© 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 ................................................................................................................. 43 7. Claims Procedures .................................................................................................................... 54 8. What Do I Do If My Claim Is Denied? ....................................................................................... 57 9. Continuation of Coverage ........................................................................................................ 67 10. What Else Do I Need to Know? ................................................................................................ 76 10.1 Important Administrative Information ............................................................................... 76 10.2 Coordination of Benefits ................................................................................................ 76 10.3 Subrogation, Overpayment and Reimbursement ............................................................ 83 10.4 Plan Administrator’s Responsibilities .............................................................................. 87 10.5 Other Information About Your Surest Plan ...................................................................... 88 11. Glossary ..................................................................................................................................... 90 12. Outpatient Prescription Drugs ............................................................................................... 100