We are pleased to offer a full benefits package to you and your eligible dependents. Read this guide to know what benefits are available to you.
Availability of Summary Health Information
Our benefits program offers one or more medical plan options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage, available from Human Resources.
YOUR NEW BENEFITS BEGIN January 1, 2026
Eligibility
You are eligible for coverage if you are a regular, full-time employee.
You may only enroll for coverage when:
● You are a new hire
● It is Open Enrollment (OE)
● You have a Qualifying Life Event (QLE)
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices for your prescription drug coverage. Please see Legal Notices for more details.
Eligibility
FOR YOUR EMPLOYEE BENEFITS
new hire
Who is Eligible
• A regular, full-time employee working an average of 30 hours or more per week
When to Enroll
• By the deadline given by Human Resources
When Coverage Starts
• First of the month after completing 30 days of full-time employment
employee
Who is Eligible
• A regular, full-time employee working an average of 30 hours or more per week
When to Enroll
• During OE or for a QLE
When Coverage Starts
• OE: Start of the plan year
• QLE: Ask Human Resources
dependent(s)
Who is Eligible
• Your legal spouse
• Children under age 26 regardless of student, dependency, or marital status
• Children age 26 or older 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
When to Enroll
• During OE or for a QLE
• When covering dependents, you must enroll for and be on the same plans
When Coverage Starts
• Ask Human Resources
Qualifying Life Events
CHANGING COVERAGE OUTSIDE OF OPEN ENROLLMENT
You may only enroll for or make changes to coverage during the plan year if you are a new hire or if you have a QLE, such as:
Marriage Divorce
Annulment
Death of spouse
Birth Adoption/placement for adoption
Change in benefits eligibility
Death of child
FMLA, COBRA event, judgment, or decree
Becoming eligible for Medicare, Medicaid, or TRICARE
Receiving a Qualified Medical Child Support Order
Gain or loss of benefits coverage
Change in employment status affecting benefits
Significant change in cost of spouse’s coverage
You have 30 days from the event to notify Human Resources and complete your changes You may need to provide documents to verify the change.
How to Enroll
Managing your benefits online is easy through ADP. Enroll for or update your benefits, and view benefit details, costs, and additional resources in one easily accessible place.
ADP Website
1 Go to https://workforcenow.adp.com
2 From the home page, select Myself, Benefits, then Enrollments
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Select Start this Enrollment next to the appropriate qualifying event (e.g., New Hire Enrollment, Open Enrollment).
This opens the Enrollment Wizard , which will guide you through each step, such as adding dependents and beneficiaries, selecting plan options, and selecting coverages.
Once you have made all your selections, be certain to review the Benefits Summary on the final page before clicking Submit to Administrator
ADP Mobile App
1 When you log in to the ADP app, you will see Recommended tiles. Click on Benefits
2 To start, select Start Enrollment
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Continue through each plan type available during your enrollment period. Once you are ready to submit, click Submit enrollment.
Make sure you receive the confirmation note indicating your selections have been submitted.
Note: At any point in your enrollment process, you can select Finish later to save your enrollment information.
benefit questions
Call or text a bilingual representative Monday through Friday from 7:00 a.m. to 6:00 p.m. CT.
If you leave a message after 3:00 p.m. CT, your call or text will be returned the next business day. Email questions or requests to houstonhospice@eb.higginbotham.net
Medical
Carrier: UnitedHealthcare (UHC)
Network: UnitedHealthcare Choice Plus PPO Network or UHC HMO Network
Your medical plan options protect you and your family from major financial hardship in the event of illness or injury. You have a choice of four plans:
• HMO Plan EIVV is an HMO using the UHC HMO Network.
• UHC HDHP/HSA Plan EITY/MM is a PPO and HSA eligible. This plan uses the UHC Choice PPO Network.
• PPO Base Plan EIXA/EJ is a PPO plan using the Choice PPO Network.
• PPO Buy-Up Plan EIW5/EJ is a PPO plan using the Choice PPO Network.
Embedded Deductible
All individual deductible amounts will count towards the family deductible, but one person will not have to pay more than the individual deductible amount.
Preferred Provider Organization
A Preferred Provider Organization (PPO) plan allows you to see any provider when you need care. When you see in-network providers, you will pay less and get the highest level of benefits. You will pay more for care if you use out-ofnetwork providers. When you see in-network providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other services are covered at the deductible and coinsurance level.
High Deductible Health Plan
A High Deductible Health Plan (HDHP) allows you to see any provider when you need care, and you will pay less when you go to in-network providers. In exchange for a lower per-paycheck cost for medical benefits, you must satisfy a higher plan deductible that applies to almost all health care expenses, including prescription drugs. If you enroll in the HDHP, you may be eligible to open a Health Savings Account (HSA).
Health Maintenance Organization
With a Health Maintenance Organization (HMO) plan, you must seek care from in-network providers in the HMO network. The selection of a primary care physician is required, and you need a referral to see a specialist. Always confirm that your doctors and specialists are in-network before seeking care.
Next Level Prime
FOR GETTING THE MOST OUT OF YOUR MEDICAL COVERAGE
Next Level Prime is your all-in-one care solution, connecting you with medical providers, coaches, and counselors to support your health and well-being - at no cost!
From everyday concerns to more complex needs, the program is designed to make it easier to get the right care, at the right time, in the way that works best for you, and include:
• Primary care
• Urgent care
• 24/7 virtual visits
• Health and wellness coaching
• Emotional wellness
• Next Level Prime Weight Loss Program
• Primary, preventive, and chronic care
• Behavioral and emotional health counseling
• Immunizations and vaccines
• Durable medical equipment
• Lab services
• Care navigation and more
Next Level Prime takes a more in-depth and personal approach to healing and wellness, starting with your annual exam. Plus, it offers more convenience with virtual visits, multiple locations, and extended business hours.
Annual Checkup Procedures
Step 1 – Meet virtually with a Prime provider to discuss your medical history, health challenges, and concerns.
Step 2 – Go to any Next Level Urgent Care location for an in-person exam and labs. Schedule this through Prime’s Care Navigator any day of the week from 9:00 a.m. to 9:00 p.m. CT.
Step 3 – Meet virtually with your Prime provider to review results, discuss any risk factors, and create a wellness plan.
Prepare for Prime
Virtual visits allow you to have unlimited access to Prime health care professionals 24/7/365. Before your first visit, download the free version of Zoom on your smartphone, tablet or computer if you do not already have it.
Visit www.nextlevelurgentcare.com .
832-957-6200
navigator@nextlevelurgentcare.com
Medical Benefits Summary
FOR PREVENTIVE TO CHRONIC CARE
1 Please see policy booklet for out-of-network
2The amount you pay after the deductible is met.
Medical Benefits Summary
PREVENTIVE TO CHRONIC CARE
Prescription Drugs
FOR SHORT- OR LONG-TERM CARE MANAGEMENT
Carrier: UHC
Your medical coverage includes prescription benefits for retail, mail order (home delivery), and specialty drugs.
Prescription Drug List
Your medical carrier controls prescription drug costs by negotiating discounts on medications. Covered drugs are listed in the Prescription Drug List. If you take maintenance medications, review the list with your doctor to see which ones are covered and available. If your medication is not listed, call the phone number on your member ID card.
Retail
Use any participating retail pharmacy to fill short-term, nonspecialty medications. Retail pharmacies often fill or refill 30to 90-day supplies.
Home Delivery
If you take medication on a daily basis, consider using home delivery. It is a convenient, low-cost option that delivers up to a 90-day supply right to your home. You will need to set up an online pharmacy account and/or download the app to easily manage your prescriptions.
Specialty
If you need a specialty drug to treat a complex or chronic condition, you will be asked to enroll in a specialty drug program. It offers support to ensure the medication works well for you and costs as little as possible. If you do not enroll in the program, the specialty drug may not be covered. Certain exclusions and limitations apply.
Save Money. Buy Generic Drugs!
Generic drugs are a safe and effective option to brandname drugs – and they cost much less! They have the same active ingredients, strength, and dosage form as brand-name drugs, and they also meet the same rigorous quality and safety standards set by the Food and Drug Administration.
Preventive Care
SMALL STEPS TODAY LEAD TO A HEALTHIER FUTURE
Your medical plan offers $0 preventive care for everyone. Preventive care is the care you receive to help prevent chronic illness or disease. It includes exams, lab work, screenings, immunizations, and counseling to prevent health problems, such as diabetes or heart disease.
Preventive Care Coverage Includes
Adults
Cholesterol screening
Blood pressure screening
Colorectal cancer screening
Lung cancer screening
Hepatitis B screening
Well visits
Bone density screening
Obesity screening
Diabetes type 2 screening
Depression screening
Mammograms
Cervical cancer screening
Immunizations
Dental cleanings and exams
Vision screening
Frequently Asked Questions
Why should I get preventive care?
Teens
Physical exam
Blood tests for iron and cholesterol
Anxiety screening
Growth screening
Hearing screening
Hepatitis B screening
Depression screening
Alcohol, tobacco, and drug use assessments
Tuberculosis screening
Immunizations
Dental cleanings and exams
Vision screening
Preventive care is the fastest and best way to uncover potential risks and avoid chronic health conditions.
Are all screenings, tests, and procedures covered under preventive care?
No. Your doctor will be able to advise you as to the preventive care you need or should obtain, based on your medical and family history.
Why
did
Children
Autism screening
Blood screening
Depression screening
Developmental screening
Hearing screening
Obesity screening and counseling
Hypothyroidism screening
Behavioral assessments
Well visits
Immunizations
Dental cleanings and exams
Oral health risk assessment
Vision screening
I get a bill for preventive care?
Diagnosis codes on the doctor’s bill must meet certain insurance company conditions for them to be processed as preventive and covered at 100%. If you have a medical complaint, or your doctor finds a specific medical issue during your preventive care doctor’s visit, a diagnosis code for that issue or complaint will be on your bill. As a result, the insurance company may process the bill for a specific medical condition, not preventive care. In this case, you must pay the copay or portion of your deductible.
Telemedicine
FOR
CONVENIENT, 24/7 CARE
Carrier: UHC
Your medical coverage offers telemedicine services so you can connect anytime day or night with a boardcertified doctor via your mobile device or computer.
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 afterhours 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
When to Use Telemedicine
Use telemedicine for minor conditions such as:
• Sore throat
• Headache
• Stomachache
• Cold/flu
• Allergies
• Dermatology
• Primary care
• Fever
• Urinary tract infections
Do not use telemedicine for serious or life-threatening emergencies.
Get More Information or Register
Skip the trip to your doctor! Register for an account so you can get on-demand medical care.
Visit www.myuhc.com 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.
Non-emergency Care
Telemedicine
Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed.
24 hours a day, 7 days a week
Doctor’s Office
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history.
Office hours vary Infections
Retail Clinic
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies.
Sore and strep throat
Hours vary based on store hours Common infections
Urgent Care
When you need immediate attention; walk-in basis is usually accepted.
Generally includes evening, weekend, and holiday hours
Emergency Care
Hospital ER
Life-threatening or critical conditions; trauma treatment ; multiple bills for doctor and facility.
24 hours a day, 7 days a week
Freestanding ER
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
Sprains and strains
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.
UHC Resources
FOR GETTING THE MOST OUT OF YOUR MEDICAL COVERAGE
myUHC Member Portal
Access your plan details at www.myuhc.com , your personalized member website. Once you register for an account, you can:
• Find care and compare costs for in-network providers and services
• Check your plan balances, view your claims, and access your ID card
• Access wellness programs and view clinical recommendations
• Get 24/7 access to board-certified doctors via virtual visits
Mobile App
Download the UnitedHealthcare app for easy access to your benefit plan information and virtual care.
Health Care Advocacy
Help is just a call away, whether you have a question about a new claim, need to find a doctor, or want to better understand your benefits. The Advocate4Me program helps you:
• Understand your benefits and claims
• Get answers about a bill or payment
• Locate care and cost options
One Pass Select
• Learn more about your prescriptions
• Find support if you have a child with complex needs
• Use your health and wellbeing benefits wisely
Maternity Support
Maternity Support provides various online resources and support to help you throughout your pregnancy and after giving birth.
Visit https://www.uhc.com/member-resources/health-careprograms/maternity-support to get started.
Smoking Cessation Program
Quit For Life offers 24/7 access to coaching, tools, and support to help you quit tobacco. The program includes:
• Nicotine replacement therapy (aka NRT)
• Tips and coaching support to build your customized plan
• One-on-one access to coaches via phone, chat, or text
• A mobile app and access to Text a Coach for resources, encouragement, and reminders
To get started, go to https://quitnow.net .
One Pass Select offers a low-cost nationwide gym membership – including digital fitness. Get access to gyms, studios, online workouts, and even grocery delivery with one monthly membership.
• There are no long-term contracts or annual gym registration fees.
• You can change your subscription or add family members (ages 18+) anytime.
Membership Options
Find a Gym Near You
Go to www.onepassselect.com to find a gym near you.
Gym partners include Anytime Fitness, Crunch, LA Fitness, Life Time, Orangetheory, and CrossFit.
UHC Resources
FOR GETTING THE MOST OUT OF YOUR MEDICAL COVERAGE
Calm Health App
The Calm Health app is designed to support your mental health and well-being at your own pace. The app starts with a short mental health screening so it can suggest a tailored program of content and tools created by psychologists to help you meditate, improve focus, move mindfully, and feel calm. You can set your own pace and track your progress along the way.
Download the Calm Health app to get started. You first need to sign into your account at www.myuhc.com or on the UnitedHealthcare app
Free Flu Shots
Protect yourself and those around you by getting your annual flu shot. Your UHC plan covers flu shots at $0 out-ofpocket when received at in-network doctors, pharmacies, or participating convenient care clinics. With more than 50,000 locations nationwide offering flu vaccinations, it’s easy to find a place that works for you. Flu shots are the best way to prevent illness and help reduce flu-related hospitalizations.
Visit www.uhc.com/flushot to find a nearby location.
Behavioral Health Resources
Get connected to self-help digital tools, in-person or virtual behavioral health providers, and other resources that may help with a variety of concerns.
• Calm Health - Calm is a self-care app designed to help you reduce stress, improve sleep, and boost mindfulness through guided meditations, sleep stories, and relaxation techniques. Visit www.uhc.app/calm to get started.
• Employee Assistance Program – Offers $0 care for three provider visits by phone or in-person for short-term support and advice on issues such as:
» Stress, anxiety, and depression
» Various personal challenges
» Work-life balance
» Legal and financial support
Call 888-887-4114 for 24/7 phone support or to schedule an in-person counseling session.
• Behavioral Health – Offers virtual and in-person visits with licensed therapists for long-term support on issues including:
» Bipolar and neurodevelopment disorders
» Compulsive habits and eating disorders
» Substance abuse, medication management, and more Visit www.myuhc.com/mh-recommendations to find support.
UHC Rewards
The UHC Rewards program lets you earn rewards for a variety of activities, such as tracking your steps or sleep, taking a health survey, or getting a checkup. To register:
• Go to www.myuhc.com or download the UnitedHealthcare app.
• Select and activate UHC Rewards .
• Choose reward activities and start earning.
Weight Loss Program
The Real Appeal free online weight loss program with personal coaching helps you and eligible family members lose weight and keep it off. This program is offered at no additional cost as part of your medical plan, and it includes:
• One-on-one coaching
• Help staying on track
• A success kit
• Scales, recipes, fitness equipment, and more delivered to your door
Learn more at www.realappeal.com .
Dental
FOR YOUR PEARLY WHITES
Carrier: Guardian
Network: Guardian DentalGuard Preferred
Our dental plans help you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work.
You will always get the highest level of benefits when you see in-network providers for your care. Out-of-network care is not based on negotiated fees, so you may be responsible for paying more for your care.
Maximum Rollover Program
If you enroll in a dental plan, you will automatically be enrolled in the Guardian Maximum Rollover Program . This program rewards you for going to the dentist regularly to prevent or detect the early signs of serious diseases. If you submit a claim (without exceeding the paid claims threshold of a benefit year), Guardian will roll over part of your unused annual maximum into a Maximum Rollover Account (MRA). This can be used in future years if your plan’s annual maximum is reached. View your MRA statement at www.guardiananytime.com or call 800-541-7846
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FOR YOUR PEEPERS
Our vision plan offers quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems. You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see in-network providers. Carrier: Guardian Network: VSP
Health Savings Account
FOR CURRENT OR FUTURE EXPENSES
Offset your HDHP health care costs, reduce your taxes, and get a long-term tax-advantaged savings account.
A Health Savings Account (HSA) is like a personal savings account that allows you to pay for current or future health care expenses with pretax dollars or save the funds for retirement. The funds can also be used for your dependents, even if they are not covered by the HDHP.
An HSA is always yours to keep, even if you change health plans or jobs.
Triple Tax Benefits
Tax-free contributions
Tax-free growth
Tax-free withdrawals
Administrator: Inspira Financial
Contributions
You may contribute up to the IRS annual maximum.
If you are age 55 or older, you can contribute an extra $1,000.
Two Ways to Use Your HSA
Use the Money Now
Pay for qualified out-of-pocket medical, dental, and vision expenses as they are incurred.
Invest Over Time
Invest and grow your HSA dollars tax-free. You can use the funds to pay for qualified expenses later.
How to Pay or Get Reimbursed
• Use your HSA debit card to pay for qualified expenses.
• Pay out-of-pocket and submit your receipts for reimbursement online or through the app.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible HDHP
• Not covered by another plan that is not a qualified HDHP (e.g., spouse’s health plan)
• Not enrolled in a Health Care Flexible Spending Account
• Not eligible to be claimed as a dependent on someone else’s tax return
• Not enrolled in Medicare, Medicaid, or TRICARE
• Not receiving Veterans Administration benefits
Note: You may have an HSA at the financial institution of your choice, but only accounts opened through Inspira Financial are eligible for automatic payroll deductions.
Flexible Spending Accounts
FOR HEALTH AND DEPENDENT CARE EXPENSES
Administrator: Inspira Financial
Set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer the following Flexible Spending Accounts (FSAs).
Health Care FSA
The Health Care FSA covers qualified medical, dental, and vision expenses for you and your eligible dependents. Eligible expenses include:
• Deductibles, copays, and coinsurance
• Prescription drugs
• Braces, glasses, and contacts
• Hearing aids and batteries
If you enrolled in an HDHP and contribute to an HSA, you may not contribute to a Health Care FSA.
Limited Purpose Health Care FSA
If you enroll in the HDHP medical plan and contribute to an HSA, you can use a Limited Purpose Health Care FSA to pay for eligible out-of-pocket dental and vision expenses only, such as:
• Dental and orthodontia care (fillings, X-rays, braces)
Dependent Care FSA
The Dependent Care FSA helps pay expenses associated with caring for children under age 13 and elder dependents so you or your spouse can work or attend school full-time.
Dependent Care FSA Guidelines
• To be eligible, you (and your spouse, if married) must be gainfully employed, looking for work, a full-time student, or incapable of self-care.
• You can use funds for daycare or babysitter expenses for your children under age 13, but only for the part of the year when the child is under 13.
• Only day camps – not overnight camps – can be considered for reimbursement.
• You can use funds for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
Health Care FSA
You have access to all your FSA funds right away.
Limited Purpose Health Care FSA
You have access to all your FSA funds right away.
Dependent Care FSA
Reimbursement is limited to the total amount deposited in your account at that time.
How to Pay or Get Reimbursed
Use your FSA debit card (excludes the Dependent Care FSA). OR
Pay out-of-pocket, and submit your receipts for reimbursement.
Visit fsastore.com for an array of FSA-eligible products.
Health Care FSAs allow you an additional grace period of 2 1/2 months to submit claims after the plan year closes (up until March 17, 2026).
$3,400
$3,400
$7,500 (single parent filing head of household; or married filing jointly)
$3,750 (married filing separately)
Call 800-258-7878 Download the Inspira Mobile app
Do you allow employees to carry over a $$ amount to the next year? No
Do you have a Limited Purpose FSA for the employees enrolled in the HDHP and contributing to an HSA account? Yes
If allowing just a grace period, are you using 2 ½ months after the plan year closes? Yes
Qualified HSA and FSA Expenses
The products and services listed below are examples of medical expenses eligible for payment under your Health Care FSA or HSA.* This list is not all-inclusive; additional expenses may qualify, and the items listed are subject to change in accordance with IRS regulations. Please refer to IRS Publication 502 Medical and Dental Expenses at www.irs.gov for complete details.
Abdominal supports
Acupuncture
Air conditioner (when necessary for relief from difficulty in breathing)
Alcoholism treatment
Ambulance
Anesthetist
Arch supports
Artificial limbs
Autoette (when used for relief of sickness/disability)
Blood tests
Blood transfusions
Braces
Cardiographs
Chiropractor
Contact lenses
Convalescent home (for medical treatment only)
Crutches
Dental treatment
Dental X-rays
Dentures
Dermatologist
* Excludes Dependent Care FSA.
Diagnostic fees
Diathermy
Drug addiction therapy
Drugs (prescription)
Elastic hosiery (prescription)
Eyeglasses
Fees paid to health institute prescribed by a doctor
FICA and FUTA tax paid for medical care service
Fluoridation unit
Guide dog
Gum treatment
Gynecologist
Healing services
Hearing aids and batteries
Hospital bills
Hydrotherapy
Insulin treatment
Lab tests
Lead paint removal
Legal fees
Lodging (away from home for outpatient care)
Metabolism tests
Neurologist
Nursing (including board and meals)
Obstetrician
Operating room costs
Ophthalmologist
Optician
Optometrist
Oral surgery
Organ transplant (including donor’s expenses)
Orthopedic shoes
Orthopedist
Osteopath
Oxygen and oxygen equipment
Pediatrician
Physician
Physiotherapist
Podiatrist
Postnatal treatments
Practical nurse for medical services
Prenatal care
Prescription medicines
Psychiatrist
Psychoanalyst
Psychologist
Psychotherapy
Radium therapy
Registered nurse
Special school costs for the handicapped
Spinal fluid test
Splints
Surgeon
Telephone or TV equipment to assist the hard-of-hearing
Therapy equipment
Transportation expenses (relative to health care)
Ultraviolet ray treatment
Vaccines
Vitamins (if prescribed)
Wheelchair
X-rays
Life and AD&D Insurance
FOR FINANCIAL SECURITY AFTER DEATH OR LOSS
Carrier: Mutual of Omaha
Life and Accidental Death and Dismemberment (AD&D) insurance are important to your financial security, especially if others depend on you for support or vice versa. With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies).
Life and AD&D coverage amounts reduce to 65% at age 65, to 40% at age 70, and to 25% at age 75.
Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at two times your basic annual salary to a maximum of $250,000 for each benefit.
Voluntary Life and AD&D
If you need more coverage than Basic Life and AD&D, you may buy Voluntary Life and AD&D for yourself and your dependent(s). If you do not elect Voluntary Life and AD&D insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health. You must elect Voluntary Life and AD&D coverage for yourself before covering your spouse and/or child(ren).
Employee
• Increments of $10,000 up to $300,000
• New hire Guaranteed Issue $100,000
Spouse
• Increments of $5,000 up to $150,000, not to exceed 50% of employee amount
• New hire Guaranteed Issue $25,000
Child(ren)
• Birth to six months - $500
• Six months to 26 years - $10,000
Coverage is portable!
Designating a Beneficiary
A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries at anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
Rates
Please refer to ADP for your specific rate.
Disability Insurance
FOR WHEN YOU CANNOT WORK DUE TO ACCIDENT OR ILLNESS
Carrier: Mutual of Omaha
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. We offer Long Term Disability (LTD) at no cost to you
Employer-paid Long Term Disability
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for a specific period of time. Benefits begin at the end of an elimination period and continue while you are disabled up to the maximum benefit period.
Long Term Disability Benefits
Benefits Begin 181st day
Percentage of Earnings You Receive 60%
Maximum Monthly Benefit $10,000
Maximum Benefit Period SSNRA1
Pre-existing Condition Exclusion 3/122
1 Social Security Normal Retirement Age
2 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.
Employee Assistance Program
Administrator: Mutual of Omaha
The Employee Assistance Program helps you and family members cope with a variety of personal and work-related issues. This program provides confidential counseling and support services at little or no cost to you to help with:
• Relationships
• Work-life balance
• Stress and anxiety
• Will preparation and estate resolution
• Grief and loss
• Childcare and eldercare issues
• Substance abuse
• Financial and legal matters
• And more Support at Any Hour of the
Administrator: World Investment Advisors
A 403(b) plan can be a powerful tool to help you be financially secure in retirement. Our 403(b) plan 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 have 90 days of service with the company. You may contribute up to the IRS annual limits.
You decide how much you want to contribute, and you can change your contribution amount anytime. 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 you may change your investment choices anytime.
Enrollment
You must enroll through our 403(b) administrator.
2026 IRS Contribution Limits
• $24,500
• $8,000 catch-up (ages 50-59 and 64+)
• $11,250 catch-up (ages 60-63)
Vesting
You are always 100% vested in your own contributions. You are 100% vested in matching company contributions after five years of service.
To enroll: Visit www.voyaretirementplans.com
• Plan ID: Plan #664661
• Verification Code: 225193 Call 800-584-6001
Additional Benefits
Mutual of Omaha provides the following programs and services at no cost to you.
Worldwide Travel Assistance
AXA Assistance USA provides travel assistance for you and your dependents if you are traveling on any single trip more than 100 miles from home. Contact a representative to get trip planning assistance; translation, interpreter, or legal services; lost baggage assistance; emergency funds; document replacement; medical emergency help; and more. Services are available for business and personal travel.
For inquiries within the USA, call 800-856-9947
From outside the USA, call 312-935-3658
Identity Theft Services
The Identity Theft Assistance program, provided by AXA Assistance, helps you understand the risks of identity theft and how to prevent it. If your information is compromised, a representative will connect you with the needed resources. Call AXA Assistance at 800-856-9947 to learn more.
Will Preparation
Creating a will is an important investment in your future. In just minutes, you can create a personalized will 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.
Hearing Discount
As part of your Disability insurance coverage, you have access to a hearing discount program at no additional cost through Amplifon . This program provides free hearing testing, a low-price guarantee, a 60-day risk-free trial period, and two years of batteries with purchase. To activate your benefit, call 888-534-1747. Learn more at www.amplifonusa.com/mutualofomaha
Accident Insurance
Carrier: Aflac
Accident insurance provides affordable protection against a sudden, unforeseen accident. It helps offset the direct and indirect expenses such as copayments, deductibles, ambulance, physical therapy, childcare, rent, and other costs not covered by traditional health plans. You will be paid a specific sum of money directly based on the care and services provided for your covered accident. Use the money any way you see fit. See the plan document for full details.
Accident Insurance Coverage Amounts
Critical Illness Insurance
FOR PROTECTION AGAINST UNEXPECTED MEDICAL COSTS
Carrier: Aflac
Critical Illness insurance helps pay the cost of non-medical expenses related to a covered critical illness or cancer. The plan provides a lump sum benefit payment to you upon first and second diagnosis of any covered critical illness or cancer. The benefit can help cover expenses such as lost income, out-oftown treatments, special diets, daily living, and household upkeep costs. See the plan document for full details.
Amyotrophic lateral sclerosis; benign brain tumor; bone marrow transplant; cancer; coma; heart attack; kidney failure; loss of hearing, sight or speech; major organ transplant; multiple sclerosis; paralysis; severe burn; stroke; sudden cardiac arrest
Advanced Alzheimer’s or Parkinson’s disease; childhood diseases; coronary artery bypass surgery; non-invasive cancer
Hospital Indemnity Insurance
Carrier: Aflac
Hospital Indemnity insurance helps you with the high cost of medical care by paying you a cash benefit when you have an inpatient hospital stay or are admitted to an intensive care unit. You decide how to use the cash, whether it’s to pay for bills, gas, childcare or eldercare, medication, or other out-of-pocket expenses. See the plan document for full details.
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:
Houston Hospice
Human Resources
1905 Holcombe Blvd. Houston, TX 77030
713-677-7145
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 Houston Hospice 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. Houston Hospice has determined that the prescription drug coverage offered by the Houston Hospice medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Houston Hospice 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 Houston Hospice 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 713-6777145
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 800-7721213. 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
Houston Hospice
Human Resources 1905 Holcombe Blvd. Houston, TX 77030 713-677-7145
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 Houston Hospice, 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.
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare. gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employersponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272)
If you live in one of the following States, you may be
eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, 2025. Contact your State for more information on eligibility.
To see if any other States have added a premium assistance program since July 31, 2025, or for more information on special enrollment rights, you can contact either:
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 Houston Hospice group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Houston Hospice 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.
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-ofnetwork providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an 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 costsharing 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, 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 outof-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 (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 and health coverage offered through your employment.
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 that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.
Does Employer 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% 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 employmentbased coverage. Also, this employer contribution -as well as your employee contribution to employmentbased 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 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 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 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 employment-based 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/getting-medicaid-chip/ for more details.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your 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: Houston Hospice
5. Employer Address: 1905 Holcombe Blvd
4. Employer Identification Number (EIN): 74-2092951
6. Employer Phone Number: 713-677-7145
7. City: Houston 8. State: TX 9. ZIP Code: 77030
10. Who can we contact about employee health coverage at this job?: Mary Grace Holvenstot
11. Phone Number (if different from above): 713-677-7145
Here is some basic information about health coverage offered by this employer:
All full-time employees working a minimum of 30 hours per week are eligible to participate in the health benefit programs. You may also enroll your eligible dependents, including:
• Your legal spouse providing that spouse has no access to health care coverage where they work
• Your children under age 26
• Any child under age 26 for whom you have been granted legal custody or required to cover as a part of a qualified medical child support order
• Any dependent child age 26 and older who is medically certified as disabled and is chiefly dependent upon the employee for support and maintenance
The coverage offered by this employer meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.
NOTE: Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household in-come, along with other factors, to determine whether you may be eligible for a premium dis-count. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.
If you decide to shop for coverage in the Marketplace, www.healthcare.gov will guide you through the process.
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.
November 12, 2025
Christine Blackmon
Houston Hospice
1905 Holcombe Boulevard
Houston, Texas 77030-4123
RE: Houston Hospice Employee Voluntary Salary Reduction Fund
ANNUAL PARTICIPANT NOTICE ACTION REQUIRED
FOR: Plan Year beginning January 1, 2026
Notice Of Right To Participate In The Plan And Contribution Limits
Your plan allows participants to defer into the Plan. This notice explains to eligible employees that they have the right to defer into the Plan and explains the annual contribution limits if a participant controls another business that sponsors a retirement plan.
Provide a copy of this notice by December 2, 2025 to all eligible employees.
Administration: Replace any existing annual notices with this new notice(s), retaining a copy of the old notice(s) with your permanent records.
If you have any questions or need further information, please feel free to contact us.
Sincerely,
Voya Retirement Insurance and Annuity Company
Enclosures
How do I elect to make contributions to the Plan?
NOTICE OF RIGHT TO PARTICIPATE IN THE PLAN AND CONTRIBUTION LIMITS
Elective Deferrals. The Houston Hospice Employee Voluntary Salary Reduction Fund (the "Plan") allows eligible employees to save for retirement. If you are eligible to participate in the Plan, then you may elect to reduce your compensation by a specified amount and have that amount contributed to the Plan as an elective deferral. There are two types of elective deferrals: Pre Tax Deferrals and Roth Deferrals. For purposes of this notice, "elective deferrals" means both Pre Tax Deferrals and Roth Deferrals. Regardless of the type of elective deferral you make, the amount you defer is counted as compensation for purposes of Social Security taxes.
Pre-Tax Deferrals. If you elect to make Pre Tax Deferrals, then your taxable income is reduced by the deferral contributions so you pay less in federal income taxes. Later, when the Plan distributes the deferrals and earnings, you will pay the taxes on those deferrals and the earnings. Therefore, with a Pre Tax Deferral, federal income taxes on the elective deferral contributions and on the earnings are only postponed. Eventually, you will have to pay taxes on these amounts.
Roth Deferrals. If you elect to make Roth Deferrals, the elective deferrals are subject to federal income taxes in the year of elective deferral. However, the elective deferrals and, in certain cases, the earnings on the elective deferrals are not subject to federal income taxes when distributed to you. In order for the earnings to be tax free, you must meet certain conditions. See the question in the Summary of Plan Provisions entitled "What are my tax consequences when I receive a distribution from the Plan?".
The amount you elect to defer will be deducted from your pay in accordance with a procedure established by the Plan Administrator. You may elect to defer a portion of your compensation payable on or after your Entry Date. Such election will become effective as soon as administratively feasible after it is received by the Plan Administrator. Your election will remain in effect until you modify or terminate it.
If you are currently participating, you may want to change your amounts for the new Plan Year. You can increase or decrease your contribution or you can leave your amounts the same.
You can contact the Plan Administrator to obtain further information on how to make contributions to the Plan.
How much can I contribute?
Your total elective deferrals in any taxable year cannot exceed a dollar limit which is set by law. The limit for 2026 is $24,500. After 2026, the dollar limit may increase for cost of living adjustments. See the paragraph below on Annual dollar limit.
Age 50 Catch Up Deferrals. If you are at least age 50 or will attain age 50 before the end of a calendar year, then you may elect to defer additional amounts (called Age 50 Catch-Up Deferrals) to the Plan as of the January 1st of that year. You can defer the additional amounts regardless of any other limitations on the amount you can defer to the Plan. The maximum Age 50 Catch-Up Deferrals that you can make in 2026 is $8,000. After 2026, the maximum might increase for cost of living adjustments.
Annual dollar limit. Each separately stated annual dollar limit on the amount you may defer (the annual deferral limit and the Catch-Up Deferral limit) is a separate aggregate limit that applies to all such similar salary deferral amounts and "catch up contributions" you may make under this Plan and any other cash or deferred arrangements (including other tax sheltered 403(b) annuity contracts, simplified employee pensions or 401(k) plans) in which you may be participating. Generally, if an annual dollar limit is exceeded, then the excess must be returned to you in order to avoid adverse tax consequences. For this reason, you need to contact the Plan Administrator if these situations might apply to you. It is desirable to request in writing that any such excess salary deferral amounts and Catch-Up Deferrals be returned to you.
If you are in more than one plan to which you can contribute elective deferrals, you must decide which plan or arrangement you would like to return the excess. If you decide that the excess should be distributed from this Plan, you must communicate this in writing to the Plan Administrator no later than the March 1st following the close of the calendar year in which such excess deferrals were made. However, if the entire dollar limit is exceeded in this Plan or any other plan the Employer maintains, then you will be deemed to have notified the Plan Administrator of the excess. The Plan Administrator will then return the excess deferral and any earnings to you by April 15th.
What is the maximum annual amount that can be contributed to my account?
The law imposes a limit on the amount of contributions that may be made to your accounts during a year. For 2026, this total cannot exceed the lesser of $72,000 or 100% of your includible compensation (generally your compensation for the prior 12 month period). After 2026, the dollar limit might increase for cost of living adjustments. Your includible compensation for purposes of this limit is limited for 2026 to $360,000. After 2026, the dollar limit for includible compensation might increase in future years for cost of living adjustments.
The above limit may also need to be applied by taking into account contributions made to other retirement plans in which you are a participant. If you have more than 50% control of a corporation, partnership, and/ or sole proprietorship, then the above limit is based on contributions made to this Plan as well as contributions made to any 403(b) or qualified plans maintained by the businesses you control. If you control another business that maintains a plan in which you participate, then you are responsible for providing the Plan Administrator with information necessary to apply the annual contribution limits. If you fail to provide necessary and correct information to the Plan Administrator, it could result in adverse tax consequences to you, including the inability to exclude contributions to the Plan from your gross income for tax purposes.
You can find out more information about the Plan in the Summary of Plan Provisions. You can obtain a copy from the Plan Administrator.
This brochure highlights the main features of the Houston Hospice 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. Houston Hospice reserves the right to change or discontinue its employee benefits plans anytime.
