Bedrock Manufacturing Family of

Companies

Guide to Your Employee

Benefits Program
Plan Year: January 1, 2025 – December 31, 2025
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 Benefits Guide
Welcome to Bedrock! We are excited to have you join our team, and we want to ensure that your journey
with us is not only professionally fulfilling but also personally rewarding. As part of your onboarding, we'd
like to introduce you to the comprehensive employee benefits package designed to support your well-
being and success.
Our benefits package is designed to provide you with the best health care options at the most
affordable rates, helping to protect your physical, emotional and financial future.

Please take a moment to explore the details in the benefits guide provided, and don't hesitate to reach out
to our Human Resources team should you have any questions or need assistance.

TABLE OF CONTENTS
Enrollment & Eligibility ..........................................4
Medical & Pharmacy Benefits ............................... 5
Health Savings Account ..................................... 11
Consumer Spending Accounts ........................... 13
Dental Benefits .................................................... 15
Vision Benefits .................................................... 16
Cost for Coverage ............................................... 17
Life and Disability Insurance ............................... 18

Employee Assistance Program ............................. 22

Pet Insurance ........................................................ 23
Rocket Mortgage ................................................. 24
Important Benefit Contacts .................................. 25
Legal Notices ........................................................26

IMPORTANT NOTICE: If you (and/or your dependents) have Medicare or will become eligible for
Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug
coverage. Please see pages 28 where Notice of Creditable Coverage and/or Notice of Non-
Creditable Coverage begin for more details.

This document is an outline of the coverage proposed by the carrier(s), based on information provided by your
company. It does not include all the terms, coverage, exclusions, limitations, and conditions of the actual
contract language. The policies and contracts themselves must be read for those details. Policy forms for your
reference will be made available upon request.

The intent of this document is to provide you with general information regarding the status of, and/or potential
concerns related to, your current employee benefits environment. It does not necessarily fully address all of your
specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding
specific issues should be addressed by your general counsel or an attorney who specializes in this practice area.

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 Enrollment & Eligibility

ELIGIBILITY QUALIFYING LIFE EVENTS

If you are a full-time employee of Bedrock Group who is When one of the following events occurs, you
regularly scheduled to work at least 30 hours per week, have 30 days from the date of the event to notify
you are eligible to participate in the Medical, Dental, Human Resources and/or request changes to
Vision, Basic Life & Disability Plans, along with Voluntary your coverage.
Life and the Flexible Spending Accounts (FSA’s) and  Change in your legal marital status
additional benefits. (marriage, divorce or legal separation)
 Change in the number of your dependents
If you are a part-time employee of Bedrock Group who is
(for example, through birth or adoption)
regularly scheduled to work at least 20-29 hours per week,
 Change in your spouse/domestic
you are eligible to participate in the Medical, Dental, Vision
partner’s employment status (resulting in
and Voluntary Life along with the Flexible Spending
a loss or gain of coverage)
Accounts (FSA’s) and additional benefits.
 Change in your employment status from
ELIGIBILE DEPENDENTS full time to part time resulting in a gain or
Dependents eligible for coverage in the Bedrock Group loss of coverage
benefits plans include:  Entitlement to Medicare or Medicaid
 Your legal spouse/domestic partner or common-law  Change in your address or location that
spouse in states that recognize such marriages. may affect the coverage for which you
 Dependent children up to age 26 (includes birth children, are eligible
stepchildren, legally adopted children, foster children, Your change in coverage must be consistent with
and children for whom legal guardianship has been your change in status
awarded to you or your spouse/legal partner).
 Dependent children, regardless of age, provided he or PREPARING TO ENROLL
she is incapable of self-support due to a mental or Bedrock provides its employees the best coverage
physical disability, is fully dependent on you for support possible. As a committed partner in your health,
and is approved by the medical plan to continue Bedrock will be absorbing a significant amount of
coverage past age 26. the costs. Your share of the contributions for
 Verification of dependent eligibility will be required upon Medical, Dental, Vision and FSA benefits is
enrollment. UMR requires a signed affidavit for coverage deducted on a pre-tax basis, which lessens your
of domestic partners or common law spouses. Please tax liability.
contact HR for a copy of the affidavit. Please note that employee contributions for
WHEN DOES COVERAGE BEGIN? medical, dental and vision coverage vary
The elections you make are effective the first of the month depending on the level of coverage you select. In
after hire. Due to IRS regulations, once you have made general, the more coverage you have, the higher
your choices for the 2025 plan year, you can’t change your your employee contribution will be.
benefits until the next enrollment period unless you You may select any combination of Medical,
experience a Qualifying Life Event. Dental and/or Vision coverage. For example, you
THINGS TO CONSIDER could select medical coverage for you and your
entire family but select dental and vision
Take the following situations into account before you enroll
coverage only for yourself. The only requirement
to make sure you have the right coverage.
is that you must elect coverage for yourself in
 Does your spouse/DP have benefits coverage available order to elect any dependent coverage. You have
through another employer? the option to select coverage from the following
 Did you get married, divorced or have a baby recently? If categories:
so, do you need to add or remove any dependent(s)
and/or update your beneficiary designation? • Single
 Did any of your covered children reach their 26thbirthday • Employee + Spouse
this year? If so, they are no longer eligible for benefits • Employee + Child(ren)
unless they meet specific criteria. • Family

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 Medical & Pharmacy Benefits

Comprehensive and preventive healthcare coverage is important in protecting you and your family from the
financial risks of unexpected illness and injury. A little prevention usually goes a long way—especially in healthcare.
Routine exams and regular preventive care provide an inexpensive review of your health. Comprehensive
healthcare also provides peace of mind. In case of an illness or injury, you and your family are covered anywhere in
the United States with a national network, through United Healthcare.

Bedrock offers two (2) medical plan options administered by UMR, utilizing the United Healthcare “Choice
Plus” network. Choose between the “Base” HDHP (Qualified High Deductible Health Plan) with HSA, or you may
“Buy-up” to the traditional PPO copay plan. With either plan, you may choose to see providers both in and out of
network, however, to get the best benefit, we recommend choosing providers within UHC’s “Choice Plus” network.

Plans UMR HDHP with Qualified (HSA) UMR Traditional PPO Buy-up Plan
Network United Healthcare Choice Plus United Healthcare Choice Plus
In-Network Benefits
Annual Deductible $2,500 / $5,000 $2,000 / $4,000
Annual Out-of-pocket Max $4,500 / $8,150 $4,000 / $8,000
Member Coinsurance 20% 20%
Member Cost Share
Preventive Care Covered in full Covered in full
Virtual Visit 20%, after deductible $25 Copay
PCP & Mental Health Visit 20%, after deductible $25 Copay
Specialist Visit 20%, after deductible $40 Copay
Urgent Care Visit 20%, after deductible $50 Copay
Emergency Room Visit 20%, after deductible $200 Copay
Diagnostic Lab & X-ray 20%, after deductible 20%, after deductible
Complex Imaging (MRI/CT/PET) 20%, after deductible 20%, after deductible
Outpatient Hospital 20%, after deductible 20%, after deductible
Inpatient Hospital 20%, after deductible 20%, after deductible
Retail Pharmacy Benefits
Generic 20%, after deductible $10 Copay
Preferred Brand 20%, after deductible $40 Copay
Non-Preferred Brand 20%, after deductible $80 Copay
Specialty 20%, after deductible Same as above
Mail Order 20%, after deductible $25 / $100 / $200
Out-of-Network Benefits
Annual Deductible $5,000 / $10,000 $4,000 / $8,000
Annual Out-of-pocket Max $9,000 / $16,300 $8,000 / $16,000
Member Coinsurance 40% 40%

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 Medical & Pharmacy

Which Medical Plan Should I Choose?

Base HDHP: If you choose the HDHP you will pay less in premiums; however, you may pay more out of pocket when
you obtain medical services and fill prescriptions. With this plan, all covered services and medications are subject to
the deductible first, with the exception of preventive care, which is covered at 100%. To view a list of Preventive
services covered in full, visit: Preventive health services | HealthCare.gov

NEW for 2025! If you enroll in the HDHP administered by UMR, Bedrock will contribute dollars into your WEX HSA:
Full-time EEs: $200 annually for single coverage, and up to $700 annually for family coverage!
Part-time EEs: $100 annually for single coverage, and up to $300 annually for family coverage!

Buy-up PPO Plan: The traditional PPO copay plan is what’s considered a “Buy-up” plan, because if you elect this
plan, it will cost more out of your paycheck. But unlike the HDHP, most services and prescriptions are covered with a
copay and the deductible is waived. The exception is your more complex care, which requires that you meet your
deductible first, than pay coinsurance. If you choose to enroll on the Buy-up plan, you may pair it with a Health care
Flexible Spending Account to set aside funds pre-tax to help pay for out-of-pocket expense.

Key Medical Terms – What Does This Mean?

Annual Deductible - Each year, you have a deductible, which is the amount that you pay before the plan starts paying
benefits for your non-preventive doctor’s visits, and any other medical services.
If you are enrolled in the medical PPO plan, when one individual has met the deductible; benefits begin to pay at
the coinsurance level for that individual. If you have several covered dependents, all charges apply towards an
“individual” deductible and will be applied toward the “family” deductible amount. When the family deductible
amount is reached, no further individual deductibles will have to be satisfied for the remainder of the calendar plan
year. No member may contribute more than the individual deductible amount toward the “family” deductible.
If you are enrolled in the medical HDHP, there is an aggregate deductible, meaning the family deductible amount
will include all combined eligible expenses that you and your covered dependents incur. The family deductible
amount may be satisfied by one member or a combination of two or more members covered under your medical plan.
If more than one person in a family is covered under the HDHP, coinsurance will not apply until the family deductible
has been met.
Coinsurance - Once your annual deductible has been met, you and the plan split the cost of your medical care. This
is called coinsurance. The plan will pay a higher percentage of the cost of care if you choose in-network providers, as
show in the tables on the following pages.
Copays - The flat dollar amount you pay at the time of service is called a copay. After you pay the copay, the plan pays
the remaining expenses for that service at a specified level. Even after you meet your deductible, you will be required
to pay your copay for each medical visit. Copays are listed in the tables on the following pages.
Out-of-Pocket Maximum - The out-of-pocket maximum is the maximum amount you would pay toward covered
medical costs in one year out of your own pocket. Once you reach this amount, the plan pays 100% of any additional
coverage costs for the rest of the year. Deductibles, coinsurance, office visit and prescription copays count toward
the out-of-pocket maximum. The out- of-pocket maximums are listed in the tables on the following page.
In-Network / Out-of-Network - When you review your medical benefits, you will see that there is a different level of
coverage for services In Network and Out-of-Network. This is because UMR partners with a wide network of providers
and facilities that offer discounted rates for members. By using in-network providers, you will save money and receive
a higher level of benefit coverage under the plan.

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 Pharmacy Benefits

Pharmacy Benefits are Administered by OptumRx

Your digital pharmacy experience within the UMR Member portal (desktop or app) will present more features to
support members to manage their healthcare.
 Pricing a medication
 Placing a home delivery order online
 Checking order status and status of a prior authorization
 Locate an in-network pharmacy with ease
Optum Rx Pharmacy Home Delivery Pharmacy
UMR partners with OptumRx home delivery pharmacy for an easy, reliable way to get your medications delivered to
your home. For individuals who take medication on a regular basis, you can receive a 90-day supply of medications
and pay only two & ½ copayments (PPO Plan).
Medications are delivered to your home at no charge. If you have downloaded the UMR App, you can request a
prescription and with approval OptumRx will send a 90-day supply to your residence on file.
90-Day Maintenance Program
The Bedrock medical plans include a maintenance medication program. You can choose getting a 90-day supply
of your maintenance medicine delivered to your home by OptumRx or pick up at a 90-day retail network pharmacy.
Most chain and many independent pharmacies participate in the 90- Day Retail Prescription Program. To find a
participating pharmacy, log in to your member account. Examples of pharmacies in this network are CVS,
Walmart, Walgreens, Rite Aid, and Publix.
How does the 90-Day Program work?
• Obtain a 90-day prescription for your medication.
• Take your prescription to a 90-day network retail pharmacy or mail it to the OptumRx home delivery program.
• Receive your medication in a 90-day supply.
Specialty Drug Coverage
Your pharmacy coverage includes specialty drugs. Specialty drugs are prescription medications that require special
handling, administration or monitoring and are used to treat complex conditions, including cancer, chronic kidney
failure, multiple sclerosis, organ transplant & rheumatoid arthritis.
There are two ways to fill specialty drug prescriptions:
 Retail: You can fill prescriptions for specialty drugs only at any Walgreens retail pharmacy. Call them
first to make sure your medication is available.
 Mail order: UMR also offers mail order service and support programs OptumRx an independent
company that provides specialty pharmacy services for UMR members.
GoodRx
In addition to your UMR coverage, you have another potential source of prescription savings through GoodRx.
GoodRx is not affiliated with Bedrock or your UMR medical/Rx plans, however, accessing GoodRx’s website is a
great way to compare costs of prescriptions in your area, as well as obtain coupons for prescriptions. Please note
if utilizing a GoodRx coupon, that claim will not process through your UMR medical/Rx insurance, so it won’t apply
toward your deductible or out-of-pocket maximum. You can visit the GoodRx website at: https://
www.goodrx.com
UMR RESOURCES
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 UMR Tools & Resources

UMR Tools & Resources

UMR Mobil app: Once enrolled, we recommend registering for a member account with UMR. Once registered,
you can look up your plans benefits and keep up to date on your deductible, coinsurance and out of pocket maximum;
monitor claims and explanation of benefits (EOB); search for in-network Providers and facilities; compare medical
and prescription costs based on your plan’s deductible, coinsurance and copays.
To create an account, you will need your UMR ID card with your unique subscriber #. On the UMR homepage,
click on the “Sign In” button, then “Create your account”. Follow the prompts to register.

Provider Search Tool: When possible, we recommend searching for providers via your UMR member account.
When you utilize the custom portal, your search results will be based on your individual enrollment.
If you are unable to login via your member portal, or need to search before you enroll, you can search online via
UMR’s homepage. Step 1: Visit www.umr.com and click on “find a provider”. Step 2: Scroll down the page and
next to “Enter network name” type in “United Healthcare Choice Plus” and click on “search”

Step 1 Step 2

Step 3: Scroll down to the bottom of the page and click on “View Providers”. Step 4: This will take you to the UHC
Choice Plus Provider Search page, where you can search for providers by your location, provider name, or type.

Step 4

Step 3

Virtual Visits - Teladoc

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 Teladoc Virtual Care

What is Virtual Care? Taking care of yourself and your family’s health can be as easy as using your smartphone,
tablet or computer for a virtual visit with a U.S. board certified doctor or licensed therapist. With Virtual Care by
Teladoc Health®, you don’t need an appointment for medical care, although an appointment for mental health
visits is required.
How do I sign up? Download the Teladoc Health app and follow the prompts to register. Remember to choose
your health plan (UMR) and enter your member ID number when updating or creating your account so your
coverage is applied correctly.
Do I need to make an appointment? Medical care is available 24/7 without an appointment. Mental
health visits are available by appointment only. Licensed therapists and U.S. board-certified
psychiatrists are available from 7 a.m. to 9 p.m. seven days a week
What if I need help? If you have questions or need help with your Virtual Care account or an online visit, please call
1-800-835-2362, 24/7
Can my family use Virtual Care? Yes. Everyone on your health care plan can use it. Parents and guardians can add
children ages 17 and younger to their account and have medical visits on their behalf. Spouses and adult children
ages 18 and older must set up their own accounts.
Will I get a prescription? If a prescription is needed, the doctor will send an electronic prescription to a pharmacy
you choose. Make the most of your benefits by choosing an in-network pharmacy. You’ll pay for the prescription at
the pharmacy according to your pharmacy benefit.
How do I schedule a virtual visit?
1. Open the Teladoc Health app and follow the prompts to
register with your insurance information (choose “UMR” from
the dropdown menu). Once you have registered, you will be
able to login with your username and password.
2. Choose a service: 24/7 Care or Mental Health.
3. Pick a doctor or begin a scheduled visit.
4. Meet with the doctor or therapist online.
5. Get a prescription, if appropriate, sent to your preferred
pharmacy.
6. After your visit, you can share an optional visit summary with your primary care provider.
How long does a visit take? For medical visits, the average wait time is 10 minutes. Length of visits vary.
Doctors will take as much time as necessary to address the issue, answer questions and determine next
steps. Therapy visits are scheduled for 45 minutes. Psychiatry visits are 30 to 40 minutes for the initial
visit; follow-up visits are 15 minutes.

How much will my visit cost?

 HDHP: 20% coinsurance, after your deductible has been met. Most medical visits cost $65
 PPO Plan: $25 office visit copay

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 Talk Space

VIRTUAL VISITS

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 Health Savings Account

Health Savings Account

An HSA is a benefit that allows you to choose how much of your paycheck you’d like to set aside, before taxes are
taken out, for healthcare expenses or use as a retirement savings tool. This plan offers tax savings that a 401(k) and
IRA don’t, making it a powerful option for diversifying your retirement portfolio.

Can I enroll?
You must be enrolled in the UMR HDHP in order to enroll in the HSA. You’re not eligible for an HSA if:
• You’re claimed as a dependent on someone else’s taxes.
• You’re covered by another plan that conflicts with the HDHP, such as Medicare, a medical
flexible spending account (FSA) or select health reimbursement arrangements (HRAs).
• You or your spouse are contributing to a medical FSA.

What are the benefits of an HSA?

It’s yours! Think of your HSA as a personal savings account. Any unspent money in your HSA remains yours,
allowing you to grow your balance over time. When you reach age 65, you can withdraw money (without penalty) and
use it for anything, including non- healthcare expenses.
Flexibility! Save for a rainy day. Invest for your future retirement. Or spend your funds on qualified expenses,
penalty free.
Easy to use! Swipe your benefits debit card at the point of purchase. There is no requirement to verify any of your
purchases. We recommend keeping any receipts in case of an IRS audit.
Smart savings! The HSA’s unique, triple-tax savings means the money you contribute, earnings from investments
and withdrawals for eligible expenses are all tax-free, making it a savvy savings and retirement tool.
Investment options! You can invest your HSA funds in an interest-bearing account or our standard mutual fund
lineup. Savvy investors may opt for a Health Savings Brokerage Account powered by Charles Schwab, giving you
access to more than 8,500 mutual funds, stocks and bonds.

HEALTH SAVINGS ACCOUNT

What does it cover? There are thousands of eligible items. The list includes,
but is not limited to:
 Copays, coinsurance, insurance premiums
 Doctor visits and surgeries
 Over the counter medications (first aid, allergy, asthma, cold/flu,
heartburn, etc.)
 Prescription drugs
 Birthing and Lamaze classes
 Dental and orthodontia
 Vision expenses such as: frames, contacts, prescription sunglasses,
etc.
View a searchable list of eligible expenses at: www.wexinc.com/
insights/benefits-toolkit/ eligible- expenses/

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 Health Savings Account

HSA Contribution Limits & IRS Regulations

Each year, the IRS sets the maximum dollar amount you can elect and contribute to a health savings account (HSA)

2025 Single Coverage Limit: $4,300

2025 Family Coverage Limit: $8,550

Note: Limits include your contributions, plus any funds

received from Bedrock.

Please note: If you’re 55 years of age or older, you are eligible to make an annual catch- up contribution, which lets
you contribute an additional $1,000 on top of the above annual contribution limits. To determine your contribution,
we recommend setting a goal on what you plan to use your HSA for. Keep in mind you’re not locked into that
decision and can change your contribution amount at any time.

WEX Benefits Mobile App

Access your benefits anytime, anywhere
Access your benefits on the go 24/7 with the WEX benefits mobile app. The app gives you convenient, real
-time access to all your benefits accounts in one spot. This makes it easy to use your hard-earned dollars
and view recent account activity without ever needing to call in.
The benefits mobile app keeps your benefits always within reach. Want to know the status of a recent claim
or easily check the balance of your accounts? Log in to our secure app to get answers to those questions
and so many more — wherever and whenever you want.

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 Consumer Spending Accounts

Consumer Spending Accounts

Contribution limits & IRS regulations
The IRS sets the maximum dollar amount you can elect and contribute to a flexible spending account,
health care FSA and dependent care FSA. The FSA annual contribution limits are listed below:

Medical FSA: $3,300

Dependent Care FSA: $5,000 per family or $2,500 if filing separately
Transit & Parking Benefits: $325 a month (pre-tax*)
*You can make post tax contributions any time.

Health Care FSA

Once you elect, all of your health care FSA dollars are available for you to use the very first day of the plan year. For
example, if you elect to contribute $1,200 to your health care FSA, your contributions will be deducted evenly
across all of your paychecks for the year, but you have access to all $1,200 on Day 1! You can use your funds for
expenses incurred by you, your spouse or eligible dependents.

 What does it cover? There are thousands of eligible items, including: Copays and coinsurance, Doctor visits
and surgeries, Over-the-counter medications (first aid, allergy, asthma, cold/ flu, heartburn, etc.),
Prescription drugs, Dental and orthodontics, Frames, contacts, prescription sunglasses, etc.
 Can I enroll? Yes, as long as you or your spouse aren’t actively enrolled and contributing to a health savings
account (HSA).

Dependent Care FSA

The dependent care FSA allows you to use funds in your account as you contribute them. After each
payroll contribution has been made, those funds are applied to your account and available for
reimbursement. This is different from a health care FSA because you do not have access to the funds
Day 1.
 What does it cover? The list includes, but is not limited to, eligible: Childcare center, babysitter, nanny (birth
through age 12), Summer day camp, Before or after-school care, Disabled dependent and/or spouse care &
Elder care
 Can I enroll? You are eligible if you and/or your spouse (if applicable) are gainfully employed, looking for
work, or are attending school on a full-time basis.

Transit & Parking Benefits

These benefits allow you to put money from your paycheck aside each month, before taxes are taken out, for
qualified mass transit and parking expenses. Save 40% or more on your costs commuting to and from work. You’ll
also get hours back in your day, the average one-way commute to work is nearly 30 minutes.
 What does it cover? The list includes, but is not limited to, eligible: Train, Bus, Subway, Ferry, Vanpool,
UberPool, Lyft Shared, Parking, Parking Meter
 How do I access my funds? Access your funds through your WEX benefits debit card or cash
reimbursement is available for parking. You can file the parking claims through your online account or
mobile app, no documentation is required. Any money contributed to your transit or parking benefit rolls
over every month until it is used, or you are no longer eligible.

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 WEX Resources

The WEX Mobile App allows access to ALL your WEX benefits - Health Savings Account (HSA), Flexible
Spending Accounts (Medical FSA and/or Dependent FSA), and/or Commuter Benefits.

Access your benefits on the go 24/7 with the WEX Mobile App. The free app gives you convenient, real-
time, access to all your benefit accounts in one spot. This makes it easy to use your hard-earned
dollars and view recent account activity without ever needing to call in.

After logging in for the first time, you can set up fingerprint or face recognition access right from your phone.

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 Dental

Bedrock offers dental coverage administered by Delta Dental. Good oral care enhances overall physical health,
appearance and mental well-being. Problems with the teeth and gums are common and easily treated health
problems. Keep your teeth healthy and your smile bright with the Bedrock dental benefit plan. With this plan you
can see any provider, however, to make your benefits go further, choose a contracted Delta Dental PPO or Premier
provider. Providers contracted within Delta Dental’s “PPO” network will save you the most money!

Delta Dental
Dental Benefits All other Providers
PPO & Premier Providers
Annual Maximum $2,000 per member $2,000 per member
Annual Deductible $50 per member/$150 per family $50 per member/$150 per family
Member Cost Share
Class 1 – Diagnostic & Preventive Plan Pays: 100% Plan Pays: 100%
Exams, Cleanings, X-rays Deductible waived Deductible waived
Class 2 – Restorative Services
Plan Pays: 80% Plan Pays: 80%
Exams, Cleanings, X-rays
Class 3 – Major Services
Plan Pays: 50% Plan Pays: 50%
Crowns, Dentures, Implants
Plan Pays: 50% up to $2,000 lifetime Plan Pays: 50% up to $2,000 lifetime
Orthodontia – Adult & Child
maximum (per member) maximum (per member)
Balance Billing? No Yes

Check Out Delta Dental Online!

Stay current on your dental benefits with Delta Dental online. This secure online tool is designed to give you 24/7
access to important information regarding your dental benefits, including:
• Current benefits information (such as how much of your yearly benefit has been used to date)
• Specific claims information, including what has been approved and when it was paid
• Explanation of benefits (EOB) statement and claim forms
1. Visit www.DeltaDentalWA.com
2. Locate a PPO or Premier dentist in your area.
Get started 3. Use your Delta Dental ID card when making an appointment.
4. Have your dentist submit a predetermination of treatment to determine if your
service is covered, and how much you will pay.

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 Vision

Regular eye examinations can not only determine your need for corrective eyewear but also may detect general health
problems in their earliest stages. Protection for the eyes should be a major concern to everyone. The vision plan
offered by Bedrock utilizes the VSP Choice network. You do not need an ID card, simply provide your name and SSN.

Vision Benefits VSP Choice Providers All other Providers (Non-VSP)

Copays
Vision Exam $10 copay $10 copay
Hardware (glasses or contacts) $25 copay $25 copay
Benefits Allowance Exam & Hardware (Lenses and Frames or Contacts) once every 12 months
Vision Exam Covered in full up to $45
Standard Lenses
Single Covered in full Up to $30
Bifocal Covered in full up to $50
Trifocal Covered in full up to $65
Lenticular Covered in full up to $100
Frames $130 allowance up to $70
Contacts in lieu of glasses $130 allowance $105 allowance
Medically Necessary Contacts $25 copay up to $210

Find a VSP vision provider at vsp.com.

Using your vision benefits is easy. This online tool is designed to give you 24/7 access to important information regarding
your vision benefits, including:
1. Choose a VSP Vision Care doctor. Visit vsp.com or call 1-800-877-7195 to find a doctor who is right for you.
2. Make an appointment and tell the doctor’s office you are a VSP member.
3. For services issues and questions, contact your VSP customer service team at 1-800-877-7195

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 Employee Cost for Coverage

Full Time Employee – 2025 Cost per paycheck (26 pay periods)

MEDICAL/RX UMR HDHP W/HSA* UMR PPO BUY UP

Single $0.00 $76.14
Employee + Spouse $123.14 $220.64
Employee + Child(ren) $87.08 $178.32

Family $227.31 $342.87

*If you enroll in the HDHP administered by UMR, Bedrock will contribute dollars into your WEX HSA:
Full-time EEs: $200 annually for single coverage, and up to $700 annually for family coverage!

DENTAL & VISION Delta Dental VSP

Single $3.96 $0.79
Employee + Spouse $10.59 $1.59
Employee + Child(ren) $16.25 $1.63
Family $26.30 $2.96

Part Time Employee - 2025 Cost per paycheck (26 pay periods)

MEDICAL/RX UMR HDHP W/HSA* UMR PPO BUY UP

Single $43.26 $101.52
Employee + Spouse $240.28 $303.82
Employee + Child(ren) $182.58 $244.57
Family $406.94 $474.94

*If you enroll in the HDHP administered by UMR, Bedrock will contribute dollars into your WEX HSA:
Part-time EEs: $100 annually for single coverage, and up to $300 annually for family coverage!

DENTAL & VISION Delta Dental VSP

Single $5.28 $1.06
Employee + Spouse $14.56 $2.17

Employee + Child(ren) $22.49 $2.24

Family $36.56 $4.09

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 LIFE INSURANCE

Life Insurance Administered by New York Life

Basic Life and AD&D

Basic Life and AD&D helps to provide financial protection for you and your beneficiaries. Bedrock pays the
full cost of this coverage for you. The coverage provided is one times your basic annual earnings, and you
must provide beneficiary information for your coverage.

Voluntary Life and AD&D

Voluntary Life and AD&D provides additional financial protection to you and your beneficiaries. You must provide
beneficiary information for your coverage. This benefit is voluntary, and 100% employee paid through payroll deduction.

Employee:
You can elect coverage for yourself in $10,000 increments up to the maximum of $500,000. The
initial Guaranteed Issue* amount when you are newly eligible for this benefit is $200,000.
Spouse:
You may also choose a coverage amount for your spouse in $10,000 increments up to 100% of your
employee election maximum of $500,000. The initial Guaranteed Issue* amount is $30,000.
Children:
You can choose $2,500 increments up to $10,000.

*Guaranteed Issue is ONLY available within 30 days of being newly eligible for this benefit.

18
 DISABILITY INSURANCE

Disability Insurance Administered by New York Life

You insure assets like your car, home, and other possessions. But have you ever thought about whether your most
valuable asset – your ability to earn a living – is protected? Well, we have. That’s why Bedrock provides two forms of
disability insurance to full-time employees to provide income replacement if you experience a covered injury,
illness, or pregnancy.
The weekly or monthly benefit payments from a disability plan can help you continue to pay the bills even when you
can’t work – things like your mortgage, rent, groceries, and other daily living expenses that health insurance
doesn’t cover. This disability insurance will fill the gap until you are approved to come back to work.

Short Term Disability (STD)

Bedrock pays the full cost of a weekly benefit if you are disabled and unable to work due to a non-work-
related injury, illness or pregnancy. If you are deemed disabled by New York Life, your benefit will begin on the
8th day of such accident or illness. If your disability is approved by New York Life, you’ll receive 60% of your
weekly income up to a maximum of $2,500 per week, for a maximum duration of 13 weeks.

Long Term Disability (LTD)

Long Term Disability coverage helps ensure that your way of life is protected in the event of a serious injury
or illness. The coverage is provided at no cost to you through New York Life. Bedrock pays the full cost of
this coverage for you if your disability continues beyond 90 days. If your qualified short-term disability
continues for more than 90 days, you will receive 60% of your monthly earnings, up to a maximum of
$12,500 per month.

Parental Leave
Bedrock recognizes the importance of parental bonding with newborn or newly adopted children. In order to assist and
support new parent relationships through its leave policies and programs and to assist with balancing work and family life
matters, Bedrock provides paid Parental Leave. This policy provides eligible employees with a period of paid time off for
activities related to the care and well- being of their newborn or newly adopted child.
Parental leave is not charged against your other paid leave credits, and the number of paid days received is 4
weeks and is paid at 100% of your salary.

19
 Additional Benefits

NY Life Value Add’s

Health Advocate: New York Life Group Benefit Solutions (NYL GBS) Health Advocacy Services offers you expert assistance
with a wide range of healthcare and health insurance issues. Let us help you – your spouse, dependents, parents and
parents-in-law – get the answers you need, when you need them, 24/7, at no additional cost to you.

Don’t know where to turn? We point the way.

 Find the right health care professionals based on your needs.
 Locate specialists, schedule appointments, arrange medical tests or special treatments.
 Answer questions about diagnoses, test results, treatments, medications and more.

Want to maximize your benefit dollars? We can help you save.

 Get the estimated fees for services in your area.
 Find options for non-covered and alternative health services.
 Receive information about generic drug options.
 Address questions and concerns related to your medical bills.
 Get help negotiating discounts on medical or dental bills over $400 not covered by insurance.

Need eldercare or special needs services? We’re there for you.

 Find in-home care, adult day care, group homes, assisted living and long-term care.
 Get access to a range of services for parents of children with special needs or autism spectrum disorders.
 Clarify or get help applying for Medicare, Medicare Supplement plans and Medicaid.
 Coordinate care among multiple providers.

My Secure Advantage: At New York Life Group Benefit Solutions (NYL GBS), we know that financial issues are one of the
leading causes of stress in America. That’s why we offer a full-service financial wellness program. My Secure Advantage
(MSA) can help support the financial health of your household, at no additional cost to you.

MSA Money Coaching: You can take advantage of a free 30-minute consultation with a certified financial expert before you
decide to participate in Money Coaching. Individuals and couples can work with a designated Money Coach for 30 days,
paid for by NYL GBS. Your Money Coach can help you handle a wide range of financial challenges, including but not limited
to basic money management, getting out of debt, saving for college or retirement, purchasing a home, marriage or divorce,
loss of income, death in the family, and more. Through an easy-to-use online portal, you can communicate with your
coach, view educational webinars and access a library of financial tools, forms and tips. After the first 30-day coaching
period, you may continue working with your Money Coach for $39.95 per month. Even if you don’t participate in Money
Coaching you can get a 25% discount on tax planning and preparation.

Identity theft protection and will preparation services include:

 Education on how to avoid identity theft, consultation with a Fraud Prevention Specialist, and an identity
theft kit that provides the right documents to use and steps to follow.
 Online resources to create and execute state-specific wills, powers of attorney and a variety of other
important legal documents.
 Free 30-minute legal consultation with a licensed practicing attorney to obtain advice or review legal
documents, and a 25% discount off standard fixed or hourly attorney’s fees.

20
 Additional Benefits

NY Life Assistance & Wellness Program

Just when you think you’ve got it figured out along comes a challenge. Whether your needs are big or small,
New York Life Group Benefit Solutions is there for you with our Employee Assistance & Wellness Support
program1. It can help you and your family find solutions and restore your peace of mind. This is just another
example of how we are committed to Putting Benefits To Work For People.

Life Assistance Program

Are you feeling overwhelmed by the demands of balancing work and family life? Maybe you have questions
about a legal or financial concern. You and your family members now have access to various counseling services
including legal, financial, and work-life balance assistance. All counseling calls are answered by a Master’s or
PhD-level counselor who will collect some general information and will discuss your needs. The Life Assistance
Program provides a maximum of three (3) sessions, per issue, per year.

Guidance Resources
When you need information quickly to help handle life’s challenges, you can visit guidanceresources.com
for resources and tools on topics such as health and well- ness, legal regulations, family and relationships,
work and education, money and investments, and home and auto. You will also have access to articles,
podcasts, videos, slideshows, on- demand trainings and “Ask the Expert” which provides personal responses
to your questions.

Well-being Coaching
Sometimes you may need help with personal challenges and physical issues that can be overwhelming. To help
you achieve your goals, you will have access to a certified coach who will work with you, one on one, to address
health and well-being issues such as burnout, time management and coping with stress. You have access to
five sessions per year. All sessions are conducted telephonically.

Phone: (800) 344-9752

Website: guidanceresources.com
Web ID: NYLGBS

ADP LifeMart

Save money with your Employee Discounts powered by ADP through LifeMart.

Your discount program includes

• Child care
• Groceries
• Electronics
• Restaurants
• Entertainment
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• Hotels
• Travel
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• Pets

Access your savings through the ADP Employer Portal today!

21
 Employee Assistance Program (EAP)

Employee Assistance Program – New Directions

When life is a little much, reach out.

Let’s be real… life can be tough at times. When your responsibilities start to feel overwhelming and showing up
each day with a smile on your face seems difficult, it is important to reach out for help. You can lean on your free
and confidential Employee Assistance Program (EAP) for support.

Your EAP can assist in the following ways:

• Being more present and productive at work
• Receiving support when you do not feel like yourself
• Getting help with responsibilities that are distracting or stressful
• Growing your personal and career skills
• Work on being a caring, loving friend or family member
• Receiving care after a traumatic event or diagnosis

Member Resources: The New Directions Resource Center contains vital information that can help you start your
journey to better mental health. Login via the New Directions home page at www.ndbh.com > in the left-hand
corner choose “Log in” > you will be prompted to “Choose Your Program”, select “Employee Assistance
Program” from the drop-down menu and enter the company code: “Bedrock”.

• Helpful tools for reducing stress

• Resources when coping after crisis
• Helping to navigate the legal system
• Custom action plans for reducing debt
• Download the “New Directions EAP” mobile app to access these resources on your smartphone or tablet!

Sometimes, people aren’t sure when or how to seek treatment. Contact New Directions 24/7 for assistance at
(800)-624-5544. Or use the chat button in the bottom right of your screen to talk to an EAP expert online. The New
Direction’s EAP is available to all Bedrock employees and household family members!

22
PET INSURANCE

23
MORTGAGE PROGRAM

BENEFIT CONTACTS

24
 Important Benefit Contacts

We have provided a list of our vendor contacts for your reference. Please contact the carrier directly if you have
specific questions or concerns. For general benefit questions, please contact HR (contact information is listed
below).

BENEFIT ADMINISTRATOR PHONE WEBSITE/EMAIL

Medical and Prescription Drug Plan UMR (800) 826-9781 www.umr.com

Virtual Visits Teladoc (800) 835-2362 www.teladochealth.com

Health Savings Account WEX (833) 225-5939 wexinc.com

Dental Plan Delta Dental WA (800) 554-1907 www.DeltaDentalWA.com

Vision Plan VSP (800) 877-7195 vsp.com

Flexible Spending Accounts WEX (833) 225-5939 wexinc.com

Life and Disability New York Life (888) 842-4462 newyorklife.com

www.ndbh.com
Employee Assistance Program (EAP) New Directions (800) 624-5544
Login: Bedrock

Bedrock/Shinola:
Pet Insurance Nationwide (877) 738-7874 petinsurance.com/shinola
Filson: petinsurance.com/filson

Health Advocate New York Life (866) 799-2725 newyorklife.com

My Secure Advantage New York Life (888) 724-2262 nyl.mysecureadvantage.com

Bedrock/Shinola: Bedrock/Shinola:
Home Loan, Refinance, Closing (800) 923-7944 VIP.RocketMortgage.com/Shinola
Costs Savings Rocket Mortgage Filson: Filson:
(888) 242-1395 VIP.RocketMortgage.com/Filson

Bedrock/Shinola:
Niki Smith
Shinola and Bedrock Human Resources [email protected]
Wun Saeteurn
Filson [email protected]

25
 Legal Notices

Women’s Health & Cancer Rights Act

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and
Cancer Rights Act of 1998 (“WHCRA”). For individuals receiving mastectomy-related benefits, coverage will be provided in a
manner determined in consultation with the attending physician and the patient, for:

• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance;
• Prostheses; and
• Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical
benefits provided under the plan. Therefore, the following deductibles and coinsurance apply:

Plan 1: Qualified HDHP with Health Savings Account (HSA)

Individual: 80% coinsurance and $2,500 deductible; Family: 80% coinsurance and $5,000 deductible
Plan 2: PPO BUY UP PLAN
Individual: 80% coinsurance and $2,000 deductible; Family: 80% coinsurance and $4,000 deductible

If you would like more information on WHCRA benefits, please contact your Plan Administrator at [email protected] or
[email protected].

Newborns and Mothers’ Health Protection Act

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of
stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less
than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s
attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96
hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization
from the plan or insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may
have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you
or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may
be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit
www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State
Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be
eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or
www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the
premiums for an employer- sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer
plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special
enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-
866-444-EBSA (3272).
26
 Legal Notices

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums.
The following list of states is current as of July 31, 2024. Contact your State for more information on eligibility –

ALABAMA – Medicaid ALASKA – Medicaid

Website: http://myalhipp.com/ The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/
Phone: 1-855-692-5447 Phone: 1-866-251-4861
Email: [email protected] Eligibility:
https://health.alaska.gov/dpa/Pages/default.aspx

ARKANSAS – Medicaid CALIFORNIA – Medicaid

Website: http://myarhipp.com/ Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hipp
Phone: 1-855-MyARHIPP (855-692-7447) Phone: 916-445-8322
Fax: 916-440-5676
Email: [email protected]

COLORADO – Health First Colorado (CO’s Medicaid Program) & Child Health FLORIDA – Medicaid
Plan Plus (CHP+)
Health First Colorado Website: https://www.healthfirstcolorado.com/ Website:
Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711 https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/ hipp/index.html
CHP+: https://hcpf.colorado.gov/child-health-plan-plus Phone: 1-877-357-3268
CHP+ Customer Service: 1-800-359-1991/State Relay 711
Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/
HIBI Customer Service: 1-855-692-6442

GEORGIA – Medicaid INDIANA – Medicaid

GA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium- Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/
payment- program-hipp Phone: 1-877-438-4479
Phone: 678-564-1162, Press 1 GA CHIPRA Website: All other Medicaid Website: https://www.in.gov/medicaid/
https://medicaid.georgia.gov/programs/third-party-liability/childrens- health- Phone: 1-800-457-4584
insurance-program-reauthorization-act-2009-chipra
Phone: 678-564-1162, Press 2

27
 Legal Notices

IOWA – Medicaid and CHIP (Hawki) KANSAS – Medicaid

Medicaid Website: https://dhs.iowa.gov/ime/members Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884
Medicaid Phone: 1-800-338-8366 HIPP Phone: 1-800-967-4660
Hawki Website: http://dhs.iowa.gov/Hawki
Hawki Phone: 1-800-257-8563
HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp
HIPP Phone: 1-888-346-9562
KENTUCKY – Medicaid LOUISIANA – Medicaid

Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207
Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx (Medicaid hotline) or
Phone: 1-855-459-6328 1-855-618-5488 (LaHIPP)
Email: [email protected]
KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718
Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms

MAINE – Medicaid MASSACHUSETTS – Medicaid and CHIP

Enrollment Website: Website: https://www.mass.gov/masshealth/pa

https://www.mymaineconnection.gov/benefits/s/?language=enUS Phone: 1-800-862-4840
Phone: 1-800-442-6003 TTY: 711
TTY: Maine relay 711 Email: [email protected]
Private Health Insurance Premium Webpage:
https://www.maine.gov/dhhs/ofi/applications-forms
Phone: 1-800-977-6740
TTY: Maine relay 711
MINNESOTA – Medicaid MISSOURI – Medicaid

Website: Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

https://mn.gov/dhs/people-we-serve/children-and- families/health-care/ health-care- Phone: 573-751-2005
programs/programs-and-services/other-insurance.jsp
Phone: 1-800-657-3739
MONTANA – Medicaid NEBRASKA – Medicaid
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633
Phone: 1-800-694-3084 Lincoln: 402-473-7000
Email: [email protected] Omaha: 402-595-1178
NEVADA – Medicaid NEW HAMPSHIRE – Medicaid

Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900 Website: https://www.dhhs.nh.gov/programs-services/medicaid/health

-insurance-premium-program
Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-852-3345, ext. 5218
NEW JERSEY – Medicaid and CHIP NEW YORK – Medicaid
Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ Website: https://www.health.ny.gov/health care/medicaid/
Medicaid Phone: 609-631-2392 Phone: 1-800-541-2831
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710

NORTH CAROLINA – Medicaid NORTH DAKOTA – Medicaid

Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100 Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825

OKLAHOMA – Medicaid and CHIP OREGON – Medicaid

Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075

28
 Legal Notices

PENNSYLVANIA – Medicaid and CHIP RHODE ISLAND – Medicaid and CHIP

Website: https://www.pa.gov/en/services/dhs/apply-for-medicaid-health- Website: http://www.eohhs.ri.gov/
insurance-premium-payment-program-hipp.html Phone: 1-855-697-4347, or
Phone: 1-800-692-7462 401-462-0311 (Direct RIte Share Line)
CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov)
CHIP Phone: 1-800-986-KIDS (5437)
SOUTH CAROLINA - Medicaid SOUTH DAKOTA - Medicaid
Website: https://www.scdhhs.gov Website: http://dss.sd.gov
Phone: 1-888-549-0820 Phone: 1-888-828-0059
TEXAS – Medicaid UTAH – Medicaid and CHIP
Website: Health Insurance Premium Payment (HIPP) Program | Texas Medicaid Website: https://medicaid.utah.gov/ CHIP Website:
Health and Human Services http://health.utah.gov/chip
Phone: 1-800-440-0493 Phone: 1-877-543-7669
VERMONT – Medicaid VIRGINIA – Medicaid and CHIP
Website: Health Insurance Premium Website: https://coverva.dmas.virginia.gov/learn/premium-assistance/ famis-
Payment (HIPP) Program | Department of select
Vermont Health Access https://coverva.dmas.virginia.gov/learn/premium-assistance/ health-
Phone: 1-800-250-8427 insurance-premium-payment-hipp-programs
Medicaid/CHIP Phone: 1-800-432-5924

WASHINGTON– Medicaid WEST VIRGINIA – Medicaid and CHIP

Website: https://www.hca.wa.gov/ https://dhhr.wv.gov/bms/ http://mywvhipp.com/
Phone: 1-800-562-3022 Medicaid Phone: 304-558-1700
CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

WISONSIN – Medicaid and CHIP WYOMING – Medicaid

Website: Website:
https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/ Phone:
Phone: 1-800-362-3002 1-800-251-1269

To see if any other states have added a premium assistance program since July 31, 2024, or for more information on special
enrollment rights, contact either:

U.S. Department of Labor U.S. Department of Health and Human

Services Employee Benefits Security Administration Centers for Medicare & Medicaid
Services www.dol.gov/agencies/ebsa www.cms.hhs.gov
1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of
information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes
that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays
a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a
currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject
to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB
control number. See 44 U.S.C. 3512.
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent.
Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security
Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-
5718, Washington, DC 20210 or email [email protected] and reference the OMB Control Number 1210-0137 . OMB Control
Number 1210-0137 (expires 1/31/2026)

29
 Legal Notices

HIPAA Notice of Privacy Practices Reminder

Protecting Your Health Information Privacy Rights
Bedrock is committed to the privacy of your health information. The administrators of the Bedrock Health Plan (the “Plan”)
use strict privacy standards to protect your health information from unauthorized use or disclosure.
The Plan’s policies protecting your privacy rights and your rights under the law are described in the Plan’s Notice of Privacy
Practices. You may receive a copy of the Notice of Privacy Practices by contacting [email protected] or
[email protected].

HIPAA Special Enrollment Rights

Bedrock Health Plan Notice of Your HIPAA Special Enrollment Rights
Our records show that you are eligible to participate in the Bedrock Health Plan (to actually participate, you must
complete an enrollment form and pay part of the premium through payroll deduction).
A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the
plan under its “special enrollment provision” if you acquire a new dependent, or if you decline coverage under this plan
for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain
qualifying reasons.
Loss of Other Coverage (Excluding Medicaid or a State Children’s Health Insurance Program). If you decline
enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health
plan coverage is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents
lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other
coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or
after the employer stops contributing toward the other coverage).
Loss of Coverage for Medicaid or a State Children’s Health Insurance Program. If you decline enrollment for yourself or
for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children’s health
insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your
dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your
dependents’ coverage ends under Medicaid or a state children’s health insurance program.

New Dependent by Marriage, Birth, Adoption, or Placement for Adoption. If you have a new dependent as a result of
marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependents.
However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
Eligibility for Premium Assistance Under Medicaid or a State Children’s Health Insurance Program – If you or your
dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a
state children’s health insurance program with respect to coverage under this plan, you may be able to enroll yourself
and your dependents in this plan. However, you must request enrollment within 60 days after your or your dependents’
determination of eligibility for such assistance.
To request special enrollment or to obtain more information about the plan’s special enrollment provisions, contact
[email protected] or [email protected].

30
 Legal Notices

Notice of Creditable Coverage

Important Notice from Bedrock About Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current
prescription drug coverage with Bedrock and about your options under Medicare’s prescription drug coverage. This
information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining,
you should compare your current coverage, including which drugs are covered at what cost, with the coverage and
costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to
make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if
you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers
prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some
plans may also offer more coverage for a higher monthly premium.
2. Bedrock has determined that the prescription drug coverage offered by the medical plan is, on average
for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage
pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable
Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join
a Medicare drug plan.
When Can You Join a Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December
7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be
eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens to Your Current Coverage if You Decide to Join a Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current Bedrock coverage will not be affected. If you do decide to join a
Medicare drug plan and drop your current Bedrock coverage, be aware that you and your dependents will be able to get this
coverage back.

When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with Bedrock and don’t join a Medicare drug plan within 63
continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at
least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For
example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than
the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare
prescription drug coverage. In addition, you may have to wait until the following October to join.

For More Information About This Notice or Your Current Prescription Drug Coverage…
Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the
next period you can join a Medicare drug plan, and if this coverage through Bedrock changes. You also may request a copy of
this notice at any time.

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For More Information About Your Options Under Medicare Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook.
You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug
plans.

For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare
& You” handbook for their telephone number) for personalized help
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For
information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213
(TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage Notice. If you decide to join one of the Medicare drug plans, you
may be required to provide a copy of this notice when you join to show whether or not you have maintained
creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

Plan Year January 01, 2025

Employer Name Bedrock Manufacturing Company
Employer Address 485 W Milwaukee St. Detroit, MI 48202-3220
Employer Contact Name Wun Saeteurn
Employer Contact Email [email protected]

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 Legal Notices

Marketplace Notice
New Health Insurance Marketplace Coverage Options and Your Health Coverage

PART A: General Information

When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health
Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic
information about the new Marketplace and employment-based health coverage offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace
offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of
tax credit
that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace
begins in October 2013 for coverage starting as early as January 1, 2014.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers
coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your
household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a
tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a
tax
credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to
you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover
you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage
your employer
provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your
employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer
contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for
Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after- tax
basis.2
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your summary plan description or contact
[email protected] or [email protected].
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace
and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage
and contact information for a Health Insurance Marketplace in your area.

Legal Notices
PART B: Information About Health Coverage Offered by Your Employer

This section contains information about any health coverage offered by your employer. If you decide to complete an
application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to
correspond to the Marketplace application.

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2
An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit
costs covered by the plan is no less than 60 percent of such costs (Section 36B(c)(2)(C)(ii) of the Internal Revenue Code of
1986)

Here is some basic information about health coverage offered by this employer:

As your employer, we offer a health plan to:

 All Eligible employees.

Eligible employees are:

 Employees working 20 hours per week or more

With respect to dependents:

 We do offer coverage to Eligible Dependents

Eligible dependents are:

 Legal spouse/domestic partner (or common-law spouse in states which recognize common-law marriages).
 Dependent children up to age 26 (includes birth children, stepchildren, legally adopted children, children placed for
adoption, foster children, and children for whom legal guardianship has been awarded to you or your spouse/
domestic partner).
 Dependent children, regardless of age, provided he or she is incapable of self-support due to a mental or physical
disability, is fully dependent on you for support as indicated on your federal tax return and is approved by your
Medical Plan to continue coverage past age 26.

X If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be
affordable, based on employee wages.

** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount
through the Marketplace. The Marketplace will use your household income, along with other factors, to determine
whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you
are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other
income losses, you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process.

Plan Year January 01, 2025

Employer Name Bedrock Manufacturing Company
Employer Address 485 W Milwaukee St. Detroit, MI 48202-3220
Employer Contact Name Wun Saeteurn
Employer Contact Email [email protected]

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35