2026 Employee Benefits Guide
Important Contacts
https://member.magellanhealthcare.com (Program Name: Principal Core)
www.principal.com/dentist
EMPLOYEE RESPONSE CENTER
Employee benefits can be complicated. The Higginbotham Employee Response Center can assist you with the following:
• Enrollment
• Benefit information
• Claims or billing questions
• Eligibility issues
Call or text 833-801-5473 to speak with a representative Monday through Friday from 8:00 a.m. to 6:00 p.m. CT. If you leave a message after 3:00 p.m. CT, your call or text will be returned the next business day. You can also email questions or requests to BigSpringsMedicalAssociationInc@eb.higginbotham.net Bilingual representatives are available.
Welcome
We are pleased to offer a full benefits package to help protect your well-being and financial health. Read this guide to learn about the benefits available to you and your eligible dependents starting January 1, 2026.
Each year during Open Enrollment, you may make changes to your benefit plans. The benefit choices you make this year will remain in effect through December 31, 2026. Take time to review these benefit options and select the plans that best meet your needs. After Open Enrollment, you may only make changes to your benefit elections if you have a Qualifying Life Event.
AVAILABILITY OF SUMMARY HEALTH INFORMATION
Your benefits program offers one medical plan coverage option. To help you make an informed choice and compare your options, a Summary of Benefits and Coverage (SBC) is available by logging into Employee Navigator.
BENEFIT HIGHLIGHTS
• Our medical plan remains with Anthem Blue Cross and Blue Shield. You will receive new medical ID cards if you enroll for medical coverage.
• We continue to offer a Health Savings Account (HSA), administered by Anthem. See page 9 for how you can get triple tax advantages with an HSA.
• Principal offers emotional support services for all employees, but an Employee Assistance Program (EAP) is available at no additional cost if you enroll in the Disability plan.
• Principal offers will preparation as a perk with its Life coverage.
• You may increase your Voluntary Life coverage for you and your dependents without Evidence of Insurability (EOI). See page 12 for details.
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. See page 16 for details.
Eligibility and Enrollment
You are eligible for benefits if you are a regular, full-time employee working an average of 30 hours per week. Your coverage is effective on the first of the month following 60 days of employment. You may also enroll eligible dependents for benefits coverage. The cost for coverage depends on the number of dependents you enroll and the benefits you choose. When covering dependents, you must select and be on the same plans.
ELIGIBLE DEPENDENTS
• Your legal spouse
• Children under the age of 26 regardless of student, dependency or marital status
• Children over the age of 26 who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return
HOW TO ENROLL
Enrollment is done online through Employee Navigator. When you log into the site, review your personal information and beneficiary designations to ensure they are up to date and accurate. Once you have confirmed these, you can proceed with enrollment by following the step-by-step instructions.
OPEN ENROLLMENT
Open Enrollment occurs annually for eligible employees to enroll for or make changes to their benefits. Open Enrollment usually takes place in the fall of 2025. The benefits you elect during Open Enrollment are effective beginning January 1, 2026.
QUALIFYING LIFE EVENTS
Once you elect your benefit options, they remain in effect for the entire plan year until the following Open Enrollment. You may only change coverage during the plan year if you have a Qualifying Life Event, some of which include:
• Marriage, divorce, legal separation or annulment
• Birth, adoption or placement for adoption of an eligible child
• Death of your spouse or child
• Change in your spouse’s employment status that affects benefits eligibility
• Change in your child’s eligibility for benefits
• Significant change in benefit plan coverage for you, your spouse or your child
• FMLA leave, COBRA event, court judgment or decree
• Becoming eligible for Medicare, Medicaid or TRICARE
• Receiving a Qualified Medical Child Support Order
If you have a Qualifying Life Event and want to change your elections, you must notify the benefits coordinator and complete your changes within 30 days of the event. You may be asked to provide documentation to support the change. Qualifying Life Events will be processed via Employee Navigator. Contact Samantha Gamblin, benefits coordinator, at samanthagamblin@mohigh.org for details.
Medical Coverage
The Preferred Provider Organization (PPO) medical plan option is a High Deductible Health Plan (HDHP) from Anthem Blue Cross and Blue Shield
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 an HSA (see page 9).
FIND A NETWORK PROVIDER
• Visit www.anthem.com
• Call 833-578-4436
• Network Blue Access PPO
COVERAGE COMPARISONS
Retail Pharmacy Up to a 30-day supply
• Generic
• Preferred
• Non-Preferred
•
• Generic
*What you will pay after your deductible is met.
Prescription Drug Coverage
Your Anthem medical plan offers retail, mail order, and specialty drug benefits. Refer to the Anthem prescription drug list to see the medications covered under this plan using the Base Network . Drugs not included on the Essential drug list will not be covered.
RETAIL PHARMACY
Get a 30-day supply of short-term medications at in-network pharmacies to get the highest level of benefits.
MAIL ORDER
If you take maintenance medication for a chronic or long-term condition, consider using home delivery to receive a 90-day supply to save time and money. Or, you may obtain two 30-day supply fills of the same maintenance medication at a retail pharmacy. However, prior to your third prescription refill, you must call Anthem at the number on your ID card to inform them how you want to receive your maintenance medication – either from a retail pharmacy or by home delivery. If you do not contact Anthem, you will pay the full retail cost of any maintenance medication until you inform Anthem of your decision.
SPECIALTY PHARMACY
Anthem may require certain drugs to be filled at a designated specialty pharmacy if the drugs require special handling, provider coordination, or patient education. Drug cost-share assistance programs may be available for certain specialty drugs.
PREVENTIVE DRUGS
You will not have a deductible for prescription drugs on the PreventiveRX Plus drug list when you use an in-network pharmacy.
YOU WILL RECEIVE A NEW MEDICAL ID CARD TO USE WHEN YOU RECEIVE HEALTH CARE OR PRESCRIPTIONS.
Health Care Options
Becoming familiar with your options for medical care can save you time and money.
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
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history Office hours vary
DOCTOR’S OFFICE
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
RETAIL CLINIC
When you need immediate attention; walk-in basis is usually accepted
Generally includes evening, weekend and holiday hours
URGENT CARE
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility 24 hours a day, 7 days a week
• Allergies
• Cough/cold/flu
• Rash • Stomachache
• Infections
• Sore and strep throat
• Vaccinations
• Minor injuries/sprains/strains
• Common infections
• Minor injuries
• Pregnancy tests
• Vaccinations
• Sprains and strains
• Minor broken bones
• Small cuts that may require stitches
• Minor burns and infections
• Chest pain
• Difficulty breathing
• Severe bleeding
• Blurred or sudden loss of vision
• Major broken bones
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
• Most major injuries except trauma
• Severe pain
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only estimates. This information is not intended as medical advice. If you have questions, please call the phone number on the back of your medical ID card.
Telemedicine
Your medical coverage offers telemedicine services through Anthem. Connect anytime day or night with boardcertified virtual care-only providers via your mobile device or computer for the same or lower cost as a visit to your regular physician. Network benefits are only available when services are provided in-network.
While Anthem’s Virtual Care services do not replace your primary care physician, they are a convenient and cost-effective option when you need care and:
• Have a non-emergency issue and are considering an after-hours health care clinic, urgent care clinic or emergency room for treatment
• Are on a business trip, vacation or away from home
• Are unable to see your primary care physician
REGISTRATION IS EASY
Register with Anthem’s LiveHealth Online so you are ready to use this valuable service when and where you need it.
• Visit www.livehealthonline.com
• Call 888-548-3432
• Download the Sydney Health mobile app
YOUR COST* PER VISIT
$0 Primary Care
$0 Mental Health
$60* Specialist
*After your deductible is met.
WHEN TO USE TELEMEDICINE
Use telemedicine services for minor conditions such as:
• Sore throat
• Headache
• Stomachache
• Cold
• Flu
• Allergies
• Fever
• Urinary tract infections
Do not use telemedicine for serious or life-threatening emergencies.
Health Savings Account
An HSA is a tax-exempt tool that supplements your retirement savings and covers current and future health costs.
An HSA is a type of personal savings account that is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for current or future qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA ELIGIBILITY
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible HDHP
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
• Not enrolled in a Health Care Flexible Spending Account
• Not eligible to be claimed as a dependent on someone else’s tax return
• Not enrolled in Medicare, Medicaid, or TRICARE
• Not receiving Veterans Administration benefits
You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP.
MAXIMUM CONTRIBUTIONS
Your HSA contributions may not exceed the annual maximum amounts established by the Internal Revenue Service (IRS). The 2026 annual contribution maximums are based on the coverage option you elect:
• Individual – $4,400
• Family – $8,750
You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. If you are age 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA. If you turn 55 anytime during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
IMPORTANT HSA INFORMATION
• Always ask your 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 Anthem are eligible for automatic payroll deduction.
OPENING AN HSA
If you meet the eligibility requirements, you may open an HSA administered by Anthem You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA. To open an account, go to www.anthem.com
Abbreviated List of Qualified HSA Expenses
The products and services listed below are examples of medical expenses eligible for payment under your Health Savings Account. This list is not all-inclusive; additional expenses may qualify, and the items listed are subject to change in accordance with IRS regulations. Please refer to IRS Publication 502 Medical and Dental Expenses at www.irs.gov for a complete description of eligible medical and dental expenses.
• Abdominal supports
• Acupuncture
• Air conditioner (when necessary for relief from difficulty in breathing)
• Alcoholism treatment
• Ambulance
• Anesthetist
• Arch supports
• Artificial limbs
• Autoette (when used for relief of sickness/disability)
• Blood tests
• Blood transfusions
• Braces
• Cardiographs
• Chiropractor
• Contact lenses
• Convalescent home (for medical treatment only)
• Crutches
• Dental treatment
• Dental X-rays
• Dentures
• Dermatologist
• Diagnostic fees
• Diathermy
• Drug addiction therapy
• Drugs (prescription)
• Elastic hosiery (prescription)
• Eyeglasses
• Fees paid to health institute prescribed by a doctor
• FICA and FUTA tax paid for medical care service
• Fluoridation unit
• Guide dog
• Gum treatment
• Gynecologist
• Healing services
• Hearing aids and batteries
• Hospital bills
• Hydrotherapy
• Insulin treatment
• Lab tests
• Lead paint removal
• Legal fees
• Lodging (away from home for outpatient care)
• Metabolism tests
• Neurologist
• Nursing (including board and meals)
• Obstetrician
• Operating room costs
• Ophthalmologist
• Optician
• Optometrist
• Oral surgery
• Organ transplant (including donor’s expenses)
• Orthopedic shoes
• Orthopedist
• Osteopath
• Oxygen and oxygen equipment
• Pediatrician
• Physician
• Physiotherapist
• Podiatrist
• Postnatal treatments
• Practical nurse for medical services
• Prenatal care
• Prescription medicines
• Psychiatrist
• Psychoanalyst
• Psychologist
• Psychotherapy
• Radium therapy
• Registered nurse
• Special school costs for the handicapped
• Spinal fluid test
• Splints
• Surgeon
• Telephone or TV equipment to assist the hard-of-hearing
• Therapy equipment
• Transportation expenses (relative to health care)
• Ultraviolet ray treatment
• Vitamins (if prescribed)
• Wheelchair
• X-rays
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. Coverage is provided through Principal
Two levels of benefits are available with the DPPO plan: in-network and out-of-network. You may see any dental provider for care, but you will pay less and get the highest level of benefits with in-network providers. You could pay more if you use an out-of-network provider.
DENTAL PLAN SUMMARY
VISION COVERAGE
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 an in-network provider. Coverage is provided through the Principal using the VSP network
• Elective
Medically Necessary
• Visit www.principal.com/dentist
• Call 800-247-4695
• Visit www.vsp.com
• Call 800-877-7195
Voluntary Life and AD&D Insurance
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).
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 you may elect coverage for your spouse or children. If you leave the company, you may be able to take the insurance with you.
LIFE AND AD&D AVAILABLE COVERAGE
• Increments of $10,000 up to $500,000
• Guaranteed Issue $200,000
•
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 anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
DID YOU KNOW?
During Open Enrollment, you can enroll in or increase your Voluntary Life and AD&D coverage by the following amounts without showing proof of good health/EOI:
• $20,000 for employee only coverage
• $10,000 for a spouse up to the Guaranteed Issue amount
• $20,000 for a child(ren) if already enrolled (or if enrolling for the first time, coverage up to $10,000)
ESTATE PLANNING
Your Principal Life coverage offers you the opportunity to create a will and other legal documents to help secure and direct the assets of your estate — all for little to no cost. Access resources through the online portal at www.aragwills.com/principal
Child(ren)
Disability Insurance
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. We offer Short Term Disability (STD) and Long Term Disability (LTD) insurance for you to purchase through Principal
SHORT TERM DISABILITY
STD coverage 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 jobrelated injury or illness. If a medical condition is jobrelated, it is considered workers’ compensation, not STD.
SHORT TERM DISABILITY
Benefits Begin 1st day for accidents 8th day for illness
of Earnings You Receive 60% Maximum Weekly Benefit $500
Pre-existing Condition Exclusion 3/12*
*Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months.
LONG TERM DISABILITY
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for more than 180 days. Benefits begin at the end of an elimination period and continue while you are disabled up to Social Security Normal Retirement Age (SSNRA), or 36 months.
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.
Use Employee Navigator to determine the cost of Disability coverage.
Counseling and Support Services
EMPLOYEE ASSISTANCE PROGRAM
Only available if enrolled in Principal Disability coverage.
An Employee Assistance Program (EAP) is available to help you and family members cope with a variety of personal or work-related issues. Magellan Healthcare provides FREE and confidential counseling and support services to help with:
• Relationships
• Work-life balance
• Stress and anxiety
• Will preparation and estate resolution
• Grief and loss
• Childcare and eldercare resources
• Substance abuse
Meet with a licensed EAP professional in person, by text message, or by live chat, video, or phone sessions. Three counseling sessions per year are included.
Support is also available for legal, financial, and identity theft services. Free consultations are available based on service type. Access webinars, live talks, and other online resources for a variety of topics. Get support at any hour of the day or night.
• Call 800-450-1327
• Visit https://member.magellanhealthcare.com (use Principal Core for program name).
EMOTIONAL SUPPORT
Available to all employees at no cost
You and your family can get FREE , confidential support 24/7 to assist with life’s challenges. If you feel overwhelmed or need support, call Principal’s EAP at 800-424-4612 to speak to a licensed behavioral health clinician. Get emotional support, tips for coping, and referrals to local resources.
Emergency Air Ambulance Protection
With AirMedCare Network (AMCN), employees have access to emergency air medical transport memberships that help protect you and your family from unexpected costs.
In the event of a serious injury or illness, AMCN providers respond to 911 scene calls and hospital-to-hospital transports to carry patients to the nearest appropriate medical facility. Members have no out-of-pocket costs if transported by an AMCN provider.
HOW TO ENROLL
Enroll through Employee Navigator. There is a one-time $70 annual fee deducted from your February payroll. Contact Samantha Gamblin if you have questions.
• Email samanthagamblin@mohigh.org
• Call 573-870-7429
Required Legal 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:
Missouri Highlands Health Care
Samantha Gamblin
Benefits Coordinator P.O. Box 157 Ellington, MO 63638
573-870-7429
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 Missouri Highlands Health Care 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.
Required Legal Notices
2. Missouri Highlands Health Care has determined that the prescription drug coverage offered by the Missouri Highlands Health Care medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is not considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods. You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Missouri Highlands Health Care 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 Missouri Highlands Health Care 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 reenroll 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 573-870-7429
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by
Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
• Call 1-800-MEDICARE (1-800-6334227). TTY users should call 877486-2048
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
Missouri Highlands Health Care Samantha Gamblin Benefits Coordinator P.O. Box 157 Ellington, MO 63638 573-870-7429
Required Legal Notices
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 Missouri Highlands Health Care, hereinafter referred to as the plan sponsor.
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer.
You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask the Human Resources Department to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources Department.
Complaints: If you believe your privacy rights have been violated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer.
Missouri Highlands Health Care
Samantha Gamblin Benefits Coordinator
P.O. Box 157 Ellington, MO 63638
573-870-7429
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 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 1-866444-EBSA (3272)
If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2026. Contact your State for more information on eligibility.
Required Legal Notices
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: 1-800-221-3943/State Relay 711
CHP+: https://hcpf.colorado.gov/child-health-planplus
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
GEORGIA – MEDICAID
GA HIPP Website: https://medicaid.georgia.gov/ health-insurance-premium-payment-program-hipp
Phone: 678-564-1162, Press 1
GA CHIPRA Website: https://medicaid.georgia.gov/ programs/third-party-liability/childrens-healthinsurance-program-reauthorization-act-2009chipra Phone: 678-564-1162, Press 2
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/ welcome-iowa-medicaid
Medicaid Phone: 1-800-338-8366
Hawki Website: https://hhs.iowa.gov/programs/ welcome-iowa-medicaid/iowa-health-link/hawki Hawki Phone: 1-800-257-8563
HIPP Website: https://hhs.iowa.gov/programs/ welcome-iowa-medicaid/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
Louisiana Medicaid Website: https://www.ldh. la.gov/healthy-louisiana
Medicaid Customer Service Line: 1-888-342-6207
Louisiana Medicaid email: healthy@la.gov
Louisiana Health Insurance Premium Program (LaHIPP) Website: https://www.ldh.la.gov/lahipp
LaHIPP phone: 1-877-697-6703
LaHIPP email: La.HIPP@la.gov
LaHIPP fax: 1-888-716-9787
LaHIPP mailing address: 100 Crescent Centre Parkway, Suite 1000 Tucker, GA 30084
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/programsservices/medicaid/health-insurance-premiumprogram
Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-8523345, 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
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-medicaid-health-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 401-462-0311 (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/health-insurance-premium-paymenthipp-program
Phone: 1-800-440-0493
Required Legal Notices
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/
Website: https://dvha.vermont.gov/members/ medicaid/hipp-program
Phone: 1-800-250-8427
Website: https://coverva.dmas.virginia.gov/learn/ premium-assistance/famis-select https://coverva.dmas.virginia.gov/learn/premiumassistance/health-insurance-premium-paymenthipp-programs
Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/ Medicaid Phone: 304-558-1700
CHIP Toll-free phone: 1-855-MyWVHIPP (1-855699- 8447)
WISCONSIN – MEDICAID AND CHIP
Website: https://www.dhs.wisconsin.gov/ badgercareplus/p-10095.htm Phone: 1-800-362-3002
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 January 31, 2026, 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 Missouri Highlands Health Care group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Missouri Highlands Health Care 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
Missouri Highlands Health Care Samantha Gamblin Benefits Coordinator P.O. Box 157 Ellington, MO 63638
573-870-7429
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 outof-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-ofnetwork providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an innetwork facility but are unexpectedly treated by an out-of-network provider. You are protected from balance billing for:
• Emergency services – If you have an emergency medical condition and get emergency services from an out-ofnetwork 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
Required Legal Notices
surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care out-ofnetwork. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-ofnetwork providers and facilities directly.
• Your health plan generally must:
• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by outof-network providers.
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-ofnetwork services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/ nosurprises for more information about your rights under federal law.
NEW HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS AND YOUR HEALTH COVERAGE
PART A: General Information
Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options in your geographic area.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium and other out-of-pocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings on your premium that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.
Does Employment-Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of the credit that lowers your monthly premium, or a reduction in certain costsharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12%1
Required Legal Notices
of your annual household income, or if the coverage through your employment does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit, and advance payment of the credit, if you do not enroll in the employment-based health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income.1, 2
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution -as well as your employee contribution to employment-based coverage- is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace.
When Can I Enroll in Health Insurance Coverage through the Marketplace?
You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15.
Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan. There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and
enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage.
Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit www.HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325
Required Legal Notices
What
about
Alternatives to Marketplace Health Insurance Coverage?
If you or your family are eligible for coverage in an employment-based health plan (such as an employersponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan, but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31, 2023 and July 10, 2023, you can request this special enrollment in the employment-based health plan through September 8, 2023. Confirm the deadline with your employer or your employment-based health plan.
Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through
the Marketplace or applying directly through your state Medicaid agency. Visit https://www.healthcare.gov/ medicaid-chip/getting-medicaidchip/ for more details.
How Can I Get More Information?
For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact Human Resources.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
PART B: Information About Health Coverage Offered by Your Employer
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
3. Employer Name: Big Springs Medical Association DBA Missouri Highlands Health Care
4. Employer Identification Number (EIN): 43-1068291
5. Employer Address: P.O. Box 157
6. Employer Phone Number: 573-870-7429
7. City: Ellington
8. State: MO 9. ZIP Code: 63638
10. Who can we contact at this job?: Samantha Gamblin
11. Phone Number (if different from above):
12. E-Mail Address: samanthagamblin@mohigh.org
As your employer, we offer a health plan to all eligible employees (see the Eligibility section of this guide). This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.
1 Indexed annually; see https://www.irs.gov/pub/irsdrop/rp-22-34.pdf for 2023.
2 An employer-sponsored or other employment-based health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.
This brochure highlights the main features of the Missouri Highlands Health Care 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. Missouri Highlands Health Care reserves the right to change or discontinue its benefits plans at anytime.