2025 Medical Benefit Overview Medical & Prescription Drugs Insured by UnitedHealthcare PPO Plan HSA Plan IN-Network Benefits IN-Network Benefits Physician Office Visit $30 per visit 20% after Deductible Specialist Office Visit $50 per visit 20% after Deductible Deductible* Embedded Embedded Single $3,000 $3,300 Family $9,000 $6,400 Coinsurance 20% 20% Out-of-Pocket Maximum Embedded Embedded Single $6,500 $6,650 Family $13,000 $13,300 Preventive Care 100% Coverage 100% Coverage Hospital Services 20% after Deductible 20% after Deductible Outpatient Services 20% after Deductible 20% after Deductible Maternity Services 20% after Deductible 20% after Deductible Emergency Room Services $250 + 20% per visit 20% after Deductible Urgent Care Centers $75 per visit 20% after Deductible Mental Health Inpatient 20% after Deductible 20% after Deductible Outpatient 20% after Deductible 20% after Deductible Lifetime Maximum Unlimited Unlimited *Some Generic Rx medications used to prevent chronic conditions are not subject to the individual and/or family deductibles. The medical plan is administered by Anthem Blue Access, which offers discounts through the largest national network of doctors and hospitals. For the best benefits and value, it's recommended to use network providers, though it’s not required. Services outside the network will cost more. Employees can visit anthem.com or use the Sydney Health app to find participating providers. Page 7 | Duncan Supply Company, Inc.| Plan Year 2025 Open Enrollment This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.