Insurance Renewal Summary — Health, Dental, Vision, and Life Coverage

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insuranceNGGarrier Village of RedMILLL€DPHPSCURRENTPLAN J”Hook, 05/01/2026 Sign + Date: CDPHP-RENEWAL PLAN _ ‘ CDPHP [] United Healthcare MVP Anthem =) | MVP Bronze 2 EPOc CDPHP Qualified HDEPO (HSA) | CDPHP Qualified HDEPO (HSA) | COPHP Qualified HDEPO (HSA) | Bronze Choice Open Access NG (Not HSA Qualified) Anthem Bronze Blue Access (421) (421) (424) 35/60/6150/70 EPO “Exchange Certified Plan” EPO 25/75 6300 50% wiHSA Plan Name "Exchange Certified Plan” "Exchange Certified Plan” "Exchange Certified Plan“ EP3M = National Network su0G Metal Level ee Bronze Bronze _. Bronze Bronze Ded. Type Embedded Embedded Aggregate/Embedded Aggregate/Embedded Embedded Agareaats. = Plan Type HDHF EFO HDHP EPO HOHP EPO EPO EPO EPO HOHP Annual INN Ded. individual $7,050 $7,108 | $6,100 36,150 $6,150 $6,300 Annual INN Ded. Family $14,100 $14,200 $12,200 $12,300 $12,300 $12,600 N/A, (100% after Ded, DME & RX q . | Ded Then 50% (DME), 30% (50% after ded. DME); (20% Coinsurance (In-Network) in PCP/SpecialistFacility) Office/OP ||Nin ('00%P aferpa PCP/SpecialistDed ThenOffice/OP 20%(RX inFacility) Ded then 30% after ded,Office/OP RX in PCP/SpecialistFacility) Ded then 50% Annual INN OOP Limits $7,050/$14,100 $7,100/$14,200 $7,800/$15,000 $9,200/$ 18,400 $8,900/$17,800 $8,450/$16,900 Annual OON Ded, NA NIA NIA NIA NIA NIA Coinsurance (Out of Network) WA N/A NIA N/A NIA NIA Annual OUT OOP Limits NA NA NIA NA NIA NIA Primary Care Visit 100% after ded. 100% afler ded. $40 Copay after ded. $35 Copay after ded. a visits at pean 39 copay $25 Copay after ded. ae — Specialist Visit 100% after ded, 100% 9, after ded, $60 Copay after ded. $0$60 Copay Copayafterafter ded.: ded.: D N $60 Capay after ded. $75 Copay after ded. Inpatient Hospital 100% after ded. | 100% after ded. $1,000 Copay after ded. 30% after ded. 30% after ded. 50% after ded. ‘ 100% after ded.; Gost Share may || 100% after ded.; Cost Share may be [$175 Capay after ded.; Cost Share $300 capay after ded.- $300 Copay Bud Beds-Gire No Charge-Amb. Surgery Center Outpatient Surgery be fess Preferred Center less Preferred Center may be less-Preferred Center PCP/Freestanding Facility/Hospital $0 after ded,-PreferredHospital Facility 50% after Ded.-OPFacility Surgery Urgent Care 100% after ded. 100% after ded. $80 Copay after ded, $60 Copay after ded. $60 Copay after ded. $100 Copay after ded. Emergency Room 100% after ded. 400% after ded. $350 Copay after ded. $350 Copay after ded, $350 Copay after ded. 50% after seaeay waived if ] Outpatient. Lab 100% after ded/Preferredis Lab/OP|} | 100% after ded./Preferred Lab/OP 100% after ded.-Preferred7 Lab 4. $35 Copay after ded. $60 after$35 ded.-Specialis¥OPCopay afteroeded.-PCPHosp. 50% after ded.-Preferred‘5 || HospitalV/Office HospitavOffice $60 after ded.-OP Haspital/Office $0 after$35 Copay ded.-Preferredafter ded-PCP Facility Lab/Office/OP Hospital Outpatient X-Ray 100% after ded/Preferred° 100% after ded./PreferredA Center/OF | 100% after ded.-Preferred Center;7 $35 Capay after ded. $60 after ded.-SpecialisyOPer Hosp, 50% after ded.-Office/ Center/OP Hospital/Office HospilaVOffice $60 after ded.-OP Hospital/Office $0 after ded.-Preferred Facility OP Hospital/Freestanding Center Rx Ded. Integrated ded. Integrated ded, Integrated ded. Integrated ded. Integrated ded. Integrated ded. 100%/100%/100% Preferred Rx 100%/100%/100% Preferred Rx 10/50/80 Preferred Rx 10/40/60 Tier 1/Tier 2/Tier 3 50% cost share for pharmacies |) 50% cost share for pharmacies not irj|50% cost share for pharmacies not 10/40/60 Preventative RX - Subject to 50%/50%/50% | not in Preferred Network Preferred Network in Preferred Network deductible Creditable Coverage YES YES YES YES YES NO AM Best Rating*** Not Listed Not Listed Not Listed At Not Listed A les 5 OM, RATESSingle Plan Rate § $879.47 $1,072.20 $1,066.85 $1,050.64 $1,085.18 $1,255.76 ed Employee/Spouse Plan Rate 41 $1,758.94 $2,144.40 $2,133.70 $2,101.28 $2,170,36 $2,511.52 eat . # |q 4 EmplaFamil y ee/Child(ren)Plan Rate Plan Rate 23 $ 21 , 506495 . 4910 $ 31 , 055822 .7 74 $ 31 , 040813 . 5265 $ 12 , 786994 . 0934 $ 13 , 844092 . 8176 $ 23 , 134578 . 7992 Monthly Total _ $16,665.96 $20,318.19 $20,216.81 $19,909.63 $20,564.16 $23,796.66 . Annual Total $199,991.52 $243,818.28 $242,601.72 $238,916.16 $246,769.92 $285,559.92 ly \ hy4Qh Annual Difference $43,826.7622% $42,610.2021% $38,924.6419% $46,778.4023% $85,568.40:43% ew ilo. ony: Pediatric Dental & Vision a dependents perAdditionalnder age cost 19: $18.45 addedfamily x tounit. max dependents 3 dependentsx maxjAdditianal 3 dependentscost under added ageper ta 19: family $18.45 ___Ineluded in Rates Included in Rates Includedin Rates | HRAHRA SetFUNDING up Fees/PEPM:ANALYSIS | $0.00/$3.50 $0.00/$3.50 $250/$3.25 $0.00/$2.25 HRA Funding” Individual 5 $7,050.00 j $7,050.00 $7,050.00 $7,050.00 $7,050.00 $7,050.00 Family 6 $14,100.00 } $14,109.00 $14,100.00 $14,100.00 $14,100.00 $14,100.00 HRA Utilization { A 100% $119,850.00 | $119,850.00)! $119,850.00 $119,850.00 $119,850.00 $119,850.06 7 60% $71,910.00 | ‘ $71,910.00 | $71,910.00 $71,910.00 $71,910.00 $71,910.00 Total at 60% Utilization ) $271,901.52 $315,728.28 $314,511.72 $310,826.16 $318,679.92 $357,469.92 Annual Difference $43,826.76 $42,610.20 $38,924.64 $46,773.40 $85,568.40 = . _ _ 16% _ 7 16% _ 14% AT% 31% wR rary THYn >5OF.P50% Teta and bar Secept pet cmon and esbenton glypons ony ate er tarpon fr the aura care. Final tte sat be based es enurenc cane envienaron 2nd fel eaclar lofi ----- End of picture text -----

C3 erent Life Insurance Company RASHELTERPOINT = |EveyrrenFax: 516504 6412 (main) | 516.504 6436 (service) | 516.504.6414 (claims)| ' Phone: 800.365.4999 (516.829.8100) www.[shelterpoint.com]

C3

February 6, 2026

FNA INSURANCE SERVICES INC 1000 WOODBURY ROAD SUITE 403 WOODBURY, NY 11797

RE: Policyholder: VILLAGE OF RED HOOK Group Policy #: GVNY26251 Policy Effective Date: 05/01/2015

Dear Broker:

_

We have completed our annual renewal evaluation of your client’s group vision coverage.

After careful consideration and review, we have established our pricing for the upcoming policy year. The following are the current rates as of the date of this letter and the renewal rates effective on 05/01/2026.

Rates are guaranteed for a period of 12 months and are subject to the terms, conditions and provisions of the group insurance policy. Please provide this information to the policyholder.

It is our intent to provide your client with the best possible relationship of benefit costs to the products we provide. Please be assured that our analysis has been completed with this in mind. We appreciate the opportunity to provide your client with benefits and look forward to continuing our relationship. If you have any questions regarding our assessment, please do not hesitate to contact your sales rep, MICHAEL POST at 516-237-9760.

Very. truly yours,

ShelterPoint Life Insurance Company Underwriting Dept.

cc: MICHAEL POST

VILLAGE OF RED HOOK GROUP PLAN # 00778763

Renewal Rates At-a-Glance

This plan is currently offered for Insurance Class 1 and 2

|

Guardian Life Insurance Company of America

4

Anniversary Date: May 1, 2026

Account Number: 1155661

Renewal rates

Effective May 1, 2026

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Group term life - rates are expressed as per $1,000 ; ALL MEMBERS | Volume Current monthly Renewal monthly P Current rate ; Renewal rate . Lives premium premium | — $0.16 $74.70 $0,199 $89.55 ‘Renewal [rates] [are] [guaranteed] [through] [April] [30,] | [2027.] Accidental Death & Dismemberment - rates are expressed as per $1,000 Active members only i | Volume Current monthly | Renewal monthly . Current rate 7 Renewal rate . eee Liveseee eee ee premium — premium— ae $0.034 | $15.30 $0.034 $15.30 Renewal rates are guaranteed through April 30, 2027. Your rates aren't changing. - _ ----- End of picture text -----

© Principal

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Principal Life Insurance Company Des Moines, lowa 50392 ©2017-2020 Principal Financial Services, Inc.

Insurance issued by Principal Life Insurance Company®, Des Moines, 1A 50392 GP61123-24 3

06/2025