IMPORTANT INFORMATION
Important: This benefits package includes a fixed indemnity policy, which is not health insurance. Please see supplemental benefits on page 13 for more details.
This fixed indemnity policy may pay you a limited dollar amount if you are sick or hospitalized. You are still responsible for paying the cost of your care.
z The payment you get is not based on the size of your medical bill.
z There might be a limit on how much this policy will pay each year.
z This policy is not a substitute for comprehensive health insurance.
z Since this policy is not health insurance, it does not have to include most federal consumer protections that apply to health insurance. Looking for comprehensive health insurance?
z Visit www.healthcare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.
z To find out if you can get health insurance through your job, or a family member’s job, contact the employer. Questions about this policy?
z For questions or complaints about this policy, contact your state Department of Insurance. Find its number on the National Association of Insurance Commissioners’ website (www.naic.org) under Insurance Departments.
z If you have this policy through your job, or a family member’s job, contact the employer.
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices for your prescription drug coverage. Please see page 18 for more details.
HELPFUL RESOURCES
Benefits King|George benefits@kinggeorge.us 817-820-0881
Human Resources King|George hr@kinggeorge.us 817-820-0881
Employee Response Center Higginbotham helpline@higginbotham.net 866-419-3518
Medicare Advisor Luann Yarberry Higginbotham lyarberry@higginbotham.net 940-228-0338
Employee Response Center
Employee benefits can be complicated. The Higginbotham Employee Response Center can assist you with the following: z Enrollment
Benefit information z Claims or billing questions
Eligibility issues Call 866-419-3518 to speak with a representative Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you leave a voicemail message after 3:00 p.m. CT, your call will be returned the next business day. You can also email questions or requests to helpline@higginbotham.net. Bilingual representatives are available.
WELCOME
We are pleased to offer you a comprehensive benefits package intended to protect your wellbeing and financial health. This guide is your opportunity to learn more about the benefits available to you and your eligible dependents beginning January 1, 2026.
To get the best value from your health care plan, please take the time to evaluate your coverage options and determine which plans best meet the health care and financial needs of you and your family. By being a wise consumer, you can support your health and maximize your health care dollars.
Each year during Open Enrollment, you have the opportunity to make changes to your benefit plans.
The enrollment decisions you make this year will remain in effect through December 31, 2026. After Open Enrollment, you may make changes to your benefit elections only when you have a Qualifying Life Event (QLE).
Availability of Summary Health Information
Your benefits program includes a medical option. To help you make an informed choice, a Summary of Benefits and Coverage (SBC) is available in your Employee Self-Service portal.
ELIGIBILITY
You are eligible for benefits if you are a regular, fulltime employee working an average of 30 hours per week. Your coverage is effective the first day of the first month following your first full day of employment. You may also enroll eligible dependents for benefits coverage. The cost to you for dependent coverage depends on the number of dependents you enroll and the particular plans you choose. When covering dependents, you must select the same plans for your dependents as you select for yourself.
Eligible Dependents include:
z Your spouse or domestic partner
z Children under the age of 26, regardless of student, dependency, or marital status
z Children over the age of 26 who are fully dependent on you for support due to a mental or physical disability, and who are indicated as such on your federal tax return
Qualifying Life Events
Your benefit elections remain in effect for the entire plan year until the following Open Enrollment. You may only change coverage during the plan year if you have a QLE such as marriage, divorce, birth or adoption, loss of other coverage, etc. You must notify Human Resources in a timely manner if any of these events occur. Contact Human Resources for a full list of QLEs and the notification timeframes required for requested changes.
When Should You Sign Up for Medicare?
Turning 65 does not mean you have to retire, despite being Medicare-eligible. You may choose to keep working due to financial needs or because you enjoy it.
Regardless of why you choose to work past 65, not enrolling in Medicare during the right enrollment period could cost you in the form of Medicare premium penalties if you miss certain dates. Late enrollment penalties for Medicare Part B and Medicare Part D are permanent and can have a meaningful impact on your finances, so think carefully about what you do and when.
If you are approaching your 65th birthday, it’s important you know your options and implications for when to enroll for Medicare.
Questions to Ask Before Delaying Medicare
z Do you have employer health coverage?
z Does your employer have 20 or more employees?
z Is the coverage considered creditable?
If you answer “yes” to all of the above, you likely qualify for a Medicare Special Enrollment Period and can delay enrolling without penalty. If you are approaching Medicare eligibility and would like to discuss your situation in more detail, contact your Higginbotham representative:
z Luann Yarberry, Medicare Advisor
z 940-228-0338
z lyarberry@higginbotham.net
MEDICAL COVERAGE
The medical plan option through Kaiser Permanente is designed to protect you and your family from major financial hardship in the event of illness or injury. The plan option we offer is the:
z Kaiser Permanente HMO plan
Health Maintenance Organization (HMO)
With an HMO plan, you must seek care from innetwork providers in the Kaiser Permanente 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.
Kaiser Permanente Member Portal
Visit www.kp.org, the secure member website where you can:
z Check the status of claims and your claim history
z Confirm dependent eligibility
z View and print Explanation of Benefits (EOB) forms
z Locate in-network providers
z Print or request an ID card
To get started, log on to www.kp.org and use the information on your ID card to complete the registration process.
Mobile App
The Kaiser Permanente mobile app can help you stay organized and in control of your health anytime, anywhere. Log in from your mobile device to access your account, including:
z Track account balances and deductibles
z Access ID card information
z Find doctors, dentists, and pharmacies
Visit www.kp.org/mobile to download the app.
MEDICAL COVERAGE
TELEMEDICINE
Your medical coverage offers telemedicine services through Kaiser Permanente. Connect anytime day or night with a board-certified doctor via your mobile device.
Access your primary care physician and gain referrals through this convenient and cost-effective option when you need care and:
z Have a non-emergency issue and are considering an after-hours health care clinic, urgent care clinic, or emergency room for treatment
z Are on a business trip, vacation, or away from home
z Are unable to see your primary care physician in person
Access is Easy
z Download the mobile app – www.kp.org/mobile
z Call – 800-966-5955
When to Use Telemedicine
Use telemedicine services for minor conditions such as:
z Sore throat
z Headache
z Stomachache
z Cold
z Flu
z Allergies
z Fever
z Urinary tract infections
Do not use telemedicine for serious or lifethreatening emergencies.
HEALTH CARE OPTIONS
Becoming familiar with your options for medical care can save you time and money. Talk with a registered nurse for general medical questions, deciding where to go for medical care, managing a health condition or understanding medication.
Non-Emergency Care
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
TELEMEDICINE
DOCTOR’S OFFICE
RETAIL CLINIC
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history
z Allergies
z Cough/cold/flu z Rash z Stomachache
Office hours vary z Infections
z Sore and strep throat
z Vaccinations
z Minor injuries/sprains/ strains
URGENT CARE
Emergency Care
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies
Hours vary based on store hours
When you need immediate attention; walk-in basis is usually accepted
Generally includes evening, weekend, and holiday hours
z Common infections
z Minor injuries
z Pregnancy tests
z Vaccinations
z Sprains and strains
z Minor broken bones
z Small cuts that may require stitches
z Minor burns and infections
HOSPITAL EMERGENCY ROOM
FREESTANDING EMERGENCY ROOM
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility
24 hours a day, 7 days a week
Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher
24 hours a day, 7 days a week
z Chest pain
z Difficulty breathing
z Severe bleeding
z Blurred or sudden loss of vision
z Major broken bones
z Most major injuries except trauma
z Severe pain
Minimal
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.
DENTAL AND VISION COVERAGE
Dental Coverage
Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions for dental will be deducted from your paycheck on a pretax basis or from your health and welfare wage if you are a King|George employee. Coverage is provided through UnitedHealthcare.
DPPO Plan
Two levels of benefits are available with the DPPO plan: in-network and out-of-network. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. Using an in-network provider will provide you with the highest level of benefits and the deepest discounts the plan offers. You could pay more if you use an out-of-network provider.
DENTAL PLAN
Preventive and Diagnostic Care
Exams, cleanings, X-rays, fluoride treatments, sealants, space maintainers
Basic Care
Fillings, simple extractions, oral surgery, endodontics, anesthesia, periodontics
Major Restorative Care
Crowns, dentures, bridges, inlays, onlays, repairs of bridges and crowns
Orthodontia Children only to age 26
* Out-of-network providers: When you use out-of-network providers, your services will be paid based on a Contracted Fee Schedule (a set amount for each type of service that is determined by UHC). If your dentist’s fee is lower than the scheduled fee, the plan will pay benefits based on the actual fee. If the fee is higher, the plan will pay benefits based only on the schedule fee and you are responsible for the difference. Pretreatment review is highly recommended when dental treatment proposed is over $200.
Vision Coverage
The vision plan through UHC Vision is designed to provide your basic eyewear needs and to preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes or high cholesterol.
You may seek care from any licensed optometrist, ophthalmologist or optician, but plan benefits are better if you use an in-network provider. The vision plan uses the UHC Spectera network of providers.
y Single Lenses
Bifocals
In lieu of Frames/Lenses
y Contact Lens Fit y Medically Necessary y Elective
Benefit Frequency
y Exams
Find a Provider
LIFE AND AD&D INSURANCE
Life insurance is an important part of your financial security, especially if others depend on you for support. Even if you are single, your beneficiary can use your Life insurance to pay off your debts, such as credit cards, mortgages and other final expenses.
Accidental Death & Dismemberment (AD&D) coverage provides you specified benefits for a covered accidental bodily injury that directly causes dismemberment (e.g., the loss of a hand, foot or eye). In the event that death occurs from an accident, 100% of the AD&D benefit would be payable to your beneficiary(ies).
Basic Life and AD&D Insurance
Basic Life insurance and AD&D coverage are provided by King|George at no cost to you through Unum. You are automatically covered at one time your salary, up to $100,000 for each benefit.
Voluntary Life and AD&D Insurance
You may purchase additional Life and AD&D insurance for you and your eligible dependents through Unum. If you decline Voluntary Life and AD&D insurance when first eligible or if you elect coverage and wish to increase your benefit amount at a later date, Evidence of Insurability (EOI) – proof of good health – may be required before coverage is approved. You must elect Voluntary Life and AD&D coverage for yourself in order to elect coverage for your spouse or children. If you leave the company, you may be able to take the insurance with you. Upon reaching age 70 your original benefit amount will reduce by 50%. Age reduction for spouse will reduce according to the employee’s age. Your Voluntary Life and AD&D rates can be found as you go through your enrollment.
LIFE AND AD&D AVAILABLE COVERAGE
Employee
Spouse
Child(ren)
y Increments of $10,000 up to $500,000 not to exceed 5 times your annual salary
y Guaranteed Issue $150,000
y Increments of $5,000 up to $250,000
y Guaranteed Issue $25,000
y Birth to six months - $1,000
y Six months to age 26 - $5,000 to $10,000
Designating a Beneficiary
A beneficiary is the person or entity you designate to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary and you can change beneficiaries anytime. If you name more than one beneficiary, you must identify the share for each.
DISABILITY INSURANCE
You may purchase Voluntary Short Term Disability (STD) and Voluntary Long Term Disability (LTD) to enhance your disability benefits. This coverage is comprehensive and gives you additional coverage should you become disabled.
Eligible employees must work the required minimum number of hours and cannot be considered a parttime, temporary or seasonal employee. If any eligible employee is not actively at work on the exact effective date, coverage for that employee will not begin until he/she returns to full-time active duty.
Benefits may not be paid for conditions for which you have been treated within the three months prior to your effective date until you have been covered under this plan for 12 months1
Voluntary Short Term Disability
You may purchase Voluntary STD coverage through Unum which pays a percentage of your weekly salary if you are temporarily disabled and unable to work due to an illness, non-work-related injury or pregnancy. STD benefits are NOT payable if the disability is due to a job-related injury or illness.
DISABILITY
Voluntary Long Term Disability
You may elect to purchase Voluntary LTD insurance through Unum which pays a percentage of your monthly salary for a covered disability or injury that prevents you from working while you are disabled. Benefits begin at the end of an elimination period and continue while you are disabled up to a maximum benefit duration.
1Benefits 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.
Rates for Voluntary
Short Term and Long Term
Disability are shown in the Employee Self-Service portal during enrollment.
SUPPLEMENTAL INSURANCE
King|George offers its employees and eligible family members the opportunity to enroll in additional coverage that complements our traditional health care programs. These plans are offered by Unum and are portable. This means if you leave your employment at King|George, you can take these policies with you. Rates for supplemental coverage are shown in the Employee Self-Service portal during enrollment.
Accident Insurance
Accident insurance provides affordable protection against a sudden, unforeseen accident. The Accident plan helps offset the direct and indirect expenses resulting from an accident, such as copayments, deductible, ambulance, physical therapy and other costs not covered by traditional health plans. Some accidents covered under this plan include: dislocations, ruptured discs, eye injuries, lacerations, internal injuries, fractures, ambulance, accidental death and dismemberment and hospital confinement.
Hospital Indemnity Plan
Hospital Indemnity Plan helps you with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment that you receive.
HOSPITAL INDEMNITY PLAN
Hospital Admission $1,000 (1 day per year)
Hospital Stay $100 per day up to 365 days
Stay $100 per day up to 30 days
y Burns
y Dislocation
y Coma
y Paralysis
SUPPLEMENTAL INSURANCE
Critical Illness Insurance
For many, a critical illness can expose an individual to an unexpected gap in protection. While health plans may help cover many of the direct costs associated with a critical illness, expenses such as lost income, child care, travel to and from treatment, high deductibles and copays may quickly diminish savings. Critical Illness insurance pays a fixed benefit if you are diagnosed with a covered critical illness after your coverage effective date. A lump sum payment is payable when you or a covered family member are diagnosed with a covered condition such as stroke, heart attack, cancer or renal failure.
CRITICAL ILLNESS
Progressive Diseases
Supplemental Critical Illness Rider
y Amyotrophic Lateral Sclerosis (ALS)
y Dementia, including Alzheimer’s
y Multiple Sclerosis (MS)
y Parkinson’s disease
y Functional loss
y Loss of sight, hearing or speech
y Benign brain tumor
y Permanent Paralysis
ADDITIONAL BENEFITS
As a Unum member, you have the following valueadd programs available to you and your eligible dependents at no cost to you.
Employee Assistance Program
Unum’s Work-life Balance Employee Assistance Program (EAP) can help you and family members cope with a variety of personal or work-related issues, including:
z Confidential Counseling – Receive up to three inperson counseling sessions from trained master’s and doctoral level clinicians for issues including stress, anxiety, depression, relationship conflicts, job pressures, substance abuse, grief and loss.
z Financial Information and Resources – Speak with certified public accountants and financial planners on a wide ranges of financial issues including getting out of debt, credit problems, tax questions, retirement planning, estate planning and saving for college.
z Legal Support and Resources – Discuss legal issues with an attorney by phone. If you require representation, you will be referred to a qualified attorney in your area for a free 30-minute consultation and a 25% discount on customary legal fees.
z Work-Life Solutions – Work-Life Specialists provides referrals and customized resources for a variety of issues including child and elder care, moving and relocation, making major purchases, college planning, pet care and home repair.
z Online Will Preparation – EstateGuidance provides online support and instructions for executing and filing your will.
Contact the EAP
Call 800-854-1446 or visit www.UNUM.com/lifebalance for assistance anytime.
(Username and password: lifebalance)
Travel Assistance
Assist America provides travel assistance for you and your dependents if you are traveling more than 100 miles from home on a trip that lasts 90 days or less. This coverage extends to your dependents even when they are traveling without you.
Representatives can help with trip planning or assistance in an emergency while traveling. They can find a translator/interpreter or legal services, along with assistance with lost baggage, emergency funds, document replacement and more.
You can access this service by phone or email:
z Within the U.S. and Canada – 800-872-1414
z Outside North America – +1-609-986-1234 collect
z Email – medservices@assistamerica.com
z Mobile app – Download from your preferred store Reference number: 01-AA-UN-762490
Life Planning
When faced with the terminal illness or loss of a loved one, making important personal, financial, and legal decisions can be overwhelming. With Unum Group Life Insurance, you and your family have access to Life Planning Financial & Legal Resources at no extra cost. This service is available to employees, spouses, and beneficiaries, offering support during challenging times.
Once a life claim is submitted and approved, a specially trained consultant with a master’s degree in mental health will provide compassionate assistance. These consultants offer emotional support, as well as financial and legal guidance on matters such as estate settlement, Social Security, taxes, and investment planning. Their goal is to help you maintain your quality of life and secure your future, all while coordinating with your family’s existing legal and financial advisors. Best of all, these services are confidential and free from any sales pressure.
Contact a Life Planning consultant to get started. Call – 800-422-5142 (multilingual)
Visit – members.healthadvocate.com (Enter: UnumLife Planning)
MY BENEFITS WORK
NewBenefits
As a King|George employee, these non-insurance Benefit Boost Programs are available to you and your family for a low monthly cost.
Benefit Boost package includes:
Comprehensive Pet Care and Telehealth
Simplify pet care with exclusive savings and support. Get 25% off in-house veterinary services and PetCareRx.com purchases, plus 24/7 Lost Pet Recovery Service and GPS-enabled notifications at discounted rates. Enjoy unlimited telehealth consultations for household pets, offering advice on behavior, training, and health concerns anytime. Consultations start within an hour and are all accessible through the My Benefits Work App.
NB Deals and Travel Savings
Unlock incredible savings with NB Deals and Travel. Access discounts from over 40 categories and 500+ merchants, including theme park tickets, sporting events, pet supplies, home technology, dining, and more. Enjoy exclusive travel perks with NB Travel, offering up to 60% off public hotel pricing and deep discounts on activities worldwide.
Legal Services
Access affordable legal assistance for issues like traffic tickets, bankruptcy, divorce, child support, and more. Benefit from free services, including consultations, legal document preparation, and representation in small claims court. Plan attorneys offer discounted rates: $125/hour or 40% off their standard rate, whichever is greater; and 10% off contingency-based cases. Referrals are tailored to your location, language, and legal needs. Call 800-305-6816 for support.
Financial Wellness
Certified Financial Counselors provide personalized guidance by phone to assess challenges, explore options, and create action plans. The Online Financial Resource Center offers curated articles, videos, checklists, and tools to streamline your journey to financial health. Call 800-704-1308 to get started.
Benefits Boost Plus
Includes everything in the Benefit Boost package, plus:
z Fertility
z Surrogacy
z Adoption Assistance
Work with a Nurse Care Manager for personalized support during your fertility, adoption, or surrogacy journey. Enjoy savings of up to 40% on IVF, IUI, egg freezing, and genetic testing through highly vetted providers. Access one-on-one coaching for adoption, foster care, surrogacy, and egg donation to navigate these processes with confidence.
Online: www.mybenefitswork.com
Call: 800-800-7616 (Monday-Friday, 7 a.m. to 7 p.m. CT) and Saturday, 8 a.m. to 5 p.m.
Download: My Benefits Work app
PLANNING FOR RETIREMENT
Your 401(k) service provider is The Standard for King|George employees. You can access your account by visiting www.standard.com/retirement or calling 800-858-5420
As a King|George employee, if you have health and welfare money that is not used to purchase health insurance, your funds will be invested with The Standard. If you do not set up an account with The Standard, your funds will be invested as described below:
INVESTMENT FUNDS
If the plan’s participant default investment option is Target Age, then for participants who are under
plan contributions and account balances will be allocated, and automatically
automatic reallocation date after reaching age 40. This information is not
How to Enroll Online
z Go to your Paycom portal
z Click Retirement enrollment
z Select Enroll in Available Plans
z Complete the guided steps, and tap Finalize to complete your enrollment
How to Enroll By Phone
Call Securian Financial at 800-858-5420 to enroll or if you have questions. Customer service is available weekdays from 7:00 a.m. – 7:00 p.m. CT.
PersonalSAGE Coaching
PersonalSAGE can help you better understand your financial situation and build a plan for the future.
z Schedule one-on-one coaching
z Register for monthly workshops
z Access educational resources
Get started today, visit www.mypersonalsage.com and enter code KingGeorge00174.
Designating a Beneficiary
A beneficiary is the person or entity you designate to receive the death benefits of your retirement plan. You can name more than one beneficiary and you can change beneficiaries at anytime. If you name more than one beneficiary, you must identify the share for each.
IMPORTANT NOTICES
Women’s Health and Cancer Rights Act of 1998
In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully.
As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:
z All stages of reconstruction of the breast on which the mastectomy was performed;
z Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
z 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:
King|George Human Resource Benefits 1228 S Adams St Fort Worth, TX 76104 817-820-0881
benefits@kinggeorge.us
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 King|George 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. King|George has determined that the prescription drug coverage offered by the King|George medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is not considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
IMPORTANT NOTICES
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 King|George 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 King|George 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 817-8200881.
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:
z Visit www.medicare.gov.
z 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.
z 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 King|George Human Resource Benefits 1228 S Adams St Fort Worth, TX 76104 817-820-0881 benefits@kinggeorge.us
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 King|George, 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
IMPORTANT NOTICES
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.
King|George Human Resource Benefits
1228 S Adams St Fort Worth, TX 76104
817-820-0881
benefits@kinggeorge.us
Conclusion
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an 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.
ALABAMA – MEDICAID
Website: http://www.myalhipp.com/ Phone: 1-855-692-5447
ALASKA – MEDICAID
The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861
Email: CustomerService@MyAKHIPP.com
Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/ default.aspx
ARKANSAS – MEDICAID
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
CALIFORNIA– MEDICAID
Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hipp
Phone: 916-445-8322
Fax: 916-440-5676
Email: hipp@dhcs.ca.gov
COLORADO – HEALTH FIRST COLORADO (COLORADO’S MEDICAID PROGRAM) AND CHILD HEALTH PLAN PLUS (CHP+)
Health First Colorado website: https://www.healthfirstcolorado. com/
Health First Colorado Member Contact Center: 1-800-2213943/State Relay 711
CHP+: https://hcpf.colorado.gov/child-health-plan-plus
CHP+ Customer Service: 1-800-359-1991/State Relay 711
Health Insurance Buy-In Program (HIBI): https://www.mycohibi. com/
HIBI Customer Service: 1-855-692-6442
FLORIDA – MEDICAID
Website: https://www.flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp/index.html
Phone: 1-877-357-3268
IMPORTANT NOTICES
GEORGIA – MEDICAID
GA HIPP Website: https://medicaid.georgia.gov/healthinsurance-premium-payment-program-hipp
Phone: 678-564-1162, Press 1
GA CHIPRA Website: https://medicaid.georgia.gov/programs/ third-party-liability/childrens-health-insurance-programreauthorization-act-2009-chipra
Phone: 678-564-1162, Press 2
INDIANA – MEDICAID
Health Insurance Premium Payment Program
All other Medicaid
Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr/
Family and Social Services Administration
Phone: 1-800-403-0864
Member Services Phone: 1-800-457-4584
IOWA – MEDICAID AND CHIP (HAWKI)
Medicaid Website: https://hhs.iowa.gov/programs/welcomeiowa-medicaid
Medicaid Phone: 1-800-338-8366
Hawki Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid/iowa-health-link/hawki
Hawki Phone: 1-800-257-8563
HIPP Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid/fee-service/hipp
HIPP Phone: 1-888-346-9562
KANSAS – MEDICAID
Website: https://www.kancare.ks.gov/
Phone: 1-800-792-4884
HIPP Phone: 1-800-967-4660
KENTUCKY – MEDICAID
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/ member/Pages/kihipp.aspx
Phone: 1-855-459-6328
Email: KIHIPP.PROGRAM@ky.gov
KCHIP Website: https://kynect.ky.gov
Phone: 1-877-524-4718
Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms
LOUISIANA – MEDICAID
Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp
Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)
MAINE – MEDICAID
Enrollment Website: https://www.mymaineconnection.gov/ benefits/s/?language=en_US
Phone: 1-800-442-6003
TTY: Maine relay 711
Private Health Insurance Premium Webpage: https://www. maine.gov/dhhs/ofi/applications-forms
Phone: 1-800-977-6740
TTY: Maine Relay 711
MASSACHUSETTS – MEDICAID AND CHIP
Website: https://www.mass.gov/masshealth/pa
Phone: 1-800-862-4840
TTY: 711
Email: masspremassistance@accenture.com
MINNESOTA – MEDICAID
Website: https://mn.gov/dhs/health-care-coverage/ Phone: 1-800-657-3672
MISSOURI – MEDICAID
Website: http://www.dss.mo.gov/mhd/participants/pages/ hipp.htm
Phone: 573-751-2005
MONTANA – MEDICAID
Website: https://dphhs.mt.gov/MontanaHealthcarePrograms/ HIPP
Phone: 1-800-694-3084
Email: HHSHIPPProgram@mt.gov
NEBRASKA – MEDICAID
Website: http://www.ACCESSNebraska.ne.gov
Phone: 1-855-632-7633
Lincoln: 402-473-7000
Omaha: 402-595-1178
NEVADA – MEDICAID
Medicaid Website: http://dhcfp.nv.gov
Medicaid Phone: 1-800-992-0900
NEW HAMPSHIRE – MEDICAID
Website: https://www.dhhs.nh.gov/programs-services/ medicaid/health-insurance-premium-program
Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-852-3345, ext. 15218
Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov
NEW JERSEY – MEDICAID AND CHIP
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Phone: 1-800-356-1561
CHIP Premium Assistance Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710 (TTY: 711)
NEW YORK – MEDICAID
Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831
NORTH CAROLINA – MEDICAID
Website: https://medicaid.ncdhhs.gov Phone: 919-855-4100
NORTH DAKOTA – MEDICAID
Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825
OKLAHOMA – MEDICAID AND CHIP
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
IMPORTANT NOTICES
OREGON – MEDICAID
Website: https://healthcare.oregon.gov/Pages/index.aspx
Phone: 1-800-699-9075
PENNSYLVANIA – MEDICAID AND CHIP
Website: https://www.pa.gov/en/services/dhs/apply-formedicaid-health-insurance-premium-payment-program-hipp. html
Phone: 1-800-692-7462
CHIP Website: https://www.dhs.pa.gov/chip/pages/chip.aspx
CHIP Phone: 1-800-986-KIDS (5437)
RHODE ISLAND – MEDICAID AND CHIP
Website: http://www.eohhs.ri.gov/
Phone: 1-855-697-4347 or 401-462-0311 (Direct RIte Share Line)
SOUTH CAROLINA – MEDICAID
Website: https://www.scdhhs.gov
Phone: 1-888-549-0820
SOUTH DAKOTA – MEDICAID
Website: https://dss.sd.gov
Phone: 1-888-828-0059
TEXAS – MEDICAID
Website: https://www.hhs.texas.gov/services/financial/healthinsurance-premium-payment-hipp-program
Phone: 1-800-440-0493
UTAH – MEDICAID AND CHIP
Utah’s Premium Partnership for Health Insurance (UPP) Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov
Phone: 1-888-222-2542
Adult Expansion Website: https://medicaid.utah.gov/ expansion/ Utah Medicaid Buyout Program Website: https://medicaid. utah.gov/buyout-program/ CHIP Website: https://chip.utah.gov/
VERMONT– MEDICAID
Website: https://dvha.vermont.gov/members/medicaid/hippprogram
Phone: 1-800-250-8427
VIRGINIA – MEDICAID AND CHIP
Website: https://coverva.dmas.virginia.gov/learn/premiumassistance/famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/ health-insurance-premium-payment-hipp-programs Medicaid/CHIP Phone: 1-800-432-5924
WASHINGTON – MEDICAID
Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
WEST
VIRGINIA – MEDICAID AND CHIP
Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/
Medicaid Phone: 304-558-1700
CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
WISCONSIN – MEDICAID AND CHIP
Website: https://www.dhs.wisconsin.gov/ badgercareplus/p-10095.htm Phone: 1-800-362-3002
WYOMING – MEDICAID
Website: https://health.wyo.gov/healthcarefin/medicaid/ programs-and-eligibility/ Phone: 1-800-251-1269
To see if any other States have added a premium assistance program since July 31, 2025, or for more information on special enrollment rights, can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565
Continuation of Coverage Rights Under COBRA
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the King|George group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the King|George 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
King|George Human Resource Benefits 1228 S Adams St Fort Worth, TX 76104 817-820-0881 benefits@kinggeorge.us
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. Outof-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 innetwork 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:
z 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 innetwork 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.
z 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:
z 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 outof-network providers and facilities directly.
z 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.
This brochure highlights the main features of the King|George 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. King|George reserves the right to change or discontinue its employee benefits plans at anytime.
