26 27
EMPLOYEE BENEFITS GUIDE for a healthy you
Axiom Medical
TABLE OF CONTENTS Contents Important Contacts.................................... 2
Diagnostic Imaging................................... 14
Welcome.................................................... 3
Axiom Wellness Initiative......................... 15
Eligibility..................................................... 4
Dental Coverage....................................... 16
Online Enrollment Instructions.................. 5
Vision Coverage........................................ 17
Medical Coverage....................................... 6
Flexible Spending Accounts..................... 18
Mental Health Resources........................... 8
Life and AD&D Insurance......................... 20
Telemedicine.............................................. 9
Disability Insurance.................................. 21
Health Care Options................................. 10
Supplemental Insurance.......................... 22
Prescription Drugs.................................... 11
Additional Benefits................................... 24
Enhanced Health Benefits........................ 12
Biweekly Contributions............................ 25
ConnectBenefit........................................ 13
Important Notices.................................... 26
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. Please see page 26 for more details.
IMPORTANT CONTACTS Coverage
Provider
Website/Email
Phone
ConnectBenefit
www.connectbenefit.com
855-624-7283 Text: 405-267-2472
Medical
Assured Benefit Administrators (ABA)
www.abadmin.com
800-247-7114
Pharmacy
VerusRx
www.verus-rx.com customerservice@verus-rx.com
800-838-0007
Natural Pain Therapy
Regenexx
www.regenexxbenefits.com/axiom
866-918-3107
Lyric
www.getlyric.com
866-223-8831
Dental
Principal
www.principal.com/find-dentist
800-247-4695
Vision
Principal
www.vsp.com/eye-doctor
800-247-4695
Higginbotham
www.flexservices.higginbotham.net
866-419-3519
Life, AD&D and Disability Insurance
Principal
www.principal.com
800-245-1522
Critical Illness and Accident Insurance
Principal
www.principal.com
800-245-1522
Hospital Indemnity
Principal
www.principal.com
800-245-1522
Principal/ComPsych
www.guidancenow.com
844-869-2365
Human Resources
Axiom Medical
axiomhr@axiomllc.com
713-568-7574
Employee Response Center
Higginbotham
helpline@higginbotham.net
866-419-3518
Plan Support / Navigation
Telemedicine
Flexible Spending Accounts
Employee Assistance Program
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2026-2027 Employee Benefits
WELCOME We are pleased to offer you a comprehensive benefits package intended to protect your well-being and financial health. This guide is your opportunity to learn more about all the benefits that are now available to you and your eligible dependents beginning July 1, 2026. Each year during Open Enrollment (OE), you have the opportunity to make changes to your benefit plans. The enrollment decisions you make this year will remain in effect through June 30, 2027. To get the best value from your health care plan, please take the time to evaluate your coverage options and determine which plans best meet the health care and financial needs of you and your family. After OE, you may make changes to your benefit elections only when you have a Qualifying Life Event (QLE).
Availability of Summary Health Information Our Employee Benefits Program offers one health coverage plan. A Summary of Benefits and Coverage is available summarizing important information about your health coverage in a standard format. The SBC is available by request within the Ask Here section of Paycom.
Benefits Assistance Employee benefits can be complicated. The Higginbotham Employee Response Center (ERC) can assist you with the following:
Benefits information
Claims or billing questions
Eligibility issues
Call or text 866-419-3518 to speak with a bilingual representative Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you reach voicemail, your call or text will be returned within 24 hours or the next business day. You can also email questions or requests to helpline@higginbotham.net.
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Axiom Medical
ELIGIBILITY You are eligible for benefits if you are a regular, full-time employee working an average of 30 hours per week (part-time and short-term employees are not eligible for benefits). Your coverage for all benefits — except Flexible Spending Accounts (FSA) — is effective the first day of the month following or coinciding with the date of hire. FSA coverage is effective the first of the month following 90 days from your date of hire. You may also enroll eligible dependents for benefits coverage. The cost to you for dependent coverage will vary depending on the coverage options you select. When covering dependents, you must select the same plans for your dependents as you select for yourself. Eligible Employees
Regular, full-time employee
Average 30 or more hours per week Eligible Dependents
Legal spouse
Children under 26 years of age
Unmarried, mentally or physically disabled children regardless of age
Qualifying Life Events Your benefit elections remain in effect for the entire plan year until the following OE. You may only change coverage during the plan year if you have a QLE such as marriage, divorce, birth or adoption, loss of other coverage, etc. You must notify Human Resources in a timely manner if any of these events occur. Contact Human Resources for a full list of QLEs and the notification timeframes required for requested changes.
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2026-2027 Employee Benefits
ONLINE ENROLLMENT INSTRUCTIONS Enrolling in benefits is simple through Paycom’s Employee Self-Service portal.
Log into your Paycom Employee Self Service Portal.
From the Notification Center or from the Benefits section, click on the 2026-2027 Benefits Enrollment link. Review the initial instructions and click Start Enrollment.
The first screen allows you to update your phone number, address, and dependent information. Please take the time to ensure the information listed is up to date and accurate. Select Next.
To add dependents, select Add Dependent. You may also edit the dependent information by selecting the pencil icon in the Edit column or delete the dependent altogether by selecting the trash icon in the Delete column. Select Next to continue.
The next screen guides you through the enrollment process for each of your available benefit plans. Each benefit screen has two check boxes: one to enroll and one to decline. You can review each plan’s details within the Plan Description section. Forms and links are located in a Plan Information drop-down option.
Click the box to enroll or decline coverage for each plan. For Voluntary Life insurance, you will select the desired amount from the drop-down option.
Basic Life and AD&D insurance and some of the plans you elect may require beneficiaries. Select or add beneficiaries when prompted. If adding a beneficiary, simply click Add Beneficiary. Select Enroll when you are finished.
Plans with no action will be automatically declined at the end of the enrollment period.
If you choose to cover dependents, select or enter them on the appropriate screen. Check the box next to the dependent to be included or select Add Dependent to add additional dependents not on the list. Once finished, select Next Step.
Once you have made a selection for each plan, you will be brought back to the Welcome to My Benefits screen. This screen provides a snapshot of the plans for which you have elected to enroll. Select Modify Enrollment to return to the beginning and go through the enrollment process or click any links from the Progress Bar to make changes. Once you are satisfied with your selections, check Finalize on the bottom right. A pop-up window will ask you to confirm that you want to complete your enrollment. NOTE: All plans not enrolled in will be declined. Select OK to continue.
Once you select Complete Enrollment, you will be brought to the Sign and Submit screen. Click Sign and Submit.
Congratulations, your enrollment is now complete! To exit, select Return Home. To print a confirmation page, select Print Confirmation. If you experience difficulties navigating the Paycom system, please reach out to Human Resources using the Ask Here section of Paycom.
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Axiom Medical
MEDICAL COVERAGE Axiom Medical offers medical coverage through Assured Benefits Administrators using the UnitedHealthcare (UHC) Choice Plus network. The plan allows access to both innetwork and out-of-network providers, but you will receive better discounts and pay less by remaining in-network. All out-of-network services are subject to Reasonable and Customary (R&C) limitations and you are responsible for all charges over this allowance.
Locate a Provider Visit www.whyuhc.com/uhss to find in-network health care providers and facilities.
Assured Benefits Administrators, not UHC, will process your claims and provide customer service. Be sure to present your new ID card to your health care provider at your next visit so your provider will have the correct claims submission information. Your provider can use the number on the top of your ID card to contact Assured Benefits Administrators and verify coverage. Medical Plan Highlights
Freedom to see any provider when you need care.
In-network preventive care is covered at 100%.
In-network office visits, urgent care visits, and prescription medications are covered with a copay.
Most other in-network services are covered at the coinsurance level after you have met your deductible:
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$2,500 individual deductible
$5,000 family deductible
Plan pays 80% after in-network deductible is met, and 100% after in-network out-of-pocket maximum is reached:
$5,000 individual
$10,000 family
Coverage includes outpatient therapy, psychiatric care, and medication management. You may receive up to 60 days of counseling per calendar year. No referral is needed for outpatient services, but precertification is required for inpatient care.
ConnectBenefit Additionally, as an enrolled Team Member, you may reach out to your ConnectBenefit Team at 855-624-7283 to be directed to high quality providers and facilities at no cost ($0) to you!
2026-2027 Employee Benefits
MEDICAL COVERAGE Medical Benefits Summary Assured Benefits Administrators Tier 1 With Connect Benefit
Tier 2 In-Network
Tier 3 Out-of-Network
Calendar Year Deductible Individual Family
$0 $0
$2,500 $5,000
$5,000 $10,000
Calendar Year Out-of-Pocket Maximum Individual Family
$0 $0
$5,000 $10,000
Unlimited Unlimited
You Pay
You Pay
UHC Choice Plus
Preventive Care
N/A
$0
50% after deductible
Lyric Telehealth
$0 with Lyric
$0
50% after deductible
N/A
$10 copay
50% after deductible
Specialist
$0 with Navigation
$60 copay
50% after deductible
Urgent Care
N/A
$75 copay
50% after deductible
Diagnostic X-ray and Lab
$0 with Navigation
$10 copay
50% after deductible
Complex Imaging (CT/PET scan, MRI)
$0 with Navigation
20% after deductible
50% after deductible
Emergency Room
N/A
20% after deductible
20% after deductible
Outpatient Services
$0 with Navigation
Outpatient: 20% after deductible Office: $10
50% after deductible
$10 copay, then plan pays 100% with Lyric 20% after deductible with Lyric
20% after deductible with a $10 office copay 20% after deductible
Primary Care Physician
If you need mental health, behavioral health, or substance abuse services1 Outpatient services Inpatient services
50% after deductible 50% after deductible
MANDATORY GENERIC APPLIES (MAIL ORDER RX UP TO 90-DAY SUPPLY IS THREE TIMES RETAIL COPAY. NOT APPLICABLE FOR SPECIALTY RX.) Retail Pharmacy Up to 31-day supply Preferred Generic Non-preferred Generic Preferred Brand Name Non-preferred Brand Name Specialty
N/A N/A N/A N/A N/A
$0 $0 $50 copay $100 copay $350 copay
N/A N/A N/A N/A N/A
Mail Order Pharmacy Up to 90-day supply Preferred Generic Non-preferred Generic Preferred Brand Name Non-preferred Brand Name Specialty
N/A N/A N/A N/A N/A
$0 $45 copay $150 copay $300 copay N/A
N/A N/A N/A N/A N/A
$0 COST PARTNERS
$0 BENEFIT FOR ENROLLED TEAM MEMBERS AND DEPENDENTS
REGENEXX
$0
N/A
N/A
CONNECT DME
$0
N/A
N/A
CANCERCARE
$0
N/A
N/A
CONNECTBENEFIT (NAVIGATION)
$0
N/A
N/A
Includes Extended Care Facility. Limited to 60 days per calendar year. Limited to the usual charge of the facility for semi-private care, including room and board and all other services. $250 penalty if pre-certification not obtained.
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Axiom Medical
MENTAL HEALTH RESOURCES If you are enrolled in a UHC medical plan, you have behavioral health resources to help support your mental and emotional well-being. You do NOT need to be enrolled in a medical plan to have access to lyric.
UHC Behavioral Health Providers UHC offers virtual and in-person support with licensed therapists for long-term support on issues including: Bipolar and neuro-development disorders
Substance abuse
Medication management
Compulsive habits and eating disorders
Visit www.myuhc.com/mh-recommendations to find support or call the number on your medical ID card.
Employee Assistance Program The Magellan Healthcare Employee Assistance Program (EAP) offers three free sessions for each covered household member by phone or in-person for short-term support and advice on issues like:
Stress, anxiety, and depression
Work-life balance
Various personal challenges
Legal and financial support
Call 800-450-1327 for 24/7 phone support or to schedule an in-person counseling session. Visit https://member.magellanhealthcare.com for more resources and information.
Telemedicine for Mental Health Schedule a video or phone counseling session with a board-certified therapist with Lyric — for $0*. These telemedicine sessions are available to all employees, even if not enrolled in a medical plan.
Online – Visit https://portal.getlyric.com.
Phone – Call 866-223-8831.
Mobile – Download the Lyric app.
*Counseling sessions are available at $0 cost, but psychologist and psychiatrist visits would be considered selfpay and do not qualify under the UHSS insurance plan.
Covered Medical Expenses P Psychiatric Expenses
Network
Non-network
80% after deductible
50% of maximum allowable charge after deductible
$10 Copay then plan pays 100%
50% of maximum allowable charge after deductible
Inpatient Treatment
80% after deductible
50% of maximum allowable charge after deductible
Partial Day Program
80% after deductible
50% of maximum allowable charge after deductible
Outpatient Facility
80% after deductible
50% of maximum allowable charge after deductible
Residential Treatment Outpatient Office Treatment
This includes extended care facility. Limited to 60 days per covered person per calendar year. Limited to the usual charge of the facility for semi-private care, including room and board and all other services. Prior authorization is required. Prior authorization is waived if sourced through ConnectBenefit.
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2026-2027 Employee Benefits
TELEMEDICINE Your medical coverage offers telemedicine services for you and your covered dependents (including children) through Lyric. You do NOT need to be enrolled in a medical plan to have access to lyric. Connect anytime day or night with a board-certified doctor via your mobile device or computer at little to no cost.
When To Use lyric
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 Call Lyric
Non-Emergency Issues
Doctor is Unavailable
Traveling
Rx Refill
Convenience
Traditional Copay Plan Only Use telemedicine services for minor conditions such as:
Sore throat
Flu
Headache
Allergies
Stomachache
Fever
Cold
Urinary tract infections
Do not use telemedicine for serious or life-threatening emergencies.
REGISTRATION IS EASY Register with lyric so you are ready to use this valuable service when and where you need it.
Online – https://portal.getlyric.com.
Phone – 866-223-8831.
Download – Lyric Health app.
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Axiom Medical
HEALTH CARE OPTIONS Becoming familiar with your options for medical care can save you time and money. Health Care Provider
Symptoms
Average Cost
Average Wait
Allergies Cough/cold/flu Rash Stomachache
$
2-5 minutes
Infections Sore and strep throat Vaccinations Minor injuries/sprains/ strains
$
15-20 minutes
Common infections Minor injuries Pregnancy tests Vaccinations
$
15 minutes
Sprains and strains Minor broken bones Small cuts that may require stitches Minor burns and infections
$$
15-30 minutes
$$$$
4+ hours
24 hours a day, 7 days a week
Chest pain Difficulty breathing Severe bleeding Blurred or sudden loss of vision Major broken bones
Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher
Most major injuries except trauma Severe pain
$$$$$$
Minimal
Non-Emergency Care
Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed TELEMEDICINE
DOCTOR’S OFFICE
24 hours a day, 7 days a week Generally, the best place for routine preventive care; established relationship; able to treat based on medical history Office hours vary Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies
RETAIL CLINIC
Hours vary based on store hours When you need immediate attention; walk-in basis is usually accepted
URGENT CARE
Generally includes evening, weekend, and holiday hours
Emergency Care
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility HOSPITAL ER
FREESTANDING ER
24 hours a day, 7 days a week
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.
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2026-2027 Employee Benefits
PRESCRIPTION DRUGS The UHC medical plan includes prescription drug benefits. Retail, mail order, and specialty drug programs are available.
VerusRx Member Portal The VerusRx Member Portal helps you manage all aspects of your prescription drug benefit. Visit verusrx.myrxplan.com/login to register. Be sure to have your cardholder ID and group number ready.
Retail Specialty Customer Service
CVS Specialty provides specialized care and support while filling your specialty medications. With a personalized CareTeam, digital tools, and the choice of pickup or delivery, we’re here to help you. Call 800-237-2767 to sign up.
VerusRx's Customer Service team available 24/7 and ready to assist you with benefit overview, eligibility, claims, prior authorization, and more. Call 800-838-0007, visit www.verus-rx.com, email customerservice@verus-rx.com, or fax 800-856-0327.
Mail Order VerusRx has partnered with Amazon Pharmacy to provide you with the fastest way to get your prescriptions delivered directly to your door. Enjoy an online shopping experience with the convenience of home delivery with free standard shipping for your 90-day supply prescriptions. Call 800-838-0007 or visit pharmacy.amazon.com/how-it-works. You can also email customerservice@verus-rx.com or fax 800-856-0327.
Specialty Medication The VerusPath Program is available to members that are taking specialty or high-cost medications. This program can help to lower your out-of-pocket expenses. If your drug is eligible for the VerusPath Program, a Patient Care Advocate will reach out to you via phone or email. You do not need to contact VerusRx to enroll. Call 800-838-0007 or email customerservice@verus-rx.com for questions.
Download the Mobile App With the Gio by VerusRx app, you'll have a virtual pharmacy on the go. Download the app to:
View medications and real-time pricing
Switch medications and pharmacies
Receive savings alerts
And more!
For assistance with the app:
Call 866-967-1132.
Email verusrx@levrx.com.
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Axiom Medical
ENHANCED HEALTH BENEFITS Diabetes Prevention and Management Program If you have need and qualify, Axiom Medical provides a diabetes prevention and management program 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 BMI greater than 30
Have type 2 Diabetes
Been diagnosed with Metabolic Syndrome
Been diagnosed as prediabetic
CancerCARE CancerCARE is available at no cost to you. This program is offered by Interlink Health and was developed to ensure you receive the best possible care if you or a covered family member are diagnosed with cancer. It 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 helping you utilize all available resources, including a triage center, nurse care management, and access to Centers of Excellence networks.
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
CancerCARE team members, working closely with your physician, are your advocate to ensure you receive evidence-based care with tested and proven results developed by leading cancer Centers of Excellence. The CancerCARE team is there to support and educate you throughout your treatment. Register Now Registering with the CancerCARE program is simple. Visit www.cancercareprogram.com or call 877-640-9610 to get started.
REGENEXX (SURGERY AVOIDANCE) = $0-COST BENEFIT Axiom Professionals, LLC offers Regenexx under your health plan. 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
Rotator cuff tendinosis
Arthritic hand/wrist/elbow
Labral/labrum tear
Tennis elbow
Arthritic ankle/foot
Ulnar nerve entrapment
Instability
Arthritic CMC joint (thumb)
Bunions
Ligament sprain or tear
Ruptured or torn disc
Joint replacement alternative
Degenerative disc disease
Arthritic knee
Disc extrusion
Meniscal tear
Disc protrusion
Sprain or tear of ACL/PCL
Carpal tunnel
Plantar fasciitis
Back or neck nerve pain
Trigger finger
Achilles tendinopathy
Arthritic shoulder
Sprain or tear of the MCL/LCL
Arthritic hip
Rotator cuff tears
Tendinopathy
Osteonecrosis
Labral tear
Joint replacement alternative
Bursitis
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2026-2027 Employee Benefits
CONNECTBENEFIT – PLAN NAVIGATION SUPPORT AVAILABLE AT NO COST TO YOU! HUGE SAVINGS
The health care system is complex. Navigating and understanding your benefits can be challenging. Your ConnectBenefit Team will help guide you to high quality physicians and facilities for no out-of-pocket expense ($0). 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/facility will result in a $0 copay benefit to you!
Limits options to lowest cost/high quality
Transparent pricing, no hidden fees
Best solution guidance
Avoid unnecessary office visits and procedures
$0 for team members and dependents!
DIRECT CONTRACTS
CONCIERGE SERVICES
Direct contracts with reputable physicians and facilities
Someone will personally help guide you to the correct providers
No surprise billing — $0 for team members and dependents!
Help make informed decisions
Members seen sooner with direct referral
Makes the process easy
Positive outcomes
Less wait time, quicker appointments
Guidance toward lowest cost, best options
MEMBER SATISFACTION
Team member education
For Assistance and to Learn More
Call 855-624-7283.
Text 405-267-2472.
Support to guide you through the process
Removing the cost barrier to high quality care
True health care; not just insurance
Less time off work
Great outcomes from start to finish
Common Procedures and Services
Cardiac care
Pain management
Urology procedures
Foot/ankle surgery
ENT surgery
Hand surgery
Oncology services
Lab services
Physical therapy
Home health
Home medical equipment
Skin cancer
General surgery
Allergy testing
Orthopedic surgery
GI procedure
Breast care
Robotic surgery
Urgent care
Gynecologic surgery
Vascular procedures
Maternity care
Sleep disturbances
Cataract and eye muscle surgery
Dermatology
Specialty infusions
Imaging services
Migraine treatment
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Axiom Medical
DIAGNOSTIC IMAGING Axiom Medical contracts with Green Imaging to provide 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 a network facility close to your home with the necessary equipment for the exam your doctor ordered. Your exam will be interpreted by a radiologist who is board-certified and fellowshiptrained. Green Imaging’s radiology staff includes sub-specialists for complex exams such as neurology, musculoskeletal, and oncology. For these services, you will not file with your insurance company. Instead, you’ll receive a voucher when you schedule your service. Simply present the voucher when you arrive for your appointment. 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.
At your appointment, show your voucher. DO NOT PRESENT YOUR REGULAR INSURANCE CARD.
Contact Green Imaging:
Text – 713-524-9190.
Online/Chat – www.greenimaging.net.
Phone – 844-968-4647.
You will have $0 payment and no after procedure bill.
Green Imaging will contact you to schedule your procedure, and will send you a voucher for service.
The report from your exam will be sent to your referring doctor.
Green Imaging Services
MRI (closed and open)
Ultrasound
Mammography
X-ray
PET/CT
Nuclear medicine
DXA
And more
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2026-2027 Employee Benefits
AXIOM WELLNESS INITIATIVE Your health is important to you and your family — and to Axiom Medical. Making good lifestyle choices and maintaining your personal health can lead to a happier, more productive life. By participating in the Axiom Wellness Initiative, you and your covered spouse can earn discounts on your monthly medical insurance premiums. Employee Discount
$150+ discount on your monthly medical premium
Complete a physical exam with biometric screenings by August 1, 2026, to qualify (contact Human Resources if you have questions)
Spouse Discount
Additional discount on your spouse’s monthly medical premium
Complete a physical exam with biometric screenings by August 1, 2026, to qualify
Child dependents are not required to complete an annual physical. Only members and their covered spouses are required to complete the physical to maintain the discount. To maintain the medical premium incentive, you and your eligible spouse must complete an annual physical exam within the first 30 days of the new plan year in addition to satisfying any additional Wellness Initiative requirements outlined by Human Resources. Your physician must sign a Physician Lab and Screen Form which must be submitted to Human Resources. NOTE: Wellness credit is granted annually for attending a biometric screening between July 1, 2026 and July 31, 2026. If you do not meet this requirement by July 31, 2026, you will receive notice that your premiums will increase to a non-wellness rate beginning August 1, 2026. Midyear enrollments automatically receive wellness rates until the next plan year (July 1, 2027, through June 30, 2028). Axiom reserves the right to extend a grace period of up to 30 days to team members.
If it is unreasonably difficult due to a medical condition for you to achieve the standards for the medical premium incentive under this program, or if it is medically inadvisable for you to attempt to achieve the standards for the medical premium incentive under this program, contact Human Resources and we will work with you to develop another way to qualify for the medical premium incentive. The purpose of this program is to promote good health and prevent disease by alerting Axiom Medical employees to potential health risks. This program is confidential and HIPAA compliant. Protected Health Information will only be collected in aggregate form in order to design programs for the purpose of addressing Axiom Medical’s overall risk(s). Any information shared will not be disclosed, except in accordance with HIPAA laws.
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Axiom Medical
DENTAL COVERAGE Our dental plan helps you maintain good dental health through affordable options for preventive care, regular checkups, and other dental work. Premium contributions for dental will be deducted from your paycheck on a pretax basis. Coverage is provided through Principal.
DPPO Plan Two levels of benefits are available with the DPPO dental plan, depending on whether your dentist is in or out of the DPPO network. You have the flexibility to select the provider of your choice, but your level of coverage may vary based on the provider you see for services. Staying in-network and going to a contracted DPPO provider will provide you with the deepest discounts your plan has to offer.
Dental Benefits Summary DPPO PLAN IN-NETWORK
OUT-OF-NETWORK1
Calendar Year2 Deductible Individual Family
$50 $150
$50 $150
Calendar Year2 Out-of-Pocket Maximum Per Individual
$1,000 each Basic and Major services combined You Pay
You Pay
$0
$0
Basic Services Fillings, space maintainers, sealants, extractions, oral surgery, endodontics, periodontics, emergency exams
20% after deductible
20% after deductible
Major Procedures Crowns, inlays/onlays, dentures and bridgework, repairs
50% after deductible
50% after deductible
Preventive Care Exams, cleanings, X-rays, fluoride treatments
Orthodontia Child(ren) to age 19 only
50% after deductible $1,500 lifetime maximum
Out-of-Network Providers: When you use out-of-network providers, your benefits will be paid based on the 90th percentile of Reasonable and Customary charges. If the fee is higher, you are responsible for the difference. Pretreatment review is highly recommended when proposed dental treatment is more than $200.
1
Calendar year is January 1 – December 31. Your calendar year deductible and out-of-pocket maximums will reset to $0 every January 1.
2
Find an In-Network Dentist Visit www.principal.com/find-dentist or call 800-247-4695.
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Maximum Rollover The Maximum Rollover benefits provision allows you and your dependents to save your dental benefit dollars for when you need them most. With this provision, Principal will roll over a portion of the unused maximum for each insured person in a given policy year, increasing the amount of the maximum for each insured person the following year (subject to certain conditions). Rollover calculations are determined based on in-network provisions. Register/Log In at www.principal.com to view your benefits online.
2026-2027 Employee Benefits
VISION COVERAGE The Axiom Medical vision plan is designed to provide your basic eyewear needs and to help preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes or high cholesterol. To help you manage your health, we offer vision coverage through Principal using the VSP network of providers. Under this plan, you may use the eye care professional of your choice. However, when you use an in-network provider, you receive higher levels of coverage.
Vision Benefits Summary Vision Plan In-Network You Pay
Out-of-Network Reimbursement Up To
Exam
$10 copay
$45
Lenses Single Bifocal Trifocal Lenticular
$25 copay $25 copay $25 copay $25 copay
$30 $50 $65 $100
Frames
$130 allowance + 20% off balance
$70
Contacts In lieu of frames/lenses Elective Medically necessary
$130 allowance + 15% off balance $25 copay
$105 $210
Exams
Once every 12 months
Once every 12 months
Lenses
Once every 12 months
Once every 12 months
Frames
Once every 24 months
Once every 24 months
Contacts
Once every 12 months
Once every 12 months
Benefit Frequency
Find an In-Network Vision Provider Visit www.vsp.com/eye-doctor or call 800-247-4695.
17
Axiom Medical
FLEXIBLE SPENDING ACCOUNTS An FSA allows you to set aside pretax dollars from each paycheck to pay for certain IRSapproved health and dependent care expenses. We offer two different FSAs: one for health care expenses and one for dependent care expenses. When you enroll, you must decide how much money to set aside from your paycheck for each account. Be sure to estimate your expenses conservatively as the IRS requires that you use the money in your account during the plan year and applicable grace period (the “use it or lose it” rule). Higginbotham administers our FSAs. Health Care FSA
Dependent Care FSA
Set aside pretax dollars from each paycheck
Set aside pretax dollars from each paycheck
Contribute up to $3,400 annually
Pay for eligible health care expenses such as copays, prescriptions, dental, and eye care expenses
Contribute up to $7,500 annually ($3,750 if married filing separately)
Use for childcare or dependent eldercare expenses
Available only if you do not have a Health Savings Account (HSA)
Allows you and your spouse to work or attend school full time
Compatible with the Assured Benefits Administrators medical plan
Cannot be used to pay for dependent health care expenses
Health Care FSA The Health Care FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. You may contribute up to $3,400 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include:
Dental and vision expenses
Prescription copays
Medical deductibles and coinsurance
Hearing aids and batteries
You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA). How the Health Care FSA Works You can access the funds in your Health Care FSA two different ways:
Use your Higginbotham Benefits Debit Card to pay for qualified expenses, doctor visits, and prescription copays.
Pay out-of-pocket and submit your receipts for reimbursement:
Fax – 866-419-3516.
Email – flexclaims@higginbotham.net.
Online – https://flexservices.higginbotham.net.
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Higginbotham Benefits Debit Card The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay 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). If you depart from Axiom, you will lose access to funds.
2026-2027 Employee Benefits
FLEXIBLE SPENDING ACCOUNTS How the DEPENDENT CARE FSA Works The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for daycare or babysitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed, disabled, or a full-time student. Things to know about the Dependent Care FSA
Overnight camps are not eligible for reimbursement (only day camps can be considered).
A dependent child must be under age 13 and claimed as a dependent on your federal income tax return, or a disabled dependent of any age incapable of caring for himself or herself and who spends at least eight hours a day in your home.
If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is incapable of self-care.
Higginbotham Portal The Higginbotham Portal provides information and resources to help manage your FSAs.
Access plan documents, letters and notices, forms, account balances, contributions, and other plan information
Update your personal information
Submit claims
Utilize Section 125 tax calculators
Look up qualified expenses
Request a new or replacement Benefits Debit Card
IMPORTANT FSA RULES
The maximum per plan year you can contribute to a Health Care FSA is $3,400. The maximum per plan year you can contribute to a Dependent Care FSA is $7,500 when filing jointly or head of household and $3,750 when married filing separately.
You cannot change your election during the year unless you experience a QLE.
The IRS has amended the “use it or lose it” rule to allow you to carryover up to $680 in your Health Care FSA into the next plan year. The carryover rule does not apply to your Dependent Care FSA.
Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
Register on the Higginbotham Portal Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.
Enter your Employee ID, which is your Social Security number with no dashes or spaces.
Follow the prompts to navigate the site.
If you have any questions or concerns, contact Higginbotham:
Phone – 866-419-3519
Email – flexclaims@higginbotham.net
Fax – 866-419-3516
19
Axiom Medical
LIFE AND AD&D INSURANCE Life and Accidental Death and Dismemberment (AD&D) insurance through Principal are important parts of your financial security, especially if others depend on you for support. With Life insurance, your beneficiary(ies) can use the coverage to pay off your debts and other final expenses. AD&D coverage provides specified benefits for a covered accidental bodily injury that causes dismemberment. In the event that death occurs from an accident, 100% of the AD&D benefit would be payable to your beneficiary(ies).
Basic Life and AD&D Insurance Basic Life and AD&D coverages are sponsored by Axiom and automatically provided at no cost to you. You are automatically covered up to $20,000. As you grow older, your Life and AD&D coverage amounts reduce at age 65.
Voluntary Life Insurance You may purchase additional Life insurance for you and your eligible dependents. You must elect voluntary coverage for yourself in order to elect coverage for your spouse or children. If you leave Axiom Medical, you may take the insurance with you by paying premiums directly to Principal. As you grow older, your coverage amount reduces at age 65.
VOLUNTARY TERM LIFE Employee/Spouse* Monthly Rate per $1,000
Age Range
Rate
Under 29
$0.060
29-34
$0.080
35-39
$0.114
40-44
$0.212
45-49
$0.325
50-54
$0.493
55-59
$0.769
60-64
$1.280
65-69
$2.124
70-74
$4.071
Child Life/AD&D Rate per $1k
$0.200
*Spouse’s cost is based on spouse’s age.
Voluntary Life Insurance Benefit
Minimum Coverage
Maximum Coverage
Guaranteed Issue
Employees
Increments of $10,000
$10,000
$150,000
$150,000 for employees under 70 $10,000 for employees 70+
Spouse
Increments of $5,000
$5,000
$50,000
$50,000 for dependents under 70 $10,000 for dependents 70+
Child(ren)
Automatically covered at 25% of employee amount $1,000 for children birth to 14 days Additional coverage amounts available for children 15 days to 26 years: • $2,000 / $3,000 / $4,000 / $5,000 / $10,000 Amount cannot exceed 100% of the employee amount
Age Reduction Employee and Spouse Age Reduction: 35% reduction at age 65, and an additional 15% reduction at age 70.
20
Designating a Beneficiary A beneficiary is the person or entity you designate to receive the death benefits of your Life and AD&D insurance policy. You can name more than one beneficiary, and you can change beneficiaries at anytime. If you name more than one beneficiary, you must identify the share for each.
2026-2027 Employee Benefits
DISABILITY INSURANCE If you suddenly become ill or are involved in an accident and unable to work, it is easy to fall behind on your rent or mortgage, car payment, and other expenses. A salary replacement plan could be an important benefit for you and your family.
Short Term Disability Insurance If you become sick, injured, or are pregnant and are unable to work, would you have enough savings to cover your living expenses during that time? Axiom Medical provides Short Term Disability (STD) coverage at no cost to you*. Coverage is provided through Principal. STD insurance is also used for maternity leave before and after your child’s birth.
Long Term Disability Insurance Long Term Disability (LTD) insurance provides long term income protection in the event of sickness or injury. A qualifying disability can occur on or off the job. Axiom Medical provides LTD coverage at no cost to you*. Coverage is provided through Principal. Short Term Disability
Long Term Disability
Benefits begin on the 8th day of injury or illness
Benefits begin on the 91st day of injury or illness
Receive 60% of your predisability earnings
Receive 50% of your predisability earnings
$1,500 maximum weekly benefit
12-week maximum benefit period
$5,000 maximum monthly benefit
Maximum benefit period until you reach Social Security Normal Retirement Age
*Axiom Medical will “gross up” your salary to cover the cost of these coverages and then deduct the cost from your paycheck. This makes the coverages “employee paid” and thus, all benefits are tax-free.
21
Axiom Medical
SUPPLEMENTAL INSURANCE Critical Illness For many, a critical illness can expose an individual to an unexpected gap in protection. While health plans may help cover many of the direct costs associated with a critical illness, related expenses such as lost income, childcare, travel to and from treatment, high deductibles, and copays may quickly diminish savings. Critical Illness insurance through Principal pays a fixed benefit if you are diagnosed with a covered critical illness after your coverage effective date. A lump-sum benefit is payable when you or a family member are diagnosed with a covered condition such as stroke, heart attack, or renal failure. Funds can be used any way you choose — to pay your mortgage, clear debts, or to replace lost income. For complete benefit details, refer to your Principal benefit summary. You may elect coverage for you and your eligible dependents. The Guaranteed Issue amounts are $20,000 for employee and $10,000 for spouse. Evidence of Insurability (EOI) is required for amounts over the guaranteed issue. Critical Illness Benefit
Minimum Coverage
Maximum Coverage
Guaranteed Issue
Employee
Increments of $5,000
$5,000
$100,000
$20,000
Spouse
Increments of $2,500
$2,500
$50,000 or up to 50% of the employee amount
$10,000
Child(ren)
25% of employee coverage up to $10,000
VOLUNTARY CRITICAL ILLNESS
Covered Illnesses Condition*
Heart attack Invasive cancer Major organ failure Stroke
Alzheimer’s disease Amyotrophic lateral sclerosis Benign brain tumor Coma Loss of hearing Loss of sight Loss of speech Multiple sclerosis Occupational infectious disease Paralysis Parkinson’s disease
First Occurrence
Additional Occurrences
100%
100%
100%
0%
Carcinoma in situ Coronary artery disease Infectious diseases
25%
25%
Childhood conditions
100%
0%
Skin cancer
$250
$0
*This is a list of common conditions, for a full list of conditions refer to the plan documents.
22
Employee/Spouse* Monthly Rate per $1,000 Age Range
Rate
<30
$0.830
30-34
$1.090
35-39
$1.090
40-44
$1.910
45-49
$1.910
50-54
$3.360
55-59
$3.360
60-64
$5.090
65-69
$5.090
70-74
$9.800
*Spouse cost is based on spouse’s age.
2026-2027 Employee Benefits
SUPPLEMENTAL INSURANCE Accident Insurance Accident insurance through Principal pays a fixed benefit directly to you in the event of an accident, regardless of any other coverage you may have. Benefits are paid according to a fixed schedule for accident-related expenses including hospitalizations, fractures, dislocations, emergency room visits, major diagnostic exams, and physical therapy. Please refer to the Summary of Benefits and Coverage for benefit details. You may enroll yourself along with your spouse or child(ren) without submitting EOI. Accident Insurance Burns
Up to $5,000
Coma
$15,000
Dental injury
$500
Dislocation
Up to $7,500
Fracture
Up to $10,000
Internal Injury
$1,500
Knee Injury With Surgical Repair
$1,500
Ruptured Disc With Surgical Repair
$1,500
Rotator Cuff Injury With Surgery
$1,500
Injuries Not Specifically Listed
$100 BIWEEKLY RATES
Employee
$4.50
Employee + Spouse
$6.90
Employee + Child(ren)
$7.47
Employee + Family
$11.93
Hospital Indemnity Insurance Hospital Indemnity insurance through Principal provides financial assistance to enhance your current coverage. It helps you avoid using savings or borrowing to pay out-of-pocket costs health insurance was never intended to cover, such as transportation and meals for family members, childcare, or time away from work. Hospital Indemnity Insurance Hospital/ICU Admission
$1,000 per admission (one per calendar year)
Hospital/ICU Confinement
$200 per day (limited to 15 days per insured per year)
ICU Supplemental Confinement
$200 per day (limited to 15 days per insured per year) BIWEEKLY RATES
Employee
$8.24
Employee + Spouse
$15.36
Employee + Child(ren)
$12.24
Employee + Family
$20.12
23
Axiom Medical
ADDITIONAL BENEFITS Included with your Principal Life, AD&D and Disability insurance is access for you and your eligible dependents to the following programs — at no additional cost to you.
Employee Assistance Program Principal’s Employee Assistance Program (EAP) through ComPsych provides support programs to help you deal with personal concerns, work-related problems, and life’s toughest issues. Whether you are dealing with job pressures, substance abuse, or depression, the EAP can help. Guidance and support are offered to help with:
Work-life balance
Childcare/eldercare resources
Stress and anxiety
Relationships
Grief and loss
Financial and legal issues
Help when you need it
Call – 844-869-2365
Visit – www.guidancenow.com (enter PrincipalCore as the company name when prompted)
Download - GuidanceNow app.
The EAP is completely confidential and available at no cost to you. Call at any hour of the day or night to receive support services.
Beneficiary Support Services Magellan Healthcare also provides family wellness and security at the most difficult times with grief and financial counseling, funeral planning, legal support, and online will preparation. Grief support services for you and your family
24/7 access to confidential guidance and coping strategies
Personal coaching over the phone or video teleconference
Local legal and community resource referrals
Private self-screening for depression
Online resources Visit https://member.magellanhealthcare.com to access a variety of online resources, including:
Health and wellness resources
Legal tools and forms
Talking to children about death
Parenting and eldercare support
Self-assessments for grief, depression, and stress
Financial services
Will Preparation The Will & Legal Document Center provided by ARAG allows you to prepare a will and other legal documents such as a power of attorney, a health care directive, and a living trust. Log on to www.aragwills.com/principal or call 800-546-3718 for assistance. 24
Worldwide Travel Assistance Access travel assistance through AXA Assistance for you and your dependents if you are traveling more than 100 miles from home. Representatives can help with trip planning or assistance in an emergency while traveling. They can find translation, interpreter, or legal services and help with lost baggage, emergency funds, document replacement, and more. They can also help if your identity has been stolen by providing education, prevention tips, and recovery resources. Contact AXA Assistance
Visit – www.principal.com/travelassistance.
Within the U.S.– 888-647-2611.
Outside the U.S. – 630-766-7696.
2026-2027 Employee Benefits
BIWEEKLY CONTRIBUTIONS Medical Coverage Non-wellness
Wellness – Employee Only
Wellness –Employee + Spouse
Employee Only
$100
$25
$25
Employee + Spouse
$350
$275
$230
Employee + Child(ren)
$215
$145
$145
Employee + Family
$415
$350
$300
$
Dental Coverage Employee Only
$14.30
Employee + Spouse
$27.30
Employee + Child(ren)
$41.63
Employee + Family
$57.89
$
Vision Coverage Employee Only
$3.36
Employee + Spouse
$6.16
Employee + Child(ren)
$6.77
Employee + Family
$10.26
$
Flexible Spending Accounts Dependent Care
$192.31 maximum biweekly contribution.
Health Care
$130.77 maximum biweekly contribution.
$
Basic Life and AD&D Insurance Employee Only
Paid by Axiom Medical.
$0
Voluntary Life Insurance Employee Spouse
$ See page 20 for rates.
Child(ren)
$ $
Disability Insurance Short Term Disability Long Term Disability
Paid by Axiom Medical.
$0 $0
Critical Illness Insurance Employee Spouse
See page 22 for rates.
$ $
Accident Insurance Employee Spouse Child(ren)
$ See page 23 for rates.
Family
$ $ $
Hospital Indemnity Insurance Employee Spouse Child(ren)
$ See page 23 for rates.
Family
$ $ $
Employee Assistance Program Family Your Total 2026-2027 Biweekly Benefit Cost
Paid by Axiom Medical.
$0 $
25
Axiom Medical
IMPORTANT NOTICES Women’s Health and Cancer Rights Act of 1998 In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully. As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:
All stages of reconstruction of the breast on which the mastectomy was performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
Prostheses and treatment of physical complications of the mastectomy, including lymphedema.
Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
Special Enrollment Rights This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time. Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP) If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage).
26
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.
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.
Axiom Medical has determined that the prescription drug coverage offered by the Axiom Medical 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.
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: Axiom Medical Human Resources 1330 Lake Robbins Dr, Suite 250 The Woodlands, TX 77380 713-568-7574 axiomhr@axiomllc.com
Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Axiom Medical 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.
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 Axiom Medical at the phone number or address listed at the end of this section.
2026-2027 Employee Benefits
IMPORTANT NOTICES If you choose to enroll in a Medicare prescription drug plan and cancel your current Axiom Medical 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 713-568-7574. 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 800772-1213. TTY users should call 800-325-0778. Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty). July 1, 2026 Axiom Medical Human Resources 1330 Lake Robbins Dr, Suite 250 The Woodlands, TX 77380 713-568-7574 axiomhr@axiomllc.com
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: Axiom Medical Human Resources 1330 Lake Robbins Dr, Suite 250 The Woodlands, TX 77380 713-568-7574 axiomhr@axiomllc.com
Notice of HIPAA Privacy Practices THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This Notice of Privacy Practices (the “Notice”) describes the legal obligations of Axiom Medical’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.
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.
27
Axiom Medical
IMPORTANT NOTICES 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.
28
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 stoploss (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.
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.
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.
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.
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.
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.
2026-2027 Employee Benefits
IMPORTANT NOTICES V. Special Situations In addition to the above, the following categories describe other possible ways that we may use and disclose your PHI without your specific authorization. For each category of uses or disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. Organ and Tissue Donation. If you are an organ donor, we may release your PHI after your death to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation. Military. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority. Workers’ Compensation. We may release your PHI for workers’ compensation or similar programs, but only as authorized by, and to the extent necessary to comply with, laws relating to workers’ compensation and similar programs that provide benefits for work-related injuries or illness. Public Health Risks. We may disclose your PHI for public health activities. These activities generally include the following: 1.
to prevent or control disease, injury, or disability;
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.
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 lawenforcement official, we may disclose your PHI to the correctional institution or lawenforcement 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.
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.
Research. We may disclose your PHI to researchers when:
Law Enforcement. We may disclose your PHI if asked to do so by a law-enforcement official.
VI. Required Disclosures
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 about criminal conduct.
2.
to report births and deaths;
3.
to report child abuse or neglect;
5.
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;
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.
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.
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.
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IMPORTANT NOTICES VII. Other Disclosures Personal Representatives. We will disclose your PHI to individuals authorized by you, or to an individual designated as your personal representative, attorney-in-fact, etc., so long as you provide us with a written notice/ authorization and any supporting documents (i.e., power of attorney). Note: Under the HIPAA privacy rule, we do not have to disclose information to a personal representative if we have a reasonable belief that: 1.
You have been, or may be, subject to domestic violence, abuse, or neglect by such person; or
2.
Treating such person as your personal representative could endanger you; and
3.
In the exercise of professional judgment, it is not in your best interest to treat the person as your personal representative.
Spouses and Other Family Members. With only limited exceptions, we will send all mail to the employee. This includes mail relating to the employee’s spouse and other family members who are covered under the Plan and includes mail with information on the use of Plan benefits by the employee’s spouse and other family members and information on the denial of any Plan benefits to the employee’s spouse and other family members. If a person covered under the Plan has requested Restrictions or Confidential Communications (see below under “Your Rights”), and if we have agreed to the request, we will send mail as provided by the request for Restrictions or Confidential Communications.
Authorizations. Other uses or disclosures of your PHI not described above will only be made with your written authorization. For example, in general and subject to specific conditions, we will not use or disclose your psychiatric notes; we will not use or disclose your PHI for marketing; and we will not sell your PHI, unless you give us a written authorization. You may revoke written authorizations at any time, so long as the revocation is in writing. Once we receive your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation. VIII. Your Rights You have the following rights with respect to your PHI: Right to Inspect and Copy. You have the right to inspect and copy certain PHI that may be used to make decisions about your Plan benefits. If the information you request is maintained electronically, and you request an electronic copy, we will provide a copy in the electronic form and format you request, if the information can be readily produced in that form and format; if the information cannot be readily produced in that form and format, we will work with you to come to an agreement on form and format. If we cannot agree on an electronic form and format, we will provide you with a paper copy. To inspect and copy your PHI, you must submit your request in writing. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request. Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan.
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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.
2026-2027 Employee Benefits
IMPORTANT NOTICES 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 a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. IX. Complaints If you believe that your privacy rights have been violated, you may file a complaint with the Plan or with the Office for Civil Rights of the United States Department of Health and Human Services. To file a complaint with the Plan, contact the person listed in the Contact Information section of this Notice. All complaints must be submitted in writing. You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office for Civil Rights or with us.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www. healthcare.gov.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol. gov or call 1-866-444-EBSA (3272). If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2026. Contact your State for more information on eligibility.
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.
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.
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IMPORTANT NOTICES ALABAMA – MEDICAID Website: http://www.myalhipp.com/ Phone: 1-855-692-5447 ALASKA – MEDICAID The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/dpa/ Pages/default.aspx ARKANSAS – MEDICAID
IOWA – MEDICAID AND CHIP (HAWKI) Medicaid Website: https://hhs.iowa.gov/programs/ welcome-iowa-medicaid Medicaid Phone: 1-800-338-8366 Hawki Website: https://hhs.iowa.gov/programs/ welcome-iowa-medicaid/iowa-health-link/hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://hhs.iowa.gov/programs/ welcome-iowa-medicaid/fee-service/hipp HIPP Phone: 1-888-346-9562 KANSAS – MEDICAID
MONTANA – MEDICAID Website: https://dphhs.mt.gov/ MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 Email: HHSHIPPProgram@mt.gov NEBRASKA – MEDICAID Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178 NEVADA – MEDICAID
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 HIPP Phone: 1-800-967-4660
CALIFORNIA– MEDICAID
KENTUCKY – MEDICAID
NEW HAMPSHIRE – MEDICAID
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs. ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov KCHIP Website: https://kynect.ky.gov Phone: 1-877-524-4718 Kentucky Medicaid Website: https://chfs.ky.gov/ agencies/dms
Website: https://www.dhhs.nh.gov/programsservices/medicaid/health-insurance-premiumprogram Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-8523345, ext. 15218 Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov
LOUISIANA – MEDICAID
Medicaid Website: http://www.state.nj.us/ humanservices/dmahs/clients/medicaid/ Phone: 1-800-356-1561 CHIP Premium Assistance Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index. html CHIP Phone: 1-800-701-0710 (TTY: 711)
Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hipp Phone: 916-445-8322 Fax: 916-440-5676 Email: hipp@dhcs.ca.gov COLORADO – HEALTH FIRST COLORADO (COLORADO’S MEDICAID PROGRAM) AND CHILD HEALTH PLAN PLUS (CHP+) Health First Colorado website: https://www. healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711 CHP+: https://hcpf.colorado.gov/child-health-planplus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https:// www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442 FLORIDA – MEDICAID Website: https://www.flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268 GEORGIA – MEDICAID GA HIPP Website: https://medicaid.georgia.gov/ health-insurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia.gov/ programs/third-party-liability/childrens-healthinsurance-program-reauthorization-act-2009chipra Phone: 678-564-1162, Press 2 INDIANA – MEDICAID Health Insurance Premium Payment Program All other Medicaid Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr/ Family and Social Services Administration Phone: 1-800-403-0864 Member Services Phone: 1-800-457-4584
Louisiana Medicaid Website: https://www.ldh. la.gov/healthy-louisiana Medicaid Customer Service Line: 1-888-342-6207 Louisiana Medicaid email: healthy@la.gov Louisiana Health Insurance Premium Program (LaHIPP) Website: https://www.ldh.la.gov/lahipp LaHIPP phone: 1-877-697-6703 LaHIPP email: La.HIPP@la.gov LaHIPP fax: 1-888-716-9787 LaHIPP mailing address: 100 Crescent Centre Parkway, Suite 1000 Tucker, GA 30084 MAINE – MEDICAID
NEW JERSEY – MEDICAID AND CHIP
NEW YORK – MEDICAID Website: https://www.health.ny.gov/health_care/ medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA – MEDICAID
Enrollment Website: https://www. mymaineconnection.gov/benefits/ s/?language=en_US Phone: 1-800-442-6003 TTY: Maine relay 711 Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applicationsforms Phone: 1-800-977-6740 TTY: Maine Relay 711
Website: https://medicaid.ncdhhs.gov Phone: 919-855-4100
MASSACHUSETTS – MEDICAID AND CHIP
OREGON – MEDICAID
Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711 Email: masspremassistance@accenture.com MINNESOTA – MEDICAID Website: https://mn.gov/dhs/health-carecoverage/ Phone: 1-800-657-3672 MISSOURI – MEDICAID Website: http://www.dss.mo.gov/mhd/ participants/pages/hipp.htm Phone: 573-751-2005
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Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900
NORTH DAKOTA – MEDICAID Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825 OKLAHOMA – MEDICAID AND CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 Website: https://healthcare.oregon.gov/Pages/ index.aspx Phone: 1-800-699-9075 PENNSYLVANIA – MEDICAID AND CHIP Website: https://www.pa.gov/en/services/dhs/ apply-for-medicaid-health-insurance-premiumpayment-program-hipp.html Phone: 1-800-692-7462 CHIP Website: https://www.dhs.pa.gov/chip/ pages/chip.aspx CHIP Phone: 1-800-986-KIDS (5437)
2026-2027 Employee Benefits
IMPORTANT NOTICES RHODE ISLAND – MEDICAID AND CHIP Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347 or 401-462-0311 (Direct RIte Share Line) SOUTH CAROLINA – MEDICAID Website: https://www.scdhhs.gov Phone: 1-888-549-0820 SOUTH DAKOTA - MEDICAID Website: https://dss.sd.gov Phone: 1-888-828-0059 TEXAS – MEDICAID Website: https://www.hhs.texas.gov/services/ financial/health-insurance-premium-paymenthipp-program Phone: 1-800-440-0493 UTAH – MEDICAID AND CHIP Utah’s Premium Partnership for Health Insurance (UPP) Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov Phone: 1-888-222-2542 Adult Expansion Website: https://medicaid.utah. gov/expansion/ Utah Medicaid Buyout Program Website: https:// medicaid.utah.gov/buyout-program/ CHIP Website: https://chip.utah.gov/ VERMONT– MEDICAID Website: https://dvha.vermont.gov/members/ medicaid/hipp-program Phone: 1-800-250-8427 VIRGINIA – MEDICAID AND CHIP Website: https://coverva.dmas.virginia.gov/learn/ premium-assistance/famis-select https://coverva.dmas.virginia.gov/learn/premiumassistance/health-insurance-premium-paymenthipp-programs Medicaid/CHIP Phone: 1-800-432-5924 WASHINGTON – MEDICAID Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022 WEST VIRGINIA – MEDICAID AND CHIP Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855699- 8447) WISCONSIN – MEDICAID AND CHIP Website: https://www.dhs.wisconsin.gov/ badgercareplus/p-10095.htm Phone: 1-800-362-3002 WYOMING – MEDICAID Website: https://health.wyo.gov/healthcarefin/ medicaid/programs-and-eligibility/ Phone: 1-800-251-1269
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 Axiom Medical group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Axiom Medical 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 Axiom Medical Human Resources 1330 Lake Robbins Dr, Suite 250 The Woodlands, TX 77380 713-568-7574 axiomhr@axiomllc.com
Your Rights and Protections Against Surprise Medical Bills When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. What is “balance billing” (sometimes called “surprise billing”)? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-ofpocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. You are protected from balance billing for:
Emergency services – If you have an emergency medical condition and get emergency services from an out-ofnetwork provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
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IMPORTANT NOTICES
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 costsharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections. You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network. When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay outof-network providers and facilities directly.
Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-ofnetwork providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
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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 lowestcost 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 employment-based coverage. Also, this employer contribution -as well as your employee contribution to employment-based coverage- is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace. 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.
2026-2027 Employee Benefits
IMPORTANT NOTICES 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 eithersubmit 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 1-800318-2596. TTY users can call 1-855-889-4325.
What about Alternatives to Marketplace Health Insurance Coverage?
PART B: Information About Health Coverage Offered by Your Employer
If you or your family are eligible for coverage in an employment-based health plan (such as an employer-sponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employmentbased 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.
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.
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.
8. State: TX
3. Employer Name: Axiom Medical Consulting 4. Employer Identification Number (EIN): 42-0127290 5. Employer Address: 1330 Lake Robbins Drive, Suite 250 6. Employer Phone Number: 281-465-7100 7. City: Spring
10. Who can we contact at this job?: Dana Sands 11. Phone Number (if different from above): 281-466-1488 12. E-Mail Address: Dana.Sands@axiomllc.com
How Can I Get More Information? For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact Human Resources. 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.
9. ZIP Code: 77380
As your employer, we offer a health plan to all eligible employees (see the Eligibility section of this guide). This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages. Indexed annually; see https://www.irs.gov/pub/irs-drop/ rp-22-34.pdf for 2023.
1
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.
2
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This brochure highlights the main features of the Axiom Medical 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. Axiom Medical reserves the right to change or discontinue its employee benefits plans anytime.