ELIGIBILITY AND ENROLLMENT
Eligibility Employees
Full-time employees who work 30 or more hours per week are eligible to participate in the employee benefits program. Coverage becomes effective on the first of the month following 60 days of full-time regular status. You must be actively at work for coverage to take effect. Time working as a temporary employee will count toward the waiting period.
Dependents
Your eligible dependents include:
Your legally married spouse
Your dependent children from birth to age 26
Your unmarried children of any age who are mentally or physically disabled and who are dependent on you for support
Verification of dependent eligibility may be required.
Open Enrollment
Open Enrollment is your opportunity to choose benefits for the upcoming plan year (January 1 – December 31, 2026). You may not make a change to your elections during the year unless you experience a Qualifying Life Event.
New Employees
You must enroll before your eligibility date. If you do not enroll during your eligibility period, you will need to wait until the next Open Enrollment unless you experience a Qualifying Life Event.
Tax Savings
Your medical, dental, and vision costs are deducted from your paycheck on a pretax basis, which means that costs are taken out of your pay before your federal taxes are calculated.
Making Changes
Due to IRS rules, you may make changes to your benefit elections during the plan year only if you experience a Qualifying Life Event, which includes:
Marriage, divorce, legal separation, or annulment
A change in your number of dependents such as birth, death, or adoption
A loss or gain of coverage due to employment status for you or your spouse
Change in your or your spouse's employment status that affects benefits eligibility (e.g., starting a new job, leaving a job, changing from part-time to full-time, starting or returning from an unpaid leave of absence)
Change in your child's eligibility for benefits
Change in residence that affects your eligibility for coverage (e.g., moving out of a medical plan's network area)
Significant change in benefit plan coverage or cost for you, your spouse, or child
FMLA leave, COBRA event, or court judgment or decree
Participating in Medicare, Medicaid, or TRICARE
Receiving a Qualified Medical Child Support Order
If you have a Qualifying Life Event and want to change your elections, you must notify Human Resources and complete your changes within 30 days of the event. You may be asked to provide documentation to support the change. Contact Human Resources at 817-429-6262 for details.
MEDICAL COVERAGE
You have two medical plans from which to choose. Both are administered by HealthEZ and use the Aetna PPO network.
Base Plan is a PPO plan with a $3,000 in-network individual deductible.
Buy-Up Plan is a PPO plan with a $1,000 in-network individual deductible.
How the Medical Plans Work
Both plans give you the freedom to seek medical care from any licensed physician or health care professional without a referral. Each time you seek medical care, you decide whether to use in-network or out-of-network providers. With in-network providers, your level of coverage is much better because of negotiated discounted rates.
Telemedicine
As a Harris Packaging/American Carton employee, you have access to quality national telemedicine services through Teladoc as part of your medical plan — at no cost to you
Teladoc can be a cost-effective alternative to visiting a convenient care clinic, urgent care center, or emergency room. Teladoc lets you get the care you need for a wide range of minor acute conditions (including prescriptions). Now you have access to board-certified doctors via secure video chat or phone, without leaving your home or office — when, where, and how it works best for you.
Telemedicine services should only be used for minor conditions which are not life threatening, such as:
Acid reflux
Allergies
Asthma
Bladder infection
Find a Provider
Log on to HealthEZ at www.aetna.com/asa and click on the Provider Search button.
1. 1. Enter your location, adjust the miles according to your preference and click Search
2. 2. Enter a keyword into the search box at the top, or select one for the categories below to narrow your search results
3. 3. Continue to narrow your search by clicking on sub-categories as applicable
To speak to an Aetna PPO Network Customer Service Representative, call 800-238-6288, Monday - Friday, 8:00 a.m. - 5:00 p.m. EST
Bronchitis
Cold and flu
Constipation
Cough
Fever
Headache
High blood pressure
Joint pain
Nausea
Pink eye
Sinus conditions
Sore throat
Stomach virus
Urinary tract infection
Register with Teladoc so you are ready to use this valuable service when and where you need it.
Online: www.teladoc.com
Phone: 800-TELADOC (835-2362)
Mobile: Download the Teladoc mobile app
Medical Plan Summary
Hospital Services
Hospital admission
Outpatient surgery
Emergency room
Retail Pharmacy (up to 30-day supply)
Generic
Mail Order Pharmacy (up to 90-day supply)
Generic
Preferred brand name
Non-preferred brand name
Specialty Drugs (up to 90-day supply)
All fills must be purchased through Express Scripts Specialty Pharmacy
Generic
Preferred brand name
Non-preferred brand name
Specialty Pharmacy Prime Therapeutics
800-424-0472
https://primetherapeutics.specialty-portal.com/
DENTAL COVERAGE
Dental coverage is provided through Renaissance, using the Renaissance PPO network.
DPPO plan with a $2,000 annual maximum benefit
The dental plan offers you a broad range of dental services through a network of participating general dentists and specialists. If you seek care from an out-of-network dentist, you will be responsible for all fees in excess of the 90th percentile of Reasonable and Customary charges (R&C).
Dental Benefits Summary
Find a Provider
Log on to Renaissance at www.renaissancebenefits.com/members/ and navigate to Find Resources.
Select Find a Provider and choose Search Dentists Enter your provider’s details and click Search
Type 1 – Preventive Oral exams, cleanings, X-rays, fluoride
Type 2 – Basic Fillings, oral surgery, endodontics, periodontics, sealants, space maintainers
Type 3 – Major Crowns, bridges, prosthodontics
Type 4 –
VISION COVERAGE
The vision plan offers a discount on lenses and exams and is administered by Renaissance Vision Benefits Summary
Eye Exam (once every 12 months)
Lenses (glass or plastic) (once every 12 months)
Single vision
Lined bifocal
Lined trifocal
Lenticular
Lens Options
Progressive (standard no line)
Premium progressive options
Custom progressive options
Plastic gradient dye
Solid plastic dye
Photochromic lenses
Polycarbonate for adults
Polycarbonate for children (under age 18)
Coatings
Scratch resistant
Anti-reflective
UV protection
Additional lens enhancements
Frames (once every 12 months)
Contact Lenses (once every 12 months)
(Elective in lieu of frames and lenses)
Elective contact lens fitting, evaluation services, and prescription contact lenses are covered up to allowance. 15% discount given for contact lens fitting and evaluation services, excluding materials
Refractive Surgery
$10 copay
$10 copay
$10 copay
$10 copay
$10 copay
$55 copay
$95-$105 copay
$150-$175 copay
$17 copay
$15 copay
$70 copay single vision/$82 copay multifocal
$31 copay single vision/$35 copay multifocal
$0
$17 copay
$41 copay
$16 copay
Up to 25% discount
$130 allowance at any VSP doctor or $70 at Costco, Sam’s, or Walmart
$130 allowance
Up to $500 in savings Discounts average 15-20% off or 4% off a promotional offer for laser surgery, including PRK, LASIK, Custom LASIK, and IntraLase
The reimbursement outlined under the Lenses section above is a total reimbursement for lenses and any lens enhancements elected.
to $70
to 105
Find a Provider
Log on to Renaissance at MyRenProviders.com and click on the Provider Search button. Select Vision and choose the VSP Choice Plus plan and the state where you would like to search. Enter your provider’s details and click Search.
LIFE AND AD&D INSURANCE
Basic Life and AD&D
Harris Packaging/American Carton provides Basic Life and Accidental Death & Dismemberment (AD&D) insurance at no cost for full-time eligible employees. Coverage is provided through Mutual of Omaha . Benefits will be decreased by any Social Security or other disability benefits you may receive.
Voluntary Life
For an added layer of protection, you may add to your Basic Life and AD&D insurance by purchasing Voluntary Life insurance. Coverage is provided through Mutual of Omaha and is available to you and your eligible dependents. Benefits are reduced at age 70.
DISABILITY INSURANCE
Short Term Disability
Harris Packaging/American Carton provides Short Term Disability (STD) at no cost to you. STD coverage provides income protection in case you become disabled due to illness or a non-occupational injury. Coverage is provided through Mutual of Omaha . Benefits will be decreased by any Social Security or other disability benefits you may receive.
Guaranteed Issue1
Children (unmarried to age 26) 3
Maximum Benefit
Increments of $10,000 to the lesser of 5 × annual salary or $500,000
$100,0002
Increments of $5,000 to the lesser of 100% of employee coverage or $250,000
$50,0002
Increments of $1,000 to $10,000
1 You must submit evidence of insurability if you are enrolling for more than this amount of coverage. Evidence of insurability means that you must supply the insurance company with proof that you are in good health. This may involve completing a questionnaire or, in some instances, taking a physical exam.
2 Employees age 70 OR over may have a reduced Guaranteed Issue amount.
3 Unmarried dependent children from live birth to age 26.
Long Term Disability
Harris Packaging/American Carton provides Long Term Disability (LTD) at no cost to you. LTD coverage provides income protection in case you become disabled for an extended time. Coverage is provided through Mutual of Omaha . Benefits will be decreased by any Social Security or other disability benefits you may receive.
RETIREMENT PLAN
The 401(k) Savings Plan is a valuable tool to help provide you with retirement income and supplement your personal savings. You are eligible to participate in the 401(k) Savings Plan if you are at least 21 years of age and have completed at least six months of service. Once eligible, you may enroll in the 401(k) Savings Plan on either January 1 or July 1. Harris Packaging/American Carton will match $0.50 for every $1.00 of employee contribution up to 6%. The plan is administered by John Hancock .
If you need assistance or have questions about the 401(k) Savings Plan, call (800) 395-1113 or log in at www.myplan.johnhancock.com .
EMPLOYEE ASSISTANCE PROGRAM
The Employee Assistance Program (EAP) is available to those employees and their dependents who feel that they could benefit from guidance with personal and work-related concerns. The coverage is provided at no cost to you. Licensed clinicians are available 24 hours a day, 365 days a year to help you with these concerns and more: Resources or concerns, include:
Relationships
Problems with your children
Substance abuse
Stress, anxiety or depression
Job pressures
Marital conflicts
Grief and loss
Empty-nesting
You have two EAP options. Contact Alliance Work Partners to speak with a professional and/or set an appointment with an EAP counselor. Mutual of Omaha offers telephone assistance and referrals.
Call Alliance Work Partners at (800) 343-3822 or go online to www.alliancewp.com.
Call Mutual of Omaha at (800) 316-2796 or go online to www.mutualofomaha.com/eap.
TRAVEL ASSISTANCE / ID THEFT PROTECTION
Worldwide emergency travel assistance is available whether you are traveling out of the country or just 100 miles from home. Services include emergency medical evacuation transport home, prescription replacement, crisis management, care and transport of unattended minor children, and more. Coverage is provided through Mutual of Omaha at no cost to you.
English-speaking providers anywhere in the world
Medical consultation and referral
Hospital admission guarantee
Lost prescription assistance
Legal and interpreter services
Emergency medical evacuation
ID theft protection is included with this benefit.
If you need emergency travel assistance, call: (800) 856-9947 from within the U.S. (312) 935-3658 collect if outside the U.S.
If you need ID theft assistance, call: (800) 856-9947
TIME OFF
Holidays
You are eligible for paid holidays after 30 days of service.
HOLIDAYS
New Year’s Day
Good Friday
Memorial Day
Independence Day
Labor Day
Thanksgiving Day Day after Thanksgiving
Christmas Eve
Christmas Day
Paid Time Off (PTO)
All full-time employees earn PTO based on the accrual schedule below. Temporary and part-time employees are not eligible to receive PTO.
EMPLOYEE DEDUCTIONS PER PAYCHECK
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:
Harris Packaging/American Carton Human Resources
1600 Carson Street
Haltom City, TX 76117
817-429-6262
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 Harris Packaging/American Carton 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. Harris Packaging/American Carton has determined that the prescription drug coverage offered by the Harris Packaging/ American Carton 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 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 Harris Packaging/American Carton 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 Harris Packaging/ American Carton 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 Phone
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778 .
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
Janurary 1, 2026
Harris Packaging/American Carton Human Resources 1600 Carson Street Haltom City, TX 76117 817-429-6262
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 Harris Packaging/American Carton, 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.
Harris Packaging/American Carton Human Resources
1600 Carson Street Haltom City, TX 76117 817-429-6262
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)
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.
TEXAS – MEDICAID
Website: https://www.hhs.texas.gov/services/ financial/health-insurance-premium-payment-hippprogram
Phone: 1-800-440-0493
To see if any other States have added a premium assistance program since January 31, 2026, or for more information on special enrollment rights, you 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 Harris Packaging/American Carton group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Harris Packaging/American Carton 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
Harris Packaging/American Carton Human Resources 1600 Carson Street Haltom City, TX 76117 817-429-6262
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-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-ofnetwork 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-of-network services toward your deductible and outof-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.
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 cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12%1 of your annual household income, or if the coverage through your employment does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit, and advance payment of the credit, if you do not enroll in the employment-based health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income.1, 2
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution -as well as your employee contribution to employment-based coverage- is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace.
When Can I Enroll in Health Insurance Coverage through the Marketplace?
You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15.
Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan.
There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage.
Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit www.HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325.
What about Alternatives to Marketplace Health Insurance Coverage?
If you or your family are eligible for coverage in an employment-based health plan (such as an employer-sponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan, but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31, 2023 and July 10, 2023, you can request this special enrollment in the employmentbased health plan through September 8, 2023. Confirm the deadline with your employer or your employment-based health plan.
Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https:// www.healthcare.gov/medicaid-chip/gettingmedicaid-chip/ for more details.
How Can I Get More Information?
For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact Human Resources.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
PART B: Information About Health Coverage Offered by Your Employer
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
3. Employer Name: Harris Packaging/American Carton
4. Employer Identification Number (EIN): 75-1536089
5. Employer Address: 1600 Carson Street
6. Employer Phone Number: 817-429-6262
7. City: Haltom City
8. State: TX 9. ZIP Code: 76117
10. Who can we contact at this job?: Tammy Dennis
11. Phone Number (if different from above): 817-546-5436
12. E-Mail Address: tdennis@americancarton.com
As your employer, we offer a health plan to all eligible employees (see the Eligibility section of this guide). This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.
1 Indexed annually; see https://www.irs.gov/pub/irsdrop/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.
IMPORTANT CONTACT INFORMATION
This guide highlights the main features of the Harris Packaging/American Carton Employee Benefits Program sponsored by Harris Packaging/American Carton. It is intended to help you choose the benefits that are best suited for you. This guide does not include all plan rules and details. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be an inconsistency between this guide and the legal plan documents, the plan documents are the final authority. Harris Packaging/American Carton reserves the right to change or discontinue its benefit plans at anytime.