99 If Your Employer Offers Retirement Coverage If you are a retiree under this Plan, filing a proceeding in bankruptcy under Title 11 of the United States Code may be a qualifying event. If a proceeding in bankruptcy is filed with respect to your Employer, and that bankruptcy results in the loss of coverage, you will become a qualified beneficiary with respect to the bankruptcy. Your Dependents will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under this Plan. If COBRA coverage becomes available to a retiree and his or her covered family members as a result of a bankruptcy filing, the retiree may continue coverage for life and his or her Dependents may also continue coverage for a maximum of up to 36 months following the date of the retiree’s death. Second qualifying event If your family has another qualifying event (such as a legal separation, divorce, etc.) during the initial 18 months of COBRA continuation coverage, your Dependents can receive up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months from the original qualifying event. Such additional coverage is only available if the second qualifying event would have caused your Dependents to lose coverage under the Plan had the first qualifying event not occurred. Notification Requirements The Employer will offer COBRA continuation coverage to qualified beneficiaries only after the Employer has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the Subscriber, commencement of a proceeding in bankruptcy with respect to the employer, or the Subscriber's becoming entitled to Medicare benefits (under Part A, Part B, or both), the Employer will notify the COBRA Administrator (e.g., Human Resources or their external vendor) of the qualifying event. You Must Give Notice of Some Qualifying Events For other qualifying events (e.g., divorce or legal separation of the Subscriber and spouse or a Dependent child’s losing eligibility for coverage as a Dependent child), you must notify the Employer within 60 days after the qualifying event occurs. Electing COBRA Continuation Coverage To continue Your coverage, You or an eligible family Member must make an election within 60 days of the date Your coverage would otherwise end, or the date the company’s benefit Plan Administrator notifies You or Your family Member of this right, whichever is later. You must pay the total fees appropriate for the type of benefit coverage You choose to continue. If the Fee rate changes for active associates, Your monthly Fee will also change. The Fee You must pay cannot be more than 102 of the Fee charged for Employees with similar coverage, and it must be paid to the company’s benefit plan administrator within 30 days of the date due, except that the initial Fee payment must be made before 45 days after the initial election for continuation coverage, or Your continuation rights will be forfeited. Disability extension of 18-month period of continuation coverage For Subscribers who are determined, at the time of the qualifying event, to be disabled under Title II (OASDI) or Title XVI (SSI) of the Social Security Act, and Subscribers who become disabled during the first 60 days of COBRA continuation coverage, coverage may continue from 18 to 29 months. These Subscribers’ Dependents are also eligible for the 18- to 29-month disability extension. (This also applies if any covered family Member is found to be disabled.) This would only apply if the qualified beneficiary gives notice of disability status within 60 days of the disabling determination. In these cases, the Employer

Anthem Blue Access PPO Option 23 with Rx Option T3 IN PPO Large 96R4 01 01 2025 L12026M001 L12026 English EOC CY - Page 100 Anthem Blue Access PPO Option 23 with Rx Option T3 IN PPO Large 96R4 01 01 2025 L12026M001 L12026 English EOC CY Page 99 Page 101