INTRODUCTION Huntington County Community School Corporation (the “Employer”) sponsors the Huntington County Community Schools Employee Health Plan (the "Plan"). The Plan has two components: (1) this document which describes the prescription benefits available through the Plan (“Rx Program”); and (2) the medical component administered by Anthem (“Medical Component Plan”). Prescription benefits provided under the Rx Program are described in this document and are exclusively provided under and subject to the terms of this document, except as specifically provided herein. Non-prescription medical benefits are available under the Medical Component Plan. Under no circumstance shall benefits be covered under both the Rx Program and the Medical Component Plan. This document and the Medical Component Plan are deemed to be the plan document and summary plan description. For purposes of simplicity, this document incorporates by reference the following provisions from the Medical Component Plan: Eligibility; enrollment and termination of coverage; coordination of benefit provisions; HIPAA Privacy and Security Rules; the appeal procedures (except as modified herein); COBRA continuation of coverage; subrogation and reimbursement rights; exclusions and limitations and ERISA information and rights; all of which shall be deemed to be fully set forth herein. RETAIL PHARMACY As a Participant in the Medical Component Plan, you are eligible for prescription benefits under the Rx Program. Your eligibility for benefits under the Rx Program ends on the date your coverage ends under the Medical Component Plan. The Rx Program uses a network of preferred pharmacies (“Participating Providers”) that have contracted with the Rx Program to charge Participants reduced fees for covered prescription drugs. In addition, certain drugs must be purchased at designated pharmacies. TrueScripts Managements Services, LLC (“TrueScripts”) provides claims processing and ministerial services for the Rx Program (but is not an insurer). Any reimbursement by the Rx Program is determined per prescription (“Script”) by the reimbursement levels described herein, which is applied to each covered drug charge and is shown on the Schedule of Benefits. Scripts that exceed the identified per script annual limit will be excluded and not considered eligible expenses under the Plan or this Rx Program. If a drug is purchased from a nonparticipating pharmacy or a Participating Pharmacy when the covered Participant’s ID card is not used, the Participant must pay the entire cost of the prescription, including copay, and then submit the receipt for direct reimbursement to TrueScripts at 513 E. South St., Washington, IN 47501 or www.truescripts.com, subject to the terms of the Rx Program. Huntington County Community Schools Prescription Benefits Program SPD January 1, 2025 Page 2 of 15