What Are My Benefits? Property of Bind Benefits, Inc., d/b/a Surest. All rights reserved © 2026. 15 The following chart shows the deductibles and out-of-pocket maximums for the Surest Plan. Benefit Features The Surest Plan In-Network Out-of-Network Deductible $0 $0 Out-of-Pocket Maximum per Plan Year Individual $4,000 $8,000 Family $8,000 $16,000 Notes: • Refer to the Surest mobile app for additional coverage information. • If you enroll in individual coverage, once you reach the out-of-pocket maximum for a Plan Year, Benefits are payable at 100% of the Eligible Expense during the rest of that Plan Year. • If you have other family members enrolled (Family coverage) in the Surest Plan, they have to meet their own individual out-of-pocket maximum until the overall family out-of-pocket maximum has been met. Once any enrolled family member has reached the individual out-of-pocket maximum, the Surest Plan will pay 100% of that individual’s Eligible Expenses for Covered Health Services for the rest of the Plan Year, even if the family out-of-pocket maximum has not yet been met. • You must pay any amounts greater than the out-of-pocket maximum if any Benefit, day, or visit maximums are exceeded, and for health care services that are not Covered Health Services. Expenses you pay for any amount in excess of the usual and customary amount will not apply towards satisfaction of the out-of-pocket maximum. • Your paycheck deductions for coverage will not apply towards satisfaction of the out-of-pocket maximum. • Except as specifically noted in the schedule of benefits in Section 5.1 (Covered Health Services) below, the amount applied to your in-network out-of-pocket maximum also applies to your out-of-network out-of-pocket maximum. The amount applied to your out-of-network out-of-pocket maximum does not apply to your in- network out-of-pocket maximum. 5.1 Covered Health Services Ambulance Services In-Network Out-of-Network Ambulance Services $225 copayment / transport $225 copayment / transport Notes: • Refer to the Surest mobile app for additional coverage information. • Out-of-network Ambulance Services copayment applies to the in-network out-of-pocket maximum. • Ground or air ambulance, as the Claims Administrator determines appropriate. Air ambulance is medical transport by helicopter or airplane. • Emergency ambulance services and transportation provided by a licensed ambulance service (either ground or air ambulance) to the nearest hospital that offers Emergency health services. • Ambulance service by air is covered in an Emergency if ground transportation is impossible or would put your life or health in serious jeopardy. • Non-Emergency ambulance transportation provided by a licensed ambulance service (either ground or air ambulance) between facilities only when the transport meets one of the following: − From an out-of-network Hospital to the closest in-network Hospital when Covered Health Services are required. − To the closest in-network Hospital that provides the required Covered Health Services that were not available at the original Hospital. − From a short-term acute care facility to the closest in-network long-term acute care facility (LTAC), in- network Inpatient Rehabilitation Facility, or other in-network sub-acute care facility where the required Covered Health Services can be delivered. • For purposes of this Benefit, the following terms have the following meanings: − “Long-term acute care facility (LTAC)” means a facility or Hospital that provides care to people with complex medical needs requiring long-term Hospital stay in an acute or critical setting.