HELPFUL RESOURCES
IMPORTANT CONTACTS
EMPLOYEE RESPONSE CENTER
Employee benefits can be complicated. The Higginbotham Employee Response Center can assist you with the following:
X Finding a provider
X Benefits information
X Claims or billing questions
X Eligibility issues
Call or text 866-419-3518 to speak with a bilingual representative Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you leave a message after 3:00 p.m. CT, your call or text will be returned the next business day. You can also email questions or requests to helpline@higginbotham.net
AVAILABILITY OF SUMMARY HEALTH INFORMATION
Your benefits program offers five 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 at www.paycom.com
We are pleased to offer a comprehensive benefits package intended to protect your well-being and financial health. This guide is your opportunity to learn more about the benefits available to you and your eligible dependents beginning January 1, 2026.
Each year during Open Enrollment (OE), you have the opportunity to make changes to your benefit plans. The enrollment decisions you make this year will remain in effect through December 31, 2026. To get the best value from your health care plan, please take the time to evaluate your coverage options and determine which plans best meet the health care and financial needs for you and/or your family. After OE, you may make changes to your benefit elections only when you have a Qualifying Life Event (QLE).
ELIGIBILITY
You are eligible for benefits if you are a regular, full-time associate working an average of 30 hours per week. Your coverage is effective the first of the month after you have completed 60 days of full-time employment. You may also enroll eligible dependents for benefits coverage.
Eligible Dependents Include
X Your legal spouse (or common law spouse in states that recognize)
X Children under the age of 26 regardless of student, dependency, or marital status
X 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
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:
X Marriage, divorce, legal separation or annulment
X Birth, adoption, or placement for adoption of an eligible child
X Death of your spouse or child
X Change in your spouse’s employment status that affects benefits eligibility
X Change in your child’s eligibility for benefits (e.g., reaching the age limit, loss of coverage under Medicaid or CHIP)
X Change in residence that affects your eligibility for coverage
X Significant change in benefit plan coverage for you, your spouse, or your child
X FMLA event, COBRA event, judgment, or decree
X Becoming eligible for Medicare, Medicaid, or TRICARE
X Receiving a Qualified Medical Child Support Order
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 details.
HOW TO ENROLL
Go to www.paycom.com .
1. Select Employee.
2. Enter your username, password and the last four digits of your Social Security number. Then select Login.
3. Select 2026 Benefit Enrollment under My Benefits. 4. Select Start Enrollment.
5. Update your personal information and add your dependents.
6. Make your benefit election(s) and click Enroll or Decline.
7. The Benefit Plan Selection Review screen will appear. Please review your benefit elections. Once you are satisfied with your elections, check Complete Enrollment , then confirm by clicking OK.
8. When you are ready to complete your enrollment, click Sign and Submit.
Please note that the rates shown are based on our biweekly paychecks.
MEDICAL COVERAGE
The medical plans provide routine preventive care at no cost. These services include annual physicals, well-child and well-woman visits, mammograms, colonoscopies, routine immunizations, and other eligible services and screenings. You have the choice of five plans administered by UMR
UMR offers the same United Healthcare Choice Plus Network you are accustomed to. You do have plan options, all of which offer you full access to the Choice Plus Network. If you choose a Nexus ACO plan, you will save money at the point of service by choosing a Nexus ACO preferred provider. Nexus ACO providers are part of a designated network of high-quality providers. They are rated favorably based on quality and affordability. By choosing a Nexus ACO provider, your cost will be lower than when you use the regular Choice Plus network. The Nexus ACO plans give you the option to visit any United Healthcare provider, but it rewards you for being selective about where you access your care. The three NexusACO plans utilize the Choice and NexusACO networks. You will pay less by using a NexusACO provider. The HDHP 5000 and PPO 3000 plans utilize the Choice network.
ARE YOU NEARING MEDICARE ELIGIBILITY?
If you are nearing Medicare eligibility, know what options you have for medical coverage. Contact Luann Yarberry with Higginbotham at lyarberry@higginbotham.net to discuss Medicare options, advantages and time frames.
Medical Plans
X Tier 1 providers will be covered at a higher level, and member expenses will be lower.
Note: Employees now have out-of-network
UMR RESOURCES
UMR MEMBER WEBSITE
Visit the UMR Health member website at www.umr.com to:
X Check your benefits and see what’s covered
X Look up what you owe and how much you’ve paid
X Find a doctor in your network
X Print an ID card
X Learn about medical conditions and your treatment options
X Access tools and resources to help you live a healthier life
THE UMR | HEALTH APP
The UMR | Health app makes it easy to access your benefits on the go. With a single tap, you can:
X Search for in-network providers
X Access your digital ID card
X Find out if there is a copay for your upcoming appointment
X View claims information
X See how much you’ve paid towards your deductible
To download the UMR Health app, scan the QR code, or visit your app store.
UMR NURSELINE
A team of registered nurses are available by phone to answer your questions and provide advice at no cost to you.
Your nurse can help:
X Choose the right health care setting for an illness or injury
X Offer information about common health issues and symptoms
X Assist you in more than 140 languages or provide hearing assistance
Call NurseLine at 866-494-4502 or chat live with a nurse anytime day or night online at www.umr.com.
VIRTUAL VISITS
Virtual Visits, included with your medical benefits, lets you see and talk to a doctor from your mobile phone or computer without an appointment. During your visit, you will be able to talk to a doctor about your health concerns, symptoms and treatment options. Use Virtual Visits when:
X You have a non-emergency issue and are considering a convenient care clinic, urgent care clinic, or emergency room for treatment
X You are on a business trip, vacation, or away from home
X Your primary care physician is unavailable
WHEN TO USE VIRTUAL VISITS
You can use telemedicine services for minor conditions such as:
X Sore throat
X Headache
X Stomachache
X Cold
X Flu
X Allergies
X Fever
X Urinary tract infections
Do not use telemedicine for serious or life-threatening emergencies.
REGISTRATION IS EASY
You can access care online at anytime through the Teladoc App or member portal. Download the Teladoc app or log in to www.teladoc.com to choose from provider sites where you can register for a Virtual Visit.
WELLNESS PROGRAMS
The following programs and services are available to you at no additional cost as an UMR member.
Learning to live healthy is easier when you have help finding your way. Making small changes and adding healthy habits to your everyday life can move you toward living a full and active life.
UMR COMPLEX CONDITION CARE
UMR Complex Condition CARE provides a dedicated nurse manager at no cost if you or a family member faces a serious injury or long-term illness. Your CARE nurse manager will be your single point of contact, guiding you through your medical and behavioral health care, helping you understand treatment options, advocating for you, and supporting your recovery. Your doctor remains responsible for all medical decisions.
Your CARE Nurse Manager Will:
X Coordinate medical and behavioral health care
X Support your treatment plan from start to finish
X Help you understand treatment options
X Advocate for your needs throughout care
X Clarify complex medical issues
X Assist with understanding your health benefits
For questions, call the number on your ID card. Eligible members will be contacted by UMR CARE.
UMR MATERNITY CARE
The UMR Maternity CARE program is designed to support a healthy pregnancy and baby – at no cost to you. Experienced OB/GYN nurses will provide personalized assessments, prenatal education, and regular check-ins each trimester and after delivery. If identified as high-risk, you will receive additional monitoring to help reduce complications. You can self-enroll or may be invited to participate based on your pregnancy status.
If you have health factors that may make it unreasonably difficult or medically inadvisable for you to achieve any of the requirements of these programs to qualify for the incentive(s), please contact Human Resources, and we will work with you and/or your physician to develop an alternative plan. The purpose of these programs is to promote health and prevent disease by alerting employees to potential health risks. These programs are confidential and HIPAA-compliant. Protected Health Information will only be collected in aggregate form to design programs for the purpose of addressing the company’s overall risk(s). Any information shared will not be disclosed, except in accordance with HIPAA laws.
YOUR MATERNITY CARE NURSE WILL:
X Conduct pre-pregnancy and prenatal assessments.
X Provide educational resources tailored to your needs.
X Check in each trimester and after delivery.
X Answer questions and keep you informed.
X Notify your physician of your participation.
X Offer secure, mobile support through the CARE app
You may also designate a support person to receive educational materials. Additional resources include virtual classes, breastfeeding support groups, and access to certified lactation consultants. You may be eligible for rewards if you enroll early and complete the program.
To enroll, call 888-438-8105 or scan the QR code.
Available starting March 1, 2026
ONE PASS SELECT
Get unlimited access to thousands of gyms, fitness studios, online workouts, and grocery delivery, all with one monthly membership.
X Choose from our large nationwide network of over 20,000 gyms and fitness studios. Use any gym in the network and create your own workout routine.
X Prefer home workouts? Choose from live or on-demand online fitness classes that will get you moving and help you stay fit, no matter what your fitness level and interests are.
X Get groceries and household essentials you need to enjoy delicious, nutritious meals delivered to your home.
Memberships start at $34 per month and include more than 20,000 gym locations. Scan the QR code for more information.
HEALTH SAVINGS ACCOUNT
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a taxexempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows taxfree and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
OPENING AN HSA
If you meet the eligibility requirements, you may open an HSA administered by Optum Bank . You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. To open an account, go to www.optumbank.com
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
X Enrolled in an HSA-eligible HDHP
IMPORTANT HSA INFORMATION
Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
You may open an HSA at the financial institution of your choice, but only accounts opened through Optum Bank are eligible for automatic payroll deduction.
Works
X Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
X Not enrolled in a Health Care Flexible Spending Account
X Not eligible to be claimed as a dependent on someone else’s tax return
X Not eligible for Medicare or TRICARE
X Have not received Veterans Administration benefits
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds for your spouse and dependent health care expenses, even if they are not covered by the HDHP.
Maximum Contributions
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. Your annual contribution maximum is based on the coverage option you elect:
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 at anytime during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
How a Health Savings Account (HSA)
FLEXIBLE SPENDING ACCOUNTS
An FSA allows you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer three different FSAs: two for health care expenses and one for dependent care expenses. Higginbotham administers our FSAs.
Health Care FSA – Allows you to set aside from your paycheck pretax dollars that can be used to pay for unreimbursed medical, prescription and eligible over-the-counter drugs, and dental, vision, and hearing expenses. The maximum amount you can set aside is $3,400. Information on the debit card is available at Open Enrollment/New Hire Orientation.
Limited Purpose Health Care FSA – Available to you if you are enrolled in the High Deductible Health Plan (HDHP) and contribute to the Health Savings Account. This account can be used to pay for eligible out-of-pocket dental and vision expenses only.
Dependent Care FSA – Allows you to set aside from your paycheck pretax dollars that can be used to pay for dependent care expenses incurred in order for you to be able to work. The maximum amount you can set aside is $7,500 (filing jointly or head of household), or $3,750 (married and filing separate tax returns).
Claims for the current year must be submitted no later than March 31 of the following plan year. Any Health Care FSA and Limited Purpose Health Care FSA rollover funds will become available on April 1, after the submission period ends.
NOTE
Highly compensated employees (HCEs) may be limited in their contribution amount due to nondiscrimination testing, under section 125 of the IRS code.
IMPORTANT FSA RULES
X The maximum per plan year you can contribute to a Health Care or Limited Purpose Health Care FSA is $3,400. The maximum per plan year you can contribute to a Dependent Care FSA is $7,500 when filing jointly or head of household and $3,750 when married filing separately.
X You cannot change your election during the year unless you experience a QLE.
X Your Health Care or Limited Purpose Health Care debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
X 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.
DENTAL COVERAGE
Our dental plans help you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through UHC
DPPO PLANS
Two levels of benefits are available with the DPPO plans: in-network and out-of-network. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an out-of-network provider.
Preventive and Diagnostic Care Exams, cleanings, X-rays, fluoride treatments, sealants, space maintainers
Basic Restorative Care Fillings, simple extractions
Major Restorative Care Inlays, onlays, crowns, dentures
Dental Plans
*The DHMO plan is available to Texas residents only.
VISION COVERAGE
Our vision plan provides quality care to help preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes and high cholesterol. Coverage is provided through UHC
•
• Trifocals
Contacts In lieu of frames and lenses
• Elective
Medically Necessary
Benefit Frequency: Exams, Lenses, Frames and Contacts –Once every 12 months
LIFE AND AD&D INSURANCE
Professional Flooring Supply provides Basic Life and AD&D insurance at no cost to you. You are automatically enrolled in these coverages provided by OneAmerica
VOLUNTARY LIFE AND AD&D
You may purchase additional Life and AD&D insurance for you and your eligible dependents. If you decline Voluntary Life and AD&D insurance when first eligible, or if you elect coverage and wish to increase your benefit amount at a later date, Evidence of Insurability (EOI) – proof of good health – may be required before coverage is approved. You must elect Voluntary Life and AD&D coverage for yourself in order to elect coverage for your spouse or children. If you leave the company, you may be able to take the insurance with you.
Life and AD&D Available Coverage
Employee
Spouse
Child(ren)
• Increments of $10,000 up to $500,000 not to exceed five times annual base salary
• Guaranteed Issue $100,000
• Increments of $5,000 up to 50% of employee amount not to exceed $250,000
• Guaranteed Issue $25,000
• Birth to six months - $1,000
• Six months to age 26 - $5,000 or $10,000
DESIGNATING A BENEFICIARY
A beneficiary is the person or entity you designate 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 the share for each.
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) through OneAmerica at no cost to you. Short Term Disability (STD) is voluntary.
VOLUNTARY SHORT TERM DISABILITY
Voluntary STD coverage pays a percentage of your weekly salary for up to 24 weeks if you are temporarily disabled and unable to work due to an illness, non-work-related injury, or pregnancy.
Voluntary Short Term Disability
*Benefits may
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 180 days. Benefits begin at the end of an elimination period and continue while you are disabled up to Social Security Normal Retirement Age (SSNRA) or two years.
Long Term Disability (Employer Paid)
*Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months.
SUPPLEMENTAL INSURANCE
Professional Flooring Supply offers you and your eligible family members the opportunity to enroll in additional coverage that complements the traditional health care programs. These plans are all offered through Allstate 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, deductible, ambulance, physical therapy, and other costs not covered by traditional health plans. Some accidents covered under this plan include: dislocations, ruptured discs, eye injuries, lacerations, internal injuries, fractures, ambulance, accidental death and dismemberment, and hospital confinement.
CRITICAL ILLNESS INSURANCE
For many, a critical illness can expose an individual to an unexpected gap in protection. While health plans may help cover many of the direct costs associated with a critical illness, expenses such as lost income, childcare, travel to and from treatment, high deductibles, and copays may quickly diminish savings. Critical Illness insurance pays a fixed benefit if you are diagnosed with a covered critical illness after your coverage effective date. A lump-sum payment is payable when you or a covered family member are diagnosed with a covered condition such as stroke, heart attack, cancer, or renal failure.
VALUE-ADDED PROGRAMS
As a OneAmerica member, you have the following value-added programs available to you and your eligible dependents at no cost to you.
EMPLOYEE ASSISTANCE PROGRAM
The ComPysch GuidanceResources Employee Assistance Program (EAP) is a confidential program to help you find solutions for personal or workplace challenges. Benefits for you and your eligible dependents include unlimited telephone access to EAP professionals and up to three faceto-face sessions* with a counselor. Face-to-face sessions can be used toward legal consultations. There are professionals available 24/7 to help with the following:
X Stress/depression
X Financial issues
X Family/relationship issues
X Drug/alcohol abuse
X Grief issues
X Parenting/eldercare
X Other personal concerns
*Per issue, per calendar year
You can access this service by calling 855-387-9727 or going to www.guidanceresources.com.
WEB ID: ONEAMERICA3
TRAVEL ASSISTANCE
Generali Global Assistance provides travel assistance for you and your dependents if you are traveling more than 100 miles from home on a trip that lasts 90 days or less. This coverage extends to your dependents even when they are traveling without you. Representatives can help with trip planning or assistance in an emergency while traveling. They can find translation/interpreter or legal services, along with assistance with lost baggage, emergency funds, document replacement, and more.
You can access this service by calling 866-816-2103 or emailing: mail@oncallinternational.com.
PAID TIME OFF
PAID TIME OFF POLICY
Paid time off (PTO) is earned on the following schedule based on years of service and assigned schedules. Accruals will be calculated as follows:
X Accrued on a biweekly basis (26 pay periods)
X Accruals are available immediately
X Payouts will be on the first payroll following anniversary date for any hours in excess of amounts designated to be carried over by state requirements
X Under this policy an associate may carry over up to 48 hours of accrued, unused PTO to the following calendar year
PTO ACCRUALS POLICY
Each full-time associate will become eligible for PTO accruals upon hire and will accrue hours based upon assigned schedules and years of service. Accrued PTO may be used as it is accrued and may carry forward a maximum balance to be used in subsequent calendar years as outlined above. Unused PTO hours will be paid out based on hourly pay (overtime and commission pay will not be considered when paying unused time). PTO time may also be used to subsidize time absent from work due to bad weather conditions. If an Exempt associate takes off and does not have any PTO accrued, Professional Flooring Supply reserves the right to prorate this as unpaid time and to deduct any commission pay due for that time. If an associate has used or borrowed PTO time not yet accrued, and employment terminates, the PTO taken is deducted from the final paycheck.
Use of PTO requires a minimum of two days of notice to the supervisor and Human Resources unless the PTO is used for legitimate, unexpected illness or emergencies.
In all instances, PTO must be approved by the associate’s supervisor in advance.
PTO accruals being used for consecutive leave will be awarded in the following manner:
1. Seniority - Associates with the most years of employment have first choice.
2. HR Department must approve.
3. Try to request three months in advance with a minimum of a one-month notice.
4. Summer months and holidays must be requested at least six months in advance in order for Seniority to apply. Do not book flights or hotels until approved. Every effort will be made to give you the days you request. Keep in mind summer months and holidays fill up quickly, and because it is a very busy time of year, we cannot allow multiple people to be out at the same time. PTO days do not have to be taken all at one time. PTO accruals used for vacation must be taken in the same week – no splitting weeks unless approved by Human Resources. PTO is paid out as straight time.
ABSENCES
Our goal is to reduce unscheduled absences in order to provide appropriate coverage in all departments at all times. You are required to call your supervisor’s cell phone a minimum of one hour prior to your starting time if you are going to be absent. If you are going to be out in excess of one day, it is your responsibility to notify your supervisor as far in advance as possible with a minimum of one hour prior to your starting time each day. Repeated absenteeism as well as improper notification will lead to disciplinary action up to and including termination. Any associates who miss two consecutive days of work without notice to their supervisor, may be considered to have voluntarily resigned.
All absences will be deducted from your PTO accruals. After all PTO accruals have been used, the balance will be unpaid. These include, but are not limited to: illness of you or a dependent (a notification from a doctor will be required for any absence of three days or longer and for all absences before or after a holiday), personal errands, doctor/dentist appointments, death in family/funerals, vacation or jury duty (subject to local law).
LEAVE OF ABSENCE
Under special circumstances, after all PTO accruals have been used, the associate may be placed on leave without pay. This could only be granted under the following circumstances:
X Any leave of absence must be submitted in writing, with a beginning and ending date for approval.
X It could only be for a limited time.
X Your job responsibilities could be distributed to other associates.
X It would have to be a long-term associate who has an exceptional work record.
X The associate shall be reinstated if a vacancy exists when able to return to work full-time and fulfill the duties of his/her position 100%.
X The company shall pay company-paid benefits for a maximum of 30 days, then associate must pay premiums in advance to the company including but not limited to: medical, dental, life, and any supplemental benefits.
X Failure to report to work on the first day after the expiration date, without approval, will be considered a voluntary termination of employment.
PTO EXCEPTIONS
X Associates who miss more than three consecutive unscheduled days are required to present a doctor’s release to the Human Resources department that permits them to return to work.
X PTO taken in excess of the PTO accrued can result in progressive disciplinary action up to and including employment termination. This time off will be unpaid.
X Unscheduled absences that result in consecutive days absent from work are subject to progressive disciplinary action up to and including employment termination.
X Any associate who misses two consecutive days of work without proper notification to their supervisor may be considered to have voluntarily resigned.
PAID HOLIDAYS / 401(K)
PAID HOLIDAYS
Holiday pay is paid as straight time (eight hours).
New Year’s Day
Memorial Day
4th of July
Labor Day
Thanksgiving Day
Friday after Thanksgiving
Christmas Eve Day
Christmas Day
PROFESSIONAL FLOORING SUPPLY 401(K) RETIREMENT PLAN
Professional Flooring Supply offers a 401(k) retirement plan. The 2026 pretax or Roth contribution maximum is $24,500. Associates age 50+ may elect to make an additional “catchup contribution” of up to $8,000.
Professional Flooring Supply will match up to 5% of your annual salary. You are immediately vested in the company match contribution. Our 401(k) retirement plan is administered by Voya
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:
Professional Flooring Supply
Human Resources PO Box 7558 Fort Worth, Texas 76111 hr@professionalflooring.com
YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Professional Flooring Supply 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. Professional Flooring Supply has determined that the prescription drug coverage offered by the Professional Flooring Supply 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.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Professional Flooring Supply 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 Professional Flooring Supply 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 hr@professionalflooring.com
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity. gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
January 1, 2026
Professional Flooring Supply
Human Resources PO Box 7558 Fort Worth, Texas 76111 hr@professionalflooring.com
NOTICE OF HIPAA PRIVACY PRACTICES
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (the “Notice”) describes the legal obligations of Professional Flooring Supply’s Group Health Plan (the “Plan”) and your legal rights regarding your protected health information held by the Plan under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act). Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law.
We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA.
The HIPAA Privacy Rule protects only certain medical information known as “protected health information.”
Generally, protected health information (PHI) is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to:
1. Your past, present, or future physical or mental health or condition;
2. The provision of health care to you; or
3. The past, present, or future payment for the provision of health care to you.
I. Contact Information
If you have any questions about this Notice or about our privacy practices, and for any correspondence or requests related to the contents of this Notice, please contact: Professional Flooring Supply Human Resources PO Box 7558 Fort Worth, Texas 76111 hr@professionalflooring.com
II. Effective Date
This Notice is effective February 15, 2026.
III. Our Responsibilities
We are required by law to:
1. maintain the privacy of your PHI;
2. provide you with certain rights with respect to your PHI;
3. provide you with a copy of this Notice of our legal duties and privacy practices with respect to your PHI; and
4. follow the terms of the Notice that is currently in effect. We reserve the right to change the terms of this Notice and to make new provisions regarding your PHI that we maintain, as allowed or required by law. If we make any material change to this Notice, we will provide you with a copy of our revised Notice of Privacy Practices.
IV. How We May Use and Disclose Your PHI
Under the law, we may use or disclose your PHI under certain circumstances without your permission. The following categories describe the different ways that we may use and disclose your PHI. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. Note that we will use and disclose PHI as described below unless otherwise prohibited or restricted by applicable state or other law, and that information can lose its protected status as PHI once re-disclosed by a recipient.
For Treatment. When and as appropriate, we may use or disclose medical information about you to facilitate medical treatment or services by health care providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about you with physicians who are treating you.
For Payment. We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary, or to determine whether the Plan will cover the treatment. We may also share your protected health information with a utilization review or pre-certification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.
For Health Care Operations. We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information in connection with conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excessloss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities. However, we will not use your genetic information for underwriting purposes.
Substance Use Disorder (SUD) Treatment Information.
Some of your health information may be part of a SUD patient record and subject to additional protections under federal law (42 CFR Part 2) governing confidentiality of SUD patient records.
If we receive or maintain any information about you from a SUD treatment program that is covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the SUD patient record for purposes of treatment, payment or health care operations, we may use and disclose your SUD patient record for treatment, payment and health care operations purposes as described in this Notice. If we receive or maintain your SUD patient record through specific consent you provide to us or another third party, we will use and disclose your SUD patient record only as expressly permitted by you in your consent as provided to us. In no event will we use or disclose your SUD patient record, or testimony that describes the information contained in your SUD patient record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.
To Business Associates. We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, transmit, use, and/or disclose your PHI, but only after they agree in writing with us to implement appropriate safeguards regarding your PHI. For example, we may disclose your PHI to a Business Associate to process your claims for Plan benefits or to provide support services, such as utilization management, pharmacy benefit management, or subrogation, but only after the Business Associate enters into a Business Associate contract with us.
Treatment Alternatives or Health-Related Benefits and Services. We may use and disclose your protected health information to send you information about treatment alternatives or other health-related benefits and services that might be of interest to you.
As Required by Law. We will disclose your PHI when required to do so by federal, state, or local law. For example, we may disclose your PHI when required by national security laws or public health disclosure laws.
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may disclose your PHI in a proceeding regarding the licensure of a physician.
To Plan Sponsors. For the purpose of administering the plan, we may disclose PHI to certain employees of the Employer. However, those employees will only use or disclose that information as necessary to perform plan administration functions or as otherwise required by HIPAA, unless you have authorized further disclosures. Your PHI cannot be used for employment purposes without your specific authorization.
V. Special Situations
In addition to the above, the following categories describe other possible ways that we may use and disclose your PHI without your specific authorization. For each category of uses or disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
Organ and Tissue Donation. If you are an organ donor, we may release your PHI after your death to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation. We may release your PHI for workers’ compensation or similar programs, but only as authorized by, and to the extent necessary to comply with, laws relating to workers’ compensation and similar programs that provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose your PHI for public health activities. These activities generally include the following:
1. to prevent or control disease, injury, or disability;
2. to report births and deaths;
3. to report child abuse or neglect;
4. to report reactions to medications or problems with products;
5. to notify people of recalls of products they may be using;
6. to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
7. to notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.
Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone involved in a legal dispute, but only if efforts have been made to tell you about the request or to obtain a court or administrative order protecting the information requested.
Law Enforcement. We may disclose your PHI if asked to do so by a 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 lawenforcement official if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Research. We may disclose your PHI to researchers when:
1. The individual identifiers have been removed; or
2. When an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of the requested information and approves the research.
VI. Required Disclosures
The following is a description of disclosures of your PHI we are required to make.
Government Audits. We are required to disclose your PHI to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule.
Disclosures to You. When you request, we are required to disclose to you the portion of your PHI that contains medical records, billing records, and any other records used to make decisions regarding your health care benefits. We are also required, when requested, to provide you with an accounting of most disclosures of your PHI if the disclosure was for reasons other than for payment, treatment, or health care operations, and if the PHI was not disclosed pursuant to your individual authorization.
VII. Other Disclosures
Personal Representatives. We will disclose your PHI to individuals authorized by you, or to an individual designated as your personal representative, attorney-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). 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.
ALABAMA – MEDICAID
Website: http://www.myalhipp.com/ Phone: 1-855-692-5447
ALASKA – MEDICAID
The AK Health Insurance
myakhipp.com/
Phone: 1-866-251-4861
Email: CustomerService@MyAKHIPP.com
Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspx
ARKANSAS – MEDICAID
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
CALIFORNIA– MEDICAID
Health Insurance Premium Payment (HIPP) Program Website: http:// dhcs.ca.gov/hipp
Phone: 916-445-8322
Fax: 916-440-5676
Email: hipp@dhcs.ca.gov
COLORADO – HEALTH FIRST COLORADO (COLORADO’S MEDICAID PROGRAM) AND CHILD HEALTH PLAN PLUS (CHP+)
Health First Colorado website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711
CHP+: https://hcpf.colorado.gov/child-health-plan-plus
CHP+ Customer Service: 1-800-359-1991/State Relay 711
Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442
FLORIDA – MEDICAID
Website: https://www.flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp/index.html
Phone: 1-877-357-3268
GEORGIA – MEDICAID
GA HIPP Website: https://medicaid.georgia.gov/health-insurancepremium-payment-program-hipp
Phone: 678-564-1162, Press 1
GA CHIPRA Website: https://medicaid.georgia.gov/programs/thirdparty-liability/childrens-health-insurance-program-reauthorizationact-2009-chipra
Phone: 678-564-1162, Press 2
INDIANA – MEDICAID
Health Insurance Premium Payment Program
All other Medicaid Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr/ Family and Social Services Administration Phone: 1-800-403-0864
Member Services Phone: 1-800-457-4584
IOWA – MEDICAID AND CHIP (HAWKI)
Medicaid Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid
Medicaid Phone: 1-800-338-8366
Hawki Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid/iowa-health-link/hawki
Hawki Phone: 1-800-257-8563
HIPP Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid/fee-service/hipp
HIPP Phone: 1-888-346-9562
KANSAS – MEDICAID
Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884
HIPP Phone: 1-800-967-4660
KENTUCKY – MEDICAID
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/ kihipp.aspx
Phone: 1-855-459-6328
Email: KIHIPP.PROGRAM@ky.gov
KCHIP Website: https://kynect.ky.gov
Phone: 1-877-524-4718
Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms
LOUISIANA – MEDICAID
Louisiana Medicaid Website: https://www.ldh.la.gov/healthy-louisiana Medicaid Customer Service Line: 1-888-342-6207
Louisiana Medicaid email: healthy@la.gov
Louisiana Health Insurance Premium Program (LaHIPP) Website: https://www.ldh.la.gov/lahipp
LaHIPP phone: 1-877-697-6703
LaHIPP email: La.HIPP@la.gov
LaHIPP fax: 1-888-716-9787
LaHIPP mailing address: 100 Crescent Centre Parkway, Suite 1000 Tucker, GA 30084
Enrollment Website: https://www.mymaineconnection.gov/benefits/ s/?language=en_US
Phone: 1-800-442-6003
TTY: Maine relay 711
Private Health Insurance Premium Webpage: https://www.maine.gov/ dhhs/ofi/applications-forms
Phone: 1-800-977-6740
TTY: Maine Relay 711
MASSACHUSETTS –
Website: https://www.mass.gov/masshealth/pa
Phone: 1-800-862-4840
TTY: 711
Email: masspremassistance@accenture.com
Website: https://mn.gov/dhs/health-care-coverage/ Phone: 1-800-657-3672 MISSOURI –
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005
MONTANA
Website: https://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084
Email: HHSHIPPProgram@mt.gov
Website: http://www.ACCESSNebraska.ne.gov
Phone: 1-855-632-7633
Lincoln: 402-473-7000
Omaha: 402-595-1178
Medicaid Website: http://dhcfp.nv.gov
Medicaid Phone: 1-800-992-0900
NEW HAMPSHIRE – MEDICAID
Website: https://www.dhhs.nh.gov/programs-services/medicaid/ health-insurance-premium-program
Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-852-3345, ext. 15218
Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov
NEW JERSEY – MEDICAID AND CHIP
Medicaid Website: http://www.state.nj.us/humanservices/dmahs/ clients/medicaid/ Phone: 1-800-356-1561
CHIP Premium Assistance Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710 (TTY: 711) NEW YORK – MEDICAID
Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA – MEDICAID
Website: https://medicaid.ncdhhs.gov
Phone: 919-855-4100
NORTH DAKOTA – MEDICAID
Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825
OKLAHOMA – MEDICAID AND CHIP
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
OREGON – MEDICAID
Website: https://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075
PENNSYLVANIA – MEDICAID AND CHIP
Website: https://www.pa.gov/en/services/dhs/apply-for-medicaidhealth-insurance-premium-payment-program-hipp.html
Phone: 1-800-692-7462
CHIP Website: https://www.dhs.pa.gov/chip/pages/chip.aspx
CHIP Phone: 1-800-986-KIDS (5437)
RHODE ISLAND – MEDICAID AND CHIP
Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347 or 401-462-0311 (Direct RIte Share Line)
SOUTH CAROLINA – MEDICAID
Website: https://www.scdhhs.gov Phone: 1-888-549-0820
SOUTH DAKOTA - MEDICAID
Website: https://dss.sd.gov Phone: 1-888-828-0059
TEXAS – MEDICAID
Website: https://www.hhs.texas.gov/services/financial/healthinsurance-premium-payment-hipp-program
Phone: 1-800-440-0493
UTAH – MEDICAID AND CHIP
Utah’s Premium Partnership for Health Insurance (UPP) Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov
Phone: 1-888-222-2542
Adult Expansion Website: https://medicaid.utah.gov/expansion/ Utah Medicaid Buyout Program Website: https://medicaid.utah.gov/ buyout-program/ CHIP Website: https://chip.utah.gov/
MEDICAID
Website: https://dvha.vermont.gov/members/medicaid/hipp-program Phone: 1-800-250-8427
Website: https://coverva.dmas.virginia.gov/learn/premium-assistance/ famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/healthinsurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-800-432-5924
Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699- 8447)
Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002
Website: https://health.wyo.gov/healthcarefin/medicaid/programsand-eligibility/ Phone: 1-800-251-1269
To see if any other States have added a premium assistance program since January 31, 2026, or for more information on special enrollment rights, can contact either:
U.S. Department of Labor
Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565
CONTINUATION OF COVERAGE RIGHTS UNDER COBRA
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the Professional Flooring Supply group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Professional Flooring Supply 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
Professional Flooring Supply
Human Resources PO Box 7558
Fort Worth, Texas 76111 hr@professionalflooring.com
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
When you get emergency care or get treated by an out-ofnetwork provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-ofpocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care— like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
• Emergency services – If you have an emergency medical condition and get emergency services from an out-ofnetwork provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these poststabilization services.
• Certain services at an in-network hospital or ambulatory surgical center – When you get services from an innetwork 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-ofnetwork. 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 (costsharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/nosurprises for more information about your rights under federal law.
NOTES
NOTES
This brochure highlights the main features of the Professional Flooring Supply 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. Professional Flooring Supply reserves the right to change or discontinue its employee benefits plans at anytime.
