Plan Year: 2025-2026

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Welcome to

Open Enrollment

Plan Year: 2025-2026

Welcome to Open Enrollment

Pick the best benefits for you and your family.

Osage Nation strives to provide you and your family with a comprehensive and valuable benefits package. We

want to make sure you’re getting the most out of our benefits—that’s why we’ve put together this Open

Enrollment Guide.

Open enrollment is a short period each year when you can make changes to your benefits. This guide will outline

all the different benefits offered, so you can identify which benefits are best for you and your family.

Elections you make during open enrollment will become effective on October 1, 2025. Employees hired after July

1, 2025, will be effective once you have completed your initial waiting period.

If you have questions about any of the benefits mentioned in this guide, please don’t hesitate to reach out to HR.

Table of Contents

Enrollment Information ........................................................................................................... 3

Health Insurance ...................................................................................................................... 4

Dental Insurance ...................................................................................................................... 9

Vision Insurance ..................................................................................................................... 10

Disability Income Benefits ..................................................................................................... 11

Life Insurance ......................................................................................................................... 12

Voluntary Benefits.................................................................................................................. 13

Flexible Spending Account ..................................................................................................... 16

Employee Assistance Plan ..................................................................................................... 17

Retirement Savings Plan ........................................................................................................ 18

Employer Annual Notices ...................................................................................................... 20

Contact Information............................................................................................................... 32

Welcome to Open Enrollment

Who is eligible?

If you’re a full-time employee at Osage Nation, you’re eligible to enroll in the benefits outlined in this guide. Fulltime employees are those who work 30 or more hours per week. In addition, the following family members are

eligible for medical, dental and vision coverage:

•

Spouse

•

Children to age 26

How to enroll?

Are you ready to enroll? The first step is to review your current benefits. Did you move recently or get married?

Verify all of your personal information and make any necessary changes in the Paycom Benefits Enrollment portal.

Once all your information is up to date, it’s time to make your benefit elections. The decisions you make during

open enrollment can have a significant impact on your life and finances, so it is important to weigh your options

carefully.

When to Enroll?

Open enrollment begins on August 1, 2025, and runs through August 31, 2025, for existing employees. The

benefits you choose during open enrollment will become effective on October 1, 2025.

New hires will enroll during your initial waiting period as outlined in your on-boarding process.

Changes outside of open enrollment?

Unless you experience a life-changing qualifying event, you cannot make changes to your benefits until the next

open enrollment period. Qualifying events include things like:

•

Marriage, divorce or legal separation

•

Birth or adoption of a child

•

Change in child’s dependent status

•

Death of a spouse, child or other qualified dependent

•

Change in residence

•

Change in employment status or a change in coverage under another employer-sponsored plan

Welcome to Open Enrollment

Health Insurance

Osage Nation offers coverage through the Blue Cross Native Blue network. This plan is designed to maximize

insurance coverage with the goal of keeping you and your covered family members healthy.

How to receive Native Blue In-Network Level of Benefits

To receive the Native Blue In-Network level of benefits a contracted Native Blue provider must be utilized. To

access the doctors and facilities that are in the Native Blue Network please go to the Blue Cross Blue Shield

member portal and select the provider search option.

www.bcbsok.com

The following is a brief summary of medical and pharmacy benefits. Please refer to the Blue Cross Summary Plan

Description for a detailed list of covered services.

Blue Cross Blue Shield

Services

Native Blue In-Network Approved

Services

Out-of-Network Approved

Services

Physician Visit Copay

Deductible, then 50%

Deductible

(Individual/Family)

$1,000 per person

Hospitalization

Inpatient

Outpatient

Home Health

MRI, CT, Complex Scans

Deductible, then 50%

Preventive Care

Deductible, then 50%

Emergency Room Copay

$200 copay

$200 Copay, Deductible, then

50%

Out-of-pocket Maximum

(Individual/Family)

Unlimited

$35

$60

$35

$60

Prescription Drugs

- Retail/Mail Order

- Generic

- Preferred

- Non-preferred

Mail Order – 90 Days 1x Copay

*Please be aware that the use of out-of-network providers and facilities could result in costs that are much

higher than the out-of-pocket costs stated in the grid above.

Welcome to Open Enrollment

Your Cost in 2025-2026

Osage Nation pays most of the employee costs for health insurance but a portion of the cost is the employee

responsibility. The per employee per month costs for each level of coverage in listed below.

Employee Monthly deductions

Employee Only

Employee & Spouse

Employee & Children

Employee & Family

$88.98

$572.02

$317.79

$826.25

Health Price Transparency Rule Machine Readable Files Requirements

Instructions for Self-Funded Accounts to access the Machine-Readable Files, each account has a unique link to a

webpage based on the account’s Employer Identification Number (EIN). This webpage is publicly available

without needing a log in. The process for accessing the Out-of-Network (Allowed Amounts) and In-Network

Machine-Readable Files will be the same.

1. Link to access: https://bcbsok.com/asomrf?EIN=731509406

Copy the above URL, paste it into the browser.

Price Comparison Tool:

Blue Cross provides a cost comparison tool that allows you to view the amount each provider or facility charges

for standard covered charges. This allows you to be an informed consumer when you select your providers.

Access the price comparison through the Blue Access for Members website: www.bcbsok.com.

Example of PPO Deductible

Being admitted to the hospital and the total charges are $2000. You pay $1000 to cover your annual deductible,

then 20% of the $1000 in charges that is left, for a total of $200. $1000 + $200 = $1200 is your responsibility.

If you go to the hospital again in the same year and have another $1,000 in charges, you would just be

responsible for 20% because you have met your annual deductible, so you would be responsible for $200 for

this visit.

Final Benefit Determination

Actual Benefits will be governed by The Summary Plan Description. Please refer to the Summary Plan

Description for clarifications, limitations, exclusions, and covered expenses not addressed in this Schedule of

Benefits. Summary of Benefits & Coverage located in Paycom Payroll portal.

Welcome to Open Enrollment

Wellness & Weight Management

Osage Nation is committed to keeping you healthy with the overall theme of removing barriers to care and

promoting wellness. Weight management including exercise, healthy eating, and a physician monitored

treatment plan will help you obtain a healthy balance now and help prevent future weight related health risks.

The wellness plan will cover weight loss medicine prescribed and monitored by your physician. Over the

counter or alternative options will not be covered by the plan.

Once your treatment plan is established, your physician will coordinate with Blue Cross for approval of weight

loss medications based on the Prior Authorization and Step Therapy process designed to encourage safe and

effective use of medications.

Prior Authorization

This program requires your doctor to request pre-approval, or prior authorization, for you to get benefits for

medications.

• Physician consultation includes BMI levels, chronic illnesses and other risk factors.

• Your doctor can find request forms at bcbsok.com/provider.

• Treatment decisions are between you and your doctor, but medications must be approved to be

covered under the weight management program.

Step Therapy

The Step Therapy program requires that you use a “preferred” medication before your benefit plan covers a

“non-preferred” medication.

Step 1: If possible, your doctor should prescribe a preferred medication that is right for your condition.

Step 2: If you and your doctor decide that a preferred medication is not right for you, or is not as good in

treating your condition, your doctor should submit a step-therapy exception to cover the non-preferred

medication. Your doctor can find these request forms at bcbsok.com/provider.

Lifestyle Management

The key to a successful weight loss program includes creating a lifestyle that will help attain and maintain your

ideal weight. Examples are listed below but coordinate with your physician to meet your lifestyle goals.

• Physical Activity such as walking

• Drinking Water

• Member Support through Blue Cross wellness tools

Watch for wellness information and tips to a healthier lifestyle information on a regular basis.

Notice: This program is not intended to be a substitute for professional medical advice, diagnosis or treatment.

Always consult with a qualified and licensed physician or other medical care provider and follow their advice

without.

Welcome to Open Enrollment

Pharmacy Benefit Tools

Easily manage your prescriptions online through the Blue Access for Members portal.

Save time and money by looking up a prescription, finding a pharmacy in your network or learn about ordering

prescriptions for home delivery.

Find medicines

Find a pharmacy

See

prescription history

Home delivery – 90-Day Supply

Skip the lines at the pharmacy

You can get medication sent directly to your door with home delivery provided by AllianceRx Walgreens Prime. It's

easy to get started with home delivery, sign up today.

Blue Cross for Members Tool – Your Online Resource

Would you like to know when your medical claims are paid and the payment amounts? Do you need to

confirm who in your family is included under your coverage? BAM, the secure member portal from Blue

Cross and Blue Shield of Oklahoma (BCBSOK), can help. Get immediate online access to health and

wellness information.

www.bcbs.com or download the mobile app

Welcome to Open Enrollment

Blue Cross Virtual Medical Visits – MD Live

Care When and Where You Need

MD Live, a leading virtual visits leader, lets you visit independently contracted MD Live board-certified doctors

when you may need care for non-emergency and pediatric health issues.

Reason for a Virtual Medical Visit

•

Instead of using Emergency Room or Urgent Care

Your Doctor is booked

While at home, work or on the go

Convenience with doctors available 24 hours a day, seven days a week

Most common reasons for visiting MD Live

•

Acne

Constipation

Fever

Pink Eye

Respiratory Problems

Sports Injuries

•

Allergies

Cough

Headache

Rash

Sinus Infection

Vomiting

Connect

Interact

Computer, smartphone,

tablet, or telephone

Real time Consultation with a

board-certified doctor

•

Mental Health

Earaches

Insect Bites

Cold & Flu

Sore Throat

Many more…

Diagnose

Prescriptions sent

electronically to a pharmacy

of your choice.

(When appropriate)

Activate MDLIVE now on the Blue App…

Get Connected today!

To register, you will need to provide your first and last name, date of birth and BCBSOK member ID number

Welcome to Open Enrollment

Dental Insurance

In addition to protecting your smile, dental insurance helps pay for dental care and usually includes regular

checkups, cleanings, and X-rays. Several studies suggest that oral diseases, such as periodontitis (gum disease),

can affect other areas of your body—including your heart. Receiving regular dental care can protect you and your

family from the high cost of dental disease and surgery.

The following chart outlines the dental benefits we offer.

Type of service

Amount Plan Pays

Preventive Services

Additional periodontal, tooth decay, gum disease and fluoride treatments may be available under

the Health through Oral Wellness (HOW) program based on dental evaluation.

100% - Exams, cleanings, X-rays

Deductible

Applies to basic and major services onl

$50 per covered member

Basic Services

Fillings, root canals, simple extractions - 90%

Major Services

Oral surgery, bridges, crowns - 60%

Annual Maximum

$1,500

Orthodontia

50% - Children to 19 years with $1,000 lifetime maximum per child

Monthly Payroll

Deductions

Employee only

Employee & Spouse

Employee & Child

Family

$0.00

$38.90

$71.60

$108.68

Welcome to Open Enrollment

Vision Insurance

Osage Nation vision insurance entitles you to specific eye care benefits. Our policy covers routine

eye exams and other procedures, and provides specified dollar amounts or discounts for the purchase of

eyeglasses and contact lenses.

Benefit

Description

Well Vision Exam

Focuses on your eyes and overall

wellness

Prescription Glasses

Frame

Lenses

Lens Enhancements

Contacts (Instead of

glasses)

Diabetic Eyecare Plus

Program

Monthly Payroll

Deductions

In-Network

Copay

$10

Out of Network

Allowance

Up to $45

Frequency

Every Plan Year

$25

$180 Allowance of Frames

$200 Allowance of Featured Brands

20% savings over the allowance

$70 Costco Frame Allowance

Single Vision

Lined Bifocal

Lined Trifocal

Polycarbonate lenses for dependent

children

Standard, Premium and Custom

Progressive lenses

Anti-Reflective coating

Average savings of 20-25% on other

lenses

$130 allowance; copay does not apply

Contact lens exam

Services related to diabetic eye disease,

glaucoma and age-related macular

degeneration. Ask your VSP doctor for

details

Employee only

Employee & Spouse

Employee & child

Family

Every Plan Year

Included with

Prescription

Copay

Included with

Prescription

Copay

Up to $70

Up to $30

Up to $50

Up to $65

Up to $50

Up to $60

Up to $150

$20

Every Plan Year

As Needed

$13.26

$26.11

$24.05

$36.93

VSP Mobile: www.vsp.com for discounts and provider information. Visit the Paycom Portal for

information on discount programs or the VSP mobile app

Welcome to Open Enrollment

Disability Income Benefits

Osage Nation provides full-time employees with short-term and long-term disability income benefits. Without

disability coverage, you and your family may struggle to get by if you miss work due to an injury or illness.

At Osage Nation, we want to do everything we can to protect you and your family. That’s why Osage Nation pays

for the full cost of short-term disability. Long-term disability insurance is on a voluntary basis with the employee

paying the full cost.

In the event that you become disabled from a non-work-related injury or sickness, disability income benefits will

provide a partial replacement of lost income. Please note, though, that you are not eligible to receive short-term

disability benefits if you are receiving workers’ compensation benefits.

Short-term Disability

Long-term Disability

Benefits Begin

1st day of accident

8th day of illness

PTO must be exhausted

After 26 Weeks

Benefits Payable

26 weeks

5 years

Percentage of Income

Replaced

60%

Maximum Benefit

$1,385

$6,000

100% Paid by Osage

Employee Paid

Based on Annual Salary

Calculated by Enrollment Portal

Employee Cost

Welcome to Open Enrollment

Basic Life Insurance

Life insurance can help provide for your loved ones if something were to happen to you.

Osage Nation pays for the full cost of this benefit—meaning you are not responsible for paying any monthly

premiums.

Life Insurance

Benefit

Accidental Death & Dismemberment

1.5 x Annual Salary

Minimum Benefit is $50,000

1.5 x Annual Salary

Minimum Benefit is $50,000

Age Reduction Schedule:

35% at age 65

50% at age 70

Beneficiary Information:

Update Beneficiary in Paycom or contact the Benefits Departments for assistance

Employee Monthly Costs

100% Paid by Osage

Voluntary Life Insurance

While Osage Nation provides basic life insurance, some employees may want to purchase additional life coverage.

With voluntary life insurance, you are responsible for paying the full cost of coverage through biweekly payroll

deductions. The chart below outlines the available coverage and monthly costs of purchasing additional

coverage.

Life Benefit

Voluntary Accident Benefit

Guarantee Issue Amounts subject

to New York Life guidelines

Evidence of Insurability

Employee

Up to 5x annual Salary in

$10,000 increments

Up to 5x annual Salary in

$10,000 increments

$160,000

Spouse to age 70

Up to 50% of Employee

Election

Up to 50% of Employee

Election

$40,000

Child(ren)

$10,000

Evidence is required for any amounts over the Guarantee Issue for initial enrollees

and for any increase in coverage to all existing employees and dependents

Portability

If you leave employment with Osage Nation request information options from New York Life.

Voluntary Life Rates

Age Band

Age Banded Rates

Employee and Spouse

18-29

30-34

35-39

40-44

45-49

Dependent Rate - $10,000

Per pay period deductions

Age Reduction

Rate per

$1,000

$0.103

$0.125

$0.180

$0.271

Age Band

Rate per

Age Band

$1,000

50-54

$0.431

75-79

55-59

$0.693

80-84

60-64

$1.062

85-89

65-69

$1.801

90-94

70-74

$3.418

95+

$2.00 per month

Calculations for benefit options provided in enrollment portal

Rate per

$1,000

$6.454

$12.040

$22.196

$36.216

$54.974

35% at age 65

50% at age 70

Not to exceed the $10,000 election band associated with reduction

Spouse cannot exceed 50% of employee reduced amount

Welcome to Open Enrollment

Colonial Life Voluntary Benefits

Colonial 24-Hour Accident Plan

Cash benefits are paid directly to employees. Helps protect savings and retirement plans 401(k)s from being depleted. Can help pay

the mortgage, continue rental payments, or perform needed home repairs for aftercare. See the plan brochure for a complete list of

coverage.

Benefit Examples

Coverage

Initial Hospital Confinement

$1,000

Daily Hospital Confinement

$200

Emergency Room Visit

$150

Urgent Care Accident Treatment

$75

Ambulance

$200

X-Ray

$100

Dislocation/Fracture

Varies by location and severity

See plan documents for a full schedule of benefits and coverage details.

Employee Only

Employee & Spouse

Employee + Child

Monthly Payroll

Deductions

$7.09

$10.64

$13.65

Family

$17.34

Colonial Life Critical Illness

The benefit is paid upon diagnosis of one of the following conditions and can be purchased in limits of $10,000 or $20,000. Benefits

pay directly to employees.

BENEFIT EXAMPLES



Heart Attack or Stroke (100%)

 Invasive Cancer (100%)

End Stage Renal Disease (100%)

 Carcinoma in Situ (25%)

Coronary Artery Bypass Surgery (25%)

 Advanced Parkinson’s Disease (100%)

Additional benefits and recurrence benefits vary on payout limits. See plan documents for details.

Critical Illness Rates

Non-Tobacco

Tobacco

Rates are based on age and smoker status.

Dependent benefit is 50% of the employee benefit amount

The enrollment portal will calculate payroll deductions based on benefits elected

AGE

18-29

30-39

40-49

50-59

60-74

$2.80

$6.10

$11.70

$20.00

$32.90

$10,000 BENEFIT

EE+CH

EE+SP

$2.80

$4.30

$6.10

$8.90

$11.70

$17.50

$20.00

$30.40

$32.90

$49.90

18-29

30-39

40-49

50-59

60-74

$3.70

$9.50

$18.60

$31.90

$52.40

$3.70

$9.50

$18.60

$31.90

$52.40

$5.70

$14.00

$27.70

$48.40

$49.60

FAM

$4.30

$8.90

$17.50

$30.40

$49.90

$5.70

$14.00

$27.70

$48.40

$49.60

$5.60

$12.20

$23.40

$40.00

$65.80

$20,000 BENEFIT

EE+CH

EE+SP

$5.60

$8.60

$12.20

$17.80

$23.40

$35.00

$40.00

$60.80

$65.80

$99.80

FAM

$8.60

$17.80

$35.00

$60.80

$99.80

$7.40

$19.00

$37.20

$63.80

$107.80

$7.40

$19.00

$37.20

$63.80

$107.80

$11.40

$28.00

$55.40

$96.80

$159.20

$11.40

$28.00

$55.40

$96.80

$159.20

Welcome to Open Enrollment

Colonial Life Voluntary Benefits

Colonial Life Hospital Indemnity

Cash benefits are paid directly to employees. Helps protect savings and retirement plans 401(k)s from being depleted. Can help pay

the mortgage, continue rental payments, or perform needed home repairs for aftercare. See the plan brochure for a complete list of

coverage

Benefit Examples

Initial Hospital Confinement

Daily Hospital Confinement

Intensive Care

Pregnancy Waiting Period

Monthly Payroll

Deductions

Coverage

$500

$100 – 10 days max

10 Months

See plan documents for a full schedule of benefits and coverage details.

Employee Only

Employee & Spouse

Employee + Child

$10.90

$24.39

$15.76

Family

$29.26

Colonial Life Rapid Pay Tribal Burial Plan

Provides Osage employees and covered dependents access to funds to pay for final expenses within 48 hours.

Policy Benefits

Coverage

Benefit Options

Eligible Members

Rapid Pay

Death Certificate Required

Rates

Benefit

$10,000

AGE

18-39

40-49

50-59

60-64

65+

$10,000 or $20,000

Employee, Spouse and Children to age 26

48-72 hours

No – funeral home or hospital verification required

Age based rates will calculate in enrollment portal

Employee Age

$2.40

$2.90

$4.00

$5.20

$9.20

Spouse Age

$2.40

$2.90

$4.00

$5.20

$9.20

Child(ren) to age 26

$2.80 per family unit

$20,000

18-39

$4.80

40-49

$5.80

50-59

$8.00

60-64

$10.40

65+

$18.40

Age Reduction applies to 65% at age 70 and 50% at age 75 for employee and spouse coverage.

Guarantee Issue for new hires in the initial enrollment period.

Evidence of Insurability is required for any member outside of the initial enrollment period.

See plan documents for specific details.

Welcome to Open Enrollment

Norton LifeLock Identity Theft

It is more important than ever to protect your identity with the increased exposure to cyber-crime. Identity theft will help you

monitor your exposure,

• Check your identity health score

• Get comprehensive identity and financial monitoring

• View and manage real time alerts

• Receive high-risk financial transaction alerts

• Depend on in-house customer care specialists 24/7

• Reply on $1 million identity expense coverage

• Protect you and family members

• And much more

Refer to detailed benefit guide located on your enrollment portal for coverages and plan restrictions

Identity Theft Monthly Rates

Family: $11.95

Employee Only: $5.95

Benefit Plan

Overview

Identity Theft Protection Device Security

•

LifeLock Identity Alert

System

Financial protections

Lifestyle protection

Social protection

Protective lock &

freeze dashboard

Online Privacy

•

Secure VPN

Data broker scanning and

removal assistance

(Privacy Monitor)

Solicitation reduction, ad

blocker

•

Norton Device Security

Online threat protection

Password manager

Child online safety tools

(Parental Controls)

Service & Support

•

Restoration &

remediation services

Dedicated phone line

and

email support

$3 Million Protection

Package

Welcome to Open Enrollment

Flexible Spending Accounts

Paying for health care, dental, hearing, and vision out-of-pocket costs can be stressful. That's why Osage Nation

offers an employer-sponsored flexible spending account (FSA). A health care FSA lets you use pre-tax dollars for

certain IRS-approved medical care expenses not covered by your insurance plan. For example, cash that you

now spend on deductibles, copayments, or other out-of-pocket medical expenses can instead be placed in the

health care FSA on a pre-tax basis.

What Are the Benefits of a Health Care FSA?

There are a variety of different benefits of using a health care FSA, including the following:

•

It saves you money. Allows you to put aside money tax-free that can be used for qualified medical

expenses.

•

It’s a tax-saver. Since your taxable income is decreased by your contributions, you’ll pay less in taxes.

•

It is flexible. You can use your FSA funds at any time, even if it’s the beginning of the year.

What Is a Dependent Care FSA?

Similar to health FSAs, dependent care FSAs allow you to contribute pre-tax dollars to qualified dependent care.

The maximum amount you may contribute each year is $5,000 (or $2,500 if married and filing separately).

Enrollment Required

Complete the FSA Enrollment on Paycom during open enrollment.

Health Care Reimbursement

Account

Annual Contribution

Maximum

Annual Roll Over Limit

Tax Status

Covered Expenses

IRS defined approved expenses as

outlined under the Section 125

Code. Approved expenses are

subject to change.

$3,300

$660 – excess balance will be forfeited

at end of plan year

Pre-tax subject to validation

Examples include:

• Out-of-pocket expenses for

Medical, Dental, Vision and

Hearing

• Eye Surgery or Vision Correction

Surgery

• Long Term Care

• Stop Smoking programs

• Weight Loss programs if it is to

treat a specific disease

Dependent Care Reimbursement

Account

$5,000 Joint with Spouse

$2,500 if married and filing separately

None – balance will be forfeited

Pre-tax subject to validation

Examples include:

• Child or Adult dependent care

• The cost for an individual to

provide care either in or out of

your house.

• Nursery schools and preschools

(excluding kindergarten)

• Note: Any amount elected must

be used by – September 30, 2025

Welcome to Open Enrollment

Employee Assistance Plan

Benefits You Receive:

The Employee Assistance Program is offered to all employees and immediate family members of Osage Nation. It is a completely

confidential counseling program that covers issues such as marital and family concerns, depression, substance abuse, grief and loss,

financial entanglement, and other personal stressors.

To use the EAP, simply contact the Employee Assistance Program toll-free to arrange for a free initial assessment interview. You may

be provided brief solution-based counseling, or you may be referred to outside resources for ongoing therapy.

Employee Assistance Program Services

918-594-5232



Free Confidential Assessment/Referral/FollowUp Services



24/7 Access for Emergency Situations



Face to Face Assessment Interview



Master-Level Licensed Counselors



Community Based Referrals



Many more…

Employee

Monthly

Costs

Free of Charge to employees and their immediate dependents

COMPLETELY CONFIDENTIAL

Welcome to Open Enrollment

Retirement Saving 401(k)

Osage Nation offers a 401(k) plan to all full-time employees on the first of the month following 60 days of employment. The reference

tool provides you with information to access and manage your plan through BOK Financial

Your Retirement Plan Summary

Osage Health Systems 401(k) Plan

How to register your

account on Start Right

(If you forget your Username

or Password, click on the

Forgot Username/ Forgot

Password.)

Start Right Website

startright.bokf.com

Start Right Retire Right

Download from the App Store or Google Play

1. Visit the startright.bokf.com or download the Start Right app from the App Store or Google Play

2. Don’t have a username? Click Register for online access or New User

3. Enter your social security number and date of birth.

4. Verify you are not a robot and click Register.

5. Create a New User ID and Password (must meet requirements and each item must have a green

check mark to continue)

6. Confirm your password and log back in with your new credentials.

7. A verification code will be sent to the phone number your employer has on file for you.

8. Enter the verification code when you receive it and click Submit.

Congratulations, you have completed the registration process for online account access!

Start Right Interactive Voice

Response System

You can check your account balance, loan balance or loan payment information at any time by

calling 1-800-876-9557. Enter your social security number and your Access code (last 4 digits of your

SSN plus the last 2 digits of your birth year) when prompted.

How to update your Profile

To verify/update your email address, phone number and beneficiaries click your name in the upper

right corner of the website or select profile on Start Right mobile.

How to add a

beneficiary

How to enroll in plan

To add/update your beneficiaries, log onto the Start Right website or Start Right mobile. You will need

the beneficiary’s name, address, social security number, and date of birth.

Check out the My RetireRight

Planner® to calculate how

much to save to reach your

goals.

Eligibility:

You are eligible to participate in the Plan the first day of each month following attainment of age 18 and

completion of 60 days

Auto Enrollment:

Following 60 days of service, you will be automatically enrolled in the plan on the first day of the

upcoming month.

•

Automatically withhold 5% of compensation

Pre-tax contribution

Target Date fund based on your date of birth

Enrollment:

To set a different contribution rate log onto UKG.

To select your own investments and designate your beneficiaries, you can enroll on the Start Right

website or Start Right mobile.

How to change your

contributions

The Roth Analyzer can help you

decide between Pre-tax or

Roth contributions.

Contributions limits:

You can contribute 1%-100% of your compensation (subject to other deductions from your pay, not to

exceed the maximum calendar year dollar amount set by federal regulations):

• The 2025 calendar year dollar amount limit is $23,000.

• If you are age 50 or older at any time during the calendar year and contribute the maximum

dollar amount, you can contribute an additional catch-up contribution of $7,500

Types of contributions:

• Pre-tax contributions – money is contributed on a before-tax basis; contributions and their

earnings are taxed when withdrawn.

• Roth contributions – money is contributed on an after-tax basis; no tax on withdrawals1

1Account must be held for at least five years, employee must be at least 59 1/2, deceased or disabled.

Welcome to Open Enrollment

Contribution rate changes:

To change your contribution, log onto the UKG payroll system. It will become effective as of the next

reasonable pay period.

Rollover contributions:

To roll a prior employer’s plan into this plan, download the rollover form on the Start Right website.

In-Plan Roth Transfers:

To transfer within the Plan fully vested pre-tax amounts in any contribution source to a

corresponding Roth after-tax source download the Roth Transfer form from plan forms.

• Minimum transfer: $1,000

• You will be required to pay federal and state (if applicable) income taxes with your individual

tax returns on the taxable amount of the transfer

Get your free money!

How to change your

investment selections

Employer Matching contributions:

• The employer intends to match dollar for dollar up to the first 5% you contribute. You must

make salary deferrals to the plan to receive the employer contribution.

Vesting schedule:

• 0 to 3 years of service: 0%

• 3 or more years of service: 100%

You may invest in any or all the options below:

• Core Investment Funds

• Target Date Funds

To make changes to your investments, log onto the Start Right website or Start Right mobile. The

Determine My Asset Allocation can help you create an investment mix that is right for you.

Financial planning services

For more detailed financial guidance from a licensed financial consultant, please contact your HR

department or Participant Services at 1-800-876-9557.

How to take a loan

To request or check the status of a loan, log onto the Start Right website.

Number of loans:

• Maximum of 1 outstanding loan at one time

Amount:

• Minimum: $1,000

• Maximum: 50% of vested account balance not to exceed $50,000

Terms:

• General loan: 5 years

Interest rate:

• National Prime Rate + 2

Fee:

• $100

How to withdraw money

You are allowed to take distributions from your account under certain circumstances. For more

information log onto the Start Right website.

Employee Pre-Tax or Roth Contributions & Employer Contributions (100% Vested):

You can take a distribution for the following reasons:

• Separation of service

• Attain age 59 ½

• Financial Hardship

Rollover account:

•

All or any portion can be withdrawn at any time

Welcome to Open Enrollment

Employee General Notices:

GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS

INTRODUCTION

This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of

coverage under the Plan. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and

what you need to do to protect the right to receive it.

Read this notice carefully to help understand your COBRA rights. Keep in mind that when you become eligible for COBRA, you may also

become eligible for other coverage options that may cost less than COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become

available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. This

notice does not fully describe COBRA continuation coverage or other rights under the Plan. For additional and more complete information about

your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan

Administrator.

You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an

individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on

your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group

health plan for which you are eligible (such as a spouse’s plan), even if that plan generally does not accept late enrollees.

WHAT IS COBRA CONTINUATION COVERAGE?

COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event known as a “qualifying

event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each

person who is a “qualified beneficiary.” You, your spouse and your dependent children could become qualified beneficiaries if coverage under the

Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage may be required to pay for

COBRA continuation coverage.

Employee

If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because either of the following qualifying

events happens:

•

Your hours of employment are reduced, or

•

Your employment ends for any reason other than your gross misconduct.

Spouse

If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following

qualifying events happens:

•

Your spouse dies.

•

Your spouse’s hours of employment are reduced.

•

Your spouse’s employment ends for any reason other than his or her gross misconduct; Your spouse becomes entitled to Medicare benefits

(under Part A, Part B or both); or

•

You become divorced or legally separated from your spouse. In the event your spouse, who is the employee, reduces or terminates your

coverage under the Plan in anticipation of a divorce or legal separation that later occurs, the divorce or legal separation may be considered a

qualifying event even though the coverage was reduced or terminated before the divorce or separation.

Dependent Children

Your dependent children (including any child born to or placed for adoption with you during the period of COBRA coverage who is properly enrolled in

the Plan and any child of yours who is receiving benefits under the Plan pursuant to a qualified medical child support order) will become qualified

beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:

•

The parent-employee dies.

•

The parent-employees’ hours of employment are reduced.

•

The parent-employee’s employment ends for any reason other than his or her gross misconduct; The parent-employee becomes entitled to

Medicare benefits (Part A, Part B or both).

•

The parents become divorced or legally separated; or

•

The child stops being eligible for coverage under the plan as a “dependent child.”

WHEN IS COBRA COVERAGE AVAILABLE?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event

has occurred. The employer must notify the Plan Administrator of the following qualifying events:

•

The end of employment or reductions of hours of employment.

•

Death of the employee.

•

The employee’s becoming entitled to Medicare benefits under Part A, Part B or both).

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for

coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must

provide this notice to the Plan Benefit Manager. The Plan procedures for this notice, including a description of any required information or

documentation, can be found in the most recent Summary Plan Description or by contacting the Plan Administrator. If these procedures are not

followed or if the notice is not provided in writing to the Plan Administrator during the 60-day notice period, you will lose your right to elect COBRA

continuation coverage.

Welcome to Open Enrollment

HOW IS COBRA COVERAGE PROVIDED?

Once the Plan Administrator receives timely notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the

qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may

elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. If

COBRA continuation coverage is not elected within the 60-day election period, a qualified beneficiary will lose the right to elect COBRA continuation

coverage.

COBRA continuation coverage is a temporary continuation of coverage.

When the qualifying event is the death of the employee, the employee's becoming entitled to Medicare benefits (under Part A, Part B or both),

your divorce or legal separation, or a dependent child's losing eligibility as a dependent child, COBRA continuation coverage may last for up to a

total of 36 months.

When the qualifying event is the end of employment or reduction of the employee’s hours of employment, COBRA continuation coverage generally

lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

Also, when the qualifying event is the end of employment or reduction of the employee's hours of employment, and the employee became entitled to

Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee

lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the

date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of

Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months).

Disability Extension

If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan

Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage,

for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and

must last at least until the end of the 18-month period of continuation coverage.

The Plan procedures for this notice, including a description of any required information or documentation, the name of the appropriate party to

whom notice must be sent, and the time period for giving notice, can be found in the most recent Summary Plan Description or by contacting the

Plan Administrator. If these procedures are not followed or if the notice is not provided in writing to the Plan Administrator during the 60-day

notice period and within 18 months after the covered employee’s termination of employment or reduction of hours, there will be no disability

extension of COBRA continuation coverage. The affected individual must also notify the Plan Administrator within 30 days of any final

determination that the individual is no longer disabled.

Second Qualifying Event Extension

If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in

your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying

event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving COBRA continuation

coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B or both) or gets divorced or legally

separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying

event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

The Plan procedures for this notice, including a description of any required information or documentation, the name of the appropriate party to

whom notice must be sent, and the time period for giving notice, can be found in the most recent Summary Plan Description or by contacting the

Plan Administrator. If these procedures are not followed or if the notice is not provided in writing to the Plan Administrator during the 60-day

notice period, there will be no extension of COBRA continuation coverage due to a second qualifying event.

ARE THERE OTHER COVERAGE OPTIONS BESIDES COBRA?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance

Marketplace, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), or other group health plan coverage options (such as a spouse’s plan)

through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more

about many of these options at www.healthcare.gov.

CAN I ENROLL IN MEDICARE INSTEAD OF COBRA CONTINUATION COVERAGE AFTER MY GROUP HEALTH PLAN COVERAGE ENDS?

In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment

period, you have an 8-month special enrollment period 1 to sign up for Medicare Part A or B, beginning on the earlier of

•

The month after your employment ends; or

•

The month after group health plan coverage based on current employment ends.

If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have

a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the

COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the

Welcome to Open Enrollment

date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of

Medicare after the date of the election of COBRA coverage.

If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation

coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare. For more information visit

https://www.medicare.gov/medicare-and-you.

IF YOU HAVE QUESTIONS

Questions concerning your Plan, or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more

information about your rights under ERISA, including COBRA, the Patient Protection and Affordable Care Act and other laws affecting group health

plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or

visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more

information about the Marketplace, visit www.healthcare.gov.

KEEP YOUR PLAN INFORMED OF ADDRESS CHANGES

To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a

copy, for your records, of any notices you send to the Plan Administrator.

PLAN CONTACT INFORMATION

Mary Lee

Benefits Administrator

Osage Nation Human Resources

239 W 12th Street, Pawhuska, OK 74056

Phone: (918) 287-5235

Email: MLee@osagenation-nsn.gov

HIPAA PRIVACY NOTICE

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it

carefully.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of health and claims records

•

You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.

•

We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable,

cost-based fee.

Ask us to correct health and claims records

•

You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.

•

We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

•

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

•

We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

Ask us to limit what we use or share

•

You can ask us not to use or share certain health information for treatment, payment, or our operations.

•

We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a list of those with whom we’ve shared information

•

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it

with, and why.

•

We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such

as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one

within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper

copy promptly.

Choose someone to act for you

•

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make

choices about your health information.

•

We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

•

You can complain if you feel we have violated your rights by contacting us.

•

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200

Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

Welcome to Open Enrollment

•

We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in

the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

•

Share information with your family, close friends, or others involved in payment for your care

•

Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in

your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

•

Marketing purposes

•

Sale of your information

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Help manage the health care treatment you receive

We can use your health information and share it with professionals who are treating you.

Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.

Run our organization

•

We can use and disclose your information to run our organization and contact you when necessary.

•

We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not

apply to long term care plans.

Example: We use health information about you to develop better services for you.

Pay for your health services

We can use and disclose your health information as we pay for your health services.

Example: We share information about you with your dental plan to coordinate payment for your dental work.

Administer your plan

We may disclose your health information to your health plan sponsor for plan administration.

Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we

charge.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and

research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

We can share health information about you for certain situations such as:

•

Preventing disease

•

Helping with product recalls

•

Reporting adverse reactions to medications

•

Reporting suspected abuse, neglect, or domestic violence

•

Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see

that we’re complying with federal privacy law.

Respond to organ and tissue donation requests and work with a medical examiner or funeral director

•

We can share health information about you with organ procurement organizations.

•

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

•

For workers’ compensation claims

•

For law enforcement purposes or with a law enforcement official

•

With health oversight agencies for activities authorized by law

•

For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

•

We are required by law to maintain the privacy and security of your protected health information.

•

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

•

We must follow the duties and privacy practices described in this notice and give you a copy of it.

Welcome to Open Enrollment

•

We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may

change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request,

on our web site, and we will mail a copy to you.

•

Effective Date of this Notice is October 1, 2025

•

Submit requests to Osage Nation privacy officer, Julio Nunez, Director of Human Resources at julio.nunez@osagnation-nsn.gov.

HIPAA SPECIAL ENROLLMENT NOTICE

This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice

even if you plan to waive coverage at this time.

Loss of Other Coverage

If you are declining coverage for yourself or your dependents (including your spouse) because of other health insurance or group health plan

coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or

if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after

your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

Example: You waived coverage because you were covered under a plan offered by your spouse's employer. Your spouse terminates his

employment. If you notify your employer within 30 days of the date coverage ends, you and your eligible dependents may apply for

coverage under our health plan.

Marriage, Birth or Adoption

If you have a new dependent because of a marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents.

However, you must request enrollment within 30 days after the marriage, birth or placement for adoption.

Example: When you were hired by us, you were single and chose not to elect health insurance benefits. One year later, you marry. You and your

eligible dependents are entitled to enroll in this group health plan. However, you must apply within 30 days from the date of your marriage.

If you or your dependents lose eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP) or become eligible for a

premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents. You must request enrollment within 60

days of the loss of Medicaid or CHIP coverage or the determination of eligibility for a premium assistance subsidy.

Example: When you were hired by us, your children received health coverage under CHIP, and you did not enroll them in our health plan. Because of

changes in your income, your children are no longer eligible for CHIP coverage. You may enroll them in this group health plan if you apply within 60

days of the date of their loss of CHIP coverage.

PLAN CONTACT INFORMATION

Mary Lee

Benefits Administrator

Osage Nation Human Resources

239 W 12th Street, Pawhuska, OK 74056

Phone: (918) 287-5235

Email: MLee@osagenation-nsn.gov

WOMEN’S HEALTH AND CANCER RIGHTS ACT

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998

(WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending

physician and the patient, for:

•

All stages of reconstruction of the breast on which the mastectomy was performed.

•

Surgery and reconstruction of the other breast to produce a symmetrical appearance.

• Prostheses; and

• Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under

this plan. If you would like more information on WHCRA benefits, call your plan administrator.

NEWBORNS AND MOTHERS HEALTH PROTECTION ACT

Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection

with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section.

However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging

the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that

a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Welcome to Open Enrollment

DEPENDENT TO AGE 26

Due to a change in the laws governing your employer’s Group Health Plan, your children generally can be covered until the plan until age 26, regardless

of their student or marital status and regardless of whether your home is their principal place of abode or whether you support them. The dependents

are eligible for coverage regardless of eligibility on another employer group health plan.

MENTAL HEALTH PARITY

According to the Mental Health Parity Act of 1996, the group health plan is prohibited from offering benefits that contain annual and/or lifetime

dollar maximums for mental health or substance abuse benefits that are more restrictive than limitations imposed on benefits for medical or

surgical benefits. However, mental health benefits may be limited to a maximum number of treatment days per year or series per lifetime.

GENETIC INFORMATION NONDISCRIMINATION ACT (GINA)

The Genetic Information Nondiscrimination Act applies to your Group Health Plan. This law establishes a basic uniform national standard to protect

the public from discrimination based on genetic information.

HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS

Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace

(“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance

Marketplace and health coverage offered through your employment.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping"

to find and compare private health insurance options in your geographic area.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium and other out-of-pocket costs, but only if your employer does not offer coverage, or

offers coverage that is not considered affordable and doesn't meet certain minimum value standards (discussed below). The savings that you're eligible

for depends on your household income. You may also be eligible for a tax credit that lowers your costs.

Does Employment-Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you

will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employmentbased health plan. However, you may be eligible for a tax credit, and advance payments of the credit that lowers your monthly premium, or a reduction

in certain cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet

minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12%i of your annual

household income, or if the coverage through your employment does not meet the "minimum value" standard set by the Affordable Care Act, you may

be eligible for a tax credit, and advance payment of the credit, if you do not enroll in the employment-based health coverage. For family members of

the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does

not exceed 9.12% of the employee’s household income. ii

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may

lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution -as well as your employee

contribution to employment-based coverage- is generally excluded from income for federal and state income tax purposes. Your payments for coverage

through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet

the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of

these factors in determining whether to purchase a health plan through the Marketplace.

When Can I Enroll in Health Insurance Coverage through the Marketplace?

You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but

generally starts November 1 and continues through at least December 15.

Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify

for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility

for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life

event to enroll in a Marketplace plan.

It is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn

more, visit HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325.

What about Alternatives to Marketplace Health Insurance Coverage?

If you or your family are eligible for coverage in an employment-based health plan (such as an employer-sponsored health plan), you or your family

may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were

enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an

employment-based health plan. Confirm the deadline with your employer or your employment-based health plan.

Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through

your state Medicaid agency. Visit https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/ for more details.

Welcome to Open Enrollment

How Can I Get More Information?

For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact

human resources.

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit

HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance

Marketplace in your area.

MEDICARE PART D NOTICE

Important Notice About Your Prescription Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage through

your employer and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to

join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost,

with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make

decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare

Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans

provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

Your employer has determined that the prescription drug coverage offered by the employer health plan is, on average for all plan participants,

expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because

your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to

join a Medicare drug plan.

When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 to December 7.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month

Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current coverage will be affected. You can keep this coverage if you elect part D and this plan will not

coordinate with Part D coverage. If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents

will only be able to get this coverage back during open enrollment or a special enrollment period.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with your employer and don’t join a Medicare drug plan within 63 continuous days

after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare

base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable

coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher

premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

Contact the person listed below for further information NOTE: You’ll get this notice each year. You will also get it before the next period you can join a

Medicare drug plan, and if this coverage through your employer changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the

handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

•

Visit www.medicare.gov

•

Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their

telephone number) for personalized help

•

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help,

visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans,

you may be required to provide a copy of this notice when you join to show whether or not you have

maintained creditable coverage and, therefore, whether or not you are required to pay a higher

Welcome to Open Enrollment

PLAN CONTACT INFORMATION

Mary Lee

Benefits Administrator

Osage Nation Human Resources

239 W 12th Street, Pawhuska, OK 74056

Phone: (918) 287-5235

Email: MLee@osagenation-nsn.gov

PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium

assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for

Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the

Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to

find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of

these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you

qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must

allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request

coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan,

contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The

following list of states is current as of March 17, 2025. Contact your State for more information on eligibility –

ALABAMA – Medicaid

ALASKA – Medicaid

Website: http://myalhipp.com/

Phone: 1-855-692-5447

The AK Health Insurance Premium Payment Program

Website: http://myakhipp.com/

Phone: 1-866-251-4861

Email: CustomerService@MyAKHIPP.com

Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspx

ARKANSAS – Medicaid

CALIFORNIA – Medicaid

Website: http://myarhipp.com/

Phone: 1-855-MyARHIPP (855-692-7447)

Health Insurance Premium Payment (HIPP) Program Website:

http://dhcs.ca.gov/hipp

Phone: 916-445-8322

Fax: 916-440-5676

Email: hipp@dhcs.ca.gov

COLORADO – Health First Colorado (Colorado’s Medicaid

Program) & Child Health Plan Plus (CHP+)

FLORIDA – Medicaid

Health First Colorado Website: https://www.healthfirstcolorado.com/

Health First Colorado Member Contact Center:

1-800-221-3943/State Relay 711

CHP+: https://hcpf.colorado.gov/child-health-plan-plus

CHP+ Customer Service: 1-800-359-1991/State Relay 711

Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/

HIBI Customer Service: 1-855-692-6442

Website:

https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hip

p/index.html

Phone: 1-877-357-3268

Welcome to Open Enrollment

GEORGIA – Medicaid

INDIANA – Medicaid

GA HIPP Website: https://medicaid.georgia.gov/health-insurancepremium-payment-program-hipp

Phone: 678-564-1162, Press 1

GA CHIPRA Website: https://medicaid.georgia.gov/programs/thirdparty-liability/childrens-health-insurance-program-reauthorization-act2009-chipra

Phone: 678-564-1162, Press 2

Health Insurance Premium Payment Program

All other Medicaid

Website: https://www.in.gov/medicaid/

http://www.in.gov/fssa/dfr/

Family and Social Services Administration

Phone: 1-800-403-0864

Member Services Phone: 1-800-457-4584

IOWA – Medicaid and CHIP (Hawki)

KANSAS – Medicaid

Medicaid Website:

Iowa Medicaid | Health & Human Services

Medicaid Phone: 1-800-338-8366

Hawki Website:

Hawki - Healthy and Well Kids in Iowa | Health & Human Services

Hawki Phone: 1-800-257-8563

HIPP Website: Health Insurance Premium Payment (HIPP) | Health &

Human Services (iowa.gov)

HIPP Phone: 1-888-346-9562

Website: https://www.kancare.ks.gov/

Phone: 1-800-792-4884

HIPP Phone: 1-800-967-4660

KENTUCKY – Medicaid

LOUISIANA – Medicaid

Kentucky Integrated Health Insurance Premium Payment Program (KIHIPP) Website:

https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx

Phone: 1-855-459-6328

Email: KIHIPP.PROGRAM@ky.gov

KCHIP Website: https://kynect.ky.gov

Phone: 1-877-524-4718

Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms

Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp

Phone: 1-888-342-6207 (Medicaid hotline) or

1-855-618-5488 (LaHIPP)

MAINE – Medicaid

MASSACHUSETTS – Medicaid and CHIP

Enrollment Website:

https://www.mymaineconnection.gov/benefits/s/?language=en_US

Phone: 1-800-442-6003

TTY: Maine relay 711

Private Health Insurance Premium Webpage:

https://www.maine.gov/dhhs/ofi/applications-forms

Phone: 1-800-977-6740

TTY: Maine relay 711

Website: https://www.mass.gov/masshealth/pa

Phone: 1-800-862-4840

TTY: 711

Email: masspremassistance@accenture.com

MINNESOTA – Medicaid

MISSOURI – Medicaid

Website:

https://mn.gov/dhs/health-care-coverage/

Phone: 1-800-657-3672

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

Phone: 573-751-2005

MONTANA – Medicaid

NEBRASKA – Medicaid

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

Phone: 1-800-694-3084

Email: HHSHIPPProgram@mt.gov

Website: http://www.ACCESSNebraska.ne.gov

Phone: 1-855-632-7633

Lincoln: 402-473-7000

Omaha: 402-595-1178

Welcome to Open Enrollment

NEVADA – Medicaid

NEW HAMPSHIRE – Medicaid

Medicaid Website: http://dhcfp.nv.gov

Medicaid Phone: 1-800-992-0900

Website: https://www.dhhs.nh.gov/programsservices/medicaid/health-insurance-premium-program

Phone: 603-271-5218

Toll free number for the HIPP program: 1-800-852-3345, ext. 15218

Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov

NEW JERSEY – Medicaid and CHIP

NEW YORK – Medicaid

Medicaid Website:

http://www.state.nj.us/humanservices/

dmahs/clients/medicaid/

Phone: 1-800-356-1561

CHIP Premium Assistance Phone: 609-631-2392

CHIP Website: http://www.njfamilycare.org/index.html

CHIP Phone: 1-800-701-0710 (TTY: 711)

Website: https://www.health.ny.gov/health_care/medicaid/

Phone: 1-800-541-2831

NORTH CAROLINA – Medicaid

NORTH DAKOTA – Medicaid

Website: https://medicaid.ncdhhs.gov/

Phone: 919-855-4100

Website: https://www.hhs.nd.gov/healthcare

Phone: 1-844-854-4825

OKLAHOMA – Medicaid and CHIP

OREGON – Medicaid and CHIP

Website: http://www.insureoklahoma.org

Phone: 1-888-365-3742

Website: http://healthcare.oregon.gov/Pages/index.aspx

Phone: 1-800-699-9075

PENNSYLVANIA – Medicaid and CHIP

RHODE ISLAND – Medicaid and CHIP

Website: https://www.pa.gov/en/services/dhs/apply-for-medicaidhealth-insurance-premium-payment-program-hipp.html

Phone: 1-800-692-7462

CHIP Website: Children's Health Insurance Program (CHIP) (pa.gov)

CHIP Phone: 1-800-986-KIDS (5437)

Website: http://www.eohhs.ri.gov/

Phone: 1-855-697-4347, or

401-462-0311 (Direct RIte Share Line)

SOUTH CAROLINA – Medicaid

SOUTH DAKOTA - Medicaid

Website: https://www.scdhhs.gov

Phone: 1-888-549-0820

Website: http://dss.sd.gov

Phone: 1-888-828-0059

TEXAS – Medicaid

UTAH – Medicaid and CHIP

Website: Health Insurance Premium Payment (HIPP) Program | Texas

Health and Human Services

Phone: 1-800-440-0493

Utah’s Premium Partnership for Health Insurance (UPP) Website:

https://medicaid.utah.gov/upp/

Email: upp@utah.gov

Phone: 1-888-222-2542

Adult Expansion Website: https://medicaid.utah.gov/expansion/

Utah Medicaid Buyout Program Website:

https://medicaid.utah.gov/buyout-program/

CHIP Website: https://chip.utah.gov/

VERMONT– Medicaid

VIRGINIA – Medicaid and CHIP

Welcome to Open Enrollment

Website: Health Insurance Premium Payment (HIPP) Program |

Department of Vermont Health Access

Phone: 1-800-250-8427

Website: https://coverva.dmas.virginia.gov/learn/premiumassistance/famis-select

Website: https://coverva.dmas.virginia.gov/learn/premiumassistance/health-insurance-premium-payment-hipp-programs

Medicaid/CHIP Phone: 1-800-432-5924

WASHINGTON – Medicaid

WEST VIRGINIA – Medicaid and CHIP

Website: https://www.hca.wa.gov/

Phone: 1-800-562-3022

Website: https://dhhr.wv.gov/bms/

http://mywvhipp.com/

Medicaid Phone:

304-558-1700

CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

WISCONSIN – Medicaid and CHIP

WYOMING – Medicaid

Website:

https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm

Phone: 1-800-362-3002

Website: https://health.wyo.gov/healthcarefin/medicaid/programsand-eligibility/

Phone: 1-800-251-1269

To see if any other states have added a premium assistance program since March 17, 2025, or for more information on special enrollment rights,

contact either:

U.S. Department of Labor

Employee Benefits Security Administration

www.dol.gov/agencies/ebsa

1-866-444-EBSA (3272)

U.S. Department of Health and Human Services

Centers for Medicare & Medicaid Services

www.cms.hhs.gov

1-877-267-2323, Menu Option 4, Ext. 61565

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless

such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct

or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is

not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also,

notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of

information does not display a currently valid OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties

are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for

reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA

Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control

Number 1210-0137.

NO SURPRISE BILLING NOTICE

Your Rights and Protections Against Surprise M edical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are

protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a

deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s

network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted

to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.”

This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an

emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or

facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these

emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your

protections not to be balanced billed for these post-stabilization services.

Welcome to Open Enrollment

As of February 2021, the following 18 states had enacted comprehensive Balance Billing Protections: California, Colorado, Connecticut, Florida,

Georgia, Illinois, Maine, Maryland, Michigan, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon Texas, Virginia, Washington.

As of February 2021, the following 15 states had enacted limited Balance-Billing Protections: Arizona, Delaware, Indiana, Iowa, Massachusetts,

Minnesota, Mississippi, Missouri, Nebraska, Nevada, North Carolina, Pennsylvania, Rhode Island, Vermont, West Virginia.

Generally, those state passed protections apply to fully insured medical plans governed by the specific state and not self-funded medical plans.

Check the state insurance commissioner website for details on specific state laws.

If your state is not listed, check your state commissioner's website as states may adopt a surprising billing mandate at any time.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases,

the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology,

radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask

you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up

your protections.

You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can

choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if

the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

Your health plan generally must:

Cover emergency services without requiring you to get approval for services in advance (prior authorization).

Cover emergency services by out-of-network providers.

Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that

amount in your explanation of benefits.

Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact the US Department of Health & Human Services at 1-877-696-6775 or your State

Insurance Commissioner.

DISCLAIMERS

This booklet gives you an overview of the primary features of your benefit plans. The plans are administered according to the legal plan documents

and insurance contracts. Although we have tried to summarize the provisions of these legal documents clearly and accurately, if any information

contained herein conflicts with the legal documents, the legal documents will govern. All benefits are subject to change from time to time and your

employer reserves the right to amend or cancel any benefits described in this booklet, with or without notice.

The intent of this booklet is to provide you with general information regarding the status of and/or potential concerns related to your current

employee benefits environment. It should not be construed as, nor is it intended to provide, legal advice. Laws may be complex and subject to

change. This information is based on current interpretation of the law and is not guaranteed. Questions regarding specific issues should be

addressed by legal counsel who specializes in this practice area.

Welcome to Open Enrollment

Contact Information

Osage Nation offers you and your eligible family members a comprehensive and valuable benefits program. See below for information

on our benefit carriers. You can find all plan documents on the PAYCOM Payroll System. If you have any questions, please contact

your Benefits Department.

Medical and Prescription Drugs:

Flexible Spending (FSA)

Customer Service: 800-672-2567

Pharmacy Assistance: 877-546-2779

Web Address: www.bcbsok.com

Client Services: 800-339-7493

Web Address: www.britulsa.com

Blue Cross Blue Shield of Oklahoma

Delta Dental of Oklahoma

Benefit Resources, Inc.

Vision Service Plan

Client Services: 800-522-0188

Web Address: www.DeltaDentalOK.org

Customer service 800-877-7195

Web Address: www.vsp.com

Life & Disability Insurance

Life: Policy# FLX967181

LTD: Policy# LK964929

ADD Policy# OK968689

STD: Policy# SHD962885

Accident -Hospital Indemnity – Critical Illness

Burial Expense

Web Address: www.ColonialLife.com/access

Online Portal for members

MD Live – Virtual Visit

Call MD Live: 888-676-4204

Web Address: www.MDLIVE.com/BCBSOK

Employee Assistance Program

Customer Service 800-827-2377 or 918-877-9685

Identity Theft and Cyber Security

Web Address: www.Norton.com/benefitplans

Phone: 800-607-9174

Osage Nation – Benefits Department

Mary Lee

Benefits Administrator

Osage Nation

239 W. 12th St, Pawhuska, OK 74056

Phone: 918-287-5235

Email: MLee@osagenation-nsn.gov

Broker Contact Information:

Chimento Insurance Agency

Account Executive: Sue Chimento

Phone: 918-291-1406

Email: sue@chimentoinsurance.com

Welcome to Open Enrollment

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.