2026 CODAC Benefit Summaries and Carrier Flyers

SECTION 3: ADMINISTRATION AND RELATED INFORMATION 3.1 Plan Funding and Constituent Benefit Programs

Funding. The Rx Plan is funded by contributions from the Employer and Employees may be required to contribute toward the coverage under this Rx Plan. The Rx Plan is self-funded or self-insured, unless the purchase of insurance funds all or a portion of the Rx Plan benefits, as stated in Exhibit A. Employees may be required to pay for a portion of the premium for coverage, as determined from time to time by the Employer. Continued eligibility is conditional upon the Employee authorizing and paying the required Employee contribution amount either from the Employee's pay or otherwise. Employee contribution amounts for the Rx Plan may in part come from contributions made for coverage under the main group health plan of the employer. The Employer will provide reasonable notice of the Employee contribution amounts, which may change from time to time, as determined by the Employer. If any rebates, credits, refunds or other amounts are paid back, or made available from insurers, administrators, or others, such amounts are paid to the Employer to offset the Employer’s cost to provide and/or administer benefits under the Plan. "Rx Benefit Programs." The plan and program of Rx Plan benefits, which may include several options, are referenced in Exhibit A to this Rx Plan document. Exhibit A will include details of eligibility, deductibles, Co-Payments, Co Insurance, Out-of-Pocket Maximums, coordination with group health plan coverage, spousal and dependent coverage information, and other details of the plan and program of Rx Plan benefits under this Prescription Drug Plan. The Rx Benefit Program or Programs stated in Exhibit A to this Rx Plan are an integral part of and incorporated into this Rx Plan document and SPD by reference. Additional documentation is often provided to Employees and covered Dependents by the Employer and Pharmacy Benefit Manager (PBM) (See Section 4.1). If there is any conflict between any documentation provided by the Employer or PBM the Plan Administrator will reconcile such inconsistency and has full rights to do so, as further provided under this Plan and SPD. 3.2 Plan Administrator, Claims Administrator and Discretionary Authority The Rx Plan is administered by the Pharmacy Benefit Manager ("PBM") that acts as the Claims Administrator, and by the Plan Administrator, in accordance with the provisions of this Rx Plan. Information on the PBM is in Section 4.1. Routine Rx Plan claims under the Rx Plan are processed by the Pharmacy Benefit Manager ("PBM") which is the Claims Administrator and is directly responsible as the fiduciary for claims and claim determinations, unless specified otherwise. In addition, the Formulary or Drug List or lists and other related determinations in this Rx Plan, including those in Section 4, when made by the PBM are subject to the full discretionary authority of the PBM as noted in this Section. When a claim determination is delegated to or is the responsibility of the PBM as Claims Administrator under the Rx Plan, the Plan Administrator is not the responsible fiduciary. When a determination on a claim, or eligibility, or other term, or of fact, law or interpretation under the Rx Plan is not specifically reserved to the PBM as the Claims Administrator, the Plan Administrator is the responsible fiduciary for such determinations under the Rx Plan. If there is any question as to whether the Claims Administrator or Plan Administrator is the responsible fiduciary, the Plan Administrator makes such determination in its sole and absolute discretion. The Rx Plan is self-funded, which means there is no insurance that funds the Rx Plan. If any part of the Rx Plan is insured, the insurance provider is the Claims Administrator and is directly responsible as the fiduciary for claims and claim determinations under the Rx Plan. If any part of the Rx Plan is insured, this is stated in Exhibit A. When the Claims Administrator acts, or when the Plan Administrator is the responsible fiduciary, such responsible fiduciary has full discretionary authority with respect to all of its determinations under this Plan, the determination of facts, the interpretation of the Rx Plan or its terms and all decisions and determinations under this Rx Plan made by such fiduciary. This discretionary authority is to be interpreted in the broadest sense permitted under law.

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CIDN:199534