If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices for your prescription drug coverage. Please see page 23 for more details.
We know you work hard every day to achieve your personal and professional goals. Since your health and wellness are key to meeting these goals, we are pleased to offer a comprehensive benefits package that supports your health, mind, and body. May you always be Working Towards Wellness!
Your benefits program offers one medical coverage plan option. To help you make an informed choice, review the plan’s Summary of Benefits and Coverage available from Human Resources or in the Documents section of BenefitsinHand (Employee Navigator portal).
♦ Field Employees : First of the month after completing 90 days of full-time employment (medical has a 30 day orientation period, then benefits begin first of the month following 60 days)
♦ Office and Superintendents : Date of Hire
♦ Regular, full-time employee
♦ Working an average of 30 hours per week
♦ Enroll during Open Enrollment (OE) or when you have a Qualifying Life Event (QLE)
♦ Your legal spouse or domestic partner
♦ Your child(ren)1 under age 26 regardless of student, dependency, or marital status
♦ Child(ren) over age 26 who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return
♦ You must enroll the dependent(s) at OE or for a QLE
♦ When covering dependents, you must enroll for and be on the same plans
♦ OE: Start of the plan year
♦ QLE: Ask Human Resources
1 Natural, adopted, stepchild, child under legal guardianship, or child under qualified medical support order
Qualifying Life Events
♦ Based on OE or QLE effective dates
The following are examples of QLEs that allow you to make changes to your coverage. You must notify Human Resources and complete any required elections within 30 days of the event. Proof of the QLE may be required.
Marriage
Divorce
Legal separation
Annulment
Death of a spouse
Birth Adoption
Placement for adoption
Change in benefits eligibility
Death of a child
Termination of Coverage
FMLA event, COBRA event, court judgment or decree
Becoming eligible for Medicare, Medicaid, or TRICARE
Receiving a Qualified Medical Child Support Order
Gain or loss of benefits coverage
Change in employment status affecting benefits
Significant change in cost of spouse’s coverage
Your coverage for all plans (except Voluntary Short Term Disability (STD) and Voluntary Long Term Disability (LTD)) will end at the end of the month in which you terminate employment. Voluntary STD and LTD will end on the day of your termination.
You may be eligible to continue your elected medical, dental and vision benefit through COBRA. Applicable COBRA notifications will be sent to you directly by iSolved.
You may be eligible to convert or port your Life, STD, Accident, or Critical Illness plans upon termination. Reach out to Human Resources or Mutual of Omaha for required paperwork and instructions within 31 days of your termination. Refer to the specific Mutual of Omaha certificate for specific requirements and details.
How to Enroll
Enrolling in benefits is simple through the Employee Navigator enrollment platform.
First-Time Users
Go to www.employeenavigator.com
1. If this is your first time to log in, click New User Registration Once you register, use your username and password to log in.
2. Enter your personal information and company identifier Drymalla and click Next
3. Create a username (work email address recommended) and password, then check the I agree to terms and conditions box before you click Finish
Returning Users
Go to www.employeenavigator.com
1. Click Start Enrollment 2. Confirm or update your personal information and click Save & Continue
3. Edit or add dependents, if needed, then click Save & Continue
4. Follow the steps on the screen for each benefit to select or decline coverage. To decline coverage, click Don’t want this benefit? and select the reason for declining.
5. When you finish making your benefit elections, review the summary of your selections. If they are correct, click the Click to Sign button to complete and submit your enrollment choices. Your enrollment will not be complete until you click the Click to Sign button.
4. If you used an email address as your username, you will get a validation email to that address to log in and begin the step-by-step enrollment process. Contact the ERC if you have questions about your benefits or need help enrolling (see page 3).
Medical Coverage
Cigna Open Access Plus (OAP)
This OAP plan has a $4,000 Individual and a $12,000 Family in-network deductible.
Open Access Plus
Like a Preferred Provider Organization (PPO) plan, the Open Access Plus (OAP) plan allows you to see any provider when you need care. When you see in-network providers for care, you will pay less and get the highest level of benefits. You will pay more for care if you use out-of-network providers. When you see in-network providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other in-network services are covered at the deductible and coinsurance level.
Medical Provider: Cigna
Medical Benefits Summary
Health Reimbursement Arrangement
HRA Administrator: iSolved
Helps offset your out-of-pocket health care costs with reimbursement for qualified in-network expenses.
Drymalla Construction provides an employer-funded Health Reimbursement Arrangement (HRA) to help offset your out-of-pocket health care costs. You can participate in the HRA if you are enrolled in the medical plan with Drymalla Construction Company.
How the HRA Works
1. You must be enrolled in the medical plan.
2.
You pay the first $1,500 of your in-network deductible. The HRA will reimburse the next $1,501 – $4,000 of in-network deductible expenses.
3. Submit your EOB from the carrier for reimbursement.
Important HRA Information
♦ Your HRA is funded entirely through company contributions.
♦ You must be enrolled in a medical plan to receive the funds.
♦ You can use the HRA to help cover out-ofpocket costs if those costs apply toward your in-network deductible.
♦ You can use your HRA to pay for a qualified medical expense for you or your covered spouse and dependents if it is not reimbursed from another source (e.g., another group health insurance plan, or if you take a tax deduction for those expenses).
Review your plan documents for full details.
Submitting a Claim
An Explanation of Benefits (EOB) from the carrier must be provided for reimbursement. Credit card receipts, canceled checks, and balance due statements are not sufficient. Submit a claim at https://infinconsumer.lh1ondemand.com
NOTE: Expenses reimbursed under a Health Savings Account (HSA) or Flexible Spending Account (FSA) are not eligible for reimbursement under the HRA.
Cigna Resources
Member Website
myCigna.com serves as your one-stop shop for all Cigna health plan and benefits information. Key features include managing and tracking claims, accessing digital ID cards, finding in-network providers, accessing cost comparison tools, reviewing coverage details, and more. Visit www. mycigna.com to register.
♦ One Guide – Get help from a personal guide to navigate your Cigna benefits and resources. Call the number on the back of your Cigna ID card, use the click-to-chat function on www.mycigna.com, or call 866-494-2111
♦ Health Information Line – Speak to a nurse anytime to get answers and recommendations based on your specific health situation. Call the number on the back of your Cigna ID card for 24/7 access.
♦ Live, 24/7 Customer Service – Contact a representative via phone, chat, or app.
MOBILE APP
Download the myCigna app to access your Cigna health plan and benefits information while on the go. This app helps you organize and access important plan information on your smartphone or tablet. It is also available in Spanish.
Cigna Digital ID Card
You have one ID card for both your pharmacy and medical needs. Cigna no longer issues and mails physical ID cards.
HOW
TO ACCESS YOUR DIGITAL ID CARD
1. Log in at www.myCigna.com or the myCigna app
2. Click or tap ID Cards
3. View your card, as well as any dependents’ card(s).
4. Email cards directly to doctors.
5. Save your digital ID cards in your Apple Wallet.
Cigna Well-being Solution
Take charge of your health with the Cigna Well-being Solution, powered by Virgin Pulse. Set personalized goals, track your activity, and join fun challenges to build lasting healthy habits, all at no extra cost to you. Connect your fitness devices, invite friends and family, and enjoy a supportive wellness community that helps you live better every day.
ENROLL TODAY
♦ Visit www.mycigna.com > Wellness > Get Started
♦ Download the myCigna app
OMADA - DIABETES
If you meet eligibility criteria, Cigna offers a personalized diabetes prevention program to you at no additional cost through Omada. The 16-week program includes a digital platform and scale, access to professional coaches, online peer support groups, and interactive online training sessions focused on healthy eating, physical activity, sleep, and stress. Learn more at https://go.omadahealth.com/omadaforcigna
CIGNA EMOTIONAL WELL-BEING RESOURCES
Emotional Health
♦ Three face-to-face visits with a licensed behavioral health provider in the Cigna Employee Assistance Program (EAP) network
♦ Live chat with an EAP advocate
♦ Unlimited telephone counseling
♦ Access to work/life resources and self-service tools on myCigna.com
Legal Services
Includes a 30-minute consultation with a program attorney for civil, personal/ family, and IRS issues, with 25% off select fees if an attorney is retained.
Financial Services
Get 25% off tax preparation and a 30-minute complimentary phone consultation with a financial specialist on debt counseling, student loans, and more.
Identity Theft Support
Includes a 60-minute consultation with a fraud resolution specialist who can help with identity theft recovery and how to protect yourself in the future.
Specialty Pharmacy Services
If you have a chronic condition and give yourself your own medications, Accredo can help you with your specialty prescriptions. Accredo offers free home delivery, online delivery tracking, and 24/7 support with your specialty prescription order.
How to Order
1. Call 800-803-2523 to register. A representative will work with your doctor on the rest.
2. After you register, go to www.accredo.com or download the Accredo app.
3. Before your scheduled fill date, someone will contact you to:
♦ Confirm your drugs, dose, and the delivery location.
♦ Check any prescription changes your doctor may have ordered.
♦ Talk about any changes in your condition or answer any questions about your health.
Specialty Pharmacy Support
Accredo gives one-on-one counseling to help you with your treatment goals, manage any side effects, stick to your regimen, and monitor your progress. Accredo can also help with any financial or insurance concerns you may have. Visit www.accredo.com or call 800-803-2523
Telemedicine
Allows 24/7/365 access to boardcertified doctors from your mobile phone or computer.
Your medical coverage offers telemedicine services through MDLIVE . Connect anytime day or night with a board-certified doctor via your mobile device or computer for free.
While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
♦ Have a non-emergency issue and are considering an after hours health care clinic, urgent care clinic, or emergency room for treatment
♦ Are on a business trip, vacation, or away from home
♦ Are unable to see your primary care physician
Did You Know?
Your regular provider may offer telemedicine services, so it is best to ask now and know what your options are before you need care. Costs may differ from MDLIVE services.
When to Use Telemedicine
Use telemedicine for minor conditions such as:
♦ Sore throat
♦ Headache
♦ Stomachache
♦ Cold/Flu
♦ Fever
♦ Urinary tract infections
♦ Pink Eye
♦ Allergies
Do not use telemedicine for serious or life-threatening emergencies.
Registration is Easy
Register with MDLIVE so you are ready to use this valuable service when and where you need it.
Log in to www.mycigna.com and click Talk to a Doctor > Select care type > Schedule appointment Call 866-494-2111 or MDLIVE at 888-726-3171
Health Care Options
Becoming familiar with your options for medical care can save you time and money.
HEALTH CARE PROVIDER
Non-Emergency Care
Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed
Telemedicine
24 hours a day, 7 days a week
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history
Doctor’s Office
Office hours vary
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies
Retail Clinic
Hours vary based on store hours
When you need immediate attention; walk-in basis is usually accepted
Generally includes evening, weekend, and holiday hours
Urgent
Care
Emergency Care
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
♦ Allergies
♦ Cough/cold/flu
♦ Rash
♦ Stomachache
♦ Infections
♦ Sore and strep throat
♦ Vaccinations
♦ Minor injuries/sprains/strains
♦ Common infections
♦ Minor injuries
♦ Pregnancy tests
♦ Vaccinations
♦ Sprains and strains
♦ Minor broken bones
♦ Small cuts that may require stitches
♦ Minor burns and infections
♦ Chest pain
♦ Difficulty breathing
♦ Severe bleeding
♦ Blurred or sudden loss of vision
♦ Major broken bones
♦ Most major injuries except trauma
♦ Severe pain
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only estimates. This information is not intended as medical advice. If you have questions, please call the phone number on the back of your medical ID card.
4+ hours
Dental Coverage
DPPO Plan
Two levels of benefits are available with the DPPO plan: 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.
2
1
Our vision plan offers quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems. You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see innetwork providers. Coverage is provided through Cigna using the Cigna Vision Network serviced by EyeMed
Life and AD&D Insurance
Provides your loved ones with a financial safety net after your death and/or after an accident that causes loss of life, limb, or function.
Life and Accidental Death and Dismemberment (AD&D) insurance through Mutual of Omaha are important to your financial security, especially if others depend on you for support or vice versa. With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies).
Employee Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at $10,000 for each benefit.
Dependent Life
Your spouse and dependent child(ren) are automatically covered for:
♦ Spouse – $5,000
♦ Child – $2,000 (ages six months to age 26);
$1,000 (birth to six months)
Voluntary Life and AD&D
If you need more coverage than Basic Life and AD&D, you may buy Voluntary Life and AD&D for yourself and your dependent(s). If you do not elect Voluntary Life and AD&D insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health. You must elect Voluntary Life and AD&D coverage for yourself before covering your spouse and/or child(ren).
Benefit Age Reductions
Life and AD&D coverage amounts reduce to 65% at age 65, and to 50% at age 70. Spouse coverage terminates when you reach age 70.
Life and AD&D Employee
♦ Increments of $10,000 up to $150,000, not to exceed five times annual salary
♦ New hire Guaranteed Issue is five times annual salary, up to $150,000
Spouse
Child(ren)
♦ Increments of $5,000 up to $30,000, not to exceed 100% of your election
♦ New hire Guaranteed Issue $30,000
♦ Under age 26: Increments of $5,000 up to $10,000, not to exceed 100% of employee election
♦ Evidence of Insurability not required on children
Designating a Beneficiary
A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
Eligibility Requirement: Employee must be actively at work, and dependents must be able to perform normal activities and not be confined to home, hospital, or any care facility.
Permanent Life Insurance (UL)
TransElite Universal Life (UL) through Transamerica is a type of permanent life insurance that includes a death benefit and a cash value component that accumulates over time. It offers flexibility, allowing for adjustments to the premium, death benefit, and cash value to adapt to life changes.
Employee
Spouse
♦ Increments of $5,000, with a minimum of $10,000 and a maximum of five times salary or $500,000, whichever is less
♦ New hire Guaranteed Issue is five times annual salary, up to $150,000
♦ Increments of $5,000, with a minimum of $10,000 and a maximum of $100,000
♦ New Hire Guaranteed Issue is $15,000 (employee must enroll for the spouse to receive a Guaranteed Issue)
In addition to protecting your family’s long-term financial security, these plans may include an accelerated death benefit and a chronic condition rider, which can function in a way to provide a monthly benefit to care for long-term care needs. Your personal premium details are available in Employee Navigator.
Disability Insurance
Provides partial income
protection if you are unable to work due to a covered accident or illness.
Voluntary Short Term Disability (STD) and Long Term Disability (LTD) coverages are available for you to purchase through Mutual of Omaha and can be paid through the convenience of payroll deduction.
Voluntary Short Term Disability
STD coverage pays a percentage of your weekly salary if you are temporarily disabled and unable to work due to an illness, pregnancy, or non-work related injury. STD benefits are not payable if the disability is due to a job-related injury or illness. If a medical condition is jobrelated, it is considered Workers’ compensation, not STD.
Voluntary Short Term Disability
Eligibility Requirement: Employee must be actively at work, and dependents must be able to perform normal activities and not be confined to home, hospital, or any care facility.
If you were temporarily unable to work, would you be able to cover your bills?
Voluntary 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 maximum benefit period or Social Security Normal Retirement Age (SSNRA).
Supplemental Benefits
Complements our traditional health care programs and pays you directly for unexpected health care costs.
Accident Insurance
Accident insurance provides affordable protection against a sudden, unforeseen accident. The Accident plan offered through Mutual of Omaha helps offset the direct and indirect expenses resulting from an accident such as copayments, deductible, ambulance, physical therapy, childcare, rent, and other costs not covered by traditional health plans. See the plan document for full details.
Health insurance covers medical bills, but if you have an emergency, an accident, or a hospital stay, you may have a lot of unexpected out-of-pocket costs to pay.
Protect your savings with additional coverage from Mutual of Omaha
Eligibility Requirement: Employee must be actively at work, and dependents must be able to perform normal activities and not be confined to home, hospital, or any care facility.
Supplemental Benefits
Critical Illness Insurance
Critical Illness insurance offered through Mutual of Omaha helps pay the cost of non-medical 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-oftown treatments, special diets, daily living, and household upkeep costs. See the plan document for full details.
Acute respiratory distress syndrome; aortic surgery; benign brain tumor; bone marrow transplant; carcinoma in situ; coronary artery bypass; heart valve surgery
Employee Assistance Program
Helps you and family members cope with a variety of personal or workrelated issues.
The Employee Assistance Program (EAP) from Mutual of Omaha provides confidential counseling and support services at little or no cost to you to help with:
♦ Relationships
♦ Work/life balance
♦ Stress and anxiety
♦ Legal Assistance
♦ Grief and loss
♦ Child and eldercare resources
♦ Substance abuse
Additional Benefit
Coverage includes three face-to-face sessions with a Master’s-level EAP professional. These sessions can be used for you or any of your eligible dependents. Visit www.mutualofomaha.com/eap for more details.
Contact the EAP
Get support at any hour of the day or night.
Visit www.mutualofomaha.com/eap
Call 800-316-2796
Additional Benefits
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
Identity Theft Services
The Identity Theft Assistance program, provided by AXA Assistance, helps you understand the risks of identity theft and how to prevent it. If your information is compromised, a representative will connect you with the needed resources. Call AXA Assistance at 800-856-9947 to learn more.
Will Preparation
Creating a will is an important investment in your future. In just minutes, you can create a personalized will tailored to your needs. The services provided by Epoq offer a secure account space to prepare wills and other legal documents tailored to your unique needs. Log in at www.willprepservices.com and use the code
MUTUALWILLS to register.
Hearing Discount
You have access to a hearing discount program at no additional cost through Amplifon . This program provides free hearing tests, custom hearing solutions, a low-price guarantee, a 60-day risk-free trial period, and two years of batteries with purchase. To access your benefit, call 888-534-1747. Learn more at www.amplifonusa.com/ mutualofomaha
Health Advocacy Services
If you’re enrolled in the voluntary critical illness plan and are diagnosed with a covered critical illness, like stroke, Alzheimer’s, or cancer, Mutual of Omaha’s Advocacy Services are here to help. Advocates provide one-on-one support to guide you through the claims process, answer benefit questions, and connect you with resources to help manage your diagnosis and recovery. Their goal is to reduce stress so you can focus on your health.
Call 866-372-5577
Email customerserve@healthcomp.com
Norton Lifelock
LifeLock Identity Protection and Support
You have identity theft protection and support plans through LifeLock
LifeLock monitors your identity, and when activity occurs involving your information, you are alerted by email, text, or a phone call. You can respond to confirm whether the activity is legitimate, and if it is not, a USA-based LifeLock identity restoration specialist will help you resolve the issue. If you are a victim of identity theft, LifeLock Benefit Elite helps protect you with the Million Dollar Protection Package. This includes reimbursement for stolen funds and coverage for personal expenses.
Norton LifeLock Benefit Plan
Help protect your identity and devices with the Norton LifeLock Benefit Plan. The plan includes:
♦ Device Security – Antivirus software and multilayered, advanced security help protect devices against existing and emerging threats, including malware and ransomware.
♦ Online Privacy – Norton Secure VPN protects devices and helps keep online activity and browsing history private.
♦ Identity – LifeLock monitors for fraudulent use of personal information and sends alerts when a potential threat is detected.
♦ Home and Family – Take action to monitor your child’s online activity with easy-to-use tools to set screen time limits, block unsuitable sites, and monitor search terms and activity history.
Contact LifeLock
Visit www.my.norton.com/benefitpremier
Important Notices
Women’s Health and Cancer Rights Act of 1998
In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully.
As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:
♦ All stages of reconstruction of the breast on which the mastectomy was performed;
♦ Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
♦ Prostheses and treatment of physical complications of the mastectomy, including lymphedema.
Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
Special Enrollment Rights
This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.
Loss of Other Coverage or Becoming Eligible for Medicaid
or a state Children’s Health Insurance Program (CHIP)
If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your
or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage). If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance.
Marriage, Birth or Adoption
If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption.
For More Information or Assistance
To request special enrollment or obtain more information, contact:
Drymalla Construction Company LLC Human Resources 608 Harbert St. Columbus TX 78934
979-732-5731
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 Drymalla Construction Company LLC 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. Drymalla Construction Company LLC has determined that the prescription drug coverage offered by the Drymalla Construction Company LLC 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).
Important 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 Drymalla Construction Company LLC 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 Drymalla Construction Company LLC 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 979-732-5731
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 (1-800-6334227). TTY users should call 877486-2048
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
Drymalla Construction Company LLC Human Resources 608 Harbert St. Columbus TX 78934 979-732-5731
Notice of HIPAA Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Effective Date of Notice: September 23, 2013
Drymalla Construction Company LLC’s Plan is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information and to inform you about:
1. the Plan’s uses and disclosures of Protected Health Information (PHI);
2. your privacy rights with respect to your PHI;
3. the Plan’s duties with respect to your PHI;
4. your right to file a complaint with the Plan and to the Secretary of the U.S. Department of Health and Human Services; and
5. the person or office to contact for further information about the Plan’s privacy practices.
The term “Protected Health Information” (PHI) includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form (oral, written, electronic).
Section 1 – Notice of PHI Uses and Disclosures
Required PHI Uses and Disclosures
Upon your request, the Plan is required to give you access to your PHI in order to inspect and copy it.
Use and disclosure of your PHI may be required by the Secretary of the Department of Health and Human Services to investigate or determine the Plan’s compliance with the privacy regulations.
Important Notices
Uses and disclosures to carry out treatment, payment and health care operations.
The Plan and its business associates will use PHI without your authorization to carry out treatment, payment and health care operations. The Plan and its business associates (and any health insurers providing benefits to Plan participants) may also disclose the following to the Plan’s Board of Trustees: (1) PHI for purposes related to Plan administration (payment and health care operations); (2) summary health information for purposes of health or stop loss insurance underwriting or for purposes of modifying the Plan; and (3) enrollment information (whether an individual is eligible for benefits under the Plan). The Trustees have amended the Plan to protect your PHI as required by federal law.
Treatment is the provision, coordination or management of health care and related services. It also includes but is not limited to consultations and referrals between one or more of your providers.
For example, the Plan may disclose to a treating physician the name of your treating radiologist so that the physician may ask for your X-rays from the treating radiologist.
Payment includes but is not limited to actions to make coverage determinations and payment (including billing, claims processing, subrogation, reviews for medical necessity and appropriateness of care, utilization review and preauthorizations).
For example, the Plan may tell a treating doctor whether you are eligible for coverage or what percentage of the bill will be paid by the Plan.
Health care operations include but are not limited to quality assessment and improvement, reviewing competence or qualifications of health care professionals, underwriting, premium rating and other insurance activities relating to creating or renewing insurance contracts. It also includes case
management, conducting or arranging for medical review, legal services and auditing functions including fraud and abuse compliance programs, business planning and development, business management and general administrative activities. However, no genetic information can be used or disclosed for underwriting purposes.
For example, the Plan may use information to project future benefit costs or audit the accuracy of its claims processing functions.
Uses and disclosures that require that you be given an opportunity to agree or disagree prior to the use or release.
Unless you object, the Plan may provide relevant portions of your protected health information to a family member, friend or other person you indicate is involved in your health care or in helping you receive payment for your health care. Also, if you are not capable of agreeing or objecting to these disclosures because of, for instance, an emergency situation, the Plan will disclose protected health information (as the Plan determines) in your best interest. After the emergency, the Plan will give you the opportunity to object to future disclosures to family and friends.
Uses and disclosures for which your consent, authorization or opportunity to object is not required.
The Plan is allowed to use and disclose your PHI without your authorization under the following circumstances:
1. For treatment, payment and health care operations.
2. Enrollment information can be provided to the Trustees.
3. Summary health information can be provided to the Trustees for the purposes designated above.
4. When required by law.
5. When permitted for purposes of public health activities, including when necessary to report product defects and to permit product
recalls. PHI may also be disclosed if you have been exposed to a communicable disease or are at risk of spreading a disease or condition, if required by law.
6. When required by law to report information about abuse, neglect or domestic violence to public authorities if there exists a reasonable belief that you may be a victim of abuse, neglect or domestic violence. In which case, the Plan will promptly inform you that such a disclosure has been or will be made unless that notice would cause a risk of serious harm. For the purpose of reporting child abuse or neglect, it is not necessary to inform the minor that such a disclosure has been or will be made. Disclosure may generally be made to the minor’s parents or other representatives although there may be circumstances under federal or state law when the parents or other representatives may not be given access to the minor’s PHI.
7. The Plan may disclose your PHI to a public health oversight agency for oversight activities required by law. This includes uses or disclosures in civil, administrative or criminal investigations; inspections; licensure or disciplinary actions (for example, to investigate complaints against providers); and other activities necessary for appropriate oversight of government benefit programs (for example, to investigate Medicare or Medicaid fraud).
8. The Plan may disclose your PHI when required for judicial or administrative proceedings. For example, your PHI may be disclosed in response to a subpoena or discovery request.
9. When required for law enforcement purposes, including for the purpose of identifying or locating a suspect, fugitive, material witness or missing person. Also, when disclosing information about an individual who is or is suspected to be a victim of
Important Notices
a crime but only if the individual agrees to the disclosure or the Plan is unable to obtain the individual’s agreement because of emergency circumstances. Furthermore, the law enforcement official must represent that the information is not intended to be used against the individual, the immediate law enforcement activity would be materially and adversely affected by waiting to obtain the individual’s agreement and disclosure is in the best interest of the individual as determined by the exercise of the Plan’s best judgment.
10. When required to be given to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as authorized by law. Also, disclosure is permitted to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent.
11. When consistent with applicable law and standards of ethical conduct if the Plan, in good faith, believes the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to a person reasonably able to prevent or lessen the threat, including the target of the threat.
12. When authorized by and to the extent necessary to comply with workers’ compensation or other similar programs established by law.
Except as otherwise indicated in this notice, uses and disclosures will be made only with your written authorization subject to your right to revoke such authorization.
Uses and disclosures that require your written authorization.
Other uses or disclosures of your protected health information not described above will only be made with your written authorization. For example, in general and subject to specific conditions, the Plan will not use or disclose your psychiatric notes; the Plan will not use or disclose your protected health information for marketing; and the Plan will not sell your protected health information, unless you provide a written authorization to do so. You may revoke written authorizations at any time, so long as the revocation is in writing. Once the Plan receives 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.
Section 2 – Rights of Individuals
Right to Request Restrictions on Uses and Disclosures of PHI
You may request the Plan to restrict the uses and disclosures of your PHI. However, the Plan is not required to agree to your request (except that the Plan must comply with your request to restrict a disclosure of your confidential information for payment or health care operations if you paid for the services to which the information relates in full, out of pocket).
You or your personal representative will be required to submit a written request to exercise this right. Such requests should be made to the Plan’s Privacy Official.
Right to Request Confidential Communications
The Plan will accommodate reasonable requests to receive communications of PHI by alternative means or at alternative locations if necessary to prevent a disclosure that could endanger you. You or your personal representative will be required to submit a written request to exercise this right.
Such requests should be made to the Plan’s Privacy Official.
Right to Inspect and Copy PHI
You have a right to inspect and obtain a copy of your PHI contained in a “designated record set,” for as long as the Plan maintains the PHI. If the information you request is in an electronic designated record set, you may request that these records be transmitted electronically to yourself or a designated individual.
Protected Health Information (PHI)
Includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form.
Designated Record Set
Includes the medical records and billing records about individuals maintained by or for a covered health care provider; enrollment, payment, billing, claims adjudication and case or medical management record systems maintained by or for the Plan; or other information used in whole or in part by or for the Plan to make decisions about individuals. Information used for quality control or peer review analyses and not used to make decisions about individuals is not in the designated record set.
The requested information will be provided within 30 days if the information is maintained on site or within 60 days if the information is maintained off site. A single 30-day extension is allowed if the Plan is unable to comply with the deadline.
You or your personal representative will be required to submit a written request to request access to the PHI in your designated record set. Such requests should be made to the Plan’s Privacy Official.
If access is denied, you or your personal representative will be provided with a written denial, setting forth the basis for the denial, a description of how you may appeal the Plan’s decision and a description of how you may complain to the Secretary of the U.S. Department of Health and Human Services.
Important Notices
The Plan may charge a reasonable, costbased fee for copying records at your request.
Right to Amend PHI
You have the right to request the Plan to amend your PHI or a record about you in your designated record set for as long as the PHI is maintained in the designated record set.
The Plan has 60 days after the request is made to act on the request. A single 30-day extension is allowed if the Plan is unable to comply with the deadline. If the request is denied in whole or part, the Plan must provide you with a written denial that explains the basis for the denial. You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of your PHI. Such requests should be made to the Plan’s Privacy Official.
You or your personal representative will be required to submit a written request to request amendment of the PHI in your designated record set.
Right to Receive an Accounting of PHI Disclosures
At your request, the Plan will also provide you an accounting of disclosures by the Plan of your PHI during the six years prior to the date of your request. However, such accounting will not include PHI disclosures made: (1) to carry out treatment, payment or health care operations; (2) to individuals about their own PHI; (3) pursuant to your authorization; (4) prior to April 14, 2003; and (5) where otherwise permissible under the law and the Plan’s privacy practices. In addition, the Plan need not account for certain incidental disclosures.
If the accounting cannot be provided within 60 days, an additional 30 days is allowed if the individual is given a written statement of the reasons for the delay and the date by which the accounting will be provided.
If you request more than one accounting within a 12-month period, the Plan will charge a reasonable, cost-based fee for each subsequent accounting.
Such requests should be made to the Plan’s Privacy Official.
Right to Receive a Paper Copy of This Notice Upon Request
You have the right to obtain a paper copy of this Notice. Such requests should be made to the Plan’s Privacy Official.
A Note About Personal Representatives
You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your PHI or allowed to take any action for you. Proof of such authority may take one of the following forms:
1. a power of attorney for health care purposes;
2. a court order of appointment of the person as the conservator or guardian of the individual; or
3. an individual who is the parent of an unemancipated minor child may generally act as the child’s personal representative (subject to state law).
The Plan retains discretion to deny access to your PHI by a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect.
Section 3 – The Plan’s Duties
The Plan is required by law to maintain the privacy of PHI and to provide individuals (participants and beneficiaries) with notice of the Plan’s legal duties and privacy practices.
This Notice is effective September 23, 2013, and the Plan is required to comply with the terms of this Notice. However, the Plan reserves the right to change its privacy practices and to apply the changes to any PHI received or
maintained by the Plan prior to that date. If a privacy practice is changed, a revised version of this Notice will be provided to all participants for whom the Plan still maintains PHI. The revised Notice will be distributed in the same manner as the initial Notice was provided or in any other permissible manner.
If the revised version of this Notice is posted, you will also receive a copy of the Notice or information about any material change and how to receive a copy of the Notice in the Plan’s next annual mailing. Otherwise, the revised version of this Notice will be distributed within 60 days of the effective date of any material change to the Plan’s policies regarding the uses or disclosures of PHI, the individual’s privacy rights, the duties of the Plan or other privacy practices stated in this Notice.
Minimum Necessary Standard
When using or disclosing PHI or when requesting PHI from another covered entity, the Plan will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations. When required by law, the Plan will restrict disclosures to the limited data set, or otherwise as necessary, to the minimum necessary information to accomplish the intended purpose.
However, the minimum necessary standard will not apply in the following situations:
1. disclosures to or requests by a health care provider for treatment;
2. uses or disclosures made to the individual;
3. disclosures made to the Secretary of the U.S. Department of Health and Human Services;
4. uses or disclosures that are required by law; and
5. uses or disclosures that are required for the Plan’s compliance with legal regulations.
Important Notices
De-Identified Information
This notice does not apply to information that has been de-identified. De-identified information is information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual.
Summary Health Information
The Plan may disclose “summary health information” to the Trustees for obtaining insurance premium bids or modifying, amending or terminating the Plan. “Summary health information” summarizes the claims history, claims expenses or type of claims experienced by participants and excludes identifying information in accordance with HIPAA.
Notification of Breach
The Plan is required by law to maintain the privacy of participants’ PHI and to provide individuals with notice of its legal duties and privacy practices. In the event of a breach of unsecured PHI, the Plan will notify affected individuals of the breach.
Section 4 – Your Right to File a Complaint With the Plan or the HHS Secretary
If you believe that your privacy rights have been violated, you may complain to the Plan. Such complaints should be made to the Plan’s Privacy Official.
You may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, D.C. 20201. The Plan will not retaliate against you for filing a complaint.
Section 5 – Whom to Contact at the Plan for More Information
If you have any questions regarding this notice or the subjects addressed in it, you may contact the Plan’s Privacy Official. Such questions should be directed to the Plan’s Privacy Official at:
Drymalla
Construction Company LLC
Human Resources
608 Harbert St. Columbus TX 78934
979-732-5731
Conclusion
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare. gov
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272)
If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, 2025. Contact your State for more information on eligibility. Alabama – Medicaid
To see if any other States have added a premium assistance program since July 31, 2025, 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 Drymalla Construction Company LLC group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Drymalla Construction Company LLC plan after you have left employment with the company. COBRA benefits are administered by iSolved. All required notices will be sent directly to eligible members from iSolved and will include contact information, deadlines to elect coverage, and instructions for paying the initial premium. If you have questions or need additional assistance regarding COBRA, please contact Human Resources.
Plan Contact Information
Drymalla Construction Company LLC Human Resources 608 Harbert St. Columbus TX 78934 979-732-5731
Important 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 outof-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-ofnetwork providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an innetwork 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 in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care 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-ofnetwork 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 out-ofnetwork services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/nosurprises for more information about your rights under federal law.
This brochure highlights the main features of the Drymalla Construction Company LLC 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. Drymalla Construction Company LLC reserves the right to change or discontinue its employee benefits plans anytime.
