EMPLOYEE
BENEFITS 2026 2027
A guide to understanding your employee benefits program
WORKING TOWARDS WELLNESS
What’s Inside 2
Introduction
3
Important Contacts
4
Eligibility
5
How to Enroll
6
Medical Coverage
8
Health Reimbursement Arrangement
9
Health Savings Account
Introduction We know you work hard every day to achieve your personal and professional goals. Since your health and wellness are key to meeting these goals, we are pleased to offer a comprehensive benefits package that supports your health, mind, and body. May you always be Working Towards Wellness!
10 Flexible Spending Accounts 12 Qualified HSA and FSA Expenses 13 Cigna Resources 14 Employee Assistance Program 15 Telemedicine 16 Health Care Options
Read this guide to learn more about these and other benefits. You may only enroll for or make changes to your benefits during Open Enrollment or when you have a Qualifying Life Event (see page 4).
Date Your New Benefits Begin: March 1, 2026 – February 28, 2027
17 Dental Coverage 18 Vision Coverage 19 Life and AD&D Insurance 20 Disability Insurance 21 Supplemental Benefits 24 401(k) Retirement Plan 25
Employee Assistance and Wellness Support
26 Employee Benefits and Time Off 27 PerkSpot Discount Program 28 Glossary of Terms 29 Important Notices
2
Availability of Summary Health Information Your plan offers medical coverage options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage (SBC) available from Human Resources.
Important Contacts COVERAGE
Provider
Group #
Phone
Website/Email
Medical
Cigna
#653737
866-494-2111
www.mycigna.com
Telemedicine
Teladoc
#325980
800-835-2362
www.teladoc.com
Employee Assistance Program
Cigna
N/A
877-231-1492
www.mycigna.com
HSA Bank
N/A
800-357-6246
www.hsabank.com
Health Reimbursement Arrangement
The Difference Card
N/A
888-343-2110
www.differencecard.com
Flexible Spending Accounts
The Difference Card
N/A
888-343-2110
www.differencecard.com
Dental
Cigna
#653737
800-244-6224
www.mycigna.com
Vision
Cigna/EyeMed
#653737
866-494-2111
www.mycigna.com
Basic and Voluntary Life and AD&D
Mutual of Omaha
#CX8Z
800-877-5176
www.mutualofomaha.com
Short Term Disability
Mutual of Omaha
#CX8Z
800-877-5176
www.mutualofomaha.com
Long Term Disability
Mutual of Omaha
#CX8Z
800-877-5176
www.mutualofomaha.com
Employee Assistance and Wellness Support
Mutual of Omaha
N/A
800-316-2796
www.mutualofomaha.com/eap
Accident
Cigna
AI112271
800-754-3207
www.supphealthclaims.com
Critical Illness
Cigna
CI112188
800-754-3207
www.supphealthclaims.com
Hospital Indemnity
Cigna
HC111809
800-754-3207
www.supphealthclaims.com
Retirement Plan
July Services
N/A
888-333-6315 Plan Password: 0630410
www.julyservices.com/participants psateam@julyservices.com
Benefits Assistance
Higginbotham
N/A
817-797-0556
inbbenefits@higginbotham.net
Health Savings Account
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices for your prescription drug coverage. Please see page 29 for more details.
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Eligibility Who is Eligible for Benefits STATUS
New Hire
Employee
Dependent(s)
Eligibility
Regular, full-time employee Working an average of 30 hours per week
Regular, full-time employee Working an average of 30 hours per week
Your legal spouse, civil union, and/or domestic partner Child(ren) under age 26 regardless of student, dependency, or marital status Child(ren) over age 26 who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return
Enrollment
Enroll by the deadline given by Human Resources
Enroll during Open Enrollment (OE) or when you have a Qualifying Life Event (QLE)
You must enroll the dependent(s) at OE or for a QLE When covering dependents, you must enroll for and be on the same plans
Coverage Begins
First of the month after completing 30 days of fulltime employment
OE: Start of the plan year QLE: Ask Human Resources
Based on OE or QLE effective dates
Qualifying Life Events You may only change coverage during the plan year if you have a QLE, such as:
Marriage
Birth
Divorce
Adoption
Legal separation
Placement for adoption
Annulment Death
Change in benefits eligibility Death
Undergoing FMLA, COBRA event, court judgment or decree Becoming eligible for Medicare, Medicaid, or TRICARE Receiving a Qualified Medical Child Support Order
Gain or loss of benefits coverage Change in employment status affecting benefits Significant change in cost of spouse’s coverage
You must notify Human Resources and make changes within 30 days of the event. Access ExponentHR site for details.
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How to Enroll Enrolling in benefits is simple through ExponentHR.
Follow these steps to enroll in your insurance benefits online:
8. FINALIZE YOUR ELECTIONS
1. ACCESS EXPONENTHR
Click the approve button to finalize your elections.
Begin by navigating to the ExponentHR website, www.exponenthr.com.
Important Note
2. LOG IN
Any elections that are started but not in approved status by the end of Open Enrollment will be force-approved by HR.
Enter your username and password to access your account. If you’re a first-time user, follow the instructions to create an account.
If you encounter any issues during the enrollment process, please contact ExponentHR Support or your HR representative for assistance.
3. START OPEN ENROLLMENT
ADDITIONAL RESOURCES
Once logged in, go to Benefits and select Open Enrollment to begin your elections.
Step-by-step video: https://help.exponenthr.com/ lessons/open-enrollment/
4. MAKE YOUR SELECTIONS
5. SAVE YOUR ELECTIONS
For general beneficiary information in Exponent HR: www.exponenthr.com/service/help/online/ management/assets/docs/Job%20Aid%20-%20 beneficiary%20designations.pdf?rhsearch= beneficiary&rhhlterm=beneficiaries%20beneficiary
After making your selections, click the save button to record your entries.
RESOURCES FOR THE DIFFERENCE CARD
In the Benefit Type column, click the edit button to make your selections for each benefit.
6. PRINT A HARD COPY Click the print button to print a copy of your elections for your records.
https://inwoodbank0.sharepoint.com/sites/ home/shared%20documents/benefits/the%20 difference%20card
7. REVIEW AND SUBMIT Review your elections to ensure all information is correct, then click submit to close your submission.
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Medical Coverage Protects you and your family from major financial hardship in the event of illness or injury.
About This Coverage You have a choice of two medical plans administered by Cigna:
High Deductible Health Plan
HDHP Plan – An IRS-qualified, HSAcompatible plan with in-network benefits Copay Plan – A PPO copay-style plan with innetwork benefits
A High Deductible Health Plan (HDHP) allows you to see any in-network provider when you need care. In exchange for a lower per-paycheck cost for medical benefits, you must satisfy a higher plan deductible that applies to almost all health care expenses, including prescription drugs. If you enroll in the HDHP, you may be eligible to open a Health Savings Account (see page 9).
Preferred Provider Organization A Preferred Provider Organization (PPO) plan allows you to see any in-network provider when you need care. When you see in-network providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other network services are covered at the deductible and coinsurance level.
Find an In-Network Provider Call 866-494-2111. Visit www.mycigna.com.
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Important: True medical emergencies will be treated as in-network for all medical plan offerings. Medical ID cards are available in the Cigna app only; they will not be mailed. There are no out-of-network benefits!
Medical Benefits Summary HDHP Plan
Copay Plan
HSAIN In-Network Only
OAPIN In-Network Only
Calendar Year Deductible Individual Family Coinsurance
$7,050 $14,100 20%
With HRA $3,400 $6,0001 -
$5,000 $10,000 30%
With HRA $2,000 $4,000 -
Out-of-Pocket Maximum Includes deductible Individual Family
$7,050 $14,100
$3,400 $6,0001
$8,700 $17,400
$3,000 $6,000
You Pay
You Pay
Preventive Care
$0
$0
Telemedicine
$0 with Teladoc
$0 with Teladoc
Primary Care Physician
$0
2
$10 copay
Specialist
$0
2
$60 copay
Diagnostic Lab and X-ray
$0
2
30%2
Complex Imaging CT/PET scan, MRI
$02
30%2
Urgent Care
$02
$25 copay
Emergency Room
$0
$500 + 30%2
Inpatient Hospital Services
$02
30%2
Outpatient Services
$02
$60 copay office visit 30%2
In-Network Only
In-Network Only
Combined with medical deductible $02 $02 $02 $02
$0 $20 $50 $85 $250
$02 $02 $02
$50 $125 $213
Prescription Drugs – Retail Up to a 30-day supply Prescription Deductible Tier 1 Tier 2 Tier 3 Specialty Prescription Drugs – Mail Order Up to a 90-day supply Tier 1 Tier 2 Tier 3
2
If you have family coverage on the HDHP plan, one member of the family must meet the $3,400 deductible/out-of-pocket maximum; remaining members will only need to meet a $2,600 deductible/out-of-pocket maximum. 1
2
The amount you pay after the HRA plan spending requirements have been met.
Employee Per Paycheck Contributions
HDHP Plan
Copay Plan
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
$76 $442 $295 $690
$152 $621 $445 $950
HDHP Plan and HSA Bank: By enrolling in the HDHP plan, you are able to establish and contribute to an HSA with HSA Bank. If you do not wish to open a Health Savings Account, you must decline HSA enrollment via ExponentHR while making your plan elections.
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Health Reimbursement Arrangement Helps offset your out-of-pocket health care costs with reimbursement for qualified in-network expenses. Inwood National Bank provides a Health Reimbursement Arrangement (HRA) to help offset your out-of-pocket health care costs for in-network expenses only. An HRA is an employer-funded account provided for employees only, and it is available with all medical plans.
How the HRA Works
1. You must be enrolled in a medical plan. You pay your portion of the deductible (see
2. Medical Plan Summary for details). 3.
You will be automatically reimbursed for your 2026 claims by The Difference Card. Set up your direct deposit for the easiest reimbursement process.
Important HRA Information
Your HRA is funded entirely through company contributions. You can use the HRA to help cover outof-pocket costs if those costs apply toward your deductible (e.g., doctor visits, diagnostic tests, and prescription drugs). You can use your HRA to pay for a qualified medical expense for you or your covered spouse and dependents if it is not reimbursed from another source (e.g., another group health insurance plan or if you take a tax deduction for those expenses).
Review your plan documents for full details.
Learn More About The Difference Card RESOURCES https://inwoodbank0.sharepoint.com/sites/ Home/Shared%20Documents/Benefits/ The%20Difference%20Card
CUSTOMER SERVICE 888-343-2110 NOTE: The HRA does not replace the Flexible Spending Account (FSA). Expenses reimbursed under the FSA are not eligible for reimbursement under the HRA.
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Health Savings Account
HSA Eligibility You are eligible to open and contribute to an HSA if you are:
Offsets your medical costs, reduces your taxes, and offers a long-term taxadvantaged savings account.
A Health Savings Account (HSA) is a tax-deductible savings plan that allows you to put aside pretax dollars to use for current or future health care expenses. It is also a tax-exempt tool to supplement your retirement savings. It is always yours to keep, even if you change health plans or jobs. The HSA runs on a calendar year (January 1 – December 31), and is only available with the HDHP medical plan.
Important HSA Information
HSA Contributions Use It Now
Let It Grow
You Decide How To Use Your HSA
Make annual HSA contributions + Use HSA funds to pay for eligible medical costs = Keep HSA funds in cash
Make annual HSA contributions + Pay for medical costs with other funds = Invest HSA funds
Triple Tax Savings
1. HSA contributions are tax-deductible 2. HSA contributions grow tax-deferred Withdrawals for qualifying medical expenses
3. are tax-free
Enrolled in the HSA-eligible HDHP Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan Not enrolled in a Health Care Flexible Spending Account Not eligible to be claimed as a dependent on someone else’s tax return Not enrolled in Medicare, Medicaid, or TRICARE Not receiving Veterans Administration benefits
Always ask your network doctor to file claims with your medical, dental, or vision carrier so you will get the highest level of benefits. You can pay the doctor with your HSA debit card for any balance due. You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit. You may open an HSA at the financial institution of your choice, but only accounts opened through HSA Bank are eligible for automatic payroll deduction.
Open an HSA If you meet the eligibility requirements, you may open an HSA administered by HSA Bank. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. To open an account, go to www.hsabank.com
Contributions 2026 Maximum Contributions
Individual – $4,400 Family (filing jointly) – $8,750 Catch-Up Contribution (if age 55+) – $1,000
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are age 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at anytime during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
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Flexible Spending Accounts Allow you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer three Flexible Spending Accounts, administered by The Difference Card. 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 Medical deductibles and coinsurance Prescription copays Hearing aids and batteries
You may not contribute to a Health Care FSA if you enrolled in an HDHP and contribute to an HSA.
Limited Purpose Health Care FSA A Limited Purpose Health Care FSA is available if you enrolled in the HDHP medical plan and contribute to an HSA. You can use a Limited Purpose Health Care FSA to pay for eligible out-of-pocket dental and vision expenses only, such as:
Dental and orthodontia care (e.g., fillings, X-rays, and braces) Vision care (e.g., eyeglasses, contact lenses, and LASIK surgery)
Refer to page 12 for a list of qualified FSA expenses.
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Important FSA Rules
The maximum per plan year you can contribute to a Health Care or Limited Purpose 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 Qualifying Life Event. Your Health Care or Limited Purpose Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses. The IRS has amended the “use it or lose it” rule to allow you to carry over up to $680 in your Health Care FSA into the next plan year. The carryover rule does not apply to your Dependent Care FSA.
Learn More About The FSA RESOURCES FOR THE DIFFERENCE CARD https://inwoodbank0.sharepoint.com/sites/ Home/Shared%20Documents/Forms/AllItems .aspx?FolderCTID=0x0120002E42D77740DF1 C438DF35CB8BFF1C456&id=%2Fsites%2FHome %2FShared%20Documents%2FBenefits%2FThe %20Difference%20Card.
CALL 888-343-2110
Flexible Spending Accounts Dependent Care FSA The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full-time. You can use the account to pay for daycare or babysitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you (and your spouse, if married) must be gainfully employed, looking for work, a full-time student, or incapable of self-care.
DEPENDENT CARE FSA CONSIDERATIONS
Overnight camps are not eligible for reimbursement (only day camps can be considered). If your child turns age 13 midyear, you may only be reimbursed for the time the child was under age 13. You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care. The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
WORKING TOWARDS SECURITY
Plan Comparison Health Care FSA
Limited Purpose FSA
Dependent Care FSA
Eligible Expenses Most medical, dental and vision care expenses that are not covered by your health plan, such as: copayments coinsurance deductibles glasses doctor-prescribed over-the-counter medications
Most dental and vision care expenses that are not covered by your health plan, such as: eyeglasses contacts LASIK eye surgery fillings X-rays braces
Dependent care expenses so you and your spouse can work or attend school full-time, such as: daycare after-school programs eldercare programs
Annual IRS Contribution Maximum
$3,400 per year
$3,400 per year
$7,500 (filing jointly or head of household) $3,750 (married and filing separate tax returns)
Benefit Saves on eligible expenses not covered by insurance Reduces your taxable income
Saves on eligible expenses not covered by insurance Reduces your taxable income
Reduces your taxable income
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Qualified HSA and FSA Expenses This list is not all-inclusive; additional expenses may qualify and the items listed may change in accordance with IRS regulations. Refer to IRS Publication 502 Medical and Dental Expenses at www.irs.gov for complete details.
Shows some medical expenses that are eligible for payment under your Health Care FSA or HSA.
Abdominal supports Acupuncture Air conditioner (when necessary for relief from difficulty in breathing) Alcoholism treatment Ambulance Anesthetist Arch supports Artificial limbs Autoette (when used for relief of sickness/disability) Blood tests Blood transfusions Braces Cardiographs Chiropractor Contact lenses Convalescent home (for medical treatment only) Crutches Dental treatment Dental X-rays Dentures Dermatologist
Diagnostic fees Diathermy Drug addiction therapy Drugs (prescription) Elastic hosiery (prescription) Eyeglasses Fees paid to health institute prescribed by a doctor FICA and FUTA tax paid for medical care service Fluoridation unit Guide dog Gum treatment Gynecologist Healing services Hearing aids and batteries Hospital bills Hydrotherapy Insulin treatment Lab tests Lead paint removal Legal fees Lodging (away from home for outpatient care)
Metabolism tests Neurologist Nursing (including board and meals) Obstetrician Operating room costs Ophthalmologist Optician Optometrist Oral surgery Organ transplant (including donor’s expenses) Orthopedic shoes Orthopedist Osteopath Oxygen and oxygen equipment Pediatrician Physician Physiotherapist Podiatrist Postnatal treatments Practical nurse for medical services
Prenatal care Prescription medicines Psychiatrist Psychoanalyst Psychologist Psychotherapy Radium therapy Registered nurse Special school costs for the handicapped Spinal fluid test Splints Surgeon Telephone or TV equipment to assist the hard-of-hearing Therapy equipment Transportation expenses (relative to health care) Ultraviolet ray treatment Vaccines Vitamins (if prescribed) Wheelchair X-rays
REFER TO IRS PUBLICATION 502 MEDICAL AND DENTAL EXPENSES FOR COMPLETE DETAILS
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Cigna Resources Cigna Member Portal
Health Information Line
myCigna serves as your one-stop-shop for all Cigna health plan and benefits information. Key features include managing and tracking claims, accessing digital ID cards, finding in-network providers, accessing cost comparison tools, reviewing coverage details, and more.
Speak to a nurse at anytime to get answers and/or recommendations based on your specific health situation. Call the number on the back of your Cigna ID card for 24/7 access to the Health Information Line.
myCigna Mobile App Download the myCigna mobile app to access your Cigna health plan and benefits information while on the go. This app helps you organize and access important plan information on your smartphone or tablet. It is also available in Spanish.
Visit www.mycigna.com to learn more.
THESE PROGRAMS ARE INCLUDED WITH YOUR CIGNA MEDICAL COVERAGE AT NO COST!
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Employee Assistance Program
Available at No Cost for INB Employees with Medical Coverage
The Employee Assistance Program (EAP), provided through your Cigna medical benefits, offers 24/7 support for emotional and general well-being, including:
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Live chat on www.mycigna.com Access to 300+ substance use Centers of Excellence Virtual counseling with 14,000 clinicians Support for autism, eating disorders, substance abuse, and more Unlimited telephone counseling and work/life resources Up to three face-to-face counseling sessions One 30-minute legal consultation One 30-minute financial consultation
Access your benefits:
Visit: www.mycigna.com Call: 877-231-1492
Telemedicine Allows 24/7/365 access to boardcertified doctors from your mobile phone or computer.
When to Use Telemedicine
Your medical coverage offers telemedicine services through Teladoc. Connect anytime day or night with a board-certified doctor via your mobile device or computer for free.
While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
Have a non-emergency issue and are considering an after hours health care clinic, urgent care clinic, or emergency room for treatment Are on a business trip, vacation, or away from home Are unable to see your primary care physician
Use telemedicine for minor conditions such as:
Sore throat Headache Stomachache Cold Flu
Mental health issues Allergies Fever Urinary tract infections
Do not use telemedicine for serious or life-threatening emergencies.
Did You Know? Your regular provider may offer telemedicine services, so it is best to ask now and know what your options are before you need care. Costs may differ from Teladoc services. Note: To receive free Teladoc services, and avoid fees, do not add insurance information.
Registration is Easy Register with Teladoc so you are ready to use this valuable service when and where you need it. Visit www.teladoc.com Call 800-835-2362 Download the Teladoc app Group #: 325980
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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
$0
2-5 minutes
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
Infections Sore and strep throat Vaccinations Minor injuries/sprains/strains
$
15-20 minutes
Common infections Minor injuries Pregnancy tests Vaccinations
$
15 minutes
$$
15-30 minutes
$$$$
4+ hours
$$$$$$
Varies
Hours vary based on store hours
When you need immediate attention; walk-in basis is usually accepted
Urgent Care
with Teladoc
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
Allergies Cough/cold/flu Rash Stomachache
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
Doctor’s Office
Generally includes evening, weekend and holiday hours
Sprains and strains Minor broken bones Small cuts that may require stitches Minor burns and infections
Emergency Care
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility
Hospital ER
24 hours a day, 7 days a week
Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher
Freestanding ER
Chest pain Difficulty breathing Severe bleeding Blurred or sudden loss of vision Major broken bones
Most major injuries except trauma Severe pain
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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Dental Coverage Provides routine dental care, basic services, and major services. DPPO Plans Two levels of benefits are available with the Dental Preferred Provider Organization (DPPO) plans: in-network and out-of-network. You may see any dental provider for care, but you will pay less and get the highest level of benefits with in-network providers. You could pay more if you use an out-of-network provider. Dental Provider: Cigna
Find an In-Network Provider Call 800-244-6224 Visit www.mycigna.com
Dental Benefits Summary CIGNA DPPO
Low Plan
High Plan In-Network
Out-of-Network2
$1,000 + $250 per year up to a maximum of $1,750
$3,000 + $250 per year up to a maximum of $1,750
$3,000 + $250 per year up to a maximum of $1,750
$1,000
$1,000
$1,000
$1,000
You Pay
You Pay
You Pay
You Pay
$50 $150
$50 $150
$50 $150
$50 $150
Preventive Care Exams, cleanings, x-rays, sealants
$0
$0
$0
$0
Basic Restorative Fillings, simple extractions, periodontics, endodontics, oral surgery, root canals, anesthetics
0%³
0%³
20%³
20%³
Major Restorative Crowns, bridges, inlays, onlays, dentures
40%³
40%³
50%³
50%³
50%
50%
50%
50%
Calendar Year Maximum Benefit Orthodontia Lifetime Maximum Benefit
Calendar Year Deductible Individual Family
Orthodontia For children up to age 19 only
In-Network
Out-of-Network
$1,000 + $250 per year up to a maximum of $1,750
Employee Per Paycheck Contributions Employee Only Employee + Spouse Employee + Child(ren) Employee + Family 1
Out-of-network benefits are based on the Maximum Allowable Charge.
2
Out-of-network benefits are based on the 90th percentile of Allowed Charges.
1
Low Plan
High Plan
$0.00 $14.00 $21.50 $35.00
$2.75 $23.50 $34.00 $54.50
³The amount you pay after the deductible has been met.
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Vision Coverage Helps detect certain medical issues, prolong your eyesight, and correct vision or eye problems.
Our vision plan offers quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems. You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see in-network providers. Coverage is provided through Cigna using the EyeMed vision network. Laser vision discounts are available through EyeMed.
Vision Benefits Summary VISION
Vision Plan In-Network You Pay
Out-of-Network Reimbursement
Exam
$10 copay
Up to $45
Standard lenses Single vision Lined bifocals Lined trifocals Lenticular
$20 copay $20 copay $20 copay $20 copay
Up to $32 Up to $55 Up to $65 Up to $80
$150 allowance
Up to $83
$150 $0
Up to $120 Up to $210
Frames Contact Lenses In lieu of eyeglasses Elective Medically necessary Benefit Frequency Exam Lenses Frames Contacts
Employee Per Paycheck Contributions Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
Once every 12 months Once every 12 months Once every 12 months Once every 12 months
Vision Plan $3.40 $5.67 $5.83 $9.22
Find an In-Network Provider Call 866-494-2111 Visit www.mycigna.com
Vision Provider: Cigna Network: EyeMed
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Life and AD&D Insurance Provides your loved ones with a financial safety net after your death and/or after an accident that causes loss of life, limb, or function. Life and Accidental Death and Dismemberment (AD&D) insurance through Mutual of Omaha are important to your financial security, especially if others depend on you for support or vice versa. With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies). Voluntary Life and AD&D coverage amounts reduce to 50% at age 75 (of the original amounts).
Voluntary Life and AD&D Employee
Increments of $10,000 to $500,000 Guaranteed Issue $150,000
Spouse
Increments of $5,000 up to 100% of employee amount; $250,000 maximum Guaranteed Issue $50,000
Child(ren)
Birth to age 26 - Increments of $1,000 up to $20,000 Guaranteed Issue $20,000
Voluntary Life
Employee and Spouse1 Monthly Rates per $1,000 Age
Rate
Age
Rate
<30
$0.08
50-54
$0.33
30-34
$0.10
55-59
$0.53
35-39
$0.11
60-64
$0.80
40-44
$0.15
65-69
$1.29
45-49
$0.22
70-99
$2.13
Spouse rates based on employee’s age. Spouse coverage terminates when Employee reaches age 70. 1
Basic Life and AD&D Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at the lesser of two times your annual salary or $500,000 for each benefit.
Voluntary Life and AD&D If you need more coverage than Basic Life and AD&D, you may buy Voluntary Life and AD&D for yourself and your dependent(s). If you do not elect Voluntary Life and AD&D insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health. You must elect Voluntary Life and AD&D coverage for yourself before covering your spouse and/or child(ren).
Voluntary Life Monthly Rates Child(ren)
Rate per $5,000
$1.00
Rate per $10,000
$2.00
Rate per $20,000
$4.00
AD&D Coverage is bundled with Life Coverage for Employee, Spouse, and Child(ren) in the rates reflected above.
Designating a Beneficiary A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries at anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
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Disability Insurance Provides partial income protection if you are unable to work due to a covered accident or illness.
If you were temporarily unable to work, would you be able to cover your bills?
We offer Voluntary Short Term Disability (STD) for you to purchase and provide Long Term Disability (LTD) at no cost to you through Mutual of Omaha.
Voluntary Short Term Disability
Employer-Paid Long Term Disability
Voluntary STD coverage pays a percentage of your weekly salary if you are temporarily disabled and unable to work due to an illness, pregnancy, or non-work-related injury. STD benefits are not payable if the disability is due to a job-related injury or illness. If a medical condition is jobrelated, it is considered workers’ compensation, not STD.
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for more than 90 days. Benefits begin at the end of an elimination period and continue while you are disabled up to Social Security Normal Retirement Age (SSNRA).
Voluntary Short Term Disability
Long Term Disability
Benefits Begin
8th day
Benefits Begin
Percentage of Earnings You Receive2
60%
Percentage of Earnings You Receive
60%
Maximum Weekly Benefit
$2,500
Maximum Monthly Benefit
up to $15,000
Maximum Benefit Period
12 weeks
Maximum Benefit Period
SSNRA
Pre-existing Condition Exclusion
3/61
Pre-existing Condition Exclusion
3/121
Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for six months. 1
Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months. 1
Benefit amount is determined based on earnings at the time of enrollment. Benefit amounts update for compensation changes on an annual basis with the plan anniversary. 2
WORKING TOWARDS SECURITY
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91st day
Supplemental Benefits Complements our traditional health care programs and pays you directly for unexpected health care costs. Accident Insurance Accident insurance provides affordable protection against a sudden, unforeseen accident. The Accident plan helps offset the direct and indirect expenses resulting from an accident such as copayments, deductible, ambulance, physical therapy, childcare, rent, and other costs not covered by traditional health plans. See the plan document for full details. ACCIDENT Ambulance Ground Air
$400 $1,600
Emergency Care Treatment
$200
Hospital Admission
$1,000
Hospital Confinement
$200 per day – up to 365 days
Intensive Care Unit
$400 per day – up to 365 days
Specific Sum Injuries Dislocations, ruptured discs, eye injuries, fractures, lacerations, concussions, and more Accidental Death & Dismemberment1 Accidental Death Automobile Accidental Death Common Carrier
$75-$10,000
$50,000 $50,000 $100,000
Protect Your Savings Health insurance covers medical bills, but if you have an emergency, an accident or a hospital stay, you may have a lot of unexpected out-ofpocket costs to pay. Protect your savings with additional coverage from Cigna.
Hospital Indemnity Insurance The Hospital Indemnity plan helps you with the high cost of medical care by paying you a cash benefit when you have an inpatient hospital stay. Unlike traditional insurance that pays a benefit to the hospital or doctor, this plan pays you directly. It is up to you how you want to use the cash benefit. These costs may include meals, travel, childcare or eldercare, deductibles, coinsurance, medication, or time away from work. See the plan document for full details. HOSPITAL INDEMNITY Hospital Admission
$1,000
Hospital Confinement
$100 per day up to 30 days
ICU Admission
$200
ICU Confinement
$200 per day up to 30 days
Newborn Nursery Care Stay
$200 per day up to 30 days
Employee Monthly Contributions Employee Monthly Contributions Employee Employee + Spouse Employee + Child(ren) Employee + Family 1
$11.13 $20.48 $27.14 $36.49
Employee Employee + Spouse Employee + Child(ren) Employee + Family
$14.70 $35.69 $24.28 $45.27
Spouse and Children get a percentage of the benefit amount shown.
BEWELL BENEFIT Each covered member can also receive a benefit each year for completing a wellness screening from their doctor in the following amounts:
$75 for Accident $50 for Hospital Indemnity
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Supplemental Benefits Critical Illness Insurance Critical Illness insurance helps pay the cost of nonmedical expenses related to a covered critical illness or cancer. The plan provides a lump-sum benefit payment to you upon first and second diagnosis of any covered critical illness or cancer. The benefit can help cover expenses such as lost income, out-of-town treatments, special diets, daily living, and household upkeep costs. See the plan document for full details.
BEWELL BENEFIT Each covered member can also receive $50 per year for completing a wellness screening with your doctor.
CRITICAL ILLNESS
Vendor Plan
Employee
$10,000/$20,000/$30,000
Spouse
100% of issued employee benefit amount
Children
100% of issued employee benefit amount First Occurrence Benefit
Full Coverage Paralysis; invasive cancer; heart attack; stroke; major organ failure; endstage renal (kidney) disease
100% of benefit amount
Partial Coverage Severe sepsis; pulmonary embolism; coronary artery disease; advanced heart failure
25% of benefit amount
Wellness Benefit One per covered person per calendar year
$50
Monthly Critical Illness Employee Cost per $10,000 Coverage Age
Employee Only
Employee + Spouse
Employee + Child(ren)
Employee + Family
<25
$4.03
$8.35
$8.87
$13.19
25–29
$4.48
$9.31
$9.32
$14.15
30–34
$5.26
$10.99
$10.09
$15.82
35–39
$7.12
$14.99
$11.95
$19.82
40–44
$9.24
$19.54
$14.08
$24.38
45–49
$12.83
$27.27
$17.67
$32.11
50–54
$17.12
$36.49
$21.96
$41.33
55–59
$24.07
$51.43
$28.90
$56.26
60–64
$30.44
$65.14
$35.28
$69.98
65–69
$39.74
$85.12
$44.58
$89.96
70-74
$51.80
$111.06
$56.64
$115.90
75-79
$67.42
$144.64
$72.26
$149.48
80-84
$79.80
$171.27
$84.65
$176.12
85+
$105.04
$225.54
$109.89
$230.39
The cost for coverage is determined by the employee’s age.
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Supplemental Benefits Monthly Critical Illness Employee Cost per $20,000 Coverage Age
Employee Only
Employee + Spouse
Employee + Child(ren)
Employee + Family
<25
$8.07
$16.70
$17.74
$26.37
25–29
$8.95
$18.62
$18.64
$28.31
30–34
$10.51
$21.97
$20.18
$31.64
35–39
$14.24
$29.98
$23.91
$39.65
40–44
$18.47
$39.09
$28.16
$48.78
45–49
$25.66
$54.55
$35.34
$64.23
50–54
$34.23
$72.98
$43.92
$82.67
55–59
$48.13
$102.85
$57.80
$112.52
60–64
$60.89
$130.28
$70.56
$139.95
65–69
$79.47
$170.25
$89.16
$179.94
70-74
$103.61
$222.13
$113.27
$231.79
75-79
$134.85
$289.28
$144.52
$298.95
80-84
$159.60
$342.53
$169.29
$352.22
85+
$210.09
$451.08
$219.78
$460.77
Monthly Critical Illness Employee Cost per $30,000 Coverage Age
Employee Only
Employee + Spouse
Employee + Child(ren)
Employee + Family
<25
$12.10
$25.05
$26.61
$39.56
25–29
$13.43
$27.93
$27.96
$42.46
30–34
$15.77
$32.96
$30.27
$47.46
35–39
$21.36
$44.97
$35.86
$59.47
40–44
$27.71
$58.63
$42.24
$73.16
45–49
$38.49
$81.82
$53.02
$96.35
50–54
$51.35
$109.47
$65.88
$124.00
55–59
$72.20
$154.28
$86.70
$168.78
60–64
$91.33
$195.42
$105.83
$209.92
65–69
$119.21
$255.37
$133.74
$269.90
70-74
$155.41
$333.19
$169.91
$347.69
75-79
$202.27
$433.92
$216.78
$448.43
80-84
$239.40
$513.80
$253.94
$528.34
85+
$315.13
$676.62
$329.66
$691.15
The cost for coverage is determined by the employee’s age.
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401(k) Retirement Program Helps you be more financially secure in your retirement. How the Retirement Plan Works You are eligible to participate in the plan if you are 18 years of age and have 90 days of service with the company. You may contribute up to the IRS limit.
2026 Contribution Limits You may make pre- and post-tax contributions from one percent up to 90% of your eligible compensation. The 2026 combined contribution limits are:
$24,500 for 401(k) and 403(b) employee deferrals $8,000 catch-up contribution (age 50+) $11,250 “super” catch-up contribution (ages 60-63)
July Services
Enrollment You must enroll by contacting July Services:
Visit www.julyservices.com/participants Email: psateam@julyservices.com Call 888-333-6315 (Plan Password: 0630410)
Vesting You are always 100% vested in your own contributions. You are 100% vested in matching company contributions after six years of service.
Investment Options
Employer Match Inwood National Bank matches 50% of the employee contribution up to 15% of the per pay period contribution. The money that you contribute and the money it earns are always 100% vested. Any rollover or transfer contributions you make are also 100% vested. You decide how much you want to contribute and can change your contribution amount anytime. All changes are effective as soon as administratively feasible and remain in effect until you update or stop your contributions. You also decide how to invest the assets in your account and may change your investment choices anytime. For more details, refer to your 401(k) Enrollment Guide or contact July Services at 888-333-6315 (Plan Password: 0630410). VESTING SCHEDULE
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401(k) Administrator
Completed Years of Service
Percent of Investment
2 Years
20%
3 Years
40%
4 Years
60%
5 Years
80%
6 Years
100%
You may direct your contributions to any of the investments offered within the company 401(k) plan.
A 401(K) PLAN CAN HELP YOU REACH YOUR INVESTMENT GOALS!
Employee Assistance and Wellness Support Helps you and family members cope with a variety of personal or work-related issues. The Employee Assistance Program from Mutual of Omaha provides confidential counseling and support services at little or no cost to you to help with:
Child and elder care resources Well-being coaching by phone (up to five sessions per year)
Coverage includes three face-to-face sessions with a certified therapist. These sessions can be used for you or any of your eligible dependents. Additional sessions can be purchased at a discounted rate.
Resources and tools on a variety of topics Family care services
Get support at any hour of the day or night. Call 800-316-2796 Visit www.mutualofomaha.com/eap and select “Request Services”
Provided by: Mutual of Omaha
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Employee Benefits and Time Off Employee Club
Educational Assistance
Inwood National Bank offers an Employee Club to host member events. You can voluntarily contribute $5.00 per month, which is deducted semimonthly from payroll. Enrollment is open each February during Open Enrollment, with a cutoff date of March 31. If you miss this deadline, you must wait until the following year to join, though exceptions may be made on a case-bycase basis, requiring catch-up payments based on the enrollment date.
Inwood National Bank values your professional growth and supports continued education to enhance responsibility and career development. To align with this commitment, we offer a reimbursement program for expenses for approved educational institutions. You may be reimbursed up to $1,500 per semester, with a maximum of $4,500 per calendar year, for accredited programs that enhance skills relevant to your current role or support potential promotional opportunities.
NOTE: It is your responsibility to confirm that deductions are being made each month. Promptly contact Human Resources if they are not.
Paid Holidays
Employee Referral Awards
Full-time employees and benefits-eligible part-time employees will be paid for the following holidays in accordance with the Federal Reserve Bank.
Inwood National Bank encourages you to refer qualified candidates for job openings. All employees, except managers in the line of authority and HR personnel, are eligible for referral awards. Applicants should list the referring employee’s name on their application. If the referral is hired, completes three months of service, and remains actively employed, the referrer will receive $500 and an additional $1,000 when the referral completes one year of service, provided both employees are actively employed and in good standing at the time. Referral incentives will not be paid if either employee resigns or is terminated before the award payout. Management reserves the right to update this plan at any time.
Vacation, Sick Time, and Salary Continuation Full-time employees will accrue benefit pay at the following rates: 8 days of sick time at the beginning of each year. Unused sick days at the end of the calendar year are converted to salary continuation, up to a maximum of 720 hours. Vacation accrual rates are based on a 40-hour work week.
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New Year’s Day Martin Luther King, Jr. Day Presidents’ Day Memorial Day Juneteenth National Independence Day Independence Day Labor Day Columbus Day Veterans’ Day Thanksgiving Day Christmas Day
Refer to the INB Employee Handbook for additional details. Refer to the ExponentHR Pay Calendar for annual dates of office closure.
Accrual Rate (per pay period)
Annual Maximum # of Days
5
3.33 hours
10
6
3.67 hours
11
7
4.00 hours
12
8
4.33 hours
13
9
4.67 hours
14
10+
5.00 hours
15
Years of Service
Employees working fewer than 30 hours per week accrue sick time based on hours worked, while those working 30 or more hours (but less than full-time) accrue both sick and vacation time proportionally.
PerkSpot Discount Program The PerkSpot Discount Program makes it easy for you to find exclusive discounts on your favorite brands. Items are curated based on your interests so you can stay healthy and save on items, activities, and places that are most meaningful to you. Explore 30,000 national and local offers that include travel, hobbies, health and fitness, beauty, toys, pets, jewelry, services, education, entertainment, apparel, and more. To get started:
Sign up at https://higginbotham.perkspot.com or download the PerkSpot app. Click Register to create your account (be sure to use a non-Inwood Bank email address). Select your interests from the My Interests feature and click on Got it!. Log in or read weekly emails to get ongoing and featured discounts.
Access the program at home, work, or on the go to save money and splurge on happiness.
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Glossary of Terms Beneficiary – Who will receive a benefit in the event of the insured’s death. A policy may have more than one beneficiary. Coinsurance – Your share of the cost of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service, typically after you meet your deductible. Copay – The fixed amount you pay for health care services received. Deductible – The amount you owe for health care services before your health insurance begins to pay its portion. For example, if your deductible is $1,000, your plan does not pay anything until you meet your $1,000 deductible for covered health care services. The deductible may not apply to all services, including preventive care. Employee Contribution – The amount you pay for your insurance coverage. Employer Contribution – The amount Inwood National Bank contributes to the cost of your benefits. Explanation of Benefits (EOB) – A statement sent by your insurance carrier that explains which procedures and services were provided, how much they cost, what portion of the claim was paid by the plan, what portion of the claim is your responsibility, and information on how you can appeal the insurer’s decision. These statements are also posted on the carrier’s website for your review. Flexible Spending Account (FSA) – An option that allows participants to set aside pretax dollars to pay for certain qualified expenses during a specific time period (usually a 12-month period). Health Savings Account (HSA) – A personal savings account that allows you to pay for qualified medical expenses with pretax dollars. High Deductible Health Plan (HDHP) – A medical plan with a higher deductible in exchange for a lower monthly premium. You must meet the annual deductible before any benefits are paid by the plan. In-Network – Doctors, hospitals, and other providers that contract with your insurance company to provide health care services at discounted rates.
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Learn some common benefits terms. Out-of-Network – Doctors, hospitals, and other providers that are not contracted with your insurance company. If you choose an out-of-network provider, you may be responsible for costs over the amount allowed by your insurance carrier. Out-of-Pocket Maximum – Also known as an out-of-pocket limit. The most you pay during a policy period (usually a 12-month period) before your health insurance or plan begins to pay 100% of the allowed amount. The limit does not include your premium, charges beyond the Reasonable & Customary (R&C), or health care your plan does not cover. Check with your health insurance carrier to confirm what payments apply to the out-of-pocket maximum. Over-the-Counter (OTC) Medications – Medications typically made available without a prescription. Prescription Medications – Medications prescribed by a doctor. Cost of these medications is determined by their assigned tier.
Brand Name Drugs (Formulary) – Brand name drugs on your provider’s list of approved drugs. You can check online with your provider to see this list. Brand Name Drugs (Non-Formulary) – Brand name drugs not on your provider’s list of approved drugs. These drugs are typically newer and have higher copayments. Generic Drugs – Drugs approved by the U.S. Food and Drug Administration (FDA) to be chemically identical to corresponding brand name versions. The color or flavor of a generic medicine may be different, but the active ingredient is the same. Generic drugs are usually the most cost-effective version of any medication.
Preventive Care – The care you receive to prevent illness or disease. It also includes counseling to prevent health problems. Reasonable and Customary Allowance (R&C) – Also known as an eligible expense or the Usual and Customary (U&C). The amount your insurance company will pay for a medical service in a geographic region based on what providers in the area usually charge for the same or similar medical service. Spouse – A legally married partner, including civil union or domestic partners as recognized by state law and your benefits plan. SSNRA – Social Security Normal Retirement Age.
Important Notices Women’s Health and Cancer Rights Act of 1998 In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully. As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits: All stages of reconstruction of the breast on which
the mastectomy was performed; Surgery and reconstruction of the other breast to
produce a symmetrical appearance; and Prostheses and treatment of physical complications of
the mastectomy, including lymphedema. Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
Special Enrollment Rights This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time. Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP) If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that
coverage stops contributing toward the other coverage). If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance. Marriage, Birth or Adoption If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption. For More Information or Assistance To request special enrollment or obtain more information, contact: Inwood National Bank Human Resources Department 7621 Inwood Rd Dallas, TX 75209 214-351-7308
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 Inwood National Bank 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.
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Important Notices 1.
Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2.
Inwood National Bank has determined that the prescription drug coverage offered by the Inwood National Bank medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is not considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
For more information about this notice or your current prescription drug coverage: Contact the Human Resources Department at 214-3517308. 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:
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).
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:
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 Inwood National Bank at the phone number or address listed at the end of this section.
(see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
If you choose to enroll in a Medicare prescription drug plan and cancel your current Inwood National Bank 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.
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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.
Visit www.medicare.gov. Call your State Health Insurance Assistance Program
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.
Important Notices 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). March 1, 2026 Inwood National Bank Human Resources Department 7621 Inwood Rd Dallas, TX 75209 214-351-7308
Notice of HIPAA Privacy Practices THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This Notice of Privacy Practices (the “Notice”) describes the legal obligations of Company’s Group Health Plan (the “Plan”) and your legal rights regarding your protected health information held by the Plan under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act). Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law. We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA. The HIPAA Privacy Rule protects only certain medical information known as “protected health information.” Generally, protected health information (PHI) is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to: 1.
Your past, present, or future physical or mental health or condition;
2.
The provision of health care to you; or
3.
The past, present, or future payment for the provision of health care to you.
I. Contact Information If you have any questions about this Notice or about our privacy practices, and for any correspondence or requests related to the contents of this Notice, please contact: March 1, 2026 Inwood National Bank Human Resources Department 7621 Inwood Rd Dallas, TX 75209 214-351-7308 II. Effective Date This Notice is effective February 15, 2026. III. Our Responsibilities We are required by law to: 1.
maintain the privacy of your PHI;
2.
provide you with certain rights with respect to your PHI;
3.
provide you with a copy of this Notice of our legal duties and privacy practices with respect to your PHI; and
4. follow the terms of the Notice that is currently in effect. We reserve the right to change the terms of this Notice and to make new provisions regarding your PHI that we maintain, as allowed or required by law. If we make any material change to this Notice, we will provide you with a copy of our revised Notice of Privacy Practices. IV. How We May Use and Disclose Your PHI Under the law, we may use or disclose your PHI under certain circumstances without your permission. The following categories describe the different ways that we may use and disclose your PHI. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. Note that we will use and disclose PHI as described below unless otherwise prohibited or restricted by applicable state or other law, and that information can lose its protected status as PHI once redisclosed by a recipient.
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Important Notices For Treatment. When and as appropriate, we may use or disclose medical information about you to facilitate medical treatment or services by health care providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about you with physicians who are treating you. For Payment. We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary, or to determine whether the Plan will cover the treatment. We may also share your protected health information with a utilization review or pre-certification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments. For Health Care Operations. We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information in connection with conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess-loss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities. However, we will not use your genetic information for underwriting purposes. Substance Use Disorder (SUD) Treatment Information. Some of your health information may be part of a SUD patient record and subject to additional protections under federal law (42 CFR Part 2) governing confidentiality of SUD patient records.
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If we receive or maintain any information about you from a SUD treatment program that is covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the SUD patient record for purposes of treatment, payment or health care operations, we may use and disclose your SUD patient record for treatment, payment and health care operations purposes as described in this Notice. If we receive or maintain your SUD patient record through specific consent you provide to us or another third party, we will use and disclose your SUD patient record only as expressly permitted by you in your consent as provided to us. In no event will we use or disclose your SUD patient record, or testimony that describes the information contained in your SUD patient record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order. To Business Associates. We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, transmit, use, and/or disclose your PHI, but only after they agree in writing with us to implement appropriate safeguards regarding your PHI. For example, we may disclose your PHI to a Business Associate to process your claims for Plan benefits or to provide support services, such as utilization management, pharmacy benefit management, or subrogation, but only after the Business Associate enters into a Business Associate contract with us. Treatment Alternatives or Health-Related Benefits and Services. We may use and disclose your protected health information to send you information about treatment alternatives or other health-related benefits and services that might be of interest to you. As Required by Law. We will disclose your PHI when required to do so by federal, state, or local law. For example, we may disclose your PHI when required by national security laws or public health disclosure laws.
Important Notices 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.
1.
to prevent or control disease, injury, or disability;
2.
to report births and deaths;
3.
to report child abuse or neglect;
4. to report reactions to medications or problems with products; 5.
to notify people of recalls of products they may be using;
6.
to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
7.
to notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.
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:
Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone involved in a legal dispute, but only if efforts have been made to tell you about the request or to obtain a court or administrative order protecting the information requested. Law Enforcement. We may disclose your PHI if asked to do so by a law-enforcement official. 1.
in response to a court order, subpoena, warrant, summons, or similar process;
2.
to identify or locate a suspect, fugitive, material witness, or missing person;
3.
about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement;
4. about a death that we believe may be the result of criminal conduct; and 5.
about criminal conduct.
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Important Notices Coroners, Medical Examiners, and Funeral Directors. We may release PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors, as necessary to carry out their duties. National Security and Intelligence Activities. We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. Inmates. If you are an inmate of a correctional institution or are in the custody of a law-enforcement official, we may disclose your PHI to the correctional institution or law-enforcement official if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. Research. We may disclose your PHI to researchers when: 1.
The individual identifiers have been removed; or
2.
When an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of the requested information and approves the research.
VI. Required Disclosures The following is a description of disclosures of your PHI we are required to make. Government Audits. We are required to disclose your PHI to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule. Disclosures to You. When you request, we are required to disclose to you the portion of your PHI that contains medical records, billing records, and any other records used to make decisions regarding your health care benefits. We are also required, when requested, to provide you with an accounting of most disclosures of your PHI if the disclosure was for reasons other than for payment, treatment, or health care operations, and if the PHI was not disclosed pursuant to your individual authorization.
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VII. Other Disclosures Personal Representatives. We will disclose your PHI to individuals authorized by you, or to an individual designated as your personal representative, attorneyin-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.
Important Notices VIII. Your Rights You have the following rights with respect to your PHI: Right to Inspect and Copy. You have the right to inspect and copy certain PHI that may be used to make decisions about your Plan benefits. If the information you request is maintained electronically, and you request an electronic copy, we will provide a copy in the electronic form and format you request, if the information can be readily produced in that form and format; if the information cannot be readily produced in that form and format, we will work with you to come to an agreement on form and format. If we cannot agree on an electronic form and format, we will provide you with a paper copy. To inspect and copy your PHI, you must submit your request in writing. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request. Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan. To request an amendment, your request must be made in writing. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: 1.
is not part of the medical information kept by or for the Plan;
2.
was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
3.
is not part of the information that you would be permitted to inspect and copy; or
4. is already accurate and complete.
If we deny your request, you have the right to file a statement of disagreement with us and any future disclosures of the disputed information will include your statement. Right to an Accounting of Disclosures. You have the right to request an “accounting” of certain disclosures of your PHI. The accounting will not include (1) disclosures for purposes of treatment, payment, or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to your authorization; (4) disclosures made to friends or family in your presence or because of an emergency; (5) disclosures for national security purposes; and (6) disclosures incidental to otherwise permissible disclosures. To request this list or accounting of disclosures, you must submit your request in writing. Your request must state the time period you want the accounting to cover, which may not be longer than six years before the date of the request. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12-month period will be provided free of charge. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Right to Request Restrictions. You have the right to request a restriction or limitation on your PHI that we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on your PHI that we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had. Except as provided in the next paragraph, we are not required to agree to your request. However, if we do agree to the request, we will honor the restriction until you revoke it or we notify you. We will comply with any restriction request if (1) except as otherwise required by law, the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (2) the PHI pertains solely to a health care item or service for which the health care provider involved has been paid in full by you or another person.
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Important Notices To request restrictions, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply-for example, disclosures to your spouse. Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests. Right to Be Notified of a Breach. You have the right to be notified in the event that we (or a Business Associate) discover a breach of unsecured PHI. Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. IX. Complaints If you believe that your privacy rights have been violated, you may file a complaint with the Plan or with the Office for Civil Rights of the United States Department of Health and Human Services. To file a complaint with the Plan, contact the person listed in the Contact Information section of this Notice. All complaints must be submitted in writing. You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office for Civil Rights or with us.
aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2026. Contact your State for more information on eligibility. Alabama – Medicaid Website: http://www.myalhipp.com/ Phone: 1-855-692-5447
Alaska – Medicaid
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
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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
Important Notices Arkansas – Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
California– Medicaid 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-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi. com/ HIBI Customer Service: 1-855-692-6442
Florida – Medicaid Website: https://www.flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268
Georgia – Medicaid GA HIPP Website: https://medicaid.georgia.gov/health-insurancepremium-payment-program-hipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https://medicaid.georgia.gov/programs/thirdparty-liability/childrens-health-insurance-program-reauthorizationact-2009-chipra Phone: 678-564-1162, Press 2
Indiana – Medicaid Health Insurance Premium Payment Program All other Medicaid Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr/ Family and Social Services Administration Phone: 1-800-403-0864 Member Services Phone: 1-800-457-4584
Iowa – Medicaid and CHIP (Hawki) Medicaid Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid Medicaid Phone: 1-800-338-8366 Hawki Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid/iowa-health-link/hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid/fee-service/hipp HIPP Phone: 1-888-346-9562
Kansas – Medicaid Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 HIPP Phone: 1-800-967-4660
Kentucky – Medicaid Kentucky Integrated Health Insurance Premium Payment Program (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
Louisiana – Medicaid Louisiana Medicaid Website: https://www.ldh.la.gov/healthylouisiana 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 Enrollment Website: https://www.mymaineconnection.gov/ benefits/s/?language=en_US Phone: 1-800-442-6003 TTY: Maine relay 711 Private Health Insurance Premium Webpage: https://www.maine. gov/dhhs/ofi/applications-forms Phone: 1-800-977-6740 TTY: Maine Relay 711
Massachusetts – Medicaid and CHIP Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711 Email: masspremassistance@accenture.com
Minnesota – Medicaid Website: https://mn.gov/dhs/health-care-coverage/ Phone: 1-800-657-3672
Missouri – Medicaid Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005
Montana – Medicaid Website: https://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084 Email: HHSHIPPProgram@mt.gov
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Important Notices Nebraska – Medicaid Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178
Nevada – Medicaid Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900
New Hampshire – Medicaid Website: https://www.dhhs.nh.gov/programs-services/medicaid/ health-insurance-premium-program Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext. 15218 Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov
New Jersey – Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/dmahs/ clients/medicaid/ Phone: 1-800-356-1561 CHIP Premium Assistance Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 (TTY: 711)
New York – Medicaid Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831
North Carolina – Medicaid Website: https://medicaid.ncdhhs.gov Phone: 919-855-4100
North Dakota – Medicaid Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825
Oklahoma – Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
Oregon – Medicaid Website: https://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075
Website: https://www.scdhhs.gov Phone: 1-888-549-0820
South Dakota - Medicaid Website: https://dss.sd.gov Phone: 1-888-828-0059
Texas – Medicaid Website: https://www.hhs.texas.gov/services/financial/healthinsurance-premium-payment-hipp-program Phone: 1-800-440-0493
Utah – Medicaid and CHIP Utah’s Premium Partnership for Health Insurance (UPP) Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov Phone: 1-888-222-2542 Adult Expansion Website: https://medicaid.utah.gov/expansion/ Utah Medicaid Buyout Program Website: https://medicaid.utah.gov/ buyout-program/ CHIP Website: https://chip.utah.gov/
Vermont– Medicaid Website: https://dvha.vermont.gov/members/medicaid/hippprogram Phone: 1-800-250-8427
Virginia – Medicaid and CHIP Website: https://coverva.dmas.virginia.gov/learn/premiumassistance/famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/healthinsurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-800-432-5924
Washington – Medicaid Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
West Virginia – Medicaid and CHIP Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699- 8447)
Pennsylvania – Medicaid and CHIP
Wisconsin – Medicaid and CHIP
Website: https://www.pa.gov/en/services/dhs/apply-for-medicaidhealth-insurance-premium-payment-program-hipp.html Phone: 1-800-692-7462 CHIP Website: https://www.dhs.pa.gov/chip/pages/chip.aspx CHIP Phone: 1-800-986-KIDS (5437)
Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095. htm Phone: 1-800-362-3002
Rhode Island – Medicaid and CHIP Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347 or 401-462-0311 (Direct RIte Share Line)
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South Carolina – Medicaid
Wyoming – Medicaid Website: https://health.wyo.gov/healthcarefin/medicaid/programsand-eligibility/ Phone: 1-800-251-1269
Important Notices 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 Inwood National Bank group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Inwood National Bank 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 Inwood National Bank Human Resources Department 7621 Inwood Rd Dallas, TX 75209 214-351-7308
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-ofnetwork providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. You are protected from balance billing for: Emergency services – If you have an emergency
medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s innetwork 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. Certain services at an in-network hospital or
ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-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 outof-network. You can choose a provider or facility in your plan’s network.
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Important Notices When balance billing is not allowed, you also have the following protections:
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You are only responsible for paying your share of
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.
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-of-network providers.
•
Base what you owe the provider or facility (costsharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
•
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/ nosurprises for more information about your rights under federal law.
New Health Insurance Marketplace Coverage Options and Your Health Coverage PART A: General Information Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options in your geographic area.
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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 employmentbased health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income.1, 2 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the 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
Important Notices 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?
within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit www.HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325.
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.
NEW HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS AND YOUR HEALTH COVERAGE
Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan. There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage. Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage
PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer. 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. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014. Can I Save Money On My Health Insurance Premiums In The Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility For Premium Savings Through The Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing
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Important Notices if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.02% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit*. Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. When Can I Enroll in Health Insurance Coverage through the Marketplace? You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15. Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan. How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact your HR Department. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit healthcare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area. *An employer-sponsored 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
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percent of such costs. PART B: Information About Health Coverage Offered by Your Employer Here is some basic information about health coverage offered by this employer: 3. Employer Name: Inwood National Bank
4. Employer Identification Number (EIN): 75-1160447
5. Employer Address: 1100 Centennial Blvd
6. Employer Phone Number: 214-351-7308
7. City: Richardson
8. State: TX
9. ZIP Code: 75081
10. Who can we contact at this job?: Sue Faucher 11. Phone Number (if different from above): N/A
12. E-Mail Address: Sue.Faucher@inwoodbank.com
All full-time employees working a minimum of 30 hours per week are eligible to participate in the health benefit programs. You may also enroll your eligible dependents, including: Your legal spouse Your children under age 26 Any child under age 26 for whom you have been
granted legal custody or required to cover as a part of a qualified medical child support order Any dependent child age 26 and older who is
medically certified as disabled and is chiefly dependent upon the employee for support and maintenance. The coverage offered by this employer meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages. NOTE: Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed midyear, or if you have other income losses, you may still qualify for a premium discount. If you decide to shop for coverage in the Marketplace, www.healthcare.gov will guide you through the process.
Notes
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This brochure highlights the main features of the Inwood National Bank 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. Inwood National Bank reserves the right to change or discontinue its employee benefits plans anytime.