2026 Ford Audio-Video Benefit Guide

IMPORTANT CONTACTS

WELCOME

We are pleased to offer a full benefits package to help protect your well-being and financial health. Read this guide to learn about the benefits available to you and your eligible dependents starting January 1, 2026.

Each year during Open Enrollment, you may make changes to your benefit plans. The benefit choices you make this year will remain in effect through December 31, 2026. Take time to review these benefit options and select the plans that best meet your needs. After Open Enrollment, you may only make changes to your benefit elections if you have a Qualifying Life Event.

ELIGIBILITY

WHO IS ELIGIBLE FOR BENEFITS

STATUS NEW HIRE

• Regular, full-time employee

Eligibility

Enrollment

Coverage Begins

• Working an average of 30 hours per week

• Enroll by the deadline given by Human Resources

• Your coverage is effective the first of the month following 60 days of employment

QUALIFYING LIFE EVENTS

EMPLOYEE

• 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)

• OE: Start of the plan year

• QLE: Ask Human Resources

DEPENDENT(S)

• Your legal spouse

• Child(ren) under age 26, regardless of student, dependency, or marital status

• Child(ren) over age 26 who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return

• You must enroll the dependent(s) during OE or for a QLE

• When covering dependents, you must enroll for and be on the same plans

• Based on OE or QLE effective dates

Notify Human Resources within 30 days of the event. You may only change coverage during the plan year if you have a Qualifying Life Event, such as:

Gain or

Change in employment status affecting benefits

Significant change in cost of spouse’s coverage

MEDICAL COVERAGE

For all our employees except those who live in Hawaii, the medical plan options through Assured Benefits Administrators, utilizing the UnitedHealthcare Choice Plus Network, protect you and your family from major financial hardship in the event of illness or injury. You have a choice of three plans:

„ Buy-Down Plan – This plan has a $3,500 Individual/$10,500 Family in-network deductible.

„ Base Plan – This plan has a $2,000 Individual/$6,000 Family in-network deductible.

„ Buy-Up Plan – This plan has a $1,000 Individual/$3,000 Family in-network deductible.

PREFERRED PROVIDER ORGANIZATION (PPO)

The UnitedHealthcare Choice (UHC) Plus Network offers the freedom to see any contracted provider when you need care. When using the UHC Choice Plus Network, all office visits, urgent care visits, and prescription drugs are covered under a copay and apply to your annual out-of-pocket maximum.

HAWAII MEDICAL PLAN

If you live in Hawaii, please see page 14

FIND AN IN-NETWORK PROVIDER

Visit www.whyuhc.com/uhss

ABA MEMBER PORTAL

The ABA portal is the secure member website where you can:

ƒ Check claim status or history

ƒ Confirm dependent eligibility

ƒ Sign up for electronic EOBs (Explanation of Benefits)

ƒ Print or request an ID card

ƒ Review your benefits

To get started, log in at www.abadmin.com and use the information on your ID card to complete the registration process.

MEDICAL BENEFITS SUMMARY

Not available in Hawaii.

BUY-DOWN PLAN – $3,500 DEDUCTIBLE

Retail Prescription Drugs (up to a 30-day supply)

• Generic

• Brand

• Non-Preferred Brand

• Specialty

Mail Order Prescription Drugs (up to a 90-day supply)

• Preferred Generic

• Non-Preferred Generic

• Brand

•

* The amount you pay after the deductible has been met.

MEDICAL BENEFITS SUMMARY

Not available in Hawaii.

BASE PLAN – $2,000 DEDUCTIBLE

•

•

•

•

•

•

* The amount you pay after the deductible has been met.

MEDICAL BENEFITS SUMMARY

Not available in Hawaii.

BUY-UP PLAN – $1,000 DEDUCTIBLE

• Generic

• Brand

• Non-Preferred Brand

• Specialty

•

•

•

•

* The amount you pay after the deductible has been met.

PRESCRIPTION DRUGS

Not Available in Hawaii.

Prescription drug coverage is provided through ProCare Rx

PROCARE RX EDGE – SPECIALTY DRUGS

ProCare Rx EDGE is a concierge, high-touch program that proactively addresses specialty drug utilization and is designed to help mitigate your specialty drug costs. A licensed, multi-disciplinary clinical team will help you communicate with your prescribing physician from the prior authorization process to the resolution of copay assistance.

OVER-THE-COUNTER MEDICATIONS

If you currently take a prescription acid reflux or allergy medication, talk to your physician about using an Over-the-Counter (OTC) treatment instead. You can receive certain OTC medications for a $0 copay using the ProCare Rx EDGE OTC program. If your physician believes an OTC alternative is right for you:

„ Ask for a pharmacy prescription

„ Present the prescription to your pharmacist

„ Pay $0 for the OTC medication

NEW MEMBER PORTAL

The member portal is an easy-to-use, online tool that allows you to review your prescription claims history or individual prescriptions, view your year-to-date prescription expenses, locate pharmacies, and much more. To register, visit www.procarerx.com.

If you are a new user, you will need to register in order to use the member portal. Your insurance card will list the information needed to complete your initial registration. Once your registration is complete, you will be able to log in with your secure username and password.

For more information or to see a complete OTC medication list, visit www.procarerx.com or call 800-311-3446

PROCARE RX EDGE PERSONAL IMPORTATION PROGRAM

The Personal Importation Program (PIM) is an opt-in, mail-order prescription program that provides you with significant savings, including refilling select brand and specialty medications at a $0 copay! One of ProCare Rx EDGE’s patient navigators will work with you and your covered dependent(s) to secure medications under the program. Get started by calling 888-999-0113.

TELEMEDICINE

Not Available in Hawaii.

Your medical coverage offers telemedicine services through Lyric. You may connect anytime with a boardcertified doctor via your mobile device or computer at little to no cost.

WHEN TO USE LYRIC

While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:

„ Have a non-emergency issue and are considering an after-hours health care clinic, urgent care clinic, or emergency room for treatment

„ Are on a business trip, vacation, or away from home

„ Are unable to see your primary care physician

Use telemedicine services for minor conditions such as:

„ Sore throat

„ Headache

„ Stomachache

„ Cold

„ Flu

„ Allergies

„ Fever

„ Urinary tract infections

Do not use telemedicine for serious or life-threatening emergencies.

REGISTRATION IS EASY

Register with Lyric so you are ready to use this valuable service when you need it.

„ Online – https://portal.getlyric.com/

„ Phone – 866-223-8831

„ Mobile – Download the mobile app.

TRINITY CARE PATIENT NAVIGATOR

Not Available in Hawaii.

Health care is confusing and finding the right care for the best cost is not easy. This is why Ford AV offers Trinity Care as your personal health care advocate. Your Trinity Care advocate will:

„ Help you find providers for a variety of services at no cost to you.

„ Navigate treatment options, coordinate care, and access necessary resources. You pay nothing for a scheduled service or procedure through Trinity Care.

„ Explain benefits, claims, medical terms, billing, and more.

„ Arrange second opinions

CONTACT PATIENT NAVIGATOR TO GET STARTED

Call: 423-TCG-CARE (423-824-2273)

Email: free@tcnavigator.com

Members enrolled in one of our plans receive additional benefits through our concierge service, Trinity Care – Patient Navigator. You can receive a variety of services at no additional cost. These include:

„ Free Surgeries1

„ Free Imaging2 (X-rays, MRIs, ultrasounds, and more)

„ Free Colonoscopies and Mammograms

„ Free Physical Therapy

„ Free Durable Medical Equipment

„ Free Infusion Therapy

„ Maternity Program – Free Diapers and Wipes For a Year as participation incentive

1Call Patient Navigator to verify the surgery is covered under the program and your dedicated concierge representative will walk you through the process.

2For these services to be covered at 100%, you must contact Patient Navigator prior to any services being rendered and follow the appropriate process.

CANCERCARE

Not Available in Hawaii.

CancerCARE is available at no cost to you. This program is offered by Interlink Health and ensures that you receive the best possible care if you or a covered family member are diagnosed with cancer. CancerCARE provides access to cancer experts who can answer questions about your diagnosis, treatment, and any potential side effects. They will guide you through your treatment process and all available resources, including a triage center, nurse care management and access to Centers of Excellence networks.

Working closely with your physician, CancerCARE employees ensure that you receive evidencebased care with tested and proven results. The CancerCARE team supports and educates you throughout your treatment.

FOR ASSISTANCE AND TO LEARN MORE

Call your Trinity Care team at 423-824-2273.

HAWAII MEDICAL PLAN

If you live in Hawaii, you have a single plan option through Kaiser Permanente:

„ Kaiser HMO Plan (Hawaii only) – This plan has a $2,500 individual and a $7,500 family out-ofpocket maximum.

HEALTH MAINTENANCE ORGANIZATION (HMO) (HAWAII ONLY)

With an HMO plan, you must seek care from innetwork providers in the Kaiser Permanente HMO network. The selection of a primary care provider is required, and you need a referral to see a specialist. Always confirm that your doctors and specialists are in-network before seeking care.

KAISER PERMANENTE MEMBER PORTAL

Visit www.kp.org, the secure member website where you can:

ƒ Check the status of claims and your claim history

ƒ Confirm dependent eligibility

ƒ View and print Explanation of Benefits (EOB) forms

ƒ Locate in-network providers

ƒ Print or request an ID card

To get started, log on to www.kp.org and use the information on your ID card to complete the registration process.

MOBILE APP

The Kaiser Permanente mobile app can help you stay organized and in control of your health anytime, anywhere. Log in from your mobile device to access your account, including:

FIND A PROVIDER

To find a list of preferred providers, visit www.kp.org or call 800-966-5955.

ƒ Track account balances and deductibles

ƒ Access ID card information

ƒ Find doctors, dentists, and pharmacies Visit www.kp.org/mobile to download the app.

HAWAII MEDICAL PLAN SUMMARY

KAISER HMO PLAN (HAWAII ONLY)

Year Deductible

•

PRESCRIPTION COVERAGE

Retail Prescription Drugs (up to a 30-day supply)

• Preferred Generic

• Non-Preferred Generic

• Preferred Brand Name

• Non-Preferred Brand Name

• Specialty

Mail Order Prescription Drugs (up to a 90-day supply)

• Preferred Generic

• Non-Preferred Generic

• Preferred Brand Name

• Non-Preferred Brand Name

1Out-of-Network coverage is available for this plan. See the plan summary for full details.

2The amount you pay after the deductible has been met.

HAWAII MEDICAL PLAN RESOURCES

If you are enrolled in the Hawaii HMO medical plan, the following benefits are available to you through Kaiser Permanente

VIRTUAL VISITS

Virtual visits provided by Kaiser Permanente make it easy for you to get the treatment you need when you need it. Whether it’s access to your doctor via email for non-emergency issues or in-person visits, you can connect to care, your way – anytime:

„ Online tools and mobile app

„ 24/7 advice and care guidance

„ Email

„ Video visits

„ E-visits

„ In-person visits

Plus, get rewarded up to $200 through fitness and online wellness programs. To learn more or enroll, use the links below.

Virtual visits – www.kp.org

Fit Rewards – www.kp.org/fitrewards

Wellness Programs – www.kp.org/healthylifestyles

HOME DELIVERY PHARMACY SERVICE

Thrive by Kaiser Permanente is a convenient, costeffective way to fill prescriptions online.

In just three easy steps, get your prescriptions delivered right where you are:

„ Sign in at www.kp.org, or download the KP app

„ Select and pay for your prescriptions

„ Confirm your mail order

ON-DEMAND SELF CARE

Access 24/7 support for anxiety, stress, sleep, mood, and more with two evidence-based self-care apps.

Calm: The top app for meditation and sleep, featuring hundreds of guided meditations, sleep stories, and mindful movement videos.

Headspace Care (formerly Ginger): Provides 1:1 emotional support coaching and self-care activities to address common challenges, with coaches available via text anytime — no cost or referral required.

DENTAL COVERAGE

Mutual of Omaha dental coverage can help you maintain strong oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions for dental coverage will be deducted from your paycheck on a pretax basis.

Our dental plans use the Mutually Preferred Dental Network of providers. These plans feature identical coinsurance rates for in-network and out-of-network services. Dental fees are based on a negotiated fee schedule — the contracted rates between Mutual of Omaha and the provider. If you receive services from out-of-network dentists, you will be responsible for the difference between the negotiated fee and the dentist’s billed charge.

IN-NETWORK OR OUT-OF-NETWORK PROVIDERS

As a participant in either dental plan, you will receive benefits for seeing any in-network or out-of-network dentist. However, using in-network Mutual of Omaha dentists will save you money. Out-of-network dentists are not obligated to accept discounted fees. To find an in-network Mutual of Omaha dentist, log in at www.mutualofomaha.com or call Member Services at 800-775-6000

MUTUAL OF OMAHA ROLLOVER PROGRAM

If you are a dental plan member, you will automatically be enrolled in Mutual of Omaha’s Benefits Rollover Program. If you have at least one cleaning and one exam in a policy year but spend less than 50% of the policy year maximum benefit, you can roll over 25% of the policy year maximum benefit to the next year. Your rollover can be used in future years if you reach the plan’s annual maximum. Leftover award balances carry over to the next benefit period. Once your account grows to two times the policy maximum benefit, no additional funds will be placed in your MRA. You and your insured dependents maintain separate MRAs based on your claim activity.

HOW TO FIND A DENTIST

Visit www.mutualofomaha.com or call Member Services at 800-775-6000 to find an in-network dentist.

DENTAL PLAN SUMMARY

MUTUAL OF OMAHA DENTAL PLANS

1You will be reimbursed up to the Maximum Allowable Charge (MAC) for services received from an out-of-network dentist. You are responsible for charges in excess of the MAC.

2Payment for covered services received from an out-of-network dentist is based on the 90th percentile of Usual, Customary, and Reasonable (UCR) charges.

3The amount you pay after the deductible is met. Refer to the Mutual of Omaha Patient Charge schedule for details.

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. You may seek care from any licensed optometrist, ophthalmologist, or optician, but plan benefits are better if you use an in-network provider. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Mutual of Omaha using the EyeMed Insight network of providers.

HOW TO FIND A VISION PROVIDER

Visit www.mutualofomaha.com or call 800-775-8805 to find an in-network vision provider.

• Single Vision

• Bifocals

• Trifocals • Lenticular

Contacts (In lieu of eyeglasses)

Fitting and evaluation

• Conventional

FLEXIBLE SPENDING ACCOUNT

A Flexible Spending Account (FSA) allows you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health care expenses. Higginbotham is our FSA plan administrator.

HEALTH CARE FSA

The Health Care FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. You may contribute up to $3,400 annually to a Health Care FSA, and you are entitled to the full election from day one of your plan year. Eligible expenses include:

„ Dental and vision expenses

„ Medical deductibles and coinsurance

„ Prescription copays

„ Hearing aids and batteries

You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).

Higginbotham Benefits Debit Card

The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay for anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).

HOW THE HEALTH CARE FSA WORKS

You can access the funds in your Health Care FSA two different ways:

ƒ Use your Higginbotham Benefits Debit Card to pay for qualified expenses, doctor visits, and prescription copays.

ƒ Pay out-of-pocket, and submit your receipts for reimbursement:

ƒ Fax – 866-419-3516

ƒ Email – flexclaims@higginbotham.net

ƒ Online –https://flexservices.higginbotham.net

IMPORTANT FSA RULES

ƒ The maximum per plan year you can contribute to a Health Care FSA is $3,400.

ƒ You cannot change your election during the year unless you experience a Qualifying Life Event.

ƒ You can continue to file claims incurred during the plan year for another 75 days (up until March 16).

ƒ Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.

HIGGINBOTHAM PORTAL

The Higginbotham Portal provides information and resources to help you manage your FSA to:

ƒ Access plan documents, letters and notices, forms, account balances, contributions, and other plan information.

ƒ Update your personal information.

ƒ Look up qualified expenses.

ƒ Submit claims.

Register on the Higginbotham Portal

Visit https://flexservices.higginbotham.net and click Get Started. Follow the instructions and scroll down to enter your information.

ƒ Enter your Employee ID, which is your Social Security number with no dashes or spaces.

ƒ Follow the prompts to navigate the site.

ƒ If you have any questions or concerns, contact Higginbotham:

ƒ Phone – 866-419-3519

ƒ Email – flexclaims@higginbotham.net

ƒ Fax – 866-419-3516

HEALTH CARE FSA

Eligible Expenses

A list of qualified expenses can be found on the IRS website at www.irs.gov. Most medical, dental, and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses, and doctorprescribed over-the-counter medications)

Contribution Limits

Benefit

$3,400

Saves on eligible expenses not covered by insurance; reduces your taxable income

Higginbotham Flex Mobile App

Easily access your Health Care FSA on your smartphone or tablet with the Higginbotham mobile app. Search for Higginbotham in your mobile device’s app store and download as you would any other app.

„ View Accounts – See detailed account and balance information.

„ Card Activity – View debit card activity.

„ SnapClaim – File a claim and upload receipt photos directly from your smartphone.

„ Manage Subscriptions – Set up email notifications to keep up-to-date on all account and Health Care FSA debit card activity.

Log in using the same username and password you use to log in to the Higginbotham Portal. Note: You must register on the Higginbotham Portal to use the mobile app.

LIFE AND AD&D INSURANCE

Life and Accidental Death and Dismemberment (AD&D) insurance through Mutual of Omaha are important parts of your financial security, especially if others depend on you for support. With Life insurance, your beneficiary(ies) can use the coverage to pay off your debts, such as credit cards, mortgages, and other final expenses. AD&D coverage provides specified benefits for a covered accidental bodily injury that causes dismemberment (e.g., the loss of a hand, foot, or eye). In the event that death occurs from an accident, 100% of the AD&D benefit would be payable to your beneficiary(ies). As you grow older, your Life and AD&D coverage amount reduces by 35% at age 65 and 50% at age 70.

BASIC LIFE AND AD&D

Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at $25,000 for each benefit.

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.

MUTUAL OF OMAHA LIFE AND AD&D INSURANCE

• Increments of $10,000, 5 times annual salary up to $500,000

Employee

Spouse

Child(ren)

• New Hire Guaranteed Issue: 5 times annual salary up to $150,000

• Increments of $5,000 up to $100,000 not to exceed 100% of employee amount

• New Hire Guaranteed Issue: 100% of employee amount up to $30,000

• Increments of $1,000 up to $10,000

• Birth to 14 days - $1,000

• 14 days to Age 26 - $10,000

• Guaranteed Issue: 100% of employee amount

During this Open Enrollment period, employees with current Life and AD&D insurance can elect an additional $10,000 (not to exceed the $150,000 guaranteed issue amount without providing health information).

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. Ford AV offers Short Term Disability (STD) insurance for you to purchase through Mutual of Omaha

SHORT TERM DISABILITY INSURANCE

STD coverage pays a percentage of your weekly salary for up to 12 weeks if you are temporarily disabled and unable to work due to an illness, non-work-related injury, or pregnancy. STD benefits are not payable if the disability is due to a job-related injury or illness.

SHORT TERM DISABILITY

*Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for six months. Waived for new hires and initial Open Enrollment.

401(k) PLAN

A 401(k) plan can be a powerful tool to help you be financially secure in retirement. Our 401(k) plan through Fidelity can help you reach your investment goals.

HOW THE RETIREMENT PLAN WORKS

You are eligible to participate in the plan if you are age 18 or older and are a full-time employee. You may enroll in the plan in the months of January or July following your one-year anniversary, and you may contribute up to the 2026 IRS limit ($24,500 plus an additional $8,000 catch-up contribution if you are age 55 or older).

You decide how much you want to contribute and can change your contribution amount anytime. The company will make a matching contribution equal to $.50 for each $1.00 that you defer, up to a maximum deferral of 5% of your compensation. You may roll over eligible funds into the plan after you have satisfied enrollment qualifications and have enrolled in the plan. All changes are effective as soon as administratively feasible and remain in effect until you update or stop your contributions. You also decide how to invest the assets in your account and may change your investment choices anytime. For more details, refer to your 401(k) Enrollment Guide or contact Fidelity at 800-343-3548

ENROLLMENT

You must enroll through Fidelity at https://nb.fidelity.com/public/nb/401k/home or by calling 800-343-3548

VESTING

You are always 100% vested in your own contributions. You are 100% vested in matching company contributions after six years of service.

401(k) VESTING SCHEDULE

An enrollment email with plan details, documents, and instructions will be sent the month prior to your eligibility. You will not be able to enroll or access your company account on Fidelity until you receive your invitation.

INVESTMENT OPTIONS

You may direct your contributions to any of the investments offered within the company 401(k) plan. Changes to your investments can be made by calling 800-343-3548.

EMPLOYEE ASSISTANCE PROGRAM

As a Mutual of Omaha member, the Employee Assistance Program (EAP) is available to you and your eligible dependents at no cost to you.

The EAP is a confidential program to help you find solutions for personal or workplace issues. Benefits for you and your eligible dependents include access to more than 10,000 licensed clinical providers for face-to-face counseling, and unlimited telephone access to more than 30,000 EAP professionals, supporting more than 120 languages. Professionals are available 24/7 to help with the following:

„ Stress or depression

„ Financial issues

„ Family and relationship issues

„ Addiction

„ Grief issues

„ Parenting and eldercare

„ Legal services

„ Financial services

„ Child- and eldercare resources and referrals

„ Coordination of health plans

„ Other personal concerns

For assistance, call 800-316-2796 or visit www.mutualofomaha.com/eap. More online resources are available on the website.

HOLIDAY/PTO SCHEDULE

HOLIDAYS

Ford is fully committed to a diverse and inclusive community, including religious diversity. We are fortunate to have members of diverse cultures and religions among our organization. To foster an inclusive environment, Ford employees are reminded to be respectful of the religious and cultural diversity of our employees, customers, and vendors, and are encouraged to use an inclusive approach in celebrating the holiday season. It is often easy for well-intentioned individuals to inadvertently offend coworkers at this time of year, especially since most of us have not had frequent interactions with people of different faiths and nationalities and may not be aware of others’ traditions or beliefs. In the month of December, there are many religious holidays observed.

The company recognizes these holidays:

„ New Year’s Day

„ Memorial Day

„ Independence Day

„ Labor Day

„ Thanksgiving Day

„ Day after Thanksgiving

„ Christmas Day

PAID TIME OFF (PTO)

PTO accruals begin upon employment.

Hourly (FLSA Non-exempt)

PTO is available to use upon accrual.

Salaried (FLSA Exempt)

PTO is available to use upon accrual.

Holiday Pay Eligibility

ƒ Hourly (FLSA non-exempt): You must have completed 30 days of service to be eligible for Holiday Pay.

ƒ Salaried (FLSA exempt): You are eligible for Holiday pay immediately.

2026 EMPLOYEE CONTRIBUTIONS

REQUIRED 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:

Ford Audio-Video Systems, LLC

Human Resources

4800 W I-40 Service Road Oklahoma City, OK 73128 405-945-2060

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 Ford Audio-Video Systems, 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. Ford Audio-Video Systems, LLC has determined that the prescription drug coverage offered by the Ford AudioVideo Systems, 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.

REQUIRED NOTICES

Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods. You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).

You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Ford Audio-Video Systems, 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 Ford Audio-Video Systems, 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 405-945-2060.

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 800325-0778

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 Ford Audio-Video Systems, LLC Human Resources 4800 W I-40 Service Road Oklahoma City, OK 73128 405-945-2060

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 Ford Audio-Video Systems, LLC 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.

REQUIRED NOTICES

We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA.

The HIPAA Privacy Rule protects only certain medical information known as “protected health information.”

Generally, protected health information (PHI) is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to:

1. Your past, present, or future physical or mental health or condition;

2. The provision of health care to you; or

3. The past, present, or future payment for the provision of health care to you.

I. Contact Information

If you have any questions about this Notice or about our privacy practices, and for any correspondence or requests related to the contents of this Notice, please contact:

Ford Audio-Video Systems, LLC

Human Resources

4800 W I-40 Service Road Oklahoma City, OK 73128 405-945-2060

II. Effective Date

This Notice is effective February 15, 2026.

III. Our Responsibilities

We are required by law to:

1. maintain the privacy of your PHI;

2. provide you with certain rights with respect to your PHI;

3. provide you with a copy of this Notice of our legal duties and privacy practices with respect to your PHI; and

4. follow the terms of the Notice that is currently in effect. We reserve the right to change the terms of this Notice and to make new provisions regarding your PHI that we maintain, as allowed or required by law. If we make any material change to this Notice, we will provide you with a copy of our revised Notice of Privacy Practices.

IV. How We May Use and Disclose Your PHI

Under the law, we may use or disclose your PHI under certain circumstances without your permission. The following categories describe the different ways that we may use and disclose your PHI. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed.

However, all of the ways we are permitted to use and disclose information will fall within one of the categories. Note that we will use and disclose PHI as described below unless otherwise prohibited or restricted by applicable state or other law, and that information can lose its protected status as PHI once redisclosed by a recipient.

For Treatment. When and as appropriate, we may use or disclose medical information about you to facilitate medical treatment or services by health care providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you.

For example, we might disclose information about you with physicians who are treating you.

For Payment. We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary, or to determine whether the Plan will cover the treatment. We may also share your protected health information with a utilization review or pre-certification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.

For Health Care Operations. We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information in connection with conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or 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

REQUIRED NOTICES

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;

REQUIRED NOTICES

4. about a death that we believe may be the result of criminal conduct; and 5. about criminal conduct.

Coroners, Medical Examiners, and Funeral Directors. We may release PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors, as necessary to carry out their duties.

National Security and Intelligence Activities. We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Inmates. If you are an inmate of a correctional institution or are in the custody of a law-enforcement official, we may disclose your PHI to the correctional institution or law-enforcement official if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Research. We may disclose your PHI to researchers when: 1. The individual identifiers have been removed; or 2. When an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of the requested information and approves the research.

VI. Required Disclosures

The following is a description of disclosures of your PHI we are required to make.

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.

REQUIRED NOTICES

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.

REQUIRED NOTICES

PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-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 Premium Payment Program

Website: http://myakhipp.com/ Phone: 1-866-251-4861

Email: CustomerService@MyAKHIPP.com

Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/ default.aspx

ARKANSAS –

MEDICAID

Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)

CALIFORNIA– MEDICAID

Health Insurance Premium Payment (HIPP) Program

Website: http://dhcs.ca.gov/hipp Phone: 916-445-8322

Fax: 916-440-5676

Email: hipp@dhcs.ca.gov

COLORADO – HEALTH FIRST COLORADO (COLORADO’S MEDICAID PROGRAM) AND CHILD HEALTH PLAN PLUS (CHP+)

Health First Colorado website: https://www. healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-2213943/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/healthinsurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1

GA CHIPRA Website: https://medicaid.georgia.gov/ programs/third-party-liability/childrens-health-insuranceprogram-reauthorization-act-2009-chipra Phone: 678-564-1162, Press 2

INDIANA – MEDICAID

Health Insurance Premium Payment Program

All other Medicaid Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr/ Family and Social Services Administration Phone: 1-800-403-0864

Member Services Phone: 1-800-457-4584

IOWA – MEDICAID AND CHIP (HAWKI)

Medicaid Website: https://hhs.iowa.gov/programs/ welcome-iowa-medicaid

Medicaid Phone: 1-800-338-8366

Hawki Website: https://hhs.iowa.gov/programs/welcomeiowa-medicaid/iowa-health-link/hawki

Hawki Phone: 1-800-257-8563

HIPP Website: https://hhs.iowa.gov/programs/welcomeiowa-medicaid/fee-service/hipp

HIPP Phone: 1-888-346-9562

REQUIRED NOTICES

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

MAINE – MEDICAID

Enrollment Website: https://www.mymaineconnection.gov/ benefits/s/?language=en_US

Phone: 1-800-442-6003

TTY: Maine relay 711

Private Health Insurance Premium Webpage: https://www. maine.gov/dhhs/ofi/applications-forms

Phone: 1-800-977-6740

TTY: Maine Relay 711

MASSACHUSETTS – MEDICAID AND CHIP

Website: https://www.mass.gov/masshealth/pa

Phone: 1-800-862-4840

TTY: 711

Email: masspremassistance@accenture.com

MINNESOTA – MEDICAID

Website: https://mn.gov/dhs/health-care-coverage/ Phone: 1-800-657-3672

MISSOURI – MEDICAID

Website: http://www.dss.mo.gov/mhd/participants/pages/ hipp.htm

Phone: 573-751-2005

MONTANA – MEDICAID

Website: https://dphhs.mt.gov/ MontanaHealthcarePrograms/HIPP

Phone: 1-800-694-3084

Email: HHSHIPPProgram@mt.gov

NEBRASKA – MEDICAID

Website: http://www.ACCESSNebraska.ne.gov

Phone: 1-855-632-7633

Lincoln: 402-473-7000 Omaha: 402-595-1178

NEVADA – MEDICAID

Medicaid Website: http://dhcfp.nv.gov

Medicaid Phone: 1-800-992-0900

NEW HAMPSHIRE – MEDICAID

Website: https://www.dhhs.nh.gov/programs-services/ medicaid/health-insurance-premium-program Phone: 603-271-5218

Toll free number for the HIPP program: 1-800-852-3345, ext. 15218

Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov NEW JERSEY – MEDICAID AND CHIP

Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Phone: 1-800-356-1561

CHIP Premium Assistance Phone: 609-631-2392

CHIP Website: http://www.njfamilycare.org/index.html

CHIP Phone: 1-800-701-0710 (TTY: 711)

NEW YORK – MEDICAID

Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831

NORTH CAROLINA – MEDICAID

Website: https://medicaid.ncdhhs.gov Phone: 919-855-4100

NORTH DAKOTA – MEDICAID

Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825

OKLAHOMA – MEDICAID AND CHIP

Website: http://www.insureoklahoma.org Phone: 1-888-365-3742

OREGON – MEDICAID

Website: https://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075

REQUIRED NOTICES

PENNSYLVANIA – MEDICAID AND CHIP

Website: https://www.pa.gov/en/services/dhs/apply-formedicaid-health-insurance-premium-payment-programhipp.html

Phone: 1-800-692-7462

CHIP Website: https://www.dhs.pa.gov/chip/pages/chip. aspx

CHIP Phone: 1-800-986-KIDS (5437)

RHODE ISLAND – MEDICAID AND CHIP

Website: http://www.eohhs.ri.gov/

Phone: 1-855-697-4347 or 401-462-0311 (Direct RIte Share Line)

SOUTH CAROLINA – MEDICAID

Website: https://www.scdhhs.gov

Phone: 1-888-549-0820

SOUTH DAKOTA - MEDICAID

Website: https://dss.sd.gov

Phone: 1-888-828-0059

TEXAS – MEDICAID

Website: https://www.hhs.texas.gov/services/financial/ health-insurance-premium-payment-hipp-program

Phone: 1-800-440-0493

UTAH – MEDICAID AND CHIP

Utah’s Premium Partnership for Health Insurance (UPP)

Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov

Phone: 1-888-222-2542

Adult Expansion Website: https://medicaid.utah.gov/ expansion/

Utah Medicaid Buyout Program Website: https://medicaid. utah.gov/buyout-program/ CHIP Website: https://chip.utah.gov/

VERMONT– MEDICAID

Website: https://dvha.vermont.gov/members/medicaid/ hipp-program

Phone: 1-800-250-8427

VIRGINIA – MEDICAID AND CHIP

Website: https://coverva.dmas.virginia.gov/learn/premiumassistance/famis-select https://coverva.dmas.virginia.gov/learn/premiumassistance/health-insurance-premium-payment-hippprograms

Medicaid/CHIP Phone: 1-800-432-5924

WASHINGTON – MEDICAID

Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022

WEST VIRGINIA – MEDICAID AND CHIP

Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700

CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699- 8447)

WISCONSIN – MEDICAID AND CHIP

Website: https://www.dhs.wisconsin.gov/ badgercareplus/p-10095.htm Phone: 1-800-362-3002

WYOMING – MEDICAID

Website: https://health.wyo.gov/healthcarefin/medicaid/ programs-and-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 Ford Audio-Video Systems, LLC group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Ford Audio-Video Systems, LLC 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

Ford Audio-Video Systems, LLC

Human Resources 4800 W I-40 Service Road Oklahoma City, OK 73128 405-945-2060

REQUIRED NOTICES

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-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-ofnetwork 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, outof-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-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.

NEW HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS AND YOUR HEALTH COVERAGE

PART A: General Information

Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options in your geographic area.

REQUIRED NOTICES

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium and other out-of-pocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings on your premium that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.

Does Employment-Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of the credit that lowers your monthly premium, or a reduction in certain costsharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12%1 of your annual household income, or if the coverage through your employment does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit, and advance payment of the credit, if you do not enroll in the employmentbased health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income.1, 2

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution -as well as your employee contribution to employment-based coverage- is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace.

When Can I Enroll in Health Insurance Coverage through the Marketplace?

You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15.

Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan. There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage.

Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit www.HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596 . TTY users can call 1-855-889-4325.

REQUIRED NOTICES

What about Alternatives to Marketplace Health Insurance Coverage?

If you or your family are eligible for coverage in an employment-based health plan (such as an employersponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employmentbased health plan, but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31, 2023 and July 10, 2023, you can request this special enrollment in the employment-based health plan through September 8, 2023. Confirm the deadline with your employer or your employmentbased health plan.

Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https://www.healthcare.gov/medicaid-chip/gettingmedicaid-chip/ for more details.

How Can I Get More Information?

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

PART B: Information About Health Coverage Offered by Your

Employer

This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

3. Employer Name: Ford Audio-Video Systems, LLC

5. Employer Address: 4800 W I-40 Service Road

7. City: Oklahoma City

4. Employer Identification Number (EIN): 73-0947837

6. Employer Phone Number: 405-945-2060

8. State: OK 9. ZIP Code: 73128

10. Who can we contact at this job?: Glenn Tunick 11. Phone Number (if different from above):

12. E-Mail Address: TUNIG@fordav.com

You are not eligible for health insurance coverage through this employer. You and your family may be able to obtain health coverage through the Marketplace, with a new kind of tax credit that lowers your monthly premiums and with assistance for out-of-pocket costs.

1 Indexed annually; see https://www.irs.gov/pub/irs-drop/rp-22-34.pdf for 2023.

2 An employer-sponsored or other employment-based health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.

This brochure highlights the main features of the Ford Audio-Video Systems, 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. Ford Audio-Video Systems, LLC reserves the right to change or discontinue its Employee Benefits plans at anytime.