2026 Cigna Health Plan Benefit Summary Traditional Plan

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 1 of 18 ©Cigna 2025 BENEFIT SUMMARY Administered by - Cigna Health and Life Insurance Co. For - Inotiv, Inc. Open Access Plus Plan OAP Traditional Plan Effective - 01/01/2026 Selection of a Primary Care Provider - your plan may require or allow the designation of a primary care provider. You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members. If your plan requires designation of a primary care provider, Cigna may designate one for you until you make this designation. For information on how to select a primary care provider, and for a list of the participating primary care providers, visit www.mycigna.com or contact customer service at the phone number listed on the back of your ID card. For children, you may designate a pediatrician as the primary care provider. Direct Access to Obstetricians and Gynecologists - You do not need prior authorization from the plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, visit www.mycigna.com or contact customer service at the phone number listed on the back of your ID card. Plan Highlights In-Network Out-of-Network Lifetime Maximum Unlimited Unlimited Plan Year Accumulation Your plan’s deductibles, out-of-pockets and benefit level limits accumulate on a calendar year basis unless otherwise stated. In addition, all plan maximums and service-specific maximums (dollar and occurrence) cross-accumulate between in- and out-of-network unless otherwise noted. Plan Coinsurance Plan pays 80% Plan pays 50% Maximum Reimbursable Charge Not Applicable 110% Plan Deductible Individual: $1,500 Family: $3,000 Individual: $3,000 Family: $6,000  Only the amount you pay for in-network covered expenses counts towards your in-network deductible. Only the amount you pay for out-of-network covered expenses counts towards your out-of-network deductible.  Benefit copays/deductibles always apply before plan deductible and coinsurance.  Family members meet only their individual deductible and then their claims will be covered under the plan coinsurance; if the family deductible has been met prior to their individual deductible being met, their claims will be paid at the plan coinsurance. Note: Services where plan deductible applies are noted with a caret (^).

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 2 of 18 ©Cigna 2025 Plan Highlights In-Network Out-of-Network Plan Out-of-Pocket Maximum Individual: $5,000 Family: $10,000 Individual: $10,000 Family: $20,000  Only the amount you pay for in-network covered expenses counts toward your in-network out-of-pocket maximum. Only the amount you pay for out-of- network covered expenses counts toward your out-of-network out-of-pocket maximum.  Plan deductible contributes towards your out-of-pocket maximum.  All benefit copays/deductibles contribute towards your out-of-pocket maximum.  Covered expenses that count towards your out-of-pocket maximum include customer paid coinsurance and charges for Mental Health and Substance Use Disorder. Out-of-network non-compliance penalties or charges in excess of Maximum Reimbursable Charge do not contribute towards the out-of-pocket maximum.  After each eligible family member meets his or her individual out-of-pocket maximum, the plan will pay 100% of their covered expenses. Or, after the family out-of-pocket maximum has been met, the plan will pay 100% of each eligible family member's covered expenses.  This plan includes a combined Medical/Pharmacy out-of-pocket maximum. Benefit In-Network Out-of-Network Note: Services where plan deductible applies are noted with a caret (^). Benefit copays/deductibles always apply before plan deductible. Physician Services - Office Visits Primary Care Physician (PCP) Services/Office Visit $25 copay, and plan pays 100% Plan pays 50% ^ Specialty Care Physician Services/Office Visit $40 copay, and plan pays 100% Plan pays 50% ^ NOTE: Obstetrician and Gynecologist (OB/GYN) visits are subject to either the PCP or Specialist cost share depending on how the provider contracts with Cigna (i.e. as PCP or as Specialist). Surgery Performed in Physician's Office Covered same as Physician Services - Office Visit Covered same as Physician Services - Office Visit Allergy Treatment/Injections and Allergy Serum Allergy serum dispensed by the physician in the office Note: Office copay does not apply if only the allergy serum is provided. Covered same as Physician Services - Office Visit Covered same as Physician Services - Office Visit Virtual Care Dedicated Virtual Providers - MDLIVE MDLIVE Urgent Virtual Care Services $25 copay, and plan pays 100% Not Covered MDLIVE Primary Care Services $25 copay, and plan pays 100% Not Covered MDLIVE Specialty Care Services $40 copay, and plan pays 100% Not Covered  Primary Care cost share applies to routine care. Virtual wellness screenings are payable under Preventive Care.  For MDLIVE Behavioral Services, please refer to the Mental Health and Substance Use Disorder section (below).  Lab services supporting a virtual visit must be obtained through dedicated labs.  Includes charges for the delivery of medical and health-related services and consultations by dedicated virtual providers as medically appropriate through audio, video, and secure internet-based technologies.

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 3 of 18 ©Cigna 2025 Benefit In-Network Out-of-Network Note: Services where plan deductible applies are noted with a caret (^). Benefit copays/deductibles always apply before plan deductible. Virtual Physician Services - Office Visits Primary Care Physician (PCP) Services/Office Visit $25 copay, and plan pays 100% Plan pays 50% ^ Specialty Care Physician Services/Office Visit $40 copay, and plan pays 100% Plan pays 50% ^  Physicians may deliver services virtually that are payable under other benefits (e.g., Preventive Care, Outpatient Therapy Services).  Includes charges for the delivery of medical and health-related services and consultations as medically appropriate through audio, video, and secure internet- based technologies that are similar to office visit services provided in a face-to-face setting. NOTE: Obstetrician and Gynecologist (OB/GYN) visits are subject to either the PCP or Specialist cost share depending on how the provider contracts with Cigna (i.e. as PCP or as Specialist). Convenience Care Clinic Convenience Care Clinic $25 copay, and plan pays 100% Plan pays 50% ^ Preventive Care Preventive Care Plan pays 100% PCP: Plan pays 50% ^ Specialist: Plan pays 50% ^  Includes coverage of additional services, such as urinalysis, EKG, and other laboratory tests, supplementing the standard Preventive Care benefit when billed as part of office visit.  Annual Limit: Unlimited Immunizations Plan pays 100% PCP: Plan pays 50% ^ Specialist: Plan pays 50% ^ Mammogram, PAP, and PSA Tests Plan pays 100% Covered same as other x-ray and lab services, based on Place of Service  Coverage includes the associated Preventive Outpatient Professional Services.  Diagnostic-related services are covered at the same level of benefits as other x-ray and lab services, based on Place of Service. Inpatient Inpatient Hospital Facility Services Plan pays 80% ^ Plan pays 50% ^ Note: Includes all Lab and Radiology services, including Advanced Radiological Imaging as well as Medical Pharmaceutical Drugs Inpatient Hospital Physician's Visit/Consultation Plan pays 80% ^ Plan pays 50% ^ Inpatient Professional Services Plan pays 80% ^ Plan pays 50% ^  For services performed by Surgeons, Radiologists, Pathologists and Anesthesiologists Outpatient Outpatient Facility Services Plan pays 80% ^ Plan pays 50% ^ Outpatient Professional Services Plan pays 80% ^ Plan pays 50% ^  For services performed by Surgeons, Radiologists, Pathologists and Anesthesiologists

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 4 of 18 ©Cigna 2025 Benefit In-Network Out-of-Network Note: Services where plan deductible applies are noted with a caret (^). Benefit copays/deductibles always apply before plan deductible. Emergency Services Emergency Room  Includes Professional, X-ray and/or Lab services performed at the Emergency Room and billed by the facility as part of the ER visit.  Per visit copay is waived if admitted. $300 copay, and plan pays 100% $300 copay, and plan pays 100% Urgent Care Facility  Includes Professional, X-ray and/or Lab services performed at the Urgent Care Facility and billed by the facility as part of the urgent care visit. $50 copay, and plan pays 100% Plan pays 50% ^ Ambulance Plan pays 80% ^ Plan pays 80% ^ Ambulance services used as non-emergency transportation (e.g., transportation from hospital back home) generally are not covered. Ambulance - Mental Health and Substance Use Disorder Plan pays 100% Plan pays 100% Ambulance services used as non-emergency transportation (e.g., transportation from hospital back home) generally are not covered. Inpatient Services at Other Health Care Facilities Skilled Nursing Facility, Rehabilitation Hospital, Sub-Acute Facilities  Annual Limit: 60 days Plan pays 80% ^ Plan pays 50% ^ Laboratory Services Physician’s Services/Office Visit Plan pays 80% ^ Plan pays 50% ^ Independent Lab Plan pays 80% ^ Plan pays 50% ^ Outpatient Facility Plan pays 80% ^ Plan pays 50% ^ Radiology Services Physician’s Services/Office Visit Plan pays 80% ^ Plan pays 50% ^ Outpatient Facility Plan pays 80% ^ Plan pays 50% ^ Advanced Radiological Imaging (ARI) Includes MRI, MRA, CAT Scan, PET Scan, etc. Outpatient Facility Plan pays 80% ^ Plan pays 50% ^ Physician’s Services/Office Visit Covered same as Physician Services - Office Visit Covered same as Physician Services - Office Visit

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 5 of 18 ©Cigna 2025 Benefit In-Network Out-of-Network Note: Services where plan deductible applies are noted with a caret (^). Benefit copays/deductibles always apply before plan deductible. Outpatient Therapy Services Outpatient Therapy Services Covered same as Physician Services - Office Visit Covered same as Physician Services - Office Visit Annual Limits:  All Therapies Combined - Includes Cognitive Therapy, Occupational Therapy, Physical Therapy, Pulmonary Rehabilitation, and Speech Therapy - Unlimited days Note: Therapy days, provided as part of an approved Home Health Care plan, accumulate to the applicable outpatient therapy services maximum. Chiropractic Services Covered same as Physician Services - Office Visit Covered same as Physician Services - Office Visit Annual Limit:  Chiropractic Care - 12 days Cardiac Rehabilitation Services Covered same as Physician Services - Office Visit Covered same as Physician Services - Office Visit Annual Limit:  Cardiac Rehabilitation - 36 days Hospice Inpatient Facilities Plan pays 80% ^ Plan pays 50% ^ Outpatient Services Plan pays 80% ^ Plan pays 50% ^ Note: Includes Bereavement counseling provided as part of a hospice program. Bereavement Counseling (for services not provided as part of a hospice program) Services Provided by a Mental Health Professional Covered under Mental Health benefit Covered under Mental Health benefit Medical Pharmaceutical Drugs Cigna Pathwell Specialty® Medical Pharmaceuticals Plan pays 80% ^ Not Covered Other Medical Pharmaceuticals Plan pays 80% ^ Plan pays 50% ^  Cigna Pathwell Specialty® Medical Pharmaceuticals are only covered when administered by a Cigna Pathwell Specialty® designated provider.  This benefit only applies to the cost of Medical Pharmaceutical drugs administered. Related Facility, Office Visit or Professional charges are covered according to the plan design.

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 6 of 18 ©Cigna 2025 Benefit In-Network Out-of-Network Note: Services where plan deductible applies are noted with a caret (^). Benefit copays/deductibles always apply before plan deductible. Maternity Initial Visit to Confirm Pregnancy Covered same as Physician Services - Office Visit Covered same as Physician Services - Office Visit All Subsequent Prenatal Visits, Postnatal Visits and Physician's Delivery Charges (Global Maternity Fee) Plan pays 80% ^ Plan pays 50% ^ Office Visits in Addition to Global Maternity Fee (Performed by OB/GYN or Specialist) Covered same as Physician Services - Office Visit Covered same as Physician Services - Office Visit Delivery - Facility (Inpatient Hospital, Birthing Center) Covered same as plan’s Inpatient Hospital benefit Covered same as plan’s Inpatient Hospital benefit Abortion Abortion Services Coverage varies based on Place of Service Coverage varies based on Place of Service Note: Elective and non-elective procedures Family Planning Women’s Services Plan pays 100% Coverage varies based on Place of Service Includes contraceptive devices as ordered or prescribed by a physician and surgical sterilization services, such as tubal ligation (excludes reversals) Men’s Services Coverage varies based on Place of Service Coverage varies based on Place of Service Includes surgical sterilization services, such as vasectomy (excludes reversals) Infertility Infertility Treatment Coverage varies based on Place of Service Coverage varies based on Place of Service Infertility covered services: lab and radiology test, counseling, surgical treatment, excludes artificial insemination and in-vitro fertilization, GIFT, ZIFT, etc. Outpatient Dialysis Services Physician’s Services/Office Visit Covered same as Physician Services - Office Visit Not Covered Home Dialysis Note: Dialysis visits will not accumulate to Home Health Care maximum Covered same as plan's Home Health Care benefit Not Covered Outpatient Facility Services Covered same as plan's Outpatient Facility Services benefit Not Covered Outpatient Professional Services Covered same as plan’s Outpatient Professional Services benefit Not Covered

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 7 of 18 ©Cigna 2025 Benefit In-Network Out-of-Network Note: Services where plan deductible applies are noted with a caret (^). Benefit copays/deductibles always apply before plan deductible. Other Health Care Facilities/Services Home Health Care Plan pays 80% ^ Plan pays 50% ^  Annual Limit: 60 days (The limit is not applicable to mental health and substance use disorder conditions.)  16 hour maximum per day Note: Includes outpatient private duty nursing when approved as medically necessary Organ Transplants Inpatient Hospital Facility Services LifeSOURCE Transplant Network® facility Plan pays 100% Not Applicable Other Facility Not Covered Not Covered Inpatient Professional Services LifeSOURCE Transplant Network® facility Plan pays 100% Not Applicable Other Facility Not Covered Not Covered  Travel Maximum - Cigna LifeSOURCE Transplant Network® facility only: $10,000 maximum per Transplant Durable Medical Equipment  Annual Limit: Unlimited Plan pays 80% ^ Plan pays 50% ^ Breast Feeding Equipment and Supplies  Limited to the rental of one breast pump per birth as ordered or prescribed by a physician  Includes related supplies Plan pays 100% Plan pays 50% ^

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 8 of 18 ©Cigna 2025 Benefit In-Network Out-of-Network Note: Services where plan deductible applies are noted with a caret (^). Benefit copays/deductibles always apply before plan deductible. External Prosthetic Appliances (EPA) Plan pays 80% ^ Plan pays 50% ^  Annual Limit: Unlimited Temporomandibular Joint Disorder (TMJ)  Unlimited Non-Surgical lifetime maximum Coverage varies based on Place of Service Coverage varies based on Place of Service Note: Provided on a limited, case-by-case basis. Excludes appliances and orthodontic treatment. Routine Foot Care Not Covered Not Covered Note: Services associated with foot care for diabetes and peripheral vascular disease are covered when approved as medically necessary. Hearing Aids Plan pays 80% ^ Plan pays 50% ^  $2,500 maximum per Calendar Year  Includes testing and fitting of hearing aid devices at Physician Office Visit cost share Wigs  Maximum of 1 wig per Lifetime Plan pays 80% ^ Plan pays 80% ^ Travel Services  Authorized eligible travel and lodging expenses when an In- network facility/provider is not available within a 60 mile radius from your primary home residence  Coverage for designated services only including all Medical and Outpatient Mental Health and Substance Use Disorder Services  Coverage when travelling to an in-network provider/facility only  Medical Lifetime Maximum: $10,000  Behavioral Lifetime Maximum: Unlimited Plan pays 100% Not Covered

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 9 of 18 ©Cigna 2025 Benefit In-Network Out-of-Network Note: Services where plan deductible applies are noted with a caret (^). Benefit copays/deductibles always apply before plan deductible. Mental Health and Substance Use Disorder Inpatient Mental Health Plan pays 80% ^ Plan pays 50% ^ Outpatient Mental Health – Physician’s Office $25 copay, and plan pays 100% Plan pays 50% ^ Outpatient Mental Health - MDLIVE Behavioral Services $25 copay, and plan pays 100% Not Covered Outpatient Mental Health – All Other Services Plan pays 80% ^ Plan pays 50% ^ Inpatient Substance Use Disorder Plan pays 80% ^ Plan pays 50% ^ Outpatient Substance Use Disorder – Physician’s Office $25 copay, and plan pays 100% Plan pays 50% ^ Outpatient Substance Use Disorder - MDLIVE Behavioral Services $25 copay, and plan pays 100% Not Covered Outpatient Substance Use Disorder – All Other Services Plan pays 80% ^ Plan pays 50% ^ Annual Limits:  Unlimited maximum Notes:  Inpatient includes Acute Inpatient and Residential Treatment.  Outpatient - Physician's Office and MDLIVE Behavioral Services - may include Individual, family and group therapy, psychotherapy, medication management, etc.  Outpatient - All Other Services - may include Partial Hospitalization, Intensive Outpatient Services, Applied Behavior Analysis (ABA Therapy), etc.  Services are paid at 100% after you reach your out-of-pocket maximum. Important Note on Mental Health and Substance Use Disorder Coverage: Covered medical services listed above, which are received to diagnose or treat a Mental Health or Substance Use Disorder condition will be payable according to this section titled “Mental Health and Substance Use Disorder.” Mental Health/Substance Use Disorder Utilization Review, Case Management and Programs Cigna Total Behavioral Health - Inpatient and Outpatient Management  Inpatient utilization review and case management  Outpatient utilization review and case management  Partial Hospitalization  Intensive outpatient programs  Changing Lives by Integrating Mind and Body Program  Lifestyle Management Programs: Stress Management, Tobacco Cessation and Weight Management.  Narcotic Therapy Management  inMynd℠ program - a comprehensive, holistic solution to help recognize and find resources to treat behavioral health conditions.

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 10 of 18 ©Cigna 2025 Pharmacy In-Network Cost Share and Supply Cigna Pharmacy Cost Share  Retail – up to 90-day supply (except Specialty up to 30-day supply)  Home Delivery – up to 90-day supply (except Specialty up to 30-day supply) Retail (per 30-day supply): Generic: You pay $10 Preferred Brand: You pay $50 Non-Preferred Brand: You pay $90 Retail and Home Delivery (per 30-day supply): Specialty: You pay 40% up to a maximum of $250 Retail and Home Delivery (per 90-day supply): Generic: You pay $25 Preferred Brand: You pay $125 Non-Preferred Brand: You pay $225  Cigna 90 Now CVS: Retail drugs for a 30-day supply may be obtained in-network at a wide range of pharmacies across the nation although prescriptions for a 90-day supply (such as maintenance drugs) will be available at select network pharmacies. Walgreens will be considered out-of-network for a 90-day supply.  Cigna 90 Now Program: You can choose to fill your medications in a 30- or 90-day supply. If you choose to fill a 30-day prescription, it can be filled at any network retail pharmacy or network home delivery pharmacy. If you choose to fill a 90-day prescription, it must be filled at a 90-day network retail pharmacy or network home delivery pharmacy to be covered by the plan.  This plan will not cover out-of-network pharmacy benefits.  Specialty medications are used to treat an underlying disease which is considered to be rare and chronic including, but not limited to, multiple sclerosis, hepatitis C or rheumatoid arthritis. Specialty Drugs may include high cost medications as well as medications that may require special handling and close supervision when being administered.  When patient requests brand drug, patient pays the brand cost share plus the cost difference between the brand and generic drugs up to the cost of the brand drug (unless the physician indicates "Dispense As Written" DAW).  Exclusive specialty home delivery: Specialty medications must be filled through home delivery; otherwise you pay the entire cost of the prescription upon your first fill. Some exceptions may apply.  If you use a manufacturer coupon to pay for some or all of the cost of a medication, the value of the coupon may not apply towards meeting your plan deductible or out-of-pocket maximum, if any.  SaveOn Specialty Program: Certain specialty pharmacy drugs may be considered non-essential health benefits and may fall outside of the deductible and out-of-pocket limits. All drugs in this program are potentially subject to a higher cost share than amounts set forth above. If you participate in the program, cost share may be paid through a manufacturer copay assistance program and your out-of-pocket cost may be reduced to $0. If you do not participate in the program, then you will be responsible for the payment of the cost share for these medications and payment will not be applied towards your deductible and out-of-pocket maximums. See your plan documents for more specific information.  Your pharmacy benefits share an out-of-pocket maximum with the medical/behavioral benefits.  If you receive a supply of 34 days or less at home delivery, the home delivery pharmacy cost share will be adjusted to reflect a 30-day supply.

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 11 of 18 ©Cigna 2025 Pharmacy In-Network Preventive Drugs: Federally required preventive drugs will not be subject to deductible and will be provided at no charge. In addition, In-Network Generic and Preferred Brand preventive drugs and products included in the Preventive Plus Package will be provided at no charge. This may apply to drugs for: Asthma, Cholesterol Lowering, Depression, Diabetes (including diabetic supplies and continuous glucose monitor supplies), Heart Disease and Stroke, High Blood Pressure, Osteoporosis, Smoking Cessation, Prenatal Vitamins, Prescription Vitamins Drugs Covered Prescription Drug List: Your Cigna Standard Prescription Drug List includes a full range of drugs including all those required under applicable health care laws. To check which drugs are included in your plan, please log on to myCigna.com. Some highlights:  Coverage includes Self Administered injectables and optional injectable drugs – but excludes infertility drugs.  Contraceptive devices and drugs are covered with federally required products covered at 100%. Pharmacy Program Information Pharmacy Clinical Management: Essential Your plan features drug management programs and edits to ensure safe prescribing, and access to medications proven to be the most reliable and cost effective for the medical condition, including:  Prior authorization requirements  Step Therapy on select classes of medications and drugs new to the market  Quantity limits, including maximum daily dose edits, quantity over time edits, duration of therapy edits, and dose optimization edits  Age edits, and refill-too-soon edits  Plan exclusion edits  Current users of Step Therapy medications will be allowed one 30-day fill during the first three months of coverage before Step Therapy program applies.  Your plan includes Specialty Drug Management features, such as prior authorization and quantity limits, to ensure the safe prescribing and access to specialty medications.  For customers with complex conditions taking a specialty medication, we will offer Accredo Therapeutic Resource Centers (TRCs) to provide specialty medication and condition counseling. For customers taking a specialty medication not dispensed by Accredo, Cigna experts will offer this important specialty medication and condition counseling. Patient Assurance Program Your plan includes the Patient Assurance Program, which waives the deductible and reduces the amount you owe for certain medications used to treat chronic conditions included in the program. Additionally:  Any amount you pay for these medications only count toward meeting your out-of-pocket maximum.  Any discount provided by a pharmaceutical manufacturer for these medications only count toward meeting your out-of-pocket maximum. Additional Information Case Management Coordinated by Cigna HealthCare. This is a service designated to provide assistance to a patient who is at risk of developing medical complexities or for whom a health incident has precipitated a need for rehabilitation or additional health care support. The program strives to attain a balance between quality and cost effective care while maximizing the patient's quality of life.

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 12 of 18 ©Cigna 2025 Additional Information Cigna Diabetes Prevention Program in collaboration with Omada Cigna Diabetes Prevention Program in collaboration with Omada is a program to help you avoid the onset of diabetes, as well as health risks that might lead to heart disease or a stroke. The program is covered by your health plan at the preventive level, just like for your wellness visit. Program participants have access to a professional virtual health coach, an online support group, interactive lessons, and a smart-technology scale. The program will help you make small changes in your eating, activity, sleep, and stress to achieve healthy weight loss through a series of 16 weekly lessons and tools to help you maintain weight loss over time. You will also be offered the opportunity to join a gym for a low monthly fee and no enrollment fee. Comprehensive Oncology Program  Care Management outreach  Case Management Included Healthy Pregnancies/Healthy Babies  Care Management outreach  Maternity Case Management  Neo-natal Case Management $150 (1st trimester) / $75 (2nd trimester) - Option 3 Maximum Reimbursable Charge The allowable covered expense for non-network services is based on the lesser of the health care professional's normal charge for a similar service or a percentage of a fee schedule (110%) developed by Cigna that is based on a methodology similar to one used by Medicare to determine the allowable fee for the same or similar service in a geographic area. In some cases, the Medicare based fee schedule will not be used and the Maximum Reimbursable Charge for covered services is based on the lesser of the health care professional's normal charge for a similar service or a percentile (80th) of charges made by health care professionals of such service or supply in the geographic area where it is received. If sufficient charge data is unavailable in the database for that geographic area to determine the Maximum Reimbursable Charge, then data in the database for similar services may be used. Out-of-network services are subject to a calendar year deductible and Maximum Reimbursable Charge limitations. Out-of-Network Emergency Services Charges 1. Emergency Services are covered at the in-network cost-sharing level as required by applicable state or federal law if services are received from a non-participating (out-of-network) provider. 2. The allowable amount used to determine the plan's benefit payment for covered Emergency Services rendered in an out-of-network hospital, or by an out-of- network provider in an in-network hospital, is the amount agreed to by the out-of-network provider and Cigna, or as required by applicable state or federal law. The member is responsible for applicable in-network cost-sharing amounts (any deductible, copay or coinsurance). The member is not responsible for any charges that may be made in excess of the allowable amount. If the out-of-network provider bills you for an amount higher than the amount you owe as indicated on the Explanation of Benefits (EOB), contact Cigna Customer Service at the phone number on your ID card.

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 13 of 18 ©Cigna 2025 Additional Information Medicare Coordination In accordance with the Social Security Act of 1965, this plan will pay Secondary to Medicare Part A and B as follows: (a) a former Employee such as a retiree, a former Disabled Employee, a former Employee's Dependent Spouse and/or Dependent Child(ren), including a former Employee’s Domestic Partner, or a COBRA continuant (whose insurance is continued for any reason), and who is also eligible for Medicare due to age or disability; (b) an Employee's Domestic Partner who is also eligible for Medicare due to age; (c) an Employee, a former Employee, an Employee’s or former Employee’s Dependent Spouse and/or Dependent Child(ren), an Employee's Dependent, including a Domestic Partner, who is eligible for Medicare due to End Stage Renal Disease after that person has been eligible for Medicare for 30 months. When a person is eligible for Medicare A and B as described above, this plan will pay as the Secondary Plan to Medicare Part A and B regardless if the person is actually enrolled in Medicare Part A and/or Part B and regardless if the person seeks care at a Medicare Provider or not for Medicare covered services. Multiple Surgical Reduction Multiple surgeries performed during one operating session result in payment reduction of 50% to the surgery of lesser charge. The most expensive procedure is paid as any other surgery. One Guide Available by phone or through myCigna mobile application. One Guide helps you navigate the health care system and make the most of your health benefits and programs. Premium Personal Health Team The Premium Personal Health Team is a designated and integrated service delivery approach using a one health advocate model. Core functions include:  Case Management - Short term and complex  Inpatient Advocacy  Pre Admission Outreach  Post Discharge Outreach  24 hour Health Information Line Outreach Care Facility - N/A Pre-Certification - Continued Stay Review - Preferred Care Management Inpatient - required for all inpatient admissions In-Network: Coordinated by your physician Out-of-Network: Customer is responsible for contacting Cigna Healthcare. Subject to penalty/reduction or denial for non-compliance.  $750 penalty applied to hospital inpatient charges for failure to contact Cigna Healthcare to precertify admission.  Benefits are denied for any admission reviewed by Cigna Healthcare and not certified.  Benefits are denied for any additional days not certified by Cigna Healthcare. Pre-Certification - Preferred Care Management Outpatient Prior Authorization - required for selected outpatient procedures and diagnostic testing In-Network: Coordinated by your physician Out-of-Network: Customer is responsible for contacting Cigna Healthcare. Subject to penalty/reduction or denial for non-compliance.  $750 penalty applied to outpatient procedures/diagnostic testing charges for failure to contact Cigna Healthcare and to precertify admission.  Benefits are denied for any outpatient procedures/diagnostic testing reviewed by Cigna Healthcare and not certified. Pre-Existing Condition Limitation (PCL) does not apply.

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 14 of 18 ©Cigna 2025 Additional Information Treatment Decision Support Treatment decision support for common health conditions. Cigna health advocates provide unbiased information and education on treatment options for common health conditions, including: back pain, coronary artery disease, osteoarthritis of the hip and knee, benign uterine conditions, breast cancer and prostate cancer. Included Well-Being Solution: Core Plus  Health assessment  Device/app integration  Personalized online content and data-driven actions  Social connections/challenges  Incentive administration Your Health First - 200 Individuals with one or more of the chronic conditions, identified on the right, may be eligible to receive the following type of support:  Condition Management  Medication adherence  Risk factor management  Lifestyle issues  Health & Wellness issues  Pre/post-admission  Treatment decision support  Gaps in care Holistic health support for the following chronic health conditions:  Heart Disease  Coronary Artery Disease  Angina  Congestive Heart Failure  Acute Myocardial Infarction  Peripheral Arterial Disease  Asthma  Chronic Obstructive Pulmonary Disease (Emphysema and Chronic Bronchitis)  Diabetes Type 1  Diabetes Type 2  Metabolic Syndrome/Weight Complications  Osteoarthritis  Low Back Pain  Anxiety  Bipolar Disorder  Depression

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 15 of 18 ©Cigna 2025 Definitions Coinsurance - After you've reached your deductible, you and your plan share some of your medical costs. The portion of covered expenses you are responsible for is called Coinsurance. Copay - A flat fee you pay for certain covered services such as doctor's visits or prescriptions. Deductible - A flat dollar amount you must pay out of your own pocket before your plan begins to pay for covered services. Out-of-Pocket Maximum - Specific limits for the total amount you will pay out of your own pocket before your plan coinsurance percentage no longer applies. Once you meet these maximums, your plan then pays 100 percent of the "Maximum Reimbursable Charges" or negotiated fees for covered services. Place of Service - Your plan pays based on where you receive services. For example, for hospital stays, your coverage is paid at the inpatient level. Prescription Drug List - The list of prescription brand and generic drugs covered by your pharmacy plan. Professional Services - Services performed by Surgeons, Assistant Surgeons, Hospital Based Physicians, Radiologists, Pathologists and Anesthesiologists Transition of Care - Provides in-network health coverage to new customers when the customer's doctor is not part of the Cigna network and there are approved clinical reasons why the customer should continue to see the same doctor. Exclusions What's Not Covered (not all-inclusive): Your plan provides for most medically necessary services. The complete list of exclusions is provided in your Certificate or Summary Plan Description. To the extent there may be differences, the terms of the Certificate or Summary Plan Description control. Examples of things your plan does not cover, unless required by law or covered under the pharmacy benefit, include (but aren't limited to):  Care for health conditions that are required by state or local law to be treated in a public facility.  Care required by state or federal law to be supplied by a public school system or school district.  Care for military service disabilities treatable through governmental services if you are legally entitled to such treatment and facilities are reasonably available.  Treatment of an Injury or Sickness which is due to war, declared, or undeclared.  Charges which you are not obligated to pay or for which you are not billed or for which you would not have been billed except that they were covered under this plan. For example, if Cigna determines that a provider or Pharmacy is or has waived, reduced, or forgiven any portion of its charges and/or any portion of Copayment, Deductible, and/or Coinsurance amount(s) you are required to pay for a Covered Expense (as shown on The Schedule) without Cigna's express consent, then Cigna in its sole discretion shall have the right to deny the payment of benefits in connection with the Covered Expense, or reduce the benefits in proportion to the amount of the Copayment, Deductible, and/or Coinsurance amounts waived, forgiven or reduced, regardless of whether the provider or Pharmacy represents that you remain responsible for any amounts that your plan does not cover. In the exercise of that discretion, Cigna shall have the right to require you to provide proof sufficient to Cigna that you have made your required cost share payment(s) prior to the payment of any benefits by Cigna. This exclusion includes, but is not limited to, charges of a non-Participating Provider who has agreed to charge you or charged you at an In-Network benefits level or some other benefits level not otherwise applicable to the services received.  Provided further, if you use a coupon provided by a pharmaceutical manufacturer or other third party that discounts the cost of a prescription medication or other product, Cigna may, in its sole discretion, reduce the benefits provided under the plan in proportion to the amount of the Copayment, Deductible, and/or Coinsurance amounts to which the value of the coupon has been applied by the Pharmacy or other third party, and/or exclude from accumulation toward any plan Deductible or Out-of-Pocket Maximum the value of any coupon applied to any Copayment, Deductible and/or Coinsurance you are required to pay.  Charges arising out of or relating to any violation of a healthcare-related state or federal law or which themselves are a violation of a healthcare-related state or federal law.  Assistance in the activities of daily living, including but not limited to eating, bathing, dressing or other Custodial Services or self-care activities, homemaker services and services primarily for rest, domiciliary or convalescent care.  For or in connection with experimental, investigational or unproven services.  Experimental, investigational and unproven services are medical, surgical, diagnostic, psychiatric, substance use disorder or other health care technologies,

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 16 of 18 ©Cigna 2025 Exclusions supplies, treatments, procedures, drug or Biologic therapies or devices that are determined by the utilization review Physician to be: o not approved by the U.S. Food and Drug Administration (FDA) or other appropriate regulatory agency to be lawfully marketed; o not demonstrated, through existing peer-reviewed, evidence-based, scientific literature to be safe and effective for treating or diagnosing the condition or Sickness for which its use is proposed; o the subject of review or approval by an Institutional Review Board for the proposed use except as provided in the "Clinical Trials" sections of this plan; or o the subject of an ongoing phase I, II or III clinical trial, except for routine patient care costs related to qualified clinical trials as provided in the "Clinical Trials" sections of this plan. In determining whether any such technologies, supplies, treatments, drug or Biologic therapies or devices are experimental, investigational and/or unproven, the utilization review Physician may rely on the clinical coverage policies maintained by Cigna or the Review Organization. Clinical coverage policies may incorporate, without limitation and as applicable, criteria relating to U.S. Food and Drug Administration-approved labeling, the standard medical reference compendia and peer-reviewed, evidence-based scientific literature or guidelines.  Cosmetic surgery and therapies. Cosmetic surgery or therapy is defined as surgery or therapy performed to improve or alter appearance or self-esteem.  The following services are excluded from coverage regardless of clinical indications: macromastia or gynecomastia surgeries; surgical treatment of varicose veins; abdominoplasty; panniculectomy; rhinoplasty; blepharoplasty; redundant skin surgery; removal of skin tags; acupressure; craniosacral/cranial therapy; dance therapy; movement therapy; applied kinesiology; rolfing; prolotherapy; and extracorporeal shock wave lithotripsy (ESWL) for musculoskeletal and orthopedic conditions.  Dental treatment of the teeth, gums or structures directly supporting the teeth, including dental X-rays, examinations, repairs, orthodontics, periodontics, casts, splints and services for dental malocclusion, for any condition. However, charges made for a continuous course of dental treatment for an Injury to teeth are covered.  For medical and surgical services, initial and repeat, intended for the treatment or control of obesity including clinically severe (morbid) obesity, including: medical and surgical services to alter appearance or physical changes that are the result of any surgery performed for the management of obesity or clinically severe (morbid) obesity; and weight loss programs or treatments, whether prescribed or recommended by a Physician or under medical supervision.  Unless otherwise covered in this plan, for reports, evaluations, physical examinations, or hospitalization not required for health reasons including, but not limited to, employment, insurance or government licenses, and court-ordered, forensic or custodial evaluations.  Court-ordered treatment or hospitalization, unless such treatment is prescribed by a Physician and listed as covered in this plan.  Reversal of male or female voluntary sterilization procedures.  Any medications, drugs, services or supplies for the treatment of male or female sexual dysfunction such as, but not limited to, treatment of erectile dysfunction (including penile implants), anorgasmy, and premature ejaculation.  Medical and Hospital care and costs for the infant child of a Dependent, unless this infant child is otherwise eligible under this plan.  Non-medical counseling and/or ancillary services including, but not limited to, Custodial Services, educational services, vocational counseling, training and rehabilitation services, behavioral training, biofeedback, neurofeedback, hypnosis, sleep therapy, return to work services, work hardening programs and driver safety courses.  Therapy or treatment intended primarily to improve or maintain general physical condition or for the purpose of enhancing job, school, athletic or recreational performance, including but not limited to routine, long term, or maintenance care which is provided after the resolution of the acute medical problem and when significant therapeutic improvement is not expected.  Consumable medical supplies other than ostomy supplies and urinary catheters. Excluded supplies include, but are not limited to bandages and other disposable medical supplies, skin preparations and test strips, except as specified in the "Home Health Services" or "Breast Reconstruction and Breast

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 17 of 18 ©Cigna 2025 Exclusions Prostheses" sections of this plan.  Private Hospital rooms and/or private duty nursing except as provided under the Home Health Services provision.  Personal or comfort items such as personal care kits provided on admission to a Hospital, television, telephone, newborn infant photographs, complimentary meals, birth announcements, and other articles which are not for the specific treatment of an Injury or Sickness.  Artificial aids including, but not limited to, corrective orthopedic shoes, arch supports, elastic stockings, garter belts, corsets and dentures.  Aids or devices that assist with non-verbal communications, including but not limited to communication boards, pre-recorded speech devices, laptop computers, desktop computers, Personal Digital Assistants (PDAs), Braille typewriters, visual alert systems for the deaf and memory books.  Eyeglass lenses and frames and contact lenses (except for the first pair of contact lenses for treatment of keratoconus or post cataract surgery).  Routine refractions, eye exercises and surgical treatment for the correction of a refractive error, including radial keratotomy.  Treatment by acupuncture.  All non-injectable prescription drugs, unless Physician administration or oversight is required, injectable prescription drugs to the extent they do not require Physician supervision and are typically considered self-administered drugs, non-prescription drugs, and investigational and experimental drugs, except as provided in this plan.  Routine foot care, including the paring and removing of corns and calluses or trimming of nails. However, services associated with foot care for diabetes and peripheral vascular disease are covered when Medically Necessary.  Membership costs or fees associated with health clubs, weight loss programs and smoking cessation programs.  Genetic screening or pre-implantations genetic screening. General population-based genetic screening is a testing method performed in the absence of any symptoms or any significant, proven risk factors for genetically linked inheritable disease.  Dental implants for any condition.  Fees associated with the collection or donation of blood or blood products, except for autologous donation in anticipation of scheduled services where in the utilization review Physician's opinion the likelihood of excess blood loss is such that transfusion is an expected adjunct to surgery.  Blood administration for the purpose of general improvement in physical condition.  Cost of biologicals that are immunizations or medications for the purpose of travel, or to protect against occupational hazards and risks.  Cosmetics, dietary supplements and health and beauty aids.  All nutritional supplements and formulae except for infant formula needed for the treatment of inborn errors of metabolism.  For or in connection with an Injury or Sickness arising out of, or in the course of, any employment for wage or profit.  Charges for the delivery of medical and health-related services via telecommunications technologies, including telephone and internet, unless provided as specifically described under Covered Expenses.  Massage therapy.

01/01/2026 ASO Open Access Plus - OAP Traditional Plan Proclaim - 37302332 - V 33 - 10/20/25 05:18 PM ET 18 of 18 ©Cigna 2025 These are only the highlights This summary outlines the highlights of your plan. For a complete list of both covered and not covered services, including benefits required by your state, see your employer's insurance certificate, service agreement or summary plan description -- the official plan documents. If there are any differences between this summary and the plan documents, the information in the plan documents takes precedence. Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth Behavioral Health, Inc., Evernorth Care Solutions, Inc. and HMO or service company subsidiaries of Cigna Health Corporation. EHB State: UT

Discrimination is against the law. Medical coverage Cigna Healthcare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Cigna Healthcare does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Cigna Healthcare: • Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) • Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact customer service at the toll-free number shown on your ID card, and ask a Customer Service Associate for assistance. If you believe that Cigna Healthcare has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by sending an email to ACAGrievance@Cigna.com or by writing to the following address: Cigna Healthcare Nondiscrimination Complaint Coordinator P.O. Box 188016 Chattanooga, TN 37422 If you need assistance filing a written grievance, please call the number on the back of your ID card or send an email to ACAGrievance@Cigna.com. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, DC 20201 1.800.368.1019, 800.537.7697 (TDD) Complaint forms are available at https://www.hhs.gov/civil-rights/filing-a-complaint/complaint- process/index.html 896375f 3/24 © 2024 Cigna Healthcare

Proficiency of Language Assistance Services English - ATTENTION: Language assistance services, free of charge, are available to you. For current Cigna Healthcare customers, call the number on the back of your ID card. Otherwise, call 1.800.244.6224 (TTY: Dial 711). Spanish - ATENCION: Hay servicios de asistencia de idiomas, sin cargo, a su disposici6n. Si es un cliente actual de Cigna Healthcare, !lame al numero que figura en el reverso de su tarjeta de identificaci6n. Si no lo es, llame al 1.800.244.6224 (los usuarios de TTY deben llamar al 711). Chinese - i±�: ft{rraJf,Sf�:9e.JftJHJ:t�!t�ia.l=l}Jij�f£ 0 lt� Cigna Healthcare EfJJJi��P , �rlfi&fflf�Efl ID -t1r®Ef1�� 0 �{-tg�p�ff¥Jl:ffl 1.800.244.6224 C �lr!H!H,i : �ffti 711) 0 Vietnamese - XIN LU'U Y: Quy vi dU'Q'C c�p djch v1,1 trQ' giup v� ng6n ngQ> mien phi. Danh cha khach hang hi(m tc;1i cua Cigna Healthcare, vui long goi s6 a mc;it sau the Hoi vien. Cac tmcmg hQ'p khac xin goi s6 1.800.244.6224 (TTY: Quay s6 711 ). Korean - -?�I: �J�Oj � J..�-§-o�J..I := ��. 111Kal...\1110HHO� KapTO4Kll1 y4aCTHll1Ka nnaHa. Ecn111 Bbl He f!BmleTeCb y4aCTHIIIKOM OAHOro 1113 HaWIIIX nnaHOB, no3BOHll1Te no HOMepy 1.800.244.6224 (TTY: 711 ) . . �I �I.hi� _)c- u.J.l.JI �)4 J�';/1 ��Y. �WI Cigna Healthcare �)l-.l .rS,] �\:i..o ��I 4_..,:ill -::.it....;.. cl.,w';/1 ��Y. - Arabic .(711 '-,-l �I :TTY) 1.800.244.6224 '-:-l �I .JI French Creole - ATANSYON: Gen sevis ed nan lang ki disponib gratis pou ou. Pou kliyan Cigna Healthcare yo, rele nimewo ki deye kat ID ou. Sinon, rele nimewo 1.800.244.6224 (TTY: Rele 711). French - ATTENTION: Des services d'aide linguistique vous sont proposes gratuitement. Si vous etes un client actuel de Cigna Healthcare, veuillez appeler le numero indique au verso de votre carte d'identite. Sinon, veuillez appeler le numero 1.800.244.6224 (A TS : composez le numero 711). Portuguese - ATENCAO: Tern ao seu dispor servii . .l_,.!,