditions, acute illnesses, general (nonemergency) health concerns, mental health, Rx mgmt.

Allergies, rashes, cold, flu, minor illnesses, minor injuries, x-rays, lab tests, minor procedures (stitches, wound care, etc.), vaccinations, etc.

Life-threatening health issues like heart attacks, strokes, seizures, severe injuries, and deep cuts or wounds.

PAID BY QUANTUM HEALTH | Available to all eligible employees, regardless of medical plan enrollment. Enrollment in these offerings is not part of your Open Enrollment election process.

More than just an EAP... Headspace

Headspace provides one-on-one mental health coaching, easy access to appointments with clinicians, and hundreds of guided exercises for meditation, mindfulness, sleep, focus, and movement to help you feel like your best self.

Quantum Health Warriors have access to a mental health benefit that helps you manage stress, build resilience, and navigate life’s challenges. Headspace offers hundreds of meditation and mindfulness exercises to help you stress less, sleep soundly, and relax more. And when you need a little more support through tough situations, you’ll have access to one-on-one guidance from mental health coaches and clinicians. Available the first day of employment. Get started at work.headspace.com/quantum/member-enroll

Everyday Mindfulness

Meditation, sleep support and mindful activities to help you stress less, sleep soundly and relax more.

Mental Health Coaching

Text with a coach who can guide you through challenging emotions, help you reach your wellbeing goals, and refer you to a clinician if you need a little more support.

Additional Work & Life Support

Referrals to resources for help with everyday stressors like child and eldercare, financial and legal needs, professional development, and more.

Guided Programs

Move through courses at your own pace and learn how to manage worry and anxious thoughts.

Care That Fits Into Your Life

When you need a little more support, your coach might recommend therapy or psychiatry to help you navigate whatever life may bring. Schedule a video session in the app and see a clinician within days. You can also meet with a therapist in person.

Who Qualifies?

Headspace is available to all Quantum Health employees and their household family members, not just full-time regular employees.

Life, AD&D and Disability

Quantum Health is proud to offer several benefits through Prudential at no cost to you.

Basic Life and Accidental Death and Dismemberment (AD&D)

• For newly hired full-time regular employees, Basic Life and AD&D will begin on the first of the month following your date of hire.

• The coverage amount is 2x an employee’s annual base salary, rounded to the next highest $1,000, to a maximum of $800,000. Any amount over $675,000 will be subject to approval, and an evidence of insurability (EOI) form will need to be completed.

• In the event of a death, this benefit would pay out to the employee’s designated beneficiaries. Make sure to have a beneficiary on file and keep it up to date.

• AD&D benefits would pay in the event of your death or serious injury from a covered accident.

Short-Term and Long-Term Disability (STD and LTD)

• Newly hired full-time regular employees are enrolled in disability coverage the first of the month following 180 days of continuous employment.

• STD provides income replacement at 60% of your normal weekly salary, up to $2,000 per week, for up to 25 weeks of injury or illness. There is a 7-day wait period before benefits will begin to pay.

• LTD is available after 180 days of continuous disability. LTD pays 60% of your monthly salary, up to $20,000 per month. LTD may pay until you reach the Social Security normal retirement age (NRA).

• Please note all benefits are subject to the approval of the medical underwriters at Prudential. Any benefit paid under the disability policies is considered taxable income.

Medicare & Social Security

Quantum Health provides direct access to experts who deliver navigational guidance and support focused on Medicare and Social Security. All regular employees and their immediate family members are invited to tap into the expertise provided by HUB | HORAN.

Medicare & Social Security Complimentary Services:

• Quarterly Seminars

• One-on-one appointment scheduling to meet with dedicated Medicare & Social Security Experts

• Designated support team to answer Medicare and Social Security Questions

• Hands-On Social Security filing guidance

• Assistance with filing for Medicare benefits including Drug Plan & Supplement / Advantage Plan

• Individualized Social Security analysis

Social Security Provides More Than Just Retirement Benefits:

• Retired workers and their dependents accounted for 76.9% of total benefits paid in 2022.

• Disabled workers and their dependents accounted for 11.6% of total benefits paid in 2022.

– In 2022, about 90% of workers aged 21-64 in covered employeement, plus their families, were protected.

– About 1 in 4 of today’s 20-yearolds will become disabled and entitled to Social Security disabled worker benefits before reaching age 67.

– 65% of the private sector workforce has no long-term disability insurance.

• Survivors of deceased workers

Identity Theft Protection

accounted for 11.5% of total benefits paid in 2022.

– More than one in eight of today’s 20-year-olds will die before reaching age 67.

– About 96% of persons aged 20-49 who worked in covered employment in 2022 have survivors insurance protection for their children under age 18 (and surviving spouses caring for children under age 16).

Scan the QR code to schedule an appointment with an expert today!

Quantum Health is proud to provide our employees with identity theft protection. Allstate Identity Protection monitors identity and credit, dark web, financial transactions, and social media reputation. Plans include a $1 million identity theft insurance policy.

How Allstate Identity Protection Works

1. Enroll: Access to your full monitoring capabilities begins on the first of the month following your date of hire. Employees must enroll in coverage by logging on to myaip.com and registering. You will NOT be auto-enrolled.

2. We Monitor: Our advanced technology looks for suspicious activity associated with your personal profile.

3. We Alert: We alert you to any activity associated with your account.

4. We Restore: In the event of identity theft, we fully manage the process of recovering your identity, credit, and sense of security so the impact to your life is minimal.

5. We Reimburse: Our $1 million identity theft insurance policy covers the costs associated with reinstating your identity.

What’s Included:

Identity and credit monitoring

Dark web monitoring

Financial transaction monitoring

Social media reputation monitoring

Accounts secured with two-factor authentication

24/7 Privacy Advocate remediation

$1 million identity theft insurance policy

Looking for More Coverage?

Employees can choose to buy additional coverage for themselves and their family members for a flat monthly rate of $9.95. Employees will be billed directly by provider for payment.

COMPLIMENTARY BENEFITS PAID BY QUANTUM HEALTH | Available to all who enroll in a Quantum Health medical plan. Enrollment in these offerings is not part of your Open Enrollment election process.

Omada

A digital care program that surrounds you with the tools and support you need to build healthy patterns that stick. All at no cost to you.

For Obesity-Related Chronic Disease

Get a jump on building healthy habits

Omada offers personalized behavior change to enable people everywhere to live free of chronic disease. Omada empowers people with obesity-related chronic disease to build healthy habits that last.

• If you are at risk for Type 2 diabetes or heart disease, or are living with diabetes (Type 1 or Type 2) or high blood pressure, and enrolled in a Quantum Health medical plan, Quantum Health will cover the cost of the program.

• You’ll get 24/7 support from professional health coaches and diabetes specialists, accountability from smart devices you need, and empowerment from weekly lessons and encouragement from an online community.

For Joint & Muscle Health

Shift your mindset, change your health

Remove the barriers between you and recovery with Omada® for Joint & Muscle Health.

What you’ll get:

• A dedicated, licensed physical therapist

• Unlimited 1:1 chats and video visits with your PT

• Treatment plan from head to toe

• Free exercise kit with all the tools you need

Enrollment

• Omada benefits are provided to participants of the Quantum Health medical plans who are 18 and older. Enrollment in the PPO Plan, HSA Health Plan or Hybrid PPO Plan is required.

App-guided exercises

3D animations and voice narration help with pacing and form.

Anytime, anywhere access Message your physical therapist for guidance and support.

To see if you qualify, go to omadahealth.com/quantum and complete the 1-minute assessment!

Migraine Reversal Solution Program

Unlike the typical migraine standard of care, AndHealth's solution takes the time to discover and treat the root cause of your migraines, and provides health coaching and behavior change support to make sure that you reach your health goals.

Migraines are an underground epidemic in the United States, with people suffering for decades undiagnosed or undertreated. That’s why Quantum Health has partnered with AndHealth to bring a revolutionary migraine reversal program to medical benefits enrollees.

The AndHealth Program Includes:

• Virtual visits and access to the program through the app, allowing you to have an appointment wherever and whenever is convenient for you

• A collaborative care team, including physicians, neurologists, health coaches, care coordinators, clinical pharmacists and nutritionists

• Collaboration (if desired) with your existing providers on your treatment plan

• Comprehensive lab testing to determine your root cause

• Personalized nutritional plan, supplements and medication management

“ It’s wonderful! I have so much more time back in my day. I feel so much more productive and quite honestly happier and accomplished that I’m not taking time off to baby myself.”

– Quantum AndHealth patient

Program Eligibility

Employees, their spouses/partners and their dependents (18+) covered under the Quantum Health medical benefit plans are eligible for the program.

Enrollment Details

You can sign up for an enrollment appointment at any time during the year at AndHealth.com/Quantum or by scanning the QR code.

VOLUNTARY BENEFIT ENHANCEMENTS (EMPLOYEE PAID ADD-ONS) | Available to all eligible employees, regardless of medical plan enrollment. To enroll, action is required during Open Enrollment.

Supplemental

Life and AD&D

In addition to the company-paid life insurance, employees may elect to purchase additional life and AD&D insurance through Prudential.

Employee Life and AD&D

Can be elected in $10,000 increments up to $750,000 with guaranteed approval for any election up to $300,000.* Any election over $300,000 requires completion of an evidence of insurability (EOI) form and approval by Prudential’s underwriting team.

Spouse (Domestic Partner) Life and AD&D

Can be elected in increments of $5,000 up to $250,000, not to exceed 50% of the employee’s supplemental life coverage. Spouse life is guaranteed for any election up to $50,000.* Anything over $50,000 requires completion of the EOI form and approval by Prudential’s underwriting team. Spouse rate is based on the employee’s age.

Child(ren) Life and AD&D

Can be elected for $10,000, if the employee has a minimum of $10,000 of supplemental employee life coverage. Rate for child life is $1.16 per pay period (26 pay periods). One premium rate covers all eligible children.

Rates Chart

How to calculate your Supplemental Life biweekly cost: Total Coverage Amount x Rate / $1,000 x 12 / 26=Biweekly Cost

SUPPLEMENTAL LIFE INSURANCE (INCLUDING AD&D) RATES FOR SPOUSE

Accident Insurance

An accident can bring unexpected expenses. Accident coverage provides a lump-sum payment when a covered person has medical services and treatments related to accidental injuries.

What’s Covered?

Accident Insurance covers a variety of accidental injuries, including broken bones, concussions, dislocations and burns. It also covers medical services like ambulance transportation, ER visits, medical tests and physical therapy. For a full list of benefits, please see the Accident Plan Summary on the Warrior Web.

Hospital Indemnity

Hospital Indemnity coverage is designed to help with out-of-pocket expenses and extra bills in the event of a hospitalization.

What’s Covered?

The plan pays a cash benefit of $1,000 upon admission and $100 for each day a covered person is hospitalized, up to a maximum of 30 days.

ENHANCEMENTS (EMPLOYEE PAID ADD-ONS) | Available to all eligible employees, regardless of medical plan enrollment. To enroll, action is required during Open Enrollment.

Critical Illness Coverage

Critical Illness coverage will pay a one-time lump-sum cash benefit in the event a covered person is diagnosed with one of the covered critical illnesses while covered on the plan.

Covered Illnesses

Some examples of a covered illness are heart attack, stroke, cancer, kidney failure, Alzheimer’s, Crohn's, MS, and Type 1 diabetes. For a full list of covered illnesses, see the plan summary on the Benefits SharePoint page.

$10,000

EMPLOYEE / $5,000 SPOUSE AND CHILD(REN) BIWEEKLY RATES

Pet Health Insurance

Routine Care Coverage

There are two tiers of routine care coverage that can be added to one of our pet health insurance plans for an additional premium at the time you enroll, or at your annual renewal.

Accident Only Coverage

If your pet currently has Addison’s Disease, Cushing’s Disease, Diabetes, Cancer, Feline Leukemia or Feline Immunodeficiency Virus, you can enroll them in Accident Only coverage, but they will be ineligible for illness coverage. The Accident Only plan does not cover medical issues such as illness or cancer, but provides up to $10,000 in annual coverage for things like broken legs, snake bites, accidental swallowing, and more. Coverage starts at $9 per month for dogs, and $6 per month for cats.

Accidents, Illness, Cancer, Hereditary Conditions, Emergency Surgeries, & Most Rx Meds

Accidents & Illness Exam Fees Associated with the Diagnosis of Your Pet for an Eligible Injury or Illness This is not intended to cover routine exams.

Rehabilitative, Acupuncture & Chiropractic Coverage or Treat Eligible Injuries and Illnesses

Add-On for Routine Care

Enrollment

To begin, enroll at petsbest.com/QHPETS and use reference code QHPETS for 10% off.

Benefits Include

• Wellness Exams

• Spaying & Neutering

• Teeth Cleaning

• Diagnostic Panels

• Preventive Medications

• Vaccinations

• Microchipping

Fidelity 401(k) Retirement Plan

Everhart Advisors, the advisor on our Fidelity 401(k) plan, provides Quantum Health employees with FREE information, guidance and resources to help manage funds and plan for retirement.

Salary Deferral Contributions: What You Need to Know

• Eligible employees will be auto-enrolled to contribute at a pretax contribution rate of 3%.

• Contribution rates will auto-increase by 1% annually in March, not to exceed 10%.

Quantum’s Contributions

• Employees can begin saving on their first day of employment! Reach out to Fidelity to increase your contribution amount by calling 800-835-5097.

• Quantum Health contributes up to 4% of your salary when you contribute at least 5%. We match dollar for dollar up to the first 3% of your salary contributions and match 50% for the next 2% you contribute.

• Employees are 100% vested in the company match starting day one!

QUESTIONS? We can help.

Everhart Advisors will provide onsite office meetings throughout the year; however, you can contact them directly to make an appointment by calling 844-GOT-401K (844-468-4015) or by emailing them at help@everhartadvisors.com

401k changes can be made at any time of the year by logging into your account at 401k.com or by calling Fidelity directly at 800-835-5097.

Time Away

Paid Parental Bonding Leave

Quantum Health is committed to supporting our Warriors and their families, especially when they welcome the arrival of a new child! For this reason, we offer eligible employees Paid Parental Bonding Leave to support the bonding experience.

This benefit provides 12 weeks of leave following the birth, adoption, placement for foster care, or placement through surrogacy of a child under 18 years old, with varying amounts of salary continuation based on the employee’s tenure.

SALARY CONTINUATION

Paid Time Off (PTO)

PTO offers full-time regular employees the flexibility to use earned time off as desired. Sick days and personal days are included in your PTO bank.

Our employees holding positions at the manager, director, vice president and executive levels are accessible to the business outside of their normal work hours. To that end, our PTO policy affords them the flexibility to take paid time off when work permits.

*Hours accrued per pay period during year one

Holidays

Regular employees of Quantum Health are eligible for holiday pay when the company closes in observance. Holiday pay is effective immediately upon hire. If a holiday falls on a weekend, the company will designate another day to be observed.

• New Year’s Day

• Memorial Day

• Independence Day

• Labor Day

Thanksgiving Day

Day After Thanksgiving • Christmas Day

Questions About Your Benefits?

View your medical ID card, or add it to Apple Wallet or Google Wallet.

Search for in-network providers and connect with a Care Coordinator.

in the

Legal

Notice of Special Enrollment Rights for Medical/Health plan coverage

As you know, if you have declined enrollment in Quantum Health Inc.’s group plan for you or your dependents (including your spouse) because of other health insurance coverage, you or your dependents may be able to enroll in some coverages under this plan without waiting for the next open enrollment period, provided that you request enrollment within 30 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your eligible dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.

Quantum Health Inc. will also allow a special enrollment opportunity if you or your eligible dependents either: Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible, or Become eligible for a state’s premium assistance program under Medicaid or CHIP.

For these enrollment opportunities, you will have 60 days – instead of 30 – from the date of the Medicaid/CHIP eligibility change to request enrollment in the Quantum Health Inc. group health plan. Note that this new 60-day extension doesn’t apply to enrollment opportunities other than due to the Medicaid/CHIP eligibility change.

Note: If your dependent becomes eligible for a special enrollment right, you may add the dependent to your current coverage or change to another health plan.

Women’s Health and Cancer Rights Act notice

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:

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;

Prostheses; and

Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your plan administrator at 1-866-952-0363.

Newborns’ and Mothers’ Health Protection Act notice

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information on maternity benefits, call your plan administrator at 1-866-952-0363

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow. gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employersponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-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, 2024. Contact your State for more information on eligibility.

Website: http://myalhipp.com/ Phone: 1-855-692-5447

Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)

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-health-plan-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

GA HIPP Website: https://medicaid.georgia.gov/health-insurancepremium-payment-program-hipp Phone: 678-564-1162, Press 1

GA CHIPRA Website: https://medicaid.georgia.gov/programs/ third-party-liability/childrens-health-insurance-programreauthorization-act-2009-chipra Phone: 678-564-1162, Press 2

Medicaid Website: Iowa Medicaid | Health & Human Services

Medicaid Phone: 1-800-338-8366

Hawki Website:

Hawki - Healthy and Well Kids in Iowa | Health & Human Services

Hawki Phone: 1-800-257-8563

HIPP Website: Health Insurance Premium Payment (HIPP) | Health & Human Services (iowa.gov)

HIPP Phone: 1-888-346-9562

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

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

Website: https://www.flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp/index.html

Phone: 1-877-357-3268

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

Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884

HIPP Phone: 1-800-967-4660

ALABAMA – MEDICAID

ALASKA – MEDICAID

ARKANSAS – MEDICAID

CALIFORNIA – MEDICAID

COLORADO – HEALTH FIRST COLORADO (COLORADO’S MEDICAID PROGRAM) & CHILD HEALTH PLAN PLUS (CHP+)

FLORIDA – MEDICAID

GEORGIA – MEDICAID

INDIANA – MEDICAID

IOWA – MEDICAID AND CHIP (HAWKI) KANSAS – 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

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/applications-forms

Phone: 1-800-977-6740

TTY: Maine relay 711

MINNESOTA – MEDICAID

Website: https://mn.gov/dhs/health-care-coverage/

Phone: 1-800-657-3672

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

Phone: 1-800-694-3084

Email: HHSHIPPProgram@mt.gov

Medicaid Website: http://dhcfp.nv.gov

Medicaid Phone: 1-800-992-0900

Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)

MASSACHUSETTS – MEDICAID AND CHIP

Website: https://www.mass.gov/masshealth/pa

Phone: 1-800-862-4840

TTY: 711

Email: masspremassistance@accenture.com

MISSOURI – MEDICAID

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp. htm

Phone: 573-751-2005

Website: http://www.ACCESSNebraska.ne.gov

Phone: 1-855-632-7633

Lincoln: 402-473-7000

Omaha: 402-595-1178

Website: https://www.dhhs.nh.gov/programs-services/medicaid/ health-insurance-premium-program

Phone: 603-271-5218

Toll free number for the HIPP program: 1-800-852-3345, ext. 15218

Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov

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)

Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831

KENTUCKY – MEDICAID

LOUISIANA – MEDICAID

MONTANA – MEDICAID NEBRASKA – MEDICAID

NEVADA – MEDICAID

NEW HAMPSHIRE – MEDICAID

NEW JERSEY – MEDICAID AND CHIP

NEW YORK – MEDICAID

Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100

Website: http://www.insureoklahoma.org

Phone: 1-888-365-3742 or 1-866-614-6005

Website: https://www.pa.gov/en/services/dhs/apply-for-medicaidhealth-insurance-premium-payment-program-hipp.html

Phone: 1-800-692-7462

CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov)

CHIP Phone: 1-800-986-KIDS (5437)

Website: https://www.scdhhs.gov

Phone: 1-888-549-0820

Website: Health Insurance Premium Payment (HIPP) Program |

Texas Health and Human Services

Phone: 1-800-440-0493

Website: Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health Access

Phone: 1-800-250-8427

Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022

Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002

Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825

Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075

Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)

Website: http://dss.sd.gov

Phone: 1-888-828-0059

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/

Website: https://coverva.dmas.virginia.gov/learn/premiumassistance/famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/ health-insurance-premium-payment-hipp-programs

Medicaid/CHIP Phone: 1-800-432-5924

1-833-522-5582

TDD: 1-888-221-1590

Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700

CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

Website: https://health.wyo.gov/healthcarefin/medicaid/programsand-eligibility/ Phone: 1-800-251-1269

PENNSYLVANIA

To see if any other states have added a premium assistance program since July 31, 2024, or for more information on special enrollment rights, 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

Marketplace/Exchange Notice

Health Insurance Marketplace Coverage Options and Your Health Coverage

PART A: General Information

Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace and health coverage offered through your employment.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options in your geographic area.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium and other out-of-pocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings that you're eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.

Does Employment-Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of the credit that lowers your monthly premium, or a reduction in certain cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.02% of your annual household income, or if the coverage through your employment does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a

tax credit, and advance payment of the credit, if you do not enroll in the employment-based health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.02% of the employee’s household income.

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution -as well as your employee contribution to employment-based coverage- is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace.

1An employer-sponsored or other employment-based health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.

2 An employer-sponsored or other employment-based health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.

When Can I Enroll in Health Insurance Coverage through the Marketplace?

You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15.

Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan.

There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals

to enroll in Marketplace coverage. Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit HealthCare. gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325.

What about Alternatives to Marketplace Health Insurance Coverage?

If you or your family are eligible for coverage in an employmentbased health plan (such as an employer-sponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan, but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31, 2023 and July 10, 2023, you can request this special enrollment in the employment-based health plan through September 8, 2023. Confirm the deadline with your employer or your employmentbased health plan.

Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https:// www.healthcare.gov/medicaid-chip/getting-medicaid-chip/ for more details.

How Can I Get More Information?

For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact the Benefits Administrator.

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

PART B: Information About Health Coverage Offered by Your Employer

This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

Quantum Health, Inc. 5240 Blazer Parkway Dublin, OH 43017 866-952-0363

FEIN 20-8423895

Contact: Benefits Administration Benefits@Quantum-Health.com

Here is some basic information about health coverage offered by this employer: As your employer, we offer a health plan to all regular fulltime salaried or hourly employees of Quantum Health, Inc. regularly scheduled to work at least 30 hours-per-week or more. With respect to dependents, we offer coverage to eligible dependents. Eligible dependents include your spouse or domestic partner, your children or your domestic partner’s children through the end of the month in which they turn age 26, children for whom the Plan is required to provide coverage under a Qualified Medical Child Support Order (QMCSO); and your mentally or physically disabled adult dependent children who live with you and who are primarily dependent on you for support provided that the child was disabled prior to age 26. Any adult child of your domestic partner who satisfies this definition will also be eligible..

**Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace, HealthCare. gov will guide you through the process. Here's the employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.

QUANTUM HEALTH, INC. HEALTH PLAN’S HIPAA PRIVACY NOTICE

Please carefully review this notice. It describes how medical information about you may be used and disclosed and how you can get access to this information.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on the use and disclosure of individual health information by Quantum Health, Inc. Health Plan. This information, known as protected health information, includes almost all individually identifiable health information held by a health plan — whether received in writing, in an electronic medium or as an oral communication. This notice describes the privacy practices of the Quantum Health, Inc. Health Plan. The plans covered by this notice are the Traditional Copay (PPO), Alternative PPO, Traditional HDHP (HSA), and Alternative HDHP (HSA) and may share health information with each other to carry out treatment, payment or healthcare operations. These plans are collectively referred to as the Plan in this notice, unless specified otherwise.

THE PLAN’S DUTIES WITH RESPECT TO HEALTH INFORMATION ABOUT YOU

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. If you participate in an insured plan option, you will receive a notice directly from the Insurer. It’s important to note that these rules apply to the Plan, not Quantum Health, Inc. as an employer — that’s the way the HIPAA rules work. Different policies may apply to other Quantum Health, Inc. programs or to data unrelated to the Plan.

HOW THE PLAN MAY USE OR DISCLOSE YOUR HEALTH INFORMATION

The privacy rules generally allow the use and disclosure of your health information without your permission (known as an authorization) for purposes of healthcare treatment, payment activities and healthcare operations. Here are some examples of what that might entail:

• Treatment includes providing, coordinating, or managing healthcare by one or more healthcare providers or doctors. Treatment can also include coordination or management of care between a provider and a third party, and consultation and referrals between providers. For example, the Plan may share your health information with physicians who are treating you.

• Payment includes activities by this Plan, other plans, or providers to obtain premiums, make coverage determinations, and provide reimbursement for healthcare. This can include determining eligibility, reviewing services for medical necessity or appropriateness, engaging in utilization management activities, claims management, and billing; as well as performing “behind the scenes” plan functions, such as risk adjustment, collection or reinsurance. For example, the Plan may share information about your coverage or the expenses you have incurred with another health plan to coordinate payment of benefits.

• Healthcare operations include activities by this Plan (and, in limited circumstances, by other plans or providers), such as

case management and care coordination, wellness and risk assessment programs, quality assessment and improvement activities, customer service and internal grievance resolution. Healthcare operations also include evaluating vendors; engaging in credentialing, training and accreditation activities; performing underwriting or premium rating; arranging for medical review and audit activities; and conducting business planning and development. For example, the Plan may use information about your claims to audit the third parties that approve payment for Plan benefits.

.The amount of health information used, disclosed or requested will be limited and, when needed, restricted to the minimum necessary to accomplish the intended purposes, as defined under the HIPAA rules. If the Plan uses or discloses Protected Health Information (PHI) for underwriting purposes, the Plan will not use or disclose PHI that is your genetic information for such purposes.

HOW THE PLAN MAY SHARE YOUR HEALTH INFORMATION WITH QUANTUM HEALTH, INC.

To determine if and when you and your family members are covered by the Plan, the Plan will share enrollment information about you and your family members with Quantum Health, Inc. and with related providers providing services under the Plan. The Health Plan will also periodically disclose PHI to Quantum Health, Inc. so that designated employees can assist participants with benefits questions, problems, and appeals; perform financial planning and projections; monitor the performance of third parties; and oversee and assist with the administration of the Health Plan. Quantum Health, Inc. agrees not to use or disclose your health information other than as permitted or required by the Plan documents and by law. Limited, designated employees within Human Resources, Benefits, the Warrior Pod, and other supporting functions as necessary (such as Business Intelligence, Infrastructure Systems, and Information Security), are the only Quantum Health, Inc. employees who will have access to your health information for plan administration functions.

Here’s how additional information may be shared between the Plan and Quantum Health, Inc. as allowed under the HIPAA rules:

• The Plan, or its insurer, may disclose “summary health information” to Quantum Health, Inc., if requested, for purposes of obtaining premium bids to provide coverage under the Plan or for modifying, amending, or terminating the Plan. Summary health information is information that summarizes participants’ claims information, from which names and other identifying information have been removed.

• The Plan, or its insurer, may disclose to Quantum Health, Inc. information on whether an individual is participating in the Plan or has enrolled or disenrolled in an insurance option offered by the Plan.

In addition, you should know that Quantum Health, Inc. cannot and will not use health information obtained from the Plan for any employment-related actions. However, health information collected by Quantum Health, Inc. from other sources — for example, under the Family and Medical Leave Act, Americans with Disabilities Act, or workers’ compensation programs — is not protected under HIPAA (although this type of information may be protected under other federal or state laws).

OTHER ALLOWABLE USES OR DISCLOSURES OF YOUR HEALTH INFORMATION

The Plan may disclose PHI to a family member, a friend, or any other person you identify, provided that information is directly relevant to that person’s involvement with your health care or payment for that care. For example, if a family member or a caregiver calls the Health Plan with prior knowledge of a claim, the Health Plan may confirm whether or not the claims has been received and paid. You have the right to stop or limit this kind of disclosure.

We may also disclose PHI to your personal representative, as established under applicable law, including under a health care power of attorney, guardianship, or the executor or administrator of your estate.

The Plan also is allowed to use or disclose your health information without your written authorization for the following activities:

• Workers’ compensation: Disclosures to workers’ compensation or similar legal programs that provide benefits for work-related injuries or illness without regard to fault, as authorized by and necessary to comply with the laws.

• Necessary to prevent serious threat to health or safety: Disclosures made in the good-faith belief that releasing your health information is necessary to prevent or lessen a serious and imminent threat to public or personal health or safety, if made to someone reasonably able to prevent or lessen the threat (or to the target of the threat); includes disclosures to help law enforcement officials to identify or apprehend an individual who has admitted participation in a violent crime that the Plan reasonably believes may have caused serious physical harm to a victim, or where it appears the individual has escaped from prison or from lawful custody.

• Public health activities: Disclosures authorized by law to persons who may be at risk of contracting or spreading a disease or condition; disclosures to public health authorities to prevent or control disease or report child abuse or neglect; and disclosures to the Food and Drug Administration to collect or report adverse events or product defects

• Victims of abuse, neglect, or domestic violence: Disclosures to government authorities, including social services or protective service agencies authorized by law to receive reports of abuse, neglect or domestic violence, as required by law or if you agree or the Plan believes that disclosure is necessary to prevent serious harm to you or potential victims (you’ll be notified of the Plan’s disclosure if informing you won’t put you at further risk)

• Judicial and administrative proceedings: Disclosures in response to a court or administrative order, subpoena, discovery request or other lawful process (the Plan may be required to notify you of the request or receive satisfactory assurance from the party seeking your health information that efforts were made to notify you or to obtain a qualified protective order concerning the information)

• Law enforcement purposes: Disclosures to law enforcement officials required by law or legal process, or to identify a suspect, fugitive, witness, or missing person; disclosures about a crime victim if you agree or if disclosure is necessary for immediate law enforcement activity; disclosures about a death that may have resulted from criminal conduct; and disclosures to provide evidence of criminal conduct on the Plan’s premises

• Decedents: Disclosures to a coroner or medical examiner to

identify the deceased or determine cause of death; and to funeral directors to carry out their duties

• Organ, eye or tissue donation: Disclosures to organ procurement organizations or other entities to facilitate organ, eye, or tissue donation and transplantation after death

• Research purposes: Disclosures subject to approval by institutional or private privacy review boards, subject to certain assurances and representations by researchers about the necessity of using your health information and the treatment of the information during a research project

• Health oversight activities: Disclosures to health agencies for activities authorized by law (audits, inspections, investigations or licensing actions) for oversight of the healthcare system, government benefits programs for which health information is relevant to beneficiary eligibility, and compliance with regulatory programs or civil rights laws

• Specialized government functions: Disclosures about individuals who are Armed Forces personnel or foreign military personnel under appropriate military command; disclosures to authorized federal officials for national security or intelligence activities; and disclosures to correctional facilities or custodial law enforcement officials about inmates

• HHS investigations: Disclosures of your health information to the Department of Health and Human Services to investigate or determine the Plan’s compliance with the HIPAA privacy rule except as described in this notice.

Except as described in this notice, other uses and disclosures will be made only with your written authorization. For example, in most cases, the Plan will obtain your authorization before it communicates with you about products or programs if the Plan is being paid to make those communications. If we keep psychotherapy notes in our records, we will obtain your authorization in some cases before we release those records.

The Plan will never sell your health information unless you have authorized us to do so. You may revoke your authorization as allowed under the HIPAA rules. However, you can’t revoke your authorization with respect to disclosures the Plan has already made. You will be notified of any unauthorized access, use, or disclosure of your unsecured health information as required by law.

The Plan will notify you if it becomes aware that there has been a loss of your health information in a manner that could compromise the privacy of your health information.

YOUR INDIVIDUAL RIGHTS

You have the following rights with respect to your health information the Plan maintains. These rights are subject to certain limitations, as discussed below. This section of the notice describes how you may exercise each individual right. See the Contact section at the end of this notice for information on how to submit requests.

RIGHT TO REQUEST RESTRICTIONS ON CERTAIN USES AND DISCLOSURES OF YOUR HEALTH INFORMATION AND THE PLAN’S RIGHT TO REFUSE

You have the right to ask the Plan to restrict the use and disclosure of your health information for treatment, payment, or healthcare operations, except for uses or disclosures required by law. You have the right to ask the Plan to restrict the use and disclosure of your health information to family members, close friends, or other persons you identify as being involved in your care or payment for your care. You also have the right to ask the Plan to restrict use and disclosure of health information to notify those persons of your location, general condition, or death — or to coordinate those efforts with entities assisting in disaster relief efforts. If you want to exercise this right, your request to the Plan must be in writing. The Plan is not required to agree to a requested restriction. If the Plan does agree, a restriction may later be terminated by your written request, by agreement between you and the Plan (including an oral agreement), or unilaterally by the Plan for health information created or received after you’re notified that the Plan has removed the restrictions. The Plan may also disclose health information about you if you need emergency treatment, even if the Plan has agreed to a restriction.

An entity covered by these HIPAA rules (such as your healthcare provider) or its business associate must comply with your request that health information regarding a specific healthcare item or service not be disclosed to the Plan for purposes of payment or healthcare operations if you have paid out of pocket and in full for the item or service.

RIGHT TO RECEIVE CONFIDENTIAL COMMUNICATIONS OF YOUR HEALTH INFORMATION

If you think that disclosure of your health information by the usual means could endanger you in some way, the Plan will accommodate reasonable requests to receive communications of health information from the Plan by alternative means or at alternative locations.

If you want to exercise this right, your request to the Plan must be in writing and you must include a statement that disclosure of all or part of the information could endanger you.

RIGHT TO INSPECT AND COPY YOUR HEALTH INFORMATION

With certain exceptions, you have the right to inspect or obtain a copy of your health information in a “designated record set.” This may include medical and billing records maintained for a healthcare provider; enrollment, payment, claims adjudication and case or medical management record systems maintained by a plan; or a group of records the Plan uses to make decisions about individuals. However, you do not have a right to inspect or obtain copies of psychotherapy notes or information compiled for civil, criminal, or administrative proceedings. The Plan may deny your right to access, although in certain circumstances, you may request a review of the denial.

If you want to exercise this right, your request to the Plan must be in writing. Within 30 days of receipt of your request (60 days if the health information is not accessible on site), the Plan will provide you with one of these responses:

• The access or copies you requested.

• A written denial that explains why your request was denied and any rights you may have to have the denial reviewed or file a complaint.

• A written statement that the time period for reviewing your request will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request.

You may also request your health information be sent to another entity or person, so long as that request is clear, conspicuous and specific. The Plan may provide you with a summary or explanation of the information instead of access to or copies of your health information, if you agree in advance and pay any applicable fees. The Plan also may charge reasonable fees for copies or postage. If the Plan doesn’t maintain the health information but knows where it is maintained, you will be informed where to direct your request. If the Plan keeps your records in an electronic format, you may request an electronic copy of your health information in a form and format readily producible by the Plan. You may also request that such electronic health information be sent to another entity or person, so long as that request is clear, conspicuous and specific. Any charge that is assessed to you for these copies must be reasonable and based on the Plan’s cost.

RIGHT TO AMEND YOUR HEALTH INFORMATION THAT IS INACCURATE OR INCOMPLETE

RIGHT TO AMEND YOUR HEALTH INFORMATION

THAT IS INACCURATE OR INCOMPLETE

With certain exceptions, you have a right to request that the Plan amend your health information in a designated record set. The Plan may deny your request for a number of reasons. For example, your request may be denied if the health information is accurate and complete, was not created by the Plan (unless the person or entity that created the information is no longer available), is not part of the designated record set, or is not available for inspection (e.g., psychotherapy notes or information compiled for civil, criminal or administrative proceedings).

If you want to exercise this right, your request to the Plan must be in writing, and you must include a statement to support the requested amendment. Within 60 days of receipt of your request, the Plan will take one of these actions:

• Make the amendment as requested.

• Provide a written denial that explains why your request was denied and any rights you may have to disagree or file a complaint.

• Provide a written statement that the time period for reviewing your request will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request.

RIGHT TO RECEIVE AN ACCOUNTING OF DISCLOSURES OF YOUR HEALTH INFORMATION

You have the right to a list of certain disclosures of your health information the Plan has made. This is often referred to as an “accounting of disclosures.” You generally may receive this accounting if the disclosure is required by law, in connection with public health activities, or in similar situations listed in the Other Allowable Uses or Disclosures of your Health Information section earlier in this notice, unless otherwise indicated below.

You may receive information on disclosures of your health information for up to six years before the date of your request. You do not have a right to receive an accounting of any disclosures made in any of these circumstances:

• For treatment, payment or healthcare operations.

• To you about your own health information.

• Incidental to other permitted or required disclosures.

• Where authorization was provided.

• To family members or friends involved in your care (where disclosure is permitted without authorization).

• For national security or intelligence purposes or to correctional institutions or law enforcement officials in certain circumstances.

• As part of a “limited data set” (health information that excludes certain identifying information).

• In addition, your right to an accounting of disclosures to a health oversight agency or law enforcement official may be suspended at the request of the agency or official.

If you want to exercise this right, your request to the Plan must be in writing. Within 60 days of the request, the Plan will provide you with the list of disclosures or a written statement that the time period for providing this list will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request. You may make one request in any 12-month period at no cost to you, but the Plan may charge a fee for subsequent requests. You’ll be notified of the fee in advance and have the opportunity to change or revoke your request.

RIGHT TO OBTAIN A PAPER COPY OF THIS NOTICE FROM THE PLAN UPON REQUEST

You have the right to obtain a paper copy of this privacy notice upon request. Even individuals who agreed to receive this notice electronically may request a paper copy at any time.

CHANGES TO THE INFORMATION IN THIS NOTICE

The Plan must abide by the terms of the privacy notice currently in effect. This notice takes effect on 1/01/2023. However, the Plan reserves the right to change the terms of its privacy policies, as described in this notice, at any time and to make new provisions effective for all health information that the Plan maintains. This includes health information that was previously created or received, not just health information created or received after the policy is changed. If changes are made to the Plan’s privacy policies described in this notice, you will be provided with a revised privacy notice.

COMPLAINTS

If you believe your privacy rights have been violated or your Plan has not followed its legal obligations under HIPAA, you may complain to the Plan and to the Secretary of Health and Human Services. You won’t be retaliated against for filing a complaint. To file a complaint, contact the Quantum Health Legal Department at 1-800-257-2038 or Quantum Health, 5240 Blazer Parkway, Dublin, OH 43017

CONTACT

For more information on the Plan’s privacy policies or your rights under HIPAA, contact the Quantum Health Legal Department at 1-800-257-2038 or Quantum Health, 5240 Blazer Parkway, Dublin, OH 43017.

This guide is intended to describe the eligibility requirements, enrollment procedures, plan highlights, and coverage effective dates for the benefits offered by Quantum Health. It is not a legal plan document and does not imply a guarantee of employment or continuation of benefits. While this guide is a tool to answer many of your benefit questions, full details of the plans are contained in the Summary Plan Descriptions (SPDs), which govern each plan’s operation. The noted plan changes in this guide may serve as a Summary of Material Modifications (SMM) to the SPD. Whenever an interpretation of a plan benefit is necessary, the actual plan documents will prevail.