2026 CODAC Benefit Summaries and Carrier Flyers

SECTION 12: QUALIFIED MEDICAL CHILD SUPPORT ORDERS (QMCSO) If you must provide health care coverage to a Dependent child under a QMCSO from a court, then you must request coverage for the child in writing within 31 days of the date of the order. Other court orders may be covered by this Rx Plan as well. The Plan Administrator has sole and absolute discretion to determine whether any QMCSO is valid and binding upon the Rx Plan and how such QMCSO applies to benefits under the Rx Plan. If any eligible person has

questions, they should contact the Plan Administrator. SECTION 13: NOTICE INFORMATION 13.1 General Notices

Notices in General . There are a number of related and additional notices that apply to the Rx Plan and any related health and welfare and or group health plan that is offered along with the Rx Plan. Such notices may be contained in other notices and information provided to the Employee and Covered Persons. These notices are incorporated by reference. If you do not have, or do not have access to notices and other information you should see the Plan Administrator, or Human Resources representative to obtain a copy. Medicaid and Children's Health Insurance Program - ("CHIP") . (Free or Low-Cost Health Coverage for Children and Families that may apply). For Eligible Employees who are Participants and are eligible for health coverage under the Rx Plan, but are unable to afford the Employee portion of the total cost (sometimes referred to as the employee premium), some states have premium assistance programs that Participants may access to help pay for coverage. Certain states use funds from their Medicaid or CHIP programs to help people who are eligible for health coverage provided by employers, but need assistance in paying their health premiums. For those Employees who are already enrolled in Medicaid or CHIP, or have Dependents so enrolled, they can contact the applicable State Medicaid or CHIP office to find out if premium assistance is available. If covered Dependents are not currently enrolled in Medicaid or CHIP, they can contact the State Medicaid or CHIP office, or dial 1-877- KIDS NOW, or go to www.insurekidsnow.gov to find out how to apply for this premium assistance. If one qualifies, the program in the state where the individual resides will provide information as to whether it has a program that might help pay the premiums toward the Employee portion payable for coverage under the Rx Plan. Once it is determined that the Eligible Employee or Dependent is eligible for premium assistance under Medicaid or CHIP, this Rx Plan will permit such Eligible Employee or Dependent to enroll, as long as such persons are eligible, and not already enrolled. This is a special enrollment period for such individuals. Such individuals must request coverage within 60 days of being determined eligible for premium assistance. SECTION 14: GENERAL COMPLIANCE AND OTHER INFORMATION 14.1 No Vesting Benefits Are Not Subject to Vesting and Are Not Vested . As stated above, the Rx Plan may be amended or terminated at any time. Any amendment may at the determination of the Employer, change, reduce, eliminate or otherwise affect benefits provided for under the Rx Plan and no Eligible Spouse, Dependent or beneficiary has any vested right, whatsoever, to benefits under the Rx Plan. 14.2 HIPAA Rules, Policies and Procedures Health Insurance Portability and Accountability Act. It is intended that this Plan comply with the Health Insurance Portability and Accountability Act of 1996, as amended ("HIPAA") and the Health Information Technology for Economic and Clinical Health ("HITECH") Act of 2009, Title XIII of division A and Title IV of division B of the American Recovery and Reinvestment Act ("ARRA"), and the regulations issued under HIPAA, HITECH and ARRA (together we refer to HIPAA, HITECH and ARRA as "HIPAA"). Any Rules and/or Policy adopted by the Employer that addresses HIPAA are automatically incorporated in this Plan by reference and become part of the Plan.

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CIDN:199534