We are pleased to offer a full benefits package to help protect your wellbeing and financial health. Read this guide to learn about the benefits available to you and your eligible dependents starting August 1, 2025
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 through July 31, 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).
Employee Response Center
Employee benefits can be complicated. The Higginbotham Employee Response Center can assist with the following:
¤ Benefit Questions
¤ Claims or Billing Questions
¤ Eligibility Issues
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, it will be returned the next business day. You can also email your questions or requests to helpline@higginbotham.net
IMPORTANT CONTACTS
ELIGIBILITY
You are eligible for benefits if you are a regular, full-time employee working an average of 30 or more hours per week. Your coverage is effective on the first of the month following 60 days.
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
Your benefit elections 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 such as marriage, divorce, birth or adoption, loss of other coverage, etc. You must notify Human Resources in a timely manner if any of these events occur. Contact Human Resources for a full list of QLEs and the notification timeframes required for requested changes.
ENROLLMENT
Enrollment Instructions
Enrollment will be completed through Paycom. Get the Paycom mobile app or visit www.paycom.com to get started.
1. From the Notifications Center, tap the current year’s Benefits Enrollment Review the instructions and tap Start Enrollment .
2. Review your information. Tap Edit to change anything or Next to continue.
3. Complete the Pre-Enrollment Questions and tap Save and Next . You can also edit existing dependent and beneficiary information on this screen, as well as add a dependent or beneficiary.
4. Choose to enroll in or decline a plan by checking the appropriate option. If necessary, choose which dependents to add. When finished, tap Enroll. Continue for each benefit plan.
5. When finished, review your enrollment and tap Finalize. Then, tap Sign and Submit in the pop-up window. To view your current benefits at anytime, navigate to Benefits > Current Benefits
MEDICAL COVERAGE
The medical plan options through Blue Cross Blue Shield of Texas (BCBSTX) protect you and your family from major financial hardship in the event of illness or injury.
You have a choice of three plans:
¤ $4,000 HSA Plan – This qualified HDHP PPO plan has a $4,000 individual and $8,000 family in-network deductible.
¤ $5,000 HSA Plan – This qualified HDHP PPO plan has a $5,000 individual and $10,000 family in-network deductible.
¤ $6,000 HSA Plan – This qualified HDHP PPO plan has a $6,000 individual and $12,000 family in-network deductible.
¤ Visit www.bcbstx.com
¤ Call 800-521-2227
Preferred Provider Organization
A Preferred Provider Organization (PPO) allows you to see any provider when you need care. When you see providers in the Blue Choice network for care, you will pay less and get the highest level of benefits. You will pay more for care if you use outof-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 coinsurance level.
High Deductible Health Plan
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 one of the High Deductible Health Plan (HDHP) options, you may be eligible to open a Health Savings Account (see page 14).
AVAILABILITY OF SUMMARY HEALTH INFORMATION
Your benefits program offers three medical plan coverage options. To help you make an informed choice and compare your options, a Summary of Benefits and Coverage for each plan is available at www.bcbstx.com or by contacting Human Resources.
MEDICAL COVERAGE
Medical Summary
Retail Rx
Up to 30-day supply
Preferred Generic
Non-Preferred Generic
Preferred Brand Name
Non-Preferred Brand Name
Mail Order Rx
Up to 90-day supply
Generic
Preferred Brand Name
Non-Preferred Brand Name
* The amount you pay after the deductible is met.
TELEMEDICINE
Illnesses and injuries seldom happen at convenient times. Regardless whether it’s after doctor’s hours, on the weekend, or on the road, you want access to immediate, cost-effective care.
Get 24/7 non-emergency care from a boardcertified doctor by phone, online video, or mobile app from almost anywhere with Teladoc by HealthJoy for $0
Skip expensive urgent care or ER bills and waiting to see a doctor. You can speak with a telemedicine doctor within minutes. Services are available in both English and Spanish with translation services available in other languages.
Why Telemedicine?
¤ 24/7 access to an independently contracted, board-certified doctor or therapist.
¤ Access via phone, online video, or mobile app from almost anywhere.
¤ Average wait time of less than 20 minutes.
¤ Doctors can send e-prescriptions to your local pharmacy.
Do not use telemedicine for serious or lifethreatening emergencies.
Virtual Dermatology and Nutrition Care
Dermatology – $85 Consult fee – Message with a dermatologist for skin care needs like rosacea, psoriasis, rashes, and more.
Nutritionist – $59 Consult fee – Meet with a nutritionist via phone or video for advice on staying healthy, eating right, or managing a health condition.
Activate Your Account
¤ Visit www.healthjoy.com/members
¤ Call 877-500-3212
¤ Download the HealthJoy app GET 24/7 CARE, ANYWHERE! THE DOCTOR’S ALWAYS IN!
HEALTH CARE OPTIONS
Becoming familiar with your options for medical care can save you time and money.
HEALTH CARE PROVIDER
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
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history Office hours vary
Allergies
Cough/cold/flu
Rash
Stomachache
*Additional cost for virtual dermatology and nutritionist services.
Infections
Sore and strep throat
Vaccinations
Minor injuries/sprains/ strains
RETAIL CLINIC
URGENT CARE
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
Common infections
Minor injuries
Pregnancy tests
Vaccinations
Sprains and strains
Minor broken bones
Small cuts that may require stitches
Minor burns and infections
HOSPITAL ER
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
Minimal
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only estimates. This information is not intended as medical advice. If you have questions, please call the phone number on the back of your medical ID card.
BCBSTX RESOURCES
Blue Access for Members
Blue Access for Members is the secure BCBSTX member website where you can:
¤ Check the status of your claims and your claim history
¤ Confirm which family members are covered under your plan
¤ View and print Explanation of Benefits (EOB) claims statement
¤ Locate an in-network provider
¤ Request a new or replacement member ID card or print a temporary member ID card. To get started, log on to www.bcbstx.com. Use the information on your BCBSTX ID card to complete the registration process.
MOBILE APP
The BCBSTX app can help you stay organized and in control of your health anytime, anywhere. Log in from your mobile device to access your Blue Access for Members account, including:
¤ Track account balances and deductibles
¤ Access ID card information
¤ Find doctors, dentists, and pharmacies
Text BCBSTX to 33633 or search your mobile device’s app store to download.
MEMBER REWARDS
Register for Member Rewards and receive rewards for making good health care decision, such as seeking care from preferred providers. Log in to Blue Access for Members and click on the Doctors & Hospitals tab under Provider Finder
Well onTarget
Well onTarget provides the support you need to make healthy choices. Access personalized tools and resources on the secure Well onTarget website, including:
¤ Self-management programs
¤ Health resources and information
¤ Tools and trackers
¤ Health assessments
Visit www.wellontarget.com to access the Well onTarget member portal. If you have already registered on Blue Access for Members, you will use the same login information. If not, you can register on this site. Customer Service is available at 877-806-9380
TOBACCO CESSATION
The Tobacco Cessation Program through Well onTarget helps you learn to quit tobacco with innovative lessons developed using the most current medical research. The interactive, digital self-management programs consist of a six week program to help you establish behaviors to achieve your goal of:
¤ Quitting Tobacco – This program will help you identity your stressor and beat addiction. You will also learn how and when medication may benefit you and strategies to help you avoid slip-ups and prevent future relapse.
¤ Staying Tobacco Free – While revisiting your reasons for quitting, you will discover ways to get past hard time and stay tobacco free.
Sign up for the Tobacco Cessation Program in the Well onTarget portal at www.wellontarget.com For more information, call 877-806-9380
BCBSTX RESOURCES
Nurseline
Call 800-581-0368 for immediate access to registered nurses who can answer general health questions, make appointments with your doctor and help determine where to go for immediate or emergency health care services. You can also access an audio library of more than 1,000 health-related topics in both English and Spanish.
Blue365
Blue365 can help you save money on health and wellness products and services not covered by insurance. There are no claims to file and you do not need a referral or preauthorization. Sign up for Blue365 at www.blue365deals.com/bcbstx to receive weekly Featured Deals by email. Discounts include:
¤ Davis Vision + LasikPlus – Eyewear and LASIK
¤ TruHearing + Beltone – Hearing aids and tests
¤ Philips Sonicare – Oral care products
¤ Dental Solutions – Dental discount card
¤ KIND + Sunbasket – Weight loss and nutrition
¤ Reebok + SKECHERS – Work footwear
HEALTHJOY
We partner with HealthJoy to provide you with health care guidance. Download the HealthJoy app to your mobile device to easily access these services at no cost to you.
Your Personal Healthcare Concierge
You get on-demand access to:
¤ Provider recommendations* – The concierge will extensively research every recommendation and call to confirm in-network participation.
¤ Facility recommendations* – Get the highest quality, fairest priced, and most convenient facilities.
¤ Answer benefits questions – Questions about your health plan, HSA, dental plan, or other employee benefits.
¤ Appointment booking – Schedule the earliest appointment with hard-to-reach specialists.
¤ Rx savings review – Get lower-cost medication alternatives.
* 1-2 hours on average
Medical Bill Advocacy
Medical bills are confusing. HealthJoy can help. This bill review service is designed to spot errors, clear up confusion, and give you peace of mind. When you submit a bill review through the App, trained experts will review, check with providers and insurance charges, and advocate on your behalf to resolve any billing errors.
Benefits Wallet
The Benefits Wallet is a valuable tool that can help you access all your employee benefits cards in one place. To view the details of the benefits offered, simply click on a card. You can also provide an electronic copy of your card at the doctor’s office, pharmacy, etc. No need to carry around a physical card. You will always have a your benefits information readily available.
Telemedicine
HealthJoy is an easy and trusted way for you to request visits with board-certified medical providers on demand for minor illnesses and injuries. Get the care you need, when and where you need it by using the HealthJoy app.
Telemedicine can help when you are not feeling your best, when you need a short-term prescription, when it’s the middle of the night, or when you are traveling.
¤ All general telemedicine visits have a $0 fee
¤ Dermatologist visits have an $85 fee
¤ Nutritionist visits have a $59 fee
See page 8 for more information.
For More Information
¤ Visit www.healthjoy.com/members
¤ Call 877-500-3212
¤ Download the HealthJoy app
EMPLOYEE ASSISTANCE PROGRAM
Guinco provides an Employee Assistance Program (EAP) to help you and family members cope with a variety of personal or work-related issues.
As part of your BCBSTX coverage, ComPsych GuidanceResources provides confidential counseling and support services at no cost to you to help with:
¤ Relationships
¤ Work-life balance
¤ Stress and anxiety
¤ Will preparation and estate resolution
¤ Grief and loss
¤ Childcare and eldercare resources
¤ Substance abuse
MAKE A POSITIVE CHANGE
Connect with a therapist for confidential emotional support. Your EAP includes five free therapy sessions per issue per year.
Contact the EAP
Don’t be afraid to reach out for help. Your health records are kept private from your employer, as required by law.
¤ Visit www.guidanceresources.com (use Web ID BCBSTXEAP).
¤ Call 844-213-8968.
¤ Download the GuidanceNow
CHECK OFF YOUR TO-DOS
Specialists can save you time by searching for local services so you don’t have to. They offer services to find childcare, eldercare, pet care, movers, home repair services, and much more.
HAVE YOUR LEGAL QUESTIONS ANSWERED
Talk to a lawyer for help with legal questions, including divorce, adoption, family law, wills, landlord, and tenant issues.
GET HELP WITH YOUR FINANCES
Experts that include accountants and financial planners can help with a wide range of money matters, which includes retirement planning, taxes, relocation, mortgages, budgeting, debt, and bankruptcy.
ACCESS ONLINE TOOLS 24/7
GuidanceResources Online is your link to information and support whenever you need it.
HEALTH SAVINGS ACCOUNT
An HSA is more than a way to help you and your family cover current medical costs — it is also a taxexempt tool to supplement your retirement savings and to cover future health costs. HSA Bank administers our HSA.
An HSA is a type of personal savings account that 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
¤ Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
¤ Not enrolled in a Health Care Flexible Spending Account
¤ Not eligible to be claimed as a dependent on someone else’s tax return
¤ Not enrolled in Medicare, 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.
Opening an HSA
If you meet the eligibility requirements, you may open an HSA administered by HSA Bank. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. To open an account, go to www.hsabank.com
Maximum Contributions
Guinco will make contributions into your HSA based on your tenure. Your total HSA contributions — including Guinco contributions — may not exceed the annual maximum amount established by the IRS. The annual contribution maximum is based on the coverage option you elect.
MAXIMUM 2025 HSA CONTRIBUTIONS
90 days-1 year
MAXIMUM 2026 HSA CONTRIBUTIONS
90 days-1 year
1-4 years
5-9 years
9+ years
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 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
Important HSA Information
¤ Always ask your network doctor to file claims with BCBSTX 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 HSA Bank are eligible for automatic payroll deduction and company contributions.
Name your Beneficiaries
If you open an HSA, it is very important to designate one or more beneficiaries!
A beneficiary is a person or entity that you designate to receive the proceeds from your HSA in the event of your death.
Most beneficiary designations can be made or changed online at www.hsabank.com However, if you are married, domiciled in a community property state, or designate a non-spouse primary beneficiary, you must submit a Beneficiary Form with the notarized consent of your spouse.
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 BCBSTX .
DPPO Plan
Two levels of benefits are available with the DPPO plan: 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 innetwork providers. You could pay more if you use an out-of-network provider.
Treatment from out-of-network providers is paid based on Reasonable and Customary (R&C) charges and is paid based on the Maximum Reimbursable Charge (MRC). The MRC is calculated at the 90th percentile of all provider charges in the geographic area. The dentist may balance bill up to their usual fees. You will be reimbursed up to a Maximum Allowable Charge (MAC). You are responsible for charges in excess of the MAC. Refer to the Patient Charge schedule for details.
Dental Benefits
A – Preventive Care Exams, cleanings, complete
Type B – Basic Restorative Fillings, extractions, periodontics, endodontics, oral surgery
C – Major Restorative Crowns, bridges, dentures
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.
You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see a network provider. Coverage is provided through BCBSTX utilizing the EyeMed vision network.
Vision Benefits Summary
Exam (Once every 12 months)
Standard Lenses (Once every 12 months)
Single vision
Lined bifocal
Lined trifocal
Lenticular
Frames (Once every 12 months)
Contacts
(Once every 12 months)
In lieu of eyeglasses
Conventional
Disposable
Medically necessary
copay
copay
copay
copay
copay
Visit www.eyemedvisioncare.com/bcbstxvis
Call 855-556-8796
LIFE AND AD&D INSURANCE
Life and Accidental Death & Dismemberment (AD&D) insurance through BCBSTX are important to 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 50% at age 70.
Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at $25,000.
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.
Increments of $5,000 up to $250,000 (not
*Spouse rate is based on employee’s age. Spouse coverage terminates when the employee attains age 75.
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 any time. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
LONG TERM DISABILITY INSURANCE
Long Term Disability (LTD) insurance
provides partial income protection if you are unable to work due to a covered accident or illness. We provide LTD insurance at no cost to you through BCBSTX .
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for more than 90 days. Benefits begin at the end of an elimination period and continue while you are disabled up to Social Security Normal Retirement Age (SSNRA).
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.
Disability Resource Services
Disability Resource Services through ComPsych Corporation help you and your family with a variety of emotional, legal, and financial issues. Whether it is for depression, addiction, grief, loss, or other legal, financial, or life issue, you can get 24/7 help from mental health professionals. Services include inperson sessions; unlimited phone contact; and web-based services. For more information, see page 23.
SUPPLEMENTAL INSURANCE
Guinco offers you and your eligible family members the opportunity to 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. The plans are offered through BCBSTX and are portable. If you leave your employment, you can take these policies with you.
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, deductible, ambulance, physical therapy and other costs not covered by traditional health plans. Guinco offers your choice of two plans.
Specific Sum Injuries
Dislocations, ruptured discs, eye injuries, fractures, lacerations, concussions, etc.
* Accidental death common carrier benefit: Plan 1 - $80,000 employee and spouse and child $12,000. Plan 2 - $150,000 employee and spouse and child $25,000.
SUPPLEMENTAL INSURANCE
Critical Illness Insurance
Critical Illness insurance helps pay the cost of non-medical expenses related to a covered critical illness or cancer. As an active employee of Guinco, you can give your family the extra security they need to lessen the financial impact of a serious illness by purchasing Critical Illness insurance. 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, out-of-town treatments, special diets, daily living, and household upkeep costs.
SUPPLEMENTAL INSURANCE
Hospital Indemnity Insurance
The Hospital Indemnity Plans provided help you with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance that pays a benefit to the hospital or doctor, these plans pay 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.
HOSPITAL INDEMNITY INSURANCE
ADDITIONAL BENEFITS
Beneficiary Resource Services
Beneficiary Resource Services through Morneau Shepell provide family wellness and security at the most difficult times.
SERVICES FOR YOU AND YOUR FAMILY
¤ Online Will Preparation – Create a personalized will and keep your information safe and secure. Log on to www.beneficiaryresource.com and enter username beneficiary
¤ Online Funeral Planning – Download a funeral planning guide and access helpful information, such as funeral cost comparisons, funeral requirements, and various religious customs.
SERVICES FOR YOUR BENEFICIARIES
¤ Unlimited phone contact for up to one year with a grief counselor, legal advisor, or financial planner
¤ Up to five face-to-face working sessions that can be split between different counselors. Counselors will initiate follow-up calls, when necessary, for up to one full year from the date of initial contact.
Call 800-769-9187 for details.
Worldwide Travel Assistance
Get travel assistance from Assist America if you are traveling more than 100 miles from home. Representatives can help with trip planning or assist in a medical emergency while traveling.
Services include:
¤ Medical evacuation/ return home
¤ Replacement of medication ¤ Interpretation/ translation
¤ Return of mortal remains
Disability Resource Services
Disability Resource Services through ComPsych Corporation help to address a variety of emotional, legal, and financial issues. Whether it is depression, alcohol and drug abuse, grief, loss, legal, financial, or other work or life issue, help is available to you and your family 24/7 for free.
Services include:
¤ In-Person Sessions – Get three face-to-face sessions per issue per year.
¤ Unlimited Phone Contact – Get 24/7 support from master’s degree-level clinicians.
¤ Web-based Services – Access extensive online resources to help with personal, relational, legal, health, financial concerns, and more.
Services must be coordinated through Assist America to be covered.
¤ Call 800-872-1414
¤ Email medservices@assistamerica.com
¤ Reference Number 01-AA-TRS-12201
EMPLOYEE CONTRIBUTIONS
VISION
Your benefit premiums will automatically be calculated for you based on the elections you make when you enroll in the Paycom portal.
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:
Guinco
Human Resources
7231 Baker Blvd.
Richland, TX 76118
817-568-2866
hr@guinco.com
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 Guinco and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Guinco has determined that the prescription drug coverage offered by the Guinco 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.
IMPORTANT NOTICES
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 Guinco 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 Guinco 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 817-568-2866
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from
Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-3250778
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).
August 1, 2025 Guinco Human Resources
7231 Baker Blvd. Richland, TX 76118
817-568-2866 hr@guinco.com
Notice of HIPAA Privacy Practices
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (the “Notice”) describes the legal obligations of Company’s Group Health Plan (the “Plan”) and your legal rights regarding your protected health information held by the Plan under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act). Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law.
IMPORTANT NOTICES
We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA.
The HIPAA Privacy Rule protects only certain medical information known as “protected health information.” Generally, protected health information (PHI) is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to:
1. Your past, present, or future physical or mental health or condition;
2. The provision of health care to you; or
3. The past, present, or future payment for the provision of health care to you.
I. Contact Information
If you have any questions about this Notice or about our privacy practices, and for any correspondence or requests related to the contents of this Notice, please contact: Guinco
2. provide you with certain rights with respect to your PHI;
3. provide you with a copy of this Notice of our legal duties and privacy practices with respect to your PHI; and
4. follow the terms of the Notice that is currently in effect. We reserve the right to change the terms of this Notice and to make new provisions regarding your PHI that we maintain, as allowed or required by law. If we make any material change to this Notice, we will provide you with a copy of our revised Notice of Privacy Practices.
IV. How We May Use and Disclose Your PHI
Under the law, we may use or disclose your PHI under certain circumstances without your permission. The following categories describe the different ways that we may use and disclose your PHI. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. Note that we will use and disclose PHI as described below unless otherwise prohibited or restricted by applicable state or other law, and that information can lose its protected status as PHI once re-disclosed by a recipient.
For Treatment. When and as appropriate, we may use or disclose medical information about you to facilitate medical treatment or services by health care providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about you with physicians who are treating you.
For Payment. We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary, or to determine whether the Plan will cover the treatment. We may also share your protected health information with a utilization review or precertification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.
For Health Care Operations. We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information in connection with conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess-loss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities. However, we will not use your genetic information for underwriting purposes.
IMPORTANT NOTICES
Substance Use Disorder (SUD) Treatment Information. Some of your health information may be part of a SUD patient record and subject to additional protections under federal law (42 CFR Part 2) governing confidentiality of SUD patient records.
If we receive or maintain any information about you from a SUD treatment program that is covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the SUD patient record for purposes of treatment, payment or health care operations, we may use and disclose your SUD patient record for treatment, payment and health care operations purposes as described in this Notice. If we receive or maintain your SUD patient record through specific consent you provide to us or another third party, we will use and disclose your SUD patient record only as expressly permitted by you in your consent as provided to us. In no event will we use or disclose your SUD patient record, or testimony that describes the information contained in your SUD patient record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.
To Business Associates. We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, transmit, use, and/or disclose your PHI, but only after they agree in writing with us to implement appropriate safeguards regarding your PHI. For example, we may disclose your PHI to a Business Associate to process your claims for Plan benefits or to provide support services, such as utilization management, pharmacy benefit management, or subrogation, but only after the Business Associate enters into a Business Associate contract with us.
Treatment Alternatives or Health-Related Benefits and Services. We may use and disclose your protected health information to send you information about treatment alternatives or other health-related benefits and services that might be of interest to you.
As Required by Law. We will disclose your PHI when required to do so by federal, state, or local law. For example, we may disclose your PHI when required by national security laws or public health disclosure laws.
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may disclose your PHI in a proceeding regarding the licensure of a physician.
To Plan Sponsors. For the purpose of administering the plan, we may disclose PHI to certain employees of the Employer. However, those employees will only use or disclose that information as necessary to perform plan administration functions or as otherwise required by HIPAA, unless you have authorized further disclosures. Your PHI cannot be used for employment purposes without your specific authorization.
V. Special Situations
In addition to the above, the following categories describe other possible ways that we may use and disclose your PHI without your specific authorization. For each category of uses or disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
Organ and Tissue Donation. If you are an organ donor, we may release your PHI after your death to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation. We may release your PHI for workers’ compensation or similar programs, but only as authorized by, and to the extent necessary to comply with, laws relating to workers’ compensation and similar programs that provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose your PHI for public health activities. These activities generally include the following:
1. to prevent or control disease, injury, or disability;
2. to report births and deaths;
3. to report child abuse or neglect;
IMPORTANT NOTICES
4. to report reactions to medications or problems with products;
5. to notify people of recalls of products they may be using;
6. to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
7. to notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.
Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone involved in a legal dispute, but only if efforts have been made to tell you about the request or to obtain a court or administrative order protecting the information requested.
Law Enforcement. We may disclose your PHI if asked to do so by a law-enforcement official.
1. in response to a court order, subpoena, warrant, summons, or similar process;
2. to identify or locate a suspect, fugitive, material witness, or missing person;
3. about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement;
4. about a death that we believe may be the result of criminal conduct; and
5. about criminal conduct.
Coroners, Medical Examiners, and Funeral Directors. We may release PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors, as necessary to carry out their duties.
National Security and Intelligence Activities. We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Inmates. If you are an inmate of a correctional institution or are in the custody of a law-enforcement official, we may disclose your PHI to the correctional institution or law-enforcement official if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Research. We may disclose your PHI to researchers when:
1. The individual identifiers have been removed; or
2. When an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of the requested information and approves the research.
VI. Required Disclosures
The following is a description of disclosures of your PHI we are required to make.
Government Audits. We are required to disclose your PHI to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule.
Disclosures to You. When you request, we are required to disclose to you the portion of your PHI that contains medical records, billing records, and any other records used to make decisions regarding your health care benefits. We are also required, when requested, to provide you with an accounting of most disclosures of your PHI if the disclosure was for reasons other than for payment, treatment, or health care operations, and if the PHI was not disclosed pursuant to your individual authorization.
IMPORTANT NOTICES
VII. Other Disclosures
Personal Representatives. We will disclose your PHI to individuals authorized by you, or to an individual designated as your personal representative, attorney-in-fact, etc., so long as you provide us with a written notice/authorization and any supporting documents (i.e., power of attorney). Note: Under the HIPAA privacy rule, we do not have to disclose information to a personal representative if we have a reasonable belief that:
1. You have been, or may be, subject to domestic violence, abuse, or neglect by such person; or
2. Treating such person as your personal representative could endanger you; and
3. In the exercise of professional judgment, it is not in your best interest to treat the person as your personal representative.
Spouses and Other Family Members. With only limited exceptions, we will send all mail to the employee. This includes mail relating to the employee’s spouse and other family members who are covered under the Plan and includes mail with information on the use of Plan benefits by the employee’s spouse and other family members and information on the denial of any Plan benefits to the employee’s spouse and other family members. If a person covered under the Plan has requested Restrictions or Confidential Communications (see below under “Your Rights”), and if we have agreed to the request, we will send mail as provided by the request for Restrictions or Confidential Communications.
Authorizations. Other uses or disclosures of your PHI not described above will only be made with your written authorization. For example, in general and subject to specific conditions, we will not use or disclose your psychiatric notes; we will not use or disclose your PHI for marketing; and we will not sell your PHI, unless you give us a written authorization. You may revoke written authorizations at any time, so long as the revocation is in writing. Once we receive your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.
VIII. Your Rights
You have the following rights with respect to your PHI: Right to Inspect and Copy. You have the right to inspect and copy certain PHI that may be used to make decisions about your Plan benefits. If the information you request is maintained electronically, and you request an electronic copy, we will provide a copy in the electronic form and format you
request, if the information can be readily produced in that form and format; if the information cannot be readily produced in that form and format, we will work with you to come to an agreement on form and format. If we cannot agree on an electronic form and format, we will provide you with a paper copy.
To inspect and copy your PHI, you must submit your request in writing. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request.
Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan.
To request an amendment, your request must be made in writing. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
1. is not part of the medical information kept by or for the Plan;
2. was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
3. is not part of the information that you would be permitted to inspect and copy; or
4. is already accurate and complete.
If we deny your request, you have the right to file a statement of disagreement with us and any future disclosures of the disputed information will include your statement.
Right to an Accounting of
Disclosures.
You have the right to request an “accounting” of certain disclosures of your PHI. The accounting will not include (1) disclosures for purposes of treatment, payment, or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to your authorization; (4) disclosures made to friends or family in your presence or because of an emergency; (5) disclosures for national security purposes; and (6) disclosures incidental to otherwise permissible disclosures.
IMPORTANT NOTICES
To request this list or accounting of disclosures, you must submit your request in writing. Your request must state the time period you want the accounting to cover, which may not be longer than six years before the date of the request. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12-month period will be provided free of charge. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on your PHI that we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on your PHI that we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had.
Except as provided in the next paragraph, we are not required to agree to your request. However, if we do agree to the request, we will honor the restriction until you revoke it or we notify you.
We will comply with any restriction request if (1) except as otherwise required by law, the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (2) the PHI pertains solely to a health care item or service for which the health care provider involved has been paid in full by you or another person.
To request restrictions, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply-for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Right to Be Notified of a Breach. You have the right to be notified in the event that we (or a Business Associate) discover a breach of unsecured PHI.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
IX. Complaints
If you believe that your privacy rights have been violated, you may file a complaint with the Plan or with the Office for Civil Rights of the United States Department of Health and Human Services. To file a complaint with the Plan, contact the person listed in the Contact Information section of this Notice. All complaints must be submitted in writing.
You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office for Civil Rights or with us.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www. insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
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.
IMPORTANT NOTICES
Alabama – Medicaid
Website: http://www.myalhipp.com/
Phone: 1-855-692-5447
Alaska – Medicaid
The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/
To see if any other States have added a premium assistance program since March 17, 2025, or for more information on special enrollment rights, can contact either:
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 Guinco group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Guinco 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
Guinco
Human Resources
7231 Baker Blvd. Richland, TX 76118 817-568-2866
hr@guinco.com
IMPORTANT NOTICES
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-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-ofnetwork provider.
You are protected from balance billing for:
Emergency services – If you have an emergency medical condition and get emergency services from an outof- network 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 in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-ofnetwork providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network).
Your health plan will pay out-of-network providers and facilities directly.
Your health plan generally must:
• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by 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.
This brochure highlights the main features of the Guinco Enterprises Corporation 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. Guinco Enterprises Corporation reserves the right to change or discontinue its employee benefits plans at anytime.
