YOUR MEDICAL PLAN OPTIONS ARE CHANGING!

OPEN ENROLLMENT FOR 2022 BENEFITSNOVEMBER 1 - 15 | MYBENEFITS.PACCAR.COM

YOUR MEDICAL PLAN OPTIONS ARE CHANGING!

OPEN ENROLLMENT DEADLINENovember 15, 2021 I Before 10:00pm Pacific Time

Plan Changes ...................................................................................................................................................................................... 3

What You Need To Do ........................................................................................................................................................................ 4

The Basics of PACCAR Benefits ......................................................................................................................................................... 5

New High Deductible Health Plan (HDHP) and Health Savings Account (HSA) ......................................................................... 6

Comparing HSAs and FSAs ............................................................................................................................................................... 7

Plan Comparison Chart (Medical) ..................................................................................................................................................... 8

Plan Comparison Chart (Prescription Drugs) .................................................................................................................................. 9

Plan Comparison Chart (Dental & Vision) ........................................................................................................................................ 10

2022 Plan Rates .................................................................................................................................................................................. 11

Consider a Tax Advantaged Account ............................................................................................................................................... 12

Special Features of the PACCAR Premera Medical Plan ................................................................................................................ 13

Diabetes Programs ............................................................................................................................................................................. 14

PACCAR Employee Assistance Program (EAP) by Magellan ......................................................................................................... 15

Helpful Websites & Phone Numbers ................................................................................................................................................ 17

Notices ................................................................................................................................................................................................. 18

2 U.S. Salaried Employees

WHAT’S IN THIS BOOKLET


BUSINESS TRAVEL ACCIDENT

Aggregate Benefit Limit: If more than one insured person is injured in the same accident, the maximum amount payable for all such losses combined will not exceed $15,000,000 per accident.

FLEXIBLE SPENDING ACCOUNTS

FSA Debit Card RenewalIf you enrolled in a Healthcare FSA for 2022 and your FSA debit card was originally issued in 2019, you will receive a new one in the mail from HealthEquity by the end of 2021, regardless of whether you activated the old card or not.

The FSA debit card is active for three years from the issue date. The expiration date is displayed on the debit card. If you need additional cards for your dependents, log into your HealthEquity account through mybenefits.paccar.com, or call the HealthEquity Customer Service at 1-877-924-3967.

This Plan Changes section constitutes a Summary of Material Modification (SMM) of the U.S. Salaried health and welfare plans effective January 1, 2022. If there is any discrepancy between what is provided in this guide and the official plan documents, the plan documents will prevail.

PLAN CHANGESNEW MEDICAL OPTION

PACCAR has added a High Deductible Health Plan and an optional Health Savings Account (HDHP/HSA). Read all about it on page 6.

ADDITIONAL PREMERA PLAN CHANGES

Medical Option A The individual deductible for Option A will change to $450. The family deductible will be $1,350.

Medical Option DThis option will be eliminated effective 1/1/2022. You can enroll in another option during open enrollment. If you are currently enrolled in Option D and do not select a new plan for 2022, you will be enrolled in Option A for 2022.

Specialty Drug Savings ProgramThe SaveOnSP program has been added. If you are eligible to participate, you will receive a letter from SaveOnSP or a referral from Accredo for more information about the program and how to enroll. See page 9 for more information.

Colorectal Cancer Screening Age LimitThe USPSTF recommends screening for Colorectal Cancer in adults at the age of 45 years old (rather than 50). Effective 1/1/2022, Premera will update the age limit for Colorectal Cancer Screening. The change is in response to recommendations from the U.S. Preventive Services Task Force (USPSTF).

New ID CardsPremera will issue new ID cards to enrolled employees and their family members.

1. Go to mybenefits.paccar.com. Use Chrome, Microsoft Edge or Safari for best results.

2. Click on the “Forgot User ID or Password?” link. See screenshot on the right.

3. Follow the prompts.

Step-by-step password reset instructions are available under the “Reset Password” tile of mybenefits.paccar.com.

Need help? Contact your local HR.

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U.S. Salaried Employees

WHAT YOU NEED TO DO

PACCAR Open Enrollment is your chance to enroll or make changes to your medical, dental/vision, flexible spending accounts, health savings account, life and AD&D benefits for 2022.

OPEN ENROLLMENT CHECKLIST REMEMBER! OPEN ENROLLMENT IS YOUR CHANCE TO:

READY TO ENROLL?Where: Online at mybenefits.paccar.comWhen: November 1 through 15, 2021Deadline: Before 10:00pm Pacific Time on November 15Effective Date of Changes: January 1, 2022

Questions: Contact your local HR Department

ADD OR REMOVE DEPENDENTS

CHANGE LIFE AND/OR AD&D ELECTIONS

CHANGE YOUR MEDICAL OPTION

ENROLL IN AN FSA OR HSA ACCOUNT

� Read this Booklet � Learn About the New Medical Option & HSA � Log into mybenefits.paccar.com � Make Your Benefit Elections

3 Change and/or Elect Benefits 3 Update Your Life and AD&D Beneficiaries 3 Update Your Personal Information Including

Your Email, Address and Phone Number

Log Qualifying Status Changes Print Confirmation

Update Benefits

OPEN ENROLLMENTDEADLINE

November 15, 2021 Before 10:00pm

Pacific Time

Update Address, Email, Phone


ELIGIBLE DEPENDENTS HEALTH PLANS

� Your lawful spouse, unless legally separated. Lawful means a legal union of two persons that was validly formed in any jurisdiction.

� Your biological or adopted children until age 26.

� Your children who are physically or mentally incapable of supporting themselves. Child must be incapacitated prior to age 26, unmarried and dependent on you for major support. Proof of disability required.

� You and your spouse’s stepchildren, foster children or children to age 26 for whom you or your spouse has obtained legal guardianship.

IF YOU MISS OPEN ENROLLMENT

� You will need to wait until the next annual Open Enrollment to make any changes to your medical, dental/vision, FSA or life and AD&D elections.

� If you have a qualifying life event (e.g. marriage, birth, divorce) during the year, you may be able to make benefit changes consistent with your life event.

� It is recommended that you submit your changes within 30 days of your life event on mybenefits.paccar.com. Supporting documentation and approval may be required by Corporate Benefits (see COVID-19 related deadline changes on page 19).

THE BASICS OF PACCAR’S BENEFITSCOMPLETE ENROLLMENT ONLINE

mybenefits.paccar.com

All benefit election changes must be made online at mybenefits.paccar.com. This website provides plan details, coverage levels, premiums and more.

If there is any discrepancy between what is provided in this guide and the official plan documents, the plan documents will prevail.


NEW HIGH DEDUCTIBLE HEALTH PLAN (HDHP) AND HEALTH SAVINGS ACCOUNT (HSA)

Annual Deductible1 $1,400/Individual $4,200/Family

Coinsurance2 20%

Preventive Care Covered in Full No Deductible

More details on the HDHP covered benefits page 8.

A Health Savings Account (HSA) is a savings account that lets you set aside money on a pre-tax basis to pay for eligible medical expenses. HSAs offer the triple tax advantage:

� Pre-tax savings � Tax-free investment earnings � No tax when used to pay for eligible medical expenses.

You own your HSA. You don’t have to use your savings within the calendar year. Balances rollover from one year to the next. Your savings go with you if you leave PACCAR.

HIGH DEDUCTIBLE HEALTH PLAN (HDHP OPTION)

HEALTH SAVINGS ACCOUNT(HSA)

In 2022 PACCAR is introducing a new Medical Option called a High Deductible Health Plan (HDHP). Enrollment in the HDHP Option makes you eligible for PACCAR’s new Health Savings Account (HSA).

Medical Option C and the new HDHP Option look similar but there is a difference in how the deductibles will be applied to your claims.

You must be enrolled in the PACCAR HDHP Option to participate in PACCAR’s HSA.

How PACCAR Medical Options’ Deductibles Work

Type of Care Medical Options A, B and C HDHP Option

Preventive Care No Deductible Applied No Deductible Applied

Prescription Drugs No Deductible, Copays Apply Family* Deductible Must be Met, Then Copays Apply

Teladoc No Deductible, Copay Applies Family* Deductible Must be Met, Then Copay Applies

If there is any discrepancy between what is provided in this guide and the official plan documents, the plan documents will prevail.


COMPARING HSAs AND FSAsHealth Savings Account Healthcare FSA

Account Owner Employee PACCAR

Contribution Limits $3,650 (Individual Plan) $7,300 (Family Plan) $2,750

Health Plan Eligibility Must be Enrolled in the HDHP Option Not Available if Enrolled in HDHP Option

Fund Availability As They are Contributed On First Day of Plan Year

Tax Savings• Contributions are Tax Free• Withdrawals for Qualified Medical Expenses are Tax-Free• Investment Earnings on the Account Balance are Tax-Free

Contributions are Tax-Free

Rollover HSA Funds Rollover Year-to-Year and Never Expire Unused Balance Forfeited Annually

Investment Capability Yes No

Portability Yes – HSA Stays with the Employee No Portability

Can Cover COBRA Costs Yes No

Can Cover Retirement Medical Costs Yes No

Administrator Fidelity HealthEquity

HEALTH SAVINGS ACCOUNT (HSA)

The HSA is an individual savings account that is available to people enrolled in the HDHP Option. Eligible contributions are tax-deductible, and you can use your HSA money tax-free to pay for qualified medical expenses for you, your spouse, and your qualified dependents. You choose how to invest your HSA money for potential growth. Investment returns are not taxed.

HSA CONTRIBUTIONS

Annual Minimum: $120Annual Maximum: $3,650/Individual

$7,300/Family

HSA contributions can be changed once a month at mybenefits.paccar.com. Changes will take effect the first of the following month.

If you’re age 55 or older at the beginning of the tax-year, you may be eligible to make an additional $1,000 catch-up contribution.

ELIGIBILITY

You’re eligible to open and contribute to a PACCAR HSA if:

1. You’re enrolled in the HDHP Option

2. You’re not covered by an ineligible health plan

3. You’re not enrolled in Medicare

4. You cannot be claimed as a dependent on someone else’s tax return

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KEY POINTS


PLAN COMPARISON CHART

This Plan Comparison section constitutes a Summary of Material Modification (SMM) of the U.S. Salaried health and welfare plans effective January 1, 2022. If there is any discrepancy between what is provided in this guide and the official plan documents, the plan documents will prevail.

PLAN FEATURESPACCAR MEDICAL PLAN

Option A Option B Option C HDHP Option

In-Network In-Network In-Network In-Network

Eligible Dependents Lawful spouse; children to age 26

Preventive Care (Not subject to annual deductible1)

Covered in full

Emergency Room $150 copay per visit; remaining expense subject to annual deductible1 then 20% coinsurance2. Copay waived if admitted.

Deductible, $150 copay per visit then 20%

coinsurance

Outpatient Lab and X-ray 20%2

Annual Deductible1 $450 Individual$1,350 Family

$700 Individual$2,100 Family

$1,400 Individual$4,200 Family

$1,400 Individual$4,200 Family Aggregate5

Your Coinsurance2 20%2

Chiropractic Care 20%2 (limited to 30 visits per calendar year)

Maternity Care 20%2

Physician Visits 20%2

Urgent Care 20%2

Annual Out-of-Pocket Limit3



$6,500 Individual

$13,000 Family

$6,500 Individual

$13,000 Family

Teladoc $10 copay After deductible, $10 copay

GLOSSARY

1 Annual Deductible – amount you pay before the plan begins paying for covered services. Preventive care and prescription drugs not subject to annual deductible.

2 Coinsurance – after meeting the annual deductible, the amount you pay, as a % of the allowable charge4.

3Annual Out-of-Pocket Limit – the most you pay per calendar year for covered medical services, including prescription drugs. Deductible, coinsurance andcopays count toward out-of-pocket limit.

4Allowable Charge – fee agreed upon by BCBS Association and the provider as the maximum charge. For out-of-network services, your provider may bill you for any amount above the allowable charge. Providers who receive COVID related relief funds cannot balance bill patients.

5Aggregate Deductible - the entire family deductible must be paid before the Plan pays for services for any family member

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All PACCAR Medical Options include

coverage for prescription drugs through Express Scripts, a pharmacy benefit manager. This coverage is not available separately.

IMPORTANT NOTESON PACCAR MEDICAL PLANS

The plan comparison chart is only a sample of the services covered. All information is based on in-network charges. For information on other, specific services covered by the PACCAR Health Plan call 1-888-PACCAR-5 or refer to the Employee Benefits Handbook on mybenefits.paccar.com.

For out-of-network provider services, you pay 40%2 of the allowable charge4 plus any amount over the allowable charge4 for most covered services.

An in-network provider has an agreement with the PACCAR Health Plan Administrator and agrees to accept the allowable charge4 as payment in full.

An out-of-network provider is not bound to negotiated rates. If the provider charges you more, you will be responsible for paying the balance over the allowable charge4.


PLAN FEATURES

Copay/Coinsurance Not Subject to Deductible

Subject to Annual Deductible, then

Copay/Coinsurance

Option A Option B Option C HDHP OptionIn-Network In-Network In-Network In-Network

Generic

Preferred Brand Name

Non-Preferred Brand Name

Retailcopay / coinsurance

Mail Ordercopay / coinsurance

(Up to 30-day supply) (Up to 90-day supply)

$10 $20

30%$30 minimum$75 maximum

30%$75 minimum

$180 maximum

50%$50 minimum

$125 maximum

50%2

$125 minimum$300 maximum

NEWAvailable through PACCAR Medical Plans

Visit pillpack.com or call 866-332-1668 to get started.

Order or refill mail-order prescriptions by logging into your Premera account at premera.com. You may also call Premera Customer Service at 1-888-PACCAR-5 for refills.

Start the Mail Order Program today to save time and money.

If you are currently taking or will be taking certain specialty medications, you may be able to participate. If you are eligible to participate, you will receive a letter from SaveOnSP or a referral from Accredo for more information about the program and how to enroll.

Not included in the HDHP Option.

• Pre-sorted dosages• Packaged by date & time• Free Delivery

Express Scripts Mail Order Program

SaveOnSP PillPack Provides:

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PLAN COMPARISON CHARTPACCAR DENTAL PLAN

Adult (members age 19 and over)

Pediatric(members under age 19)

Annual Deductible1 $50 per individual limited to $150 per family

$50 per individual limited to $150 per family

Individual Benefit Maximum

Benefits for preventive, basic and major care are

limited to $1,500 per calendar year

Benefits for preventive, basic and major care are unlimited

Preventive Care(Not subject to annual deductible1)

100% of allowable charges4 100% of allowable charges4

Basic Care 20%2 20%2

Major Care 40%2 40%2

Orthodontia(Not subject to annual deductible1)

50%2; limited to $2,000 individual lifetime maximum

Medically necessary: 50%2; no benefit limit per calendar

year

Cosmetic: 50%2; $2,000 individual lifetime maximum

PACCAR VISION PLANVision Exam 100% allowable charges4

Vision HardwareCovered at 100% of allowable charges4 for any

combination of lenses, frames or contact lenses; limited to $250 per calendar year for adults and children

PACCAR Dental & Vision Plans are provided through Premera Blue Cross.

To locate an in-network provider log in at premera.com and select Find a Doctor from the menu or call Customer Service at 888-PACCAR-5 Monday through Friday, 6 a.m. to 6 p.m. (Pacific Time).

1, 2, 4 See page 8 for glossary definitions.

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KEY POINTS


2022 PLAN RATES

Semi-Monthly Medical Employee Contributions*

PACCAR MEDICAL PLAN COSTSOption A Option B Option C HDHP Option

Below Salary Grade 35

Employee $99.00 $78.50 $44.50 $36.00

Employee +1 $197.50 $139.00 $85.50 $69.00

Family $297.00 $204.50 $129.50 $104.50

Semi-Monthly Dental/Vision Employee Contributions

PACCAR DENTAL/VISION PLAN COSTS

All Employee Grades

Employee $7.21

Employee +1 $14.11

Family $20.99

* Employees grades 35-44 pay an additional $20/$30/$40 (employee/employee +1/family) per month; Employees grades 45 and above pay an additional $40/$60/$80 (employee/employee +1/family) per month; Tobacco users pay an additional $30 per month.

Get the best healthcare for you and your family

REFERRALS TO QUALITY, IN-NETWORK PROVIDERS

EXPERT SECOND OPINIONS

NEED A PRIMARY CARE DOCTOR? GRAND ROUNDS HEALTH AND

PREMERA CAN HELP

Use a Grand Rounds advisor to find a high-quality in-network doctor that can meet your personal needs. To get started, call 855-PACCAR-9 or visit grandrounds.com/paccar.

Use the find a doctor tool on premera.com or call Premera customer service at 888-PACCAR-5.


HEALTHCARE FSA DEPENDENT CARE (DAYCARE) FSA HEALTH SAVINGS ACCOUNT (HSA)

Description of Account

This plan lets you set aside pre-tax dollars through payroll deductions, spread over 24 pay periods, for eligible healthcare expenses for you and your eligible dependents.

This plan lets you set aside pre-tax dollars through payroll deductions, spread over 24 pay periods, for eligible dependent care expenses such as daycare to allow you and your spouse to work or attend school full time.

An individual savings account that is available to people enrolled in a the HDHP Option. Eligible contributions are tax-deductible, and you can use your HSA money tax-free to pay for qualified medical expenses for you and your qualified dependents. You choose how to invest your HSA money for potential growth. Investment returns are not taxed.

Annual Contributions

• Annual Minimum: $120• Annual Maximum: $2,750• No waiting- access full annual amount

regardless of year-to-date payroll contributions.

• Annual Minimum: $120• Annual Maximum: $5,000 (highly-

compensated employees may have a lower maximum)

• Can only access available balance in your FSA account.

• Annual Minimum: $120• Annual Maximum: $3,650/Individual

$7,300/Family• Can only access available balance in

your HSA account.

Eligible Expenses

Go to www.HealthEquity.com for a detailed list of eligible expenses.

Go to www.HealthEquity.com for a detailed list of eligible expenses.

Go to www.fidelity.com/go/hsa/how-to-spend for a list of eligible expenses.

Important Account Limitations

• Use it or lose it!• Employees enrolled in the HDHP are not

eligible to enroll in the Healthcare FSA.

• Use it or lose it!• Only available for children under 13

Go to www.HealthEquity.com for details on eligible dependents.

• Must be enrolled in HDHP• Cannot be enrolled in Healthcare FSA• Cannot be enrolled in Medicare• Cannot be claimed as a dependent on

someone else's tax return.

DeadlinesHealthcare expenses must be incurred by March 15, 2023 and claims submitted by April 30, 2023.

Dependent Care expenses must be incurred by December 31, 2022 and claims submitted by March 31, 2023.

No deadline as long as you incurred your qualified medical expense after you established your HSA.

Debit CardsAutomatically sent after enrollment. Activation of the card disables automatic reimbursement.

Not Applicable. Automatically sent after enrollment. Cards arrive within 7-10 days.

Reminder: Healthcare FSA Debit Card: As soon as you activate your debit card, the automatic reimbursement option, available to PACCAR Plans through Premera Blue Cross, will be turned off for you. If you want to switch back to automatic reimbursement, you can turn it back on by logging into your HealthEquity account through mybenefits.paccar.com.

REMEMBER! WITH A TAX ADVANTAGED ACCOUNT: You have to enroll every year during the annual Open Enrollment.

CONSIDER A TAX ADVANTAGED ACCOUNT

Teladoc provides a variety of telemedicine services, including general medical and mental health from the comfort of home. You can even get a prescription sent to your local pharmacy, if medically necessary.

Get StartedDownload the free Teladoc app or call 1-855-332-4059.

Find the best doctors in your network

Grand Rounds Health can help you:• Find a top-rated doctor who’s

in-network, nearby and accepting new patients

• Get an expert second opinion• Answer your difficult medical

questions.

Get StartedDownload the free Grand Rounds Health app, visit grandrounds.com/PACCAR, or call 1-855-PACCAR-9 between 8am - 9pm ET.

Consult with a nurse by phone to discuss symptoms and where to go for care.

Get StartedThe phone number is at the back of your Premera Blue Cross ID Card.

Your call is free and confidential at1-888-PACCAR-5.

TELADOC GRAND ROUNDS 24-HOUR NURSELINE


SPECIAL FEATURES OF THE PACCAR PREMERA MEDICAL PLAN

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KEY POINTS


Omada is a lifestyle change program to help you lose

weight, gain energy and reduce the risk of type 2 diabetes and

heart disease.

omadahealth.com/paccar

Livongo provides diabetes management tools including

a connected device, test strips and lancets, all delivered

to your home.

join.livongo.com/paccar

Virta is a clinically-proven treatment to control type

2 diabetes by reducing blood sugar and A1c levels,

eliminating the need for medication.

virtahealth.com

14

PACCAR supports you in the prevention and management of prediabetes and diabetes with these programs.

All at no additional cost to you and your dependents enrolled in a PACCAR Medical Plan administered by Premera Blue Cross.

PREVENT MANAGE CONTROL

DIABETES PROGRAMS PART OF YOUR PACCAR PREMERA MEDICAL PLAN

DISCOUNTS OFFERED THROUGH MAGELLAN/LIFE MART

Access real savings on real life needs• Car buying and services • Child and elder care • Financial and legal products • Furniture, appliances, electronics and more

Access the Magellan Healthcare Discounts: 1. Go to MagellanAscend.com. 2. Click on “Find My Company/Log In.” 3. Find your division in the drop-down menu, or select

“PACCAR Inc” if you cannot find your division then click on “Go.”

4. On the Magellan homepage under “Explore” click on the Discount Center

Questions? Call Magellan Healthcare at 1-800-523-5668


1-800-523-5668MagellanAscend.com

The Employee Assistance Program (EAP) is available to you and your household members even if you’re not enrolled in a PACCAR health plan. Get started today. Call your EAP at 1-800-523-5668 or visit MagellanAscend.com

EMPLOYEE ASSISTANCE PROGRAM (EAP)

KEY FEATURES• Up to 5 free counseling

sessions• Confidential services

provided by a third party• Available 24/7/365

COUNSELING • Get help with anxiety, grief,

depression, relationships and more

• Counselors are available in-person, by text, live chat, phone or video

LIFESTYLE COACHING• Your coach helps you

develop action-based solutions and remain accountable

• Coaches are available by phone or video

SELF-CARE PROGRAMS• Emotional wellness

coaching apps help you reduce stress, build resilience and improve sleep

• Programs are personalized

PACCAR EMPLOYEE ASSISTANCE PROGRAM


PACCAR EMPLOYEE ASSISTANCE PROGRAM

Free Employee Assistance Program Apps

myStrength

Available to All Employees and Families via Magellan

myStrength is a digital self-care program that has 30-plus topics and thousands of activities to help you live your best life.

Get Started:• Go to magellanascend.com• Click the blue

“Find My Company/Log In”• Enter “PACCAR Inc” or select your

division from the drop-down list• In the “Explore” section, click on the

“Self-Care Programs” icon• Click on “Get Started”

BetterHelp is confidential virtualtherapy and offers an alternative form of traditional, in-person counseling.

Sessions are available via:• Text messaging• Live phone chat• Live video chat• Live chat session

To get started, go tobetterhelp/magellan and click on“Get Started” or call 800-523-5668.

PACCAR MEDICAL PLAN (PREMERA) � In-Network Directory: premera.com, then select “Find a Doctor” or call Grand Rounds 855-PACCAR-9

� 888-PACCAR-5 (888-722-2275) for: • Premera Customer Service (M-F 5am-8pm Pacific Time)

• Medical/Dental/Vision/Prescription Plan Information (including PillPack)

• 24-Hour Nurseline• Teladoc• Omada • Livongo• Virta Health• PACCAR Designated Centers of Excellence

GRAND ROUNDS HEALTH 855-PACCAR-9 GRANDROUNDS.COM/PACCAR

FLEXIBLE SPENDING ACCOUNT (FSA) � HealthEquity.com (formerly WageWorks) � HealthEquity Customer Service: 877-924-3967

HEALTH SAVINGS ACCOUNT (HSA) � 401k.com � Fidelity Customer Service: 800-835-5098

DEPENDENT CARE REFERRAL SERVICES � MagellanAscend.com � Magellan 24 Hour Support: 800-523-5668

TOBACCO CESSATIONQuit For Life Program � Quitnow.net � Customer Service: 866-QUIT-4-LIFE (866-784-8454)

EXPERIAN FREE CREDIT MONITORING � Premera.com (log into your account) � Customer Service: 888-PACCAR-5 (888-722-2275)

PACCAR LIFE AND AD&D � MetLife Customer Service: 800-638-6420 � Travel Assistance Services• webcorp.axa-assistance.com

• Username: axa• Password: travelassist

• AXA Customer Service:• US: 800-454-3679• International: 312-935-3783 (collect)

EMPLOYEE DISCOUNTS � Magellan - MagellanAscend.com � PACCAR - mybenefits.paccar.com

EMPLOYEE ASSISTANCE PROGRAM (EAP) � MagellanAscend.com � Magellan Customer Service: 800-523-5668

INTERNATIONAL SOS � Internationalsos.comPACCAR Member #: 11BYCA529386

� Customer Service (from US): 215-942-8226

Detailed plan information is provided in the Employee Handbook available on mybenefits.paccar.com17 U.S. Salaried Employees

HELPFUL WEBSITES AND PHONE NUMBERS


NOTICESIf you would like to request a special enrollment or obtain more information, go to mybenefits.paccar.com and select Update Benefits. You may also contact Human Resources or the Corporate Benefits Department.

Notice of Privacy PracticesThe HIPAA (Health Insurance Portability and Accountability Act of 1996) privacy regulations protect your rights regarding the use and disclosure of Protected Health Information. The PACCAR Plan Notice of Privacy Practices describes how your plan may use or disclose your health information and your rights with regard to this information.

To obtain a copy of this notice, go to mybenefits.paccar.com, contact your Human Resources representative or the PACCAR Privacy Officer, Corporate Benefits Department, PACCAR Inc, 777 106th Ave NE, Bellevue, WA 98004, (425) 468-7440.

Patient Protection DisclosureIf a medical benefit option offered under the PACCAR Health Plans requires or allows the designation of a primary care provider, you have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members. If the medical plan option designates a primary care provider automatically, the Plan will designate one for you until you make a designation. For information on how to select a primary care provider, and how to obtain a list of the participating primary care providers, please refer to the applicable certificate of coverage or Summary Plan Description (SPD). For children, you may designate a pediatrician as the primary care provider.

You do not need prior authorization from the Plan Administrator or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a healthcare professional in the benefit networks who specializes in obstetrics or gynecology. The healthcare professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. You can locate healthcare professionals who specialize in obstetrics or gynecology by contacting the Plan Administrator.

Post-Mastectomy BenefitsThe PACCAR Medical Plans provide coverage for the following post-mastectomy services in a manner determined in consultation with the attending physician and the patient:

� Reconstruction of the breast on which the mastectomy had been performed;

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

� Prostheses; and � Physical complications of all stages of mastectomy,

including lymphedemas.

These benefits are provided to any covered individual who receives mastectomy-related services subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this Plan.

For more information, call Premera Customer Service at 888-PACCAR-5 (888-722-2275).

Special Enrollment Rights6 (Qualifying Life Event) If you are declining enrollment for yourself or your dependents (including your spouse) because you have other health insurance coverage, you may be able to enroll yourself and your dependents at a later date.

� If you or your dependents lose eligibility for other group health coverage (or if the employer stops contributing toward your or your dependents’ other coverage), you may be able to enroll yourself and your dependents if you request enrollment online within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

� In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment online within 30 days5 after the marriage, birth, adoption or placement for adoption.

� If you or your dependents lose coverage under Medicaid or the Children’s Health Insurance Program (CHIP) because of ineligibility or become eligible for state premium assistance (under Medicaid or CHIP) for a PACCAR Medical Plan, you may be able to enroll yourself and your dependents if you request enrollment online within 60 days from the date of the qualifying Medicaid or CHIP event.

Newborns’ and Mothers’ Health Protection Act (NMHPA)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 issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Genetic Information Nondiscrimination Act (GINA)Among other safeguards, GINA prohibits an employer from discriminating against employees on the basis of genetic information and limits a Plan’s ability to acquire or monitor genetic information except as expressly provided in the Act. As with other compliance duties, the Plan and Employer will satisfy all applicable laws and regulations related to GINA requirements.

Pregnancy Discrimination ActThe Pregnancy Discrimination Act (PDA) forbids discrimination based on pregnancy when it comes to any aspect of employment, including hiring, firing, pay, job assignments, promotions, layoff, training, fringe benefits, such as leave and health insurance, and any other term or condition of employment.

CARES Act The Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The Act allows over-the-counter (OTC) drugs and medicines without a prescription, along with feminine hygiene products purchased on or after January 1, 2020, to be eligible for healthcare flexible spending account (FSA) & Health Savings Account (HSA) reimbursement.

CARES Act Hub The HealthEquity CARES Act Hub will be updated as new information is available, we encourage you to visit this website today and bookmark it for future reference, healthequity.com/cares.

6 The deadlines summarized in this section have been extended during the COVID-19 National Emergency, see page 19.


USERRACoverage During Military LeaveUnder a federal law called the Uniformed Services Employment and Reemployment Rights Act (USERRA), if you are absent from work because of service in the uniformed services, you can continue health coverage for yourself and your dependents.

How Coverage WorksDuring a military leave that is expected to be 30 days or less5, your current employee coverage will continue without interruption, assuming you pay the normal share of premiums for the coverage. Regarding benefits during your period of paid military service leave (up to one year), see the section below titled “Benefits While on Military Service Leave.” If your military leave is expected to be longer than one year, you are entitled to continue health, dental, and vision benefits for you and your dependents under both USERRA and COBRA.

USERRA expands on your COBRA continuation coverage rights in the following ways:• You can continue coverage for yourself and for any dependent who is covered when your service in the uniformed services

begins.• Coverage extends for the length of active service or 24 months, whichever is less. Note that COBRA coverage may extend

beyond 24 months in some cases, depending on the type of qualifying event.• Coverage costs for disabled dependents cannot exceed 102% of the COBRA premium while you are entitled to USERRA

continuation coverage.• Your USERRA coverage is not required to end if you or a covered dependent becomes covered under another health plan.

Paying for CoverageIf you or your covered dependents choose coverage under USERRA, you or the dependents must pay monthly premiums for the coverage.

Benefits While on Military Service LeaveWhile on paid military service leave, you may maintain the health, dental, and vision benefits in which you were enrolled before your military service leave by paying your normal share of premiums for coverage. Short and long-term disability coverage will continue during a paid military service leave for up to 26 weeks.

After your paid military service leave ends, you will not be eligible to participate in the employer’s health, dental, and vision benefits. However, you may elect continuation coverage under USERRA (which, in general, is coverage similar to COBRA continuation coverage) for up to 24 months.

You also may be eligible to continue life insurance and other benefits at your own expense, if permitted by the plan terms and applicable law. All benefits are subject to the terms and conditions of the plans, which may include coverage limits (for example, a war exclusion).

COVID-19 COMPLIANCE UPDATES COVID-19 Related Benefit Changes Federal Regulations & Guidance to Implement Recent Congressional Acts deductibles, copays and coinsurance are waived for COVID-19 diagnostic testing covered with cost-sharing waived for insured plans and ERISA group plans. Antibody testing is considered “COVID-19 diagnostic testing” in certain situations.

Deadline Extensions Due to the COVID-19 National Emergency, the Internal Revenue Service (IRS) and the Department of Labor (DOL) have temporarily extended certain benefit deadlines. The temporary deadline for any of the items below is determined by ignoring the “Outbreak Period”. The Outbreak Period started on March 1, 2020 and runs through at least 60 days after the COVID-19 National Emergency ends. The official end of the Outbreak Period has yet to be announced.

Extended deadlines have been provided for the following items: • Qualifying life events notification and enrollment changes

(e.g. marriage, birth, divorce). • COBRA election period and COBRA premium payment

period. • The date you must inform PACCAR of a divorce, legal

separation, disability or dependents losing eligibility for COBRA purposes.

• The filing of benefit claims and appeals deadlines (e.g. this means you have longer to submit 2019 and 2020 FSA claims for reimbursement).

In addition, deadlines related to COBRA eligibility, election period and premium payment have been extended.

NOTICES


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).

CHIP NOTICESIf 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 July 31, 2021. Contact your State for more information on eligibility.

Alabama - Medicaid

Website: http://myalhipp.com/Phone: 1-855-692-5447

Alaska - Medicaid

The AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com/Phone: 1-866-251-4861Email: [email protected] Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Arkansas - Medicaid

Website: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)

COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)

Health First Colorado Website: https://www.healthfirstcolorado.com/Health First Colorado Member Contact Center:1-800-221-3943/ State Relay 711CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plusCHP+ Customer Service: 1-800-359-1991/ State Relay 711

Florida - Medicaid

Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/Phone: 1-877-357-3268

Georgia - Medicaid

Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hippPhone: 678-564-1162 ext 2131

Indiana- Medicaid

Healthy Indiana Plan for low-income adults 19-64Website: http://www.in.gov/fssa/hip/Phone: 1-877-438-4479All other MedicaidWebsite: http://www.indianamedicaid.comPhone 1-800-403-0864

Iowa - Medicaid

Website: http://dhs.iowa.gov/HawkiPhone: 1-800-257-8563

Kansas - Medicaid

Website: http://www.kdheks.gov/hcf/Phone: 1-785-296-1500

Kentucky - Medicaid

Website: https://chfs.ky.govPhone: 1-800-635-2570

Louisiana - Medicaid

Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331Phone: 1-888-342-6207

Massachusetts - Medicaid and CHIP

Website: http://www.mass.gov/eohhs/gov/departments/masshealth/Phone: 1-800-841-2900

Minnesota - Medicaid

Website: https://mn.gov/dhs/partners-and-providers/news-initiatives-reports-workgroups/minnesota-health-care-programs/spa.jspPhone: 1-800-657-3739


CHIP NOTICESMissouri - Medicaid

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 1-855-373-4636

Nebraska - Medicaid

Website: http://www.ACCESSNebraska.ne.govPhone: (855) 632-7633Lincoln: (402) 473-7000Omaha: (402) 595-1178

Nevada - Medicaid

Medicaid Website: https://dhcfp.nv.govMedicaid Phone: 1-800-992-0900

New Hampshire - Medicaid

Website: https://www.dhhs.nh.gov/oii/hipp.htmPhone: 603-271-5218Toll free number for the HIPP program: 1-800-852-3345, ext 5218

New Jersey - Medicaid and CHIP

Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Medicaid Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710

New York - Medicaid

Website: https://www.health.ny.gov/health_care/medicaid/Phone: 1-800-541-2831

North Carolina- Medicaid

Website: https://medicaid.ncdhhs.gov/Phone: 919-855-4100

Oklahoma - Medicaid

Website: http://www.insureoklahoma.orgPhone: 1-888-365-3742

Oregon - Medicaid

Website: http://healthcare.oregon.gov/Pages/index.aspxhttp://www.oregonhealthcare.gov/index-es.htmlPhone: 1-800-699-9075

Pennsylvania - Medicaid

Website: http://www.dhs.pa.gov/provider/medicalassistance/healthinsurancepremiumpaymenthippprogram/index.htmPhone: 1-800-692-7462

South Carolina - Medicaid

Website: https://www.scdhhs.govPhone: 1-888-549-0820

Texas - Medicaid

Website: http://gethipptexas.com/Phone: 1-800-440-0493

Utah - Medicaid and CHIP

Medicaid Website: https://medicaid.utah.gov/CHIP Website: http://health.utah.gov/chipPhone: 1-877-543-7669

Virginia - Medicaid and CHIP

Medicaid Website: https://coverva.org/Medicaid Phone: 1-855-242-8282CHIP Website: https://www.insurekidsnow.gov/coverage/va/index.htmlCHIP Phone: 1-877-543-7669

Washington - Medicaid

Website: https://www.hca.wa.gov/Phone: 1-800-562-3022 ext. 15473

West Virginia - Medicaid

Website: http://mywvhipp.com/Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

Wisconsin - Medicaid

Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdfPhone: 1-800-362-3002

Documents

YOUR MEDICAL PLAN OPTIONS ARE CHANGING!