© 2026 Surest. All Rights Reserved . i Table of Contents 1. Quick Reference ..........................................................................................................................1 2. How Does the Surest Health Plan Work? .................................................................................2 3. Am I Eligible and How Do I Enroll? ...........................................................................................3 4. When Does My Coverage Begin and End? ............................................................................... 7 4.1 Effective Dates ..................................................................................................... 7 4.2 End Dates ............................................................................................................ 7 4.3 Leave of Absence ................................................................................................ 8 5. What Are My Benefits? ...............................................................................................................9 5.1 Covered Health Services.................................................................................... 15 5.2 Prior Authorization and Pre-Admission Notification ............................................ 34 5.3 Clinical Programs and Resources ...................................................................... 36 5.4 Transition of Care and Continuity of Care .......................................................... 40 6. What Is Not Covered .................................................................................................................42 7. Claims Procedures ....................................................................................................................53 8. What Do I Do If My Claim Is Denied? .......................................................................................56 9. What are My Rights under ERISA? ..........................................................................................66 10. Continuation of Coverage ........................................................................................................68 11. What Else Do I Need to Know? ................................................................................................77 11.1 Important Administrative Information .................................................................. 77 11.2 Coordination of Benefits ................................................................................... 77 11.3 Subrogation, Overpayment and Reimbursement ............................................... 84 11.4 Plan Administrator’s Responsibilities ................................................................. 88 11.5 Other Information About Your Surest Plan ......................................................... 89 12. Glossary .....................................................................................................................................91 13. Outpatient Prescription Drugs ...............................................................................................101