Retiree Health Benefits - 2022 ENROLLMENT GUIDE - Benefits that deliver choice, flexibility and value (2024)

RetireeHealthBenefits2022 ENROLLMENT GUIDEBenefitsthat deliverchoice,flexibilityand value

Choice. The Public Employee Benefits Cooperative (PEBC) offers a variety of benefits and programs to protect your health while Flexibility. keeping benefit costs affordable. In this guide, you’ll find information on your 2022 health plan benefits to help you choose the coverage that works best for you. Value. Questions? Please contact your Human Resources department. Find the right information for you This guide has sections for each type of retiree. Note the headings on each page to determine if the information applies to you. Table of contents ALL RETIREES NON-MEDICARE ELIGIBLE MEDICARE ELIGIBLE The information applies This information applies to This information applies to to all retirees. retirees under age 65 and retirees age 65 and over. covered spouses of any age. 1 What’s changing 12 Choosing the 36 Choosing the Medicare for 2022 non-Medicare medical plan thatʼs right for you plan that’s right for you 2 Required 39 Summary of Benefits enrollment action 26 Saving on prescription medications 45 Additional benefits 3 2022 enrollment included with the overview Group Medicare Enhancing well-being Advantage PPO (MPO) 30 and HMO (PMA) plans with vision and dental benefits 34 Getting the right care at the right time 48 Tools to help you manage the details 50 2022 important notices KEEP READING TO LEARN MORE >b Retiree Health Benefits 2022 Enrollment Guide

ALL RETIREESNEWWhat’s changing for 2022Here’s an overview of what you can expectHealth savings account (HSA) New fitness benefit with the Groupcontributions Medicare Advantage PPO (MPO)The maximum contribution to an HSA for 2022 is and HMO (PMA) plans$3,650 for individuals and $7,300 for families. If you Effective Jan. 1, 2022, the fitness benefit includedare age 55 or older, you can make an extra catch-up with the UnitedHealthcare Group Medicaredeposit of $1,000 in 2022. Advantage PPO (MPO) and HMO (PMA) plans will move from SilverSneakers® to Renew Active™.New vision plan administrator See page 45 for more information.Starting Jan. 1, 2022, VSP will be administeringthe PEBC vision plan. Although VSP matched the New post-discharge benefit throughprevious plan, there could be slight changes to UnitedHealthcare® Healthy at Homecoverage, and Denton County is now offering Effective Jan. 1, 2022, the UnitedHealthcarea high/low option. In addition, the contact Group Medicare Advantage PPO (MPO) andinformation for your vision plan will change. For HMO (PMA) plans will include the Healthymore information, turn to page 30 of this guide. at Home program designed to help members transition back home after an inpatientNew dental plan administrator admission or a convalescent stay. See page 46Starting Jan. 1, 2022, Delta Dental will be for more information.administering PEBC dental plan benefits. Whilethere are no changes to coverage, the contactinformation for your dental plan will change. Formore information, turn to page 32 of this guide.Retiree choicesMedical plans — Retirees under age 65 and not Medical plans — Retirees enrolled in Medicareenrolled in Medicare Parts A & B• PPO plan (includes spouses and dependents • UnitedHealthcare Group Medicare Advantage enrolled in PMD/MPD) PPO (MPO) with Part D prescription drug coverage• High-deductible plan (HDP) — you can contribute to • UnitedHealthcare Group Medicare Advantage an HSA as long as you are not enrolled in Medicare HMO (PMA) with Part D prescription drug coverageDental plans The PEBC PPO is available only to non-Medicare• Delta Dental DPPO — Delta Dental PPO Plan dependents of retirees enrolled in either the UnitedHealthcare Medicare Advantage PPO (MPO)• DeltaCare USA DHMO — Delta Dental HMO Plan or HMO (PMA) plans. If your spouse and/or dependents are not eligible for Medicare, don’t letVision plan that stop you from enrolling. Your non-Medicare• VSP — VSP Advantage Plan spouse and/or dependents can enroll in the PEBC PPO plan. To enroll, select the PMD or MPD plan (with non-Medicare dependents) Retiree Health Benefits 2022 Enrollment Guide 1

ALL RETIREES Required enrollment action Spouse Medical Plan Surcharge Affidavit The medical plan spouse surcharge will not apply if: If your medical coverage includes your spouse, you • Your spouse is enrolled in dental and must sign a “Spouse Medical Plan Surcharge Affidavit” vision coverage. during annual enrollment confirming their access • Your spouse is enrolled in both their employer to employer medical plan coverage through their medical plan (proof of enrollment required) and employer — regardless of whether they enrolled in your PPO plan or HDP; or that coverage. Verify submission requirements and deadlines with your employer. A copy of the form is • Your spouse does not work outside the home and in your enrollment packet, or visit pebcinfo.com to has no access to employer coverage; or get a copy of the form. • Your spouse’s employer does not offer medical coverage, or your spouse is not eligible for that Medical plan spouse surcharge coverage; or If your spouse’s employer offers a medical plan, your • Your spouse’s other coverage is Medicare, Medicaid, spouse did not enroll in that plan and you cover your TRICARE or care received at a Department of spouse in your PPO medical plan or HDP, a $200 per Veteran Affairs (VA) facility; and month spouse surcharge will apply to your retiree • You turned in the required Spouse Medical Plan premium, unless your spouse is enrolled in their Surcharge Affidavit on time. employer medical plan and you turned in the Affidavit on time. PLEASE NOTE: The surcharge will apply for each The surcharge will also apply if you fail to turn in the month the Spouse Medical Plan Surcharge Affidavit required Spouse Medical Plan Surcharge Affidavit was not submitted by your employer's deadline (even or if you were late turning it in. if the surcharge does not apply or if it was submitted late) or if you fail to notify your employer of a change, which would have triggered or stopped the surcharge. 2 Retiree Health Benefits 2022 Enrollment Guide

ALL RETIREES2022 enrollment overviewAnnual enrollment is the only time of the year that Moving from active employeeyou can change your benefit elections or dependents to retiree status?without a qualified change in status event. It’s very If you are a new retiree selecting group retiree healthimportant that you follow your employer’s annual benefits for the first time (not during annual enrollment),enrollment instructions and deadlines so that you can review your enrollment information with carefulenroll in your chosen benefits in 2022. attention to deadlines. Enrollment cannot be retroactive and you are responsible for enrolling on time.Can you enroll in coverage you currentlydo not have? Visit your Human Resources department at least 60 daysYou cannot enroll in coverage you do not already have. before you retire to complete your Retiree BenefitIf you are already enrolled in a PEBC medical, dental Enrollment forms.or vision plan and you want to change that plan duringannual enrollment, check the options available to you. Retiree Health Benefit Enrollment forms must beOnce you leave the plan, you cannot return. signed and dated no more than 60 days before your retiree health benefits become effective.Make an informed choiceAs you know, the world of health benefits has changed. Carefully review the retiree premium paymentIt’s more important than ever to make the most of your information included in this Retiree Enrollmenthealth care dollars. To do that, use all of the resources Guide to understand exactly how and when to payavailable to you to learn more about your plan options. your premium.Consider how your coverage needs will change onceyou (and your covered spouse) turn 65, including how As an active employee, if you chose to opt out of yourMedicare will change your benefits. Weigh the cost of employer’s medical plan before you retire, you areeach plan against your needs and determine the right not eligible for medical plan coverage as a retiree.benefits mix for you and your family. Making smart Likewise, if you did not have dental or vision coveragedecisions about your health benefits helps you keep as an active employee, you cannot elect dental orcosts down while getting the coverage you need vision coverage as a retiree.after you retire. Don’t forget to review your optional life insurance. You have 31 days after your active employee optional life coverage ends to apply for conversion or portability of your life insurance benefits. If you miss the deadline, you cannot continue your life insurance coverage. NOTE: During annual enrollment, you must re-enroll if: • Your employer requires you to re-enroll (important deadlines apply) • Anything changed, including dependent eligibility, your address or your plan choice Retiree Health Benefits 2022 Enrollment Guide 3

ALL RETIREES Dependent eligibility Who is not an eligible dependent? Who is an eligible dependent? Enrollment of an ineligible dependent can be Your dependent can be enrolled in a plan only if considered fraud and subject you to penalties, they are an eligible dependent. If both you and your including termination of employment, financial risk spouse work for the same employer, your dependents and criminal prosecution. Anyone eligible as an can be covered by only one of you. employee is not eligible as a dependent. Eligible spouse Ineligible spouse • Your lawful spouse (You must have a valid certificate • Your divorced spouse, or a person to whom of marriage considered lawful in the State of Texas you are not lawfully married, such as your or a signed and filed legal Declaration of Informal significant other Marriage considered lawful in the State of Texas.) • A surviving spouse who was not covered by the • A surviving spouse of a deceased retiree, if the deceased retiree at the time of the retiree’s death spouse was covered at the time of the retiree’s death Ineligible child(ren) Eligible child(ren) • Your natural, age-26-or-older child who is not • Your natural child under age 26 disabled or whose disability occurred after the 26th birthday • Your natural, mentally or physically disabled child, if the child has reached age 26 and is dependent • A child for whom your parental rights have upon you for more than one-half of their support as been terminated defined by the Internal Revenue Code. To be eligible, • A child living temporarily with you, including a foster the disability must occur before or within 31 days of child who is living temporarily with you or a child the child’s 26th birthday. placed with you in your home by a social service • Your legally adopted child, including a child who is agency, or a child whose natural parent is in a living with you who has been placed for adoption position to exercise or share parental responsibility or for whom legal adoption proceedings have or control been started, or a child for whom you are named • Your current spouse’s stepchild or the stepchild Permanent Managing Conservator of a former spouse • A surviving child of a deceased retiree who was Managing conservator not covered as a dependent at the time of the • Your stepchild (natural or adopted child of retiree’s death current spouse) • A sibling, another family member or an • Your unmarried grandchild (child of your child) individual not specifically listed by the plan as under age 26 who, at the time of enrollment, is your an eligible dependent dependent for federal income tax purposes, without regard to income limitations When a child’s coverage ends • A child for whom you are required to provide You may cover your child (natural child, stepchild, coverage by court order adopted child) in a medical, dental and/or vision • A surviving, eligible child of a deceased retiree, only plan until the last day of the month in which the child if the child was covered as a dependent at the time turns age 26, whether or not the child is a student, of the retiree’s death working, living with you and regardless of the child’s marital status. This coverage does not extend to your child’s spouse or their children. Your grandchild is Dependent verification eligible only if the grandchild is unmarried and your dependent for federal income tax purposes. You Valid proof of dependent eligibility is required before must provide your Form 1040 to prove grandchild you can add a new dependent or spouse to the plan. dependent status. Check with your Human Resources department for more information. 4 Retiree Health Benefits 2022 Enrollment Guide

ALL RETIREESChange in status spouse to your applicable retiree benefits at that time, provided you meet the timing rules for a qualifyingIRS regulations state that unless you experience a change in status event.qualified change in status event (described below),you cannot change your benefit choices until the next Examples of a spouse’s employment-related eventannual enrollment period. are spouse retirement (and spouse’s employer does not offer retiree benefits), loss of job or employerThe qualified change in status event must result cancellation of benefits. An employment-relatedin either becoming eligible for or losing eligibility event is not a spouse’s voluntary cancellation of theirunder the plan. The change must correspond with the employee or retiree benefits or termination fromspecific eligibility gain or loss. this benefit due to late or non-payment. You cannot add your spouse to your retiree coverage if your spouse is not on your plan when you retire unless theySpouse enrollment after you retire experience the loss of spouse coverage as described above. If you are enrolled in the PPO plan or HDP, theIf your spouse is still working and enrolled in their spouse surcharge could apply. Refer to page 2 of thisbenefits at work, you can delay your spouse’s guide for more information.enrollment in your retiree plan if you wish. If yourspouse then loses their employer health benefits dueto an employment-related event, you can add your Important deadlines apply You must take action within 31 days of the qualifying event — coverage elections are not retroactive. • 31-day notification rule — You must notify your Human Resources department of the event AND turn in required paperwork (including proof of the change) within 31 days of the event date. • Effective date — The change is effective the first day of the month following the date you notified your employer of the qualified change in status event. Effective date exception: Newborns are effective on the date of birth, and adoptions are effective the date placed for adoption or on the adoption date. Retiree Health Benefits 2022 Enrollment Guide 5

ALL RETIREES Qualified events Retirement Change in family status Thinking about retirement? Applies to employee, employee’s spouse or If you are flipping through this guide because you are employee’s dependents: thinking about retiring, make sure you review your • Marriage, divorce or annulment employer’s retiree health plan policies before you retire. Your employer offers retiree health benefits, but retiree • Death of your spouse or dependent health benefits cost more than your active employee • Child’s birth, adoption or placement for adoption coverage. Make an appointment to discuss your retiree benefit options with your Human Resources department • An event causing a dependent to no longer meet at least 60 days before you retire. eligibility requirements, such as reaching age 26 Examples of events that do not qualify: If you are age 65 or older, or if you are turning 65 soon, contact the Social Security Administration at least 90 • Your doctor or provider is not in the network. days before you retire. Carefully review the Retiree • You prefer a different medical plan. Health Benefits Guide, available at pebcinfo.com or from your employer. • You were late turning in your paperwork. Change in employment status Countdown to retirement • 60 to 90 days before you retire — Contact the Social The following changes in the employment status of an Security office. If you are age 65 or older, sign up for employee, spouse or dependent may affect benefit Medicare Part A and Part B (you and your spouse). eligibility under your benefit plan or the employer benefit plan of your spouse or your dependent: • 60 days before you retire — Contact your Human Resources department and complete retirement • Switching from a salaried to an hourly paid job paperwork. Choose your retiree health benefits. (or vice-versa) • 30 days before you retire — Make sure your retiree • Reduction or increase in hours of employment, health benefits are chosen and your premium is paid. such as going from part-time to full-time • If you move — Let your Human Resources department • Any other employment-related change that results know as soon as possible. in becoming eligible for or losing eligibility for a particular plan Did you know? • Termination or commencement of employment Medicare becomes effective on the first day of the • Strike or lockout month in which you turn 65, regardless if you are at full • Start or return from an unpaid leave of absence retirement age for Social Security benefits. If your 65th birthday is on the first day of the month, then Medicare • USERRA (military) leave becomes effective the first day of the prior month. This applies to your covered spouse as well. 6 Retiree Health Benefits 2022 Enrollment Guide

ALL RETIREESTurning age 65 and still working CAUTION: If you are preparingMost people become eligible for Medicare when they turn 65. If you are to retire and you or your spousestill working and covered under your employer’s plan, you can delay your are age 65 or older or turning 65Medicare enrollment until you retire. soon, you must contact the Social Security Administration to enroll inIf you are already collecting Social Security payments, you are Medicare Part A and Part B. If youautomatically enrolled in Part A. Otherwise, you may choose to delay delay, your Medicare enrollmentyour Medicare enrollment until you retire for several reasons, including: can be delayed, and you may be• You are an active employee and you (and your spouse, regardless of subject to a higher Part B premium. spouse’s age) are enrolled in the employer health plan. After you retire, Medicare becomes• You (and your spouse, regardless of spouse’s age) want to delay primary for you and your Medicare- payment of Part B premium. eligible spouse. You may be• You still want contributions to be made to your HSA (as long as you are eligible for your employer’s retiree not enrolled in Medicare and you are enrolled in the HDP). plan but only if you are enrolled in both Medicare Part A and Part B. Retiree Health Benefits 2022 Enrollment Guide 7

ALL RETIREES Helpful tools pebcinfo.com caremark.com Go to pebcinfo.com and click the button for your Log in to or download the CVS Caremark® app to employer group. Select “Retiree” from the top menu. manage your prescription drug benefits. This centralized benefits site offers plan information, forms and links to PEBC vendor sites. Retirees enrolled in the Medicare Advantage To compare plans, check the Summary of Benefits and PPO (MPO) or HMO (PMA) plan Coverage (SBC). The SBC helps you compare certain • Visit UHCRetiree.com to search for a network health plan provisions. provider or pharmacy using the online directories. Once you’re a member, register on our member myuhc.com® website, UHCRetiree.com, to get specific plan Register for an account on myuhc.com and you’ll be information and materials, view claims and more. able to locate a network provider nearby, estimate costs You can also view the plan Drug List (Formulary) for care, access your HSA and much more. to see what drugs are covered and if there are any restrictions. • Use the cost estimator to help estimate your out-of-pocket costs, compare treatment options • Visit our virtual education center at and select a quality provider for a procedure. UHCVirtualRetiree.com/pebc anytime to learn about the benefits and services offered for 2022 from the • Access myClaims Manager to help manage your comfort of your home. claims and understand your share of the plan cost. You can view your deductible, annual All retirees regardless of age out-of-pocket maximum and claims history. • 2022 Retiree Health Benefits Enrollment Guide — • Select “Find Physician, Laboratory or Facility” to find A quick summary guide that includes features of each network providers (including Tier 1 and Premium Care plan available to you, contact information and other Physicians) and even pay your out-of-pocket costs important information about your plan benefits securely online. • 2022 Retiree Benefits Rate Sheet — Lists retiree • Download the UnitedHealthcare® app to access your contribution rates for each plan health plan ID card, find nearby care and more right on your phone or mobile device, anywhere, anytime. • Important Notices — 2022 8 Retiree Health Benefits 2022 Enrollment Guide

ALL RETIREES Retired public safety officers: The HELPS ACT If you are a retired public safety officer and you enroll in the retiree group health plan, you may benefit from a tax savings provision known as the HELPS Act. Federal law permits eligible retired public safety officers to exclude up to $3,000 of their qualified health insurance premiums from their gross taxable income each year as long as the premiums are deducted from their retirement benefit. This means your health premium must be deducted from your TCDRS monthly retirement benefit to qualify for the tax savings. Contact your Human Resources department (not TCDRS) for additional information and the required enrollment form. Information is also available at pebcinfo.com (select “employer member group,” then select “retiree” from the top menu for retiree information specific to your employer). If you are currently enrolled, you do not need to enroll again.What is a self-funded health plan?PEBC employer groups self-fund (or self-insure) theHDP, the PPO plan and the PEBC Dental Plan. Thismeans there is not an insurance company and youremployer funds the cost of health claims. With self-funding, each PEBC employer group’s experiencestands on its own and is not combined with any othergroup. Your plan cost is based on your workforce alone— not on the claims of other member groups — andyour employee cost is based on the experience of youremployer group.Even with the administrative costs associated withself-funded plans, when compared to fully insuredplans (e.g., an HMO plan), the savings can besignificant. The PEBC consistently administers all PEBCemployer health plans, which drives savings evenfurther. Subject to benefit differences to an employeeand health care provider, a self-funded insurance planmay feel no different than many insurance plans, evenwithout an insurance company. Retiree Health Benefits 2022 Enrollment Guide 9

ALL RETIREES Life insurance Continuing your life insurance When you retire, you can choose to either carry over (port) or convert selected life insurance when employment ends, paying your premium directly to The Hartford. You cannot add life insurance if you did not convert or port coverage when you retired. When your employment terminates, review your life insurance needs quickly. You must apply and pay a premium to The Hartford no later than 31 days after your active employee coverage ends. Visit pebcinfo.com for more information about portability and conversion. Portability If your coverage terminates, you can continue an amount up to $250,000 of your TLF and the full amount of your SLF and DGL benefit without EOI at The Hartford’s portability rates (without AD&D). Portability rates are higher than the cost available to active employees. Contact The Hartford for cost information. Conversion Conversion allows employees and covered dependents to convert all or part of GLF, TLF/SLF and DGL to an individual whole life policy. Whole life costs more than group term life coverage. Contact The Hartford for cost information. 10 Retiree Health Benefits 2022 Enrollment Guide

ALL RETIREESPremium payment informationPayment due date An authorization form is available at pebcinfo.com orYour monthly payment is due on the first day of the from your Human Resources department. If you wantmonth and the grace period expires 30 days later. Your to start this program with your January 2022 premium,coverage is terminated if your payment is not received enroll online at UHCServices.com or mail the formor postmarked by the last day of the grace period. to UnitedHealthcare. If you change banks or yourRetiree group health premiums are not deducted from account number, you must contact UnitedHealthcareyour Social Security check. Premiums are deducted immediately. Double-check your premium to makefrom your retirement benefit only if you are enrolled in sure it is for the correct 2022 amount.the HELPS program. Where to mail your payment:Automatic premium payment program UnitedHealthcare Benefit ServicesIf you already participate in the automatic bank P.O. Box 713082, Cincinnati, OH 45271-3082draft program, and your payment information isthe same for 2022, you do not need to re-enroll. Need to contact UnitedHealthcare?UnitedHealthcare will automatically deduct the correct UHCServices.com2022 premium amount. If you are not signed up for Phone: 1-877-237-8576, TTY 711the automatic premium payment program, consider Email: DirectBill_KYOperations@uhc.comenrolling soon. Fax: 1-866-525-1740 Retiree Health Benefits 2022 Enrollment Guide 11

Choosing the non-Medicare medical plan that’s right for youNON-MEDICARE ELIGIBLE Understanding how much you can expect to pay Your out-of-pocket costs and your deductible — the amount you must pay each year before the plan begins to pay — will be different, depending on the plan you choose. PPO With this plan, you pay a fixed copay for many services, which count toward your out-of-pocket costs. Copays do not count toward the deductible. Network deductibles Out-of-network deductibles For 2022, your deductible for The individual out-of-network services in the network is: deductible applies to each enrolled family member and does not have a family deductible limit: $500 for individual $1,000 for each (single) coverage individual (single) Need more details? $1,000 for family coverage* Unlimited for family coverage Visit pebcinfo.com. *If you cover family members, the network family deductible is met when the combined eligible network expenses for you and/or your covered family members reach $1,000. If one family member reaches $500 but the combined family deductible of $1,000 has not been met, the member who met the $500 deductible can move to coinsurance until one more family member reaches the deductible. If no family member reaches the $500 deductible but the combined family deductible is met, all family members move to coinsurance. 12 Retiree Health Benefits 2022 Enrollment Guide

NON-MEDICARE ELIGIBLEHDPThe HDP does not use copays. You pay 100% of the allowable costfor network services — including office visits, urgent care, prescriptiondrugs, emergency room visits and other covered expenses — until yourdeductible is met. Once the deductible is met, you pay a portion of thecosts as coinsurance.The deductibles are another big difference between this plan and thePPO plan:• $1,500 individual (single) deductible• $3,000 family deductible**If you cover any family member, the entire network family deductible must be met beforeany family member can move to coinsurance. The HDP network family deductible is metwhen the combined eligible expenses for you and/or any covered family members reach$3,000. Even if one family member reaches the $1,500 deductible, that member cannotmove to coinsurance until the full $3,000 family deductible is met.Pre-certificationIf care is provided by a network doctor, hospital or other health careprovider, you do not need pre-certification for services. If you receivecare from an out-of-network provider, your care must be pre-certifiedor you may incur higher costs. It is your responsibility to make sure yourout-of-network care is pre-certified.NetworkTo locate a doctor, hospital or other provider in UnitedHealthcare’sChoice Plus network, visit myuhc.com. While each plan includesout-of-network benefits, you will often pay more for care received froman out-of-network provider.Transition benefits Questions?Are you new to the HDP or PPO plan? Transition of Care is a service that Talk to yourenables new enrollees to receive time-limited care for specific medical Human Resourcesconditions from an out-of-network doctor but at the network benefit level. representative.Complete Sections 1 and 2 of the Application for Transition of Care form(available at pebcinfo.com or from your Human Resources department).Ask your doctor to complete Section 3 and forward to UnitedHealthcareno later than 30 days after your benefits become effective. Transitionbenefits may apply if you are in your second or third trimester ofpregnancy, a high-risk pregnancy, in nonsurgical treatment (radiation,chemotherapy) for cancer, treatment for symptomatic AIDS, treatment forsevere or end-stage kidney disease, or if you are on the waiting list for orrecently underwent a bone marrow or organ transplant. Retiree Health Benefits 2022 Enrollment Guide 13

NON-MEDICARE ELIGIBLE Health savings account (HSA) You must be enrolled in the HDP to contribute to an HSA. Contributions cannot be made to an HSA if you are enrolled in Medicare. What is an HSA? Your HSA An HSA is a savings account for health care expenses. An HSA will be opened with Optum Bank for all newly Unlike a flexible spending account (FSA), your savings enrolled HSA participants. Once your account is account can grow from year to year and there is no “use opened, you will receive a Welcome Kit in the mail. As it or lose it” rule. The HSA works differently than an FSA. long as you maintain an account balance of $500 or A big difference is that the HSA has triple-tax benefits: more, you will not be charged the $1 monthly account – Deposits are income tax-free maintenance fee. If your account balance is $2,000 or more, you can choose to invest funds — look for details – Savings grow tax-free in your Welcome Kit. – Withdrawals made for qualified expenses are also income tax-free For 2022, you can contribute $3,650 if you have individual coverage or $7,300 if you have family coverage. The IRS also allows catch-up contributions of $1,000 if you are age 55 or older. Important information if you enroll in the HDP with HSA You must file IRS Form 8889 with your annual tax return to report contributions to and distributions from your HSA. HSA contributions, investment earnings (if any) and withdrawals (if made for qualified medical expenses) are generally not taxable for federal (and, in most cases, state and local) income tax purposes. However, under certain circ*mstances, your HSA may be subject to taxes and/or penalties. And, if your HSA contributions for any year exceed the annual limit, you are responsible for contacting your HSA bank to request a refund of the excess. Be sure to save receipts for all withdrawals from your HSA. You are responsible for verifying eligible medical expenses under the IRS tax code. Some of your responsibilities include: • Determining your eligibility to contribute to an HSA • Keeping receipts to show you used your HSA for qualified medical expenses • Tracking contribution limits and withdrawing any excess contributions • Making sure funds are transferred to a qualified HSA • Identifying tax implications and reporting distributions to the IRS Contact your HSA bank for detailed information about eligible expenses and your responsibilities regarding contributions and recordkeeping. Since this is your personal account and you are responsible for complying with the tax rules, it is recommended that you consult with your personal tax advisor about your personal situation. Your employer cannot provide you tax advice. 14 Retiree Health Benefits 2022 Enrollment Guide

NON-MEDICARE ELIGIBLEWhy would a retiree consider an HSA? Paying for insurance premiumsIf you want to set aside money on a pretax basis before with HSA fundsyou enroll in Medicare, you may want to consider Typically, you cannot use HSA funds to pay medicalenrolling in the HDP with HSA. Once you enroll in insurance premiums, but there are some exceptionsMedicare, you can no longer contribute to the HSA, that may apply to you. Here are a few examples of howbut you can still use the money tax-free as long as HSA funds can (or cannot) be used to pay premiums.funds are used to pay for qualified medical expenses.To have an HSA, the IRS requires you be enrolled • Medicare Advantage Plan PPO (MPO) — If you arein a qualified high-deductible health plan, like the age 65 or older, you can use HSA funds to payHDP offered through PEBC. Before enrolling in the premiums (known as Part C coverage).HDP, you will want to compare the advantages of the • Medicare Advantage Plan HMO (PMA) — If youplan with your specific situation. Consult your tax or are age 65 or older, you can use HSA funds to payfinancial advisor, or contact your HSA bank if you have premiums (known as Part C coverage).questions about the HSA. Your employer cannot giveyou tax advice. • Medicare Part B — If you are age 65 or older, you can use HSA funds to reimburse yourself for the cost ofMedicare and the HSA Part B coverage.As long as you are not enrolled in Medicare (even if • Medicare Part D — If you are age 65 or older, you canyou have reached age 65), you can still contribute to use HSA funds to reimburse yourself for the cost ofan HSA until the month you enroll in Medicare. You can Part D coverage.even continue to make catch-up contributions prior to • If you are age 65 or older and still working, youyour Medicare effective date. Once you are enrolled can use HSA funds to reimburse yourself for yourin Medicare, you cannot contribute to an HSA, but the employer group premium (you cannot use your HSAmoney is still yours to save, spend or leave to your heirs. to pay for these premiums before age 65). • If you are age 65 or older and not working, you canMedicare and out-of-pocket expenses use HSA funds to pay your employer-sponsoredWhile you cannot contribute to an HSA if you are retiree group premium.enrolled in Medicare, you can use funds in your HSAto pay for out-of-pocket, qualified medical expenses —even if you are enrolled in Medicare. To illustrate, if youare enrolled in the Medicare Advantage plan, you canuse HSA funds to pay an office visit copay. Retiree Health Benefits 2022 Enrollment Guide 15

NON-MEDICARE ELIGIBLE Enrolling in Medicare 4 Before you enroll in the HDP with HSA, double-check your things you Medicare status. Generally, you have to contact the Social Security Administration (SSA) to enroll in Medicare (Part A/Part B). You are need to know automatically enrolled in Medicare if you are already collecting about HSAs Social Security benefits. If you are enrolled in Medicare, you cannot contribute to an HSA. In that case, you probably should not enroll in the HDP. The PEBC HDP is an HSA-eligible Qualified medical expenses plan. You can deposit funds in an HSA if: The IRS determines which expenses can be paid with an HSA. Check IRS Publication 969 for more HSA information. If you are 1. You are covered under an under age 65 and use funds for something other than a qualified eligible high-deductible plan medical expense, you are subject to a 20% penalty and the funds (like the HDP). become taxable as income. If you are age 65 or older, while a distribution may be considered income, the 20% penalty does 2. You are not covered by another not apply to you. You can use the funds as you wish. medical plan (unless it is an HDP) or a general-purpose FSA. Your HSA bank account 3. You are not enrolled in Medicare. If you are newly enrolled in the HDP, your employer will automatically notify Optum Bank® (affiliated with UnitedHealthcare) 4. You cannot be claimed as a to open your HSA. After your account is opened, you will receive a dependent on someone else’s Welcome Kit from Optum Bank. As long as you maintain an account tax return. balance of $500 or more, you will not be charged the $1 monthly account maintenance fee. If your account balance is $2,000 or more, you can choose to invest funds if you wish. More information is included in your Welcome Kit. PLEASE NOTE: Some other restrictions apply, especially if you receive services at a VA facility or clinic. Contact your tax or financial advisor if you have questions. If you switch to a health plan that makes you ineligible to continue depositing money in an HSA, you can continue to use the money in your account for qualified medical expenses, but you can no longer make deposits. If you enroll in the HDP with an HSA, Build your balance be sure to save receipts You can also make pretax contributions You are responsible for verifying your HSA was to your HSA, up to IRS limits, to help used for eligible medical expenses under the IRS your account grow. tax code. Contact Optum Bank for details. 16 Retiree Health Benefits 2022 Enrollment Guide

NON-MEDICARE ELIGIBLEUnitedHealth Premium® programChoosing a doctor is one of the most important health decisions you’ll make.Studies show that people who actively engage in their health care decisions havefewer hospitalizations, fewer emergency visits, higher utilization of preventive careand overall lower medical costs. Take an active part in your health by seeking outand choosing providers with the help of the UnitedHealth Premium program.Choosing a Premium Care PhysicianThe UnitedHealth Premium program makes it easy for you to find doctors whomeet benchmarks based on national standards for quality and cost efficiency.The program evaluates physicians in various specialties using evidence-basedmedicine and national standardized measures. If a doctor does not have a Premiumdesignation, it does not mean he or she provides a lower standard of care. It couldmean that the data available to us was not sufficient to include the doctor in theprogram or that the doctor practices in a specialty not evaluated as a part of thePremium program. Learn more at unitedhealthpremium.com.The UnitedHealth Premium® designation program is a resource for informational purposes only.Designations are displayed in UnitedHealthcare online physician directories at myuhc.com®. You shouldalways visit myuhc.com for the most current information. Premium designations are a guide to choosing aphysician and may be used as one of many factors you consider when choosing a physician. If you alreadyhave a physician, you may also wish to confer with him or her for advice on selecting other physicians.Physician evaluations have a risk of error and should not be the sole basis for selecting a physician. Pleasevisit myuhc.com for detailed program information and methodologies. To find Premium Care Physician, look for two blue hearts on myuhc.com. Retiree Health Benefits 2022 Enrollment Guide 17

NON-MEDICARE ELIGIBLE Mental health support Sometimes a little extra help can go a long way. Your To view information on your mental health benefits benefits include behavioral health support provided by coverage, search for a provider or access online United Behavioral Health, with some resources that can resources, visit myuhc.com > Coverage & Benefits > be accessed right at home. From everyday challenges Mental Health. to more serious issues, support is on your side. Resource How it works How to access Live and Find support for a variety of concerns, including: Visit liveandworkwell.com and Work Well • Anxiety and stress enter access code: PEBC • Alcohol and drug use • Coping with grief and loss • Marital problems • Eating disorders • Compulsive spending or gambling • Medication management Talkspace Communicate with a licensed therapist via text or live video Register at talkspace.com/connect from your phone or desktop. It’s private, confidential and convenient. Five days of unlimited texting via the Talkspace app equals one in-person office visit through either your EAP or behavioral health benefit. Virtual Talk to a psychiatrist or therapist without leaving your home. • Sign in to liveandworkwell.com. behavioral These providers can evaluate and treat general mental health • Select Find a Resource > health visits conditions such as depression and anxiety. virtual visits. • Choose Get Started. You can schedule an appointment online or by phone. In-person From everyday challenges to more serious issues, you can Search for a provider near you on behavioral receive confidential help with a psychiatrist or therapist for: liveandworkwell.com. health visits • Depression, stress and anxiety • Substance use and recovery • Eating disorders • Parenting and family concerns Sanvello™ Dial down the symptoms of stress, anxiety and depression Download the app at with an app that uses clinical techniques. Sanvello premium sanvello.com. access is available at no extra cost as part of your behavioral health benefit. Substance Speak with a substance use recovery advocate who will listen, Call 1-855-780-5955 or visit Use provide support and develop personalized recovery plans. liveandworkwell.com/recovery to Treatment The helpline is available 24/7 as part of your benefits and find care options and resources. Helpline is completely confidential — you can even choose to remain anonymous. These services and programs are for informational purposes only and should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. This content is for informational and/or educational purposes only. It is not meant to be used in place of professional clinical consultations for individual health needs. Certain treatments may not be covered in some benefit plans. 18 Retiree Health Benefits 2022 Enrollment Guide

NON-MEDICARE ELIGIBLEReal Appeal®Real Appeal is an online program that can help you lose weight andimprove your health at no additional cost to you. Conveniently accessReal Appeal from your desktop, tablet or mobile device.Receive up to a year of supportA Transformation Coach will lead online group sessions with simplesteps on nutrition, exercise and how to break through barriers to reachyour goals. Get startedProven weight lossReal Appeal members who attend four or more sessions during theprogram lose 10 pounds on average. Register today atTools for success enroll.realappeal.com.You’ll receive a Success Kit containing food and weight scales,delicious recipes, workout DVDs and more. Monitor your progresswith online food and activity trackers — available anywhere, anytime. Real Appeal is a voluntary weight-loss programReal benefits that is offered to eligible participants over the age of 18 at no additional cost as part ofReal Appeal will help you learn how to live a healthy, balanced life. their plan benefits. The information providedResearch shows that losing just 5% of your body weight can help under this program is for general informationalreduce the risk of type 2 diabetes and heart disease.1 purposes only and is not intended to be nor should be construed as medical and/or1 In the past 20 years, researchers have demonstrated that structured weight-loss and nutritional advice. Participants should consultlifestyle-change programs can accomplish three critical employee and population an appropriate health care professional tohealth goals: 1. Improving overall health outcomes for individuals who are overweight determine what may be right for them. Anyand obese but do not yet have prediabetes or diabetes (Jensen MD, Ryan DH, items/tools that are provided may be taxableDonato KA, et al., 2014); 2. Reducing the progression to diabetes in those who have and participants should consult an appropriateprediabetes (Williamson DA, Bray CA, Ryan DH, 2015); and 3. Improving clinical tax professional to determine any tax obligationsmarkers for individuals who already have type 2 diabetes (Espeland MA, Glick HA, they may have from receiving items/tools underBertoni A, et al., for the Look AHEAD Research Group, 2014). Talk to your doctor the program. Talk to your doctor before startingbefore starting any weight-loss program. any weight-loss program. Retiree Health Benefits 2022 Enrollment Guide 19

NON-MEDICARE ELIGIBLE Preventive care Both the PPO plan and HDP cover preventive care at 100% as long as services are performed by a network provider. Preventive care services may include physical examinations, immunizations, laboratory tests and other types of screening tests. To see which preventive care services may be right for you, visit uhc.com/preventivecare. Preventive care vs. diagnostic care During a preventive care visit, if you discuss symptoms or treatment of a health concern, your visit will become diagnostic. For diagnostic care, you may be charged a copay, coinsurance or deductible. Discuss all of your health concerns with your provider but be aware that you will be billed based on the type of visit — preventive or diagnostic. Examples of diagnostic care may include: • Medical treatment for specific health issues or conditions • Ongoing care for a health condition • Lab tests or other screenings necessary to diagnose, manage or treat an identified health issue Preventive services covered Flu shots and vaccines at no extra cost Flu shots and many other vaccines are available to you at no extra cost. Age-appropriate immunizations are Covered preventive services are based on the available at many retail pharmacy locations. Always ask recommendations of the United States Preventive the pharmacist to check your plan coverage before Services Task Force (USPSTF), the U.S. Department of the immunization is administered to make sure the Health and Human Services, the Advisory Committee immunization is covered. on Immunization Practices (ACIP) of the CDC and the HRSA Guidelines for women and children, including CVS Caremark retail pharmacy vaccines the American Academy of Pediatrics Bright Futures Your pharmacy benefits will cover many vaccines periodicity guidelines. under the 100% preventive benefit when administered at a participating retail pharmacy. While flu shots Contraception, prenatal and breastfeeding do not require a prescription, other vaccines may The plan covers, at no additional cost to you, at least require a prescription. Save even more by using a CVS one form of contraception in each of the 18 methods Caremark National Network retail pharmacy. Here are identified and approved by the FDA, including a few of the many CVS Caremark National Network necessary clinical services, patient education and retail pharmacies. Contact CVS Caremark or visit counseling. Certain prenatal and breastfeeding pebcinfo.com for more CVS Caremark National supplies and services are also covered. To view Network options (UnitedHealthcare ID card with a summary of covered preventive services, CVS Caremark information card required). visit pebcinfo.com. 20 Retiree Health Benefits 2022 Enrollment Guide

NON-MEDICARE ELIGIBLECVS Caremark National Network UnitedHealthcare retailretail pharmacies: pharmacy vaccines• CVS Select vaccines can be• Albertsons administered at certain retail pharmacies using your• Minyard UnitedHealthcare ID card.• Brookshire North Texas retail pharmacies• RiteCare include those listed below. Visit myuhc.com if you need• Costco more information.• Tom Thumb • Albertsons• HEB • HEB• Walmart/Sam’s Club • Kroger• Kroger • Safeway/Tom Thumb IMPORTANT: Always check before you receive an immunization at the • Walgreens retail pharmacy to make sure youCovered vaccines include: • Walmart/Sam’s Club know how much your immunization• Flu will cost. The list of available• COVID-19 Convenience care clinics pharmacies is subject to change.• Zoster (shingles) You can receive your flu shot• Tdap (whooping cough) or pneumonia vaccine at a convenience care clinic. DFW-area• Tetanus booster locations include MinuteClinic• Meningitis located at certain CVS Pharmacy• Pneumonia locations and Baylor Scott & White Convenient Care Clinics located• Hepatitis B at certain Tom Thumb stores. If• Childhood diseases (MMR, etc.) you receive additional services, a• Rabies* copay or out-of-pocket expense may apply.• Travel vaccines**Additional cost may apply. Retiree Health Benefits 2022 Enrollment Guide 21

NON-MEDICARE ELIGIBLE PPO plan quick-reference guide Refer to plan documents for limitations and additional information. PPO — medical plan Feature Your network cost Your out-of-network cost PLUS you pay charges exceeding plan payment Annual deductible $500 individual/$1,000 family $1,000 each person Coinsurance (after the annual 20% after deductible 40% after deductible deductible is met) Annual coinsurance maximum $2,500 individual/$5,000 family No limit Annual out-of-pocket $3,000 individual/$6,000 family No limit maximum (OOP) Plan pays 100% after annual OOP Physician services Office visits $25 primary care physician (PCP) 40% after deductible $25 Premium Care Specialist $35 non-Premium Care Specialist 24/7 Virtual Visits $0 copay 40% after deductible Telehealth $25 PCP/$25 Premium Care Specialist 40% after deductible $35 non-Premium Care Specialist Hospital visits 20% after deductible 40% after deductible Urgent care visit $35 copay 40% after deductible Preventive care* Well-child care Covered at 100% 40% after deductible Well-woman exam Covered at 100% 40% after deductible Routine screening mammography Covered at 100% 40% after deductible Adult health assessments Covered at 100% 40% after deductible Immunizations Covered at 100% 40% after deductible Screening colonoscopy Covered at 100% 40% after deductible Maternity services Routine prenatal care Covered at 100% 40% after deductible Delivery in hospital 20% after deductible 40% after deductible Newborn care in hospital (routine) 20% after deductible 40% after deductible *Subject to Affordable Care Act requirements. 22 Retiree Health Benefits 2022 Enrollment Guide

NON-MEDICARE ELIGIBLEHDP quick-reference guideRefer to plan documents for limitations and additional information.HDP — medical plan Feature Your network cost Your out-of-network cost PLUS you pay charges exceeding plan payment Annual deductible (the entire $1,500 individual/$3,000 family $3,000 individual/$6,000 family family deductible must be met before benefits pay — unless you selected employee only) Coinsurance (after the annual 20% after deductible 40% after deductible deductible is met) Annual coinsurance maximum $1,500 individual/$3,000 family No limit Annual out-of-pocket $3,000 individual/$6,000 family No limit maximum (OOP) Plan pays 100% after annual OOP Physician services Office visits 20% after deductible 40% after deductible 24/7 Virtual Visits 20% after deductible 40% after deductible Telehealth 20% after deductible 40% after deductible Hospital visits 20% after deductible 40% after deductible Urgent care visits 20% after deductible 40% after deductible Preventive care* Well-child care Covered at 100% 40% after deductible Well-woman exam Covered at 100% 40% after deductible Routine screening mammography Covered at 100% 40% after deductible Adult health assessments Covered at 100% 40% after deductible Immunizations Covered at 100% 40% after deductible Screening colonoscopy Covered at 100% 40% after deductible Maternity services Routine prenatal care Covered at 100% 40% after deductible Delivery in hospital 20% after deductible 40% after deductible Newborn care in hospital (routine) 20% after deductible 40% after deductible*Subject to Affordable Care Act requirements. Retiree Health Benefits 2022 Enrollment Guide 23

NON-MEDICARE ELIGIBLE PPO — medical plan (continued) Feature Your network cost Your out-of-network cost PLUS you pay charges exceeding plan payment Infertility services: 5 artificial 20% after deductible (excludes 40% after deductible (excludes insemination visits (lifetime) in vitro and drug coverage) in vitro and drug coverage) Additional services Inpatient hospital 20% after deductible 40% after deductible Outpatient surgery 20% after deductible 40% after deductible Lab & X-ray outpatient (minor) Covered at 100% in physician 40% after deductible office or network lab or radiological provider Hospital emergency care services $300 copay + 20% after deductible; $300 copay + 20% after (treated as network) copay waived if admitted deductible; copay waived if admitted Skilled nursing facility 20% after deductible; 40% after deductible; up to 60 days annually* up to 60 days annually* Home health care 20% after deductible; 40% after deductible; up to 120 visits annually* up to 120 visits annually* Allergy care services $25 PCP/$25 Premium Care Specialist 40% after deductible $35 non-Premium Care Specialist Chiropractic $35 copay per visit; 40% after deductible; maximum 20 visits per year* maximum 20 visits per year* Medical supply & equipment (DME) 20% after deductible 40% after deductible Mental health services Outpatient visits $25 visit 40% after deductible Inpatient 20% after deductible 40% after deductible Serious mental illness Treated like any other illness Treated like any other illness Substance abuse Treated like any other illness Treated like any other illness *Limits apply for any combination of network and out-of-network benefits. 24 Retiree Health Benefits 2022 Enrollment Guide

NON-MEDICARE ELIGIBLEHDP — medical plan (continued) Feature Your network cost Your out-of-network cost PLUS you pay charges exceeding plan payment Infertility services: 5 artificial 20% after deductible; (excludes 40% after deductible; (excludes insemination visits (lifetime) in vitro and drug coverage) in vitro and drug coverage) Additional services Inpatient hospital 20% after deductible 40% after deductible Outpatient surgery 20% after deductible 40% after deductible Lab & X-ray outpatient (minor) 20% after deductible 40% after deductible Hospital emergency care services 20% after deductible 20% after deductible (treated as network) Skilled nursing facility 20% after deductible; 40% after deductible; up to 60 days annually* up to 60 days annually* Home health care 20% after deductible; 40% after deductible; up to 120 visits annually* up to 120 visits annually* Allergy care services 20% after deductible 40% after deductible Chiropractic 20% after deductible; 40% after deductible; maximum 20 visits per year* maximum 20 visits per year* Medical supply & equipment (DME) 20% after deductible 40% after deductible Mental health services Outpatient visits 20% after deductible 40% after deductible Inpatient 20% after deductible 40% after deductible Serious mental illness Treated like any other illness Treated like any other illness Substance abuse Treated like any other illness Treated like any other illness*Limits apply for any combination of network and out-of-network benefits. Retiree Health Benefits 2022 Enrollment Guide 25

Saving on prescription medicationsNON-MEDICARE ELIGIBLE CVS Caremark CVS Caremark has approximately 68,000 pharmacies in their national Register at network, made up of major chains such as CVS Pharmacy, Kroger, caremark.com Albertsons, Walmart, Costco and most independent pharmacies across the United States. Manage your prescriptions online with tools available CVS Health’s Standard Control Formulary at caremark.com. The formulary is the list of safe and effective medications available for you. Not all medications on the formulary are covered by your plan, • Check the cost of a drug and some medications are excluded entirely. Not seeing a specific • Find available alternative medication on the formulary? Talk to your doctor about an alternative medications that can work for you. For questions, call CVS Caremark Customer • See your prescription history Service at 1-855-335-7698. • View balances Out-of-pocket costs • View the Preferred Drug List Eligible pharmacy costs count toward your out-of-pocket maximum • Locate a participating (OOP). There are certain prescription drug expenses that do not count pharmacy toward the OOP, such as items excluded by the • And more plans or the cost difference if you choose a brand-name drug instead of a generic. 26 Retiree Health Benefits 2022 Enrollment Guide