2026 EMPLOYEE BENEFITS
WORKING TOWARDS WELLNESS
A comprehensive guide to understanding your employee benefits program
What’s Inside 03
Introduction
07
• Date your New Benefits Begin • Availability of Summary Health Information
04
09
• DPPO Plan
• High Deductible Health Plan
• Dental Benefits Summary
Cigna Resources
• Health Savings Account
• Cigna Resources
• Alight Navigator Healthcare Advocacy
• MyCigna Mobile App • Health Information Line
• Doctors Online • Dental • Vision
10
• Dental Network Information • Maximum Rollover Program
• Accident • Critical Illness
• HSA Contributions
11
14
• Find an In-Network Provider
15
• Employee and Spouse Rates
16
• HSA Eligibility • Important HSA Information
• Qualifying Life Events
• Open an HSA • Contributions
Enrollment • How to Enroll • Miss the Enrollment Deadline?
Disability Insurance • Long Term Disability
• Covering Your Children
Eligibility • Who is Eligible for Benefits?
06
Life and AD&D Insurance • Life and AD&D Benefits Summary
• Triple Tax Savings
05
Vision Coverage • Vision Benefits Summary
Health Care Options Health Savings Account
• Voluntary Life and AD&D
Dental Coverage
• Preferred Provider Organization
• Medical Benefits Summary
• Medical
• Employee Assistance
13
• About this Coverage
Important Contacts • Telemedicine
Medical Coverage
12
Qualified HSA Expenses
16
Unum Programs and Services • Employee Assistance Program • Worldwide Emergency Travel Assistance • Survivor Benefit
• Benefits Assistance
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 22 for more details.
02
Introduction We know you work hard every day to achieve your personal and
17
Supplemental Benefits
professional goals. Since your health and wellness are key to
• Accident Insurance
benefits package that supports your health, mind, and body. May
• Critical Illness Insurance
19
• My Benefits Work Mobile App
Benefits Plan Year:
• Did you Know?
January 1, 2026 to December 31, 2026
• Teladoc Telemedicine
New hires are eligible to enroll beginning the first of the month
• Healthcare Advocacy via Alight Navigator Doctors Online
Extra Perks • Paid Time Off • Employee Events • Family Bonding
22
you always be Working Towards Wellness!
New Benefits • Employee Assistance Program
20
meeting these goals, we are pleased to offer a comprehensive
following 30 days of employment.
Availability of Summary Health Information Your plan offers medical coverage options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage (SBC) available from Human Resources.
Important Notices • Women’s Health and Cancer Rights Act of 1998 • Special Enrollment Rights • Your Prescription Drug Coverage and Medicare
It’s time to enroll for benefits!
• Notice of HIPAA Privacy Practices • Premium Assistance Under Medicaid and the Children’s Health Insurance Program • Continuation of Coverage Rights Under COBRA • Your Rights and Protections Against Surprise Medical Bills
Important: This guide provides a summary of Loftwall’s benefits. If any information in this guide differs from the Loftwall Employee Handbook or official plan documents, the Employee Handbook and plan documents will take precedence. Employees should refer to the handbook for the most accurate policy details.
03
Important Contacts WHO TO TALK TO FOR MORE INFORMATION COVERAGE
Provider
Group #
Phone
Website/Email
Cigna
651153
800-244-6224
www.cigna.com hcpdirectory.cigna.com
Telemedicine
New Benefits/Teladoc
N/A
855-847-3627
www.mybenefitswork.com
Health Savings Account
UMB
N/A
866-520-4HSA
https://www.umb.com/hsa
Alight Navigator Healthcare Advocacy
New Benefits
175866
800-513-1667, x629
www.mybenefitswork.com
Doctors Online
New Benefits
175866
800-800-7616
www.mybenefitswork.com
Employee Assistance Program
New Benefits
175866
800-800-7616
www.mybenefitswork.com
Dental
Cigna
651153
800-244-6224
www.hcpdirectory.cigna.com
Vision
Cigna/EyeMed
651153
800-244-6224
www.hcpdirectory.cigna.com
Voluntary Life and AD&D
Principal
1130931
800-247-4695
www.principal.com
Accident
Principal
1130931
800-247-4695
www.principal.com
Critical Illness
Principal
1130931
800-247-4695
www.principal.com
Long Term Disability
UNUM
916588
866-779-1054
www.unum.com
Medical
WORKING TOWARDS ANSWERS
04
Eligibility
FIND OUT YOUR AND YOUR FAMILY’S ELIGIBILITY
Who is Eligible for Benefits? STATUS
New Hire
Employee
Dependent(s)
Eligibility
• Regular, full-time employee working at least 30 hours per week
• Regular, full-time employee • Working an average of 30 hours per week
• Your legal spouse • Child(ren) under age 26, regardless of student, dependency, or marital status • Child(ren) over age 26 who are fully dependent on you for support due to a mental or physical disability, and who are indicated as such on your federal tax return
Enrollment
• Enroll by the deadline given by Human Resources
• Enroll during Open Enrollment (OE) or when you have a Qualifying Life Event (QLE)
• You must enroll the dependent(s) at OE or for a QLE • When covering dependents, you must enroll for and be on the same plans
Coverage Begins
• First of the month following 30 days from date of hire
• OE: Start of the plan year • QLE: Ask Human Resources
• Based on OE or QLE effective dates
Qualifying Life Events You may only change coverage during the plan year if you have a Qualifying Life Event, such as: •
Marriage
•
Legal separation
•
Divorce
•
Annulment
•
Birth
•
Change in benefits
•
Adoption
•
Placement for adoption
•
Undergoing FMLA,
•
eligibility •
Death
•
Receiving a
COBRA event, court
Qualified Medical
judgment or decree
Child Support Order (QMCSO)
Becoming eligible for Medicare, Medicaid, or TRICARE
•
Gain or loss of benefits coverage
•
Change in employment
•
Significant change in cost of spouse’s coverage
status affecting benefits
05
Enrollment
STEPS TO TAKE TO ENROLL FOR BENEFITS When you are ready to enroll, log in to BambooHR at https://app.bamboohr.com/login. 1.
Start the enrollment process: •
On your home screen, look for the Start Enrollment widget and click it.
•
You can also find the option in the Benefits section under the my info tab or on the mobile app.
2.
Complete your selections: •
An intuitive wizard will guide you through the process.
•
Review the available plans, which may update in realtime with costs as you make selections.
•
If prompted, add dependents to your plans.
•
Some plans may have auto-enrollment, and you can also choose to enroll in or waive voluntary plans.
3.
Submit your elections: •
Review a summary of your choices and their associated costs before submitting.
Miss the Enrollment Deadline?
•
Electronically sign to confirm your selections.
If you do not enroll for the following benefits by the deadline
•
You can access your submitted elections for reference
have to wait until the next Open Enrollment or until you have a
throughout the year on your employee tab.
Qualifying Life Event:
given to you, you will not receive the following benefits and will
•
Medical
•
Vision
•
Health Savings Account
•
Voluntary Life and AD&D
•
Doctors Online/Alight
•
Long Term Disability
•
Dental
•
Critical Illness
Benefits Assistance For enrollment and benefits-related questions, contact your HR Manager: Patsy Phillips patsy@loftwall.com 214-239-3162
06
Medical Coverage PROTECTS YOU AND YOUR FAMILY FROM MAJOR FINANCIAL HARDSHIP IN THE EVENT OF ILLNESS OR INJURY.
Preferred Provider Organization (PPO) A PPO allows you to see any provider when you need care. When you see in-network providers for care, you will pay less
Medical Provider:
Network:
Cigna Open Access
Cigna
and get the highest level of benefits. You will pay more for care if you use out-of-network providers. When you see in-network providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other in-network services are covered at the deductible and coinsurance level.
High Deductible Health Plan (HDHP) An HDHP allows you to see any provider when you need care, and you will pay less for care 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 (see page 11).
About This Coverage You have a choice of three medical plans: •
PPO Copay 2500 Plan – This PPO plan has a $2,500 Individual and a $5,500 Family in-network deductible.
•
HDHP/HSA 5000 Plan – This HDHP plan has a $5,000 Individual and a $10,000 Family in-network deductible.
•
HDHP/HSA 3200 Plan – This HDHP plan has a $3,200 Individual and a $6,400 Family in-network deductible.
FIND AN IN-NETWORK PROVIDER Call 800-244-6224 Visit www.cigna.com or hcpdirectory.cigna.com
07
Medical Coverage Medical Benefits Summary
08
HDHP/HSA 5000 Plan
HDHP/HSA 3200 Plan
PPO Copay 2500 Plan
In-Network1
In-Network1
In-Network1
Calendar Year Deductible • Individual • Family
$5,000 $10,000
$3,200 $6,4002
$2,500 $5,500
Out-of-Pocket Maximum Includes deductible • Individual • Family
$5,000 $10,000
$3,200 $6,4002
$5,500 $11,000
You Pay
You Pay
You Pay
Preventive Care
$0
$0
$0
Telemedicine through New Benefits
$0
$0
$0
Primary Care Physician
$0
3
$0
3
$25 copay
Specialist
$03
$03
$40 copay
Diagnostic Lab and X-ray
$03
$03
In office: covered under copay Outside provider’s office: 20%3
Complex Imaging CT/PET scan, MRI
$03
$03
20%3
Urgent Care
$03
$03
$50 copay
Emergency Room
$0
3
$0
$250 copay + deductible + 20%
Inpatient Hospital Services
$03
$03
20%3
Outpatient Services
$03
$03
20%3
HDHP/HSA 5000 Plan
HDHP/HSA 3200 Plan
PPO Copay 2500 Plan
In-Network1
In-Network1
In-Network1
Prescription Drugs – Retail4 Up to 30-day supply • Tier I – Preferred Generic/ Generic • Tier II – Preferred Brand • Tier III – Non-Preferred Brand • Tier IV – Specialty Drugs
$03 $03 $03 $03
$03 $03 $03 $03
$10 copay $20 copay $30 copay 25% to $250 maximum
Prescription Drugs – Mail Order Up to 90-day supply • Tier I – Preferred Generic/ Generic • Tier II – Preferred Brand • Tier III – Non-Preferred Brand • Tier IV – Specialty Drugs
$03 $03 $03 $03
$03 $03 $03 $03
$30 copay $60 copay $90 copay 25% to $750 maximum
1
See plan documents for out-of-network coverage.
2
$3,400 when part of a family.
3
What you will pay after your deductible is met.
4
Focused - 90 CVS Advantage
3
Cigna Resources Cigna Member Portal
myCigna Mobile App
myCigna serves as your one-stop-shop for all Cigna health
Download the myCigna mobile app to access your Cigna
plan and benefits information. Key features include managing
health plan and benefits information while on the go. This app
and tracking claims, accessing digital ID cards, finding in-
helps you organize and access important plan information on
network providers, accessing cost comparison tools, reviewing
your smartphone or tablet. It is also available in Spanish.
coverage details, and more.
FOR MORE INFORMATION Visit www.mycigna.com to learn more.
Health Information Line Speak to a nurse at anytime to get answers and/or recommendations based on your specific health situation. Call the number on the back of your Cigna ID card for 24/7 access to the Health Information Line.
WORKING TOWARDS HEALTH
09
Health Care Options
BECOMING FAMILIAR WITH YOUR OPTIONS FOR MEDICAL CARE CAN SAVE YOU TIME AND MONEY. HEALTH CARE PROVIDER
Symptoms
Average Cost
Average Wait
Non-Emergency Care Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed
Virtual Visits/ Telemedicine
24 hours a day, 7 days a week
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history
Doctor’s Office
Office hours vary
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies
Retail Clinic
Hours vary based on store hours
When you need immediate attention; walk-in basis is usually accepted
Urgent Care
Generally includes evening, weekend and holiday hours
• • • •
Allergies Cough/cold/flu Rash Stomachache
$0
2-5 minutes
• • • •
Infections Sore and strep throat Vaccinations Minor injuries/sprains/strains
$
15-20 minutes
• • • •
Common infections Minor injuries Pregnancy tests Vaccinations
$
15 minutes
$$
15-30 minutes
Chest pain Difficulty breathing Severe bleeding Blurred or sudden loss of vision • Major broken bones
$$$$
4+ hours
• Most major injuries except trauma • Severe pain
$$$$$$
Varies
• Sprains and strains • Minor broken bones • Small cuts that may require stitches • Minor burns and infections
Non-Emergency Care
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility
Hospital ER
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
Freestanding ER
• • • •
24 hours a day, 7 days a week
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.
10
Health Savings Account
OFFSETS YOUR MEDICAL COSTS, REDUCES YOUR TAXES, AND OFFERS A LONG-TERM TAX-ADVANTAGED SAVINGS ACCOUNT. A Health Savings Account (HSA) is a tax-deductible savings plan that allows you to put aside pretax dollars to use for
Covering Your Children
current or future health care expenses. It is also a tax-exempt
Children can be covered under your medical plan up to age 26,
tool to supplement your retirement savings. It is always yours
but you can only use your HSA to cover their expenses to age
to keep, even if you change health plans or jobs.
19 (or age 24 if a full-time student). Your child may open their own HSA at the family maximum limit of $7,300 on their 19th or
HSA Contributions
24th birthday.
Use It Now
Let It Grow
You Decide How To Use Your HSA
Make annual HSA contributions + Use HSA funds to pay for eligible medical costs = Keep HSA funds in cash
Make annual HSA contributions + Pay for medical costs with other funds = Invest HSA funds
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, such as your spouse’s health plan
Triple Tax Savings 1. HSA contributions are tax-deductible 2. HSA contributions grow tax-deferred Withdrawals for qualifying medical expenses
3. are tax-free
2026 MAXIMUM CONTRIBUTIONS
•
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
Open an HSA If you meet the eligibility requirements, you may open an HSA administered by UMB. You will receive a debit card to manage
•
Individual – $4,400
your HSA account reimbursements. Keep in mind, available
•
Family (filing jointly) – $8,750
account, go to https://www.umb.com/hsa.
•
Catch-Up Contribution (if age 55+) – $1,000
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are age 55 or older, you may make a yearly catchup contribution of up to $1,000 to your HSA. If you turn 55 anytime during the plan year, you are eligible to make the catchup contribution for the entire plan year.
funds are limited to the balance in your HSA. To open an
EMPLOYER CONTRIBUTIONS If you enroll in the HDHP/HSA 5000 medical plan, Loftwall will contribute to your HSA each pay period in the following amounts: •
$20 Individual
•
$40 Family
11
Qualified HSA Expenses
SHOWS SOME MEDICAL EXPENSES THAT ARE ELIGIBLE FOR PAYMENT UNDER YOUR HEALTH CARE HSA. This list is not all-inclusive; additional expenses may qualify and the items listed may change in accordance with IRS regulations. 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)
•
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
•
Alcoholism treatment
•
Ambulance
•
Anesthetist
•
Arch supports
•
Artificial limbs
•
• Autoette (when used for relief of sickness/disability) •
Hearing aids and batteries
•
Blood tests
•
Hydrotherapy
•
Blood transfusions
•
Insulin treatment
•
Braces
•
Lab tests
•
Cardiographs
•
Lead paint removal
•
Chiropractor
•
Legal fees
•
Contact lenses
•
•
Convalescent home (for medical treatment only)
Lodging (away from home for outpatient care)
•
Metabolism tests
•
Crutches
•
Neurologist
•
Dental treatment
•
•
Dental X-rays
Nursing (including board and meals)
•
Dentures
•
Obstetrician
•
Operating room costs
•
Ophthalmologist
•
Optician
•
Optometrist
•
Oral surgery
•
Organ transplant (including donor’s expenses)
• •
12
•
Dermatologist Diagnostic fees
•
Diathermy
•
Drug addiction therapy
•
Drugs (prescription)
•
Elastic hosiery (prescription)
•
Eyeglasses
Hospital bills
•
Orthopedic shoes
•
Radium therapy
•
Orthopedist
•
Registered nurse
•
Osteopath
•
•
Oxygen and oxygen equipment
Special school costs for the handicapped
•
Spinal fluid test
•
Pediatrician
•
Splints
•
Physician
•
Surgeon
•
Physiotherapist
•
•
Podiatrist
Telephone or TV equipment to assist the hard-of-hearing
•
Postnatal treatments
•
Therapy equipment
•
Practical nurse for medical services
•
Transportation expenses (relative to health care)
•
Prenatal care
•
Ultra-violet ray treatment
•
Prescription medicines
•
Vaccines
•
Psychiatrist
•
Vitamins (if prescribed)
•
Psychoanalyst
•
Wheelchair
•
Psychologist
•
X-rays
•
Psychotherapy
Important HSA Information •
Always ask your in-network doctor to file claims with your medical, dental, or vision carrier so you will get the highest level of benefits. You can pay the doctor with your HSA debit card for any balance due.
•
You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
•
You may open an HSA at the financial institution of your choice, but only accounts opened through UMB are eligible for automatic payroll deduction and company contributions.
Dental Coverage
Maximum Rollover Program
HELPS MAINTAIN FRESH BREATH, HEALTHY GUMS AND TEETH, AND OTHER DENTAL WORK.
If you enroll in a dental plan, you will automatically be enrolled in the maximum accumulation plan. The plan rewards you for going to the dentist regularly to prevent or detect early signs
DPPO Plan
of serious diseases. If you submit a claim (without exceeding the paid claims threshold of a benefit year), the plan will roll
Two levels of benefits are available with the DPPO plan: in-
over part of your unused annual maximum into an account.
network and out-of-network. You may see any dental provider
The funds can be used in future years if your plan’s annual
for care, but you will pay less and get the highest level of
maximum is reached. The entire accumulation amount will be
benefits with in-network providers. You could pay more if you
forfeited if no dental service is submitted within a calendar
use an out-of-network provider.
year. If your benefits begin in the fourth quarter, the rollover will begin in the first quarter of the new year.
DENTAL NETWORK INFORMATION
Example of How the Maximum Accumulation Plan Works
Call 800-997-1654 Visit https://hcpdirectory.cigna.com/web/ public/consumer/directory/search Medical Provider:
Network:
Cigna
Cigna DPPO network
Plan Annual Maximum
$2,000 Maximum claims reimbursement
Threshold
Maximum Rollover Amount
Maximum Accumulation Plan Account Limit
$1,000 Claims amount that determines rollover eligibility
$500 Additional dollars added to a plan’s annual maximum for future years
$2,000 Your account cannot exceed this amount
Dental Benefits Summary CIGNA DPPO NETWORK
Dental Low In-Network
Dental High
Out-of-Network
1
1
In-Network1
Out-of-Network1
Calendar Year Maximum Benefit
$2,000
$2,000
$2,000
$2,000
Orthodontia Lifetime Maximum Benefit
not applicable
not applicable
$2,000
$2,000
You Pay
Calendar Year Deductible • Individual • Family
You Pay
$50 $150
$50 $150
$25 $75
$25 $75
Preventive Care Exams, cleanings, complete series x-rays
$0
$0
$0
$0
Basic Restorative Fillings, simple extractions
20%2
20%2
20%2
20%2
Root Canal Therapy - Endodontics
50%2
50%2
20%2
20%2
Periodontics
50%2
50%2
20%2
20%2
Major Restorative Crowns, bridges, dentures, oral surgery
50%2
50%2
50%2
50%2
not applicable
not applicable
50%
50%
Orthodontia Dependent children to age 19 1 2
Payment for covered services received from an out-of-network dentist is based on the 90th percentile of Usual, Customary, and Reasonable (UCR) charges. What you will pay after your deductible is met.
13
Vision Coverage
HELPS DETECT CERTAIN MEDICAL ISSUES, PROLONG YOUR EYESIGHT, AND CORRECT VISION OR EYE PROBLEMS.
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. Coverage is provided through Cigna using the EyeMed vision network. Cigna offers a large network of providers, no claims to file, and online shopping perks. Go during the day or night, on weekends, or just walk in to many in-network locations.
Vision Benefits Summary VISION
EyeMed Network In-Network
Out-of-Network
You Pay
Reimbursement
Exam
$10 copay
up to $45
Lenses • Single vision • Lined bifocals • Lined trifocals • Lenticular
$25 copay $25 copay $25 copay $25 copay
up to $32 up to $55 up to $65 up to $80
$150 allowance; 20% off balance
up to $83
$150 allowance $25 materials copay
up to $120 $210
Frames Contacts In lieu of frames and lenses • Elective • Medically necessary Benefit Frequency • Exam • Lenses • Frames • Contacts
Once every 12 months Once every 12 months Once every 12 months Once every 12 months
Medical Provider:
Network:
Cigna
EyeMed Network
FIND AN IN-NETWORK PROVIDER Call 800-244-6224 Visit https://eyedoclocator. eyemedvisioncare.com/cigna/en
14
Life and AD&D Insurance
PROVIDES YOUR LOVED ONES WITH A FINANCIAL SAFETY NET AFTER YOUR DEATH AND/OR AFTER AN ACCIDENT THAT CAUSES LOSS OF LIFE, LIMB, OR FUNCTION. Life and Accidental Death and Dismemberment (AD&D) insurance through Principal 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 by 65% at age 65, and 50% at age 70.
Voluntary Life and AD&D You may buy Voluntary Life and AD&D for yourself and your
Voluntary Life and AD&D Employee
• Increments of $10,000 not to exceed $500,000 • Guaranteed Issue: $100,000
Spouse
• Increments of $5,000 up to $150,000 (not to exceed 100% of employee’s coverage) • Guaranteed Issue: $30,000
Child(ren)
• Live birth to 14 days: $1,000 • 14 days to age 26: $10,000 • Guaranteed Issue $10,000
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).
Voluntary Life
Annual Increase Rule
Employee and Spouse1 Rates per $1,000 Age
Rate
Age
Rate
<29
$0.11
50-54
$0.71
Guaranteed Issue (GI) amount without showing Evidence of
29-34
$0.12
55-59
$1.10
Insurability (EOI) in the following amounts:
35-39
$0.17
60-64
$1.69
40-44
$0.27
65-69
$2.77
45-49
$0.44
70+
$4.67
If you and your spouse are currently enrolled in Voluntary Life and AD&D, you may increase your coverage up to the
•
$20,000 for Employee Only
•
$10,000 for Spouse
AD&D
Rates per $10,000
1
Employee
$0.04
Spouse
$0.04
Child(ren)
$2.000
Spouse rate is based on employee’s age.
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%).
15
Disability Insurance
PROVIDES PARTIAL INCOME PROTECTION IF YOU ARE UNABLE TO WORK DUE TO A COVERED ACCIDENT OR ILLNESS. We provide Long Term Disability (LTD) at no cost to you through Unum.
Long Term Disability
If you were temporarily unable to work, would you be able to cover your bills?
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for more than 90 days. Benefits begin at the end of an elimination period and continue while you are disabled up to the maximum benefit period. You can use the money however you choose. It can help pay for your rent or mortgage, groceries, out-of-pocket medical expenses, and more. The monthly benefit may be reduced or offset by other sources of income. The IRS may require you to pay taxes on certain benefit payments. See your tax advisor for details.
Long Term Disability Benefits Benefits Begin
91st day
Percentage of Earnings You Receive
60%
Maximum Monthly Benefit
up to $12,000
Maximum Benefit Period
SSNRA*
Pre-existing Condition
not covered
*Social Security Normal Retirement Age
Unum Programs and Services The following are available at no additional cost as part of your Unum Disability coverage. See plan documents for full details.
Employee Assistance Program
Worldwide Emergency Travel Assistance
Survivor Benefit
Get access to professional help for a range of personal and work-
One phone call gets you and your
disabled and have received
related issues, including counselor
family immediate help anywhere
benefits for at least 180 days, your
referrals, financial planning, and
in the world, as long as you are
family could get a benefit equal
legal support.
traveling 100 or more miles from
to three months of your gross
home. However, business travel for
disability payment.
your spouse is not covered.
16
If you die while you have been
Supplemental Benefits COMPLEMENTS OUR TRADITIONAL HEALTH CARE PROGRAMS AND PAYS YOU DIRECTLY FOR UNEXPECTED HEALTH CARE COSTS.
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, childcare, rent, and other costs not covered by traditional health plans. See the plan document for full details.
ACCIDENT
Benefit
Ambulance Ground/Air
Up to $1,000
Emergency Room
$150
Hospital Admission
$200 once/year
Hospital Confinement
$400 per day – up to 365 days
Intensive Care Unit
$800 per day – up to 15 days
Specific Sum Injuries Dislocations, ruptured discs, eye injuries, fractures, lacerations, concussions, and more
PROTECT YOUR SAVINGS Health insurance covers medical bills, but if you have an emergency, an accident, or a hospital stay, you may have a lot of unexpected out-ofpocket costs to pay. Protect your savings with additional coverage from Principal.
$500-$10,000
Monthly Rates Employee Employee + Spouse Employee + Child(ren) Employee + Family
$8.30 $12.92 $18.19 $24.55
17
Supplemental Benefits Critical Illness Insurance 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-of-town
BEWELL BENEFIT Each covered member can also receive $50 per year for completing a wellness screening with your doctor.
treatments, special diets, daily living, and household upkeep costs. See the plan document for full details.
CRITICAL ILLNESS
Vendor Plan
Employee
Increments of $5,000 up to $50,000 Guaranteed Issue: $20,000
Spouse
50% of employee benefit Guaranteed Issue: $10,000
Children
25% of employee benefit Condition
First Occurrence Benefit
Heart attack, stroke, end stage renal failure, major organ transplant
100%
Coronary artery bypass surgery, benign brain tumor
25%
Cancer Invasive
100%
Carcinoma In Situ
25%
Childhood Conditions - Applies to Dependents only Cerebral palsy, congenital metabolic disorder, cystic fibrosis, type 1 diabetes
100%
Wellness benefit
$50
EMPLOYEE AND SPOUSE COVERAGE RATES PER $1,000 OF BENEFIT
18
Age Band
Monthly Rates
<30
$0.28
30-39
$0.50
40-49
$1.10
50-59
$2.36
60-69
$5.01
70+
$9.36
New Benefits Programs and Services
THE FOLLOWING PROGRAMS AND SERVICES ARE PROVIDED THROUGH NEW BENEFITS AT NO ADDITIONAL COST TO YOU. THEY ARE DESIGNED TO HELP YOU SAVE TIME AND MONEY ON YOUR HEALTH CARE.
Employee Assistance Program
DID YOU KNOW?
Untreated mental health issues can lead to serious physical
Your emotional health contributes to your overall health. Yet, 32% of U.S. employees report suffering from severe stress, anxiety, or depression, and 51% say they are less productive at work as a result of stress. Measure your mindset and get free feedback and resources for a positive, healthy outlook. Visit www.mybenefitswork.com to get started.
illnesses – like high blood pressure and heart disease – that produce more claims and increased health care expenses. New Benefits provides a 24/7, confidential Employee Assistance Program (EAP) to support you and your eligible dependents by phone or computer. You may get unlimited short-term assistance for personal issues like stress, depression, family problems, substance abuse, financial and legal issues, child and eldercare help, and more. Long-term assistance and referrals for specialized care are also available.
CONTACT THE EAP Call 800-800-7616 Visit mybenefitswork.com
Teladoc Telemedicine Connect anytime day or night with a board-certified doctor via your mobile device or computer when you use Teladoc
Download the My Benefits Work mobile app.
services through New Benefits. If you are enrolled in a
My Benefits Work Mobile App
While telemedicine does not replace your primary care
Download the My Benefits Work mobile app to have on-
you need care and:
demand access to your benefits. The app features: •
•
physician, it is a convenient and cost-effective option when
•
Have a non-emergency issue and are considering an
My Wallet to access benefit information and store and view
after-hours health care clinic, urgent care clinic, or
medical and HSA cards
emergency room for treatment
Benefits tiles that link directly to your benefit access points for the services in your bundle
•
Loftwall medical plan, your cost for Teladoc visits is $0!
•
Are on a business trip, vacation, or away from home
•
Are unable to see your primary care physician
Single-Sign On for telemedicine, advocacy, pricing transparency, and more
Use telemedicine services for minor conditions such as:
•
My Insurance for insurance details and contact information
•
Sore throat
•
Mental health issues
•
Timely emails and push notifications
•
Headache
•
Allergies
•
On-demand support and resources
•
Stomachache
•
Fever
Download the My Benefits Work app, or visit
•
Cold/flu
•
Urinary tract infections
www.mybenefitswork.com. Use your Member ID and Group ID to register.
Do not use telemedicine for serious or life-threatening emergencies. Register with Teladoc so you are ready to use this valuable service when and where you need it. Online – www.mybenefitswork.com Phone – 855-VIP-DOCS
19
Health Care Advocacy via Alight Navigator Health care is confusing and finding the right care for the best cost is not easy. That is why Loftwall offers Alight Navigator as your personal health care advocate for free! Personal health advocates can help you get the most out of your health care benefits and educate you on how to navigate insurance and health care systems. This includes knowing exactly what you will pay for health care through price transparency. Call 800-513-1667, x629 or access www.mybenefitswork.com for details. Personal health advocates will help you: •
Locate doctors, specialists, hospitals, dentists,
•
and pharmacies
Provide cost estimates for covered and non-covered treatment
•
Research treatments
•
Help negotiate a fee or payment plan
•
Arrange second opinions
•
Review medical bills and resolve errors
•
Assist with the transfer of medical records
•
Save you a lot of time, money, and stress
•
Explain medical terms
Doctors Online With Alight’s Doctors Online, you have 24/7 email access to doctors, pharmacists, psychologists, dentists, dieticians, and more to get treatment options and advice. Expect responses within a few hours. This service also includes an array of articles and videos as well as a Health Encyclopedia that you can review for free. Doctors Online offers unlimited, confidential services for your immediate family in a secure format. Alight does not share any of your personal health information with Loftwall. Visit www.member.compassphs.com and click “Register” to get started.
Extra Perks
20
Paid Time Off
Employee Events
Family Bonding
Loftwall offers paid time
We like being together!
This one is a big deal. We love celebrating when our
off, sick leave, bereavement
We host events throughout
team members’ families are growing. That is why
leave, jury duty leave, and
the year, large and small.
Loftwall offers time off at full pay for individuals who
maternity/paternity leave. But
Whether it’s a happy hour,
carry a child and time off for bonding between other
we don’t stop there! We give
cornhole tournament, or
parents and a child. Other parent bonding can refer
all team members the final
shutting down the entire
to those who adopt a child or are the secondary
week of the calendar year off
company to attend the Texas
caregiver. You are already losing sleep in this stage,
to recharge and celebrate
State Fair, having fun is in our
so Loftwall is here to help you sleep just a bit easier.
with their families.
DNA!
Refer to the Loftwall Handbook for policy details.
Employee Contributions Your Contributions MEDICAL
HDHP/HSA 5000 Plan
HDHP/HSA 3200 Plan
PPO Copay 2500 Plan
Employee
$56.36
$64.71
$70.98
Employee + Spouse
$147.77
$169.66
$186.12
Employee + Child(ren)
$125.85
$144.49
$158.51
Employee + Family
$202.55
$232.55
$255.12
DENTAL
Low Plan
High Plan
Employee
$3.10
$3.89
Employee + Spouse
$6.42
$8.07
Employee + Child(ren)
$7.94
$12.17
Employee + Family
$11.84
$17.33
$
$
VISION Employee
$1.13
Employee + Spouse
$2.50
Employee + Child(ren)
$2.33
Employee + Family
$3.94
$
LIFE AND AD&D Voluntary Life and AD&D
See page 15 for rates
$
Paid by Loftwall, Inc.
$0
DISABILITY Long Term Disability
YOUR TOTAL BENEFITS COST
$
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Important Notices Women’s Health and Cancer Rights Act of 1998 In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully. As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits: All stages of reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; and Prostheses and treatment of physical complications of the mastectomy, including lymphedema. Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
Special Enrollment Rights This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.
Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP) If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage). If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance. Marriage, Birth or Adoption If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption. For More Information or Assistance To request special enrollment or obtain more information, contact: Loftwall Human Resources c/o Tony Groat 2617 N. Great SW Pkwy., Ste. 100 Grand Prairie, TX 75050 214-239-3162
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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 Loftwall Inc. 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. Loftwall Inc. has determined that the prescription drug coverage offered by the Loftwall Inc. medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is considered Creditable Coverage.
Important Notices Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods. You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty). You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Loftwall Inc. 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 Loftwall Inc. 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 214-239-3162. 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 (1-800633-4227). TTY users should call 877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778. Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty). January 1, 2026 Loftwall Human Resources c/o Tony Groat 2617 N. Great SW Pkwy., Ste. 100 Grand Prairie, TX 75050 214-239-3162
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 Loftwall Inc., hereinafter referred to as the plan sponsor.
23
Important Notices 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. Loftwall Human Resources c/o Tony Groat 2617 N. Great SW Pkwy., Ste. 100 Grand Prairie, TX 75050 214-239-3162 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.
24
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www. healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www. insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of 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 (855-6927447) 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
Important Notices 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: 1-800-221-3943/ State Relay 711 CHP+: https://hcpf.colorado.gov/ child-health-plan-plus CHP+ Customer Service: 1-800359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ HIBI Customer Service: 1-855-6926442 Florida – Medicaid
Website: https://www. flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp/ index.html Phone: 1-877-357-3268 Georgia – Medicaid
GA HIPP Website: https:// medicaid.georgia.gov/healthinsurance-premium-paymentprogram-hipp Phone: 678-564-1162, Press 1 GA CHIPRA Website: https:// medicaid.georgia.gov/programs/ third-party-liability/childrenshealth-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: 1-800457-4584
Iowa – Medicaid and CHIP (Hawki)
Massachusetts – Medicaid and CHIP
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
Website: https://www.mass.gov/ masshealth/pa Phone: 1-800-862-4840 TTY: 711 Email: masspremassistance@ accenture.com
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
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-premiumprogram Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext. 15218 Email: DHHS.ThirdPartyLiabi@ dhhs.nh.gov
25
Important Notices New Jersey – Medicaid and CHIP
South Carolina – Medicaid
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)
Website: https://www.scdhhs.gov Phone: 1-888-549-0820
New York – Medicaid
Website: https://www.health. ny.gov/health_care/medicaid/ Phone: 1-800-541-2831 North Carolina – Medicaid
Website: https://medicaid.ncdhhs. gov Phone: 919-855-4100 North Dakota – Medicaid
Website: https://www.hhs.nd.gov/ healthcare Phone: 1-844-854-4825 Oklahoma – Medicaid and CHIP
Website: http://www. insureoklahoma.org Phone: 1-888-365-3742 Oregon – Medicaid
Website: https://healthcare. oregon.gov/Pages/index.aspx Phone: 1-800-699-9075 Pennsylvania – Medicaid and CHIP
Website: https://www.pa.gov/en/ services/dhs/apply-for-medicaidhealth-insurance-premiumpayment-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 401-4620311 (Direct RIte Share Line)
26
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-hippprogram Phone: 1-800-440-0493 Utah – Medicaid and CHIP
Utah’s Premium Partnership for Health Insurance (UPP) Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov Phone: 1-888-222-2542 Adult Expansion Website: https:// medicaid.utah.gov/expansion/ Utah Medicaid Buyout Program Website: https://medicaid.utah. gov/buyout-program/ CHIP Website: https://chip.utah. gov/ Vermont– Medicaid
Website: https://dvha.vermont.gov/ members/medicaid/hipp-program Phone: 1-800-250-8427 Virginia – Medicaid and CHIP
Website: https://coverva.dmas. virginia.gov/learn/premiumassistance/famis-select https://coverva.dmas.virginia.gov/ learn/premium-assistance/healthinsurance-premium-payment-hippprograms Medicaid/CHIP Phone: 1-800-4325924 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/programsand-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 Loftwall Inc. group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Loftwall Inc. 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 Loftwall Human Resources c/o Tony Groat 2617 N. Great SW Pkwy., Ste. 100 Grand Prairie, TX 75050 214-239-3162
Your Rights and Protections Against Surprise Medical Bills When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. What is “balance billing” (sometimes called “surprise billing”)? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-ofpocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-ofnetwork provider.
You are protected from balance billing for: Emergency services – If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most the provider or facility may bill you is your plan’s in- network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these poststabilization services. Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network costsharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.
When balance billing is not allowed, you also have the following protections: You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly. Your health plan generally must: •
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
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Cover emergency services by out-of-network providers.
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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.
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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.
You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.
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This brochure highlights the main features of the Loftwall Inc. 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. Loftwall Inc. reserves the right to change or discontinue its employee benefits plans anytime.