What’s Inside Introduction
We know you work hard every day to achieve your personal and professional goals. Since your health and wellness are key to meeting these goals, we are pleased to offer a comprehensive benefits package that supports your health, mind and body. May you always be Working Towards Wellness!
Read this guide learn more about these and other benefits. You may only enroll for or make changes to your benefits during Open Enrollment or when you have a Qualifying Life Event (see page 4).
Date Your New Benefits Begin: January 1, 2026
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.
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 25 for more details.
Eligibility
Who is Eligible for Benefits STATUS
Eligibility
Enrollment
Coverage Begins
• Regular, full-time employee
• Working an average of 30 hours per week
• Enroll by the deadline given by Human Resources
• First of the month, coinciding with or following date of hire
Qualifying Life Events
• Regular, full-time employee
• Working an average of 30 hours per week
Enroll during Open Enrollment (OE) or when you have a Qualifying Life Event (QLE)
• OE: Start of the plan year
• QLE: Ask Human Resources
Dependent(s)
• 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
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
• Based on OE or QLE effective dates
You may only change coverage during the plan year if you have a Qualifying Life Event, such as:
Undergoing FMLA, COBRA event, court judgment or decree
Becoming eligible for Medicare, Medicaid, or
Receiving a Qualified Medical Child Support Order (QMCSO)
Significant change in cost of spouse’s
How to Enroll
Enrolling in benefits is simple through BenefitsInHand.
First-Time Users
Go to www.benefitsinhand.com .
1. If this is your first time to log in, click New User Registration Once you register, use your username and password to log in.
2. Enter your personal information and company identifier (Potts Law Firm) and click Next
3. Create a username (work email address recommended) and password, then check the I agree to terms and conditions box before you click Finish
Returning Users
Go to www.benefitsinhand.com .
1. Click Start Enrollment
2. Confirm or update your personal information and click Save & Continue
3. Edit or add dependents, if needed, then click Save & Continue
4. Follow the steps on the screen for each benefit to select or decline coverage. To decline coverage, click Don’t want this benefit? and select the reason for declining.
5. When you finish making your benefit elections, review the summary of your selections. If they are correct, click the Click to Sign button to complete and submit your enrollment choices. Your enrollment will not be complete until you click the Click to Sign button.
4. If you used an email address as your username, you will get a validation email to that address to log in and begin the step-by-step enrollment process. Contact the Employee Response Center if you have questions about your benefits or need help enrolling (see page 3).
Medical Coverage
Protects you and your family from major financial hardship in the event of illness or injury. Find an In-Network Provider Call 800-997-1654 Visit www.mycigna.com
Medical Provider: Cigna Network: Open Access Plus
OAP Base Plan
This OAP plan has a $3,000 Individual and a $6,000 Family in-network deductible.
OAP Buy-up Plan
This OAP plan has a $1,000 Individual and a $2,000 Family in-network deductible.
Open Access Plus (OAP)
With an OAP plan, named after the Open Access Plus network of providers, you can go to any doctor, but you will pay less and get the best care in network. Choosing a primary care physician is an option, but you do not need a referral to see a specialist. OAP plans can steer you through different tiers of in-network providers for the best specialized care. Prior authorization may be required for hospitalizations and some outpatient services.
Cigna Medical Benefits Summary
Cigna Pharmacy Benefits
Your Pharmacy Network
You have the choice of two pharmacy networks – CVS Pharmacy or Walgreens Pharmacy. There is no option that includes both pharmacy networks. You can choose to switch to Walgreens Pharmacy anytime at www.mycigna.com, on the myCigna app, or by calling the toll-free number on your Cigna Healthcare ID card.
Your Prescription Drug List
Your plan uses the Cigna Healthcare Advantage 3 Tier prescription drug list. Log in at www.mycigna.com or the myCigna app and use the Price a Medication tool to see how your medication is covered and how much it costs.
Some medications on your drug list have extra requirements before your plan will cover them.
• Prior Authorization – Certain medications need approval from Cigna before your plan will cover them.
• Quantity Limits – For some medications, your plan only covers up to a certain amount over a certain length of time. For example, 30mg a day for 30 days.
• Step Therapy – Certain high-cost medications are part of the Step Therapy program. Your plan doesn’t cover Step Therapy medications until you try one or more generic and/or preferred-brand alternatives first (unless you receive approval from Cigna).
Prescription Services
If you take medication on a regular basis for a chronic condition, Cigna 90 Now will make buying your maintenance medications easier. The program allows you to choose how, where, and in what quantity you fill your medication. You can:
• Choose a 30-day or 90-day supply
• Choose a pharmacy for retail or home delivery
• Order, manage, track, and pay for medications by phone or online
Go to www.cigna.com/rx90network or download the myCigna app to learn more.
Home Delivery Service
Cigna’s Express Scripts Home Delivery service is a convenient, cost-effective way to receive up to a 90day supply of prescription drugs. Your medication is delivered by mail directly to your home or work address. Orders can be managed online and through the myCigna app. To learn more about the Home Delivery service, call 800-835-3184
Specialty Pharmacy Services
Cigna Pathwell Specialty offers the support you need to treat complex medical conditions, including providers and specialty medications that are covered under the Cigna medical benefit. Some restrictions apply.
For infused or injected medication needs, go to www.cigna.com/pathwellspecialty to find network providers. In-home infusions are also available. Call 877-505-3681 to speak with a Cigna specialty care manager.
Cigna also offers a specialized support team to help manage complex chronic health conditions so you can understand, manage, and treat complex conditions that require specialty medications. The Cigna team provides:
• 24/7 specialized support
• Free home delivery
• Financial assistance
• Online delivery tracking
For more information, go to go to www.cigna.com/specialty call 800-351-3606
Cigna Resources
Member Website
myCigna.com serves as your one-stop shop for all Cigna health plan and benefits information. Key features include managing and tracking claims, accessing digital ID cards, finding in-network providers, accessing cost comparison tools, reviewing coverage details, and more. Visit www.mycigna.com to register.
• One Guide – Get help from a personal guide to navigate your Cigna benefits and resources. Call the number on the back of your Cigna ID card, use the click-to-chat function on www.mycigna.com, or call 866-494-2111
• Health Information Line – Speak to a nurse anytime to get answers and recommendations based on your specific health situation. Call the number on the back of your Cigna ID card for 24/7 access.
• Live, 24/7 Customer Service – Contact a representative via phone, chat, or app.
Mobile App
Download the myCigna app to access your Cigna health plan and benefits information while on the go. This app helps you organize and access important plan information on your smartphone or tablet. It is also available in Spanish.
Cigna Education Site
Choosing the right health plan is one of the most important decisions you will make all year. Cigna created a benefits education website to make your pre-enrollment experience easier. Compare your plan options, get answers to benefits questions, and choose a plan that best fits your needs. Representatives are also available to speak with you.
• Visit www.benefitseducationcigna.com
• Call 888-806-5094
Cigna Digital ID Card
You have one ID card for both your pharmacy and medical needs. Cigna no longer issues and mails physical ID cards.
HOW TO ACCESS YOUR DIGITAL ID CARD
1. Log in at www.myCigna.com or the myCigna app
2. Click or tap ID Cards.
3. View your card, as well as any dependents’ card(s).
4. Email cards directly to doctors.
5. Save your digital ID cards in your Apple Wallet.
Cigna Wellness
Preventive Services
Your health plan covers screenings and services with no out-of-pocket costs when you visit a doctor in your plan’s provider network – even if you have not met your deductible. Some examples of preventive care services covered by your plan include general wellness exams each year, assessments and counseling, and screenings for diabetes, cancer, or depression. Preventive services are provided for women, men, and children of all ages.
Gym Discount
With Active&Fit Direct, a standard gym membership is only $28 a month. Get 20-70% off a premium exercise studio. Enrollment is free with the code FITNESSFIRST. There are no long-term contracts, and there are no fees to cancel. Create a free account and get instant access to 13,000+ on-demand workout videos. Get started at https://discoverhealthyrewards.sites.cigna.com.
Wellness Coaching
Download the Coach by Cigna app and get access to a team of health coaches. Using five integrated lifestyle areas – exercise, food, sleep, stress and weight – the app helps you focus on what matters to you.
Online Physical Therapy
RecoveryOne for Cigna is an online exercise program for acute and chronic back and joint pain. Check in weekly with a certified health coach, watch video lessons, and get unlimited video, voice and chat with the support team. The multimedia app uses motion-tracking technology to track your body motion and give visual and audio feedback. Log in to www.mycigna.com and then download the RecoveryOne app.
Dietary Help
The Foodsmart app pairs you with a clinically trained dietitian, who works with your medical history, needs, and preferences to develop a nutritional plan. Meet with your dietician regularly, plus get thousands of healthy recipes and save on groceries delivered to your door. Visit https://foodsmart.com/members/cigna-healthcare
Diabetes Prevention
If you meet eligibility criteria, Cigna offers a personalized diabetes prevention program to you at no additional cost through Omada . The 16-week program includes a digital platform and scale, access to professional coaches, online peer support groups, and interactive, online training sessions focused on healthy eating, physical activity, sleep, and stress. Learn more at go.omadahealth.com/ omadaforcigna
Maternity Care
Cigna Healthy Baby provides information from WebMD, Healthwise and the March of Dimes to help you plan for a healthy pregnancy, monitor your pregnancy week by week, prepare for labor and delivery, and care for your baby. Get 24/7 telephone support and help from a maternity specialist if you’re hospitalized during pregnancy or your baby is in the NICU. Log in www.mycigna.com and get the Cigna Healthy Pregnancy app
Cigna Well-being Solutions
If you are enrolled in a Cigna medical plan, you have access to the wellness program – Well-being Solution. Offered in partnership with Virgin Pulse, this program helps you reach your health goals.
Health Assessment
Take a short, confidential survey and assess your health across seven factors, from mental health to fitness. Then receive a personalized report and recommended actions to start improving your wellness.
My Care Checklist
Manage your health by keeping track of well visits and screenings – all in one place.
Personalized Fitness
Customize your goals, sync a fitness tracking device – like Max GO, Apple Watch, Fitbit, MyFitness Pal, and Google Fit – and get real-time insights to drive healthy routines and lasting change.
• Healthy Habits: Get bite-sized ways to build a healthy routine and improve your wellness. Your Healthy Habits will be customized based on your Health Assessment results and the interests you set in your profile.
• Challenges: Choose between a personal challenge or a health habit challenge. Use a fitness tracking device or app to track or try your steps or a goal like sleeping well or being productive. Simply track it every day to reach your goal.
• Journeys: Get help from a digital coach to eat or sleep better, be more active, reduce stress, quit smoking, reduce alcohol consumption, or cope with grief.
• Daily Cards: Get two new tips a day to help you live well and work on health habits.
Get Started Log in to www.mycigna.com and go to the Wellness tab, and download the myCigna app
Health Resources
• Media Library: Find interactive videos by trainers and coaches on a variety of topics.
• Nutrition Guide: Choose what you would like to work on, like cutting out sweets or portion control. Then get tips and recipes to achieve your goals.
• Recipes: Get ideas for healthy meals, make a weekly meal plan, and build a shopping list.
• Sleep Guide: Find help getting to bed earlier or quieting down and rest better.
• Pillars: Quickly and easily find content, tools, and resources important to you.
Fitness Discounts
The Wellness Store offers over 400 items across 50 brands. Shop a wide variety of health and wellness items like fitness trackers, digital scales, water bottles, Bluetooth speakers, deep-tissue massagers, beauty products, and more.
Cigna Mental Health Resources
If you are enrolled in a Cigna medical plan, you have behavioral health resources to help support your mental and emotional well-being.
Cigna Behavioral Health Providers
Online visits with our behavioral health network providers cost the same as in-office visits.
1. Go to www.mycigna.com and select Find Care & Cost
2. Search for Behavioral Health Counselor under Doctor by Type
3. Call to make an appointment with your selected provider.
You can also download the myCigna app or call 800-433-5768 24/7, and a Behavioral Health Advocate will find the help you need.
Mental Health Apps
Employee Assistance Program
The Cigna Employee Assistance Program offers three free sessions by phone or in-person for short-term support and advice on issues like:
• Stress, anxiety, and depression
• Various personal challenges
• Work/life balance
• Legal and financial support
Call 877-231-1492 for 24/7 phone support or to schedule an in-person counseling session.
Telemedicine for Mental Health
Schedule a video or phone visit with a board-certified therapist or psychiatrist with MDLIVE — for the same cost or less as seeing a regular in-network behavioral health provider.
• Visit www.mycigna.com
• Call MDLIVE 24/7 at 888-726-3171
• Download the MyCigna app
iPrevail Get online mental health support 24/7 with lessons, activities, on-demand coaching, and support groups.
Take control of your feelings and thoughts with engaging activities, games, and other effective tools developed by leading mental health experts.
Get coaching, therapy, and psychiatry – all in one seamless experience. Start by chatting with a coach, then easily add therapy or psychiatry as needed.
Complete a brief survey and get matched with three potential licensed therapists. You can send unlimited messages or schedule live video sessions with the therapist you choose.
How Stressed Are You?
• Go to www.mycigna.com and click on the iPrevail link
• Go to www.mycigna.com and click on the Happify link
• Download the Happify app
• Go to www.ginger.com/cigna
• Download the Ginger Emotional Support app
• Go to www.talkspace.com/cigna
Same cost as an office visit
• Download the Talkspace app Texting
See if stress is impacting your life. Simply take our quick online stress quiz. Then visit www.cigna.com/mystressplan for a plan tailored to help you manage your level of stress.
Telemedicine
Allows 24/7/365 access to boardcertified doctors from your mobile phone or computer.
Your medical coverage offers telemedicine services through MDLIVE for Cigna Healthcare. Connect anytime day or night with a board-certified doctor via your mobile device or computer for free.
While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
• Have a non-emergency issue and are considering an 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
When to Use MDLIVE
Cigna partners with MDLIVE for minor medical and behavioral/mental health virtual care. Do not use telemedicine for serious or life-threatening emergencies.
MINOR
MEDICAL
• Acne
• Allergies
• Cold/flu
• Earaches
• Fever
• Nausea
• Stomachache
• Skin infections
• Urinary tract infections
• Pink eye
• And more
BEHAVIORAL/MENTAL HEALTH
• Addictions
• Child/adolescent issues
• Depression
• Grief/loss
• Panic disorders
• Parenting issues
• Relationship and marriage issues
• Bipolar disorders
• Life changes
• And more
Do not use telemedicine for serious or lifethreatening emergencies.
Connect
Virtual Care Options
Access
Health Care Options
Becoming familiar with your options for medical care can save you time and money.
Non-Emergency Care
Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed
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
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
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
• 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
• Most major injuries except trauma
• Severe pain
Dental Coverage
Helps maintain fresh breath, healthy gums and teeth, and other dental work.
DPPO Plan
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.
Maximum Accumulation Account
When you have regular dental checkups and your yearly claims are below $1,000, Principal will carry over a portion of your unused annual maximum for each person on the plan. If you have at least $1,000 in your current year annual maximum benefit, Principal will carry over $500. Leftover award balances carry over to the next benefit period – up to $2,000. Note: the entire accumulation amount will be forfeited if you do not have any dental services during a calendar year.
VSP Vision Discounts with Dental
If you enroll in dental coverage, you can get vision discounts from VSP, including 20% off sunglasses, 15% off contact lenses, and 15% off laser correction. To learn more, visit www.principal.com/vsp or call 800-877-7195
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 innetwork providers. Coverage is provided through Principal using the VSP vision network.
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Flexible Spending Accounts
Allows you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer two different FSAs: one for health care expenses and one for dependent care expenses. Higginbotham administers our FSAs.
Health Care FSA
The Health Care FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. You may contribute up to $3,400 annually to a Health Care FSA, and you are entitled to the full election from day one of your plan year. Eligible expenses include:
• Dental and vision expenses
• Medical deductibles and coinsurance
• Prescription copays
• Hearing aids and batteries
You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).
See page 18 for a full list of qualified FSA expenses.
Important FSA Rules
Dependent Care FSA
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for daycare or babysitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled, or a full-time student.
THINGS TO CONSIDER REGARDING THE DEPENDENT CARE FSA
• Overnight camps are not eligible for reimbursement (only day camps can be considered).
• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
The maximum per plan year you can contribute to a Health Care FSA is $3,400. The maximum per plan year you can contribute to a Dependent Care FSA is $7,500 when filing jointly or head of household and $3,750 when married filing separately.
• You cannot change your election during the year unless you experience a Qualifying Life Event.
• You can continue to file claims incurred during the plan year.
• The IRS has amended the “use it or lose it rule” to allow you to carry over up to $680 in your Health Care FSA into the next plan year.
Pay with FSA Debit Card or Get Reimbursed
Use your Higginbotham Benefits Debit Card to pay for qualified expenses, doctor visits, and prescription copays.
• Pay out-of-pocket, and submit your receipts for reimbursement:
• Fax – 866-419-3516
• Email – flexsupport@higginbotham.net
• Online – https://flexservices.higginbotham.net
Qualified FSA Expenses
Shows some medical expenses that are eligible for payment under your Health Care FSA.
• 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)
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.
• Metabolism tests
• Neurologist
• Nursing (including board and meals)
• Obstetrician
• Operating room costs
• Ophthalmologist
• Optician
• Optometrist
• Oral surgery
• Organ transplant (including donor’s expenses)
• Orthopedic shoes
• Orthopedist
• Osteopath
• Oxygen and oxygen equipment
• Pediatrician
• Physician
• Physiotherapist
• Podiatrist
• Postnatal treatments
• Practical nurse for medical services
• Prenatal care
• Prescription medicines
• Psychiatrist
• Psychoanalyst
• Psychologist
• Psychotherapy
• Radium therapy
• Registered nurse
• Special school costs for the handicapped
• Spinal fluid test
• Splints
• Surgeon
• Telephone or TV equipment to assist the hard-of-hearing
• Therapy equipment
• Transportation expenses (relative to health care)
• Ultraviolet ray treatment
• Vaccines
• Vitamins (if prescribed)
• Wheelchair
• X-rays
Life and AD&D Insurance
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 to 65% at age 65, and to 50% at age 70.
Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at $50,000 for each benefit.
Voluntary Life and AD&D
If you need more coverage than Basic Life and AD&D, you may buy Voluntary Life and AD&D for yourself and your dependent(s). If you do not elect Voluntary Life and AD&D insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health. You must elect Voluntary Life and AD&D coverage for yourself before covering your spouse and/or child(ren).
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%).
Employee
Spouse
Child(ren)
Voluntary Life and AD&D
• Increments of $10,000 up to $500,000
• New Hire Guaranteed Issue under 70: $150,000
• New Hire Guaranteed Issue 70 or older: $10,000
• Increments of $5,000 up to $100,000 not to exceed 50% of your election
• New Hire Guaranteed Issue under 70: $30,000
• New Hire Guaranteed Issue 70 or older: $10,000
• Choose from $2,000, $4,000, $5,000, or $10,000 not to exceed 50% of your election
• Birth to 14 days - $1,000
• New Hire Guaranteed Issue $10,000
Upon termination of employment, you have the option to continue your basic Life and AD&D insurance by paying premiums directly to Principal. You can also port your voluntary Life coverage — though not your voluntary AD&D. If you are disabled at the time your employment is terminated, contact HR to see if you are eligible for a Waiver of Premium while you are disabled.
Disability Insurance
Provides partial income protection if you are unable to work due to a covered accident or illness.
We provide Short Term Disability (STD) and Long Term Disability (LTD) at no cost to you 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, pregnancy or non-work related injury. STD benefits are not payable if the disability is due to a job-related injury or illness. If a medical condition is job-related, it is considered workers’ compensation, not STD.
Short Term Disability Benefits
If you were temporarily unable to work, would you be able to cover your bills?
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 90 days. Benefits begin at the end of an elimination period and continue while you are disabled up to Social Security Normal Retirement Age (SSNRA)..
Long Term Disability Benefits
Employee Assistance Programs
Help you and family members cope with a variety of personal or work-related issues.
The Employee Assistance Program (EAP) from Cigna provides confidential counseling and support services at little or no cost to you to help with:
• Relationships
• Work-life balance
• Stress and anxiety
• Will preparation and estate resolution
• Grief and loss
• Child and elder care resources
• Substance abuse
Additional Benefit
Coverage from Cigna includes three face-toface sessions with a certified therapist. These sessions can be used for you or any of your eligible dependents. Additional sessions can be purchased at a discounted rate.
Additional Benefits
The following programs and services from Principal and Cigna are available at no extra cost to you.
Worldwide Travel Assistance
AXA Assistance USA provides travel assistance for you and your dependents if you are traveling on any single trip more than 100 miles from home. Contact a representative to get trip planning assistance; translation, interpreter, or legal services; lost baggage assistance; emergency funds; document replacement; medical emergency help; and more. Services are available for business and personal travel.
• For inquiries within the USA, call 888-647-2611
• From outside the USA, call 630-766-7696
• Visit www.principal.com/travelassistance
Will and Legal Document Center
Use online resources and tools provided by ARAG to prepare, print, and store essential legal documents such as a will, living will, health care power of attorney, durable power of attorney, and medical treatment authorization for minors. Access estate planning tools and resources and a personal information organizer at www.aragwills.com/principal. To register, call Arag at 800-546-3718, or call Principal at 866-539-1728 with any questions.
Identity Theft Kit
If your identity is stolen, get valuable tips on how to restore it at www.aragwills.com/principal
Identity Theft Protection
IdentityForce – free with Cigna to you and your children under 18 living at home – offers identity monitoring, restoration, and response services to help protect you from identity theft. To enroll, visit https://cigna.identityforce.com/starthere or call 833-580-2523
Retirement Plan
A 401(k) plan can be a powerful tool to help you be financially secure in retirement. Our 401(k) plan through Empower can help you reach your investment goals.
How the Retirement Plan Works
You are eligible to participate in the plan if you are 18 years of age and have three months of service. You may contribute up to the IRS limit. You may direct your contributions to any of the investments offered within the company 401(k) plan. You decide how much you want to contribute and can change your contribution amount anytime. All changes are effective as soon as administratively feasible and remain in effect until you update or stop your contributions. You also decide how to invest the assets in your account and may change your investment choices anytime. For more details, contact human resources.
Enrollment
You must enroll through Empower at www.empower.com or by calling 855-756-4738
Vesting
You are always 100% vested in your own contributions.
A 401(k) plan can help you reach your investment goals!
Employee Contributions
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:
Potts Law Firm LLP
Human Resources
3737 Buffalo Speedway, Suite 1900 Houston, TX 77098 214-373-0404
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 Potts Law Firm LLP 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. Potts Law Firm LLP has determined that the prescription drug coverage offered by the Potts Law Firm LLP medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods. You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Potts Law Firm LLP at the phone number or address listed at the end of this section.
Important Notices
If you choose to enroll in a Medicare prescription drug plan and cancel your current Potts Law Firm LLP 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 214-373-0404
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
Call 1-800-MEDICARE (1-800-633-4227) TTY users should call 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www. socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800325-0778
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
Potts Law Firm LLP Human Resources
3737 Buffalo Speedway, Suite 1900 Houston, TX 77098
214-373-0404
Notice of HIPAA Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Effective Date of Notice: September 23, 2013
Potts Law Firm LLP Plan is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information and to inform you about:
1. the Plan’s uses and disclosures of Protected Health Information (PHI);
2. your privacy rights with respect to your PHI;
3. the Plan’s duties with respect to your PHI;
4. your right to file a complaint with the Plan and to the Secretary of the U.S. Department of Health and Human Services; and
5. the person or office to contact for further information about the Plan’s privacy practices.
The term “Protected Health Information” (PHI)
includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form (oral, written, electronic).
Section 1 – Notice of PHI Uses and Disclosures
Required PHI Uses and Disclosures
Upon your request, the Plan is required to give you access to your PHI in order to inspect and copy it.
Use and disclosure of your PHI may be required by the Secretary of the Department of Health and Human Services to investigate or determine the Plan’s compliance with the privacy regulations.
Uses and disclosures to carry out treatment, payment and health care operations.
The Plan and its business associates will use PHI without your authorization to carry out treatment, payment and health care operations. The Plan and its business associates (and any health insurers providing benefits to Plan participants) may also disclose the following to the Plan’s Board of Trustees: (1) PHI for purposes related to Plan administration (payment and health care operations); (2) summary health information for purposes of health or stop loss insurance underwriting or for purposes of modifying the Plan; and (3) enrollment information (whether an individual is eligible for benefits under the Plan). The Trustees have amended the Plan to protect your PHI as required by federal law.
Treatment is the provision, coordination or management of health care and related services. It also includes but is not limited to consultations and referrals between one or more of your providers.
For example, the Plan may disclose to a treating physician the name of your treating radiologist so that the physician may ask for your X-rays from the treating radiologist.
Payment includes but is not limited to actions to make coverage determinations and payment (including billing, claims processing, subrogation, reviews for medical necessity and appropriateness of care, utilization review and preauthorizations).
For example, the Plan may tell a treating doctor whether you are eligible for coverage or what percentage of the bill will be paid by the Plan.
Important Notices
Health care operations include but are not limited to quality assessment and improvement, reviewing competence or qualifications of health care professionals, underwriting, premium rating and other insurance activities relating to creating or renewing insurance contracts. It also includes case management, conducting or arranging for medical review, legal services and auditing functions including fraud and abuse compliance programs, business planning and development, business management and general administrative activities. However, no genetic information can be used or disclosed for underwriting purposes.
For example, the Plan may use information to project future benefit costs or audit the accuracy of its claims processing functions.
Uses and disclosures that require that you be given an opportunity to agree or disagree prior to the use or release.
Unless you object, the Plan may provide relevant portions of your protected health information to a family member, friend or other person you indicate is involved in your health care or in helping you receive payment for your health care. Also, if you are not capable of agreeing or objecting to these disclosures because of, for instance, an emergency situation, the Plan will disclose protected health information (as the Plan determines) in your best interest. After the emergency, the Plan will give you the opportunity to object to future disclosures to family and friends.
Uses and disclosures for which your consent, authorization or opportunity to object is not required.
The Plan is allowed to use and disclose your PHI without your authorization under the following circumstances:
1. For treatment, payment and health care operations.
2. Enrollment information can be provided to the Trustees.
3. Summary health information can be provided to the Trustees for the purposes designated above.
4. When required by law.
5. When permitted for purposes of public health activities, including when necessary to report product defects and to permit product recalls. PHI may also be disclosed if you have been exposed to a communicable disease or are at risk of spreading a disease or condition, if required by law.
6. When required by law to report information about abuse, neglect or domestic violence to public authorities if there exists a reasonable belief that you may be a victim of abuse, neglect or domestic violence. In which case, the Plan will promptly inform you that such a disclosure has been or will be made unless that notice would cause a risk of serious harm. For the purpose of reporting child abuse or neglect, it is not necessary to inform the minor that such a disclosure has been or will be made. Disclosure may generally be made to the minor’s parents or other representatives although there may be circumstances under federal or state law when the parents or other representatives may not be given access to the minor’s PHI.
7. The Plan may disclose your PHI to a public health oversight agency for oversight activities required by law. This includes uses or disclosures in civil, administrative or criminal investigations; inspections; licensure or disciplinary actions (for example, to investigate complaints against providers); and other activities necessary for appropriate oversight of government benefit programs (for example, to investigate Medicare or Medicaid fraud).
8. The Plan may disclose your PHI when required for judicial or administrative proceedings. For example, your PHI may be disclosed in response to a subpoena or discovery request.
9. When required for law enforcement purposes, including for the purpose of identifying or locating a suspect, fugitive, material witness or missing person. Also, when disclosing information about an individual who is or is suspected to be a victim of a crime but only if the individual agrees to the disclosure or the Plan is unable to obtain the individual’s agreement because of emergency circumstances. Furthermore, the law enforcement official must represent
that the information is not intended to be used against the individual, the immediate law enforcement activity would be materially and adversely affected by waiting to obtain the individual’s agreement and disclosure is in the best interest of the individual as determined by the exercise of the Plan’s best judgment.
10. When required to be given to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as authorized by law. Also, disclosure is permitted to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent.
11. When consistent with applicable law and standards of ethical conduct if the Plan, in good faith, believes the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to a person reasonably able to prevent or lessen the threat, including the target of the threat.
12. When authorized by and to the extent necessary to comply with workers’ compensation or other similar programs established by law.
Except as otherwise indicated in this notice, uses and disclosures will be made only with your written authorization subject to your right to revoke such authorization.
Uses and disclosures that require your written authorization.
Other uses or disclosures of your protected health information not described above will only be made with your written authorization. For example, in general and subject to specific conditions, the Plan will not use or disclose your psychiatric notes; the Plan will not use or disclose your protected health information for marketing; and the Plan will not sell your protected health information, unless you provide a written authorization to do so. You may revoke written authorizations at any time, so long as the revocation is in writing. Once the Plan receives your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.
Important Notices
Section 2 – Rights of Individuals
Right to Request Restrictions on Uses and Disclosures of PHI
You may request the Plan to restrict the uses and disclosures of your PHI. However, the Plan is not required to agree to your request (except that the Plan must comply with your request to restrict a disclosure of your confidential information for payment or health care operations if you paid for the services to which the information relates in full, out of pocket).
You or your personal representative will be required to submit a written request to exercise this right. Such requests should be made to the Plan’s Privacy Official.
Right to Request Confidential Communications
The Plan will accommodate reasonable requests to receive communications of PHI by alternative means or at alternative locations if necessary to prevent a disclosure that could endanger you.
You or your personal representative will be required to submit a written request to exercise this right.
Such requests should be made to the Plan’s Privacy Official.
Right to Inspect and Copy PHI
You have a right to inspect and obtain a copy of your PHI contained in a “designated record set,” for as long as the Plan maintains the PHI. If the information you request is in an electronic designated record set, you may request that these records be transmitted electronically to yourself or a designated individual.
Protected Health Information (PHI)
Includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form.
Designated Record Set
Includes the medical records and billing records about individuals maintained by or for a covered health care provider; enrollment, payment, billing, claims adjudication and case or medical management record systems maintained by or for the Plan; or other information used in whole or in part by or for the Plan to make decisions about individuals. Information used for quality control or peer review analyses and not used to make decisions about individuals is not in the designated record set.
The requested information will be provided within 30 days if the information is maintained on site or within 60 days if the information is maintained off site. A single 30-day extension is allowed if the Plan is unable to comply with the deadline.
You or your personal representative will be required to submit a written request to request access to the PHI in your designated record set. Such requests should be made to the Plan’s Privacy Official.
If access is denied, you or your personal representative will be provided with a written denial, setting forth the basis for the denial, a description of how you may appeal the Plan’s decision and a description of how you may complain to the Secretary of the U.S. Department of Health and Human Services.
The Plan may charge a reasonable, cost-based fee for copying records at your request.
Right to Amend PHI
You have the right to request the Plan to amend your PHI or a record about you in your designated record set for as long as the PHI is maintained in the designated record set.
The Plan has 60 days after the request is made to act on the request. A single 30-day extension is allowed if the Plan is unable to comply with the deadline. If the request is denied in whole or part, the Plan must provide you with a written denial that explains the basis for the denial. You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of your PHI.
Such requests should be made to the Plan’s Privacy Official.
You or your personal representative will be required to submit a written request to request amendment of the PHI in your designated record set.
Right to Receive an Accounting of PHI Disclosures
At your request, the Plan will also provide you an accounting of disclosures by the Plan of your PHI during the six years prior to the date of your request. However, such accounting will not include PHI disclosures made: (1) to carry out treatment, payment or health care operations; (2) to individuals about their own PHI; (3) pursuant to your authorization; (4) prior to April 14, 2003; and (5) where otherwise permissible under the law and
the Plan’s privacy practices. In addition, the Plan need not account for certain incidental disclosures.
If the accounting cannot be provided within 60 days, an additional 30 days is allowed if the individual is given a written statement of the reasons for the delay and the date by which the accounting will be provided.
If you request more than one accounting within a 12-month period, the Plan will charge a reasonable, cost-based fee for each subsequent accounting.
Such requests should be made to the Plan’s Privacy Official.
Right to Receive a Paper Copy of This Notice Upon Request
You have the right to obtain a paper copy of this Notice. Such requests should be made to the Plan’s Privacy Official.
A Note About Personal Representatives
You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your PHI or allowed to take any action for you. Proof of such authority may take one of the following forms:
1. a power of attorney for health care purposes;
2. a court order of appointment of the person as the conservator or guardian of the individual; or
3. an individual who is the parent of an unemancipated minor child may generally act as the child’s personal representative (subject to state law).
The Plan retains discretion to deny access to your PHI by a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect.
Section 3 – The Plan’s Duties
The Plan is required by law to maintain the privacy of PHI and to provide individuals (participants and beneficiaries) with notice of the Plan’s legal duties and privacy practices. This Notice is effective September 23, 2013, and the Plan is required to comply with the terms of this Notice. However, the Plan reserves the right to change its privacy practices and to apply the changes to any
Important Notices
PHI received or maintained by the Plan prior to that date. If a privacy practice is changed, a revised version of this Notice will be provided to all participants for whom the Plan still maintains PHI. The revised Notice will be distributed in the same manner as the initial Notice was provided or in any other permissible manner.
If the revised version of this Notice is posted, you will also receive a copy of the Notice or information about any material change and how to receive a copy of the Notice in the Plan’s next annual mailing. Otherwise, the revised version of this Notice will be distributed within 60 days of the effective date of any material change to the Plan’s policies regarding the uses or disclosures of PHI, the individual’s privacy rights, the duties of the Plan or other privacy practices stated in this Notice.
Minimum Necessary Standard
When using or disclosing PHI or when requesting PHI from another covered entity, the Plan will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations. When required by law, the Plan will restrict disclosures to the limited data set, or otherwise as necessary, to the minimum necessary information to accomplish the intended purpose.
However, the minimum necessary standard will not apply in the following situations:
1. disclosures to or requests by a health care provider for treatment;
2. uses or disclosures made to the individual;
3. disclosures made to the Secretary of the U.S. Department of Health and Human Services;
4. uses or disclosures that are required by law; and
5. uses or disclosures that are required for the Plan’s compliance with legal regulations.
De-Identified Information
This notice does not apply to information that has been de-identified. De-identified information is information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual.
Summary Health Information
The Plan may disclose “summary health information” to the Trustees for obtaining insurance premium bids or modifying, amending or terminating the Plan. “Summary health information” summarizes the claims history, claims expenses or type of claims experienced by participants and excludes identifying information in accordance with HIPAA.
Notification of Breach
The Plan is required by law to maintain the privacy of participants’ PHI and to provide individuals with notice of its legal duties and privacy practices. In the event of a breach of unsecured PHI, the Plan will notify affected individuals of the breach.
Section 4 – Your Right to File a Complaint With the Plan or the HHS
Secretary
If you believe that your privacy rights have been violated, you may complain to the Plan. Such complaints should be made to the Plan’s Privacy Official.
You may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, D.C. 20201. The Plan will not retaliate against you for filing a complaint.
Section 5 – Whom to Contact at the Plan for More Information
If you have any questions regarding this notice or the subjects addressed in it, you may contact the Plan’s Privacy Official. Such questions should be directed to the Plan’s Privacy Official at:
Potts Law Firm LLP
Human Resources
3737 Buffalo Speedway, Suite 1900 Houston, TX 77098 214-373-0404
Conclusion
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow. gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employersponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.
Important Notices
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.
Texas – Medicaid
Website: https://www.hhs.texas.gov/ services/financial/health-insurancepremium-payment-hipp-program
Phone: 1-800-440-0493
To see if any other States have added a premium assistance program since July 31, 2025, or for more information on special enrollment rights, you can contact either:
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 Potts Law Firm LLP group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Potts Law Firm LLP 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
Potts Law Firm LLP Human Resources
3737 Buffalo Speedway, Suite 1900 Houston, TX 77098 214-373-0404
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/ or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services – If you have an emergency medical condition and get emergency services from an out-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 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.
You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay outof-network providers and facilities directly.
Your health plan generally must:
• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by 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.
Glossary of Terms
Beneficiary – Who will receive a benefit in the event of the insured’s death. A policy may have more than one beneficiary.
Coinsurance – Your share of the cost of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service, typically after you meet your deductible.
Copay – The fixed amount you pay for health care services received.
Deductible – The amount you owe for health care services before your health insurance begins to pay its portion. For example, if your deductible is $1,000, your plan does not pay anything until you meet your $1,000 deductible for covered health care services. The deductible may not apply to all services, including preventive care.
Employee Contribution – The amount you pay for your insurance coverage.
Employer Contribution – The amount Potts Law Firm contributes to the cost of your benefits.
Explanation of Benefits (EOB) – A statement sent by your insurance carrier that explains which procedures and services were provided, how much they cost, what portion of the claim was paid by the plan, what portion of the claim is your responsibility and information on how you can appeal the insurer’s decision. These statements are also posted on the carrier’s website for your review.
Flexible Spending Account (FSA) – An option that allows participants to set aside pretax dollars to pay for certain qualified expenses during a specific time period (usually a 12-month period).
High Deductible Health Plan (HDHP) – A medical plan with a higher deductible in exchange for a lower monthly premium. You must meet the annual deductible before any benefits are paid by the plan.
In-Network – Doctors, hospitals and other providers that contract with your insurance company to provide health care services at discounted rates.
Out-of-Network – Doctors, hospitals and other providers that are not contracted with your insurance company. If you choose an out-of-network provider, you may be responsible for costs over the amount allowed by your insurance carrier.
Learn some common benefits terms.
Out-of-Pocket Maximum – Also known as an out-of-pocket limit. The most you pay during a policy period (usually a 12-month period) before your health insurance or plan begins to pay 100% of the allowed amount. The limit does not include your premium, charges beyond the Reasonable & Customary (R&C) or health care your plan does not cover. Check with your health insurance carrier to confirm what payments apply to the out-of-pocket maximum.
Over-the-Counter (OTC) Medications – Medications typically made available without a prescription.
Prescription Medications – Medications prescribed by a doctor. Cost of these medications is determined by their assigned tier.
• Brand Name Drugs (Formulary) – Brand name drugs on your provider’s list of approved drugs. You can check online with your provider to see this list.
• Brand Name Drugs (Non-Formulary) – Brand name drugs not on your provider’s list of approved drugs. These drugs are typically newer and have higher copayments.
• Generic Drugs – Drugs approved by the U.S. Food and Drug Administration (FDA) to be chemically identical to corresponding brand name versions. The color or flavor of a generic medicine may be different, but the active ingredient is the same. Generic drugs are usually the most cost-effective version of any medication. Preventive Care – The care you receive to prevent illness or disease. It also includes counseling to prevent health problems.
Reasonable and Customary Allowance (R&C) – Also known as an eligible expense or the Usual and Customary (U&C). The amount your insurance company will pay for a medical service in a geographic region based on what providers in the area usually charge for the same or similar medical service.
SSNRA – Social Security Normal Retirement Age
This brochure highlights the main features of the Potts Law Firm 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. Potts Law Firm reserves the right to change or discontinue its employee benefits plans at anytime.