2026 CODAC Benefit Summaries and Carrier Flyers

EMPLOYEE "Employee" refers to an eligible Employee of the Plan Sponsor or a participating Employer under the Rx Plan and such status is determined by the Plan Administrator in its sole and absolute discretion. EXPERIMENTAL OR INVESTIGATIVE Medications, Drugs, supplies or therapies that are determined by the Rx Plan to be: (1) not approved by the U.S. Food and Drug Administration ("FDA") to be lawfully marketed for the proposed use and not identified in the American Hospital Formulary Service or the United States Pharmacopeia Dispensing Information as appropriate for the proposed use; or (2) subject to review and approval by any Institutional Review Board for the proposed use; or (3) the subject of an ongoing clinical trial that meets the definition of a Phase I, II, or III Clinical Trial set forth in the FDA regulations, regardless of whether the trial is actually subject to FDA oversight; or (4) not demonstrated through prevailing peer reviewed medical literature to be safe and effective for treating or diagnosing the condition or illness for which its use is proposed. FDA The term "FDA" means the United States Food and Drug Administration. FORMULARY OR FORMULARY MEDICATION The Term "Formulary" or "Formulary Medication" or "Drug List" all mean a Medication or Drug or other pharmaceutical product, service or supply set forth on a Formulary Drug List (or just "Drug List") provided by the PBM. This list is updated and revised by the PBM from time to time under the terms of this Rx Plan to include new drugs, generic equivalents and drugs removed from the market or made available over the counter. A current version of the Formulary may be found at the PBM's website as indicated in the PBM Data Sheet. GENERIC The term "Generic" refers to a Drug or Medication that is not a Brand-name Medication, is a non-Specialty Medication and is chemically equivalent to a Brand or Brand-name Medication on which a patent has expired. Generic drugs are identified by the PBM based on criteria provided by nationally recognized source(s) of prescription drug pricing information, as deemed appropriate by the PBM. ILLNESS The term "Illness" means Sickness, disease, or pregnancy. Sickness refers to any physical illness, disease or Pregnancy. Sickness also includes mental illness and substance-related and addictive disorder, regardless of the cause or origin of the mental illness or substance-related and addictive disorder. INJECTABLE DRUG LIST An Injectable Drug List may be provided by a PBM and includes injectable medications covered under this Rx Plan that are intended to be self-administered by the Covered Employee or Dependent and/or a family member as well as some injectable drugs that may need to be administered by a medical professional. The cost to inject these Prescription Drugs is not covered under this Rx Plan. Coverage is limited to those medications that have been designated by the Rx Plan. This list is subject to periodic review and modification. INJURY The term "Injury" means bodily damage or loss sustained by a Covered Person which requires treatment by a Physician, and is incurred by a Covered Person on or after the date of coverage under this Prescription Drug Plan, excluding any condition arising from an occupational Injury.

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CIDN:199534