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EMPLOYEE BENEFITS HANDBOOK JULY 1, 2025 - JUNE 30, 2026 ---PAGE BREAK--- Read full descriptions and plan details at mymarkiii.com Table of Contents All information in this booklet is a brief description of your coverage and is not a contract. Please refer to your policy or certificate for each product for the exact terms and conditions. Disclaimer Page 2 Important Points Page 3 Qualifying Life Events Page 4 Welcome to Your Benefits Page 5 How to Enroll Page 6 Employee Benefits Portal Page 7 MyMark III Mobile App Page 8 Cigna Medical Page 10 FlexCare Digital Health Page 11 Cigna Dental & Vision Page 12 FBA Flexible Spending Accounts Page 13 The Standard Short-Term Disability Page 17 The Standard Long-Term Disability Page 18 The Standard Basic & Voluntary Term Life Page 19 The Standard Employee Assistance Program (EAP) Page 20 Nationwide Pet Insurance Page 21 Disclosure Page 24 CHIP Notice Page 25 Contact Information Page 28 1 ---PAGE BREAK--- Read full descriptions and plan details at mymarkiii.com This guide is a brief summary of benefits offered to your group and does not constitute a policy. Your employer may amend the benefits program at any time. Your Summary Plan Description (SPD) will contain the actual detailed provisions of your benefits. The SPD will be available at mymarkiii.com. If there are any discrepancies between the information in this guide and the SPD, the language in the SPD will always prevail. DISCLAIMER 2 ---PAGE BREAK--- Read full descriptions and plan details at mymarkiii.com Important Points ü Your plan year runs from July 1, 2025 to June 30, 2026. This means your benefit elections will take effect July 1, 2025 unless otherwise noted. Deductibles and Out-of-Pocket Maximums are on a calendar year (January 1 – December 31). ü Open Enrollment is MANDATORY: May 13 – May 16, 2025. ü Once the enrollment period is over, you will not be able to make changes unless you experience a qualifying life event outlined by the IRS. ü REMINDER! Employees must re-enroll in their Flexible Spending and Dependent Care accounts each year! It will not automatically renew. ü Benefit Updates: Medical, Dental, and Vision rates have changed. Please see plan pages for more details. ü This benefits guide is equipped with mobile-friendly barcodes commonly referred to as QR Codes. Use your smartphone to scan the QR codes to view your benefit summaries. ü All policy information can be found on your employee benefits portal at 3 ---PAGE BREAK--- Read full descriptions and plan details at mymarkiii.com Qualifying Life Events Open Enrollment selections are generally locked for the plan year, but certain exceptions called Qualifying Life Events (QLEs) can grant you a special enrollment period in which to make midyear changes. You are permitted to change benefit elections if you have a “change in status” and you make an election change that is consistent with the “change in status.” Examples of QLEs The following events will open a special 30-day enrollment period from the date of the event, allowing you to make changes to your coverage. Documentation may be required. marriage divorce childbirth/ adoption death of a family member loss of parental coverage spouse gains or loses coverage 4 ---PAGE BREAK--- Read full descriptions and plan details at mymarkiii.com ü Cigna Medical ü Cigna Dental ü Cigna Vision ü FBA Flexible Spending Accounts ü The Standard Short-Term Disability ü The Standard Long-Term Disability ü The Standard Voluntary Term Life ü Nationwide Pet Insurance Post-Tax Benefit Information A “post-tax basis” means that the money you pay towards the cost of coverage comes out of your salary after you pay taxes. You WILL NOT be able to make any changes once the enrollment period is over unless you experience a qualified life event outlined by the IRS (i.e. birth of a child, divorce, separation, reduction in hours, etc.). Pre-Tax Benefit Information A “pre-tax basis” means that the money you pay towards the cost of coverage comes out of your salary before you pay any taxes on it. These benefits allow you to reduce your taxable income, therefore reducing the taxes you owe. If you choose this option, you cannot drop coverage until the next annual enrollment period or unless you have a qualifying life event (i.e. birth of a child, divorce, separation, reduction in hours, etc.). If your premiums are deducted on a pre-tax basis, any benefits received under the plan could be treated as taxable income. Welcome to Your Benefits! Mark III Employee Benefits is here to help guide you through the benefits offered by your employer. This guide is simply a brief summary of benefits offered and does not constitute a policy. 5 ---PAGE BREAK--- Read full descriptions and plan details at mymarkiii.com Onsite Enrollment is Mandatory Our trusted Mark III Benefits Counselors will be available to meet with employees onsite to explain the benefits offered and to help get you enrolled. Employee Benefits Portal Use your smartphone to scan the QR code or visit the link for quick access to your employee benefits portal page. Review your benefits guide online, access claim forms, and much more! How to Enroll at Open Enrollment 6 ---PAGE BREAK--- Read full descriptions and plan details at mymarkiii.com Employee Benefits Portal Find details about all of your benefits, download forms, submit claims, ask questions, and more at ü Benefits Guide ü Product Videos ü Policy Certificates ü Plan Forms ü Contact Info ü Enrollment Info Available 24/7* from any internet enabled device for your convenience. *As with all technology, due to technical difficulties beyond our control there may be small windows of time the benefits website is down. In the case of outage, plan information can always be requested from your HR office or Mark III Employee Benefits. 7 ---PAGE BREAK--- Read full descriptions and plan details at mymarkiii.com MyMark III Mobile App Find details about all of your benefits, download forms, submit claims, ask questions, and more on the MyMark III Mobile App! ü Benefits Guide ü Product Videos ü Policy Certificates ü Plan Forms ü Contact Info ü Enrollment Info Your Trusted Benefits Partners at your fingertips! Search for “MyMark III” to access benefit information on the go! Available on: 8 ---PAGE BREAK--- Read full descriptions and plan details at mymarkiii.com HEALTHY LIVING Core Benefit options to keep you and your family healthy. 9 ---PAGE BREAK--- Medical Plan Summary Read full descriptions and plan details at mymarkiii.com This document is a highlight of plan benefits provided by Cigna as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For a complete list of covered procedures, please see your benefits administrator. Benefit Cigna Open Access Plus In-Network (HMO) Cigna Open Access Plus (PPO) In-Network Out-of-Network In-Network Calendar Year Deductible Single Family $1,500 $4,500 $2,500 $7,500 $7,500 $20,000 In-Network Coinsurance 80% 80% 60% Out-of-Pocket Calendar Year Limit Single Family $4,000 $8,000 $7,900 $15,800 $23,700 $47,400 Office Visits Primary Care Physician Specialty Care Physician $30 $45 $35 $60 40% coinsurance after deductible Inpatient Services: In-Network (Facility, physician services, etc.) 20% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible Outpatient Services: In-Network (Facility, physician services, etc.) 20% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible Urgent Care Center $75 $75 100% after deductible Emergency Room $350 $350 $350 Prescription Drugs Generic Preferred Brand Non-preferred Brand Specialty $10 $40 $70 25% to $300 max $15 $35 $60 25% to $300 max N/A Cigna Medical Benefit Summary Tier of Coverage – 24 Pay Periods Cigna Open Access Plus In-Network (HMO) Cigna Open Access Plus (PPO) Employee Only $58.34 $56.28 Employee & Spouse $245.00 $236.36 Employee & Child(ren) $221.67 $213.85 Employee & Family $350.00 $337.66 Summary of Benefits & Coverage (SBC) Documents The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. This is only a summary. For more information about your coverage or to get a copy of the complete terms of coverage, visit www.cigna.com. Scan the QR Code or visit to view your SBCs. Locate a Provider Your plan may require or allow the designation of a primary care provider. You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members. If your plan requires designation of a primary care provider, Cigna may designate one for you until you make this designation. For information on how to select a primary care provider, and for a list of the participating primary care providers, visit www.mycigna.com or contact customer service at the phone number listed on the back of your ID card. For children, you may designate a pediatrician as the primary care provider. 10 ---PAGE BREAK--- Telemedicine Read full descriptions and plan details at mymarkiii.com FlexCare Digital Health Provider FlexCare provides you and your family members access to a doctor 24/7/365 from your home, office or on-the-go, at no cost! Get access to healthcare faster through a virtual visit with a board certified physician who can diagnose, treat and prescribe medication, when necessary, for many acute medical conditions. FlexCare Benefits ü Available anytime, day or night ü US Board-Certified Doctors in all 50 states ü Average response time is less than 15 minutes ü Consults at NO COST by phone, video or mobile app ü Prescriptions, if medically necessary, can be sent to your nearest pharmacy ü Treatment for many non-emergency medical issues including: • Acne • Allergies • Cold/Flu • Ear Problems • Insect Bites • Nausea/Vomiting • Pink Eye • Prescription Refills • Respiratory Problems • Skin Conditions/Rashes • Urinary Tract Infections • And Much More! Contact Email: [EMAIL REDACTED] Phone: 1-[PHONE REDACTED] Download the FlexCare Digital Health app in the App Store or on Google Play. 11 ---PAGE BREAK--- Dental & Vision Plan Read full descriptions and plan details at mymarkiii.com Cigna Dental Benefit Summary Below is a benefit summary for your Cigna dental coverage. Keep in mind that you will pay less if you use a in-network provider. To locate a participating provider, go to www.cigna.com and select Find a Doctor. Dental Benefit In-Network (DPPO) Out-of-Network Annual Deductible (Applies to Class II and Class III Services) $50 per Individual I $150 per Family $50 per Individual I $150 per Family Class I: Preventative & Diagnostic Care (Exams/Cleanings) 100% I No Deductible 100% I No Deductible Class II: Basic Care (Restorative Benefits/Surgical Extractions) 80% After Deductible 80% After Deductible Class III: Major Care (Crowns & Cast, Bridges, and Dentures) 50% After Deductible 50% After Deductible Class IV: Orthodontia (Child only to age 19) 50% 50% Annual plan maximum per member $1,000 $1,000 Lifetime Orthodontia Maximum $1,000 $1,000 Eligibility Employee, Spouse, and Dependent children to age 26 Employee, Spouse, and Dependent children to age 26 Cigna Vision Benefit Summary Below is a benefit summary for your Cigna vision coverage. Keep in mind that you will pay less if you use a in-network provider. . To locate a participating provider, go to www.cigna.com and select Find a Doctor. Frequency is 12 months for exams, lenses, contact lenses, and frames. Vision Benefit Member Cost In-Network Reimbursement Out-of-Network Examination Copay $0 N/A Materials Copay $15 N/A Exam Covered in Full $45 Allowance Single Vision Lenses Lined Bifocal Lenses Lined Trifocal Lenses Lenticular Lenses Covered in Full Covered in Full Covered in Full Covered in Full $32 Allowance $55 Allowance $65 Allowance $80 Allowance Contact Lenses Materials (retail allowance) Elective Therapeutic $130 Allowance Covered in Full $105 Allowance $210 Allowance Frames (retail allowance) $130 Allowance $71 Allowance Retinal Screening Up to $39 N/A Lens Enhancements Minimum of 20% savings N/A Dependent Children can be covered to age 26. *Note: The plan covers either contact lenses or lenses for your glasses once every 12 months. The discounts available on the balance for lenses and frames may not apply at certain locations. Please see summary plan description for further details. Coverage Tier – 24 Pay Periods Dental – Cigna DPPO Vision – Cigna PPO Employee Only $14.13 $3.11 Employee & Spouse $28.75 $6.21 Employee & Child(ren) $35.46 $6.34 Employee & Family $49.98 $10.01 This benefit summary highlights some of the benefits available under the proposed plan(s). A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance certificate or plan description. 12 ---PAGE BREAK--- Flexible Spending Account Read full descriptions and plan details at mymarkiii.com Get reimbursed for out-of-pocket healthcare & child/aged adult day care expenses with tax free dollars!! Maximize Your Income Flexible Spending Accounts (FSAs) allow you to pay certain healthcare and dependent care expenses with pre-tax money. (The key to the Flexible Benefit Plan is that your eligible expenses are paid for with Tax Free Dollars!) You will not pay any federal, state or social security taxes on funds placed in the Plan. You will save approximately $27.65 to $37.65 on every $100 you place in the Plan. The amount of your savings will depend on your federal tax bracket. Eligibility Participation in the plan begins on July 1, 2025 and ends on June 30, 2026. You will be eligible to join the Plan if you are a full-time employee working at least 30 hours or more per week on the first 30 days following your date of hire. Those employees having a qualifying event are eligible to enroll within 30 days of the qualifying event. Deductions begin on the first pay period following your Plan start date. You must complete an enrollment to participate in the Flexible Spending Accounts each year during the enrollment period. If an enrollment is not completed during open enrollment, you will not be enrolled in the Plan and you will not be able to join until the next Plan Year or if you have a qualifying event. The Health Care Account is a Pre-Funded Account This means that you can submit a claim for medical expenses on the first day of the Plan Year and you will be reimbursed your total claim amount up to your annual election. The funds that you are pre-funded will be recovered as deductions which are taken from your paycheck on a pre-tax basis. Contribution Limits: The maximum you may place in this account for the Plan Year is $3,300.00. Election Changes Election changes are only allowed if you experience one of the following qualifying events: • Marriage or divorce • Birth or adoption • Involuntary loss of spouse’s medical or dental coverage • Death of dependent (child or spouse) • Unpaid FMLA or Non-FMLA leave • Change in dependent care providers Reimbursement Schedule All manual or paper claims received in the office of Flexible Benefit Administrators, Inc. will be processed within one week. You may also use your Benefits Card to pay for expenses. Please refer to the Benefits Card section for details. Online Access Flexible Benefit Administrators, Inc. provides on-line account access for all FSA participants. Please visit their website at to view the following features: • FSA Login – view balances, check status and view claims history, download participation forms • FSA Educational Tools – FSA calculator: estimate how much you can save by utilizing an FSA. Health Care Reimbursement With this account, you can pay for your out-of-pocket health care expenses for yourself, your spouse and all of your tax dependents for healthcare services that are incurred during your plan year and while an active participant. Eligible expenses are those incurred “for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.“ This is a broad definition that lends itself to creativity. Examples of Eligible Health Care Expenses Fees/Co-Pays/Deductibles for: • Acupuncture I Prescription eyeglasses/reading glasses/contact lens and supplies I Eye Exams/Laser Eye Surgery I Physician I Ambulance I I I Anesthetist I Hospital I Chiropractor I Laboratory/Diagnostic I Fertility Treatments I Surgery I Dental/Orthodontic Fees I Obstetrician I X-Rays I Eye Exams I Prescription Drugs I Artificial limbs & teeth I Orthopedic shoes/inserts I Therapeutic care for drug & alcohol addiction I Vaccinations & Immunizations I Mileage I Take-home screening kits 13 ---PAGE BREAK--- Flexible Spending Account Read full descriptions and plan details at mymarkiii.com Diabetic supplies I Routine Physicals I Oxygen I Physical Therapy I Hearing aids & batteries I Medical equipment I Antacids I Pain relievers I Allergy & Sinus Medication Over-the-Counter Expense (Examples of medication and drugs that may be purchased in reasonable quantities with a prescription): • Acne Treatment I Humidifiers I Multivitamins I Herbal Supplements I Baby Formula I Fiber Supplements Day Care/Aged Adult Care Reimbursement The Day Care/Aged Adult Care FSA allows you to pay for daycare expenses for your qualified dependent/child with pre-tax dollars. Eligible Day Care/Aged Adult Care expenses are those you must pay for the care of an eligible dependent so that you and your spouse can work. Eligible dependents, as revised under Section 152 of the Code by the Working Families Tax Act of 2005, are defined as either dependent children or dependent relatives that you claim as dependents on your taxes. Refer to the Employee Guide for more details. Eligible dependents are further defined as: • Under age 13 • Physically or mentally unable to care for themselves such as: - Disabled spouse - Children who became disabled prior to age 19. - Elderly parents that live with you Contribution Limits: The annual maximum contribution may not exceed the lesser of the following: • $5,000 ($2,500 if married filing separately) • Your wages for the year or your spouse’s if less than above • Maximum is reduced by spouse’s contribution to a Day Care/Aged Adult Care FSA How to Receive Reimbursement To obtain a reimbursement from your Flexible Spending Account, you must complete a Claim Form. This form is available to you in your Employee Guide or on our website. You must attach a receipt or bill from the service provider which includes all the pertinent information regarding the expense: • Date of service • Patient’s name • Amount charged • Provider’s name • Nature of the expense • Amount covered by insurance (if applicable) Canceled checks, bankcard receipts, credit card receipts and credit card statements are NOT acceptable forms of documentation. You are responsible for paying your healthcare or dependent care provider directly. Eligible Day Care/Aged Adult Expenses • Au Pair I Nannies I Before & After Care I Day Camps I Babysitters I Daycare for an Elderly Dependent I Daycare for a Disabled Dependent I Nursery School I Private Pre Schools I Sick Child Center I Licensed Day Care Centers Ineligible Expenses: • Overnight Camps I Babysitting for Social Events I Tuition Expenses including Kindergarten I Food Expenses (if separate from dependent care expenses) I Care provided by children under 19 (or by anyone you claim as a dependent) I Days your spouse doesn’t work (though you may still have to pay the provider) I Kindergarten expenses are ineligible as an expense because it is primarily educational, regardless if it is half or full day, private, public, state mandated or voluntary I Transportation, books, clothing, food, entertainment and registration fees are ineligible if these expenses are shown separately on your bill I Expenses incurred while on Leave of Absence or Vacation Forfeiting Funds Plan carefully! Unused funds will be forfeited back to your employer as governed by the IRS’s “use-it-or-lose-it” rule. Your employer has elected to add the $660 roll-over provision to the Medical FSA. Please see the Employee Guide for more info. How to Enroll in our FSA Plan Step 1 Carefully estimate your eligible Health Care and Day Care/Aged Adult Care expenses for the upcoming Plan Year. Then use our online FSA Educational Tools located at to help you determine your total expenses for the Plan Year. Step 2 Complete your enrollment during the open enrollment period, which instructs payroll to deduct a certain amount of money for your expenses. This amount will be contributed on a pre-tax basis from your paychecks to your FSA. Remember the amount you elect will be set aside before any federal, social security, and state taxes are calculated. 14 ---PAGE BREAK--- Flexible Spending Account Read full descriptions and plan details at mymarkiii.com How the Flexible Benefit Plan Works Without FSA With FSA Gross Income $2,500.00 $2,500.00 Eligible Pre-Tax employer medical insurance $0.00 $200.00 Eligible Pre-Tax medical expenses $0.00 $60.00 Eligible Pre-Tax dependent child care expenses $0.00 $300.00 Taxable Income $2,500.00 $1,940.00 Federal Tax (15%) $375.00 $291.00 State Tax (5.75%) $125.00 $97.00 FICA Tax (7.65%) $191.25 $148.41 After-Tax employer medical insurance $200.00 $0.00 After-Tax medical expenses $60.00 $0.00 After-Tax dependent child care expenses $300.00 $0.00 Spendable Income $1,248.75 $1,403.59 By taking advantage of the Flexible Benefit Plan, this employee was able to increase his/her spendable income by $154.84 every month! This means an annual tax savings of $1,858.08. Remember, with the FLEXIBLE BENEFIT PLAN, the better you plan the more you save! Online Wealthcare Portal View your account status, submit claims and report your benefits card lost/stolen right from your computer. Once your account is established, you can use the same user name and password to access your account via our Mobile App! Follow the simple steps below to establish your secure user account. ü Get started by visiting and click the register button in the top-right corner of the homepage. ü You will be directed to the registration page. ü Follow the prompts to create your account. • User Name • Password • Name • Email Address • Employee ID (Your SSN, no spaces/dashes) • Registration ID • Employer ID (FBADWCG) • Your Benefits Card Number ü Once completed, please proceed to your account. Benefits Card The Benefits Card can be used as a direct payment method for eligible expenses incurred at approved service providers and merchants. Using your card allows you instant access to your funds with no out-of-pocket expense. Please keep all your itemized receipts. Flexible Benefit Administrators, Inc. may request documentation to substantiate Benefits Card transactions to determine eligibility of an expense. Benefits Cards are available upon request of the account holder for dependents over the age of 18. Please contact Flexible Benefit Administrators, Inc. to order additional cards. FBA Participant Portal, Mobile App, Benefits Card & Claim Submission Scan the QR code with your smartphone to view the FBA Participant Portal, FBA Mobile App, FBA Benefits Card, and Claim submission information. The Participant Portal provides powerful self-service account access, plus education and decision-support tools that help put you in the driver’s seat when it comes to your healthcare finances. The Mobile App offers a personalized, real-time and self-guided experience that allows you to easily manage your Benefit Account and delivers tools to help save you money. The benefits debit card eliminates the hassles of claim submission and waiting for a reimbursement check. For more information, please call [PHONE REDACTED] P.O. Box 8188 • Virginia Beach, VA 23450 www.flex-admin.com 15 ---PAGE BREAK--- Read full descriptions and plan details at mymarkiii.com STAY WELL Voluntary Benefit options that enhance you and your family’s well being. 16 ---PAGE BREAK--- Short-Term Disability Plan Read full descriptions and plan details at mymarkiii.com Dawson County offers each full-time, benefits eligible, employee Short-Term Disability coverage through Standard. Short-Term Disability is an insurance program that provides you with weekly income if you are unable to work or have a reduced income due to an illness or injury unrelated to your occupation. Short-Term Disability Benefits Short-Term Disability Benefits Coverage Percentage of Weekly Income 60% Maximum Weekly Benefit $1,150 Elimination Period 0 days for accidental injuryI 7 days for physical disease, pregnancy or mental disorder Maximum Benefit Duration 180 Days Late Entrant Waiting Period If you do not apply for coverage within 31 days of becoming eligible, your benefit waiting period for any qualifying disability caused by physical disease, pregnancy or mental disorder occurring during the first 12 months of coverage will be 60 days. Age of Insured on Last July 1 Rate Per $10 of STD Benefit Before Reduction by Deductible Income Under 30 $0.548 30 - 34 $0.563 35 - 39 $0.547 40 - 44 $0.503 45 - 49 $0.589 50 - 54 $0.640 55 - 59 $0.665 60 - 64 $0.639 65 - 69 $0.628 70 - 74 $0.563 75 or over $0.563 Benefit Waiting Period: If you suffer a qualifying disability, your benefit waiting period is the length of time you must be continuously disabled before you can begin receiving your weekly benefit. 0 days for accidental injury. 7 days for physical disease, pregnancy or mental disorder Deductible Sources of Income: Your benefit payments will be reduced by other income you receive or are eligible to receive due to your disability, such as: sick pay; benefits under worker’s compensation; disability benefits from any other group insurance or under your employer’s retirement plan; benefits under any state disability income benefit law; earnings from work activity while you are disabled, amounts due from third party because of your disability, whether by judgment, settlement or other method. Return to Work Incentive: Your disability benefit will not be reduced by any work earnings you receive until the combined amount of the benefit and your work earnings exceeds 100 percent of your predisability earnings. Help with Returning to Work: If a worksite modification would enable you to return to work, we can help your employer make approved modifications by covering some or all of the cost. Limitations: Short Term Disability benefits are not payable for any period when you are: Not under the ongoing care of a physician in the appropriate specialty, as determined by The Standard; Not participating in good faith in a plan, program or course of medical treatment or vocational training or education approved by The Standard, unless your disability prevents you from participating; Confined for any reason in a penal or correctional institution; Able to work and earn at least 20 percent of your predisability earnings in your own occupation but you elect not to; Eligible to receive benefits for your disability under a workers’ compensation law or similar law. Exclusions: Subject to state variations, you are not covered for a disability caused or contributed to by any of the following: Your committing or attempting to commit an assault or felony, or your active participation in a violent disorder or riot; An intentionally self-inflicted injury, while sane or insane; War or any act of war (declared or undeclared, and any substantial armed conflict between organized forces of a military nature); The loss of your professional or occupational license or certification; An activity arising out of or in the course of any employment for wage or profit. 17 ---PAGE BREAK--- Long-Term Disability Plan Read full descriptions and plan details at mymarkiii.com Long-Term Disability Benefits Coverage Percentage of Income 60% Maximum Benefit $5,000 Elimination Period 180 Days Maximum Benefit Duration Social Security Normal Retirement Age Survivors Benefit If you die while receiving benefits, your survivor may be eligible to receive a one-time additional payment Dawson County offers each full-time, benefits eligible, employee Long-Term Disability coverage through Standard. Long Term Disability is an insurance program that provides you with income if you are unable to work or have a reduced income due to an illness or injury unrelated to your occupation. Long-Term Disability Benefits Age of Insured on Last July 1 % Times Amount of Each Insured Member’s Insured Predisability Earnings Before Reduction by Deductible Income Under 30 0.110% 30 - 34 0.189% 35 - 39 0.278% 40 - 44 0.368% 45 - 49 0.528% 50 - 54 0.528% 55 - 59 0.528% 60 - 64 0.528% 65 - 69 0.767% 70 or over 0.770% Elimination Period: If you suffer a qualifying disability, your benefit waiting period is the length of time you must be continuously disabled before you can begin receiving your benefit. Deductible Sources of Income: Your benefit payments will be reduced by other income you receive or are eligible to receive due to your disability, such as: sick pay; benefits under worker’s compensation; disability benefits from any other group insurance or under your employer’s retirement plan; benefits under any state disability income benefit law; earnings from work activity while you are disabled, amounts due from third party because of your disability, whether by judgment, settlement or other method. Limitations: Mental illness and substance treatment is limited to a benefit period of 24 months. Exclusions: Benefits will not be payable for any disability caused by an intentionally self inflicted injury; an act of war (declared or undeclared); commission of a felony; a pre-existing condition unless you have been covered under the policy for at least 12 months. For a comprehensive list of exclusions, limitations, and any applicable benefit offsets, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits. Help with Returning to Work: This plan provides incentives to help you get back to work. For instance, you’ll get help paying for some of the expenses associated with participating in an approved rehabilitation plan. If a worksite modification would enable you to return to work, the coverage can help your employer make approved modifications. You may also be eligible to receive an additional benefit of 10 percent of your predisability earnings for participating in an approved rehabilitation plan, subject to the plan maximum. Your disability benefit will not be reduced by any work earnings you receive until the combined amount of the benefit and your work earnings exceeds 100 percent of your predisability earnings. Support When You Need It: You’ll have access to an Employee Assistance Program, a valuable confidential counseling resource if you’re experiencing personal or work-related issues. This service is provided through an arrangement with a service provider who is not affiliated with The Standard. Pre-Existing Condition Exclusions: Any sickness or injury for which you received medical treatment, consultation, care, or services (including diagnostic measures or the taking of prescribed medications) during the specified months (3 months) prior to your coverage effective date. A disability arising from any such sickness or injury will be covered only if it begins after you have performed your regular occupation on a full-time basis for the specified months (12 months) following the coverage effective date. 18 ---PAGE BREAK--- Basic & Voluntary Term Life Plan Read full descriptions and plan details at mymarkiii.com Term Life Insurance provides valuable financial protection for your family. Dawson County is pleased to offer $50,000 of Basic Life and Accidental Death and Dismemberment (AD&D) for all full-time eligible employees. Enrollment is automatic, but you must select beneficiaries. In addition, your employer provides you with Dependent Life insurance in the amount of $5,000 for an eligible spouse and $2,500 for each eligible child. Dawson County also offers Voluntary Life Coverage for employees and their dependents. This additional life insurance is available for you, your spouse and your children. This coverage can provide you financial protection for you and your family. Details of the available coverage are listed in the chart below. Benefit Coverage Employee Voluntary Life Newly eligible employees are able to elect $10,000 up to $500,000 in multiples of $10,000. Guaranteed Issue amount of $100,000. Elections above $100,000 will require a Medical History Statement/Evidence of Insurability Form. Spouse Voluntary Life Newly eligible employees are able to elect $5,000 to $100,000 in multiples of $5,000 of coverage on their spouse (not to exceed 100% of employee coverage). Guaranteed Issue amount of $20,000. Elections above $20,000 will require a Medical History Statement/Evidence of Insurability Form. Child(ren) Voluntary Life You can purchase coverage of either $5,000 or $10,000 for eligible child(ren). Child(ren) are covered from the age of 15 days to age 26. Reduction of Coverage: The Voluntary Life benefits will reduce by 35% of the original amount at age 65, and 50%of the original amount at age 70. Portability: If your insurance ends because your employment terminates, you may be eligible to buy portable group insurance coverage from The Standard. Conversion: If your insurance reduces or ends, you may be eligible to convert your existing life insurance to an individual life insurance policy without submitting proof of good health. Additional Benefits Living Benefit (accelerated death benefit): You can request up to 75% of your optional life benefits to be paid while you are living if you are terminally ill with less than 12 months to live. If you take a Living Benefit payment, the amount your beneficiary gets after your death will be reduced by the amount you were paid. Rate Per $1,000 Age Employee & Spouse Rate <20 $0.080 20 - 24 $0.080 25 - 29 $0.080 30 - 34 $0.080 35 - 39 $0.120 40 - 44 $0.200 45 - 49 $0.280 50 - 54 $0.480 55 - 59 $0.820 60 - 64 $1.290 65 - 69 $2.030 70 - 74 $3.240 75 - 99 $5.740 Child Life Rate is $0.20 per $1,000 (all covered children) per month. 19 ---PAGE BREAK--- Employee Assistance Program (EAP) Read full descriptions and plan details at mymarkiii.com There are times in life when you might need a little help coping or figuring our what to do. Take advantage of the Employee Assistance Program1 (EAP) which includes WorkLife Services and is available to you and your family in connection with group insurance from Standard Insurance Company (The Standard). It’s confidential – information will be released only with your permission or as required by law. Connection to Resources, Support & Guidance You, your dependents (including children to age 26)2 and all household members can contact master’s-degreed clinicians 24/7 by phone, online, live chat, email and text. There’s even a mobile EAP app. Receive referrals to support groups, a network counselor, community resources or your health plan. If necessary, you’ll be connected to emergency services. Your program includes up to three counseling sessions per issue. Sessions can be done in person, on the phone, by video or text. EAP services can help with: ü Depression, grief, loss and emotional well-being ü Family, marital and other relationship issues ü Life improvement and goal-setting ü Addictions such as alcohol and drug abuse ü Stress or anxiety with work or family ü Financial and legal concerns ü Identity theft and fraud resolution ü Online will preparation WorkLife Services WorkLife Services are included with the Employee Assistance Program. Get help with referrals from important needs like education, adoption, travel, daily living and care for your pet, child or elderly loved ones. Online Resources Visit healthadvocate.com/standard3 to explore a wealth of information online, including videos, guidelines, articles, webinars, resources, self-assessments and calculators. 1 The EAP service is provided through an arrangement with Morneau Shepell, which is not affiliated with The Standard. Morneau Shepell is solely responsible for providing and administering the included service. EAP is not an insurance product and is provided to groups of 10 – 2, 499 lives. This service is only available while insured under The Standard’s group policy. 2 Individual EAP counseling sessions are available to eligible participants 16 years and older; family sessions are available for eligible members 12 years and older, and their parents or guardian. Children under the age of 12 will not receive individual counseling sessions. Contact EAP [PHONE REDACTED] (TTY Services: 711) 24 hours a day, seven days a week Organization Name is: The Standard – EAP – 3 Visits Email: [EMAIL REDACTED] Web: http://healthadvocate.com/standard3 Download the Mobile App Health Advocate’s new app makes healthcare easier for members. As a Health Advocate member, it puts our experts and resources right at your fingertips for quick and convenient access anytime, anywhere, allowing you to reach all of your Health Advocate programs as well as other health, wellness and benefits services in one place. Download today in Google Play or the App Store. NOTE: It’s a violation of your company’s contract to share this information with individuals who are not eligible for this service. With EAP, personal assistance is immediate, confidential and available when you need it. 20 ---PAGE BREAK--- Pet Insurance Read full descriptions and plan details at mymarkiii.com Nationwide Pet Insurance With two budget-friendly options, there’s never been a better time to protect your pet. Plan Features ü Get cash back on eligible vet bills: Choose your reimbursement level of 50% or 70%1 ü Available exclusively for employees: Plans with preferred pricing only offered through your company ü Use any vet, anywhere: No networks, no pre-approvals 50% Reimbursement 70% Reimbursement Choose Your Level of Coverage with My Pet Protection® Avian & Exotic Pet Plan Affordable medical coverage for your bird or exotic pet. Choose 50% or 70% reimbursement. Coverage includes medical treatments and surgeries for accidents, illnesses and diseases, including cancer.* This plan covers: • Amphibians • Birds • Chameleons • Chinchillas • Ferrets • Geckos • Gerbils • Guinea pigs • Hamsters • Iguanas • Lizards • Mice • Rats • Rabbits • Snakes • Tortoises • Turtles Get a Fast, No-obligation Quote Today at PetsNationwide.com 1Some exclusions may apply. Certain coverages may be subject to pre-existing exclusion. See policy documents for a complete list of exclusions. Reimbursement options may not be available in all states. 2Starting prices indicated. Final cost varies according to plan, species and ZIP code. *Some exclusions may apply. Certain coverages may be subject to pre-existing exclusion. See policy documents for a complete list of exclusions. Plans may not be available in all states. Policy eligibility may vary. Some species of avian and exotic pets are not eligible for coverage. Plans feature a $250 annual deductible and have a maximum annual benefit of $7,500. How to Use Your Pet Insurance Plan 1. Visit any vet, anywhere 2. Submit claim 3. Get reimbursed 21 ---PAGE BREAK--- Pet Insurance Read full descriptions and plan details at mymarkiii.com Nationwide Pet Rx Express℠FAQs Nationwide and Walmart have joined forces to help families with pets save time and money when filling their pet prescription medications at any of Walmart’s 4,700 pharmacies across the country. Read the entire announcement here. Who is eligible for Nationwide Pet Rx Express? This optional program is available to all Nationwide pet insurance members with active plans for dogs, cats, birds or exotic pets. Members can take advantage of Walmart’s low prices for prescriptions and enjoy the convenience of having the pharmacy submit claims directly to Nationwide on their behalf. Is there an additional charge for Nationwide Pet Rx Express? There is no cost to sign up for and use Nationwide Pet Rx Express. How do members use Nationwide Pet Rx Express? Using Nationwide Pet Rx Express is simple and convenient. 1. Nationwide pet insurance members can sign up at my.petinsurance.com. 2. After allowing 24 hours from sign-up, members can bring their pet prescriptions to any in-store Walmart pharmacy. 3. At checkout, members provide their pet insurance information and pay for the prescription. Walmart pharmacy will automatically submit claims to Nationwide for processing, and members will be reimbursed for eligible expenses.* *Reimbursement or co-insurance is based on coverage detailed in policy. See Nationwide Pet Rx Express Terms of Service. Certain coverages maybe excluded due to pre-existing conditions. See policy documents for a complete list of exclusions. If enrolled in Nationwide Pet Rx Express, can members still fill prescriptions at their vet office or other pharmacies? Yes. Members can fill prescriptions at any pharmacy or veterinarian and then submit a traditional claim. What pet medications are available through Walmart pharmacy? In-store Walmart pharmacies carry many of the same pet medications found in most veterinary offices. Members may want to call ahead to make sure their preferred Walmart location carries their specific medication. Is prescription pet food included? Prescription diets are not included in this program, only prescription medications. Does Nationwide Pet Rx Express cover medications for pre-existing conditions? Unfortunately, no. Like all pet insurers, Nationwide does not cover pre- existing conditions. Is a prescription required to get pet medications through Walmart pharmacy? Walmart pharmacies may offer over-the-counter medications that do not require a prescription. However, a valid prescription from a veterinarian is required for the medication to be eligible for coverage under a Nationwide pet insurance plan. How does the Nationwide claim process work for prescriptions filled through Walmart? When filling a pet prescription at an in-store Walmart pharmacy, members simply provide their digital Nationwide pet insurance ID card to receive preferred pricing and have claims submitted on their behalf. Where can members find their pet insurance information? After signing up for Nationwide Pet Rx Express, members will receive an email with instructions on where to find their digital pet insurance ID card, which can be viewed and downloaded at my.petinsurance.com. Can a vet call in a prescription to Walmart? Yes. Veterinarians can call in prescriptions, just like they currently do. Once the pharmacy receives the prescription and the member’s eligibility is verified, the prescription will be filled, and the claim submitted. Employee FAQ Do I need to re-enroll for this benefit every year? No. Once enrolled, the policy will renew automatically each year. How can I make changes to my policy? You can make changes to your policy during your policy renewal period. All changes are subject to underwriting approval. When is the policy renewal period? The renewal period starts 60 days before the policy’s current 12-month term expires. The policy’s effective date and expiration date can be found on the Declarations Page, which is included with the policy packet that is mailed to you at each new term. What happens to my pet insurance policy if I am no longer with the company? You will be notified and asked to update billing information in order to keep the policy active. Will pre-existing conditions be covered? Unfortunately, no. Like all pet insurers, we don’t cover pre-existing conditions on any of our plans. Can I still use my vet? Absolutely. You’re free to visit any licensed veterinarian, anywhere in the world—even specialists and emergency providers. If I have a pet other than a dog or cat, can I enroll? Yes! If you want coverage for your bird, rabbit, reptile or other exotic pet, you’ll find it only with Nationwide. To enroll in the Avian & Exotic Pet Plan, please call [PHONE REDACTED]. What is vethelpline® and how does it work? Veterinary professionals are available 24/7 through vethelpline, a service provided exclusively for Nationwide pet insurance members. You can get live help with any pet health concern, including identifying urgent care needs. Please note, a vethelpline consultation is not a substitute for a visit to your primary veterinarian. How do I file a claim? It’s easy. Simply pay your vet bill and then send us a claim for reimbursement via mail, email or online. • Mail: Nationwide Claims Dept., P. O. Box 2344, Brea, CA 92822-2344 • Email: • Online: Submit claims through your Nationwide Pet Account Access page at my.petinsurance.com. Please allow 48 hours from the time you submit your claim for it to appear online. Subject to underwriting guidelines, review and approval. Products and discounts not available to all persons in all states. Insurance terms, definitions and explanations are intended for informational purposes only and do not in any way replace or modify the definitions and information contained in individual insurance contracts, policies or declaration pages, which are controlling. For more information, call [PHONE REDACTED] Get a quote at PetsNationwide.com 22 ---PAGE BREAK--- Read full descriptions and plan details at mymarkiii.com FOR YOUR REFERENCE Additional benefit information from your employer. 23 ---PAGE BREAK--- Disclosure Notice – Prescription Drug and Medicare Notice Read full descriptions and plan details at mymarkiii.com Important Notice from the Dawson County Board of Commissioners About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the Dawson County Board of Commissioners and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher premium. 2. The Dawson County Board of Commissioners has determined that the prescription drug coverage offered by the Cigna HMO and the Cigna POS plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Dawson County Board of Commissioners coverage will not be affected. If you drop your current prescription drug coverage and enroll in Medicare prescription drug coverage, you may enroll back into the Dawson County Board of Commissioners benefit plan during an open enrollment period under the Dawson County Board of Commissioners benefit plan. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with the Dawson County Board of Commissioners and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your premium may go up by at least 1%of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19%higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Dawson County Board of Commissioners changes. You also may request a copy of this notice at any time. For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit www.medicare.gov. Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help. Call 1-800-MEDICARE (1-[PHONE REDACTED]). TTY users should call 1-[PHONE REDACTED]. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-[PHONE REDACTED] (TTY 1-[PHONE REDACTED]). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). From: July 1, 2025 – June 30, 2026 Name of Entity/Sender: Dawson County Board of Commissioners Contact Person: Kristi Finley 24 ---PAGE BREAK--- Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) Read full descriptions and plan details at mymarkiii.com If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2025. Contact your State for more information on eligibility – ALABAMA-Medicaid Website: http://myalhipp.com Phone: 1-[PHONE REDACTED] ALASKA-Medicaid The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-[PHONE REDACTED] Email: [EMAIL REDACTED] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx ARKANSAS-Medicaid FLORIDA-Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP ([PHONE REDACTED]) CALIFORNIA-Medicaid Website: Health Insurance Premium Payment (HIPP) Program http://dhcs.ca.gov/hipp Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] Email: [EMAIL REDACTED] COLORADO-Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) Health First Colorado Website: Health First Colorado Member Contact Center: 1-[PHONE REDACTED] State Relay 711 CHP+: CHP+Customer Service: 1-[PHONE REDACTED]/ State Relay 711 Health Insurance Buy-In Program (HIBI): HIBI Customer Service: 1-[PHONE REDACTED] FLORIDA-Medicaid Website: com/hipp/index.html Phone: 1-[PHONE REDACTED] GEORGIA-Medicaid A HIPP Website: payment-program-hipp Phone: [PHONE REDACTED], Press 1 GA CHIPRA Website: liability/childrens-health-insurance-program-reauthorization-act-2009- chipra Phone: (678) 564-1162, Press 2 INDIANA-Medicaid Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-[PHONE REDACTED] All other Medicaid Website: Phone 1-[PHONE REDACTED] IOWA-Medicaid and CHIP (Hawki) Medicaid Website: Medicaid Phone: 1-[PHONE REDACTED] Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-[PHONE REDACTED] HIPP Website: HIPP Phone: 1-[PHONE REDACTED] KANSAS-Medicaid Website: Phone: 1-[PHONE REDACTED] KENTUCKY-Medicaid Kentucky Integrated Health Insurance Premium Payment Program (KI- HIPP) Website: Phone: 1-[PHONE REDACTED] Email: [EMAIL REDACTED] KCHIP Website: Phone: 1-[PHONE REDACTED] Kentucky Medicaid Website: 25 ---PAGE BREAK--- Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) Read full descriptions and plan details at mymarkiii.com LOUISIANA-Medicaid Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-[PHONE REDACTED] (Medicaid hotline) or 1-[PHONE REDACTED] (LaHIPP) MAINE-Medicaid Enrollment Website: Phone: 1-[PHONE REDACTED] TTY: Maine relay 711 Private Health Insurance Premium Webpage: Phone: -[PHONE REDACTED]. TTY: Maine relay 711 MASSACHUSETTS-Medicaid and CHIP Website: Phone: 1-[PHONE REDACTED] MINNESOTA-Medicaid Website: families/health-care/health-care-programs/programs-and-services/other- insurance.jsp Phone: 1-[PHONE REDACTED] MISSOURI-Medicaid Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: [PHONE REDACTED] MONTANA-Medicaid Website: Phone: 1-[PHONE REDACTED] NEBRASKA-Medicaid Website: http://www.ACCESSNebraska.ne.gov Phone: 1-[PHONE REDACTED] Lincoln: [PHONE REDACTED] Omaha: [PHONE REDACTED] NEVADA-Medicaid Medicaid Website: Medicaid Phone: 1-[PHONE REDACTED] NEW HAMPSHIRE-Medicaid Website: Phone: [PHONE REDACTED] Toll free number for the HIPP program: 1-[PHONE REDACTED], ext 5218 NEW JERSEY-Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ Medicaid Phone: [PHONE REDACTED] CHIPWebsite: http://www.njfamilycare.org/index.html CHIP Phone: 1-[PHONE REDACTED] NEW YORK-Medicaid Website: Phone: 1-[PHONE REDACTED] NORTH CAROLINA-Medicaid Website: Phone: [PHONE REDACTED] NORTH DAKOTA-Medicaid Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-[PHONE REDACTED] OKLAHOMA-Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-[PHONE REDACTED] OREGON-Medicaid Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-[PHONE REDACTED] Website: Program.aspx Phone: 1-[PHONE REDACTED] RHODE ISLAND-Medicaid and CHIP Website: http://www.eohhs.ri.gov/ Phone: 1-[PHONE REDACTED], or [PHONE REDACTED] (Direct RIte Share Line) SOUTH CAROLINA-Medicaid Website: Phone: 1-[PHONE REDACTED] SOUTH DAKOTA-Medicaid Website: http://dss.sd.gov Phone: 1-[PHONE REDACTED] TEXAS-Medicaid Website: http://gethipptexas.com/ Phone: 1-[PHONE REDACTED] UTAH-Medicaid and CHIP Medicaid Website: CHIP Website: http://health.utah.gov/chip Phone: 1-[PHONE REDACTED] VERMONT-Medicaid Website: http://www.greenmountaincare.org/ Phone: 1-[PHONE REDACTED] VIRGINIA-Medicaid and CHIP Website: Medicaid Phone: 1-[PHONE REDACTED] CHIP Phone: 1-[PHONE REDACTED] WASHINGTON-Medicaid Website: Phone: 1-[PHONE REDACTED] WEST VIRGINIA-Medicaid and CHIP Website: Medicaid Phone: [PHONE REDACTED] CHIP Toll-free phone: (1-[PHONE REDACTED]) WISCONSIN-Medicaid and CHIP Website: Phone: 1-[PHONE REDACTED] WYOMING-Medicaid Website: eligibility/ Phone: 1-[PHONE REDACTED] 26 ---PAGE BREAK--- Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) Read full descriptions and plan details at mymarkiii.com To see if any other states have added a premium assistance program since January 31, 2025, 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-[PHONE REDACTED], Menu Option 4, Ext. 61565 Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email [EMAIL REDACTED] and reference the OMB Control Number 1210-0137. 27 ---PAGE BREAK--- Contact Information Read full descriptions and plan details at mymarkiii.com Cigna Customer Service: 1-[PHONE REDACTED] Medical, Dental, & Vision: 1-[PHONE REDACTED] www.cigna.com Mark III Employee Benefits (Broker) Phone: [PHONE REDACTED] Toll-Free: 1-[PHONE REDACTED] www.markiiieb.com Flexible Benefit Administrators (FSA Accounts) Phone: 1-[PHONE REDACTED] Fax: [PHONE REDACTED] [EMAIL REDACTED] Nationwide (Pet Insurance) Phone: [PHONE REDACTED] www.petsnationwide.com FlexCare Telemedicine: 1-[PHONE REDACTED] Email: [EMAIL REDACTED] www.flexcare.com The Standard Disability & Life: 1-[PHONE REDACTED] EAP: [PHONE REDACTED] www.standard.com www.healthadvocate.com/standard3.com 28 ---PAGE BREAK--- Arranged and Enrolled by Mark III Brokerage, Inc. 3205 S. Cherokee Lane, Suite 110 Woodstock, GA 30188 (800) 532-1044 (704) 365-4280 View additional benefits information or download forms at: mymarkiii.com