State Addendum: Colorado (Trailborn)

IPNLSAUNRSANCE Potentially eligible teammates will be provided with benefit enrollment information upon hire. Insurance coverage begins on the first calendar day of the month after thirty (30) days of employment if I enroll within 30 days of hire. If not, I will need to wait for Open Enrollment (unless I have a qualified life event*), in which case my benefits will become effective on the January 1 following my enrollment. *Qualified life events include 1) marriage or divorce, 2) birth or adoption of a child, 3) a child reaching the age limit for coverage, 4) death of a spouse, domestic partner, or child, 5) loss of coverage through a plan provided to spouse or domestic partner, or 6) gaining coverage through Medicaid or CHIP. If I experience a qualified life event and wish to change or enroll for benefit coverage, I should contact the Department of People & Culture right away. Insurance Plans 1

2 Insurance Plans HEALTH PLANS. Out-of-Pocket-Maximum: The most I have Valor is proud to offer me a choice of to pay for covered services in a plan year. four different medical plans that provide After I spend this amount on deductibles, comprehensive medical and prescription copayments, and coinsurance for in- drug coverage. Details can be found in network care and services, my health the Summary Plan Description, but the plan will pay 100% of the costs of covered information and charts below summarize benefits. some of the key elements. Coinsurance: The percentage of costs of Definitions: a covered health care service I pay (20%, Deductible: The amount I pay for covered for example) after I’ve paid my deductible. health care services before my insurance plan starts to pay.With a $2,000 deductible, • For example, if my health insurance for example, I pay the first $2,000 of plan has an allowed amount of $900 covered services myself. for an MRI and my coinsurance is 20%: Copay: A fixed amount I pay for a covered o If I’ve paid my deductible, I pay service. For example, I may have a $20 20% until I reach the plan out-of- copay for a doctor’s office visit, or a pocket maximum. $35 copay for a Preferred Brand Name o If I haven’t met my deductible, I prescription. In these situations, I pay pay 100% until the deductible has the copay amount for services by an in- been met. If there is any amount network provider. left over, above the deductible, I would pay 20% until the out-of- pocket maximum is reached.

CIGNA HEALTH INSURANCE: TELADOC: Teladoc™ offers me the convenience [Insert chart from Valor booklets] of 24/7 access to U.S. board-certified physicians either a phone call or a click DENTAL PLAN: away. Physicians can discuss symptoms, Trailborn offers me Delta Dental DPPO, recommend treatment options, diagnose which offers me the freedom and flexibility many common non-emergency conditions to use the dentist of my choice, though my and prescribe medication when medically costs will be less and my benefits greater appropriate. This option may be available if I choose a dentist who participates in the for me even if I am not enrolled in a CIGNA Delta Dental network. plan, at a cost of $4.62 per pay period. [Insert chart from Valor booklets] [Insert chart from Valor booklets] Insurance Plans 3 VISION PLAN: Trailborn’s Vision Service Provider Plan offers me the freedom and flexibility to use the vision care provider of my choice, though my costs will be less and my benefits greater if I choose a vision care provider who participates in the VSP network. [Insert chart from Valor booklets]