We are pleased to offer a full benefits package to you and your eligible dependents. Read this guide to know what benefits are available to you. You may only enroll or make changes to your benefits during Open Enrollment or when you have a Qualifying Life Event.
Availability of Summary Health Information
Your plan offers medical coverage options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage (SBC), available from Human Resources.
YOUR NEW BENEFITS BEGIN July 1, 2025
eligibility
You are eligible for coverage if you are a regular, full-time employee.
You may only enroll for coverage when:
● You are a new hire
● It is Open Enrollment (OE)
● You have a Qualifying Life Event (QLE)
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 for your prescription drug coverage. Please see Legal Notices for more details.
eligibility
new hire
Who is Eligible
• A regular, full-time employee working an average of 30 hours per week
When to Enroll
• Enroll by the deadline given by Human Resources
When Coverage Starts
• First of the month after completing 30 days of full-time employment
employee
Who is Eligible
• A regular, full-time employee working an average of 30 hours per week
When to Enroll
• Enroll during OE or when you have a QLE
When Coverage Starts
• OE: Start of the plan year
• QLE: Ask Human Resources
dependent(s)
Who is Eligible
• Your legal spouse or domestic partner
• Child(ren) under age 26, regardless of student, dependency, or marital status
• Child(ren) over age 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
When to Enroll
• You may enroll your dependent(s) at OE, or if you experience a QLE
• When covering dependents, you may enroll for and be on the same plans
When Coverage Starts
• Ask Human Resources, if needed
qualifying life events
CHANGING COVERAGE OUTSIDE OF OPEN ENROLLMENT
You may only change coverage during the plan year if you have a Qualifying Life Event, such as:
FMLA, COBRA event, court judgment or decree
Becoming eligible for Medicare, Medicaid, or
in benefits eligibility
Receiving a Qualified Medical Child Support Order Gain or loss of benefits coverage
Change in employment status affecting benefits
Significant change in cost of spouse’s coverage
You have 30 days from the event to notify Human Resources and complete your changes . You may need to provide documents to verify the change.
how to enroll
ADP Website
Managing your benefits online is easy through ADP. Enroll for or update your benefits, and view benefit details, costs, and additional resources in one easily accessible place.
1 Go to https://workforcenow.adp.com.
2 From the home page, select Myself, Benefits, then Enrollments.
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4
5
Select Start this Enrollment next to the appropriate qualifying event (e.g., New Hire Enrollment, Open Enrollment).
This opens the Enrollment Wizard , which will guide you through each step, such as adding dependents and beneficiaries, selecting plan options, and selecting coverages.
Once you have made all your selections, be certain to review the Benefits Summary on the final page before clicking Submit to Administrator
ADP Mobile App
1 When you log in to the ADP app, you will see Recommended tiles. Click on Benefits
2 To start, select Start Enrollment
3
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Continue through each plan type available during your enrollment period. Once you are ready to submit, click Submit enrollment
Make sure you receive the confirmation note indicating your selections have been submitted.
Note: At anytime in your enrollment process, you can select Finish later to save your enrollment information.
medical coverage
The Lanier Law Firm contracts with Assured Benefits Administrators (ABA) to manage our medical plans using the UnitedHealthcare Choice Plus PPO network .
Your medical plan options protect you and your family from major financial hardship in the event of illness or injury. You have a choice of two plans:
● $1,750 Copay Plan
● $4,000 HDHP/HSA Plan
Preferred Provider Organization (PPO)
Both plans are a PPO and allow 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. On the Copay Plan, when you see in-network providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other network services are covered at the deductible and coinsurance level. On the HDHP/HSA Plan , you must meet your deductible before all in-network services and providers are coverered in full.
What is a High Deductible Health Plan (HDHP)?
If you enroll in the HDHP, you may be eligible to open a Health Savings Account (see page 18).
Know Where to Go
While the UnitedHealthcare name or logo may be on your medical ID card, our medical insurance is through ABA – not UnitedHealthcare. Always call ABA if you have a question about your medical benefits or a claims issue.
Health Care Navigation and Support
• Call ConnectBenefit at 855-624-SAVE (7283).
• Email info@connectbenefit.com .
Find a Provider
• Visit https://www.whyuhc.com/uhss
• Select from the Choice Plus PPO network.
Access Claims
• Visit https://portal.abadmin.com/logon
• Call 866-231-5589
Show Your ID
Be sure to show your doctor's office your medical ID card so they bill correctly. The billing should go to ABA – not UnitedHealthcare.
PREVENTIVE TO CHRONIC CARE
1 The amount you pay after the deductible is met.
2 Prescriptions must be sourced using the Personal Importation Medicine
ConnectBenefit
YOUR NAVIGATION PARTNER
ConnectBenefit is our medical concierge service and your main contact to find the best medical care at little to no cost. When ConnectBenefit assists you and coordinates your care, you will pay $0 out of pocket* !
Concierge Services
Personal health care advocates are available to answer your questions and take on virtually any health care issue so you and your family get the right care at the right time. You always have a choice of providers, but using a ConnectBenefit preferred provider and/or facility helps you pay $0 for care! Contact the Connect Team Email info@connectbenefit.com
• Someone will personally help guide you to the correct providers the first time
• Help make informed decisions
• Makes the process easy
• Less wait time, quicker appointments
• Guidance toward lowest cost, best options
Direct Contracts
• Direct contracts with reputable physicians and facilities
• No surprise billing – $0 for you and your covered dependents
• Be seen sooner with a direct referral
• Get positive outcomes
Let ConnectBenefit Find Care
855-624-SAVE (7283).
Step 1. Ask your doctor if you require testing or a specialist for your care for any of the following:
Step 2. Call the Connect Team and request a medical voucher.
Step 3. Make an appointment when a ConnectBenefit provider calls you. If approved, your claims will be paid in full – you will not receive a bill or pay anything.
If you choose not to use the ConnectBenefit provider or facility, you can use the provider or facility of your choice and pay the copay per your plan. See the medical summary for details.
* Note: HDHP/HSA plan members pay $0 only after meeting their plan deductible.
$0 cost enhanced care
FOR GETTING THE MOST OUT OF YOUR MEDICAL COVERAGE
Our medical plans come with many incredible valueadded benefits, allowing you to pay $0 out of pocket .
• $1,750 Copay Plan – Eligible to save with all the free services available.
• $4,000 HDHP/HSA Plan – Eligible for free services after your deductible is met.
Regenexx – Surgery Avoidance
If you suffer from a medical condition or injury that causes you pain, Regenexx uses your body’s natural healing agents to help you recover. Your stem cells and blood platelets are injected precisely into the area of your injury to promote healing. If you suffer from issues in the spine, hand, shoulder, knee, hip, ankle, or foot problems, Regenexx may be able to help you get back to your everyday life.
Conditions Treated
Spine bulging, collapsed, or herniated disc
Ruptured or torn disc
Degenerative disc disease
Disc extrusion
Disc protrusion
Back or neck
nerve pain
Arthritic shoulder
Rotator cuff tears
Labral tear
Rotator cuff tendinosis
Joint replacement alternative
Arthritic knee
Meniscal tear
Sprain or tear of ACL/PCL
Sprain or tear of the MCL/LCL
Tendinopathy
Joint replacement alternative
Arthritic hand/ wrist/elbow
Tennis elbow
Ulnar nerve entrapment
Arthritic CMC joint (thumb)
Carpal tunnel
Trigger finger
Arthritic hip
Osteonecrosis
Bursitis
Labral/labrum tear
Arthritic ankle/ foot
Instability
Bunions
Ligament sprain or tear
Plantar fasciitis
Achilles tendinopathy
Contact Regenexx
Visit https://regenexxbenefits.com/lanierlawfirm
Call ConnectBenefit at 855-624-SAVE (7283)
CancerCARE – Cancer Support
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. CancerCARE provides access to cancer experts who can answer questions about your diagnosis, treatment, and any potential side effects. They will guide you through your treatment process and all available resources, including a triage center, nurse care management, and access to Centers of Excellence networks. Call ConnectBenefit at 855-624-SAVE (7283) to learn more.
DPCHealthcare – Diabetes Prevention and Management Program
A diabetes prevention and management program is provided at no cost to you through DPCHealthcare. To qualify, you must meet ONE of the following criteria:
• Be 30 pounds or more overweight
• Have a body mass index greater than 30
• Have Type 2 Diabetes
• Are diagnosed with Metabolic Syndrome
• Are diagnosed as prediabetic
Call ConnectBenefit at 855-624-SAVE (7283) or visit www. dpchealth.com for details.
Quality Care Access
• A physician-specialized clinical team trained in chronic diabetes management and prevention will oversee your care
• Diabetic labs including A1C, CMP, lipid profile, and creatine
• Health coaching
• Diabetes education and nutrition
• Physician-supervised weight management program
Employees enrolled in the HDHP/HSA Plan must satisfy their deductible first before receiving these services for $0.
Green Imaging – Diagnostic Imaging Services
Green Imaging provides diagnostic imaging services at $0 cost to you . The Green Imaging network is made up of high-quality imaging facilities nationwide. Green Imaging will consider the procedure you need and find the right network facility close to your home. When Green Imagining coordinates the service, you will get a voucher to take to your appointment to receive the service for free. The flow chart below shows you how the Green Imaging system works.
How Green Imaging Works for You
Your doctor gives you an order for diagnostic services. Contact ConnectBenefit.
Green Imaging will contact you to schedule your procedure, and will send you a voucher for service.
At your appointment, show your voucher. DO NOT PRESENT YOUR REGULAR INSURANCE CARD.
Contact ConnectBenefit
Email info@connectbenefit.com
Call 855-624-SAVE (7283)
Text 405-655-5678
You will have $0 payment and no after procedure bill. The report from your exam will be sent to your referring doctor.
Green Imaging Services
• MRI (closed and open)
• PET/CT
• Ultrasound
• Nuclear medicine
• Mammography
• DXA
• X-ray
• And more
Employees enrolled in the HDHP/HSA Plan must satisfy their deductible first before receiving Green Imaging services for $0.
Genetic Testing for Prescription Drugs
Everyone absorbs medications differently. Two people can take the same dose of the same drug but respond in very different ways.
Pharmacogenomic (PGx) testing allows you and your doctor(s) to understand how your body absorbs the ingredients in certain medications. With this knowledge, your physician will be able to prescribe the correct medications and dosage at the onset of your treatment plan.
PGx testing uses a cheek swab test done at home and sends it to the lab. Once the results are available, you and your doctor can discuss next steps for your treatment plan.
How the program works:
1. Register at www.accessdxlab.com to order your free test kit. The test kit is shipped to your employer.
2. Follow the sample kit instructions place the tube with your swab in the FedEx clinical pack. Then drop off the pack at any FedEx drop-off location.
3. You will receive an email from MEDTEK21 that your test results are ready. The email will also have instructions on how to schedule your consultation with our genomics specialist.
4. Review your test results with our genomics specialist via a telemedicine visit.
Call PGx at 888-380-7040. Whitelist email from accessdxlab.com (so they are not flagged as spam).
telemedicine
FOR CONVENIENT, 24/7 CARE
Your medical coverage offers telemedicine services through Lyric . Connect anytime day or night with a board-certified doctor via your mobile device or computer.
• Employees enrolled in the $1,750 Copay Plan pay $0 for routine medical care.
• Employees enrolled in HDHP/HSA Plan pay a $40 fee for routine medical care.
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.
When to Use Telemedicine
Use telemedicine 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.
Employees not enrolled in a medical plan can also use Lyric for routine medical care and pay $40.
Registration is Easy Register with Lyric so you are ready to use this valuable service when and where you need it.
Visit www.getlyric.com . Email info@getlyric.com
Call 866-223-8831
Download the Lyric Health app.
On-demand Behavioral Health Access
Virtually connect with a psychiatrist or licensed professional counselor through secure and private phone and video sessions, whenever and wherever you need it. Simply make an appointment on your lunch break, while traveling, or weekends to utilize this service anytime, anywhere.
Virtual Counseling
Consult a therapist with a master’s in counseling. The number of counseling sessions will be clinically appropriate based on the issue. This program is for short-term problem resolution, referral, and crisis intervention services.
• Death of a loved one
• Relationship issues
• Parenting issues
• Substance abuse
• Stress and anxiety
Virtual Psychologist Services
Speak with a licensed psychologist for one-on-one sessions to assess your symptoms and evaluate your medical psychiatric and family history to determine a productive treatment plan.
• Life changes
• Grief and loss
• Relationship issues
• Depression
• Addiction
• Stress management
Virtual Psychiatrist Services
Connect with a U.S.-based, board-certified psychiatrist who can diagnose, treat, conduct psychotherapy, and prescribe medication for a range of mental health disorders, as necessary.
• Panic disorders
• Bipolar disorder
• Addictive behavior
• And more
health care options
FOR NON-EMERGENCY AND EMERGENCY CARE
Becoming familiar with your options for medical care can save you time and money.
Non-emergency Care
Telemedicine
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
Doctor’s Office
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history.
Office hours vary
Retail Clinic
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
Urgent Care
When you need immediate attention; walk-in basis is usually accepted.
Generally includes evening, weekend, and holiday hours
Emergency Care
Hospital ER
Life-threatening or critical conditions; trauma treatment ; multiple bills for doctor and facility.
24 hours a day, 7 days a week
Freestanding ER
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
Allergies
Infections
Sore and strep throat Vaccinations Minor injuries/sprains/strains
infections
Sprains and strains
Minor broken bones Small cuts that may require stitches
Chest pain
Difficulty breathing
Severe bleeding
Blurred or sudden loss of vision
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 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.
prescription drugs
Prescription drug coverage is managed by EHIM Pharmacy Benefit Management Services. The following programs and services are designed to save you a lot of money on your prescriptions.
Start Here for Pharmacy Questions and Support
EHIM is your main contact for pharmacy programs and services. EHIM representatives will connect you to the following programs and direct your access for covered medication.
Visit https://ehim.procarerx.com
Call 800-311-3446 (EHIM will be on caller ID as 888-999-0113. Please add this number to your contacts).
Drug Requirements
Prescription drugs may be subject to the following requirements:
• Prior Authorization – EHIM will review information provided by your doctor to ensure you meet coverage guidelines. If approved, the medicine will be covered.
• Quantity Limits – Some medications are only covered for a certain dosage for a specific length of time. (For example, 30mg per day for 30 days.) The plan only covers larger amounts if your doctor requests and receives approval from EHIM.
• Age Requirements – For certain medications, you must be within a specific age range for the plan to cover them. This is because some drugs are not considered clinically appropriate for individuals who are not within that age range.
Drug Formulary
EHIM uses a Prescription Drug List that shows what medications are covered under your plan. Review this list often to know if any changes have occurred for the medicine you take and to consider lower cost options. The formulary is online at www.ehimrx.com
Retail Pharmacies
Retail pharmacies offer both a 30-day and a 90-day supply of medication.
Over-the-Counter Drugs
If you currently take a prescription acid reflux or allergy medication, ask your doctor about over-the-counter (OTC) drug options. Certain OTC medications have a $0 copay under the EHIM OTC program. If an OTC option is right for you, get a prescription to take to your pharmacist and pay $0 for the medication.
Mail Order
The Personal Importation Medicine (PIM) program is an opt-in, international mail order prescription program that offers huge savings. Refill select brand and specialty medications at a $0 copay! If you need or take certain drugs, EHIM Patient Navigators will contact you and your doctor about the program and how to get available medication. The Navigators will provide continued support, including confirmation, tracking of shipment, and refill status on all prescriptions filled under the PIM program. Medications will be shipped directly to your door from pre-screened international pharmacies. Call 888-999-0113 with any questions about this program.
Specialty Drugs
EHIM Cares is a concierge, high-touch program that helps you get and pay less for specialty drugs. The program involves you throughout the process. The EHIM Cares team will reach out to you to answer questions, help with prior authorizations, ensure the drug works for you, offer copay assistance, and work with your prescribing doctor to get the best results for you.
Free Smoking Cessation Drugs
The Commit to Quit Smoking cessation program offers over-the-counter and prescription drugs for a $0 copay. Just get a prescription from your doctor for the OTC or prescription medication and take it to your pharmacist. The pharmacist will fill the order and bill EHIM.
Insulin Options
EHIM offers generic insulin options to help offset your out-of-pocket costs for this life-sustaining drug. Generic drugs are identical to their branded products and can be substituted at the pharmacy counter. In fact, generic drugs are packaged and marketed by the same brand manufacturers but without the brand name. So, you will pay less for the same brand-name drug.
FOR YOUR PEARLY WHITES
Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Coverage is provided through Sun Life.
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 in-network providers. You could pay more if you use an out-of-network provider.
Pre-treatment Estimates
While your dental plan covers most dental procedures, we highly suggest that you work with your dentist and have any expenses that will cost more than $500 submitted to the carrier for pre-approval. Obtaining a pre-treatment estimate allows you and your dentist to understand your full financial responsibility prior to any work being done.
complete series X-rays, exams, fluoride treatments, sealants, space maintainers
Basic Services
Basic restorative (fillings), complex oral surgery, extractions, general anesthesia, repairs of crowns, inlays, onlays, bridges and dentures
1 Payment for covered services received from an out-of-network dentist is based on the 90th percentile of Usual, Customary, and Reasonable (UCR) charges. Find an
Visit www.sunlife.com/account
Call 800-442-7742 .
Download the Sun Life mobile app after you create your online account and use the same credentials.
Lifetime of Smiles Program
In addition to your routine cleanings, if you require periodontal cleanings, you can get up to two additional periodontal cleanings in a year. Tooth-colored fillings for the back teeth, and brush biopsies for the early detection of oral cancer may also be available.
YOUR EYES
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 in-network providers. Coverage is provided through Sun Life using the VSP vision network.
You will not receive a member ID card. Visit VSP online to find a provider.
Exam (once every 12 months)
• Well Vision Exam
• Routine Retinal Screen
• Contacts – Fitting and Evaluation
Lenses (once every 12 months)
• Single vision
• Lined bifocals
• Lined trifocals
• Lenticular
• Standard progressive plastic
• Premium progressive plastic
• Custom progressive plastic
Frames (once every 24 months)
• Walmart
• Costco
Contacts (once every 12 months) In lieu of frames and lenses
• Elective
• Medically
Download the Sun Life mobile app after you create your online account and use the same credentials.
health savings account
FOR CURRENT OR FUTURE EXPENSES
A Health Savings Account (HSA) is a tax-exempt tool to supplement your retirement savings and to cover current and future health costs.
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.
YOU DECIDE HOW TO USE YOUR HSA FUNDS
Use it Now
Make annual HSA contributions. Pay for eligible medical costs. Keep HSA funds in cash.
Let it Grow
Make annual HSA contributions. Pay for medical costs with other funds. Invest HSA funds.
tax benefits
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
Open 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 .
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 HSA Bank are eligible for automatic payroll deduction.
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are age 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at anytime during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
There are no employer contributions, effective July 1, 2025.
frequently asked questions
What is the difference between an HSA and an FSA?
Both accounts are regulated by the IRS with annual contribution limits and spending requirements, but each one is different in how you use them.
• HSA – You are limited to the funds available in your account, but there is no “use is or lose it” rule – your balance rolls over and can grow year after year.
• FSA – You can access the full elected amount on day one.
Can I contribute to both an HSA and an FSA?
If you contribute to an HSA, you may enroll in a Limited Purpose FSA to cover eligible dental and vision services only. If you enroll in a Health Care FSA, you may not contribute to an HSA.
What happens if I enroll in an HSA mid-year?
You can make a full year’s contribution if you are covered by the HSA for the 12-month period following that year.
By what date must my HSA be established to receive tax-free reimbursement on qualified expenses?
Your HSA must be established before you incur qualified medical expenses so you can get reimbursement free from federal and state income taxes.
My qualified HDHP coverage was effective January 1, but I didn’t open my HSA until June. Are expenses incurred prior to June eligible for reimbursement from my HSA?
No. See previous answer.
Can I use my HSA to cover expenses for my dependents?
Yes, but only for tax-eligible dependents. Qualifying dependents may be:
• Your spouse.
• Your child, stepchild, foster child, sibling, stepsibling, half-sibling, grandchild, niece, or nephew who is:
» Under age 19 at the end of the tax filing year.
» Under age 24 at the end of the tax filing year and a full-time student.
» Any age and permanently disabled.
• A dependent who has lived with you for more than half of the tax year.
• A dependent who did not provide over half of their own support for the tax filing year.
• A dependent who did not file a joint return other than to claim a refund.
Can my dependents have their own HSA if they are covered under my HDHP?
If your adult children do not qualify as eligible dependents but are still covered under your HDHP, they can open their own HSA and contribute the full family amount to their account. Because the account is separate, it does not reduce the amount you contribute to your HSA. Consult your tax advisor before opening this type of HSA as money deposited will be on a post-tax basis.
Example: Tim has an HDHP medical plan through his employer and contributes to an HSA. He covers himself, his wife Karen, and their 24-year old daughter, Jill. His daughter has surgery, but because she is not a fulltime student, Tim cannot use his HSA to cover her surgical expenses. Jill decides to open her own HSA and contributes the full family amount of $8,750 for 2025. She can then use the HSA to cover any future out-of-pocket qualified expenses. Tim can also contribute the full family amount to his HSA for his and Karen’s medical expenses.
flexible spending accounts
FOR HEALTH CARE EXPENSES
Set aside pretax dollars from each paycheck to pay for certain IRS-approved health care expenses. We offer the following FSAs, administered by Higginbotham.
Health Care FSA
The Health Care FSA covers qualified medical, dental, and vision expenses for you and your eligible dependents. Eligible expenses include:
• Deductibles, copays, and coinsurance
• Prescription drugs
• Braces, glasses, and contacts
• Hearing aids and batteries
If you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA), you may not contribute to a Health Care FSA.
Important FSA Rules
Limited Purpose Health Care FSA
If you enroll in the HDHP medical plan and contribute to an HSA , you can use a Limited Purpose Health Care FSA to pay for eligible out-of-pocket dental and vision expenses only, such as:
• Dental and orthodontia care (e.g., fillings, X-rays, and braces)
• Vision care (e.g., eyeglasses, contact lenses, and LASIK surgery)
• The maximum per plan year you can contribute to a Health Care or Limited Purpose Health Care FSA is $3,300
• You cannot change your election during the year unless you experience a Qualifying Life Event.
• Your Health Care or Limited Purpose Health Care FSA debit card can be used for health care expenses only.
• You can continue to file claims incurred during the plan year for another 90 days.
• All claims must be filed within 90 days of the plan year end close. Employees who terminate employment must file claims within 90 days of termination date. Any monies left in your account will be forfeited thereafter.
Care FSA
You have access to all your FSA funds right away.
Limited Purpose Health Care FSA
You have access to all your FSA funds right away.
How to Pay or Get Reimbursed
Access your FSA funds in two different ways:
• Use your FSA debit card
• Pay out-of-pocket, and submit your receipts for reimbursement:
» Visit https://flexservices.higginbotham.net
» Email flexclaims@higginbotham.net
» Download the Higginbotham app.
» Fax 866-419-3516.
Note: You can continue to file claims incurred during the plan year for another 90 days.
Higginbotham Benefits Card
The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care or Limited Purpose Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay for anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).
Higginbotham Portal and Mobile App
The Higginbotham Portal provides a central resource to manage your Health Care FSA, submit claims, and access your account information.
Register for an account at https://flexservices.higginbotham.net
Once you register for an account, download the Higginbotham mobile app using the same username and password as your portal account for on-the-go account access and convenience.
Get More Information
This benefit is administered by Higginbotham
Call 866-419-3519
Email flexclaims@higginbotham.net
Download the Higginbotham app.
Fax 866-419-3516
commuter benefit program
FOR COMMUTER EXPENSES
If you live in New York City, the Commuter Benefit Program, administered by Health Equity/Wage Works, offers you the opportunity to pay for out-of-pocket commuting expenses through pretax payroll deductions. You can use this program for both parking and public transit. Set aside up to $325 per month in pretax dollars for work-related commuter transit expenses.
PLEASE NOTE: Commuter benefits are limited to employees living in the New York City area only.
For More Information or to Sign Up
Visit www.healthequity.com/wageworks
Call 855-428-0447
Email relationship.management@healthequity.com
Parking Benefit
Eligible parking expenses include:
• Parking at or near work
• Parking at or near transportation service site
• Park and ride expenses
Transit Benefit
The transit benefit applies to monthly passes, tokens, fare cards, vouchers, or similar ticket options for:
• Bus
• Subway
• Train
• Ferry
• Uber Pool and Lyft Line
• Commercial Vanpool (vanpool registration varies by state)
life and AD&D insurance
Life and Accidental Death and Dismemberment (AD&D) insurance through Sun Life 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 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 $50,000 for each benefit.
Voluntary Life and AD&D
If you need more coverage than Basic Life and AD&D, you may buy Voluntary Life and AD&D for yourself and your dependent(s). 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, or Evidence of Insurability (EOI). You must elect Voluntary Life and AD&D coverage for yourself before covering your spouse and/or child(ren).
employee
• Increments of $10,000 up to $500,000
• Guaranteed Issue: $130,000
spouse
• Increments of $5,000 up to $200,000 not to exceed 100% of employee amount
• Guaranteed Issue: $25,000
child(ren)
• Increments of $10,000 up to 100% of employee election to $10,000
1 Spouse rate is based on employee’s age. Spouse coverage ends when employee reaches age 70.
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%).
Annual Enrollment
During annual enrollment you may elect or increase your insurance coverage for you and/or your spouse up to two increments on a guaranteed acceptance basis. Any amounts elected that is above the Guaranteed Issue will require the completion of an EOI form and carrier approval. Employees and/or spouses previously declined for coverage are not eligible for this benefit.
Converting or Porting Your Coverage
Upon termination of employment, you will have the option of converting or porting your Basic Life and Voluntary Term Life insurance.
disability insurance
FOR WHEN YOU CANNOT WORK DUE TO ACCIDENT OR ILLNESS
Disability insurance through Sun Life provides partial income protection if you are unable to work due to a covered accident or illness.
Short Term Disability
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. The Firm provides STD coverage at no cost to you
Short Term Disability Benefits
Long 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 90 days. Benefits begin at the end of an elimination period and continue while you are disabled up to maximum benefit period.
The LTD plan is a mandatory contributory plan. This means that you pay the premiums of this benefit and recognize a tax-free payment should a claim arise. Rates are calculated at $0.487 of $100 of covered payroll.
Long Term Disability Benefits
Benefits
Pre-existing Condition Exclusion None
Pre-existing Condition Exclusion 3/12 1
1 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.
additional benefits
FOR WHEN YOU NEED A HELPING HAND
Employee Assistance Program
The Employee Assistance Program (EAP) helps you and family members cope with a variety of personal and work-related issues. This program from GuidanceResources provides confidential counseling and support services at little or no cost to you.
Confidential Counseling
This no-cost 24/7 counseling service helps you address stress, relationship issues, and other personal issues you and your family may face. GuidanceConsultants are highly trained master’s and doctoral level clinicians who will listen to you and offer referrals for in-person counseling and other local resources for stress, anxiety and depression; work issues; relationship/marital conflicts; grief and loss; substance abuse; and more.
Financial Information and Resources
Speak by phone with Certified Public Accountants and Certified Financial Planners on a wide range of financial issues, including debt reduction, retirement planning, credit or loan resolution, estate planning, college planning, and more. If needed, you may get a referral to a financial professional for an initial one-hour, in-person consult at no cost.
Legal Support and Resources
Talk to an attorney by phone on a variety of legal matters or concerns, such as divorce and family law, real estate transactions, debt and bankruptcy, landlord/ tenant issues, contracts, and civil and criminal actions. If you need representation, you will get a referral to a qualified attorney in your area for a free 30-minute consultation with a 25% reduction in customary legal fees thereafter.
Work-Life Solutions
Work-Life specialists will research and provide qualified referrals and customized resources for child and elder care needs, college planning, moving and relocation, pet care, major purchases, and home repair.
GuidanceResources Online
GuidanceResources Online is your one stop for expert information on the issues that matter most to you, such as relationships, work, school, children, wellness, legal, financial, free time, and more. Access a variety of content, including articles, videos, self-assessments, planners, and more.
Free Online Will Preparation
Create a free, customized online will and give your family the peace of mind it deserves. Just complete a simple will questionnaire, then print and review your will. EstateGuidance can also print and mail a hard copy of your will for $14.99, or you can purchase a Living Will for $19.99. Go to www.guidanceresources.com and click on EstateGuidance to begin.
Help for New Parents
ParentGuidance supports you through the process of becoming a biological or adoptive parent, and helps you balance the demands of work and parenthood. ParentGuidance specialists can assist with pre- and postfamily issues, such as how to prepare for a baby; emotional concerns; financial issues; childcare resources; wills and estate planning; and more.
Support for Life’s Challenges
Contact GuidanceResources
Visit www.guidancersources.com Web ID: EAPBusiness
Call 877-595-5281
Download the GuidanceResources Now app.
Online Will Preparation
Online will preparation through ComPsych Corporation offers support to help you properly prepare the documents necessary to preserve your family’s estate and financial security. Services include online planning documents, a resource library, and access to professional help. Visit www.estateguidance.com , and use promo code SLF4VAS
Travel Assistance and Identity Theft Protection
Assist America provides an travel assistance program that connects you with doctors, hospitals, pharmacies, and other services if you experience an emergency while traveling 100+ miles away from your permanent residence, or if you are in another country. Visit www.assistamerica.com
You also have access to Identity Theft Protection for the safeguarding, prevention, and resolution of your data integrity and fraud issues include:
• 24/7 access to identity protection experts
• Credit card and document registration
• Internet fraud monitoring
• 24/7 identity fraud support
Contact Travel Assistance
Visit www.assistamerica.com/sunlife.
Use reference number 01-AA-SUL-100101
Call 800-872-1414 (within the USA).
Call 609-986-1234 (outside the USA).
Email medservices@assistamerica.com
Download the Assist America app.
Contact ID Theft Protection
Visit www.assistamerica.com/sunlife
Use reference number 01-AA-SUL-100101 .
Call 877-409-9597 (within the USA).
Call 614-823-5227 (outside the USA).
Download the Assist America app.
Family Planning Services
The Firm provides two programs to help employees grow their families. Up to $30,000 per family is available to assist with adoption or infertility treatment.
• Adoption Assistance – Funds can be used to cover fees associated with the adoption process.
• Infertility Treatment Assistance – Funds can be used to pay for services not traditionally covered under the medical plan, including IVF, IUI, and medical services of a surrogate. The funds cannot be used to compensate a surrogate.
Please contact Human Resources for additional information.
retirement plan
FOR FINANCIAL SECURITY IN YOUR LATER YEARS
A 401(k) plan can be a powerful tool to help you be financially secure in retirement. Our 401(k) plan can help you reach your investment goals.
How the Retirement Plan Works
If you are 21 years of age, you are eligible to participate in the plan the first of the month following six months of fulltime employment. You may contribute up to the IRS limit. 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 Voya at 800-584-6001 .
Enrollment
The 401K savings plan has an auto-enrollment feature allowing you to be automatically enrolled after six months of service. You will be automatically enrolled at 3% and this amount will increase by 1% each year thereafter until reaching 6%. You can opt out or make contribution changes at www.voyaretirementplans.com .
Company Matching Contributions
The Lanier 401k plan is a Safe Harbor plan with a match of 100% of the first 1% followed by a 50% match of the next 2-5%. This means that if you contribute at least 6% of your salary, you will receive a 3.5% employer match.
Vesting
You are always immediately vested 100% in the funds you contribute. You are 100% vested in the employer match after two years of service. A minimum of 1,000 hours per year determines annual vesting.
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 by calling 800-584-6001
The Firm believes that you should have opportunities to enjoy time away from work to help balance your lives. For this reason, we provide a Paid Time-Off (PTO) program to all full-time employees working 30 hours or more per week 1
PTO provides the freedom to decide how to use your personal time off. Use your PTO days for vacation, personal business, emergencies, doctor appointments, etc.
In the first year of employment, you qualify for 15 days per calendar year, prorated according to your hire date. For each year of successive employment, you will qualify for one additional PTO day, up to a maximum of 25 days. California employees accumulate PTO monthly.
If you are a non-attorney employee, you may carry over up to a maximum of five unused PTO days to the next calendar year. This amount will be in excess of your allotted PTO for the year.
Holidays
You are eligible for the following holidays upon employment:
• New Year’s Day
• Martin Luther King Day
• Good Friday
• Memorial Day
• Juneteenth
• Independence Day
• Labor Day
• Rosh Hashanah (NY Only)2
• Yom Kippur (NY Only)2
• Thanksgiving
• Day after Thanksgiving
• Christmas Eve
• Christmas Day
The exact dates holidays are observed will be published at the beginning of each calendar year.
Federal Floating Holidays
The firm allows you to take one of the following Federal Holidays of your choice:
• Presidents Day
• Columbus Day
• Veterans Day
1 PTO may vary for employees working less than 30 hours per week.
2 In lieu of Yom Kippur and Rosh Hashanah, California, and Texas employees will receive two additional holidays each calendar year (dependent upon when the holidays fall).
Medical Coverage
Assured Benefits Administrators
Group No. 70060 866-231-5589
Find a provider: www.whyuhc.com/uhss Claims access: https://portal.abadmin.com/logon
Medical Navigation Partner
ConnectBenefit
Call 855-624-SAVE (7283) Text 401-267-2472 info@connectbenefit.com
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:
The Lanier Law Firm Human Resources
10940 W. Sam Houston Pkwy N, Suite 100 Houston, TX 77064
713-659-5200
Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with The Lanier Law Firm 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. The Lanier Law Firm has determined that the prescription drug coverage offered by the The Lanier Law Firm 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 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 The Lanier Law Firm 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 The Lanier Law Firm 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 Phone
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 800-7721213. 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
The Lanier Law Firm Human Resources 10940 W. Sam Houston Pkwy N, Suite 100 Houston, TX 77064 713-659-5200
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 The Lanier Law Firm’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.
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:
The Lanier Law Firm Human Resources 10940 W. Sam Houston Pkwy N, Suite 100 Houston, TX 77064 713-659-5200
II. Effective Date
This Notice is effective February 15, 2026.
III. Our Responsibilities
We are required by law to:
1. maintain the privacy of your PHI;
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 pre-certification 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.
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.
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;
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.
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-infact, 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.
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.
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 1-877KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employersponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272)
If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2026. Contact your State for more information on eligibility.
To see if any other States have added a premium assistance program since January 31, 2026, or for more information on special enrollment rights, 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 The Lanier Law Firm group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the The Lanier Law Firm 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
The Lanier Law Firm Human Resources 10940 W. Sam Houston Pkwy N, Suite 100 Houston, TX 77064
713-659-5200
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-ofnetwork 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-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-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network costsharing 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 post-stabilization 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, 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 outof-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-ofnetwork 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.
New Health Insurance Marketplace Coverage Options and Your Health Coverage
PART A: General Information
Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options in your geographic area.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium and other out-of-pocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings on your premium that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.
Does Employment-Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of the credit that lowers your monthly premium, or a reduction in certain cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12%1 of your annual household income, or if the coverage through your employment does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit, and advance payment of the credit, if you do not enroll in the employment-based health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income.1, 2
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employmentbased coverage. Also, this employer contribution -as well as your employee contribution to employmentbased coverage- is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace.
When Can I Enroll in Health Insurance Coverage through the Marketplace?
You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15.
Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan.
There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage.
Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit www.HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325
What about Alternatives to Marketplace Health Insurance Coverage?
If you or your family are eligible for coverage in an employment-based health plan (such as an employersponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan, but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31, 2023 and July 10, 2023, you can request this special enrollment in the employment-based health plan through September 8, 2023. Confirm the deadline with your employer or your employment-based health plan.
Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https://www.healthcare.gov/ medicaid-chip/getting-medicaid-chip/ for more details.
How Can I Get More Information?
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
3. Employer Name: The Lanier Law Firm
5. Employer Address: 10940 W. Sam Houston Pkwy N, Ste 100
7. City: Houston
4. Employer Identification Number (EIN): 76-0515650
6. Employer Phone Number: 713-659-5200
8. State: TX 9. ZIP Code: 77064
10. Who can we contact at this job?: Human Resources
You are not eligible for health insurance coverage through this employer. You and your family may be able to obtain health coverage through the Marketplace, with a new kind of tax credit that lowers your monthly premiums and with assistance for out-of-pocket costs.
1 Indexed annually; see https://www.irs.gov/pub/irs-drop/rp-22-34.pdf for 2023.
2 An employer-sponsored or other employment-based health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.
This brochure highlights the main features of the Lanier Law Firm 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. Lanier Law Firm reserves the right to change or discontinue its employee benefits plans at anytime.
