Carrier Contact Information
800-872-1414 (U.S.) 609-986-1234 (international) medservices@assistamerica.com
June 1, 2026, to May 31, 2027
Availability Of Summary Health Information
Our benefits program offers one or more medical plan options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage, available from Human Resources.
Summary of Material Modification
This benefits guide constitutes a summary of material modification (SMM) to the Second Baptist Church 2026-2027 summary plan description (SPD). It is meant to supplement and/or replace certain information in the SPD. Please retain it for further reference along with your SPD. Please share these materials with your covered family members.
Welcome
Second Baptist Church is committed to helping you and your family enjoy the best possible health and well-being. That is why we offer you a comprehensive, competitive benefits package, with the flexibility to make the choice that best meets your needs.
In this enrollment guide, you will find information on your new health plan options. Use this information and other helpful resources available on www.workforcenow.adp.com to choose the coverage that is right for you and your family. You must enroll for coverage this year as many plans are changing.
We encourage you to review this guide carefully to understand your options. When you are ready, enroll online through the ADP portal.
About this Guide
Second Baptist Church HR Employee Portal
The Second Baptist Church HR portal is provided through our partner, ADP. You may download benefits-related information from the ADP Workforce Now portal. Visit www.workforcenow.adp.com to:
z View your benefits.
z View plan rates and benefits-related information.
z Add/change dependent and beneficiary information.
z Update your personal demographic information.
z Update your emergency contact information.
What’s New
This guide highlights the main features of the Second Baptist Church 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 guide and the legal plan documents, the plan documents are the final authority. Second Baptist Church reserves the right to change or discontinue its employee benefits plans anytime. Scan the code to access the ADP Worforce Now portal.
z Enroll in paperless payroll.
z Second Baptist Church is a self-funded medical plan administered by Allied Health
z Medical deductibles, out-of-pocket maximums, and copays are changing.
z Teladoc will provide virtual care.
z Pharmacy benefits will be through VytlOne.
z Discounted prescription drug options will be available for brand and specialty medications through VytlOne and its network of partners.
z The Aetna Dental DPPO Max Plan is changing.
z Unum and EyeMed will provide our Vision benefits. The plan offers eyewear discounts, laser vision correction savings, and a no-cost hearing plan with discounted exams and hearing aids.
z Our Health Savings Account and Flexible Spending Accounts will be administered by HealthEquity
z All other plan designs and carriers will remain as is.
Eligibility
Who is Eligible for Benefits
• A regular, full-time employee working an average of 30 hours or more per week
Who is Eligible
When to Enroll
When Coverage Starts
• By the deadline given by Human Resources
• Full-time salaried employees are eligible for medical coverage on the first day of your employment. All other benefits begin on the first day of the month following your date of hire.
• Full-time hourly employees are eligible for benefits on the 1st of the following month after completing 60 days of employment.
Qualifying Life Events
• A regular, full-time employee working an average of 30 hours or more per week
• During OE or for a QLE
• OE: Start of the plan year
• QLE: Ask Human Resources
Plan Year: June 1 – May 31
OE: Open Enrollment
QLE: Qualifying Life Event
Dependent(s)
• Your legal spouse
• Children under age 26 regardless of student, dependency, or marital status
• Children age 26 or older 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
• During OE or for a QLE
• When covering dependents, you must enroll for and be on the same plans
• Ask Human Resources
You may only enroll for or make changes to coverage during the plan year if you are a new hire or if you have a QLE, such as:
z Marriage
z Divorce
z Legal separation
z Annulment
z Death of spouse
z Birth
z Adoption/placement for adoption
z Change in benefits eligibility
z Death of child
z FMLA, benefit continuance event, judgment, or decree
z Becoming eligible for Medicare, Medicaid, or TRICARE
z Receiving a Qualified Medical Child Support Order
z Gain or loss of benefits coverage
z Change in employment status affecting benefits
z Significant change in cost of spouse’s coverage
You have 30 days from the event to notify Human Resources and complete your changes
You may need to provide documents to verify the change.
Medical Coverage
You have a choice of two medical plans:
z Traditional Copay PPO Plan.
z HDHP/HSA PPO Plan.
Our Provider Network
Allied does not have its own network of doctors, so it contracts with Aetna for the provider network we use. That’s why Aetna appears on your medical ID card. The doctor will recognize and bill Aetna, but Aetna will always send the bill to Allied. Always call Allied Health if you have a claims or billing issue. If you try to call Aetna’s representatives to help you, they will not be able to do so because you will not be in their system as a member of their plan. You are a member of the Allied medical plan.
Find a Doctor or Hospital
Always call Allied Member Services when you have questions or need to find a doctor or hospital.
z Visit https://www.alliedbenefit.com/ providernetworks and select Aetna Signature Administrators
z Call 866-455-8727.
If you discover that your current provider is out of network, reach out to Allied Member Services:
z Monday through Friday, 8:00 a.m. to 8:00 p.m. CT.
z Saturday 9:00 a.m. to 12:00 p.m. CT.
Contact Allied Member Services
z Call 833-918-1384.
z Monday through Friday, 8:00 a.m. to 8:00 p.m. CT.
z Saturday 9:00 a.m. to 12:00 p.m. CT.
My Allied Portal
Manage your benefits anytime from any device by creating an account at https://member.alliedbenefit.com or downloading the My Allied Portal mobile app
What you can do on the portal:
z View and share your digital ID card with providers.
z Find in-network providers and compare costs.
z Track claims, benefits, and deductibles.
z See what’s covered under your plan.
z Discover enhanced Care programs for you and your family.
If you need help, call Allied Member Services.
Allied Member Services
Contact an Allied Members Services representative for live, personal care. Representatives can help with:
z Submitting claims and explaining your medical bills.
z Verifying benefits and coverage.
z Finding in-network providers.
z Navigating your benefits.
z Resolving complex care or billing issues.
Medical Coverage
Network: Aetna Signature Administrators
Medical Benefits Summary
•
• Formulary (Brand)
•
•
Health Care Options
Know Where To Go
Becoming familiar with your options for medical care can save you time and money.
Non-Emergency Care
Telemedicine
Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed.
24 hours a day, 7 days a week
Doctor’s Office
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history.
Office hours vary
Retail Clinic
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies.
Infections
Sore and strep throat
Vaccinations
Minor injuries/sprains/strains
Hours vary based on store hours Common infections
Urgent Care
When you need immediate attention; walk-in basis is usually accepted.
Generally includes evening, weekend, and holiday hours
Emergency Care
Hospital ER
Life-threatening or critical conditions; trauma treatment ; multiple bills for doctor and facility.
24 hours a day, 7 days a week
Freestanding ER
Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher
24 hours a day, 7 days a week
Sprains and strains
Minor broken bones
Small cuts that may require stitches
Chest pain
Difficulty breathing
Severe bleeding
Blurred or sudden loss of vision Major broken bones
Most major injuries except trauma
Severe pain
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only 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.
Preventive Care
Your medical plan offers $0 preventive care for everyone.
Preventive care is the care you receive to help prevent chronic illness or disease. It includes exams, lab work, screenings, immunizations, and counseling to prevent health problems, such as diabetes or heart disease.
Preventive Care Coverage Includes Adults
Cholesterol screening
Blood pressure screening
Colorectal cancer screening
Lung cancer screening
Hepatitis B screening
Well visits
Bone density screening
Obesity screening
Diabetes type 2 screening
Depression screening
Mammograms
Cervical cancer screening
Immunizations
FREQUENTLY ASKED QUESTIONS
Teens
Physical exam
Blood tests for iron and cholesterol
Anxiety screening
Growth screening
Hearing screening
Hepatitis B screening
Depression screening
Alcohol, tobacco, and drug use assessments
Tuberculosis screening Immunizations
Children
Autism screening
Blood screening
Depression screening
Developmental screening
Hearing screening
Obesity screening and counseling
Hypothyroidism screening
Behavioral assessments
Well visits
Immunizations
Why should I get preventive care?
Preventive care is the fastest and best way to uncover potential risks and avoid chronic health conditions.
Are all screenings, tests, and procedures covered under preventive care?
No. Your doctor will be able to advise you as to the preventive care you need or should obtain, based on your medical and family history.
Why
did
I get a bill for preventive care?
Diagnosis codes on the doctor’s bill must meet certain insurance company conditions for them to be processed as preventive and covered at 100%. If you have a medical complaint, or your doctor finds a specific medical issue during your preventive care doctor’s visit, a diagnosis code for that issue or complaint will be on your bill. As a result, the insurance company may process the bill for a specific medical condition, not preventive care. In this case, you must pay the copay or portion of your deductible.
Telemedicine
Provider: Teladoc
Your medical coverage offers telemedicine services so you can connect anytime day or night with a board-certified doctor via your mobile device or computer.
While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
z Have a non-emergency issue and are considering an after-hours health care clinic, urgent care clinic, or emergency room for treatment
z Are on a business trip, vacation, or away from home
z Are unable to see your primary care physician
When to Use Telemedicine
Use telemedicine for minor conditions such as:
z Sore throat
z Headache
z Stomachache
z Cold
z Flu
z Allergies
z Dermatology
z Primary care
z Fever
z Urinary tract infections
Do not use telemedicine for serious or life-threatening emergencies.
YOUR COST PER VISIT
z Traditional Copay PPO Plan: $0 copay per visit
z HDHP/HSA PPO Plan: $0 copay per visit
Get More Information or Register
Skip the trip to your doctor! Register for an account so you can get on-demand medical care.
z Visit https://member.alliedbenefit.com
z Call 800-TELADOC (835-2362).
Prescription Drugs
Pharmacy Benefits Manager (PBM): VytlOne
Your medical coverage includes prescription benefits for retail, mail order (home delivery), and specialty drugs.
Prescription Drug List
Your medical carrier controls prescription drug costs by negotiating discounts on medications. Covered drugs are listed in the Prescription Drug List. If you take maintenance medications, review the list with your doctor to see which ones are covered and available. If your medication is not listed, call VytlOne
Some medications may require:
z Prior Authorization: Approval before coverage.
z Quantity Limits: Restrictions on how much you can get.
z Step Therapy: Trying an alternative medication first.
Retail
Use any participating retail pharmacy to fill short-term, non-specialty medications. Retail pharmacies often fill or refill 30- to 90-day supplies.
Home Delivery
If you take medication on a daily basis, consider using home delivery. It is a convenient, low-cost option that delivers up to a 90-day supply right to your home. You will need to set up an online pharmacy account and/or download the app to easily manage your prescriptions.
Specialty
If you need a specialty drug to treat a complex or chronic condition, you will be asked to enroll in a specialty drug program. It offers support to ensure the medication works well for you and costs as little as possible. If you do not enroll in the program, the specialty drug may not be covered. Certain exclusions and limitations apply.
Sign Up for Home Delivery
Create a member portal account and sign up for home delivery.
z Visit http://members.vytlone.com
z Call 800-687-8629.
Specialty Pharmacy
z Visit www.vytlonespecialty.com.
z Call 866-629-6779
SAVE MONEY. BUY GENERIC DRUGS!
Generic drugs are a safe and effective option to brand-name drugs – and they cost much less! They have the same active ingredients, strength, and dosage as brand-name drugs, and they also meet the same rigorous quality and safety standards set by the Food and Drug Administration.
Medication Savings Programs
If you enroll in the medical plan and obtain a prior authorization for a medication, VytlOne or one of its partners will contact you with a lower-cost option – saving money for both you and the plan.
How It Works
Depending on your medication type – brand or specialty –VytlOne will explore:
z Alternative specialty pharmacies (domestic and international)
z Patient and manufacturer assistance programs
z Other alternative fill options
Ask your doctor to write long-term prescriptions for a 90-day supply – one of the easiest ways to maximize your savings.
Our Pharmacy Partners
z VytlOne Specialty
z PaydHealth
z National Integrative Health (NIH)
z CANARX
z ElectRx
Get Started
Visit https://members.vytlone.com to create your account and manage your pharmacy benefits online.
Questions?
Dental Coverage
Carrier: Aetna
Our dental plans help you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work.
Dental Benefits Summary
Choice of Dentist
Specialty Care
Filings of Claims
Preselect an in-network primary care dentist; each enrolled family member may choose a different DHMO dentist
Referral needed; but no preauthorization is required
Your choice: out-of-pocket expenses may be higher when using an out-of-network dentist
Your choice: out-of-pocket expenses may be higher when using an out-of-network dentist
submit claim forms You or your dentist may submit claim forms
1 You will be reimbursed up to the Maximum Allowable Charge (MAC) for services received from an out-of-network dentist. You are responsible for charges in excess of the MAC.
2 Payment for covered services received from an out-of-network dentist is
Vision Coverage
Carrier: Unum | Network: EyeMed
Helps detect certain medical issues, prolong your eyesight, and correct vision or eye problems.
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.
Hearing Savings Plan
A Hearing Savings Plan is included with your Vision coverage at no additional cost through Amplifon Benefits include:
z 40% off hearing exams at thousands of convenient locations nationwide
•
•
•
•
•
•
•
z Discounted set pricing on thousands of hearing aids, including those with the newest, most advanced technology
z Low price guarantee – if you find the same product at a lower price elsewhere, Amplifon will beat it by 5%
z 60-day hearing aid trial period with no restocking fees
z Free batteries for two years with initial purchase
z 3-year warranty plus loss and damage coverage
DISCOUNTS
z Receive discounts on LASIK surgery through TLC Vision and participating local providers.
z Get 40% off a complete second pair of prescription glasses from participating innetwork providers.
Health Savings Account
Administrator: HealthEquity
Offset your HDHP health care costs, reduce your taxes, and get a long-term tax-advantaged savings account.
A Health Savings Account (HSA) is like a personal savings account that allows you to pay for current or future health care expenses with pretax dollars or save the funds for retirement. The funds can also be used for your dependents, even if they are not covered by the HDHP. An HSA is always yours to keep, even if you change health plans or jobs.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
z Enrolled in an HSA-eligible HDHP
z Not covered by another plan that is not a qualified HDHP (e.g., spouse’s health plan)
z Not enrolled in a Health Care Flexible Spending Account
z Not eligible to be claimed as a dependent on someone else’s tax return
z Not enrolled in Medicare, Medicaid, or TRICARE
z Not receiving Veterans Administration benefits
Note: You may have an HSA at the financial institution of your choice, but only accounts opened through HealthEquity are eligible for automatic payroll deductions and company contributions.
Two Ways to Use Your HSA
Use the Money Now
Pay for qualified out-of-pocket medical, dental, and vision expenses as they are incurred.
Invest Over Time
Invest and grow your HSA dollars tax-free. You can use the funds to pay for qualified expenses later.
TRIPLE TAX BENEFITS
z Tax-free contributions
z Tax-free growth
z Tax-free withdrawals
Contributions
You may contribute up to the IRS annual maximum. Your employer will contribute up to a maximum match per year of $500 for Employee Only and $1,000 for Employee & Family. You must contribute in order to receive the employer match. Maximum
If you are age 55 or older, you can contribute an extra $1,000.
HOW TO PAY OR GET REIMBURSED
z Use your HSA debit card to pay for qualified expenses. OR
z Pay out-of-pocket and submit your receipts for reimbursement online or through the app.
Get More Information or Submit Receipts
z Visit www.healthequity.com
z Call 866-346-5800
z Download the HealthEquity Mobile app.
Flexible Spending Accounts
Administrator: HealthEquity
Set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer the following Flexible Spending Accounts (FSAs).
Maximum FSA Contributions
You
You have access to all your
Dependent Care FSA
Reimbursement is limited to the total amount deposited in your account at that time.
$7,500 (single parent filing head of household; or married filing jointly)
$3,750 (married filing separately)
Get More Information or Submit Receipts
z Visit www.healthequity.com
z Call 866-346-5800
z Email memberservices@healthequity.com .
z Download the EZ Receipts Mobile app
z Fax 877-353-9236 (include completed Pay
Me Back form from your HealthEquity portal); fax 877-220-3248 for appeals.
Health Care FSA
The Health Care FSA covers qualified medical, dental, and vision expenses for you and your eligible dependents. Eligible expenses include:
z Deductibles, copays, and coinsurance
z Prescription drugs
z Braces, glasses, and contacts
z Hearing aids and batteries
If you enrolled in an HDHP and contribute to an HSA, you may not contribute to a Health Care FSA.
Limited Purpose Health Care FSA
If you enroll in the HDHP medical plan and contribute to an HSA, you can use a Limited Purpose Health Care FSA to pay for eligible out-of-pocket dental and vision expenses only, such as:
z Dental and orthodontia care (fillings, X-rays, braces)
z Vision care (eyeglasses, contact lenses, LASIK)
Dependent Care FSA
The Dependent Care FSA helps pay expenses associated with caring for children under age 13 and elder dependents so you or your spouse can work or attend school full-time.
Dependent Care FSA Guidelines
z 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.
z You can use funds for daycare or babysitter expenses for your children under age 13, but only for the part of the year when the child is under 13.
z Only day camps – not overnight camps – can be considered for reimbursement.
z You can use funds 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.
z The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
Life and AD&D Insurance
Carrier: Unum
Life and Accidental Death and Dismemberment (AD&D) insurance are important to your financial security, especially if others depend on you for support or vice versa.
With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies). Life and AD&D coverage amounts reduce by 65% at age 65 and by 50% at age 70.
Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at $50,000 for each benefit.
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 anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
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).
• Increments of $10,000 up to five times annual salary not to exceed $500,000
• Guaranteed Issue: $250,000
• Increments of $5,000 up to 100% of employee amount
• Guaranteed Issue: $25,000
• Increments of $2,000 up to $10,000
• Birth to six months: $1,000
• Six months to age 26: $10,000
• Guaranteed Issue: $10,000
Disability Insurance
Administrator: Second Baptist Church Carrier: Unum
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. We offer Short Term Disability (STD) and Long Term Disability (LTD) at no cost to you. Salaried employees are eligible for coverage after six months of service. Hourly employees are eligible for coverage after three years of services.
Employer-paid Short Term Disability
The STD plan is designed to provide full-time, salaried, and hourly employees with salary continuations, when he/ she is unable to work due to an injury or an illness. This is an employer-paid benefit with automatic enrollment.
Once an employee has 10 consecutive absences, he/ she is eligible to receive STD pay. The disability pay is based upon a schedule of service years and paid until the earlier of, the release by the physician to return to work or eligibility for long-term disability.
At the onset of the disability, the employee’s physician is to provide a statement of the nature of the disability and estimated duration of the absence. Your first step to receive your STD benefit while ill or injured is to contact your Human Resources Department for further instructions and additional information. The employer reserves the right to request that a physician of the employer’s choice examine the employee at the company’s expense. Absences due to pregnancy will be treated the same as any other illness under this plan.
Short Term Disability Benefits
Benefits Begin
11th day
Percentage of Earnings You Receive Paid based on length of service
Maximum Weekly Benefit Based on length of service
Maximum Benefit Period 90 days
6 months of service for salaried employees
Eligibility Requirements
3 years of service for hourly employees
Note: You are not eligible to receive disability benefits if you are receiving workers’ compensation benefits.
Employer-paid Long Term Disability
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for a specific period of time. Benefits begin at the end of an elimination period and continue while you are disabled up to the maximum benefit period.
Long Term Disability Benefits
Benefits Begin
91st day
Percentage of Earnings You Receive 60%
Maximum Monthly Benefit
$10,000
Maximum Benefit Period To age 65
Pre-existing Condition Exclusion 3/12 1
1 Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months.
Additional Benefits
Administrator: Unum
Employee Assistance Program
The Employee Assistance Program (EAP) helps you and family members cope with a variety of personal and work-related issues. The EAP is available to all eligible employees, their spouses, dependent children, parents, and parents-in-law.
This program provides confidential counseling and support services at little or no cost to you to help with:
z Relationships
z Work-life balance
z Stress and anxiety
z Childcare and eldercare issues
z Grief and loss
z Financial and legal matters
z And more
Unlimited online and telephone support is available 24/7. You can also get up to three face-to-face visits with a licensed professional counselor in your area at no additional cost.
Medical Bill Saver
As health care costs continue to rise, many people have trouble paying medical expenses that insurance does not cover. Medical Bill Saver is one more way the EAP helps you manage the stresses of modern life. Benefits include:
z Negotiations for medical/dental bills with a non-covered balance of $400 or more
z Expert use of critical pricingtrend information to obtain discounts from providers
How it Works
z Easy-to-read Savings Result Statement summarizing the outcome of the negotiation
z Provider sign-off on payment terms and conditions
z Speedy provider payments
When you have a medical or dental bill totaling over $400 in outof-pocket costs, Unum’s skilled negotiating team works with the provider(s) to get a discount. Successful negotiations can save hundreds, and sometimes thousands, of dollars. Unum’s experts can also show you how to keep bills lower in the future (by using in-network providers, for example). By helping reduce out-of-pocketcosts, Medical Bill Saver can also make choosing an HDHP medical plan more attractive and effective.
z Visit www.unum.com/lifebalance.
z Call 800-854-1446
z Upload your bills directly for negotiation through the Health Advocate app
Travel Assistance
Get More Information
z Visit www.unum.com/ lifebalance
z Call 800-854-1446.
z Download the MyUnum for Members app.
Unum provides 24/7 worldwide travel assistance through Assist America, Inc. when you are traveling 100 or more miles from home. Medically certified professionals can connect you with pre-qualified, English-speaking medical providers and coordinate emergency support for new or pre-existing conditions, including sports-related injuries. Coverage includes your spouse and dependent children (spouses traveling on business for their own employer are not eligible).
Emergency Contacts
z Call 800-872-1414 in the U.S. or +1-609-986-1234 outside the U.S.
z Email medservices@assistamerica.com
z Reference number 01-AA-UN-762490.
Supplemental Benefits
Carrier: Aflac
Aflac plans can be purchased to help supplement your major medical insurance. The cost for Aflac supplemental insurance is covered 100% by the employee. Premiums are pretax and payroll-deducted. This is a summary of benefits offered through Aflac. For additional information, please see the plan brochure.
Accident Indemnity Advantage
Option 1 (24-hour Accident-only Insurance)
This plan is designed to help with the financial strain of out-of-pocket expenses and lost wages associated with an injury. The plan pays cash directly to you if you or any covered family member is injured and seek treatment on or off the job, 24/7. This plan pays accident specific-sum injuries (based on severity) as well as accident emergency treatment, x-rays, accident follow-up treatment, initial accident hospitalization, and much more. In addition, Aflac offers a Wellness Benefit that pays you an annual $100 if you or any one family member undergoes a routine examination or other preventive treatment, including dental or vision, after you have completed your first year of coverage.
Short Term Disability
This plan helps to provide a source of income should you ever become disabled due to an off the job accident or illness. The plan offers the option of guaranteed-issue short term disability coverage for up to three months. It is designed to provide, to persons insured, coverage for disabilities resulting from a covered accident or sickness and is subject to limitations and exclusions and pre-existing condition limitations. Limitations and exclusions are waived for pregnancy and childbirth. The plan provides benefits for both total and partial disability with no medical questionnaire required. This plan has a 0/7-day(s) elimination period for accident/sickness. Premiums are specific to age and income. Policy includes riders at no additional cost.
Hospital Choice – Hospital Confinement Indemnity Series
This plan was developed to help you and your family better cope, financially and emotionally, due to an injury or sickness requiring hospital attention and/or admittance. It is designed to pay specific amounts directly to you for a covered injury or sickness when a charge is incurred in hospital stays, hospital emergency room, and surgery and rehabilitation facilities.
The benefit coverage varies according to each policy series and benefit covered amounts vary based on treatment or confinement received.
Aflac PLUS Rider
This rider can be added to the Accident Indemnity Advantage plan, Hospital Choice plan, or the Short Term Disability plan. It is designed to help with the onset diagnosis of heart attack, stroke, coma, paralysis, type 1 diabetes, traumatic brain injury, Alzheimer’s disease, Parkinson’s disease, ALS Lou Gehrig’s disease, loss of independence, MS, permanent loss of sight, permanent loss of hearing, permanent loss of speech, and sudden cardiac arrest. It also has benefits for encephalitis, bacterial meningitis, Lyme disease, sickle cell anemia, cerebral palsy, necrotizing fasciitis, osteomyelitis, systemic lupus, cystic fibrosis, and coronary artery bypass surgery.
Supplemental Benefits
Cancer Protection Assurance (Level 1 and 2)
This plan was developed to help you and your family to better cope financially and emotionally if a cancer diagnosis ever occurs. This plan pays a lump-sum benefit upon the initial covered internal cancer diagnosis, which doubles for dependent children (DCR). This plan also offers an annual Wellness Benefit per covered person to encourage early detection and prevention. Payable cancer treatment benefits include radiation, chemotherapy, experimental treatments, surgery due to cancer, and much more. This plan is portable with no lifetime limit. Dependent children are covered at no additional cost. Premiums listed include initial diagnosis rider (IDR), Dependent Child Rider (DCR), and Specified Disease Rider (SDR).
Riders are included at an additional cost.
Critical Care Protection Specified Health Event Insurance Option 2
This plan was developed to help you and your family better cope financially and emotionally due to a specified health event. This policy pays a first-occurrence benefit, as well as hospital confinement and continuing care benefits that include ambulance, transportation, and lodging. Primary specified health events covered by the critical care and recovery policy include coma, paralysis, heart attack, sudden cardiac arrest, major third-degree burns, stroke, coronary artery bypass surgery, end-stage renal failure, persistent vegetative state, and major human organ transplant.
Included in this plan is a hospital intensive care insurance policy that provides cash benefits for accidents or illnesses that result in an admission to a hospital intensive care unit. With Aflac, these cash benefits are paid directly to you, no matter what other insurance you have. The hospital ICU insurance policy has a straightforward benefit design that complements your major medical or limited benefit health insurance plans. Aflac hospital intensive care insurance advantages include initial cash benefit the first seven days in the ICU, with an increased benefit for the next eight days; progressive benefits that build over time; major human organ transplant benefit; ambulance benefit; and no deductibles.
Supplemental Benefits
Aflac Monthly Premiums
Accident Indemnity Advantage
1 Elimination period for accident or sickness is 0/7 days. Benefit period is three
1 Elimination period for accident or
Retirement Program
Administrator: GuideStone
A 403(b) plan can be a powerful tool to help you be financially secure in retirement. Our 403(b) plan can help you reach your investment goals.
You have a choice of two account options:
z Traditional – Contributions are deducted prior to federal tax being calculated. You will be taxed on your contributions and their earnings when you withdraw the money from your account at retirement.
z Roth – Your contributions are taxed on your paycheck. Therefore, you will not be taxed when you withdraw the money from your account at retirement. Additionally, you do not pay taxes on the increased value of the earnings from your account.
How the Retirement Plans Work
You are eligible to participate in the plan on your date of hire and if you are a full-time permanent employee age 18 or older. You may contribute up to the IRS annual limits.
You decide how much you want to contribute, and you 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.
ENROLLMENT
Log in to the ADP Employee Portal to download applications and forms. Or, call Jan Fox at ext. 6012
2026 IRS CONTRIBUTION LIMITS
z $24,500
z $8,000 catch-up (ages 50-59 and 64+)
z $11,250 catch-up (ages 60-63)
Note: If your prior-year wages from Second Baptist Church exceed $150,000, catch-up contributions must be made as Roth (after-tax) contributions.
School Church
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:
z All stages of reconstruction of the breast on which the mastectomy was performed;
z Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
z 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:
Second Baptist Church Human Resources 6400 Woodway Houston, TX 77057 713-365-2332
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 Second Baptist Church and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Second Baptist Church has determined that the prescription drug coverage offered by the Second Baptist Church medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is not considered Creditable Coverage.
Important Notices
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Second Baptist Church at the phone number or address listed at the end of this section.
If you choose to enroll in a Medicare prescription drug plan and cancel your current Second Baptist Church prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.
If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.
For more information about this notice or your current prescription drug coverage:
Contact the Human Resources Department at 713-365-2332
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
z Visit www.medicare.gov
z Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
z Call 1-800-MEDICARE (1-800-6334227). TTY users should call 877-4862048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www. socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
June 1, 2026
Second Baptist Church Human Resources 6400 Woodway Houston, TX 77057 713-365-2332
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 Second Baptist Church’s Group Health Plan (the “Plan”) and your legal rights regarding your protected health information held by the Plan under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act). Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law.
Important Notices
We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA.
The HIPAA Privacy Rule protects only certain medical information known as “protected health information.” Generally, protected health information (PHI) is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to:
1. Your past, present, or future physical or mental health or condition;
2. The provision of health care to you; or
3. The past, present, or future payment for the provision of health care to you.
I. Contact Information
If you have any questions about this Notice or about our privacy practices, and for any correspondence or requests related to the contents of this Notice, please contact:
Second Baptist Church Human Resources 6400 Woodway Houston, TX 77057
713-365-2332
II. Effective Date
This Notice is effective February 15, 2026.
III. Our Responsibilities
We are required by law to:
1. maintain the privacy of your PHI;
2. provide you with certain rights with respect to your PHI;
3. provide you with a copy of this Notice of our legal duties and privacy practices with respect to your PHI; and
4. follow the terms of the Notice that is currently in effect.
We reserve the right to change the terms of this Notice and to make new provisions regarding your PHI that we maintain, as allowed or required by law. If we make any material change to this Notice, we will provide you with a copy of our revised Notice of Privacy Practices.
IV. How We May Use and Disclose Your PHI
Under the law, we may use or disclose your PHI under certain circumstances without your permission. The following categories describe the different ways that we may use and disclose your PHI. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. Note that we will use and disclose PHI as described below unless otherwise prohibited or restricted by applicable state or other law, and that information can lose its protected status as PHI once re-disclosed by a recipient.
For Treatment. When and as appropriate, we may use or disclose medical information about you to facilitate medical treatment or services by health care providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about you with physicians who are treating you.
For Payment. We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary, or to determine whether the Plan will cover the treatment. We may also share your protected health information with a utilization review or precertification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.
For Health Care Operations. We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information in connection with conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess-loss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities. However, we will not use your genetic information for underwriting purposes.
Substance Use Disorder (SUD)
Treatment Information. Some of your health information may be part of a SUD patient record and subject to additional protections under federal law (42 CFR Part 2) governing confidentiality of SUD patient records.
If we receive or maintain any information about you from a SUD treatment program that is covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the SUD patient record for purposes of treatment, payment or health care operations, we may use and disclose your SUD patient record for treatment, payment and health care operations purposes as described in this Notice. If we receive or maintain your SUD patient record through specific consent you provide to us or another third party, we will use and disclose your SUD patient record only as expressly permitted by you in your consent as provided to us. In no event will we use or disclose your SUD patient record, or testimony that describes the information contained in your SUD patient record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.
Important Notices
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 HealthRelated Benefits and Services. We may use and disclose your protected health information to send you information about treatment alternatives or other healthrelated benefits and services that might be of interest to you.
As Required by Law. We will disclose your PHI when required to do so by federal, state, or local law. For example, we may disclose your PHI when required by national security laws or public health disclosure laws.
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may disclose your PHI in a proceeding regarding the licensure of a physician.
To Plan Sponsors. For the purpose of administering the plan, we may disclose PHI to certain employees of the Employer. However, those employees will only use or disclose that information as necessary to perform plan administration functions or as otherwise required by HIPAA, unless you have authorized further disclosures. Your PHI cannot be used for employment purposes without your specific authorization.
V. Special Situations
In addition to the above, the following categories describe other possible ways that we may use and disclose your PHI without your specific authorization. For each category of uses or disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
Organ and Tissue Donation. If you are an organ donor, we may release your PHI after your death to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation. We may release your PHI for workers’ compensation or similar programs, but only as authorized by, and to the extent necessary to comply with, laws relating to workers’ compensation and similar programs that provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose your PHI for public health activities. These activities generally include the following:
1. to prevent or control disease, injury, or disability;
2. to report births and deaths;
3. to report child abuse or neglect;
4. to report reactions to medications or problems with products;
5. to notify people of recalls of products they may be using;
6. to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
7. to notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.
Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone involved in a legal dispute, but only if efforts have been made to tell you about the request or to obtain a court or administrative order protecting the information requested.
Law Enforcement. We may disclose your PHI if asked to do so by a lawenforcement official.
1. in response to a court order, subpoena, warrant, summons, or similar process;
2. to identify or locate a suspect, fugitive, material witness, or missing person;
3. about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement;
4. about a death that we believe may be the result of criminal conduct; and
5. about criminal conduct.
Coroners, Medical Examiners, and Funeral Directors. We may release PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors, as necessary to carry out their duties.
Important Notices
National Security and Intelligence Activities. We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Inmates. If you are an inmate of a correctional institution or are in the custody of a law-enforcement official, we may disclose your PHI to the correctional institution or law-enforcement official if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Research. We may disclose your PHI to researchers when:
1. The individual identifiers have been removed; or
2. When an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of the requested information and approves the research.
VI. Required Disclosures
The following is a description of disclosures of your PHI we are required to make.
Government Audits. We are required to disclose your PHI to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule.
Disclosures to You. When you request, we are required to disclose to you the portion of your PHI that contains medical records, billing records, and any other records used to make decisions regarding your health care benefits. We are also required, when requested, to provide you with an accounting of most disclosures of your PHI if the disclosure was for reasons other than for payment, treatment, or health care operations, and if the PHI was not disclosed pursuant to your individual authorization.
VII. Other Disclosures
Personal Representatives. We will disclose your PHI to individuals authorized by you, or to an individual designated as your personal representative, 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.
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.
Important Notices
Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan. To request an amendment, your request must be made in writing. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
1. is not part of the medical information kept by or for the Plan;
2. was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
3. is not part of the information that you would be permitted to inspect and copy; or
4. is already accurate and complete.
If we deny your request, you have the right to file a statement of disagreement with us and any future disclosures of the disputed information will include your statement.
Right to an Accounting of Disclosures. You have the right to request an “accounting” of certain disclosures of your PHI. The accounting will not include (1) disclosures for purposes of treatment, payment, or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to your authorization; (4) disclosures made to friends or family in your presence or because of an emergency; (5) disclosures for national security purposes; and (6) disclosures incidental to otherwise permissible disclosures.
To request this list or accounting of disclosures, you must submit your request in writing. Your request must state the time period you want the accounting to cover, which may not be longer than six years before the date of the request. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12-month period will be provided free of charge. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions.
You have the right to request a restriction or limitation on your PHI that we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on your PHI that we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had.
Except as provided in the next paragraph, we are not required to agree to your request. However, if we do agree to the request, we will honor the restriction until you revoke it or we notify you.
We will comply with any restriction request if (1) except as otherwise required by law, the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (2) the PHI pertains solely to a health care item or service for which the health care provider involved has been paid in full by you or another person.
To request restrictions, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply-for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Right to Be Notified of a Breach. You have the right to be notified in the event that we (or a Business Associate) discover a breach of unsecured PHI.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
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.
Important Notices
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an 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
The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861
Email: CustomerService@MyAKHIPP.com
Medicaid Eligibility: https://health.alaska. gov/dpa/Pages/default.aspx
Arkansas – Medicaid
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/childhealth-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-insurance-premium-paymentprogram-hipp
Phone: 678-564-1162, Press 1
GA CHIPRA Website: https://medicaid. georgia.gov/programs/third-party-liability/ childrens-health-insurance-programreauthorization-act-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-iowa-medicaid
Medicaid Phone: 1-800-338-8366
Hawki Website: https://hhs.iowa.gov/ programs/welcome-iowa-medicaid/iowahealth-link/hawki
Hawki Phone: 1-800-257-8563
HIPP Website: https://hhs.iowa.gov/ programs/welcome-iowa-medicaid/feeservice/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
Important Notices
Louisiana – Medicaid
Louisiana Medicaid Website: https://www. ldh.la.gov/healthy-louisiana
Medicaid Customer Service Line: 1-888342-6207
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-carecoverage/
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
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/healthinsurance-premium-program
Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-852-3345, ext. 15218
Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov
New Jersey – Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/ humanservices/dmahs/clients/medicaid/ Phone: 1-800-356-1561
CHIP Premium Assistance Phone: 609-6312392
CHIP Website: http://www.njfamilycare.org/ index.html
CHIP Phone: 1-800-701-0710 (TTY: 711)
New York – Medicaid
Website: https://www.health.ny.gov/health_ care/medicaid/
Phone: 1-800-541-2831
North Carolina – Medicaid
Website: https://medicaid.ncdhhs.gov Phone: 919-855-4100
North Dakota – Medicaid
Website: https://www.hhs.nd.gov/ healthcare Phone: 1-844-854-4825
Oklahoma – Medicaid and CHIP
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
Oregon – Medicaid
Website: https://healthcare.oregon.gov/ Pages/index.aspx
Phone: 1-800-699-9075
Pennsylvania – Medicaid and CHIP
Website: https://www.pa.gov/en/services/ dhs/apply-for-medicaid-health-insurancepremium-payment-program-hipp.html
Phone: 1-800-692-7462
CHIP Website: https://www.dhs.pa.gov/chip/ pages/chip.aspx
CHIP Phone: 1-800-986-KIDS (5437)
Rhode Island – Medicaid and CHIP
Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347 or 401-462-0311
(Direct RIte Share Line)
South Carolina – Medicaid
Website: https://www.scdhhs.gov
Phone: 1-888-549-0820
South Dakota - Medicaid
Website: https://dss.sd.gov
Phone: 1-888-828-0059
Texas – Medicaid
Website: https://www.hhs.texas.gov/ services/financial/health-insurancepremium-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/hipp-program
Phone: 1-800-250-8427
Virginia – Medicaid and CHIP
Website: https://coverva.dmas.virginia.gov/ learn/premium-assistance/famis-select
https://coverva.dmas.virginia.gov/learn/ premium-assistance/health-insurancepremium-payment-hipp-programs
Medicaid/CHIP Phone: 1-800-432-5924
Important Notices
Washington – Medicaid
Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
West Virginia – Medicaid and CHIP
Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700
CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699- 8447)
Wisconsin – Medicaid and CHIP
Website: https://www.dhs.wisconsin.gov/ badgercareplus/p-10095.htm
Phone: 1-800-362-3002
Wyoming – Medicaid
Website: https://health.wyo.gov/ healthcarefin/medicaid/programs-andeligibility/
Phone: 1-800-251-1269
To see if any other States have added a premium assistance program since 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 Second Baptist Church group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Second Baptist Church 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
Second Baptist Church Human Resources 6400 Woodway Houston, TX 77057
713-365-2332
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 outof-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-ofpocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an innetwork facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
z Emergency services – If you have an emergency medical condition and get emergency services from an out-ofnetwork provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
z 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 innetwork facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care out-ofnetwork. You can choose a provider or facility in your plan’s network.
Important Notices
When balance billing is not allowed, you also have the following protections:
z You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was innetwork). Your health plan will pay out-of-network providers and facilities directly.
z Your health plan generally must:
» Cover emergency services without requiring you to get approval for services in advance (prior authorization).
» Cover emergency services by outof-network providers.
» Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
» Count any amount you pay for emergency services or out-ofnetwork services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/nosurprises for more information about your rights under federal law.
New Health Insurance Marketplace Coverage Options and Your Health Coverage
PART A: General Information
Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options in your geographic area.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium and other out-ofpocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings on your premium that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.
Does Employment-Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of the credit that lowers your monthly premium, or a reduction in certain cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12%1 of your annual household income, or if the coverage through your employment does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit, and advance payment of the credit, if you
do not enroll in the employment-based health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income.1, 2
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution -as well as your employee contribution to employment-based coverage- is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace.
When Can I Enroll in Health Insurance Coverage through the Marketplace?
You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15.
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.
Important Notices
There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage.
Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update an existing application on HealthCare. gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit www.HealthCare.gov or call the Marketplace Call Center at 1-800-3182596. TTY users can call 1-855-8894325
What about Alternatives to Marketplace Health Insurance Coverage?
If you or your family are eligible for coverage in an employment-based health plan (such as an employer-sponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan, but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31, 2023 and July 10, 2023, you can request this special enrollment in the employment-based health plan through September 8, 2023. Confirm the deadline with your employer or your employmentbased health plan.
Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https://www. healthcare.gov/medicaid-chip/gettingmedicaid-chip/ for more details. How Can I Get More Information?
For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact Human Resources.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
PART B: Information About Health Coverage Offered by Your Employer
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
3. Employer Name: Second Baptist Church
4. Employer Identification Number (EIN): 74-1222252
5. Employer Address: 6400 Woodway
6. Employer Phone Number: 713-365-2332
7. City: Houston
8. State: TX 9. ZIP Code: 77057
10. Who can we contact at this job?: Saida Rhodes
11. Phone Number (if different from above): 713-365-6013
12. E-Mail Address: srhodes@second.org
As your employer, we offer a health plan to all eligible employees (see the Eligibility section of this guide). This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.
1 Indexed annually; see https://www.irs.gov/pub/irsdrop/rp-22-34.pdf for 2023.
2 An employer-sponsored or other employmentbased health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.
This brochure highlights the main features of the Second Baptist Church 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. Second Baptist Church reserves the right to change or discontinue its employee benefit plans at any time.