Important Contacts
www.doctorondemand.com/health-plans-inc support@doctorondemand.com
www.cancercareprogram.com
www.mutualofomaha.com/eap
www.empowermyretirement.com Fitness and Nutrition
HUSK ID: HS00220 800-294-1500
Employee Response Center
Employee benefits can be complicated. The Higginbotham Employee Response Center can assist you with the following:
⊲ Enrollment
⊲ Benefits information
⊲ Claims and billing questions
⊲ Eligibility issues
https://marketplace.huskwellness.com customerservices@huskwellness.com
Call or text 866-419-3518 to speak with a bilingual representative Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you leave a message after 3:00 p.m. CT, your call or text will be returned the next business day. You can also email questions or requests to helpline@higginbotham.net .
What’s Inside
Welcome
We are pleased to offer a full benefits package to help protect your well-being and financial health. Read this guide to learn about the benefits available to you and your eligible dependents.
Each year during Open Enrollment (OE), you may make changes to your benefit plans. The benefit choices you make this year will remain in effect from July 1, 2025, through June 30, 2026 . Take time to review these benefit options and select the plans that best meet your needs. After OE, you may only make changes to your benefit elections if you have a Qualifying Life Event (QLE).
Availability of Summary Health Information
Your benefits program offers two medical plan coverage options. To help you make an informed choice and compare your options, a Summary of Benefits and Coverage for each plan is available at www.hpitpa.com or by calling 800-532-7575 .
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices about your prescription drug coverage. Please see page 24 for more details.
Eligibility
You are eligible for benefits if you are a regular, full-time employee working an average of 30 hours per week . If you are a new hire, your coverage will be effective immediately upon employment.
You may also enroll eligible dependents for benefits coverage. The cost for coverage depends on the number of dependents you enroll and the benefits you choose. When covering dependents, you must select and be on the same plans.
Eligible Dependents
⊲ Your legal spouse
⊲ Children under the age of 26 regardless of student, dependency, or marital status
⊲ Children over the age of 26 who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return
Qualifying Life Events
Once you elect your benefit options, they remain in effect for the entire plan year until the following OE. You may only change coverage during the plan year if you have a QLE, some of which include:
⊲ Marriage, divorce, legal separation, or annulment
⊲ Birth, adoption, or placement for adoption of an eligible child
⊲ Death of your spouse or child
⊲ Change in your spouse’s employment status that affects benefits eligibility
⊲ Change in your child’s eligibility for benefits
⊲ Significant change in benefit plan coverage for you, your spouse, or your child
⊲ FMLA leave, COBRA event, judgment, or decree
⊲ Becoming eligible for Medicare, Medicaid, or TRICARE
⊲ Receiving a Qualified Medical Child Support Order
If you have a QLE and want to change your elections, you must notify Human Resources and complete your changes within 30 days of the event. You may be asked to provide documentation to support the change. Contact Human Resources for details.
Enrollment
How to Enroll for
Benefits
1. Log in to Paycor. Click People > Benefits, and then click Benefits Advisor. You are not asked to log in again.
2. You are directed to your Benefits Home screen. On the home screen, select Start Your Enrollment on the message board.
3. Before beginning your enrollment, verify the accuracy of all your personal information (e.g. address, DOB, etc.). When you are finished, check I agree and click Continue
4. Be sure to add all dependents who might be missing from the Family Information section before proceeding. To do this, click the Add Dependents card. When all family information has been entered, read through the Dependent Information Notice section, check I agree, and click Continue
5. Most plan types require to you to select a plan. This is noted in the lower left corner of the plan type pod with red text Selection Required .
6. You can waive out of the plan by selecting I don’t want this benefit (waive). Selecting View Plan Options opens a plan selection page. If the plan can cover your dependents, you must first choose which of those dependents to cover before being able to review all the plans available. You can cover a dependent by checking the box next to the dependent’s name. Click Back to return to the landing page, or click Continue to proceed after selecting dependents.
7. Each plan is listed in a pod that explains the plan name, vendor, and the plan data. The plan’s cost appears to the right of any plan data. The coverage tier appears below your cost.
8. When you have chosen a plan, the selection appears in the corresponding benefit plan type pod on the landing page as complete. Be sure to review and designate or update your beneficiaries.
9. Carefully review all your benefit selections and covered dependents. Note: You can change your selections by clicking Edit Selection for any of your plan selections. The dependents you wish to have included in your coverage are listed.
10. When you have reviewed your selections, check I agree and click Continue. It is highly recommended that you send yourself an email or print your confirmation statement of your selections.
Medical Plans
The medical plan options administered by Health Plans, Inc. (HPI) using the UnitedHealthcare (UHC) Choice Plus Network protect you and your family from major financial hardship in the event of illness or injury. You have a choice of two plans:
⊲ 2500 PPO – This plan is a PPO.
⊲ 2800 QHDHP – This plan is an HDHP.
Preferred Provider Organization
A Preferred Provider Organization (PPO) plan allows you to see any provider when you need care. When you see in-network providers for care, you will pay less and get the highest level of benefits. You will pay more for care if you use out-of-network providers. When you see in-network providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other in-network services are covered at the deductible and coinsurance level.
High Deductible Health Plan
A High Deductible Health Plan (HDHP) allows you to see any provider when you need care, but you will pay less for care when you go to in-network providers. In exchange for a lower per-paycheck cost for medical benefits, you must satisfy a higher plan deductible that applies to almost all health care expenses, including prescription drugs. If you enroll in the HDHP, you may be eligible to open a Health Savings Account (HSA). See page 13.
Bluejack will contribute $500 to your HSA account if you are enrolled in the HDHP this year.
Manage your medical plan online with My Plan
Get 24/7 access to your plan and account details.
Register in Minutes!
Step 1: Go to the website listed on the back of your member ID card (it will be at the top).
Step 2: Visit the Members section and then click Get Registered.
Step 3: Enter your information to create your username and password.
If you are a dependent, be sure to have the five-digit home ZIP code and the last four digits of the employee’s (plan subscriber’s) Social Security number.
Access all of your account details* in one secure location anytime, anywhere!
⊲ Review your claims.
⊲ Check your benefits.
⊲ Access your prescription drug plan.
⊲ Search your provider network.
⊲ Download a report of your claims.
⊲ Request claim reimbursements.
⊲ View, print, or order your member ID card.
⊲ View or print applicable tax forms.
⊲ Find a primary care physician.
⊲ View your HSA details.
*You will have access to details applicable to your plan. Please note, not all of the items listed above apply for all plans.
SmithRx
SmithRx is ready to provide you with world-class pharmacy benefits.
Nationwide Pharmacy Network – Our broad network includes more than 79,000 pharmacy locations such as CVS, Walgreens, Walmart, Costco, and more.
⊲ Our specialty pharmacy network includes high-touch providers.
⊲ Our mail network provides personalized service to patients.
⊲ If your current pharmacy is out-of-network, partner with your physician to have your prescription sent to one of our innetwork pharmacies.
Member Portal – Our new member portal is intuitively designed to improve the member experience and to help you easily access your benefits details.
⊲ Download or print your ID cards.
⊲ Search for an in-network pharmacy close to you.
⊲ Access prescription forms, claims, a full history of your prescriptions, and more.
Connect Programs – Your local pharmacy might not always be the cheapest option. Our Connect Team will continuously check your prescriptions to see if we can lower your out-of-pocket expenses.
Rx Processing – Please give your pharmacy the SmithRx processing information, including the RxBIN (024368), RxPCN (3207), and RxGroup Number (found on your ID card).
Prior Authorization – If you are prescribed a medication requiring prior authorization, you will need additional authorization through SmithRx. Our clinical team reviews these to ensure appropriate and safe use of medications for specific medical conditions. If you have any questions or if your medication requires a prior authorization, contact our Member Support team at 844-454-5201 .
Health Care Options
VIRTUAL VISITS/ TELEMEDICINE
DOCTOR’S OFFICE
Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed
24 hours a day, 7 days a week ⊲ Allergies
Cough/cold/flu
Rash
Stomachache
RETAIL CLINIC
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history
Office hours vary
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies
Hours vary based on store hours
When you need immediate attention; walk-in basis is usually accepted
Generally includes evening, weekend, and holiday hours
⊲ Infections
⊲ Sore and strep throat
⊲ Vaccinations
⊲ Minor injuries/sprains/ strains
⊲ Common infections
⊲ Minor injuries
⊲ Pregnancy tests
⊲ Vaccinations
⊲ Sprains and strains
⊲ Minor broken bones
⊲ Small cuts that may require stitches
⊲ Minor burns and infections
URGENT CARE
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility
24 hours a day, 7 days a week
Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher
24 hours a day, 7 days a week
⊲ Chest pain
⊲ Difficulty breathing
⊲ Severe bleeding
⊲ Blurred or sudden loss of vision
⊲ Major broken bones
⊲ Most major injuries except trauma ⊲ Severe pain
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only
Telemedicine
Your medical coverage offers telemedicine services through Doctor On Demand . Connect anytime day or night with a board-certified doctor via your mobile device or computer for the same or lower cost than a visit to your regular physician.
When to Use Doctor On Demand
While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
⊲ Have a non-emergency issue and are considering an after-hours health care clinic, urgent care clinic, or emergency room for treatment
⊲ Are on a business trip, vacation, or away from home
⊲ Are unable to see your primary care physician
Use telemedicine services for minor conditions such as:
⊲ Sore throat
⊲ Headache
⊲ Stomachache
⊲ Cold/flu
⊲ Mental health issues
⊲ Allergies
⊲ Fever
⊲ Urinary tract infections
Do not use telemedicine for serious or life-threatening emergencies.
Registration is Easy
Register with Doctor On Demand so you are ready to use this valuable service when and where you need it.
⊲ Visit – www.doctorondemand.com/health-plans-inc .
⊲ Call – 800-997-6196
⊲ Email – support@doctorondemand.com
⊲ Mobile – Doctor On Demand app.
HealthJoy
Welcome to a world of seamless health care management and boundless benefits at your fingertips – HealthJoy, which Bluejack provides for free when you enroll in one of our medical plans.
Experience the transformative power of the ultimate insurance companion. Seamlessly locate in-network doctors, uncover extra savings on prescriptions, and easily navigate your benefits. With our mobile app and dedicated Member Support team, staying healthy has never been easier. Plus, get 24/7 access to a dedicated health care team, telemedicine, and intuitive care navigation tools, unlocking the full potential of your insurance coverage through:
⊲ Telemedicine consultations
⊲ Provider, facility, and procedure recommendations
⊲ Appointment booking
⊲ Medical device help
⊲ Prescription drug price comparisons
⊲ Personalized recommendation for a local doctor
⊲ Health care concierge services to save time and money
⊲ Prescription savings
⊲ Expert review and negotiation of medical bills
⊲ HSA or Flexible Spending Account (FSA) support
⊲ A benefits wallet to view your benefits cards
Say farewell to health care complexities and embrace simplified solutions with HealthJoy — where instant access to virtual doctor visits and hassle-free prescription refills revolutionize your health care journey.
Download the HealthJoy app today or call 877-500-3212
Additional Benefits
Cancer Management
CancerCARE is available at no cost to you . This program ensures you get the best possible care if you or a covered family member are diagnosed with cancer. Cancer experts can answer questions about your diagnosis, treatment, and any potential side effects. They will guide you through your treatment process and help you use all available resources, including a triage center, nurse care management, and access to Centers of Excellence networks.
Get Started
⊲ Visit – www.cancercareprogram.com .
⊲ Call – 877-640-9610
Surgery and Imaging KISx Card
The KISx Card is a surgery and imaging program that helps you save money on outpatient procedures while connecting you to high-quality care. Some typical procedures through the KISx Card include: orthopedic, general surgery, colonoscopies, MRI, CT, and PET scans. By utilizing the program and choosing a KISx Card provider, you will always pay $0 out of pocket for your procedure.
Before seeking in-network providers through your medical plan, call a KISx Card nurse regarding your elective procedure. If your procedure can be done in an outpatient setting, KISx Card will assist you in finding a nearby facility and scheduling your procedure. Just call, text, or email a KISx Card nurse to find out more about your procedure and how the program works.
⊲ Visit – www.getkisx.com .
⊲ Call – 877-GET-KISX .
⊲ Email – info@getkisx.com
Health Savings Account
An HSA is a tax-exempt tool to supplement your retirement savings and to cover current and future health costs.
As a type of personal savings account, it is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for current or future qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA ELIGIBILITY
You are eligible to open and contribute to an HSA if you are:
⊲ Enrolled in an HSA-eligible HDHP (3200 QHDHP)
⊲ Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
⊲ Not enrolled in a Health Care FSA
⊲ Not eligible to be claimed as a dependent on someone else’s tax return
⊲ Not enrolled in Medicare, Medicaid, or TRICARE
⊲ Not receiving Veterans Administration benefits
You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP.
MAXIMUM CONTRIBUTIONS
Your HSA contributions may not exceed the annual maximum amounts established by the Internal Revenue Service. The 2025-2026 annual contribution maximums are based on the coverage option you elect:
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are age 55 or older, you may make an additional yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at anytime during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
If you enroll in the HDHP, Bluejack will contribute $500 to your HSA.
Opening an HSA
If you meet the eligibility requirements, you may open an HSA administered by HealthEquity. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. To open an account, go to www.healthequity.com
Important HSA Information
⊲ Always ask your network doctor to file claims with your medical, dental, or vision carrier so you will get the highest level of benefits. You can pay the doctor with your HSA debit card for any balance due.
⊲ You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
⊲ You may open an HSA at the financial institution of your choice, but only accounts opened through HealthEquity are eligible for automatic payroll deduction and company contributions.
Dental Coverage
Our dental plans help you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Coverage is provided through Ameritas .
DPPO Plan
Two levels of benefits are available with the DPPO plans: in-network and out-of-network. You may see any dental provider for care, but you will pay less and get the highest level of benefits with in-network providers. You could pay more if you use an out-of-network provider.
Vision Coverage
Our vision plan offers quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems.
Vision Benefits Summary
You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see an in-network provider. Coverage is provided through Ameritas using the EyeMed Insight network.
Flexible Spending Accounts
An FSA allows you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses.
We offer two different FSAs: one for health care expenses and one for dependent care expenses. Clarity Benefit Solutions administers our FSAs.
Health Care FSA
This FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. You may contribute up to $3,300 annually to a Health Care FSA, and you are entitled to the full election from day one of your plan year. Eligible expenses include:
⊲ Dental and vision expenses
⊲ Medical deductibles and coinsurance
⊲ Prescription copays
⊲ Hearing aids and batteries
You may not contribute to a Health Care FSA if you enrolled in an HDHP and contribute to an HSA..
How the Health Care FSA Works
You can access the funds in your Health Care FSA two ways:
⊲ Use your FSA debit card to pay for qualified expenses, doctor visits, and prescription copays.
⊲ Pay out-of-pocket and submit your receipts for reimbursement: Visit: www.claritybenefitsolutions.com . Call: 888-423-6359
Flexible Spending Accounts
Dependent Care FSA
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full-time. You can use the account to pay for daycare or babysitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you (and your spouse, if married) must be gainfully employed, looking for work, a full-time student, or incapable of self-care.
Dependent Care FSA Guidelines
⊲ Overnight camps are not eligible for reimbursement (only day camps can be considered).
⊲ If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
⊲ You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
⊲ The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
Important FSA Rules
⊲ The maximum per plan year you can contribute to a Health Care FSA is $3,300. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when married filing jointly or head of household and $2,500 when married filing separately.
⊲ You cannot change your election during the year unless you experience a QLE.
⊲ You can continue to file claims incurred during the plan year for another 30 days.
⊲ Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
⊲ The IRS has amended the “use it or lose it” rule to allow you to carry over up to $660 in your Health Care FSA into the next plan year. The carryover rule does not apply to your Dependent Care FSA.
Life and AD&D Insurance
Life and Accidental Death and Dismemberment (AD&D) insurance through Mutual of Omaha are important to your financial security, especially if others depend on you for support or vice versa.
With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies). Life and AD&D coverage amounts reduce by 35% at age 65, and by 50% at age 70.
Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you when you are enrolled in one of the medical plans. You are automatically covered at $50,000 for each benefit.
Voluntary Life and AD&D
You may buy more Life and AD&D insurance for you and your eligible dependents. If you do not elect Voluntary Life and AD&D insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health. You must elect Voluntary Life and AD&D coverage for yourself before you may elect coverage for your spouse or children. If you leave the company, you may be able to take the insurance with you.
Designating a Beneficiary
A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries at anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
*Spouse’s premium is based on employee’s age.
Conversion, Portability, or Waiver of Premium
Upon termination of employment, you have the option to continue your company-paid Life and AD&D insurance and pay premiums directly to Mutual of Omaha. Your company-paid Life and AD&D insurance may be converted to individual policies. Portability is available for Life coverage if you are enrolled in additional Life coverage. Portability is not available for AD&D. If you are disabled at the time your employment is terminated, you may be eligible for a Waiver of Premium while you are disabled. Contact Human Resources for a Conversion, Portability, or Waiver of Premium application.
Disability Insurance
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness.
Bluejack provides Short Term Disability (STD) to all eligible employees. Long Term Disability (LTD) is provided to all employees enrolled in the medical plan. Disability coverage is provided through Mutual of Omaha
Short Term Disability
STD coverage pays a percentage of your weekly salary if you are temporarily disabled and unable to work due to an illness, pregnancy, or non-work-related injury. STD benefits are not payable if the disability is due to a job-related injury or illness. If a medical condition is job-related, it is considered workers’ compensation, not STD.
Short Term Disability
Long Term Disability
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for more than 180 days. Benefits begin at the end of an elimination period and continue while you are disabled up to Social Security Normal Retirement Age (SSNRA).
Long Term Disability
*Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months.
Employee Assistance Program
As part of your Mutual of Omaha coverage, you have access to the Employee Assistance Program (EAP) at no cost to you . The EAP helps you and family members cope with a variety of personal or work-related issues. This program provides confidential counseling and support services to help with:
⊲ Relationships
⊲ Work-life balance
⊲ Stress and anxiety
24/7 Access and Support
⊲ Three free counseling sessions per incident, per year
⊲ Confidential and private
⊲ Will preparation and estate resolution
⊲ Grief and loss
⊲ Childcare and eldercare resources
⊲ Substance abuse
Contact the EAP
Call 800-316-2796 or visit www.mutualofomaha.com/eap
Supplemental Coverages
You and your eligible family members can enroll in additional coverage that complements our traditional health care programs. Health insurance covers medical bills, but if you have an emergency, you may face unexpected out-ofpocket costs such as deductibles, coinsurance, travel expenses, and non-medical related expenses. These voluntary plans are offered through Mutual of Omaha and are portable.
Accident Insurance
Accident insurance provides affordable protection against a sudden, unforeseen accident. The Accident plan helps offset the direct and indirect expenses resulting from an accident such as copayments, deductibles, ambulance, physical therapy, and other costs not covered by traditional health plans.
Supplemental Coverages
Critical Illness Insurance
Critical Illness insurance helps pay the cost of non-medical expenses related to a covered critical illness or cancer. The plan provides a lump-sum benefit payment to you upon first and second diagnosis of any covered critical illness or cancer. The benefit can help cover expenses such as lost income, outof-town treatments, special diets, daily living, and household upkeep costs.
Critical Illness Insurance
Increments of $10,000 up to a Guaranteed Issue amount of $20,000
Increments of $10,000 up to a Guaranteed Issue amount of $20,000 not to exceed 100% of employee election
Child(ren)
Benign brain tumor or spinal cord tumor; bone flap/skull defect; bone marrow/stem cell recipient; coma; end-stage renal failure; heart attack; invasive cancer; loss of hearing, sight or speech; major organ failure; paralysis; severe burns; stroke; sudden cardiac arrest; type 1 diabetes
Cerebral palsy; congenital heart disease; congenital metabolic disorders; genetic disorders; structural congenital defects
respiratory distress syndrome; carcinoma in situ; coronary artery disease; inflammatory bowel disease; transient
50% of employee election up to a Guaranteed Issue amount of $10,000
*Employee/member and spouse premiums are calculated with the employee/member’s age as of the effective date of the plan. Rates are adjusted once each year on the plan anniversary date that coincides with or follows the day an employee/member reaches the starting age of the next age band.
Hospital Indemnity Insurance
Hospital Indemnity insurance helps you with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance, which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment that you receive. These costs may include meals and transportation, childcare, or time away from work due to a medical issue that requires hospitalization.
401(k) Retirement Program
A 401(k) plan can be a powerful tool to help you be financially secure in retirement. Our 401(k) plan through Empower can help you reach your investment goals.
How the Retirement Plan Works
You are eligible to participate in the plan if you are age 21 or older and have three months of service with the company. You may contribute up to the 2025-2026 IRS limits.
You decide how much you want to contribute and can change your contribution amount anytime. All changes are effective as soon as administratively feasible and remain in effect until you update or stop your contributions. You also decide how to invest the assets in your account and may change your investment choices anytime. For more details, refer to your 401(k) Enrollment Guide or contact Empower at 800-338-4015
Enrollment
You must enroll through Empower by calling 800-338-4015 or by visiting www.empowermyretirement.com .
401(k) Company Matching
If you contribute, Bluejack will deposit a Safe Harbor matching contribution to your account. The match will be calculated on a per-pay-period basis using the matching formula 100% of deferrals on the first 3% of compensation deferred, plus 50% of deferrals on the next 2% of compensation deferred.
Vesting
You are 100% vested in your own contribution and the Safe Harbor matching contribution that the company is making on your behalf.
Investment Options
You may direct your contributions to any of the investments offered within the company 401(k) plan. Changes to your investments can be made online at www.empowermyretirement.com .
Fitness and Nutrition
HUSK Marketplace
Achieve optimal health with best-in-class pricing on fitness, nutrition, and wellness through HUSK Marketplace.
To begin, visit https://marketplace.huskwellness.com
⊲ Click on Activate Benefit to register for the program and to unlock your discounts and offers.
⊲ Use the provided Eligibility ID (HS00220) to register.
⊲ For questions, contact the customer support team at customerservice@huskwellness.com or call 800-294-1500.
As part of the HUSK Marketplace, you’re eligible for exclusive discounts on:
⊲ Gyms and Fitness Centers – With savings and flexible membership options at a variety of facilities, members can find something for every workout.
⊲ HUSK Nutrition – Through virtual health, meet with a registered dietitian and implement a one-on-one nutrition program designed to meet your wellness goals, needs, and lifestyle.
⊲ Home Equipment and Tech – No matter your fitness level or health goals, HUSK has the latest equipment and wearable technology to support you on your wellness journey.
⊲ On-demand Fitness – Streaming membership options provide a number of wellness and workout classes from the comfort of your own home.
⊲ Mental Health – Don’t go through mental struggles alone. Connect with licensed therapists who guide, support, and empower you through evidence-based practices.
Important Notices
Women’s Health and Cancer Rights Act of 1998
In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully.
As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:
• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
• Prostheses and treatment of physical complications of the mastectomy, including lymphedema.
Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
Special Enrollment Rights
This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.
Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP)
If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage).
If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance.
Marriage, Birth or Adoption
If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption.
For More Information or Assistance
To request special enrollment or obtain more information, contact:
Bluejack Management Partners Human Resources 4430 South FM 1486 Montgomery, TX 77316 281-204-2721
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 Bluejack Management Partners and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
Important Notices
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Bluejack Management Partners has determined that the prescription drug coverage offered by the Bluejack Management Partners medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is not considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Bluejack Management Partners at the phone number or address listed at the end of this section.
If you choose to enroll in a Medicare prescription drug plan and cancel your current Bluejack Management Partners prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.
If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.
For more information about this notice or your current prescription drug coverage:
Contact the Human Resources Department at 281-204-2721
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov.
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048
Important Notices
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity. gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778.
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
July 1, 2025
Bluejack Management Partners Human Resources
4430 South FM 1486 Montgomery, TX 77316 281-204-2721
Notice of HIPAA Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan –whether received in writing, in an electronic medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by Bluejack Management Partners, hereinafter referred to as the plan sponsor.
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer.
You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask the Human Resources Department to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources Department.
Complaints: If you believe your privacy rights have been violated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer.
Bluejack Management Partners Human Resources 4430 South FM 1486 Montgomery, TX 77316 281-204-2721
Conclusion
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov
Important Notices
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 March 17, 2025. Contact your State for more information on eligibility.
http://www.myalhipp.com/ Phone: 1-855-692-5447
myakhipp.com/ Phone: 1-866-251-4861
Email: CustomerService@MyAKHIPP.com
Health
dhcs.ca.gov/hipp
Phone: 916-445-8322
Fax: 916-440-5676
Email: hipp@dhcs.ca.gov
Colorado – Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+)
Health First Colorado website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711
CHP+: https://hcpf.colorado.gov/child-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
Florida – Medicaid
Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery. com/hipp/index.html
Phone: 1-877-357-3268
Georgia – Medicaid
GA HIPP Website: https://medicaid.georgia.gov/health-insurancepremium-payment-program-hipp
Phone: 678-564-1162, Press 1
GA CHIPRA Website: https://medicaid.georgia.gov/programs/thirdparty-liability/childrens-health-insurance-program-reauthorization-act2009-chipra
Phone: 678-564-1162, Press 2
Indiana – Medicaid
Health Insurance Premium Payment Program
All other Medicaid Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr/
Family and Social Services Administration Phone: 1-800-403-0864
Member Services Phone: 1-800-457-4584
Iowa
– Medicaid and CHIP (Hawki)
Medicaid Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid
Medicaid Phone: 1-800-338-8366
Hawki Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid/iowa-health-link/hawki
Hawki Phone: 1-800-257-8563
HIPP Website: https://hhs.iowa.gov/programs/welcome-iowa-medicaid/ fee-service/hipp
HIPP Phone: 1-888-346-9562
Kansas – Medicaid
Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884
HIPP Phone: 1-800-967-4660
Kentucky – Medicaid
Kentucky Integrated Health Insurance Premium Payment Program (KIHIPP) 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
Important Notices
Louisiana – Medicaid
Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp
Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)
Maine – Medicaid
Enrollment Website: https://www.mymaineconnection.gov/benefits/ s/?language=en_US
Phone: 1-800-442-6003
TTY: Maine relay 711
Private Health Insurance Premium Webpage: https://www.maine.gov/ dhhs/ofi/applications-forms
Phone: 1-800-977-6740
TTY: Maine Relay 711
Massachusetts – Medicaid and CHIP
Website: https://www.mass.gov/masshealth/pa
Phone: 1-800-862-4840
TTY: 711
Email: masspremassistance@accenture.com
Minnesota – Medicaid
Website: https://mn.gov/dhs/health-care-coverage/
Phone: 1-800-657-3672
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 573-751-2005
Website: https://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084
Email: HHSHIPPProgram@mt.gov
Nebraska – Medicaid
Website: http://www.ACCESSNebraska.ne.gov
Phone: 1-855-632-7633
Lincoln: 402-473-7000
Omaha: 402-595-1178
Medicaid Website: http://dhcfp.nv.gov
Medicaid Phone: 1-800-992-0900
Website: https://www.dhhs.nh.gov/programs-services/medicaid/healthinsurance-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
New Jersey – Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/humanservices/dmahs/ clients/medicaid/
Phone: 1-800-356-1561
CHIP Premium Assistance Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710 (TTY: 711)
New York – Medicaid
Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831
North Carolina – Medicaid
Website: https://medicaid.ncdhhs.gov
Phone: 919-855-4100
North Dakota – Medicaid
Website: https://www.hhs.nd.gov/healthcare
Phone: 1-844-854-4825
Oklahoma – Medicaid and CHIP
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
Oregon – Medicaid
Website: https://healthcare.oregon.gov/Pages/index.aspx
Phone: 1-800-699-9075
Pennsylvania – Medicaid and CHIP
Website: https://www.pa.gov/en/services/dhs/apply-for-medicaidhealth-insurance-premium-payment-program-hipp.html
Phone: 1-800-692-7462
CHIP Website: https://www.dhs.pa.gov/CHIP/Pages/CHIP.aspx
CHIP Phone: 1-800-986-KIDS (5437)
Rhode Island – Medicaid and CHIP
Website: http://www.eohhs.ri.gov/
Phone: 1-855-697-4347 or 401-462-0311 (Direct RIte Share Line)
South Carolina – Medicaid
Website: https://www.scdhhs.gov
Phone: 1-888-549-0820
South Dakota – Medicaid
Website: https://dss.sd.gov
Phone: 1-888-828-0059
Texas – Medicaid
Website: https://www.hhs.texas.gov/services/financial/healthinsurance-premium-payment-hipp-program
Phone: 1-800-440-0493
Utah – Medicaid and CHIP
Utah’s Premium Partnership for Health Insurance (UPP) Website: https:// medicaid.utah.gov/upp/ Email: upp@utah.gov
Phone: 1-888-222-2542
Adult Expansion Website: https://medicaid.utah.gov/expansion/ Utah Medicaid Buyout Program Website: https://medicaid.utah.gov/ buyout-program/
CHIP Website: https://chip.utah.gov/
Important Notices
Vermont– Medicaid
Website: https://dvha.vermont.gov/members/medicaid/hipp-program
Phone: 1-800-250-8427
Virginia – Medicaid and CHIP
Website: https://coverva.dmas.virginia.gov/learn/premium-assistance/ famis-select
https://coverva.dmas.virginia.gov/learn/premium-assistance/healthinsurance-premium-payment-hipp-programs
Medicaid/CHIP Phone: 1-800-432-5924
Washington – Medicaid
Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
West Virginia – Medicaid and CHIP
Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/
Medicaid Phone: 304-558-1700
CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
Wisconsin – Medicaid and CHIP
Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002
Wyoming – Medicaid
Website: https://health.wyo.gov/healthcarefin/medicaid/programs-andeligibility/ Phone: 1-800-251-1269
To see if any other States have added a premium assistance program since March 17, 2025, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
Continuation of Coverage Rights Under COBRA
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the Bluejack Management Partners group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Bluejack Management Partners plan after you have left employment with the company. If you wish to elect COBRA coverage, contact your Human Resources Department for the applicable deadlines to elect coverage and pay the initial premium.
Plan Contact Information
Bluejack Management Partners
Human Resources
4430 South FM 1486 Montgomery, TX 77316 281-204-2721
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-ofnetwork provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-ofpocket limit.
Important Notices
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care— like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
• Emergency services – If you have an emergency medical condition and get emergency services from an out-ofnetwork provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these poststabilization services.
• Certain services at an in-network hospital or ambulatory surgical center – When you get services from an innetwork hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s innetwork cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, outof-network providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care out-ofnetwork. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (costsharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/nosurprises for more information about your rights under federal law.
Glossary of Terms
Beneficiary – Who will receive a benefit in the event of the insured’s death. A policy may have more than one beneficiary.
Coinsurance – Your share of the cost of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service, typically after you meet your deductible.
Copay – The fixed amount you pay for health care services received.
Deductible – The amount you owe for health care services before your health insurance begins to pay its portion. For example, if your deductible is $1,000, your plan does not pay anything until you meet your $1,000 deductible for covered health care services. The deductible may not apply to all services, including preventive care.
Employee Contribution – The amount you pay for your insurance coverage.
Employer Contribution – The amount Bluejack Management Partners contributes to the cost of your benefits.
Explanation of Benefits (EOB) – A statement sent by your insurance carrier that explains which procedures and services were provided, how much they cost, what portion of the claim was paid by the plan, what portion of the claim is your responsibility, and information on how you can appeal the insurer’s decision. These statements are also posted on the carrier’s website for your review.
Flexible Spending Account (FSA) – An option that allows participants to set aside pretax dollars to pay for certain qualified expenses during a specific time period (usually a 12-month period).
Health Savings Account (HSA) – A personal savings account that allows you to pay for qualified medical expenses with pretax dollars.
High Deductible Health Plan (HDHP) – A medical plan with a higher deductible in exchange for a lower monthly premium. You must meet the annual deductible before any benefits are paid by the plan.
In-Network – Doctors, hospitals, and other providers that contract with your insurance company to provide health care services at discounted rates.
Out-of-Network – Doctors, hospitals, and other providers that are not contracted with your insurance company. If you choose an out-of-network provider, you may be responsible for costs over the amount allowed by your insurance carrier.
Out-of-Pocket Maximum – Also known as an out-ofpocket limit. The most you pay during a policy period (usually a 12-month period) before your health insurance or plan begins to pay 100% of the allowed amount. The limit does not include your premium, charges beyond the Reasonable & Customary (R&C) Allowance or health care your plan does not cover. Check with your health insurance carrier to confirm what payments apply to the out-ofpocket maximum.
Prescription Medications – Medications prescribed by a doctor. Cost of these medications is determined by their assigned tier: Generic, Formulary Brand Name or NonFormulary Brand Name.
⊲ Generic Drugs – Drugs approved by the U.S. Food and Drug Administration (FDA) to be chemically identical to corresponding brand name versions. The color or flavor of a generic medicine may be different, but the active ingredient is the same. Generic drugs are usually the most cost-effective version of any medication.
⊲ Formulary Brand Name Drugs – Brand name drugs on your provider’s list of approved drugs. You can check online with your provider to see this list.
⊲ Non-Formulary Brand Name Drugs – Brand name drugs not on your provider’s list of approved drugs. These drugs are typically newer and have higher copayments.
⊲ Over-the-Counter (OTC) Medications –Medications typically made available without a prescription.
Preventive Care – The care you receive to prevent illness or disease. It also includes counseling to prevent health problems.
Reasonable and Customer (URC) Allowance – Also known as an eligible expense or the Usual and Customary (U&C). The amount your insurance company will pay for a medical service in a geographic region based on what providers in the area usually charge for the same or similar medical service.
SSNRA – Social Security Normal Retirement Age.
This brochure highlights the main features of the Bluejack Management Partners employee benefits program. It does not include all plan rules, details, limitations, and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be an inconsistency between this brochure and the legal plan documents, the plan documents are the final authority. Bluejack Management Partners reserves the right to change or discontinue its employee benefits plans anytime.