TexasBank is pleased to offer a full benefits package to help protect your well-being and financial health. Read this guide to learn about the benefits available to you and your eligible dependents starting June 1, 2026.
Each year during Open Enrollment (OE), you may make changes to your benefit plans. The benefit choices you make this year will remain in effect through May 31, 2027. Take time to review these benefit options and select the plans that best meet your needs. After OE you may only make changes to your benefit elections if you have a Qualifying Life Event (QLE).
Availability of Summary Health Information
Your benefits program offers three medical plan coverage options. To help you make an informed choice and compare your options, a Summary of Benefits and Coverage for each plan is available online via Paycom or by contacting Human Resources.
Helpful Information
Important Contacts
Employee Response Center
Enrollment and Eligibility
New Hires
You are eligible for benefits if you are a regular, full-time employee working an average of 30 hours per week. Your coverage is effective on the first of the month following your date of hire or change of status from part-time to fulltime employee. You may also enroll eligible dependents for benefits coverage. The cost for coverage depends on the number of dependents you enroll, and the benefits you choose. When covering dependents, you must select and be on the same plans.
Current Employees
You may enroll for, or change your benefits coverage annually during OE. Benefits you elect or change will be effective June 1, 2026, through May 31, 2027, unless you have a QLE.
Enrollment and Eligibility
Eligible Dependents
z Your legal spouse or domestic partner.
z Children under the age of 26 regardless of student, dependency, or marital status and/or children of your domestic partner. Natural children of the first degree, legally adopted children, stepchildren, and children whose parents are both deceased for whom you have legal custody.
z Children over the age of 26 who are fully dependent on you for support due to a mental or physical disability, and who are indicated as such on your federal tax return.
Pre-tax Benefits
You must actively choose any benefit that you pay for, or share in the cost with TexasBank. The premium for your elected coverages is automatically taken from your paycheck. There are two ways to take the money out: pretax or after-tax. When the money is taken out pretax, it lowers your taxable income and you pay less in taxes.
Qualifying Life Events
Once you elect your benefit options, they remain in effect for the entire plan year until the following OE. You may only change coverage during the plan year if you have a QLE, some of which include:
z Marriage, divorce, legal separation, or annulment
z Birth, adoption, or placement for adoption of an eligible child
z Death of your spouse or your child
z Change in your spouse’s employment status that affects benefits eligibility
z Change in your child’s eligibility for benefits
z Significant change in benefit plan coverage for you, your spouse, or your child
z FMLA, COBRA event, judgment, or decree
z Becoming eligible for Medicare, Medicaid, or TRICARE
z Receiving a Qualified Medical Child Support Order
How to Enroll
To enroll for, or make changes to your coverage, go to the Paycom Employee Self Service Notifications Center, tap the current year’s Benefits Enrollment, and Start Enrollment.
If you have a QLE and want to change your elections, you must notify Human Resources and complete your changes within 30 days of the event You may be asked to provide documentation to support the change. Contact Human Resources for specific details.
Where can I find my Curative member information?
You can set up your member account by visiting www.curative.com. Here you can get contact information for your Care Navigator, find providers, see claims and prior authorization activity, view a digital ID card and more. You can also download the app on your phone to find care or have an ID Card on the go.
What is my Curative Care Navigator
When you complete your Baseline Call, you will be assigned a Care Navigator, your go-to source for all things Curative. They will serve as your direct point of contact if you have questions or concerns about your coverage.
You can also contact Member Services 24/7 for general assistance. Their team has resources to answer your questions or assist such as help finding providers, locating a pharmacy, prior authorizations status, or member portal login.
Where do I find providers that are in the Curative network?
www.curative.com. Choose the PPO-PPO+ network when looking for a provider. Curative is part of the First Health Network.
Do I have to do a Baseline Call
renewal?
There are two ways to complete your Curative Baseline Call - 855-428-7284
For new employees: visit www.curative.com/baseline to schedule a Zoom virtual meeting with your Care Navigator.
For current Curative members: All current Curative members must complete a baseline call annually. If you did not complete your baseline call in the first plan year, you will have another opportunity in the first 120 days of the new plan year. If you complete your baseline, you can complete an online renewal within the first 120 days of the new plan year by visiting www.curative.com/baseline.
What is the Curative Cash Card?
Think of the Curative Cash Card as a cash payment card. It can be used for office visits, urgent care, behavioral health, and some outpatient services. It cannot be used for medications, labs, and non-covered benefits.
If a provider appears in your search but does not take your ID Card or tries to charge a copay, hand over your Curative Cash Card and tell them you will be paying cash.
My planned procedure requires Prior Authorization, and it was denied. What do I do now?
Your care provider will receive a detailed explanation of the reason for the denial via mail with instructions for steps to take to appeal the decision and provide the additional information needed for reconsideration. It is important that they provide the information requested so that Curative has what it needs to review the appeal. Your Care Navigator is always a great resource for the most up-to-date claim status information.
What is ClassPass?
ClassPass is a benefit available to all members who choose the PPO Max coverage. ClassPass is a creditbased membership which brings you access to thousands of gyms, spas, studios, and salons. You receive twenty-nine credits each month to use to try out classes of our choice.
What do I give my vision provider when I visit?
When you visit your eye doctor, provide them with the TexasBank EyeMed Group Number 1017422 . Many providers are more familiar with the EyeMed network.
Curative Medical Coverage
The medical plan through Curative protects you and your family from major financial hardship in the event of illness or injury. Your Curative EPO, PPO, and PPO Max health plans have no deductible and $0 copays for in-network providers and preferred prescriptions as long as you complete a Baseline Visit within the first 120 days.
•
•
Curative Medical Coverage
•
•
• Tier 4: Non-Preferred Brand Name⁵
• Tier 5: Preferred Specialty
• Tier 6: Non-Preferred Specialty⁵
copay
1 $0 immunizations for children under the age of six.
2 What you will pay after your deductible is met.
3 Prior authorization required.
4 Prior authorization may be required. If you don’t get prior authorization, your prescription may not be covered.
5 For in-network providers: $7,500 individual/$15,000 family deductible.
Baseline Visit must be completed within 120 days of effective date in Curative medical plans to waive all medical in-network copays, deductibles, and coinsurance. For more information, refer to page 10.
Curative Medical Coverage
Retail Pharmacy
Up to a 30-day supply
• Tier 1: Preferred Generic
• Tier 2: Non-Preferred Generic⁵
• Tier 3: Preferred Brand Name
• Tier 4: Non-Preferred Brand Name⁵
• Tier 5: Preferred Specialty
• Tier 6: Non-Preferred Specialty⁵
1 $0 immunizations for children under the age of six.
2 What you will pay after your deductible is met.
3 Prior authorization required.
copay
copay
4 Prior authorization may be required. If you don’t get prior authorization, your prescription may not be covered.
5 For in-network providers: $7,500 individual/$15,000 family deductible.
Note: The PPO Max plan has extended pharmacy options and covers chiropractic care.
Baseline Visit must be completed within 120 days of effective date in Curative medical plans to waive all medical in-network copays, deductibles, and coinsurance. For more information, refer to page 10.
Pharmacy Coverage
Our medical plan through Curative includes prescription drug coverage. Curative Pharmacy offers convenient access to thousands of preferred generic, brand, and specialty prescription drugs free of charge.
Curative Pharmacy
As a concierge service, Curative Pharmacy processes prescriptions and delivers them directly to your home or office, typically within 24 hours. There is also an extensive formulary of drug options, which includes $0 copay options for almost every therapeutic area, including diabetes, heart disease, asthma, COPD, and mental health. Visit www.curative.com/pharmacy for more information.
CONVENIENCE
z Same-day or next-day delivery in Austin, Dallas, Houston, and San Antonio
z All medications from one pharmacy (over-the-counter, retail, specialty, etc.).
z 90-day supplies for most maintenance medications
SUPPORT
z Care coordination with your prescribers for refills and prior authorizations
z New medication follow-up
z Medication optimization to find $0 cost options
z Two-way text messaging
z Pharmacist consultations
National Retail Pharmacies
In-network retail pharmacies include:
z Albertsons
z Brookshire
z Publix
z H-E-B
z Walmart
z Walgreens
z CVS
Don’t see a retailer? If you are not near an in-network retail pharmacy or a Curative pharmacy, Curative will find an alternative option using its extended network.
The PPO plan has limited in-network pharmacies that are covered. Under the PPO Max plan, all pharmacies are covered as in-network.
Prior Authorization
For certain prescriptions, you will need prior authorization.
1. Your doctor must submit a new prior authorization request to Curative for any planned treatments. Your doctor can refer to the Curative Drug Formulary, which is the preferred drug list.
2. When you fill a new prescription, your pharmacy will check if it is covered. If it is not covered, it might need your prior authorization by your doctor.
3. If a certain drug is denied, your provider can appeal the decision.
CURATIVE DRUG SEARCH
Visit www.curative.com/drugs.
Curative – Baseline
If you complete your baseline visit within 120 days of your effective date in the Curative medical plan, all medical in-network copays, deductibles, and coinsurances will be waived so that your cost for provider services in-network will be $0. Maximum visits, limitations, and tiered pharmacy benefits will continue to apply.
During the first 120 days enrolled in the Curative Plan, all copays, deductibles, and coinsurance will be waived for in-network services for all members. Each member age 18 or older must complete their own baseline visit.
The baseline visit is a free, confidential virtual meeting with a health expert who reviews your health history and develops a plan to best meet your unique health care needs, including preventive and ongoing care, in the most cost-effective way. You will be paired with a care navigator, who will be your first point of contact, and who will follow up while you are enrolled with Curative. Care navigators provide support to help you maximize your Curative benefits, find in-network care, and navigate the health care system.
Onboard in two ways:
OPTION 1: LIVE ONBOARDING
Schedule a Zoom virtual meeting with your Care Navigator. They will explain how Curative works and what your health plan includes. Austin residents can also schedule in-person.
Visit www.curative.com/baseline to learn more.
OPTION 2: SELF-GUIDED ONBOARDING
Complete your onboarding on your own by watching videos and completing important tasks. Your Care Navigator will follow up with you after to answer any questions. Available after the first year.
For Your Baseline Onboarding
z List of current health care providers: Include primary care physicians, specialists, or other health care professionals you regularly see.
z List of medications: Include prescriptions, overthe-counter medications, and supplements or vitamins you take regularly.
z Current pharmacy: Note the pharmacy you use so we can confirm if it's in-network.
z Planned care/surgeries: List any upcoming procedures so we can check if prior authorization is needed.
Curative – Getting Started
Registration Process
Visit www.curative.com/for-members and follow these steps to register:
1. Click Create an Account.
2. Select Verify your Identity, and enter your member ID or date of birth and Social Security number. Click Continue
3. Enter your email address and phone number to create your account, and click Continue
4. Click Login.
5. Validate your account information and click Continue.
6. Click Invite Dependents to add covered dependents.
7. Review the legal agreements, and check the box indicating you read and understood the legal statements listed on the page AND that you have agreed to accept electronic records and use electronic signatures as legal representations of your written signature on the site.
Curative App
The Curative app can help you stay organized and in control of your health anytime, anywhere. Log in from your mobile device to access your member website. Search your mobile device’s app store to download.
Prior Authorization
Certain medical services, treatments, and prescription drugs require a prior authorization. This process ensures appropriate treatment without unnecessary risks or side effects.
1. Ask your doctor to submit a prior authorization form at the start of your plan year. If necessary, your doctor also can submit the form before any service or treatment requiring prior authorization.
2. The request will be reviewed by Curative medical experts based on benefits coverage, established guidelines, and medical necessity.
3. If approved, you can proceed. If denied, your doctor can appeal on your behalf.
Visit www.curative.com/prior-authorization to learn more. Providers can call 855-414-1083.
Curative Member Website
Access the Curative health member website to manage your medical and pharmacy benefits. The website allows you to:
z Download, print, and request a replacement ID card
z View your pharmacy and care benefits
z Update personal information
z Register and connect to telemedicine
Member Services
Contact Member Services by calling 855-428-7284 or emailing health@curative.com for help with:
z Finding and verifying in-network providers
z Locating a participating pharmacy
z Transferring prescriptions
z Medication coverages and tiers
z Member portal access
z Scheduling a baseline visit
z Updating member contact information
z Prior authorizations
z Claims processing and denial resolution
Curative Value Adds
Curative Cash Card
If for some reason your member ID card is declined, the Curative Cash Card can cover your in-network costs. If you complete your baseline visit within 120 days, you can use this card and enjoy $0 deductibles and $0 copays.
The Curative Cash Card covers office visits, urgent care visits, behavioral health, inpatient hospital services (like surgeries and medical monitoring), and outpatient hospital services (like imaging or procedures). Tell the front desk you will pay the cash price and hand over your Curative Cash Card. Curative covers the cost directly; members pay $0 out of pocket. No prior authorization is required for services under $500 when using the Curative Cash Card. Anything over $500 will need prior authorization to use the Curative Cash Card.
Backup: If a provider appears in our search but does not take your Member ID Card for any reason or tries to charge a copay, use your Curative Cash Card.
To get started, log in to the member portal at www.health.curative.com and select Curative Cash Card. Then follow the activation steps. You will immediately have access to the digital Curative Cash Card. To get a physical card, call Member Services at 855-428-7284. It should arrive in about one week. To learn more, go to www.curative.com/cash-card.
Curative Telehealth – 24/7 Virtual Care
Access licensed providers anytime, anywhere with Curative Telehealth. Available 24/7 nationwide, you can connect with a provider in less than seven minutes via phone or video directly through your Curative Member Portal. It’s fast, seamless care—guided symptom intake, no waiting rooms, and support when you need it most.
Learn more: www.curative.com/telehealth
Log in or create an account: https://health.curative.com/curative-telehealth.
Curative Value Adds
Mental Health Support
Rula connects Curative members with over 15,000 licensed therapists and psychiatrists nationwide, offering therapy for individuals, couples, families, and children (ages 5+), as well as psychiatry for teens (13+) and adults. Get matched with a provider in 30 seconds and be seen in as little as two days. Virtual care is available in all 50 states—and it’s $0 for members who complete their Baseline Visit within 120 days of their plan start date.
Get started at www.rula.com/curative
Mental Health Virtual Therapy
Get $0 virtual therapy, including therapists, psychiatrists, and psychologists. Treatment and resources emphasize holistic health that address the connection between physical and mental health. You have access to services through:
z Televero – If you live in Texas or Florida
z Teladoc – If you are outside of Texas
Substance Use and Mental Health Treatment
Recovery Unplugged provides no-cost, accredited treatment for substance use and mental health disorders. Services include inpatient care in Austin and Fort Lauderdale, plus virtual intensive outpatient programs in Texas and Florida. Their innovative approach combines proven clinical methods with music-assisted therapy, offering a personalized path to recovery.
Visit www.recoveryunplugged.com/curative to get started.
Substance Use Management
Pelago is a free virtual program for substance use/ abuse management. The program, available for those 18 or older, is completely confidential and judgmentfree, and offers:
z A personalized care plan – With goals that fit your needs and lifestyle
z Mobile app – With 24/7 access and the ability to monitor your progress
z One-on-one coaching – Working around your schedule
Download the Pelago app to get started.
Curative Wellness Programs
If you are enrolled in a Curative medical plan, the following programs and services are available to you at no extra cost.
Weight Management Programs NOOM
You have one year of free access to Noom, an app which helps you build healthy habits and lifestyle changes to manage your weight, including:
z Daily lessons
z Coaching and support
z Optional one-on-one coaching and support groups
z Tracking tools for food, exercise, and more
H-E-B
H-E-B Wellness Nutrition Services can work with you to create a customized nutrition plan to help fit your health needs. Our partnership includes support for:
z Weight management
z Diabetes management
z Childhood and family nutrition
z Cancer nutrition
z Food allergies
z Digestive issues
z Sports nutrition
z Cardiovascular health
Fitness and Wellness Credits
Curative PPO Max members receive a 25-credit ClassPass membership each month—completely free. Use your credits to book thousands of fitness classes, salon visits, spa treatments, or wellness appointments through one easy-to-use app. Credits roll over each month as long as you stay active (within 60 days).
To activate or connect an existing account, use the ClassPass registration email or call 855-4-CURATIVE (855-428-7284).
Curative Value Adds
Multi-Cancer Screening
Galleri offers a cancer screening at no cost using a detection test from GRAIL. If you are at least 50 years old and have completed your annual baseline visit, have no history of cancer, and are not currently pregnant, take advantage of Galleri’s screening for more than 50 types of cancer. It takes only a single blood test, and you receive results within two weeks.
1. Request the test at www.galleri.com/curative
2. Once approved, schedule a blood test at www.galleri.com/schedule.
Diabetes Program
The Curative Diabetes Type 2 Program can help you manage your diabetes and achieve your health goals, including:
z An in-depth look into current treatment plans
z One-on-one support and checkins from our care team
z Recommendations based on your individual needs
z Connecting with a registered dietitian for a nutrition plan that’s right for you
To join the program, make sure to complete your baseline visit within 120 days of enrollment, and then contact member services at 855-428-7284.
Curative Value Adds
Audicus Hearing Aids –$0 with Curative
Get high-quality hearing aids from Audicus at no cost and no prior authorization required. Audicus offers advanced, techdriven hearing solutions with the convenience of at-home telehealth appointments and 5-star audiology care. You’ll receive expert support for setup and lifetime audiology services, all included. When you’re ready, use your Curative Cash Card for easy payment through your member portal or physical card.
To find in-network providers, visit www.cuative.com/get-care.
Free Costco Hearing Aids
You can receive hearing aids through Costco for $0. Once you complete your baseline visit, no prior authorization is required. Along with a wide choice of hearing aids, you also get free cleanings and follow-up visits, and a free annual basic-level Costco membership.
1. Call Member Services at 855-428-7284 to order your free Costco card.
2. Pick up your Costco card from the membership counter, and check out using your Curative Cash Card.
3. Schedule a complimentary hearing evaluation at your nearest Costco.
4. After your evaluation, you can choose the hearing aids that work best for you.
5. When you are ready to check out, call Member Services for approval to unlock your Curative Cash Card for use.
6. Come back for cleanings and follow-up visits as needed.
Health Care Options
Becoming familiar with your options for medical care can save you time and money.
NON-EMERGENCY CARE
VIRTUAL VISITS/ TELEMEDICINE
DOCTOR’S OFFICE
Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed 24 hours a day, 7 days a week
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history
Office hours vary
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies
RETAIL CLINIC
Hours vary based on store hours
• Allergies
• Cough/cold/flu
• Rash
• Stomachache
• Behavioral health
• Infections
• Sore and strep throat
• Vaccinations
• Minor injuries/sprains/ strains
• Common infections
• Minor injuries
• Pregnancy tests
• Vaccinations
URGENT CARE
EMERGENCY CARE
When you need immediate attention; walk-in basis is usually accepted
Generally includes evening, weekend, and holiday hours
• Sprains and strains
• Minor broken bones
• Small cuts that may require stitches
• Minor burns and infections
HOSPITAL ER
FREESTANDING ER
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility
24 hours a day, 7 days a week
Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher
24 hours a day, 7 days a week
• Chest pain
• Difficulty breathing
• Severe bleeding
• Blurred or sudden loss of vision
• Major broken bones
• Most major injuries except trauma
• Severe pain
2-5 minutes
15-20 minutes
15 minutes
15-30 minutes
Minimal
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only estimates. This information is not intended as medical advice. If you have questions, please call the phone number on the back of your medical ID card.
Dental Coverage
Our dental plans help you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Coverage is provided through Mutual of Omaha .
DPPO Plans
Two levels of benefits are available with the 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.
Note: Adding domestic partners and children of domestic partners to this benefit will result in additional tax consideration.
DENTAL PLAN SUMMARIES
Preventive and Diagnostic Care
Exams, cleanings, X-rays, fluoride treatments, sealants, space maintainers
¹ The Maximum Allowance for out-of-network services is based on the 90th percentile as determined by Mutual of Omaha. Charges that exceed the Maximum Allowance (as defined in the certificate booklet) for any covered dental service are not considered.
The plan pays the percentage shown after the deductible is satisfied up to the maximum. Additional information about the benefits and covered services of this plan will be included in the certificate booklet, which you will receive after enrolling for this coverage. Please contact your employer or benefits administrator if you have questions prior to enrolling.
The plan provides the same coverage levels for both in-network and out-of-network services. However, because In-network providers offer their services at predetermined fees, out-of-pocket expenses may be lower for plan members when receiving covered services from an in-network provider.
Vision Coverage
Our vision plan coverage is provided through Mutual of Omaha , using the EyeMed vision network, and 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 an in-network provider. In addition to EyeMed’s large independent provider network, you may seek care from LensCrafters, Target Optical, and Pearle Vision. You do not need a medical ID card to receive services.
Note: Adding domestic partners and children of domestic partners to this benefit will result in additional tax consideration.
Lenses
• Single vision
• Bifocals
• Trifocals
• Lenticular
Frames
Contacts
In lieu of frames and lenses
• Conventional
• Disposable
• Medically necessary
Benefit Frequency
• Exam
• Lenses
• Frames
• Contacts
copay, $150 allowance + 20% off balance
$0 copay, $150 allowance + 15% off balance $0 copay, $150 allowance + balance over $0
Once every 12 months
Once every 12 months
Once every 24 months Once every 12 months
to $102
VISION PLAN - MUTUAL OF OMAHA
Flexible Spending Accounts
WEX Benefits Card
You can access the funds in your Health Care FSA two ways:
z Use your WEX benefits card to pay for qualified expenses, doctor visits, and prescription copays.
z Pay out-of-pocket and submit your receipts for reimbursement.
The WEX benefits card is the fastest and most convenient way to access your funds and pay for eligible expenses.
Your WEX benefits card can be used for one or both of your FSA accounts. You can also add it to your mobile wallet for contactless payment options.
A Flexible Spending Account (FSA) allows you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer two different FSAs: one for health care expenses, and one for dependent care expenses. WEX administers our FSAs.
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:
z Dental and vision expenses
z Medical deductibles and coinsurance
z Prescription copays
z Hearing aids and batteries
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 GUIDELINES
z Overnight camps are not eligible for reimbursement (only day camps can be considered).
z If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
z 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.
z The dependent care provider cannot be your child under age 19, or anyone claimed as a dependent on your income taxes.
FLEXIBLE SPENDING
medical, dental, and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses, and doctor-prescribed over-thecounter medications)
Care FSA
Dependent care expenses (such as daycare, after-school programs, or eldercare programs) so you and your spouse can work or attend school full-time
contribution is $3,400 per year Saves on eligible expenses not covered by insurance; reduces your taxable income
contribution is $7,500 per year ($3,750 if married and filing separate tax returns) Reduces your taxable income
Important FSA Rules
z The maximum per calendar year you can contribute to a Health Care FSA is $3,400. The maximum per calendar 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.
z You cannot change your election during the year unless you experience a QLE.
z After the end of the calendar year, active employees may continue to file claims incurred during the plan year for another 90 days. If you are terminated from employment, you will have 30 days from your termination date to file claims.
z 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.
z Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
Abbreviated List of Qualified FSA Expenses
The products and services listed below are examples of medical expenses eligible for payment under your Health Care FSA. This list is not all-inclusive; additional expenses may qualify and the items listed are subject to change in accordance with IRS regulations. Please refer to IRS Publication 502 Medical and Dental Expenses at www.irs.gov/forms-pubs/about-publication-502 for a complete description of eligible medical and dental expenses.
z Abdominal supports
z Acupuncture
z Air conditioner (when necessary for relief from difficulty in breathing)
z Alcoholism treatment
z Ambulance
z Anesthetist
z Arch supports
z Artificial limbs
z Autoette (when used for relief of sickness/disability)
z Blood tests
z Blood transfusions
z Braces
z Cardiographs
z Chiropractor
z Contact lenses
z Convalescent home (for medical treatment only)
z Crutches
z Dental treatment
z Dental X-rays
z Dentures
z Dermatologist
z Diagnostic fees
z Diathermy
z Drug addiction therapy
z Drugs (prescription)
z Elastic hosiery (prescription)
z Eyeglasses
z Fees paid to health institute
prescribed by a doctor
z FICA and FUTA tax paid for medical care service
z Fluoridation unit
z Guide dog
z Gum treatment
z Healing services
z Hearing aids and batteries
z Hospital bills
z Hydrotherapy
z Insulin treatment
z Lab tests
z Lead paint removal
z Legal fees
z Lodging (away from home for outpatient care)
z Metabolism tests
z Neurologist
z Nursing (including board and meals)
z Obstetrician
z Operating room costs
z Ophthalmologist
z Optician
z Optometrist
z Oral surgery
z Organ transplant (including donor’s expenses)
z Orthopedic shoes
z Orthopedist
z Osteopath
z Oxygen and oxygen equipment
z Pediatrician
z Physician
z Physiotherapist
z Podiatrist
z Postnatal treatments
z Practical nurse for medical services
z Prenatal care
z Prescription medicines
z Psychiatrist
z Psychoanalyst
z Psychologist
z Psychotherapy
z Radium therapy
z Registered nurse
z Special school costs for the handicapped
z Spinal fluid test
z Splints
z Surgeon
z Telephone or TV equipment to assist the hard-of-hearing
z Therapy equipment
z Transportation expenses (relative to health care)
z Ultraviolet ray treatment
z Vaccines
z Vitamins (if prescribed)
z Wheelchair
z X-rays
Life and AD&D Insurance
Please visit www.paycom.com.
Accelerated Death Benefit
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). Life and AD&D coverage amounts reduce by 33% at age 70, and 50% at age 75.
Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at two times your salary to a maximum of $300,000 with a minimum of $10,000.
Voluntary Life and AD&D
You may buy more Life and AD&D insurance for you and your eligible dependents. If you do not elect Voluntary Life and AD&D insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health. If you elect coverage over the Guaranteed Issue amount, you must submit an Evidence of Insurability form separately. You must elect Voluntary Life and AD&D coverage for yourself before you may elect coverage for your spouse or children. If you leave the company, you may be able to take the insurance with you.
Birth to six months - $1,000
If you are diagnosed with a terminal illness and are expected to live less than 24 months, you may request up to 80% of your life insurance (minimum of $7,500 and maximum $250,000). The amount you receive will be deducted from the final payout to your beneficiaries.
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%). Primary and contingent beneficiary: A primary beneficiary receives your benefits first. A contingent beneficiary is the backup if the primary cannot receive them.
Disability Insurance
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. We provide Long Term Disability (LTD) insurance at no cost to you, and offer Voluntary Short Term Disability (STD) for you to purchase through www.mutualofomaha.com.
Voluntary Short Term Disability
Voluntary STD coverage pays a percentage of your weekly salary if you are temporarily disabled and unable to work due to a pregnancy, illness, or non-work-related injury. STD benefits are not payable if the disability is due to a jobrelated injury or illness. If a medical condition is job-related, it is considered workers’ compensation, not STD. For questions regarding workers’ compensation, please contact Human Resources.
VOLUNTARY SHORT TERM DISABILITY
Pre-existing Condition Exclusion 3/121
1Benefits may not be paid for any condition treated within 3 months prior to your effective date until you have been covered under this plan for 12 months. Pregnancy is not considered pre-existing.
Long Term Disability
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for more than 90 days. Benefits begin at the end of an elimination period and continue while you are disabled up to Social Security Normal Retirement Age (SSNRA).
LONG TERM DISABILITY
Pre-existing Condition Exclusion (Pregnancy not excluded.) 3/121
1Benefits 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.
Life and Disability Value Adds
Mutual of Omaha provides the following programs and services at no cost to you.
Employee Assistance Program
The Employee Assistance Program (EAP) is a confidential program to help you find solutions for personal and workplace issues. Benefits for you and your eligible dependents include unlimited telephone access to EAP professionals and up to three face-to-face sessions with a counselor. Professionals are available 24/7 to help with the following:
z Stress and depression
z Financial issues
z Family and relationship issues
z Addiction
z Grief issues
z Parenting and eldercare
z Legal services
z Financial services
z Other personal concerns
For assistance, call 800-316-2796 or visit www.mutualofomaha. com/eap. Additional resources are available on the website.
Worldwide Travel Assistance
AXA Assistance USA provides travel assistance for you and your dependents if you are traveling on any single trip more than 100 miles from home. Contact a representative to get trip planning assistance; translation, interpreter, or legal services; lost baggage assistance; emergency funds; document replacement; medical emergency help; and more. Services are available for business and personal travel.
For inquiries within the USA, call 800-856-9947
From outside the USA, call 312-935-3658.
Will Preparation
Creating a will is an important investment in your future. In just minutes, you can create a personalized will that keeps your information safe and secure. The services provided by Epoq offer a secure account space to prepare wills and other legal documents. Log in at www.willprepservices.com and use the code MUTUALWILLS to register.
Supplemental Coverage
You and your eligible family members can enroll in additional coverage that complements our traditional health care programs. Health insurance covers medical bills, but if you have an emergency, you may face unexpected out-of-pocket costs such as deductibles, coinsurance, travel expenses, and non-medical-related expenses. These voluntary plans are offered through Mutual of Omaha and are portable.
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, deductibles, ambulance, physical therapy, and other costs not covered by traditional health plans.
ACCIDENT INSURANCE
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. No pre-existing conditions apply.
CRITICAL ILLNESS INSURANCE
Employee Increments of $5,000, up to $20,000
Spouse Increments of $5,000, up to $20,000, not to exceed 100% of employee's amount
Child(ren) 25% of employee's amount, up to $5,000
First Occurrence Benefit
Full Coverage
Advanced multiple sclerosis; advanced Parkinson’s disease; ALS (a/k/a Lou Gehrig’s disease); Alzheimer’s disease; benign brain tumor; endstage renal failure; full benefit cancer; heart attack; heart, kidney, or organ failure; invasive cancer; stroke
Intensive Care Unit
Specific Sum Injuries Burns, concussions, dislocations, eye injuries, fractures, lacerations, ruptured discs, and more
Accidental Death & Dismemberment*
• Employee
• Spouse
• Child(ren)
$400 per day up to 365 days
$800 per day up to 15 days
$50-$25,000
$70,000
$35,000
$10,000
*Percentage of benefit paid for dismemberment is dependent on type of loss.
Partial Coverage Coronary artery disease; carcinoma in situ; acute respiratory distress; transient ischemic attack (TIA) 25%-50% of benefit amount
Wellness Benefit
One per covered person per calendar year $50
Supplemental Coverage
Hospital Indemnity Insurance
Hospital Indemnity insurance helps you with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance, which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment that you receive. These costs may include meals and transportation, childcare, or time away from work due to a medical issue that requires hospitalization.
MASA Medical Transport
Many health insurance plans lack effective coverage when it comes to emergency transportation, which is very expensive. A MASA MTS membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the U.S. and Canada regardless of whether the provider is in- or out-of-network.
MASA BENEFITS COMPARISON
Pet Insurance
You may buy Nationwide medical insurance for your pet(s).
The My Pet Protection plan covers cats, dogs, birds, and exotic animals, and it offers a choice of reimbursement options (50% or 70%) so you can choose the coverage that best fits your budget. All plans have a $250 deductible, and a $7,500 maximum annual benefit.
See any veterinary professional for care and get discounts for multiple pets. Coverage includes:
z Accidents
z Illnesses
z Surgeries and hospitalization
z Hereditary and congenital conditions
z Cancer
z Dental diseases
z Behavioral treatments
z Therapeutic diets
z And more
Every policy includes 24/7 access to veterinary experts by phone, chat, and email, and unlimited help for general to urgent care needs via the VetHelpline. PetRxExpress is also included to save money on your pet’s prescriptions. Pre-existing conditions are not covered.
How to Enroll
You may enroll for pet coverage anytime during the year.
z Visit https://my.petinsurance.com/login
z Visit www.petsnationwide.com and enter your company name when prompted.
z Call 877-738-7874 and mention you are a TexasBank employee.
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 TexasBank 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).
In-Network – Doctors, hospitals, and other providers that contract with your insurance company to provide health care services at discounted rates.
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-ofpocket maximum.
Prescription Medications –Medications prescribed by a doctor. Cost of these medications is determined by their assigned tier.
z 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.
z Over-the-Counter (OTC) Medications – Medications typically made available without a prescription.
Preventive Care – The care you receive to prevent illness or disease. It also includes counseling to prevent health problems.
Prior Authorization – A process where a healthcare provider must obtain approval from an insurance company before a specific medical service or prescription is covered.
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.
SSNRA – Social Security Normal Retirement Age.
Biweekly Employee Contributions
2
1
Monthly Employee Contributions
2
1
Legal 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: TexasBank Human Resources 4521 S Hulen St Fort Worth, TX 76109 817-717-2489
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 TexasBank 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. TexasBank has determined that the prescription drug coverage offered by the TexasBank 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.
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).
Legal Notices
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 TexasBank 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 TexasBank prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.
If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.
For more information about this notice or your current prescription drug coverage:
Contact the Human Resources Department at 817-717-2489
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 800772-1213. TTY users should call 800-325-0778.
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
June 1, 2026
TexasBank
Human Resources 4521 S Hulen St Fort Worth, TX 76109 817-717-2489
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 TexasBank 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:
TexasBank
Human Resources
4521 S Hulen St Fort Worth, TX 76109 817-717-2489
Legal Notices
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.
For Treatment. When and as appropriate, we may use or disclose medical information about you to facilitate medical treatment or services by health care providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about you with physicians who are treating you.
For Payment. We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary, or to determine whether the Plan will cover the treatment. We may also share your protected health information with a utilization review or pre-certification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.
For Health Care Operations. We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information in connection with conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess-loss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities. However, we will not use your genetic information for underwriting purposes.
Substance Use Disorder (SUD) Treatment Information. Some of your health information may be part of a SUD patient record and subject to additional protections under federal law (42 CFR Part 2) governing confidentiality of SUD patient records.
If we receive or maintain any information about you from a SUD treatment program that is covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the SUD patient record for purposes of treatment, payment or health care operations, we may use and disclose your SUD patient record for treatment, payment and health care operations purposes as described in this Notice. If we receive or maintain your SUD patient record through specific consent you provide to us or another third party, we will use and disclose your SUD patient record only as expressly permitted by you in your consent as provided to us. In no event will we use or disclose your SUD patient record, or testimony that describes the information contained in your SUD patient record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.
To Business Associates. We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, transmit, use, and/or disclose your PHI, but only after they agree in writing with us to implement appropriate safeguards regarding your PHI. For example, we may disclose your PHI to a Business Associate to process your claims for Plan benefits or to provide support services, such as utilization management, pharmacy benefit management, or subrogation, but only after the Business Associate enters into a Business Associate contract with us.
Treatment Alternatives or Health-Related Benefits and Services. We may use and disclose your protected health information to send you information about treatment alternatives or other health-related benefits and services that might be of interest to you.
As Required by Law. We will disclose your PHI when required to do so by federal, state, or local law. For example, we may disclose your PHI when required by national security laws or public health disclosure laws.
Legal 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.
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 workrelated injuries or illness.
Public Health Risks. We may disclose your PHI for public health activities. These activities generally include the following:
1. to prevent or control disease, injury, or disability;
2. to report births and deaths;
3. to report child abuse or neglect;
4. to report reactions to medications or problems with products;
5. to notify people of recalls of products they may be using;
6. to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
7. to notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.
Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone involved in a legal dispute, but only if efforts have been made to tell you about the request or to obtain a court or administrative order protecting the information requested.
Law Enforcement. We may disclose your PHI if asked to do so by a law-enforcement official.
1. in response to a court order, subpoena, warrant, summons, or similar process;
2. to identify or locate a suspect, fugitive, material witness, or missing person;
3. about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement;
4. about a death that we believe may be the result of criminal conduct; and
5. about criminal conduct.
Coroners, Medical Examiners, and Funeral Directors. We may release PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors, as necessary to carry out their duties.
National Security and Intelligence Activities. We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Inmates. If you are an inmate of a correctional institution or are in the custody of a law-enforcement official, we may disclose your PHI to the correctional institution or law-enforcement official if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Research. We may disclose your PHI to researchers when:
1. The individual identifiers have been removed; or
2. When an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of the requested information and approves the research.
VI. Required Disclosures
The following is a description of disclosures of your PHI we are required to make.
Legal Notices
Government Audits. We are required to disclose your PHI to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule.
Disclosures to You. When you request, we are required to disclose to you the portion of your PHI that contains medical records, billing records, and any other records used to make decisions regarding your health care benefits. We are also required, when requested, to provide you with an accounting of most disclosures of your PHI if the disclosure was for reasons other than for payment, treatment, or health care operations, and if the PHI was not disclosed pursuant to your individual authorization.
VII. Other Disclosures
Personal Representatives. We will disclose your PHI to individuals authorized by you, or to an individual designated as your personal representative, attorney-in-fact, etc., so long as you provide us with a written notice/authorization and any supporting documents (i.e., power of attorney). Note: Under the HIPAA privacy rule, we do not have to disclose information to a personal representative if we have a reasonable belief that:
1. You have been, or may be, subject to domestic violence, abuse, or neglect by such person; or
2. Treating such person as your personal representative could endanger you; and
3. In the exercise of professional judgment, it is not in your best interest to treat the person as your personal representative.
Spouses and Other Family Members. With only limited exceptions, we will send all mail to the employee. This includes mail relating to the employee’s spouse and other family members who are covered under the Plan and includes mail with information on the use of Plan benefits by the employee’s spouse and other family members and information on the denial of any Plan benefits to the employee’s spouse and other family members. If a person covered under the Plan has requested Restrictions or Confidential Communications (see below under “Your Rights”), and if we have agreed to the request, we will send mail as provided by the request for Restrictions or Confidential Communications.
Authorizations. Other uses or disclosures of your PHI not described above will only be made with your written authorization. For example, in general and subject to specific conditions, we will not use or disclose your psychiatric notes; we will not use or disclose your PHI for marketing; and we will not sell your PHI, unless you give us a written authorization. You may revoke written authorizations at any time, so long as the revocation is in writing. Once we receive your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.
VIII. Your Rights
You have the following rights with respect to your PHI:
Right to Inspect and Copy. You have the right to inspect and copy certain PHI that may be used to make decisions about your Plan benefits. If the information you request is maintained electronically, and you request an electronic copy, we will provide a copy in the electronic form and format you request, if the information can be readily produced in that form and format; if the information cannot be readily produced in that form and format, we will work with you to come to an agreement on form and format. If we cannot agree on an electronic form and format, we will provide you with a paper copy.
To inspect and copy your PHI, you must submit your request in writing. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request.
Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan.
To request an amendment, your request must be made in writing. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
1. is not part of the medical information kept by or for the Plan;
2. was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
3. is not part of the information that you would be permitted to inspect and copy; or
4. is already accurate and complete.
If we deny your request, you have the right to file a statement of disagreement with us and any future disclosures of the disputed information will include your statement.
Right to an Accounting of Disclosures. You have the right to request an “accounting” of certain disclosures of your PHI. The accounting will not include (1) disclosures for purposes of treatment, payment, or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to your authorization; (4) disclosures made to friends or family in your presence or because of an emergency; (5) disclosures for national security purposes; and (6) disclosures incidental to otherwise permissible disclosures.
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).
Legal Notices
The first list you request within a 12-month period will be provided free of charge. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on your PHI that we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on your PHI that we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had.
Except as provided in the next paragraph, we are not required to agree to your request. However, if we do agree to the request, we will honor the restriction until you revoke it or we notify you.
We will comply with any restriction request if (1) except as otherwise required by law, the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (2) the PHI pertains solely to a health care item or service for which the health care provider involved has been paid in full by you or another person.
To request restrictions, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply-for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Right to Be Notified of a Breach. You have the right to be notified in the event that we (or a Business Associate) discover a breach of unsecured PHI.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
IX. Complaints
If you believe that your privacy rights have been violated, you may file a complaint with the Plan or with the Office for Civil Rights of the United States Department of Health and Human Services. To file a complaint with the Plan, contact the person listed in the Contact Information section of this Notice. All complaints must be submitted in writing.
You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office for Civil Rights or with us.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272)
If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2026. Contact your State for more information on eligibility.
To see if any other States have added a premium assistance program since January 31, 2026, or for more information on special enrollment rights, can contact either:
U.S. Department of 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 TexasBank group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the TexasBank 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
TexasBank
Human Resources 4521 S Hulen St Fort Worth, TX 76109 817-717-2489
Legal Notices
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/ or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
• Emergency services – If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network 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-ofnetwork providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (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 outof-network services toward your deductible and out-ofpocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/nosurprises for more information about your rights under federal law.
New Health Insurance Marketplace Coverage Options and Your Health Coverage
PART A: General Information
Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options in your geographic area.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium and other out-of-pocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings on your premium that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.
Legal Notices
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.
There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage. Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit www.HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325.
What about Alternatives to Marketplace Health Insurance Coverage?
If you or your family are eligible for coverage in an employmentbased 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 employment-based health plan.
Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https:// www.healthcare.gov/medicaid-chip/getting-medicaid-chip/ for more details.
Legal Notices
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: TexasBank
5. Employer Address: 4521 S Hulen St Ste 200
7. City: Ft. Worth
4. Employer Identification Number (EIN): 75-1225814
6. Employer Phone Number: 817-386-8289
8. State: TX 9. ZIP Code: 76109
10. Who can we contact at this job?: Harriett Basham
11. Phone Number (if different from above):
12. E-Mail Address: hr@texasbank.com
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/irs-drop/rp-22-34.pdf for 2023.
2 An employer-sponsored or other employment-based health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.
This brochure highlights the main features of the TexasBank 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. TexasBank reserves the right to change or discontinue its employee benefits plans anytime.
