2026 Glen Rose Medical Center Employee Benefits Guide
Guide to Employee Benefits
Glen Rose Medical Center is pleased to offer you a comprehensive benefits package intended to protect your well-being and financial health. This guide is your opportunity to learn more about the benefits available to you and your eligible dependents beginning January 1, 2026 Each year during Open Enrollment, you have the opportunity to make changes to your benefit plans. The enrollment decisions you make this year will remain in effect through December 31, 2026. To get the best value from your health care plan, please take the time to evaluate your coverage options and determine which plans best meet the health care and financial needs of you and your family. After Open Enrollment, you may make changes to your benefit elections only when you have a Qualifying Life Event.
Availability of Summary Health Information
Your benefits program offers three medical plan coverage options. To help you make an informed choice and compare your options, a Summary of Benefits and Coverage (SBC) is available summarizing important information about your health coverage options in a standard format. The SBC is available by contacting Human Resources.
Important Contacts
Human Resources Bonnie Mangin, HR Director Rosy Rodriguez
Benefits Specialists
Employee Response Center
Higginbotham Kennedy Leis
Higginbotham
bmangin@grmf.org rrodriguez@grmf.org
817-984-8937 kleis@higginbotham.net
866-419-3518
helpline@higginbotham.net
Employee Response Center
Employee benefits can be complicated. The Higginbotham Employee Response Center can assist you with the following:
Enrollment
Benefits information
Claims or billing questions
Eligibility issues
Call or text
866-419-3518 to speak with a representative Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you leave a message after 3:00 p.m. CT, your call or text will be returned the next business day. You can also email questions or requests to helpline@higginbotham.net
Bilingual representatives are also available.
Benefits Eligibility
You are eligible for benefits if you are a regular, full-time or part-time employee working an average of 20 hours per week. Your coverage is effective the first of the month following 30 days of employment. You may also enroll eligible dependents for benefits coverage. The cost to you for dependent coverage depends on the number of dependents you enroll and the particular plans you choose. When covering dependents, you must select the same plans for your dependents as you select for yourself.
Eligible Dependents Include
Your legal spouse or domestic partner
Children under the age of 26 regardless of student, dependency or marital status
Children over the age of 26 who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return
Qualifying Life Events
Your benefit elections remain in effect for the entire plan year until the following Open Enrollment. You may only change coverage during the plan year if you have a Qualifying Life Event such as marriage, divorce, birth, or adoption, loss of other coverage, etc. You must notify Human Resources in a timely manner if any of these events occur. Contact Human Resources for a full list of Qualifying Events and the notification timeframes required for requested changes.
If you have a Qualifying Life Event and want to request a midyear change, you must notify Human Resources and complete your election changes within 30 days following the event. Be prepared to provide documentation to support the Qualifying Life Event.
How to Enroll
To begin the enrollment process, go to www.benefitsinhand.com. First-time users, follow steps 1-4. Returning users, log in and start at step 5.
1. If this is your first time to log in, click on the New User Registration link. Once you register, you will use your username and password to log in.
2. Enter your personal information and company identifier of GRMC 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
4. If you used an email address as your username, you will receive a validation email to that address. You may now log in to the system.
5. Click the Start Enrollment button to begin the enrollment process.
6. Confirm or update your personal information and click Save & Continue
7. Edit dependents or add dependents that need to be covered on your benefits. Once all dependents are listed, click Save & Continue
8. Follow the steps on the screen for each benefit to make your selection. Please notice there is an option to Decline Coverage. If you wish to decline, click the Don’t want this benefit? button and select the reason for declining.
9. Once you have elected or declined all benefits, you will see a summary of your selections. Click the Click to Sign button. You enrollment will not be complete until you click the Click to Sign button.
Have questions about your benefits or need help enrolling? Contact your HR Department or call the Employee Response Center at 866-419-3518. Benefits experts are available to take your call Monday through Friday, 7:00 a.m. to 6:00 p.m. CT.
Medical Coverage
The medical plan options through UnitedHealthcare (UHC) protect you and your family from major financial hardship in the event of illness or injury. You have a choice of three plans:
Buy-Up PPO Plan – PPO with $1,500 individual/$3,000 family in-network deductible
Mid PPO Plan – PPO with $3,000 individual/$6,000 family innetwork deductible
Base PPO/HSA Plan – HDHP with a $4,000 individual/$8,000 family in-network deductible
Preferred Provider Organization
A Preferred Provider Organization (PPO) allows you the freedom to see any provider when you need care. When you use in-network providers, you receive benefits at a discounted network cost. You may pay more for services if you use out-of-network providers.
High Deductible Health Plan
A High Deductible Health Plan (HDHP) also allows you the freedom to see any provider when you need care; however, you will pay less if you use in-network providers. In exchange for a lower perpaycheck cost, you must satisfy a higher deductible that applies to almost all health care expenses, including those for prescription drugs. The plan pays 100% for health care and prescription drug expenses once you meet your deductible. If you enroll in the HDHP, you may be eligible to open a Health Savings Account (HSA – see page 11).
Find a Provider
To find a list of Choice Plus Network providers, visit www.myuhc.com or call 866-633-2446
myuhc.com
Get easy access to details about your benefits, doctors, eligibility, hospitals, and more by visiting www.myuhc.com
Find a doctor, specialist, or other health care professional, plus urgent care and hospital locations
View detailed information about your coverage, including any applicable copayments and deductibles
Print a temporary ID card or order a replacement
Estimate medical expenses using a cost calculator
View your claim history and payments
Read hospital performance reviews
Gain access to wellness tools and resources
To create an account, log in to www.myuhc.com, click Register Now and complete the required fields.
Mobile App
For quick and easy access to your health care information, download the UnitedHealthcare app. Use the same login information you used to set up your www.myuhc.com account.
UHC Medical Benefits Summary
1 After deductible.
GRMC Out-of-Pocket Benefit
Services rendered by GRMC provided at no cost to the employee and their covered dependents.
Pharmacy Benefits
UHC manages your prescription drug costs by negotiating discounts on medications. Drugs included in the UHC Prescription Drug List (PDL) are classified in Tiers — the different cost levels you pay for a medication. If your medication is placed in Tier 2 or 3, discuss with your doctor if there is a Tier 1 alternative.
Tier 1 – lowest cost medications
Tier 2 – midrange cost medications
Tier 3 – highest cost medications
To access information on drugs included under the UHC PDL, log on to www.myuhc.com or use the UHC mobile app.
PreCheck MyScript
PreCheck MyScript provides patient-specific pharmacy information that alerts your physician if prior authorization is needed. The system reduces the chance of medication errors and sends drug safety alerts to your doctor.
UHC Virtual Visits
Virtual Visits, included with your UHC medical benefits, lets you see and talk to a doctor from your mobile phone or computer without an appointment.
When to Use Virtual Visits
Your doctor is unavailable
You become ill while traveling
You are considering visiting an emergency room for a nonemergency health condition, such as:
Sore throat
Headache
Stomachache
Cold
Affordable Care
Flu
Allergies
Fever
Urinary tract infections
Virtual Visits is an affordable option if you need care for a nonemergency issue.
Who Can Use Virtual Visits
If you are enrolled in one of our UHC medical plans, Virtual Visits are available to you and your covered dependents. Register Online
Access care online at any time. For more information, log in to www.uhc.com/virtualvisits and choose a provider site where you can register for a Virtual Visit. You can also call 855-615-8335 or request a Virtual Visit through the UnitedHealthcare app
Request a Virtual Visit
Visit www.uhc.com/virtualvisits
Call 855-615-8335
Download the UnitedHealthcare app
Health Care Options
Becoming familiar with your options for medical care can save you time and money. HEALTH CARE
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
DOCTOR’S OFFICE
RETAIL CLINIC
24 hours a day, 7 days a week
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history
Office hours vary
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies
Hours vary based on store hours
When you need immediate attention; walk-in basis is usually accepted
• Allergies
• Cough/cold/flu
• Rash
• Stomachache
• Infections
• Sore and strep throat
• Vaccinations
• Minor injuries, sprains and strains
• Common infections
• Minor injuries
• Pregnancy tests
• Vaccinations
• Sprains and strains
• Minor broken bones
URGENT CARE
EMERGENCY CARE
Generally includes evening, weekend and holiday hours
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
1 Telemedicine visits are $50 on Plan 3 – Base PPO/HSA.
• 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.
Health Savings Account
An HSA is more than a way to help you and your family cover health care costs — it is also a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs. A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows taxfree and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA Eligibility
You are eligible to open and contribute to an HSA if you:
Are enrolled in an HSA-eligible HDHP (Base PPO/HSA medical plan)
Are not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
Are not enrolled in a Health Care Flexible Spending Account (FSA)
Are not eligible to be claimed as a dependent on someone else’s tax return
Are not eligible for Medicare, Medicaid, or TRICARE
Have not received Veterans Administration benefits
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds for your spouse and dependents’ health care expenses, even if they are not covered by the HDHP.
Maximum Contributions
Your HSA contributions, when combined with GRMC contributions, may not exceed the annual maximum amount established by the IRS. The annual contribution maximum for 2026 is based on the coverage option you elect:
Important HSA Information
Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
You may open an HSA at the financial institution of your choice, but only accounts opened through Optum Bank are eligible for automatic payroll deduction and company contributions.
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are age 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 anytime during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
Company Contributions
GRMC requires employees to contribute $10 per pay period to their HSA in order for GRMC to contribute as well. GRMC makes an annual contribution to your HSA based on your hourly wage level:
Less than $24.04 per hour – $450 individual or $900 family
$24.04-$48.07 per hour – $300 individual or $600 family
More than $48.07 per hour – no contribution
Opening an HSA
If you meet the eligibility requirements, you may open an HSA administered by Optum Bank. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. To open an account, go to www.optumbank.com
Cost-Saving Resources
GoodRx
Prescription drug prices are not regulated and can vary greatly between pharmacies. GoodRx allows you to view prices and find coupons, discounts, and savings tips. Visit www.goodrx.com to print coupons or download the GoodRx app and display the coupon on your phone. You can also search for your prescription and compare prices at nearby pharmacies.
Compare prescription drug prices
Receive coupons, discounts, and savings tips for pharmacies near you
Print coupons online or view from the mobile app GoodRx is a Free Service
You do not have to create an account to search for prices and receive discounts. If you do create an account, you can store your prescription list for ease of use in the future.
Visit www.goodrx.com for more information.
Healthcare Bluebook
Healthcare Bluebook levels the playing field with cost and quality transparency that makes shopping for health care services simple and straightforward. With fair price transparency, Healthcare Bluebook makes it simple to find high-quality, low-cost providers.
How it Works
Search – Search for medical procedures and locate providers in your area.
Compare – Compare the cost for procedures and providers.
Save – Save hundreds to thousands of dollars on out-ofpocket costs.
Visit www.healthcarebluebook.com for more information.
Wellness Programs
UHC Rewards
Your health plan comes with a new way to earn up to $300 and is included in your health plan at no additional cost. UHC Rewards offers a variety of actions, including many things you may already be doing, leading to rewards. Here are some ways you can earn:
Reach daily goals
Track 5,000 steps or 15 active minutes each day, or double it for an even bigger reward
Track 14 nights of sleep
Complete one-time reward activities
Go paperless
Get a biometric screening
Take a health survey
Connect a tracker
Two ways to get started
On the UnitedHealthcare app
1. Download the app
2. Sign in or register
3. Select the menu tab and choose UHC Rewards
On myuhc.com
1. Sign in or register
2. Select UHC Rewards
3. Activate UHC Rewards
4. Choose reward activities that inspire you and start earning Questions? Call Customer Service at 866-230-2505
Real Appeal
Real Appeal is a free digital program that provides up to a full year of support for lasting weight loss, including:
A personal transformation coach to offer step-by-step guidance and customization for a program that fits your needs, preferences, and goals
24/7 convenience through online access to food, activity and goal trackers, group classes, and expert health tips
A Success Kit to help kick-start your weight loss journey and keep you on the road to results
Visit www.realappeal.com to get started.
Quit for Life
The Quit for Life program is available to help meet your goal of becoming tobacco free. This program provides the support you need to quit the way you want.
Online Support – Get access to a website with an Action Plan and quit guide to help you beat urges, manage withdrawal, and switch your habits to avoid tobacco.
Quit for Life Mobile App – 24/7 urge management support plus on-the-go access to your program. Download the app through your mobile device’s app store.
Quit Smoking Medication – You may be eligible for medications to help you quit.
Live Tobacco-Free Course – Participate in an online quit tobacco course at your own pace and gain knowledge and skills to help you quit and stay on track.
Visit www.myuhc.com to enroll.
Dental Coverage
Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Guardian DHMO Plan
If you enroll in the DHMO plan, you must select a Primary Care Dentist (PCD) from the Managed Dental Guard network directory to manage your care. Each eligible dependent may choose their own PCD. Dental services are unlimited, you pay fixed copays, there are no deductibles, and there are no claim forms to file. There is no coverage for services provided without a referral from your PCD or from out-of-network providers.
Dental Benefits Summary
DPPO Plans
Two levels of benefits are available with the DPPO plans: in-network and out-of-network. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services.
DPPO Value Plan – Provides the best benefit if you choose a Dental Guard Preferred provider. Treatment from outof-network providers is paid based on Reasonable and Customary rates. You are responsible for charges in excess of eligible expenses.
DPPO NAP Plan – Provides the same benefit if you use a Dental Guard Preferred provider, but reimburses at a higher rate if you choose an out-of-network provider.
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 Guardian using the VSP Network
Vision Benefits Summary
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 insurance 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). Your Life and AD&D coverage amount reduces by 35% at age 65, and 60% at age 70.
Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you. If you are a regular employee working at least 20 hours per week, you are automatically enrolled up to your annual salary not to exceed $160,000. Executives/Directors are eligible for up to two times your annual salary not to exceed $400,000.
Designating a Beneficiary
A beneficiary is the person or entity you designate to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries at any time. If you name more than one beneficiary, you must identify the share for each.
Voluntary Life and AD&D
You may purchase additional Life and AD&D insurance for yourself 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.
Voluntary Life and AD&D
Increments of $10,000 up to five times your
earnings not to exceed $500,000
Age-based Guaranteed Issue $200,000
Increments of $5,000 up to 100% of employee amount not to exceed $500,000
Age-based Guaranteed Issue $50,000 Child(ren)
Live birth to six months – $1,000
Six months to 26 years – increments of $2,000 not to exceed $10,000
Disability Insurance
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. GRMC offers Voluntary Short Term Disability (STD) for you to purchase and provides Long Term Disability (LTD) insurance at no cost to you. Coverage is provided through Mutual of Omaha Voluntary Short Term Disability Insurance
Voluntary STD coverage pays a percentage of your weekly salary for up to 11 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 jobrelated injury or illness.
Long Term Disability Insurance
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.
Long Term Disability
Condition Exclusion 3/121 3/121
1 Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months.
1 Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for six months.
2 Pregnancy is not considered a pre-existing condition and is not excluded
3 Visit www.benefitsinhand.com for a complete list of rates.
Supplemental Insurance
Glen Rose Medical Center offers you and your eligible family members the opportunity to enroll in additional coverage that complements our traditional health care programs. Health insurance covers medical bills, but if you have an emergency, you may face unexpected out-of-pocket costs, such as deductibles, coinsurance, travel expenses, and non-work-related expenses. The plans are offered through Mutual of Omaha and are portable. If you leave your employment, you can take these policies with you.
Accident Insurance
Accident insurance provides affordable protection against a sudden, unforeseen accident. The Accident plan helps offset the direct and indirect expenses resulting from an accident, such as copayments, deductible, ambulance, physical therapy, and other costs not covered by traditional health plans.
Accident Insurance
Intensive Care Unit
Specific Sum Injuries
Concussions, dislocations, eye injuries, fractures, lacerations, ruptured discs, and more
& Dismemberment*
$300 per day up to 365 days
$600 per day up to 15 days
Critical Illness
Critical Illness insurance helps pay the cost of non-medicalrelated expenses related to a covered critical illness or cancer. The plan provides a lump-sum benefit payment to you upon first and second diagnosis of any covered critical illness or cancer. The benefit can help cover expenses, such as lost income, out-of-town treatments, special diets, daily living, and household upkeep costs.
Critical Illness Insurance
Full Coverage
Benign brain tumor or spinal cord tumor; Alzheimer’s disease; amyotrophic lateral sclerosis; bone flap/ skull defect; bone marrow/stem cell recipient; coma; dementia; heart attack; invasive cancer; loss of hearing, sight or speech; major organ failure; multiple sclerosis; occupational hepatitis B, C or D; occupational HIV; paralysis; Parkinson’s disease; severe burn; stroke; sudden cardiac arrest
1 Employee/member and spouse premiums are calculated with the employee/ member’s age as of the effective date of the plan. Child coverage is included with employee premium.
Additional Benefits
Included with your Mutual of Omaha plans is access to the following programs at no additional cost.
Employee Assistance Program
Employee Assistance Program (EAP) is a confidential program to help you find solutions for personal and workplace issues. Benefits for you and your eligible dependents include unlimited telephone access to EAP professionals and up to three face-toface sessions with a counselor. Professionals are available 24/7 to help with the following:
Stress and depression
Financial issues
Family and relationship issues
Addiction
Grief issues
Parenting and eldercare
Legal services
Financial services
Other personal concerns
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 that keeps your information safe and secure. The services provided by Epoq offer a secure account space to prepare wills and other legal documents. Log in at www.willprepservices.com and use the code MUTUALWILLS to register.
Call 800-316-2796 or visit www.mutualofomaha.com/eap for assistance. Additional resources are available on the website.
Advocacy Services
If you and/or a family member are diagnosed with a critical illness, the Advocacy Services program offers support for your health care needs so you can focus on your treatment and recovery. The program provides personalized and confidential problem-solving assistance in a one-on-one setting for any benefit, claim, or provider/hospital issue or question.
Contact Advocacy Services at 866-372-5577 or email customerserve@healthcomp.com
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
Employee Contributions
This worksheet helps you calculate your per pay period benefit costs. It is not an enrollment form. Visit www.benefitsinhand.com for a complete list of all rates.
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:
Glen Rose Medical Center
Human Resources 1021 Holden Glen Rose, TX 76043
254-897-1437
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 Glen Rose Medical Center 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. Glen Rose Medical Center has determined that the prescription drug coverage offered by the Glen Rose Medical Center 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).
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 Glen Rose Medical Center 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 Glen Rose Medical Center 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.
Important Notices
For more information about this notice or your current prescription drug coverage:
Contact the Human Resources Department at 254-897-1437
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 877-4862048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www. socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
January 1, 2026 Glen Rose Medical Center Human Resources 1021 Holden Glen Rose, TX 76043 254-897-1437
Notice of HIPAA Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan – whether received in writing, in an electronic medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by Glen Rose Medical Center, hereinafter referred to as the plan sponsor.
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer.
You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask the Human Resources Department to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources Department.
Complaints: If you believe your privacy rights have been violated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer.
Glen Rose Medical Center Human Resources 1021 Holden Glen Rose, TX 76043 254-897-1437
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 1-877-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)
Important Notices
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.
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 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 Glen Rose Medical Center group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Glen Rose Medical Center 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
Glen Rose Medical Center Human Resources 1021 Holden Glen Rose, TX 76043 254-897-1437
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services – If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most the provider or facility may bill you is your plan’s in- network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-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-of-network. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-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 Glen Rose Medical Center 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. Glen Rose Medical Center reserves the right to change or discontinue its employee benefits plans anytime.
