Post-65 Retiree Guide_AmWins

c/o Amwins Group Benefits 50 Whitecap Drive North Kingstown, RI 02852 DePauw University Retiree Medical Program Your 2025 Benefits

Your 2025 Retiree Medical Benefits Having quality health insurance is of utmost importance. To provide the best insurance value available, factoring coverage, service and price, DePauw University offers the enclosed Retiree Medical Program and prescription drug plans. This Post-65 Retiree Medical Program is available to you and your Medicare eligible spouse. To participate, you must be 65 or older and enrolled in Medicare Parts A & B. This program offers a medical plan underwritten by United American Insurance Company and serviced by Amwins Group Benefits, Inc. This program includes three Medicare Part D prescription drug plan options underwritten by Express Scripts Insurance. To enroll in a prescription drug plan you must also elect the medical plan. By electing the prescription drug plan you will be enrolled in a Medicare Part D plan. If you are currently enrolled in a Medicare Part D plan, you will need to contact the administrator and end enrollment. How to enroll  Review the information in this booklet  Complete and sign the appropriate enrollment form(s)  Return the above items and first month’s payment in the postage-paid return envelope Materials must be received to activate your benefits. If you have any questions, please contact the Amwins Group Benefits Customer Care Center toll- free at 1-888-883-3757, Monday through Friday, from 8 a.m. to 8 p.m. (EST). Amwins Group Benefits Customer Care Center Toll-Free 1-888-883-3757

Retiree Medical Insurance Plan Summary of Benefits Underwritten by: United American Insurance Company MEDICARE (PART A) - HOSPITAL SERVICES - PER BENEFIT PERIOD* Services Medicare Pays Plan Pays You Pay HOSPITAL CONFINEMENT BENEFIT* Semiprivate room and board, general nursing and miscellaneous services and supplies: First 60 days All but Part A Part A Deductible $0 Deductible st th All but Part A $0 61 through 90 day Coinsurance Part A Coinsurance 91st through 150th day All but Part A (While using 60 lifetime reserve Coinsurance Part A Coinsurance $0 days) Once Lifetime Reserve days are used: Additional 365 days: $0 100% of Medicare $0 Eligible Expenses Beyond the Additional 365 days $0 $0 All costs SKILLED NURSING FACILITY CARE* You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital: First 20 days All approved $0 $0 amounts 21st through 100th day All but Part A $0 Coinsurance Part A Coinsurance 101st day and after $0 $0 All costs BLOOD DEDUCTIBLE – Hospital Confinement and Out-Patient Medical Expense When furnished by a hospital or skilled nursing facility during a covered stay. First 3 pints $0 3 pints $0 Additional amounts 100% $0 $0 HOSPICE CARE All but very limited Available as long as your doctor coinsurance for certifies you are terminally ill and outpatient drugs $0 Balance you elect to receive these services. and inpatient respite care MEDICARE (PART B) - MEDICAL SERVICES - PER CALENDAR YEAR

Retiree Medical Insurance Plan Summary of Benefits Underwritten by: United American Insurance Company Services Medicare Pays Plan Pays You Pay OUT-PATIENT MEDICAL EXPENSES - - In or Out of the Hospital and Out-Patient Hospital Treatment, such as Physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment: Medicare Part B Deductible: First $0 $0 Part B Deductible Medicare-approved amounts** 20% until Calendar Next Medicare-approved amounts Generally 80% $0 year deductible is met ($400) 4% until Out Of Next Medicare-approved amounts Generally 80% 16% Pocket Maximum is met ($1,250) Remainder of Medicare-approved Generally 80% Generally 20% 0% amounts Part B Excess Charges (Above Medicare Approve $0 100% 0% Amounts) BLOOD First 3 pints $0 All costs $0 Next Medicare Approved $0 $0 Part B Deductible Amounts** 20% until Calendar Next Medicare-approved amounts Generally 80% $0 year deductible is met ($400) 4% until Out Of Next Medicare-approved amounts Generally 80% 16% Pocket Maximum is met ($1,250) Remainder of Medicare Approved 80% 20% $0 Amounts CLINICAL LABORATORY SERVICES Blood tests for Diagnostic Services 100% $0 $0

Retiree Medical Insurance Plan Summary of Benefits Underwritten by: United American Insurance Company MEDICARE PARTS A & B Services Medicare Pays Plan Pays You Pay HOME HEALTH CARE – Medicare Approved Services: Medically necessary skilled care 100% $0 $0 services and medical supplies DURABLE MEDICAL EQUIPMENT First of Medicare Approved $0 $0 Part B Deductible Amounts** 20% until Calendar Next Medicare-approved amounts Generally 80% $0 year deductible is met ($400) 4% until Out Of Next Medicare-approved amounts Generally 80% 16% Pocket Maximum is met ($1,250) Remainder of Medicare Approved 80% 20% $0 Amounts OTHER BENEFITS NOT COVERED BY MEDICARE Services Medicare Pays Plan Pays You Pay FOREIGN TRAVEL -Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA: First $250 each calendar year $0 $0 $250 80% to a lifetime 20% and amounts Remainder of charges $0 maximum of $50,000 over the $50,000 lifetime max *A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. **Once you have been billed the first dollars of Medicare-Approved amounts for covered services (which are noted with two asterisks), your Medicare Part B Deductible will have been met for the calendar year. Benefits are paid only for those expenses which have been approved as eligible by the federal Medicare program. Benefits will not be paid for any expenses which are not determined to be Medicare Eligible Expenses by the Federal Medicare Program or its administrators, except as otherwise specified. This policy’s renewability, cancellability and termination provisions are at the option of the group policy holder except in cases of non-payment of premium The summary of program benefits described herein is for illustrative purposes only. In case of differences or errors, the Group Policy governs. The Medicare Parts A and B deductibles and co-insurance amounts shown are the 2024 amounts. Your plan will automatically adjust to the changes to Medicare Parts A and B amounts for 2025.

Benefit Overview ® Express Scripts Medicare (PDP) YOUR 2025 PRESCRIPTION DRUG PLAN BENEFIT Here is a summary of what you will pay for covered prescription drugs across the different stages of your Medicare Part D benefit. You can fill your covered prescriptions at a network retail pharmacy or through our home delivery service. Prescription Drug Plan Option 1: Deductible stage $590.00 Initial After you pay your yearly deductible: You will pay the following until your total yearly drug costs (what Coverage you and the plan pay) reach $2,000: stage Tier Retail Retail Home Delivery One-Month Three-Month Three-Month (31-day) Supply (90-day) Supply (90-day) Supply (Standard) Tier 1: 15% 15% 10% Generic Drugs Tier 2: 30% 30% 25% Preferred Brand Drugs Tier 3: 30% 30% 30% Non- Preferred Brand Tier 4: 25% 25% 25% Specialty If your doctor prescribes less than a full month’s supply of certain drugs, you will pay a daily cost-sharing rate based on the actual number of days of the drug that you receive. You may receive up to a 90-day supply of certain maintenance drugs (medications taken on a long-term basis) by mail through the Express Scripts PharmacySM. There is no charge for standard shipping. Not all drugs are available at a 90-day supply, and not all retail pharmacies offer a 90-day supply. Non-part D Drugs Covered; Excluding lifestyle Compound Compound Management Solution applies. Compound Management Solution is in place to mitigate compound drug abuse by means of inclusion and exclusion lists Catastrophic After your yearly out-of-pocket drug costs reach $2,000, you will pay $0.00 Coverage stage

Benefit Overview ® Express Scripts Medicare (PDP) YOUR 2025 PRESCRIPTION DRUG PLAN BENEFIT Here is a summary of what you will pay for covered prescription drugs across the different stages of your Medicare Part D benefit. You can fill your covered prescriptions at a network retail pharmacy or through our home delivery service. Prescription Drug Plan Option 2: Deductible stage $100.00 Initial After you pay your yearly deductible: You will pay the following until your total yearly drug costs (what Coverage you and the plan pay) reach $2,000: stage Tier Retail Retail Home Delivery One-Month Three-Month Three-Month (31-day) Supply (90-day) Supply (90-day) Supply (Standard) Tier 1: 15% 15% 10% Generic Drugs Tier 2: 30% 30% 25% Preferred Brand Drugs Tier 3: 50% 50% 50% Non- Preferred Brand Tier 4: 25% 25% 25% Specialty If your doctor prescribes less than a full month’s supply of certain drugs, you will pay a daily cost-sharing rate based on the actual number of days of the drug that you receive. You may receive up to a 90-day supply of certain maintenance drugs (medications taken on a long-term basis) by mail through the Express Scripts PharmacySM. There is no charge for standard shipping. Not all drugs are available at a 90-day supply, and not all retail pharmacies offer a 90-day supply. Non-part D Drugs Covered; Excluding lifestyle Compound Compound Management Solution applies. Compound Management Solution is in place to mitigate compound drug abuse by means of inclusion and exclusion lists Catastrophic After your yearly out-of-pocket drug costs reach $2,000, you will pay $0 Coverage stage

Benefit Overview ® Express Scripts Medicare (PDP) YOUR 2025 PRESCRIPTION DRUG PLAN BENEFIT Here is a summary of what you will pay for covered prescription drugs across the different stages of your Medicare Part D benefit. You can fill your covered prescriptions at a network retail pharmacy or through our home delivery service. Prescription Drug Plan Option 3: Deductible stage $100.00 Initial After you pay your yearly deductible: You will pay the following until your total yearly drug costs (what Coverage you and the plan pay) reach $2,000: stage Tier Retail Retail Home Delivery One-Month Three-Month Three-Month (31-day) Supply (90-day) Supply (90-day) Supply (Standard) Tier 1: 15% 15% 10% Generic Drugs Tier 2: 30% 30% 25% Preferred Brand Drugs Tier 3: 40% 40% 35% Non- Preferred Brand Tier 4: 25% 25% 25% Specialty If your doctor prescribes less than a full month’s supply of certain drugs, you will pay a daily cost-sharing rate based on the actual number of days of the drug that you receive. You may receive up to a 90-day supply of certain maintenance drugs (medications taken on a long-term basis) by mail through the Express Scripts PharmacySM. There is no charge for standard shipping. Not all drugs are available at a 90-day supply, and not all retail pharmacies offer a 90-day supply. Non-part D Drugs Covered; Excluding lifestyle Compound Compound Management Solution applies. Compound Management Solution is in place to mitigate compound drug abuse by means of inclusion and exclusion lists Catastrophic After your yearly out-of-pocket drug costs reach $2,000, you will pay $0 Coverage stage

IMPORTANT PLAN INFORMATION Long-Term Care (LTC) Pharmacy If you reside in an LTC facility, you pay the same as at a network retail pharmacy. LTC pharmacies must dispense brand-name drugs in amounts of 14 days or less at a time. They may also dispense less than a one month’s supply of generic drugs at a time. Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed. Out-of-Network Coverage You must use Express Scripts Medicare network pharmacies to fill your prescriptions. Covered Medicare Part D drugs are available at out-of-network pharmacies only in special circumstances, such as illness while traveling outside of the plan’s service area where there is no network pharmacy. You generally have to pay the full cost for drugs received at an out-of-network pharmacy at the time you fill your prescription. You can ask us to reimburse you for our share of the cost. Please contact the plan or the Retiree Customer Service Center for more details. Additional Information About This Coverage  The service area for this plan is all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands and American Samoa. You must live in one of these areas to participate in this plan.  The amount you pay may differ depending on what type of pharmacy you use; for example, retail, home infusion, LTC or home delivery.  To find a network pharmacy near you, visit our website at www.Express-Scripts.com.  Your plan uses a formulary – a list of covered drugs. The amount you pay depends on the drug’s tier and on the coverage stage that you’ve reached. From time to time, a drug may move to a different tier. If a drug you are taking is going to move to a higher (or more expensive) tier, or if the change limits your ability to fill a prescription, Express Scripts will notify you before the change is made.  To access your plan’s list of covered drugs, visit our website at www.Express- Scripts.com.  The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition.  Your healthcare provider must get prior authorization from Express Scripts Medicare for certain drugs.  If the actual cost of a drug is less than the normal cost-sharing amount for that drug, you will pay the actual cost, not the higher cost-sharing amount.  Each month, you may need to pay a monthly premium amount to continue your participation in this plan. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party, even if your Medicare Part D plan premium is $0. Express Scripts Medicare (PDP) is a prescription drug plan with a Medicare contract. Enrollment in Express Scripts Medicare depends on contract renewal. © 2018 Express Scripts Holding Company. All Rights Reserved.

MONTHLY PAYMENT SUMMARY 2025 Medical & Rx Monthly Rates* Amount You Pay Medical + Amount You Pay Medical + Amount You Pay Medical + Rx Low Plan Option 1 Rx Mid Plan Option 2 Rx High Plan Option 3 $70.99 $134.00 $246.17 * Per Person Covered 2025 Dental and Vision Monthly Rates Vision Plan Dental Plan (Hired after 7/1/05) Retiree $8.08 $30.18 Retiree + Spouse $12.66 $75.00 A check for your first monthly payment is required. Mail a check for your first month’s premium to: DePauw University/Amwins Group Benefits, Inc., 50 Whitecap Drive, North Kingstown, RI 02852 Make your check payable to: DePauw University/Amwins Group Benefits, Inc. If you are interested in monthly automatic withdrawals from your bank account, complete the Direct Payment Authorization form and return it with a voided check and a check for your first month's payment. If you do not sign up for automatic payments, you will begin receiving monthly invoices from Amwins. Please st return a check for your first month's payment in the enclosed return envelope. Payments are due on the 1 of every month.

RETIREE MEDICAL PLAN ELECTION FORM DePauw University Underwritten by: United American Insurance Company Dental Plan is underwritten by: Delta Dental Vision Plan is underwritten by: Anthem You must return your election form to put your coverage in force! Retiree Information (Please print) Name Date of Birth Address Social Security Number City Sex Phone Number State Zip Code Medicare ID# (From Medicare Id card): Hospital (Part A) effective date Medical (Part B) effective date (from Medicare ID card): (from Medicare ID card): Email Address Date of Retirement Spouse Information (if enrolling) Name Date of Birth Sex Social Security Number Date of Retirement Medicare ID# (From Medicare Id card): Hospital (Part A) effective date Medical (Part B) effective date (from Medicare ID card): (from Medicare ID card): Please Choose Type of Coverage Effective Date: {effective_date} Retiree Only Retiree & Spouse Surviving Spouse Check Desired Coverage: Medical Plan Delta Dental Plan Anthem Vision Plan Please Check box for VEBA Payment, if Applicable: I would like my monthly premium to be deducted from my VEBA account: ☐Yes ☐No (continue to next page) CW

RETIREE MEDICAL PLAN ELECTION FORM Please sign and date below: Date: Retiree Signature: Date: Spouse/Surviving Spouse Signature: If you are an authorized representative, you must sign above and provide the following information: Name: _______________________________________________ Address: ______________________________________________ Phone Number: ________________________________________ Relationship to Retiree: _________________________________ Please return signed election form to: Amwins Group Benefits 50 Whitecap Drive, North Kingstown, RI 02852 For Customer Service, please call: 1-888-883-3757 Monday through Friday, 8:00 AM to 8:00 PM EST CW

MEDICARE PRESCRIPTION DRUG PLAN INDIVIDUAL ENROLLMENT FORM SPONSORED GROUP PLAN ® To enroll in Express Scripts Medicare (PDP) please provide the following information: Group Name: DePauw University Desired Effective Date: {effective_date} Retiree Last Name: First Name: Middle Initial:  Mr.  Mrs.  Ms. Birth Date: (__ __/__ __/__ __ __ __) (M M / D D / Y Y Y Y) Sex:  M  F Social Security Number: Home Phone Number: ( ) E-Mail Address: Permanent Resident Street Address: City: State: ZIP Code: Mailing Address (only if different from your Permanent Residence Address): Street Address: City: State: ZIP Code: Spouse or Surviving Spouse Last Name: First Name: Middle Initial:  Mr.  Mrs.  Ms. Birth Date: (__ __/__ __/__ __ __ __) (M M / D D / Y Y Y Y) Sex:  M  F Social Security Number: Home Phone Number: ( ) E-Mail Address: Permanent Resident Street Address: City: State: ZIP Code: Mailing Address (only if different from your Permanent Residence Address): Street Address: City: State: ZIP Code: Emergency Contact: (Optional) Name: Phone Number: Relationship to you: E-Mail Address: Continued next page

Please Provide Your Medicare Insurance Information Please take out your Medicare Card to complete this section.  Please fill in these blanks so they match your red, white and blue Medicare card. - OR -  Attach a copy of your Medicare card or your letter from the Social Security Administration or Railroad Retirement Board. You must have Medicare Part A or Part B (or both) to join a Medicare prescription drug plan. Retiree: Spouse or Surviving Spouse: Name: Name: ____________________________________ ____________________________________ Medicare Number Medicare Number __ __ __ __ - __ __ __ - __ __ __ __ __ __ __ __ - __ __ __ - __ __ __ __ OR Medicare Claim Number OR Medicare Claim Number __ __ __ - __ __ - __ __ __ __ - __ __ __ __ __ - __ __ - __ __ __ __ - __ __ Is Entitled To Effective Date Is Entitled To Effective Date HOSPITAL (Part A) ____________ HOSPITAL (Part A) ____________ MEDICAL (Part B) ____________ MEDICAL (Part B) ____________ Select Your Enrollment Options Below (Please Check Desired Coverage) Please check which plan you want to enroll in: Retiree: Spouse or Surviving Spouse:  Option 1  Option 1  Option 2  Option 2  Option 3  Option 3 Important Information About Your Medicare Part D Prescription Drug Plan Express Scripts Medicare® (PDP) is offered by Medco Containment Life Insurance Company, which contracts with the Federal government. This coverage is Medicare Part D coverage and is in addition to your coverage under Medicare Parts A and B. You must keep your Medicare Parts A and/or B coverage in order to qualify for this plan. You must inform your former employer of any other prescription drug coverage you may have. Enrollment Requirements You can be in only one Medicare prescription drug plan at a time. If you are currently in a Medicare prescription drug plan, a Medicare Advantage Plan with prescription drug coverage, or an individual Medicare Advantage Plan, your enrollment in Express Scripts Medicare may end that enrollment. Continued on next page

Important Information About Your Medicare Part D Prescription Drug Plan You must live within the 50 U.S. states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands or American Samoa, and be a U.S. citizen or lawfully present in the United States to participate in this plan. It is your responsibility to inform your former employer of any address changes. You can join a new Medicare prescription drug plan or Medicare health plan from October 15 to December 7. Except in special cases, you cannot join a new plan at any other time of the year. If you leave this plan and don’t have or get other Medicare prescription drug coverage or creditable coverage (as good as Medicare’s), you may be required to pay a late enrollment penalty (LEP) if you go 63 days or more without Medicare Part D coverage or other creditable prescription drug coverage. Some people may have to pay an extra premium amount because of their yearly income. If you have to pay an extra amount, the Social Security Administration – not your Medicare plan – will send you a letter telling you what that extra amount will be and how to pay it. If you have any questions about this extra amount, contact the Social Security Administration at 1.800.772.1213. TTY users call 1.800.325.0778. Medicare beneficiaries with low or limited income and resources may qualify for Extra Help. If you qualify, your Medicare prescription drug plan costs will be less. Once you are enrolled in this drug plan, Medicare will tell the plan how much assistance you will receive and Express Scripts will send you information on the amount you will pay. If you are not currently receiving Extra Help, you can contact 1.800.MEDICARE (1.800.633.4227) to see if you might qualify. TTY users call 1.877.486.2048. Once you are a member of this plan, you have the right to file a grievance or appeal plan decisions about payment or services if you disagree. Read your Evidence of Coverage to know which rules you must follow to receive coverage with this Medicare prescription drug plan. This information is not a complete description of benefits. Contact Express Scripts Medicare for more information. Limitations, copayments and restrictions may apply. Benefits, premium (if applicable) and/or copayments/coinsurance may change on January 1 of each year. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary. Release of Information: By joining this Medicare prescription drug plan, I acknowledge that Express Scripts Medicare can release my information to Medicare and other plans as is necessary for treatment, payment and health care operations. I also acknowledge that Express Scripts Medicare can release my information, including my prescription drug event data, to Medicare, who may release it for research and other purposes that follow all applicable Federal statutes and regulations. Retiree’s Signature: Today’s Date: Spouse or Surviving Spouse’s Signature: Today’s Date: Express Scripts Medicare (PDP) is a prescription drug plan with a Medicare contract. Enrollment in Express Scripts Medicare depends on contract renewal. © 2019 Express Scripts Holding Company. All Rights Reserved

DIRECT PAYMENT AUTHORIZATION FORM Please read, sign and return with your Enrollment Forms Name (Last, First, Middle Initial): Phone: Street Address: City: State: Zip: Type of Account: Select Monthly Withdrawal Date:  Savings  Checking  1st  8th  15th Please fill in the below information: Routing Number: Account Number: Confirm Account Number: st Monthly payments are withdrawn on the 1 business day on or after the date you selected above. You will receive a confirmation from Amwins Group Benefits that we have set up your account information to withdraw from your designated bank account. Note: Your monthly deduction will show as Amwins on your bank statement. I authorize Amwins to withdraw my payment as communicated to me, by invoice or letter, from my checking or savings account. I agree to notify Amwins in writing or by phone, if my account information changes or to stop the direct debit authorization at least 10 days in advance of the scheduled transfer. I understand that the premium to be withdrawn may change, in which case I will be notified in writing at least 10 days before the new premium is withdrawn. To the extent I have enrolled in preauthorized checking, I understand that the addition or removal of a dependent will impact the amount withdrawn, and hereby consent to such change. I understand that Amwins will confirm the new preauthorized amount, but depending on when I submit this request, such confirmation may occur after the amounts are withdrawn from my account. If my account is erroneously charged, my financial institution will immediately credit the same amount to the account up to the 15 days following issuance of the statement or 45 days after posting, which occurs first. Signature: Date: Amwins Group Benefits, LLC: 50 Whitecap Drive, North Kingstown, RI 02852

WAIVER of COVERAGE If you DO NOT wish to enroll in the DePauw University Plan(s), please complete, sign and return this Waiver of Coverage form. Retiree Spouse (or Surviving Spouse) Name: Name: Address: Address: City: City: State: Zip Code: State: Zip Code: Please Sign & Date Below: NO, DO NOT ENROLL ME (us) in the DePauw University Plan(s). I (we) understand that by choosing this option, I am (we are) declining medical and prescription drug coverage, and may or may not be able to re-enroll at a later date. Retiree: Date: Spouse (or Surviving Spouse): Date: All applicable signatures are required for individuals declining coverage in the Plan. Reason for Declining Coverage:

ANSWERS to YOUR QUESTIONS Q: Who can I call if I have questions? Q: How are my medical claims paid? A: Please contact the Amwins Group Benefits A: As long as your physician accepts Medicare you Customer Care Center toll-free at 1-888-883-3757, will not have to send in any claim forms. Present Monday through Friday, from 8 a.m. to 8 p.m. ET. your ID card along with your Medicare card to your doctor. Medicare pays the provider of the Q: How does the plan work? Medicare portion of your claim and forwards the A: Medicare has coverage gaps which are the costs balance due to the claims administration that you must pay, like coinsurance, co-payments, department. Remaining amounts will be billed to and deductibles. This plan helps fill those gaps. You you. may go to any doctor, specialist, or hospital that accepts Medicare. Medicare pays its share and Q: Do I still need my Medicare ID Card? then your plan pays based on your plan’s benefits. A: Yes. You will continue to use your Medicare ID You will receive a Medicare Summary Notice in the card with this plan in conjunction with your Plan ID mail (in most cases each month), including card. information on the amount paid on your behalf and any additional amount due. Q: Do my prescription drug co-payments count toward my medical plan deductible? Q: Can my age 65 spouse enroll if I am not yet age A: No. Any co-payments you make for prescription 65? drugs do not count toward deductibles or out of A: Yes. As long as your spouse is eligible to pocket maximum amounts for your medical plan. participate in the Program and is age 65 or over. As soon as you become Medicare eligible, you can Q: How do I get my prescriptions filled? enroll on the first day of the month in which you A: Simply present your ID card and prescription to reach your 65th birthday. a participating pharmacy in the plan network. You will also receive information about mail order Q: My spouse is not yet 65. What will happen to prescriptions when you enroll. You can find more coverage for my spouse after I enroll in this plan? information about your prescription coverage by A: Your spouse will continue coverage under the visiting www.Express-Scripts.com or by calling pre-Medicare early retiree plan. Two months prior Amwins Group Benefits at 1-888-883-3757. to your spouse attaining age 65, a Medicare enrollment packet will be mailed. At that time, Q: Where can I get information on using Mail your spouse should contact Social Security to enroll Order Services? in Medicare Parts A and B in order to be eligible to A: Once you enroll in the plan, you will receive a enroll in the group Medicare Plan. fulfillment kit in the mail which will include mail order through the Express Scripts Pharmacy. Please Q: Will I have to re-enroll in the Plan next year? be aware that you will need to obtain new A: No, once you enroll, you remain in the plan until prescriptions from your Doctor before ordering you elect or terminate coverage. prescriptions from this new mail order program. The necessary forms and instructions on how to Q: When will I receive my ID Cards? order prescriptions through the mail order service A: ID cards will be sent once we process your will be included in your fulfillment packet. Please enrollment materials. Medical and Prescription expect your package and materials to arrive shortly Drug ID cards will arrive in two separate packages. before your plan effective date.

ANSWERS to YOUR QUESTIONS Q: How can I find out if my drugs are covered on Q: How do I pay for my coverage? the new plan? A: Your premium is deducted from your retiree A: You will receive a copy of the formulary (List of benefit check. Covered Drugs) in your fulfillment packet once you enroll. Some covered drugs may have additional Q: Can I enroll in a separate Medicare Part D plan requirements or limits on coverage. You can find and the Amwins medical and prescription plan? out if your drug has any additional requirements or A: No. You cannot enroll in two Medicare Part D limits by reviewing the formulary. If your drug is plans. If you enroll in a separate Medicare Part D not included on the formulary, you should first plan, you are not eligible to enroll in the Amwins contact us and ask if your drug is covered. Please medical plan and prescription drug plan. contact Amwins Group Benefits Customer Care toll- free at 1-888-883-3757 or visit www.Express- Q: How do I obtain a replacement ID card for my Scripts.com for more information about your plans? prescriptions. A: Call Amwins Group Benefits at 1-888-883-3757, Monday through Friday, from 8 a.m. to 8 p.m. EST. Q: How can I lower my drug expenses? A: Generic medications often cost less than brand- Q: What happens to coverage for a spouse if the name counterparts. Talk to your doctor to retiree dies? determine if a generic is available. You may also A: The spouse or family member of the retiree have the option of mail order, where you can should notify Amwins as soon as possible. The receive up to a 90-day supply for one mail order co- Surviving Spouse will have the option to remain on payment. the plans. Amwins will direct bill the surviving spouse for the monthly premium due. Q: What services are not covered? A: Services not covered by Medicare are not covered by this plan. Please contact us for the Medicare exclusion list. You may also call 1-800- MEDICARE or visit www.medicare.gov. Q: If I choose not to enroll this year, can I enroll next year? A: Yes, you will have the opportunity to enroll in the group plan at the next open enrollment, or if you have a qualified family status change. Q: Do I have the option to enroll in just medical or prescription drug coverage or do I have to enroll in both plans? A: The Amwins health benefit plan combines two separate plans into one package which includes both medical and prescription drug coverage. You may not elect the prescription drug coverage without participating in the medical plan, or vice versa. The premium for medical insurance includes the prescription drug benefit.

Disclaimer: The benefit information contained in this brochure is subject to change at any time, and the University reserves the unlimited right to make benefit plan changes at any time. Any changes to the benefit plans implemented by the University will be considered effective, regardless of whether notice has been given, on the date set by the University. If you are ever in doubt about your retiree medical benefits, please contact Amwins Group Benefits at 1-888-883-3757.