2026 CODAC Benefit Summaries and Carrier Flyers

• Covered services provided by a Physician (excluding surgeons) during an Inpatient stay will be payable at the In-Network level of benefits when provided at an In-Network Hospital. • If there is no In-Network provider, or no In-Network provider is willing or able to provide the necessary service(s) to the Covered Person within a 50- mile radius of the Covered Person’s residence, the Covered Person may be eligible to receive In-Network benefits from an Out-of Network provider. In this situation, Your In-Network Physician will notify the claims administrator, who will work with You and Your In-Network Physician to coordinate care through an Out-of Network provider. • Wigs, toupees, and hairpieces will be payable at the In-Network level of benefits when provided by an Out-of-Network provider. Each covered Employee, COBRA participant, and Child or guardian of a Child who is considered an alternate recipient under a Qualified Medical Child Support Order will automatically be given or electronically provided a separate document, at no cost, that lists the participating Network providers for this Plan. The Employee should share this document with other covered individuals in his or her household. If a covered spouse or Dependent wants a separate provider list, he or she may make a written request to the Plan Administrator. The Plan Administrator may make a reasonable charge to cover the cost of furnishing complete copies to the spouse or other covered Dependents. Certain eligible expenses that would have been considered at the In-Network benefit level by the prior claims administrator, but that are not considered at the In-Network benefit level by the current claims administrator, may be paid at the applicable In-Network benefit level if the Covered Person is currently under a treatment plan by a Physician who was a member of this Plan’s previous PPO but who is not a member of the Plan’s current PPO in the Employee’s or Dependent’s network area. In order to ensure continuity of care for certain medical conditions already under treatment, the In-Network medical plan benefit level may continue for 90 days for conditions approved as transitional care. Examples of medical conditions appropriate for consideration for transitional care include, but are not limited to: • Cancer if under active treatment with chemotherapy and/or radiation therapy. • Organ transplants for patients under active treatment (e.g., seeing a Physician on a regular basis, being on a transplant waiting list, or being ready at any time for a transplant). • Being an Inpatient in a Hospital on the Covered Person’s Effective Date. • Post-acute Injury or surgery within the past three months. • Pregnancy in the second or third trimester and up to eight weeks postpartum. • Behavioral health (any previous treatment). Provider Directory Information TRANSITIONAL CARE

You or Your Dependent must call UMR within 90 days prior to Your Effective Date or within 90 days after Your Effective Date to see if You or Your Dependent is eligible for this benefit.

Routine procedures, treatment for stable chronic conditions, treatment for minor Illnesses, and elective surgical procedures will not be covered by transitional level benefits.

CONTINUITY OF CARE

You or Your Dependents have the option of requesting extended care from Your current health care provider or facility if the provider or facility is no longer working with Your health Plan and is no longer considered In-Network.

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