Skip to main content

2026 Wallis Bank Benefits Book

Page 1


EMPLOYEE BENEFITS

for a healthy you

We are pleased to offer a full benefits package to you and your eligible dependents. Read this guide to know what benefits are available to you.

Availability of Summary Health Information

Our benefits program offers one or more medical plan options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage, available from Human Resources.

YOUR NEW BENEFITS BEGIN April 1, 2026

eligibility

You are eligible for coverage if you are a regular, full-time employee.

You may only enroll for coverage when:

● You are a new hire

● It is Open Enrollment (OE)

● You have a Qualifying Life Event (QLE)

This year, Wallis Bank is hosting an active enrollment. Active enrollment means you must log into HRP and make elections, or you will forfeit coverage. You will not be able to make any new elections until open enrollment for the next plan year or if you have QLE

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices for your prescription drug coverage. Please see Legal Notices for more details.

new hire

Who is Eligible

• A regular, full-time employee working an average of 30 hours or more per week

When to Enroll

• By the deadline given by Human Resources

When Coverage Starts

• First of the month after completing 30 days of full-time employment

eligibility

FOR YOUR EMPLOYEE BENEFITS

employee

Who is Eligible

• A regular, full-time employee working an average of 30 hours or more per week

When to Enroll

• During OE or for a QLE

When Coverage Starts

• OE: Start of the plan year

• QLE: Ask Human Resources

dependent(s)

Who is Eligible

• Your legal spouse

• Children under age 26 regardless of student, dependency, or marital status

• Children age 26 or older who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return

When to Enroll

• During OE or for a QLE

• When covering dependents, you must enroll for and be on the same plans

When Coverage Starts

• Ask Human Resources

qualifying life events

CHANGING COVERAGE OUTSIDE OF OPEN ENROLLMENT

You may only enroll for or make changes to coverage during the plan year if you are a new hire or if you have a QLE, such as:

Birth Adoption/placement for adoption

Legal separation

Annulment

Death of spouse

Change in benefits eligibility

Death of child

FMLA, COBRA event, judgment, or decree

Becoming eligible for Medicare, Medicaid, or TRICARE

Receiving a Qualified Medical Child Support Order

Gain or loss of benefits coverage

Change in employment status affecting benefits

Significant change in cost of spouse’s coverage

You have 31 days from the event to notify Human Resources and complete your changes in HRP You may need to provide documents to verify the change.

Carrier: Blue Cross Blue Shield of Texas (BCBSTX)

Your medical plan options protect you and your family from major financial hardship in the event of illness or injury. You have a choice of two plans:

• PPO Plan is a PPO.

• HSA Plan is an HDHP.

Preferred Provider Organization

A Preferred Provider Organization (PPO) plan allows you to see any provider when you need care. When you see in-network providers, you will pay less and get the highest level of benefits. You will pay more for care if you use outof-network providers. When you see in-network providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other services are covered at the deductible and coinsurance level.

High Deductible Health Plan

A High Deductible Health Plan (HDHP) allows you to see any provider when you need care, and you will pay less when you go to in-network providers. In exchange for a lower per-paycheck cost for medical benefits, you must satisfy a higher plan deductible that applies to almost all health care expenses, including prescription drugs. If you enroll in the HDHP, you may be eligible to open a Health Savings Account.

Download the BCBSTX app

medical benefits summary

FOR PREVENTIVE TO CHRONIC CARE

Prescription Drugs – Retail Up to 30-day supply •

Prescription Drugs – Mail Order Up to 90-day supply • Preferred generic •

Prescription Drugs – Specialty

1 The amount you pay after the deductible is met.

2 Emergency room copayment waived if admitted. Out-of-network benefit can be found on the plan SBCs. The out-of-pocket dollars will be lower if you seek treatment from a contracted in-network provider.

prescription drugs

FOR SHORT- OR LONG-TERM CARE MANAGEMENT

Carrier: BCBSTX

Your medical coverage includes prescription benefits for retail, mail order (home delivery), and specialty drugs.

Prescription Drug List

Your medical carrier controls prescription drug costs by negotiating discounts on medications. Covered drugs are listed in the Prescription Drug List. If you take maintenance medications, review the list with your doctor to see which ones are covered and available. If your medication is not listed, call the phone number on your member ID card.

Retail

Use any participating retail pharmacy to fill short-term, nonspecialty medications. Retail pharmacies often fill or refill 30to 90-day supplies.

Home Delivery

If you take medication on a daily basis, consider using home delivery. It is a convenient, low-cost option that delivers up to a 90-day supply right to your home. You will need to set up an online pharmacy account and/or download the app to easily manage your prescriptions.

Sign Up for Home Delivery

Visit www.bcbstx.com .

Call 800-521-2227

Download the BCBSTX app

ePrescribe – Ask your doctor to send an electronic prescription to www.bcbstx.com .

Specialty

If you need a specialty drug to treat a complex or chronic condition, you will be asked to enroll in a specialty drug program. It offers support to ensure the medication works well for you and costs as little as possible. If you do not enroll in the program, the specialty drug may not be covered. Certain exclusions and limitations apply.

Save Money. Buy Generic Drugs!

Generic drugs are a safe and effective option to brandname drugs – and they cost much less! They have the same active ingredients, strength, and dosage form as brand-name drugs, and they also meet the same rigorous quality and safety standards set by the Food and Drug Administration.

preventive care

SMALL STEPS TODAY LEAD TO A HEALTHIER FUTURE

Your medical plan offers $0 preventive care for everyone. Preventive care is the care you receive to help prevent chronic illness or disease. It includes exams, lab work, screenings, immunizations, and counseling to prevent health problems, such as diabetes or heart disease.

Preventive Care Coverage Includes!

Adults

Cholesterol screening

Blood pressure screening

Colorectal cancer screening

Lung cancer screening

Hepatitis B screening

Well visits

Bone density screening

Obesity screening

Diabetes type 2 screening

Depression screening

Mammograms

Cervical cancer screening

Immunizations

Dental cleanings and exams

Vision screening

Frequently Asked Questions

Why should I get preventive care?

Teens

Physical exam

Blood tests for iron and cholesterol

Anxiety screening

Growth screening

Hearing screening

Hepatitis B screening

Depression screening

Alcohol, tobacco, and drug use assessments

Tuberculosis screening

Immunizations

Dental cleanings and exams

Vision screening

Children

Autism screening

Blood screening

Depression screening

Developmental screening

Hearing screening

Obesity screening and counseling

Hypothyroidism screening

Behavioral assessments

Well visits

Immunizations

Dental cleanings and exams

Oral health risk assessment

Vision screening

Why

did

I get a bill for preventive care?

Preventive care is the fastest and best way to uncover potential risks and avoid chronic health conditions.

Are all screenings, tests, and procedures covered under preventive care?

No. Your doctor will be able to advise you as to the preventive care you need or should obtain, based on your medical and family history.

Diagnosis codes on the doctor’s bill must meet certain insurance company conditions for them to be processed as preventive and covered at 100%. If you have a medical complaint, or your doctor finds a specific medical issue during your preventive care doctor’s visit, a diagnosis code for that issue or complaint will be on your bill. As a result, the insurance company may process the bill for a specific medical condition, not preventive care. In this case, you must pay the copay or portion of your deductible.

FOR CONVENIENT, 24/7 CARE

Carrier: MDLIVE

Your medical coverage offers telemedicine services so you can connect anytime day or night with a boardcertified doctor via your mobile device or computer.

While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:

• Have a non-emergency issue and are considering an afterhours health care clinic, urgent care clinic, or emergency room for treatment

• Are on a business trip, vacation, or away from home

• Are unable to see your primary care physician

When to Use Telemedicine

Use telemedicine for minor conditions such as:

• Sore throat

• Headache

• Stomachache

• Cold/flu

• Allergies

• Dermatology

• Primary care

• Fever

• Urinary tract infections

Do not use telemedicine for serious or life-threatening emergencies.

Get More Information or Register

Skip the trip to your doctor! Register for an account so you can get on-demand medical care.

Visit www.mdlive.com/BCBSTX

Call 888-680-8646.

Text BCBSTX to 635-483

Download the MDLIVE app

health care options

FOR NON-EMERGENCY AND EMERGENCY CARE

Becoming familiar with your options for medical care can save you time and money.

Non-emergency Care

Telemedicine

Access to care via phone, online video, or mobile app whether you are home, work, or traveling; medications can be prescribed.

24 hours a day, 7 days a week

Doctor’s Office

Generally, the best place for routine preventive care; established relationship; able to treat based on medical history.

Office hours vary

Retail Clinic

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

Urgent Care

When you need immediate attention; walk-in basis is usually accepted.

Generally includes evening, weekend, and holiday hours

Emergency Care

Hospital ER

Life-threatening or critical conditions; trauma treatment ; multiple bills for doctor and facility.

24 hours a day, 7 days a week

Freestanding ER

Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher.

24 hours a day, 7 days a week

Allergies

Cough/cold/flu

Rash

Stomachache

Infections

Sore and strep throat

Vaccinations

Minor injuries/sprains/strains

infections

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

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.

BCBSTX resources

FOR GETTING THE MOST OUT OF YOUR MEDICAL COVERAGE

BCBSTX Member Portal and App

Blue Access for Members (BAM) is the secure BCBSTX member website where you can:

• Print or request an ID card

• Check claim status or history

• Confirm dependent eligibility

• Sign up for electronic Explanation of Benefits statements

• Locate in-network providers

• Review your benefits

• Get tips to live and eat healthier Register for an account at www.bcbstx.com

Get the BCBSTX app for easy access to your information. Log in from your mobile device to access your BAM account.

Cash Rewards Program

Member Rewards offers you cash rewards when you use the Provider Finder tool to choose the lower-cost, quality option for your health care.

• Visit www.bcbstx.com, register for or log in to BAM, and select Find Care.

• Shop and compare costs for screenings, scans, surgeries, and more.

• Get the procedure or service at a reward-eligible location.

• Receive a cash reward by check, mailed directly to your home, after the claim is paid and the location is verified as reward-eligible.

Blue365 Discounts

Blue365 can save you money on health and wellness products and services not covered by insurance. There are no claims to file, and you do not need a referral or preauthorization. Visit www.blue365deals.com/bcbstx to sign up and receive weekly featured deals by email. Discount categories include:

• Apparel and footwear

• Fitness

• Hearing and vision

• Home and family

• Nutrition

• Personal care

Maternity Support

Special Beginnings supports you from early pregnancy until six weeks after delivery, including:

• Online prenatal classes

• Support from a dedicated service coordinator before and after your baby is born

• 24-hour Nurse Advice Line ( 844-971-8906)

It is free, easy, and confidential. Call 888-421-7781 to enroll or get more details.

Nurseline

Call 800-581-0368 for access to registered nurses who can answer general health questions, make appointments with your doctor, and help determine where to go for emergency health care services. You can also access an audio library of more than 1,000 health-related topics in both English and Spanish.

Weight Loss

If you would like to lose weight and change how your body stores and uses energy, Wondr may be right for you. Its digital weight loss program teaches you how to eat your favorite foods and still lose weight, have energy, stress less, and sleep better. Visit https://wondrhealth.com/bcbstx .

Well onTarget Wellness Program

You have access to the BCBSTX wellness program – Well onTarget . When you are healthy, you spend less on doctors and hospitals, you feel better, and you tend to live longer. The wellness program can help you set and reach your health goals.

Wellness Portal

The Wellness Portal connects you with the entire wellness program, which includes a digital library with articles, podcasts, and videos on health topics. You can also participate in more than 30 challenges to help manage stress, sleep, physical activity, and more.

1. Go to www.bcbstx.com to sign up or log in.

2. Click the Wellness tab.

3. After you sign up, go directly to www.wellontarget.com

AlwaysOn App

Download the AlwaysOn app to access the Wellness Portal on your phone.

• Take your health assessment.

• Set personal health and wellness goals, and track your progress.

• Take an online educational course.

• View your Blue Points balance.

• Track data synced with fitness devices and apps.

Fitness Program

Get a discounted monthly gym membership – for you and your family (ages 16 and older) – from a nationwide network of thousands of fitness locations. You can also get discounts on massage therapists, personal trainers, nutrition counselors, and more. Access your membership through the Well onTarget website or app.

Omada

If you are at risk of diabetes and/or high blood pressure, Omada helps you change the habits that put you most at risk for developing a chronic condition. A virtual care team will work with you to create a program to reduce your risk and build healthy habits. You will receive weekly support and connect with a small group of peers, all from the comfort of your own home. If you have any health claims that show you may be at risk for diabetes or high blood pressure, Omada will reach out to you directly. Visit www.omadahealth.com/bcbstx for details.

Livongo

Livongo offers digital solution programs to help you manage chronic diabetes and high blood pressure (hypertension). Participation is FREE and available to you and your family members.

Diabetes Management Program

Manage Type 1 and Type 2 diabetes by using:

• Livongo’s advanced blood glucose meter – Get immediate feedback and alert loved ones in real time (using a cellular connection) when your blood glucose is too high or low

• Unlimited strips and lancets – Livongo ships supplies to you at NO COST

• Real-time tips and support – Get 24/7 support if your glucose is not in range or if you want tips on diabetes management

High Blood Pressure Management Program

Livongo offers personal support by monitoring your blood pressure using:

• A wireless, connected blood pressure cuff

• Support and coaching with licensed professionals 24/7

• Notifications and reminders for high blood pressure readings

• Blood pressure reading reports

Participation in Livongo is Easy!

for

Digital Home Fitness is also available if you prefer to work out at home. Access thousands of digital fitness videos and live classes such as cardio, boot camp, barre, and more.

• Log in at www.bcbstx.com, and select Fitness Program, then Enroll Now

• Call 888-762-2583 ( BLUE ).

Visit https://get.livongo.com/txhealth/register

Call 800-945-4355.

Text TXHEALTH to 85240

Use registration code TXHEALTH when prompted.

Carrier: Guardian

Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work.

You will always get the highest level of benefits when you see in-network providers for your care. Out-of-network care is not based on negotiated fees, so you may be responsible for paying more for your care.

1

PEEPERS

Our vision plan offers quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems. You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see in-network providers.

health savings account

FOR CURRENT OR FUTURE EXPENSES

Offset your HDHP health care costs, reduce your taxes, and get a long-term tax-advantaged savings account.

A Health Savings Account (HSA) is like a personal savings account that allows you to pay for current or future health care expenses with pretax dollars or save the funds for retirement. The funds can also be used for your dependents, even if they are not covered by the HDHP.

An HSA is always yours to keep, even if you change health plans or jobs.

Tax-free contributions

Tax-free growth

Tax-free withdrawals

Administrator: Optum Bank

Contributions

You may contribute up to the IRS annual maximum.

HSA Eligibility

You are eligible to open and contribute to an HSA if you are:

• Enrolled in an HSA-eligible HDHP

• Not covered by another plan that is not a qualified HDHP (e.g., spouse’s health plan)

• Not enrolled in a Health Care Flexible Spending Account

If you are age 55 or older, you can contribute an extra $1,000.

Two Ways to Use Your HSA

Use the Money Now

Pay for qualified out-of-pocket medical, dental, and vision expenses as they are incurred.

Invest Over Time

Invest and grow your HSA dollars tax-free. You can use the funds to pay for qualified expenses later.

How to Pay or Get Reimbursed

• Use your HSA debit card to pay for qualified expenses.

• Pay out-of-pocket and submit your receipts for reimbursement online or through the app.

• Not eligible to be claimed as a dependent on someone else’s tax return

• Not enrolled in Medicare, Medicaid, or TRICARE

• Not receiving Veterans Administration benefits

Note: You may have an HSA at the financial institution of your choice, but only accounts opened through Optum Bank are eligible for automatic payroll deductions.

www.optumbank.com . Call 800-243-5543 Download the Optum Bank app.

flexible spending accounts

FOR HEALTH AND DEPENDENT CARE EXPENSES

Administrator: Optum Bank

Set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer the following Flexible Spending Accounts (FSAs).

Health Care FSA

The Health Care FSA covers qualified medical, dental, and vision expenses for you and your eligible dependents. Eligible expenses include:

• Deductibles, copays, and coinsurance

• Prescription drugs

• Braces, glasses, and contacts

• Hearing aids and batteries

If you enrolled in an HDHP and contribute to an HSA, you may not contribute to a Health Care FSA.

Limited Purpose Health Care FSA

If you enroll in the HDHP medical plan and contribute to an HSA, you can use a Limited Purpose Health Care FSA to pay for eligible out-of-pocket dental and vision expenses only, such as:

• Dental and orthodontia care (fillings, X-rays, braces)

• Vision care (eyeglasses, contact lenses, LASIK)

Dependent Care FSA

The Dependent Care FSA helps pay expenses associated with caring for children under age 13 and elder dependents so you or your spouse can work or attend school full-time.

Dependent Care FSA Guidelines

• To be eligible, you (and your spouse, if married) must be gainfully employed, looking for work, a full-time student, or incapable of self-care.

• You can use funds for daycare or babysitter expenses for your children under age 13, but only for the part of the year when the child is under 13.

• Only day camps – not overnight camps – can be considered for reimbursement.

• You can use funds for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.

• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.

Health Care FSA

You have access to all your FSA funds right away. $3,400

Limited Purpose Health Care FSA

You have access to all your FSA funds right away.

Dependent Care FSA

Reimbursement is limited to the total amount deposited in your account at that time.

How to Pay or Get Reimbursed

Use your FSA debit card (excludes the Dependent Care FSA). OR

Pay out-of-pocket, and submit your receipts for reimbursement.

Visit fsastore.com for an array of FSA-eligible products.

Health Care FSAs and Limited Purpose Health Care FSAs allow you to carry over up to $680 into the next plan year.

Health Care FSAs and Limited Purpose Health Care FSAs allow you an additional grace period of 90 days to submit claims after the plan year closes (up until 6/29/2027).

$3,400

$7,500 (2026 limit) (single parent filing head of household; or married filing jointly)

$3,750 (2026 limit) (married filing separately)

qualified HSA and FSA expenses

The products and services listed below are examples of medical expenses eligible for payment under your Health Care FSA, Limited Purpose Health Care FSA, or HSA.* This list is not all-inclusive; additional expenses may qualify, and the items listed are subject to change in accordance with IRS regulations. Please refer to IRS Publication 502 Medical and Dental Expenses at www.irs.gov for complete details.

Abdominal supports

Acupuncture

Air conditioner (when necessary for relief from difficulty in breathing)

Alcoholism treatment

Ambulance

Anesthetist

Arch supports

Artificial limbs

Autoette (when used for relief of sickness/disability)

Blood tests

Blood transfusions

Braces

Cardiographs

Chiropractor

Contact lenses

Convalescent home (for medical treatment only)

Crutches

Dental treatment

Dental X-rays

Dentures

Dermatologist

* Excludes Dependent Care FSA.

Diagnostic fees

Diathermy

Drug addiction therapy

Drugs (prescription)

Elastic hosiery (prescription)

Eyeglasses

Fees paid to health institute prescribed by a doctor

FICA and FUTA tax paid for medical care service

Fluoridation unit

Guide dog

Gum treatment

Gynecologist

Healing services

Hearing aids and batteries

Hospital bills

Hydrotherapy

Insulin treatment

Lab tests

Lead paint removal

Legal fees

Lodging (away from home for outpatient care)

Metabolism tests

Neurologist

Nursing (including board and meals)

Obstetrician

Operating room costs

Ophthalmologist

Optician

Optometrist

Oral surgery

Organ transplant (including donor’s expenses)

Orthopedic shoes

Orthopedist

Osteopath

Oxygen and oxygen equipment

Pediatrician

Physician

Physiotherapist

Podiatrist

Postnatal treatments

Practical nurse for medical services

Prenatal care

Prescription medicines

Psychiatrist

Psychoanalyst

Psychologist

Psychotherapy

Radium therapy

Registered nurse

Special school costs for the handicapped

Spinal fluid test

Splints

Surgeon

Telephone or TV equipment to assist the hard-of-hearing

Therapy equipment

Transportation expenses (relative to health care)

Ultraviolet ray treatment

Vaccines

Vitamins (if prescribed)

Wheelchair

X-rays

life and AD& D insurance

FOR FINANCIAL SECURITY AFTER DEATH OR LOSS

Carrier: Unum Coverage is portable!

Life and Accidental Death and Dismemberment (AD&D) insurance are important to your financial security, especially if others depend on you for support or vice versa. With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies). Life and AD&D coverage amounts reduce to 65% at age 65, 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 2.5 times your basic annual earnings from a minimum of $10,000 to a maximum of $750,000 for each benefit. The guaranteed issue amount is $500,000. Any amount over $500,000 will require an Evidence of Insurability (EOI) form. Age reduction schedule applies.

Voluntary Life and AD&D

If you need more coverage than Basic Life and AD&D, you have the option to buy Voluntary Life and AD&D for yourself and your dependent(s). If you do not elect Voluntary Life and AD&D insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health. You must elect Voluntary Life and AD&D coverage for yourself before covering your spouse and/or child(ren).

Employee

• Increments of $10,000 up to the lesser of 5 times annual earnings or $500,000

Spouse

• Increments of $5,000 up to the lesser of 100% of employee’s amount or $50,000

Child(ren)

• Increments of $2,000 up to the lesser of 100% of employee’s amount or $10,000

• Birth to 14 days – $1,000

• 14 days to six months – $1,000

• Six months to age 26 – $1,000 up to the lesser of 100% of employee’s amount or $10,000

1 The premium paid for child coverage is based on the cost of coverage for one child, regardless of how many children you have. Children are eligible up to age 26.

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%).

disability insurance

Carrier: Unum

Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. Voluntary Short-Term Disability (STD) coverage is available for purchase. Long-Term Disability (LTD) coverage is provided at no cost to employees.

Voluntary Short Term Disability

Voluntary 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 jobrelated injury or illness. If a medical condition is job-related, it is considered workers’ compensation, not STD.

Voluntary Short Term Disability Benefits

Benefits

Pre-existing Condition Exclusion 3/12 1

1 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.

Employer-paid Long Term Disability

LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for a specific period of time. Benefits begin at the end of an elimination period and continue while you are disabled up to the maximum benefit period.

Long Term Disability Benefits

Benefits Begin 91st day Percentage of Earnings You Receive 60%

Maximum Benefit Period Social Security Normal Retirement Age

Pre-existing Condition Exclusion 3/12 1

1 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.

Administrator: Unum

Help when you need it most. With your Employee Assistance Program and Work/Life Balance service, confidential assistance is as close as your phone or computer.

• Relationships

• Work-life balance

• Stress and anxiety

• Will preparation and estate resolution

• Grief and loss

• Childcare and eldercare issues

• Substance abuse

• Financial and legal matters

• And more

emergency travel assistance

FOR UNEXPECTED EMERGENCIES WHEN YOU TRAVEL

Administrator: Unum

Your Unum coverage includes emergency travel assistance and identity theft protection services, which are provided through Assist America.

If you experience an emergency while traveling 100+ miles away from your permanent residence, the emergency travel assistance program connects you with doctors, hospitals, pharmacies, and other services. One phone call to Assist America will connect you to:

• A 24/7 operations center

• Experienced, multilingual crisis management professionals

• Worldwide emergency response capabilities

• Ground and air ambulance service providers

Medical travel assistance services include:

• Medical consultation, evaluation, and referral

• Foreign hospital admissions assistance

• Emergency medical evacuation

• Medical monitoring

• Medical repatriation

• Prescription assistance

• Care of minor children

• Compassionate visit

• Return of mortal remains

Non-medical emergency assistance services include:

• Return of vehicle

• Lost luggage and document assistance

• Legal and interpreter referrals

• Emergency message transmission

• Bail bond and emergency cash coordination

• Emergency trauma counseling

• Trip/travel information

For Assistance

Call 800-872-1414 (within the USA) or 609-986-1234 (outside the USA). Use reference number 01-AA-UN-762490.

Email medservices@assistamerica.com

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: Wallis Bank

2929 W Sam Houston Pkwy N, Ste 300 Houston, TX 77043

713-935-3786

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 Wallis Bank 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. Wallis Bank has determined that the prescription drug coverage offered by the Wallis Bank medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is considered Creditable Coverage.

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 Wallis Bank 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 Wallis Bank 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 Phone

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 800-3250778

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).

April 1, 2026

Wallis Bank

2929 W Sam Houston Pkwy N, Ste 300 Houston, TX 77043

713-935-3786

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 Wallis Bank, 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.

Wallis Bank

2929 W Sam Houston Pkwy N, Ste 300 Houston, TX 77043

713-935-3786

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 employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272)

If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2026. Contact your State for more information on eligibility.

Alabama – Medicaid

Website: http://www.myalhipp.com/

Phone: 1-855-692-5447

Alaska – Medicaid

The AK Health Insurance Premium Payment Program Website: http:// myakhipp.com/

Phone: 1-866-251-4861

Email: CustomerService@MyAKHIPP.com

Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspx

Arkansas – Medicaid

Website: http://myarhipp.com/

Phone: 1-855-MyARHIPP (855-692-7447)

California– Medicaid

Health Insurance Premium Payment (HIPP) Program Website: http:// dhcs.ca.gov/hipp

Phone: 916-445-8322

Fax: 916-440-5676

Email: hipp@dhcs.ca.gov

Colorado – Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+)

Health First Colorado website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711

CHP+: https://hcpf.colorado.gov/child-health-plan-plus

CHP+ Customer Service: 1-800-359-1991/State Relay 711

Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442

Florida – Medicaid

Website: https://www.flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp/index.html

Phone: 1-877-357-3268

Georgia – Medicaid

GA HIPP Website: https://medicaid.georgia.gov/health-insurancepremium-payment-program-hipp

Phone: 678-564-1162, Press 1

GA CHIPRA Website: https://medicaid.georgia.gov/programs/thirdparty-liability/childrens-health-insurance-program-reauthorization-act2009-chipra

Phone: 678-564-1162, Press 2

Indiana – Medicaid

Health Insurance Premium Payment Program

All other Medicaid

Website: https://www.in.gov/medicaid/ http://www.in.gov/fssa/dfr/ Family and Social Services Administration Phone: 1-800-403-0864

Member Services Phone: 1-800-457-4584

Iowa – Medicaid and CHIP (Hawki)

Medicaid Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid

Medicaid Phone: 1-800-338-8366

Hawki Website: https://hhs.iowa.gov/programs/welcome-iowamedicaid/iowa-health-link/hawki

Hawki Phone: 1-800-257-8563

HIPP Website: https://hhs.iowa.gov/programs/welcome-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/programs-services/medicaid/ health-insurance-premium-program

Phone: 603-271-5218

Toll free number for the HIPP program: 1-800-852-3345, ext. 15218

Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov

New Jersey – Medicaid and CHIP

Medicaid Website: http://www.state.nj.us/humanservices/dmahs/ clients/medicaid/

Phone: 1-800-356-1561

CHIP Premium Assistance Phone: 609-631-2392

CHIP Website: http://www.njfamilycare.org/index.html

CHIP Phone: 1-800-701-0710 (TTY: 711)

New York – Medicaid

Website: https://www.health.ny.gov/health_care/medicaid/

Phone: 1-800-541-2831

North Carolina – Medicaid

Website: https://medicaid.ncdhhs.gov

Phone: 919-855-4100

North Dakota – Medicaid

Website: https://www.hhs.nd.gov/healthcare

Phone: 1-844-854-4825

Oklahoma – Medicaid and CHIP

Website: http://www.insureoklahoma.org

Phone: 1-888-365-3742

Oregon – Medicaid

Website: https://healthcare.oregon.gov/Pages/index.aspx

Phone: 1-800-699-9075

Pennsylvania – Medicaid and CHIP

Website: https://www.pa.gov/en/services/dhs/apply-for-medicaidhealth-insurance-premium-payment-program-hipp.html

Phone: 1-800-692-7462

CHIP Website: https://www.dhs.pa.gov/chip/pages/chip.aspx

CHIP Phone: 1-800-986-KIDS (5437)

Rhode Island – Medicaid and CHIP

Website: http://www.eohhs.ri.gov/

Phone: 1-855-697-4347 or 401-462-0311 (Direct RIte Share Line)

South Carolina – Medicaid

Website: https://www.scdhhs.gov

Phone: 1-888-549-0820

South Dakota - Medicaid

Website: https://dss.sd.gov

Phone: 1-888-828-0059

Texas – Medicaid

Website: https://www.hhs.texas.gov/services/financial/healthinsurance-premium-payment-hipp-program

Phone: 1-800-440-0493

Utah – Medicaid and CHIP

Utah’s Premium Partnership for Health Insurance (UPP) Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov Phone: 1-888-222-2542

Adult Expansion Website: https://medicaid.utah.gov/expansion/ Utah Medicaid Buyout Program Website: https://medicaid.utah.gov/ buyout-program/ CHIP Website: https://chip.utah.gov/

Vermont– Medicaid

Website: https://dvha.vermont.gov/members/medicaid/hipp-program Phone: 1-800-250-8427

Virginia – Medicaid and CHIP

Website: https://coverva.dmas.virginia.gov/learn/premium-assistance/ famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/healthinsurance-premium-payment-hipp-programs

Medicaid/CHIP Phone: 1-800-432-5924

Washington – Medicaid

Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022

West Virginia – Medicaid and CHIP

Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/

Medicaid Phone: 304-558-1700

CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-

Wisconsin – Medicaid and CHIP

Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002

Wyoming – Medicaid

Website: https://health.wyo.gov/healthcarefin/medicaid/programs-andeligibility/ 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, 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 Wallis Bank group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Wallis Bank 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.

April 1, 2025

Wallis Bank

2929 W Sam Houston Pkwy N, Ste 300 Houston, TX 77043

713-935-3786

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-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these poststabilization services.

• Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network 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-ofnetwork 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 out-of-network providers and facilities directly.

• Your health plan generally must:

Cover emergency services without requiring you to get approval for services in advance (prior authorization).

Cover emergency services by out-of-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 cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12%1 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

What about Alternatives to Marketplace Health Insurance Coverage?

If you or your family are eligible for coverage in an employmentbased health plan (such as an employer-sponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan, but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31, 2023 and July 10, 2023, you can request this special enrollment in the employment-based health plan through September 8, 2023. Confirm the deadline with your employer or your employment-based health plan.

Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https://www. healthcare.gov/medicaid-chip/getting-medicaid-chip/ for more details.

How Can I Get More Information?

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: Wallis Bank

5. Employer Address: 929 W Sam Houston Pkwy N, Suite 300

7. City: Houston

4. Employer Identification Number (EIN): 76-0567959

6. Employer Phone Number: 713-580-9900

8. State: TX 9. ZIP Code: 77043

10. Who can we contact at this job?: Samantha Ward

11. Phone Number (if different from above): 713-580-9900

12. E-Mail Address: samantha.ward@wallisbank.com

You are not eligible for health insurance coverage through this employer. You and your family may be able to obtain health coverage through the Marketplace, with a new kind of tax credit that lowers your monthly premiums and with assistance for out-of-pocket costs.

1 Indexed annually; see https://www.irs.gov/pub/irs-drop/rp-22-34.pdf for 2023.

2 An employer-sponsored or other employment-based health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.

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 Wallis Bank 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).

Health Savings Account (HSA) – A personal savings account that allows you to pay for qualified medical expenses with pretax dollars.

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.

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 and Customary Allowance (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 costeffective 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 Wallis Bank 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. Wallis Bank reserves the right to change or discontinue its employee benefits plans anytime.

Turn static files into dynamic content formats.

Create a flipbook