HEALTH PLAN LIST AND FEE SCHEDULE

PO BOX 71717 PHOENIX, AZ 85050 TEL 877.311.3338 FAX 602.485.3100 Don’t Miss 70% - 85% of Billed Charge Reimbursement Rates

“We present you with the 2021 health plan and fee schedules for your health care network. Everything you need is just a few pages away!”

The Health Plan List: This booklet contains a current Health Plan List and Fee Schedule of payers that Healthcare Networks of America (HNA) contracts with on behalf of its members. Changes in payer contracts are mailed out annually with membership renewals. Within this document the contract is listed within the grey bar with the Fee Schedule indicated directly under each contract heading. Specialties, coverage, states applicable, reimbursement, claims submission and patient identification are also listed. The payers the contract represents are then listed for a complete plan overview.

Regarding the HNA Network: HNA is not an insurance company, we are a provider network. The Health Plan List and Fee Schedule contain the current list of payers. HNA contracts its network of doctors directly with the PPO’s named in the grey bars. You will notice that there are thousands of payers, including insurance companies, self-funded employers, unions, and TPAs within each PPO contract. You will be listed in the Preferred Provider Directory with each of these 4600+ payers upon completion of the credentialing process. Regarding future contracts: HNA continues to research and find new patient contracts, both nationally and locally for our members, and negotiates the highest possible rate of reimbursement available. When new contracts are secured: 1. HNA then releases the contracts to our providers, our providers then have the right to opt-out of any contracts or components they do not wish to participate in. 2. HNA updates your information to the payers monthly via electronic file to ensure that patients have your most current information. 3. Changes that are made to the payer contracts are also passed on to the participating providers as they become available. Regarding patient identification: Patients sent to you from HNA client payers are not identified as “HNA” patients on the patient ID card. Unless otherwise noted, the patient ID card will identify the insurance carrier or PPO. This will be the PPO listed in the grey bar as well as any of the thousands of payers they service to which HNA has contracted and listed you as a preferred provider. The following list provides you with the names of payers through HNA’s contracting efforts. You may opt out of any component of any contract at any time by advising HNA in writing naming the specific component. If you are already listed with any of the contracts or payers, that agreement will supersede your HNA agreement. Regarding Claims Submission: All claims must be forwarded to the payer and address indicated on the patient ID card, if applicable. Much more than your ordinary provider network! Healthcare Networks of America’s mission is to drive more high paying fee for service patients to its members and provide the latest resources for managing and promoting a successful practice. Sponsers and Networks:

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 2 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee THREE RIVERS PROVIDER NETWORK (TRPN) - PPO Fee Schedule: 125% of the existing Medicare fee schedule as total reimbursement for covered services less applicable co-payments, co-insurance or deductibles.

Patients enrolled: 200 Million States applicable: All States Specialties applicable: All specialties Reimbursement: Fee for Service. Service’s less any applicable co-payments, co-insurance, or deductible’s. Claims Submission: Submit claim to address on back of patient ID card Patient Identification: Three Rivers Provider Network (TRPN) will appear on patient ID card. Payer Clients: The following is a partial listing. For the complete list, please visit: www.trpnppo.com

(AAA) American Automobile Assoc. Allied National Companies Antares Management Solutions 3hab Medical Management Allstate APA Partners Inc. 4most Alpha Review Company Applebee’s International, Inc. 7-Eleven, Inc. Alternative Risk Management Argo Insurance A & I Benefit Plan Administrator Alzheimer S Association Argo Select A & S Financial Services AMCC Inc Argonaut Insurance A.E.B.S.,Co. Ameriben Solutions Arizona Foundation For Medical Care A1 International Foods America West Airlines,Inc Artisan Claims Aaon Inc. American Administrators Asert Benefit Services ABPA American Benefits Association Asmed Health Partners Acadamic Risk American Benefits Management ASR Admin Systems Wp Access General Insurance American Claims Exchange ASR Corporation Acordia American Commerce Insurance Group Associated Administrators, Inc ACS Benefit Services, Inc. American Community Mutual Associated Plan Administrators ACS Compiq American Crystal Sugar Co. Association Insurance Trust Actor’s Guild American Foodservice Corp. Assurant / Fortis Administrative Concepts Inc. American Golf Corporation Assured Assistance Administrators West American Health Holding AT&T Wireless Services, Inc. Adminone Corporation American Medical Auditors Atlanticare Adminstrators Advanced Insurance Administrators American Medical Bill Review Atlas Administrators, Inc. Advantek Benefit Administrators American Medical Security Life Auto Injury Solutions Aegis Administrators Insurance Co. Auto One Insurance Company AFS Insurance Services, Inc. American Modern Insurance Group Autozone, Inc. AG Administrators American National P&C Avis Budget Group, Llc Aggressive Medical Cost Containment American National Property & Avmed Health Plans AIG Hawaii Insurance Company, Inc Casualty Avmed North AIG Insurance Co American Postal Workers Union Avon Products, Inc. AIM Healthcare Services, Inc. (Apwu) Banner Health Systems Airborne Freight Corporation American Professional Risk Services Beacon Risk Strategies AIS American Republic Insurance Benefit Assistance Alaska Airlines Company Benefit Coordinators Corporation Alaska Electrical H&W American Solutions Group Benefit Management Systems Alaska Forest Association American Tire Distributors, Inc. Benefit Plan Administrators Alaska Pipe Trades Ual 375 American Trust Administrators Benefit Planning, Inc Alaska Teamsters American Underwriters Benefit Services, Inc. Alaska Ufcw H&W Trust Americomp Benefit Solutions Albertsons, Inc. Amerihealth Administrators Benefit Source ALLCO Amerisafe Insurance Benefit Systems & Services, Inc. Alliance International Assistance AMERPRISE Benesight / Fiserve Alliant Health Plans Anchor Benefit Consulting Berkley Specialty Underwriting Bme PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 3 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Gateway Claims Applications Management Inc Culligan Intl Co. Berkley Specialty Underwritting Claims Benefits, Inc. Cwi Benefits Managers, Llc Clark County Firefighters (Nv) Cypress Benefit Administrators Berkshire Hathaway Homestate Cleaners Hanger Company D. Edward Wright, Inc. Companies Cnic Health Solutions Definity Health Plans Best Life Coastalcomp Health Networks Del Monte Food Company Blue Bell Creameries Coca Cola (Manhattan) Delta Air Lines Global Svcs., Inc. Blue Shield Of California Coca Cola Company Denny’s Restaurant Program BME Gateway Colonial Life Insurance Destiny Health BMI Health Plans Combined Life Insurance Company Dh Evans Associates, Inc. Bob Mccloskey Insurance Commerce Insurance Company Dillard Department Boeing Company Commercial Travelers Ins. Director’s Guild Bon Appetit Management Company Community Care Diversified Administrators Bridge Benefits, Inc. Comp I.Q. Corporation Bridgestone Comp Usa, Inc. Diversified Group Brokerage Broadspire Companion Property & Casuality Corporation Brokerage Concepts Group Dollar General Brotherhood Mutual Insurance Compensable Benefits LLC Dr. Pepper/Seven Up Bottling Group Broadspire Competitive Health Insured Drake Insurance Administrators Brown Rehabilitation Complete Benefit Solutions Dunn And Associates Brown Review Complete Claims Solutions Inc E.S.I.S. BSI Florida Comprehensive Behavioral Care East Coast Underwriters Buckeye Insurance Group Comprehensive Care Services EBAM Butler Benefit Service Compstar Ecolab Inc C.L. Frates & Company Compstar Systems Inc Educators Mutual C.N.A. Comptech, Llc. Electrical Workers H & W Cam Administrative Services Concise Bill Management Elite Administration & Insurance Cambridge Integrated Services Conseco Group Canassistance Conservent Elmco Capital District Physician Health Consociate Emc Insurance Plans Consolidated Service Group Employee Benefit Administrators Capitol Administrators Construction Ind & Laborers H & W Employee Benefit Concepts Caprock Claims Management Construction Teamsters Employee Benefits Services Care Choices Container Store, The Employee Plans Llc Careington Contract Claims Services, Inc Employee Security Inc. Careworks, USA Cooperative Mutual Insurance Co Employers Life Insurance Company Carpenters Southwest Administrative Coresource Employers Plan Services Group Cornerstone Benefits Administrations, Enabler Managed Care Corporation CBA, Inc. Inc Enterprise Group Planning CBCA Cornerstone National Insurance Equitable Plan Services CBSA Company Erin Group Administrators CCA Cornerstone Preferred Fair Pay Solutions CCL & H Corporate Benefits Services Farmers Insurance CCSI Corporate Care Management Fcci Insurance Group CDS Group Health Correct Care Solutions Federated Mutual Celina Insurance Group Corvel Fic Corporation Cement Masons Nevada Cost Containment Strategies, Inc. Fidelity Insurance Company Cement Masons Of Southern Ca Cost Pro Firefighters Family Medical Central Benefits Mutual Costal Administrative Services First Administrators Inc Century Health Solutions Costco Wholesale Corporation First Health Ceres Health Care, Inc. Cottingham & Butler Fiserve Cerner Corporation Countryway Insurance Co. Fitzharris Charter Management Services Coventry Health Care Florida 1st Service Administrators, Chatwins Administration Crawford & Company Inc. Chubb Insurance Company Cross Summit Enterprises Florida Benefit Administrators CIGNA Crum Foster Insurance Fmh Benefit Services

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 4 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Food Giant Supermarkets, Inc. HMA, Inc. Kenworth Northwest, Inc. Ford Motor Company Horizon Air Industries Key Partners Fox Everett HPS Paradigm Key Risk Management Services, Inc Fringe Benefits Huffy Corporation Kraft Foods Frito-Lay, Inc. Humana L’oreal Usa, Inc. Future Care, Inc. Hyatt Corporation La Quinta Inns, Inc. Gab Robins IAC Laborers Metro Detroit Health Gallagher Benefit Administrators, Inc. IBA Land O’lakes, Inc. GBSI IBEW Southwestern Health & Benefit LBA Healthplans, Inc. Geico Corporation Fund Leahy & Associates, Inc. Gem Administrators Idaho Pipe Trades Liberty Mutual Genex Services Imed Cost Containment Solution, Llc Life Investors Insurance Company Of Georgia Administrative Services Imerica Life And Health Insurance America Gilsbar Insurance Company Company Lifewell Healthplans Global Assurance Indiana Farm Bureau Littleton Group Global Care Indiana Laborers Liz Claiborne, Inc. Global Excel Management, Inc. Indiana Roofers Local Engineers 15 Global Medical Management Inetico Lone Star Steakhouse Global Risk Management Ingenix Loomis Company GMAC Injury Care of Nevada Louisiana Farm Bureau Gmac Insurance Innovante Benefit Administrators MagnaCare Golden Rule Insurance Company Innovated Health Strategies Mail Boxes Etc Grange Insurance Innovative Claim Solutions Maksin Management Corporation Great American Insurance Co. Insurance Administrators Of America Managed Benefits Administrators & Great Fidelity Insurance Design Administrators Ins. Consultants Great West Healthcare Insurance Programmers, Inc. Managed Health Funding Insurance Group Administrators Insurica Claim Management Administrators Group Insurance Services Center Integra Admin Group - Supp Marsh Advantage Group Resources Integrated Claims Administrators Mca Administrators Guarantee Trust Life Insurance Intel Corporation Mcdonald’s Corporation Company Intelligent Medical Solutions, Inc. Mcgraw-Hill, Inc. Guardian Inter-Americas Insurance Med Claim Partners, Llc HAA Preferred Partners Intercom Hrential Corp. Medata Hartford International Monetary Fund Medaudit Services Inc. Health Administration Service International Paper Medical Administrators Inc Health Choice Of NW Missouri Interstate Brands Corporation Medical Claims Resources Health Cost Management Interstate Hotels & Resorts, Inc. Medical Claims Review Services Health Design Plus Intracorp Medical Consultants Network Health Future IPC Medical Cost Management Health Link Island Group Medical Savings Insurance Company Health Management Solutions Itpe Health & Welfare Fund Medicor Managed Care Health Markets IUOE Local 15 Medipac International Health Net, Inc J. Crew Group-Tpa Melane Company Health New England J.M. Smucker Company, The Memorial Integrated Healthcare Health Plans. Inc. Jm Family Enterprises Mennonite Mutual Aid Health Reinsurance Management Jmh Health Plan Mercy Care Insurance Partnership Jo-Ann Stores, Inc. Meridican Resource Company Health Special Risk John Deere Met Life Health Systems Management Johnson & Johnson Metropolitan Life Healthcare Direct JP Farley Corporation MGIS Healthcare Resource Group JW Terrill Michaels Stores, Inc. Healthcomp Administrators Kaiser (Northern California) Midest Security Administrators HealthFirst TPA Kaiser Aluminum Corporation Miller Brewing Company Healthplan Of Nevada Kb Holdings/Kay Bee Toys Mitchell International Healthscope Benefits Keebler Company MMOH Healthstar Kemper Insurance MMSI HIP Of NY Kentucky Laborers District Council Mokan Sheet Metal Workers PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 5 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Molson Coors Brewing Co Oxford Health Plans Quality Health Management, Llc Monterey Bay Clothing Company P5 Health Services Quest Medical Claims Montgomery Management PACBLU Regional Care, Inc Morgan & Franz Pacific Coast Claims Consultants Resolved Healthcare Morgan White International Pacific Foundation Retirees Welfare Trust Administrators Pacificare Health Systems, Inc. Reunion Industries Morris Associates Pacifice Heritage Administrators Review Works Mountain States Administrators Pacmed Rising Medical Solutions Mountain States Insurance Company Painters District Council #2 Risk Administration Resources Mutual Assurance Administration Palm Harbor Homes, Inc. Rj Reynolds Domestic Tobacco Mutual Medical Plans, Inc. Paradigm Management Services RMPG Mutual Of Omaha Paramount Healthcare Inc Rockford Mutual Insurance Company Myerson Stevenson Toohey PCM, Inc. Royalty Carpet Mills, Inc. Nabisco Group Holdings Corp. Pekin Life Insurance Company Rubbermaid Incorporated NALC Health Benefit Plan Penn Western Benefits Rural Health Plans Initiative National Benefit Administrators Pepsi-Cola Company Safeco National Care Network Pequot Healthcare Safety Insurance National Comp Care Perkins Restaurant & Bakery SAIF National Comp Care ( Tyson ) Permanent General Insurance Co. Salt River Indian Community National Health Administrators Perrier Group Sara Lee Corporation National Roofing Company, Inc Personnel Staffing Scot Industries National Rural Electric Cooperative Petco Animal Supplies, Inc. Scott & White Healthplans Assoc. Petsmart, Inc Scottsdale Insurance Company National Telecommunications Coop. Phelps Dodge Screen Actors Guild Association Philip Morris Usa Sears Merchandise Group Nationwide Insurance Physician Benefit Trust Secure Health Plans Of Ga Nationwide Mutual Insurance Physicians Mutual Insurance Secureone Company Company Securitas Security Service Inc NCAS Pier 1 Imports Security Administrative Services Nebraska Farm Bureau Pioneer Administrators Security Health Plan Of W.I. Nestle Pizza Hut, Inc. Sedgwick Claims Management New England Financial Planned Administrators See’s Candies, Inc. New England Health Plans Plumbers & Pipefitters Select Benefit Administrators, Inc. New Era Life Insurance Co Plymouth Rock Assurance Corp Selective Insurance Group, Inc NGS American, Inc. Pomco Self Insured Services Co NNSI Prairie States Tpa Seminole Tribe Of Florida Noitu Insurance Trust Fund Preferred Care Sentry Insurance Norfolk & Dedham Preferred Medical Claims Solutions Servicemaster North American Administrators Preffed Medical Management Sheakley Unicomp Nova Health Systems Solutions Shorman Solutions NYCM Premier Comp Solutions Sierra Health & Life Insurance NYSUT Prime Health Services Company Office Depot, Inc. Principal Financial Group Signature Network Plus Ohio Carpenters Prison Health Services Significa Benefit Services Fka Erin Ohio Health Choice Pro-Claim Plus Group Administrators Ohio Mutual Insurance Company Procura Management, Inc. SIHO Insurance Services Oklahoma Property and Casualty Producer’s Guild SISCO Insurance Guaranty Association Professional Benefit Administration Skilstaf, Inc. Olympus Managed Health Care Professional Benefit Services Smc, Inc. One Beacon Insurance Professional Claims Administration So. Ca. Risk Management Associates Operating Engineers Health & Welfare Professional Claims Management Spooner Incorporated Trust PROGRESSIVE Sonoco Products Co Oroweat Baking Co Protection One Sonoma Tilemakers Inc. Oscar Health Corp Provider Benefit Plans Source One Computer Corporation Oshkosh Truck Corporation Puma Corporation & Subsidiarie Southern California Pipe Traders Outback Steakhouse Pupil Benefits Plan, Inc. Southern California Risk Management Outsourced One Qualcare Association PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 6 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Southern National Life Insurance THIPA USair, Inc. Specialty & Paper Products Health Titan Propane Valero, Inc. And Welfare TLC First Administration Valunet, Llc Spectrum Administrators TMLIntergov Employee Benfits Vanguard Services, Inc. Spooner Incorporated Tomgass Timber Trust Vermont Managed Care Stanislaus Foundation Tongass Timber Trust- Alaska Forest Vermont Mutual Stanley Steemer Association Viant Starbucks Total Managed Care Vision Quest State Farm Toyota Vista America State Of Louisianna Ogb TPA Of Georgia Vista Health Plans State-Wide Insurance Company TQ Consultants Volvo Cars Stowe Associates Trans World Airlines Inc. Washington Employers Trust Student Insurance Travelers Insurance Washington Idaho Carpenters Student Plans, Inc. Travtens Insurance Group Washington Mutual Summit Administrators Services Trissel Graham & Toole Washington Teamsters Summit Insurance Company TriStar Health Benefits Wausau Sun Chemical Corporation Tristar Risk Management WEA Trust Sun-Maid Growers Of California Tru Services, Inc. Wellcomp Sunmed True Course Medical Data Analysis Wells Fargo Alarm Services T.R. Paul Group Services And Claims Services Western Benefits Tandem Care, Llc Trusteed Plans Service Corporation Western Growers Tbg Administrative Services Tyson Foods Western Mutual Insurance Tc3 Health U.S. Benefits Western Teamsters Trust Teamster Construction Industry UICI Administrators Westport Benefits Teamsters Local 14 Ulico Insurance Westport Shipyard, Inc. Teamsters Local 631 Sec Fund Ultramar Corp Weyco, Inc. Teamsters Local 995 Underwriters Safety & Claims Worcomp Bill Review Services Texas Farm Bureau Unicare Workcomp MC/Health Choice Of Texas Industries, Inc. Unified Group Serivces, Inc. North West Missouri Texas True Choice United Artists Theatre Circuit Worldwide Management Care The Alliance United Benefits Partners The ASU Group United Claims Solutions, Llc WPS, Inc. The Claims Trust UnitedHealthcare Writer’s Guild The Comptech Group Unitrin Auto And Home Xerox Corp The Epoch Group Unity Health Insurance York Claims The Guardian Universal Underwritters Insurance York Insurance Services Group, Inc. The Henry J. Kaiser Family Upstate Administrative Services Zeneks The Pillsbury Co. US Foods Zenith Administrators The Reny Company USAA Zenith Insurance Company

NATIONAL PREFERRED PROVIDER NETWORK (NPPN) - PPO Fee schedule: 80% of billed charges. Patients enrolled: 2 Million+ nationwide States applicable: All states Specialties applicable: All specialties Reimbursement: Fee for service Claims submission: Submit claims to the address on the card sleeve. Patient identification: Payer name indicated on the member ID card. Payer clients: The following list of Payer clients are NPPN Medical Payers Website: www.nppn.com

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 7 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee A&S Financial California Foundation for Medical Enterprise Group Planning, Inc. Acclaim, Inc. Care EOS Healthcare Acrometis, LLC WC Calvos Equian ACS Benefit Services Cambridge Administrators, LLC Evolutions Healthcare Systems Activa Benefit Services Cannon Cochran Management ExcelCare Advanced Correctional Healthcare Services, Inc. FCE Benefits Advantage Health Plans (Kempton) Caresys Federated Insurance Company Aegon CBA Administrators Federated Mutual Ins Co. Aetna CCMSI First Chicago Insurance Company Aggressive Medical Cost Cerner HealthPlan Services First Health Containment, Inc. Charter/ Polaris Foundation for Medical Care AIG Chartis Insurance Company of Foundation Health Alaska Forest Association Canada Fox Everett, Inc. Alicare PA Chicago Heights Steel Raw Materials Freedom Life Insurance (Ascent Allegiance Benefit Plan Management, Highway Steel Mgmt) Inc. Chicago Regional Council of Geisinger Health Plan Allied National, Inc Carpenters GENEX Services, Inc. Alpha Review Corporation CMN, Inc. Genworth Financial Alta Services CMR Administrtors George Segenreich Ltd Alternative Insurance Resources,Inc Commercial Travelers Ins. Gilsbar, Inc. Alternative Risk Management Companion Life Ins Co Dental GLHP AmeriBen Dental Complete Claim Solutions, Inc. GlobalCare AmeriBen Solutions Comprehensive Care Services TPA Go Self Insured American Freightways Conifer formerly Informed LLC Government Employees Health American Healthcare Alliance Consilium Association American National Insurance Consociate Grange Insurance Co. American Republic Ins. Co. Consolidated Health Plan-DENTAL Group Administrators Ltd. Amerisafe Risk Services Inc Cooperative Managed Care Services, Group Benefit Services, Inc. Ameritas Dental LLC Group Marketing Services, Inc. Amtrust CoreSource Group Plan Solutions (GPS) Anchor Benefit Consulting Inc. Cornerstone Benefits Administrators Group Resources Anthem (Healthlink) Inc. Guardian Dental Apex Benefits Services, LLC Corporate Benefits Service,Inc. Gulf South Risk Services, Inc. Arizona Foundation for Medical Care CorrectCare Integrated Health Hartland Employer Benefits ASI Services Inc. CorVel Healthcare Corp. Health Alliance Associated Third Party Administrators Coventry Health Care Workers Health Cost Solutions Assurant Health - Individual Compensation, Inc. Health Design Plus, Inc. Assurant-DENTAL Crawford & Co Health Net CA Aultcare Crescent Health Solutions Health Net Plus Aultra Administrative Group CRM HealthCare Solutions Group Automated Benefit Service Custard Claims Management Services Healthlink Auxiant Custom Design Benefits HealthSCOPE Benefits INC AZ Foundation for Med Care Cypress Benefit Administrators HealthScope Dental BAC DeCare/Wellpoint HealthSmart Benefit Solutions Benefit Administration Service Dental Network of America, LLC HealthSpan Integrated Care Benefit Administrative Systems, Ltd Dental Select Hewitt Coleman Benefit Assistance Corporation DGA HFN Benefit Management, Inc. Diversified Healthcare Services Inc. HRGI Benefit Plan Administrators EBMS Humana CAS Benefit Support, Inc. EBS Ctr Humana Dental BeneSys, Inc. EBSO Expert Benefit Solutions Humana Metavance Berkley Risk Administrators, Co. LLC ECOM - ABF IHC Administrative Services Blue Cross of Atlantic Canada ECOM - NEL IHC Health Solutions BMI Benefits, LLC Elite Administration & Insurance Illinois Risk Management Services BMI Health Plans Group IMA, INC. Boon-Chapman Benefit Elmco Ingenix Administrators Employee Benefit Service Center Insurance Management Services Boulder Administration Services Inc. Employee Security, Inc. Insurance Systems, Inc Broadspire-WC Employers Associations Integra Employer Health/BMS Brokerage Concepts Employers Claim Service Inter-America`s Insurance Corp. PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 8 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Intergroup Services NALC 2 SIEBA IPMG-Employee Benefits Services NAMCI (Premier Health Network of Sierra Health And Life JFP Benefit Management AL) SIHO John Muir Physician Network National Choice Care Sinclair Health Services Kaiser Hawaii National Health Benefit Corporation Southern Benefit Services Kaiser Permanente (NHBC) Spectrum Administrators, Inc. Kaiser Permanente Self-Funded Native Care Health, LLC Spraying Systems Kansas City Life Network Health Plan St. Joseph Heritage Healthcare Kemper Dental New Life Agency, Inc. Starmark Insurance Kentucky Health Administrators NGS America StrataCare Key Benefit Administrators NGS CoreSource Sunmed KPIC Fully Insured Norfolk Dredging Company Syracuse University Athletic Lake County Indiana Correction North America Administrators, Inc. Department Center Northern Illinois Health Plan TC3 Health Lifetime Benefit Solutions Northwestern Memorial Hospital Teachers Health Trust Little League Association NovaNet, Inc. The Alliance Lockard & Williams Paramount Health Plans, Inc. The ASU Group M S Administrative Services, Inc. Parkview Health Plan Services The Covenant Magellan Health Services Pekin Insurance The GEMGroup ManageAbility, Inc. People 1st Health Strategies, Inc The Health Plan of Upper Ohio Valley Managed Care of America Phoenix Builders The Loomis Company Mayo Clinic Health Solutions aka PHP of Mid-Michigan The Ohio State University MMSI Physicians Health Plan The Stafford Companies MCA Administrators Prairie States Enterprises Thomas Cooper & Company McLaren Health Advantage Preferred Health Choices TLC Benefit Solutions MCMC Preferred Health Plans of the TPM Administrators MCMC, WC Carolinas Transwestern Insurance MECA Preferred One Administrators Med Pay Principal Financial Group -DENTAL Tri Star Benefit Administrators Med-Net Connect Priority Health Tri-State Joint Fund Med-Pay Inc. Pro-Claim Plus Tristar Insurance Group Medata, Inc. Procura Inc. TRUSTMARK INSURANCE COMPANY Medben Professional Benefit Administrators, Tucker Administrators, Inc. MedCost Benefit Services Inc. (PBA) UFCW Local 100-A & Local 1546 Medical Audit and Review Solutions, Professional Claims Management UMR LLC Protective Insurance Company Underwriters Service Corporation Medical Benefit Administrators Inc. Protegrity Services Inc. Unified Group Services Inc ASO Provena Hospitals Union Health Service Medical Mutual of OH Providence Health Plans United Healthcare Dental MedInsights WC Provider Select United Parcel Service/Aetna MedRisk, Inc. Q3 Business Technologies Unity Health Insurance Mercy Care Ins. Co. QualCare Inc. Universal Fidelity Admin Co. Meritain a.k.a CBSA Performax QualChoice University Of Chicago Health Plan Meritain Health Corp. Quality Health Management LLC (UCHP) Mid-America Associates Queensborough USA MCO Midlands Claim Administrators WC Regency Employee Benefits Viva Health Midlands Occupational Accident Reny WC WAB/VH Mitchell International Reserve National Insurance Company Wallrab, Capenigro & Associcate, Inc. Mitchell Test TPA ReSource Munich Re America Walmart: Texas Non-Subscribers Mitchell WC ResourceOne Administrators Ward North America MMOH RHS Business Services WebTPA Employers Svcs MMSI Rising Medical Solutions Inc. Western & Southern Financial Group Mountain Benefits Management Rockport Healthcare Group William C. Earhart Co. Company Seaton Corporation William Charles Risk Management Mutual Assurance Administrators Security Life Ins Co of America Wilson McShane Mutual Health Services SecurityHealth Plan Worksite Benefit Services, LLC Mutual Medical Plans, Inc. Self Funded Plan WV Laborers Trust Fund Mutual of Omaha Insurance Company Self Insured Services Company Zenith American Solutions NAHGA Claims Administrators SFM

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 9 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee FEDMED INC. – PPO Fee Schedule: 15% discount off providers’ usual charge for covered service’s less any applicable co- payments, co-insurance, or deductible’s. Patients enrolled: 18 Million nationwide States applicable: All States Specialties applicable: All specialties Reimbursement: Fee for Service. Service’s less any applicable co-payments, co-insurance, or deductible’s. Claims Submission: Submit claim to address on back of patient ID card Patient Identification: FedMed shall make best efforts to ensure that Payors clearly identify the FedMed network on Covered Members’ Insurance Identification Cards or Explanation of Benefits (EOB), in the event that FedMed is not identified on the Covered Members’ Insurance Identification Card or Explanation of Benefits (EOB), may elect not to honor the discount. Payer clients: The following list of Payer clients are FedMed Payers Website: www.fedmedinc.com

A-G Administrators First Agency ODS Health Plan Administrative Concepts, Inc. Global Excel Management Penfield Care Management Aetna - National Advantage Program GlobalCare Preferred Medical Claim Solutions (NAP-non-facility only) Group Administrators Ltd. (PMCS) AIG Group and Pension Administrators Premier Healthcare Exchange (PHX) Allied National (GPA) Professional Benefit Administrators American Benefit Plan Administrators Group Insurance Service Center (PBA) (ABPA) (GISC) Regency Employee Benefits Assurant Health (ASR) Health Care Services International Security Health WI Auxiant HealthCare Horizons Southwest Service Administrators, Blue Shield of CA HealthRisk Resource Group Inc. Bollinger, Inc. HealthSmart Stratose California Water Service HMA TC3 Health CareFirst Administrators HUB The Loomis Company Carpenters Southwest Administrators Humana Tower Life CDS Group Health International Medical Group (IMG FH) Trusteed CIGNA inVentiv Medical Management UFCW Local 1500 CNIC Health Solutions Kaiser Permanente (Northern and UMR - Cincinnati, Harrington, Co-ordinated Benefit Plans (CBP) Southern California Regions) Onalaska, Wausau Cypress Benefits Liberty HealthShare United Food & Commercial Workers Deseret Mutual (DMBA) Local 560 Benefit Fund (UFCW Southern California) Employee Benefits Administration MedBen United Medical Resources (UMR) & Management (EBAM) Mutual Health Services (BSI) USBenefits Insurance Equian (formerly HSI) National Health Benefit Corporation WEA Trust Federated Mutual Insurance Company (NHBC) Wells Fargo TPA FELRA/UFCW NGS American (CoreSource) Western Health Advantage First Administrators Nippon Life Zenith Administrators

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 10 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee AMERICA’S CHOICE PROVIDER NETWORK (ACPN) – PPO Fee Schedule: 20% off of providers’ billed charges. Patients enrolled: 26 Million States applicable: All States Specialties applicable: All specialties Reimbursement: Fee for Service. Service’s less any applicable co-payments, co-insurance, or deductible’s Claims Submission: Submit claim to address on back of patient ID card Patient Identification: ACPN will appear on patient ID card. Payer clients: The following list of Payer clients are ACPN Payers Website: www.acpnusa.com

1199 National Benefit Fund Health AHH - Correctcare Allied National 1921 Iron Workers AHH - Ironworks Local 549 & 550 Allina Health 21ST Century & Health Benefits AHH - Motorola Alpha Data Systems, Inc. 21st Century Health & Benefits AHH - Motorola Employees/ACS Alpha Vision Insurance 3P Administrators Employees Alternative Benefit Plans, Inc. AAA Central PA AHH - OH Carpenters Health & Alternative Insurance Resources,lnc Acadia Insurance Company Welfare Alternative Risk Management Accelera Health Inc/ATPA AHH - Painting Industry Funds Alternative Risk Solutions Access Administrators Inc AHH - Toledo Electrical Welfare Fund Alternative Service Concepts ACE International AHH - University of Alaska ALTRUA ACMS AIG Accident and Health Amalgamated Life Insurance ACS Benefit Services AIG Benefit Solutions AmeriBen Solutions Activa Benefit Services AIG Claims Services American Benefit Corporation Activar Inc. AIG Hawaii American Benefits Association Actuarial & Employee Benefit Services AIG Worker’s Comp Manual American Benefits Company, Inc. Co. Alabama Insurance Guaranty American Benefits Management Actuarial Management Resources, Association American Enterprise Inc. Alabama Trucking Association American Family Insurance Administrative Claims Management Alakska Here Health & Welfare American Hydrotech, Inc. Administrative Concepts Alaska Care American Insurance Administrative Services Inc. Alaska Childrens Services American International Group (AIG) Advance Admin Local 592 Alaska Forest Association American Management Advisors Advance Admin Local 803 Alaska Here Health & Welfare American Medical Security Advanced Benefit Administrators Alaska Laborers Construction American National Life Insurance Advanced Correctional Healthcare Alaska Native Tribal Health Plan Company Advanced Medical Strategies Alaska Pipe Trades 367 American Professional Risk Services, Advantage City of Greenwood Self Alaska UFCW Health and Welfare Inc Funde Trust American Republic Insurance Advantage Franciscan Self Funded ALFA Virginia Mutual Insurance Company ADVANTAGE Health Solutions, Inc. Alfa Vision American Specialty Insurance Advantek Benefit Administration Alicare American Trust Administrators Affordable Benefit Administrators All Nations Insurance Americas Choice Healthplans LLC AFS Insurance Services Health Plan All Risk Insurance AmeriComp Benefits AG Administrators Inc. Allegiance - MC AmeriHealth Administrators AGLC Employer Group National Allegiance Benefit Plan Management, AmeriPlan AHH - Advocate Services Inc. Ameriprise AHH - American Benefit Management Alliance Benefit Management Amerisure Insurance - 1426 Company AmeriTrust Insurance Corporation AHH - American Health Holding Alliant Insurance Amway Health Plan AHH - Aultcare Allied Benefit Systems Anchor Benefit Consulting PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 11 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Andrews Excavating Benefit Management Administrators, Carey International Insurance ANPAC Inc. Company Antares Management Solutions Benefit Management Services Carey International APEA AFT Benefit Management, Inc. (MO) Carolina Benefit Administrators Apex Benefits Services, LLC Benefit Plan Administrators Carpenters H&W Trust of St Louis Appalachian Benefit Administrators Benefit Planners, Inc Carpenters Local 491 Health & Ariel Corporation Benefit Services of PA Welfare Plan Ariel Third Party Administrators Benefit Solutions, Inc Carpenters Southern California Arise/WPS Benefit Support Carpenters’ Benefit Fund Arizona Pipe Trades Health and Benefit Systems & Services CAS Benefit Plans Welfare Fund BeneSys Inc. Casto Technical Services Arkansas Pipe Trades Health and BeniComp, Inc. CBA Welfare Fund Berkly Cbca - Savannah Armed Forces Insurance Insurance Beverage Drivers Local 792 CDS Health Plans AS&G Claims Administration Bibb County Public Schools Celtic Life Insurance Company Asbestos Workers Local 8 Blalock Construction Cement Masons Ascendant HealthCare Blue Cross Blue Shielf of SC Central Data Services, Inc. Ascendant HealthCare BlueGrass Family Health Plan Central Reserve Life ASE/AFSCME L 52 Health Benefits BMI Benefits, LLC Central Security Life Insurance ASERT Benefit BMI-HealthPlans Company Aspen Administrators Bob McCloskey Insurance/BMI Central States Southeast and ASR Health Plans (ASR Corp) Benefits Southwest Areas Health & Welfare F Associated Administrators (4Most) Boilermakers Century Planners Associated Administrators LLC Boon-Chapman, Inc. Cerner Corporation Associated Benefits Corporation Boston Plasterers CFBB Assurant Health Boulder Administration Services Inc Charter Benefit Administrators Assure Care Boyd Brothers Transportation Charter/ Polaris Assure Care Risk Management BPA Chesapeake Employers Insurance Assured Benefits Administrators Bragg and Associates, Inc Company ASU Group Brenner Tank LLC Chesterfield Resources Atlanta Public Schools Brentwood Services, Inc CHRISTIAN BROTHERS AultCare Brethren Mutual Insurance Company Christian Care Ministry Auto Club Association Brevard Partnership Network Christian Fidelity Life Insurance Automated Benefit Services (ABS) Bricklayers - Local 6 Company Automated Group Administrators Bridgestone Americas, Inc. Chubb Insurance Automobile Mechanics Local 701 Brokerage Concepts Inc. Cigna AUXIANT Brotherhood Mutual Cincinnati Insurance AVERA HEALTH PLANS Brown and Bigelow Cities and Villages Mutual Insurance AvMed Health Plans Bunch & Associates, Inc City of Amarillo AVMED Health Plans Business Insurance Group, LLC City of Davenport AZ Foundation for Med Care C.H. Carpenter Lumber City of Hollywood (Florida) B.1 Baldwin Electric C&O Employees’ Hospital Association City of Montgomery Babb, Inc. California Indemnity City of Sarasota PPO and EPO BAC Local Union 15 Welfare Fund California Water Services (CWS) (Florida) Baker Benefits Administrators CAM Administrative Services, Inc. City of Venice (Florida) Bakery & Confection Health & Pension Cambridge Insurance Co. City of York (Pennsylvania) Fund Canal Insurance Co. CL Frates & Company/Plico Health Bakery and Sales Drivers Canassistance Claim Management Services Baldwin County Cannon Cochran Management Claim Technologies Incorporated Bank Life & Casualty Services Claims Administrative Services Banner Health Systems Capital District Physicians Health Clarion Benefits Administration LLC Bashas’ Risk Management Plan Cleveland Brothers Benefit Administrative Systems Capitol Administrators CM High Benefit Administrator Services Capitol Administrators of The CMN, Inc. Benefit Assistance Corporation Southeast CMR Administrators, Inc. Benefit Concepts, Inc. Caprock HealthPlans CNIC Health Solution PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 12 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Co-ordinated Benefit Plans, Inc. Creative Risk Solutions Federated Coastal Administrative Svcs Inc dba CWI Benefits FHA-TPA CAS Benefit Plans CWI Benefits Inc Fidelity Insurance Colonial Group Cypress Benefit Administrators Fireman’s Fund Colonial Healthcare Incorporated D.H. Evans Associates, Inc. First Administrators Inc. (FAI) Colorado Farm Bureau DAKOTACARE First Agency, inc Columbia County Daniel H. Cook Associates, Inc. First Benefits Insurance Columbia Insurance Group Dean Health Plan, Inc. First Carolina Care Combined Benefits Administrators, Definiti Healthcare Management First Health TPA LLC Delta Health Systems First Service Administrators, Inc. Commerce Bank Deseret Mutual Benefit Admin FirstCare Commerce Benefits Group, Inc. District #77 IAMAW Five Rivers Carpenters Commercial Travelers Ins. Diversified Administration Florida Hospital Healthcare Systems Commodity Specialists Company Diversified Group Administrators Florida League of Cities, Inc. Community Administrators Duluth Building Trades FMA Community Care EASTEX Telephone FMH Benefit Sery Companion EBAM Corporation Food Drug Administration Compass Rose Benefits Group EBPA Formula Corporation Comprehensive Benefits ECOM (NELIC) Fortis Benefits Insurance Company Comprehensive Benefits ECOM (PALIC) Foundation for Medical Care Administrator Inc Educators Mutual Life Foundation Health Preferred Comprehensive Benefits Service Inc. Electrical Welfare Trust Fund Administrators Comprehensive Cost Solutions Electrical Workers (IBEW) Fox Everett CompStar Systems, Inc Elite Brokerage Service Fox’s Market CompTech Group LLC ELMCO Frankenmuth Insurance Company Compusys EMC Insurance Companies Frates Benefit Administrators Conifer Health Solutions Employee Benefit Administrators Freedom Insurance ConMed Healthcare Management Employee Benefit Claims of Freeman Admin Solutions, Inc ConnectiCare Wisconsin Freight Drivers Local Union No. 557 Connecticut Pipe Trades Health Fund Employee Benefit Concepts, Inc. Friedland Misler, PLLC Consociate Group Employee Benefit Management Corp Frontier Consolidated Benefits Resources Employee Benefit Management FrontPath Health Coalition Consolidated Health Plans Services Fulton County Construction Industry Laborers Employee Benefit Services Future Care Welfare Fund Employee Benefits Corp. GAB Robins Construction Suppliers Fund A Employee Plans, LLC Gallagher Bassett Construction Suppliers Fund B Employee Security, Inc. Gard (North America) Inc Construction Workers Trust Fund Employer Plan Services, Inc. GBS - CarePlus Continental General Insurnace Enterprise Group Planning Geisinger Health Plan Company Enterprise Rent-a-Car Genex Continental Western Group Entrust Inc Genworth Financial Continental Western Insurance Co. Epharata Manufacturing George J Hayden Electric Contract Claims Services, Inc Epitome, Inc. Georgia Insurers Insolvency Pool CoreSource Erin Group Adminstrators Gerber Life Insurance Company Cornerstone Benefits Admin Evolent Health Inc Gettysburg Health Administrators Cornpfirst Exam Works Gilsbar Corporate Benefit Services, Inc. Fair Isaac Global Health Provider Networks Corporate Systems Administration, Fairbanks Northstar Borough Global Medical Management Inc Farm Bureau - Iowa Global Underwriters Inc. CorrectCare Integrated Health Farmers Insurance GMS TPA Services Cottingham & Butler FBMC Golden Rule Insurance County of Riverside, CA. FCCI PPO and EPO Governmental Risk Solutions Covenant Administrators FCE Benefit Administrators Grange Insurance Group Covenant Group Services Federated Insurance Graphic Communications Cox Health Plan Federated Mutual Insurance Co. Great American Insurance Group Creative Plan Administrators LLC Federated Rural Great West PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 13 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Great West Casualty Company Healthcare Payers Coalition of NJ ING Employee Benefits Great West Risk Management HealthCare Solutions Group, Inc. Ingenex Greater Cincinnati Bricklayers Healthcare St Innovative Claim Solutions Greater Kansas City Laborers Welfare HealthCare Strategies, Inc. Insura Property & Casualty Co. Fund Healthcare Workers Comp Fund Insurance Administrator Group & Pension Admin (GPA) Healthcomp, Inc Insurance Administrators of America, Group Administrators Ltd (GAL) HealthEZ (Formerly America’s TPA) Inc. Group Benefit Administrators, Inc. HealthFirst TPA Insurance Programmers Group Benefit Service Healthgram Insurers Admin Corp Group Executive Insurance Marketing Healthlink Insurex Benefits Admin Inc Group Health Cooperative HealthMarkets Integra Administrative Group Group Health Managers HealthPlan Southeast Integra Employer Health Group Health Options HealthSCOPE Benefits Integra Group Group Insurance Service Center Healthsmart Inter-Americas Insurance Corporation (GISC) HealthyCT Inc Intermediary Insurance Services Group Resources Heating, Piping and Refrigeration Intermountain UFCW Guarantee Bank & Trust Medical Fund International Benefits Administrators Guarantee Insurance Company Heritage Consultatnts - Professional International Medical Group (IMG) Guarantee Insurance Resources Administrators International SOS Assistance Inc Guarantee Trust Life Insurance Co. Herr Foods, Inc. Intracoro Guardian Life Insurance HFN TPA InVentiv Medical Management Guide One Insurance Highland Physicians IOA Re Gulf Guarantee HM Benefits Administrators, Inc. IPM Health & Welfare H&B Fund HM Insurance Group IPMG-Employee Benefits Services Hagerstown Teamsters and Motor HMA Inc Iron Workers Carriers Health Holtra Chem Iron Workers Dist Counsil Hanover Foods Hometown Health IUOE Local No. 132 H&W Fund Hanover Insurance Hospital Benefits, Inc. J P Farley Corporation Hanover Lantern Hotel Restaurant Employees Trust Jefferson County Schools Risk Hastings Mutual Insurance Company HSBA Management Hawaii Mainland Administration Hubbard Construction Jensen Administrative Services HCC Life Insurance Company Humana JMH Health Plan Health Access America IATSE Local 22 Welfare Fund John Copes Food Health Administration Services, Inc. IBEW 640 John Muir Physician Network Health Alliance IBEW Local No. 1 H&W Fund JW Terrill Health Care Plan of South Dakota IBEW Local Union 124 Kaiser Medical Association/Dakotacare IBT Local Union No. 145 Kansas Building Trade Health Claims Administration, Inc. ICC Kappa Benefit Services Health Cost Solutions Idaho Pipe Trades Kemper Insurance Health Design Plus, Inc IEES, Inc. Kentucky Access Health First IHC Health Solutions Kentucky Health Administrators, LLC Health Insurance Plan of Greater NY ILWU-PMA Kentucky League of Cities Health Markets Inc IMT Insurance Kentucky School Board Insurance Health Net IMWCA Trust Health New England Incentus Klais and Company Health Plan Administrators, Inc. Indecs Corporation Kovatch Health Plan Intermediaries Independent Health KRB Health Plan Select Independent Health Assoc Inc Kroger Health Plan National Health Plus of Michigan Indian River Laborers District Council Local 351 Health Services Benefit Indiana Comprehensive Health H&W Administrators Insurance Assoc. Laborers International Union Local Health Services Review, Inc. Indiana Insurance 616 Health Special Risk, Inc. Indiana University Health Laborers SE HEALTH SPRING INFORMED 9000 Laborers Trust Fund Local 980 H&W Health West InforMed LLC Laird HealthCare Partners Medical Group ING - Medical Risk Solutions Lake County

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 14 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Lancaster Bible College Medical Benefits Administrators, Inc. National Rural Electrical Coop. Las Vegas Firefighters Health & Medical Benefits Companies Association Welfare Trust Medical Benefits Mutual National Telephone Corporation Laslett, Blue & Associates Medical Mutual of Ohio Nationwide Insurance LBA Health Plans MEDICAL NETWORK Native Care Health, LLC Liberty Mutual MEDICOMPANIES LLC NECA - Local 145 Linn County Risk Management Medpartners Network Health Plan Lion Insurance Company Medsave USA Inc New Era Life Little League Association Accidental Meridian Products New Holland Custom Wood Local 1102 TWDSU Meritain Health Corp. New Jersey Health Local 1180 TWDSU Messelman Lumber Inc. New Mexico Association of Counties Local 226 IBEW Michigan Property & Casualty Nexcaliber Local 229 IBEW Gauranty Assn. Niagara County Local 23 IBEW Mid-America Associates Niagara Frontier Transit Metro Local 25 SEIU Welfare Fund Mid-American Benefits System, Inc. Local 309 Benefits Office MidAmerica Administrators Norcal Laborers Local 520 Benefits Office Middletown Retirees Norfolk Dredging Company Local 57 Benefits Office Midlands Claim Administrators North America Administrators Local 70 Benefits Office Midwestern Insurance Alliance North American Health Plans/Meritain Local 877 IUOE Minneapolis and Suburban Lumber Health Locals 302 & 612 Construction Dealers North Carolina Electric Cooperative Lockheed Minneapolis Auto Dealers Northern California Carpenters London Insurance Minnesota and North Dakota Northwest Plumbing & Pipefitting Lone Star TPA Bricklayers Northwest Sheet Metal Works Loomis Companies Minnesota Laborers Nova Healthcare Administrators Los Angeles Fire Fighters Local Minnesota Teamsters Construction Novasys Health 10121 Div Highway ODS M ed 3000 Minnesota Timber Workers Ohio Bricklayers M S Administrative Services, Inc. MMSI Ohio Casualty Group Magna Administrative Services Molton, Allen & Williams Ohio State University Health Plan MagnaCare TPA Montana Teamsters Old Republic Insurance Magstar Technologies Montgomery Insurance Co Olympus Managed Health Care, inc. Maksin Management Group Montgomery Mutual Insurance Omni Administrators MAMSI Company One Beacon Insurance Co. Managed Care Administrators Monumental Life One Beacon Professional Partners Managed Care of America Monumental Life Insurance Go Operating Engineers Local 4 Managed Health Services Mountain States Administrative OptumHealth Manatee Glens Services Orange County Public Schools Marine Engineers Benefit Association Municipal Health Benefit Fund Orion Auto Mariners Hospital Mutual Assurance Oscar Insurance Corporation Markel Insurance Company Mutual Medical Plans Inc Oscar Insurance Corporation Marsh Affinity Group Services Mutual of America Osceloa County (Florida) Maryland Electrical Industry Health Mutual of Omaha Outsource One Fund MVP Health Plan Oxford Health Plans, MBA Benefit Administrators NAHGA, Inc. PA Manufacturer’s Association MBA Benefits National Administrative Services Insurance MBA Merrill Bostrom Assoc National Asbestos Workers PacifiCare of California MBMC National Association of Letter Painters and Allied Trades MCA Administrators, Inc. Carriers Pan-American Life Insurance Group MCAudit National Benefit Administrators, Inc. Paramount Health Plans, Inc. Meadowbrook Insurance Group National Claims Administrative Payer Fusion Meatcutters - Wilson McShane Corp Services Pekin Life Insurance Medata National Employee Benefits Penn National Insurance Co MedCom National Farmers Union Penn Western Benefits, Inc. MedCost Benefit Services National Health Benefits Peppermill Inc Medical Associates Health Plans National Liability Pequot Plus Health Benefit Services PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 15 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Perfect Health Insurance Queensboro Corporation School District #1 Health & Welfare Performax Quik Trip Corporation Trust Personal Insurance Administrators Rady Childrens Hospital San Diego School Insurance of Florida Philadelphia America Life Insurance Co Railroad Maintenance and Industrial Scott & White Health Plan Physicians Benefit Trust H&W Fund Scottish Rite Health Plan Physicians Health Plan of Michigan Ram Mutual Insurance Seabury & Smith Physicians Plus Insurance RDWSU Local 338 Secura Insurance Company Corporation Ready Mixed Concrete Secure Comp Pinnacle Claims Management Regence/Asuris Secure Health Pioneer Managment Systems Regional Care Inc. SecureOne Benefit Administrators, Pipefitters 533 Health and Welfare ReliaMax Insurance Co Inc. Fund Remco Petroleum Security Health Plans Plumbers & Pipefitters Local 25 Republic Group Security Life Insurance Company of Plumbers & Pipefitters Local 501 Reserve National Insurance Company America Plumbers & Steamfitters Local #106 RESOURCEONE Security Workers Health and Welfare H&W Fund Retiree Health Trust Fund Plumbers & Steamfitters Local 33 RG Applegate Select Benefit Administrators Plumbers and Steamfitters Local RGB Retailer Group Select Health Plans #486 RH Administrators Select Health Plumbers Local 522 RHS Business Services SelectCare Risk Management Corp Plumbers Local 75 Rich Maid Kabinetry Selective Insurance Plumbers Local 8 Rigid ply Self Funded Plans Plumbers Local 88 Risk Solution Resources Self Funding Administrators PMA Riverside Benefit Administrators Corporation Polaris Benefits Riverside County, CA. Self Insured Group Marketing(SIGMA) POMCO RMSCO, Inc. Self Insured Plans, LLC Populytics RMSCO, Inc. Self Insured Services Company Prairie State Insurance Cooperative Roanoke Iron Workers Trust Fund Sentara Health Management Inc Preferred Benefit Administrators Local 697 Sentra Health Management Preferred Care - MVP Health Plans Robert C Bouck, Inc Sheakley Vocational Services Preferred Health Alliance Robert F Kennedy Farm Workers Sheet Metal #10 Preferred Medical Plan Inc Rocky Mountain Administrators Sheet Metal WK Local 24 Preferred One Rocky Mountain Health Plan Sheet Metal WK Local 265 PrimeNet, Inc. Roofers & Waterproofer Local 136 Sheet Metal Worker’s International Priority Health Roofers Local 74 Assoc. Pro-Claims Plus Roofers Local 96 Sheet Metal Workers #73 ProCentury Insurance Company Royal Insurance Sheet Metal Workers Local 100 Professional Benefit Admin (PBA) Ruan Sheet Metal Workers Union Professional Benefits Services S & S Healthcare Strategies Sheffield Insurance Professional Claims Administrators S A Allen Sheffield Risk Management Service Professional Claims Management S11-10 Sheffield, Olson & McQueen Progressive Benefits Services Salt River Shelter Insurance Companies ProPeer Resources, Inc. Salvation Army Sierra Health And Life Providence Administrative Services, Samaritan Health Services Significa Benefit Services Inc Inc. San Diego Electrical HWT Significa Insurance Group Inc Providence Risk San Jose Administrators Simplifi (Formerly CBCA) Provident American Insurance San Luis Valley HMO Society Insurance Company SANFORD HEALTH PLAN Southeastern Indiana Health PSI Santa Monica Bay Physicians Health Southeastern Insurance Group Public Employees Health Plan Svcs Southern Benefit Administrators Public Employers Local 71 Trust Sarasota County Government Southern Group Administrators, Inc. Pupil Benefits Plan, Inc. Sarasota Heart Southern National Life Insurance Q3 Business Technologies Sarasota Memorial Hospital Southwest Administrators Qmedtrix Sarasota Pathology Southwest Service Administrators Quality Health Management LLC Sarasota YMCA Southwire Company Quantum Imaging Savers Property & Casualty Special Insurance Services Inc.

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 16 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Spectrum Risk The Integrity Benefit Network Union Pacific Railroad Emp Health St Johns Claims Administration The Kempton Company Sys. St Paul Electric Workers The Peninsula Insurance Company Union Standard Insurance Group St Paul Printing Therma Core Union Trowel Trades St. Francis Health Network THIPA- Torrance Hospital United American Insurance Company St. Joseph Heritage Healthcare Independent Practice United Claim Solutions St. Paul Auto Dealers and District Thomas Cooper & Company United Employee Health Plans Standard Life & Accident Insurance Three Rivers Benefit Corporation United Healthcare Integrated Services Co TLC Advantage Sanford Health (administered by UMR) Star Insurance Company Toledo Electric Welfare United Insurance Companies, Inc. State National Insurance Co. Total Broker Benefits United Med Res State of Georgia, DOAS Total Claims Management United Press International Steadfast Insurance Company Total Plan Administrators United Security Life and Health Steel of West Virgini Total Plan Services Insurance Company Stirling and Stirling Tower Life Insurance Unity Health Insurance Stirling Benefits Inc TPA of Georgia Universal Assistance Stoner and Associates TR Paul, Inc. University Of Chicago Health Plan Stonewood Insurance Company Transguard Insurance (UCHP) Student Plans, Inc. Transport Workers Union Health & University of Colorado-University Risk Sturm and Associates Welfare Funds Mgmt Suburban Health Organization Transwestern Insurance US Administrator Claims Summit - PIA Administrators US Health Group Summit America Insurance Services Travel Insurance Services US Network and Healthcare Summit, Inc. Travelers Insurance US Oil Company Employer Group Sun Life Financial Tri-State Insurance Company National Susquehanna Laborers Tri-State Joint Fund Valley Baptist Health Plan Inc Sutherland Food Service Trident Plan Administrators Vallorbs Swiss RE Reinsurance National Tristar Managed Care Value Options/NRLC Syracuse University Athletic Tristate Local 1035 Vanliner Insurance Department Tristate Local 191 VIA Metropolitan Transi T.L. Groseclose Associates, Inc. Tristate Local 404 Viva Health T.R. Paul Inc Tristate Local 443 Voya Financial Tall Tree Admin Tristate Local 493 W.I Cox Associates, Inc. TBG Administrative Services Tristate Local 559 Warehouse Employees Local 570 Teacher’s Protective Mutual Life Tristate Local 677 Trust Fund Insurance Company Tristate Retires Wasatch Teachers Health Trust Truck Drivers and Helpers Local 365 Washington State Department of Teachers Protective Trusteed Plans Transport Team Health Trustmark Insurance Watkins Teamster Local 175 & 505 H&W Trust Tufts Health Plan WEA Fund Twin Cities Case Management WEB TPA Teamsters Local 135 Health Benefit Twin City Floor Covering Webbco Fund Twin City Pipe Welfare & Pension Admin Svc Teamsters Local 560 Benefit Fund UA Local 125 H&W Welfare and Education Fund Teamsters Local 618 UA Local 782 Health Plan Wells Fargo TPA, Inc. (AKA Technology Insurance Company UFC Local 711 HealthSmart) Tennessee Insurance Company UFCW Wenger Family of Companies Texas Carpenters and Millwrights UICI Holding Company West Bend Mutual Insurance H&W Fund Ultra Benefits West Virginia Laborers’ Trust Fund Texas Mutual Insurance UltraBenefits Inc Western & Southern Financial Group The Alliance UMR Western Growers Assurance Trust The Frank Gates Service Company UMR/Benesight/Fisery Western Guaranty Fund Services The GEMGroup Underwriter Safety & Claims Western Southern Life The Gray Insurance Company, Inc. Unicare Western Southern Life Insurance The Harleysville Insurance Companies Union Insurance Company Company The Hartford Union Labor Life Insurance Company William Earhart Co, Inc. PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 17 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Williamsburg National Insurance Co. Wisconsin Health Fund WP Puget Willims, Parker, Harrison, Dietz, & Wisconsin Insurance Security Fund WPS Health Insurance Getzen WMI Mutual Insurance Co & WMI TPA WR Berkley Corp Wilson Mcshane Twin City Sheet WP Northwest Iron Workers Trust Yoders Metal WP Northwest Roofers Yusen Transportation Wilson Mutual Insurance WP Operating Engineers Zenith Administrators

GALAXY / MANAGED CARE INCORP. (MCI) - PPO Fee Schedule: 30% discount off billed charges. Patients enrolled: 4.5 Million+ nationwide States applicable: All States Specialties applicable: All specialties Reimbursement: Fee for Service. Claims Submission: Member ID will indicate. Patient Identification: Galaxy Health Network will appear on the patient’s card or card sleeve. Payer clients: The following list of Payer clients are Galaxy/MCI Medical Payers Website: www.galaxyhealth.net

2 Land, LLC AIM Administrators American Insurance Company 2187 United Teamsters Fund Aim Benefit Services American Insurance Company of 2190 Local 840 Aladdin Carpets and Interiors, Inc Texas A & G Financial Consultants Aladdin Industries American National Carbide Aaron’s Service Company ALATEC American National Insurance ABC Iowa Trust & AG Processing, Alexander International Company Inc. All Risk Administrators, Inc American National Life Insurance Co Able Telecon Holding All Staffing Employee Healthcare American National Standard Accutax Plan Automation ACE USA Allen Medical American Pawn and Jewelry ACMG Allen University American Pioneer Insurance ACS Consulting Services, Inc. Allen’s Company Activation, Inc. Alliance International Assistance American Printing Acurite – OOA Travel Allied Benefit Administrators American Residential Adams Northlake Pharmacy Allied Services Workers Union No. 1 American Sigma – OOA Travel Administrative Benefit Services Alpine Moving of Texas American States Insurance Administrative Claim Services Ameraplan American Union Life Insurance Co. Administrative Consultants, Inc American Administrative Group American Western Life Administrative Support, Inc. American Appliance Outlet Americorp Administrators & Consultants American Benefit Management Ameripac, Inc. Adminone Corporation American Cometra, Inc AMFED Employee Benefit Plan Trust Advanced Industrial Assistance American Freightways, Inc. AMTI/ACF 10145 AFC Group American General Anchor Benefit Consulting, Inc Affiliated Benefits Organization American Health Care Alliance Anderson Lithograph, Inc Affiliated Foot Center American Health Care Partnership Anesthesia Associates Affinity Group Underwriters American HealthCare Partnership– Anthem Health & Life Ins Co AHGL ProTrans Anthony Armstrong Agency Ahrens Financial Systems, Inc American Heritage Apa Partner/Kamtech AIG International Services American Home Assurance Apache County AIG Worldsource American Ice Machines, Inc Apartment Hunters

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 18 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Apex Home Healthcare Benefit Life Insurance Company Calnada Surveying, Inc APW Union Health Plan Benefit Management Corporation Cam Administrative Services Argus, Inc. Benefit Negotiators, Inc Cambria Capital Corporation Aristacom International, Inc. Benefit Planning Services, Inc Camden County Arizona Health Dimensions Benefit Resource Management Campbell Industries Inc. Arrow Metals Benefit Resources/The Resource Canada Life Assurance Company ASC International, Inc. Grp Car Shops ASO North America Benefit Solutions Cardinal Investment Company, Inc Associated Plan Administrators Benefit Support Carolina Benefit Administrators Assurance Resources, Inc Benefit Systems Carriage House – OOA Travel Atlas Life Insurance Company Benefit Systems & Services, Inc Carroll Automotive ATS & Midwestern Benicorp, Inc. Casa Linda Remodeling, Inc. Aubrey Auto Sales Betlis Construction, Inc Cattle Baron Restaurants Aurora Dairy Corporation Betro, Inc CBR Aurora National Gas Bible Baptist Church and Schools CBSA Automated Benefit Services Biesse America CBSI Automated Group Administrators Bitterroot International Cedar Creek Bank Automotive Fuels Company Blake Trainer Trucking Celtic Life Insurance Company Automotive Parts Blansett Pharmacal Centerline Industries, Inc AX5 Blasland, Bouk & Lee Associates Centerville Independent School B & B Gravel Blueworks District B B L – Pomco BOA Central Concrete BABB, Inc. Bob McClosley Agency, Inc Central United Life Insurance Bakakel Communication Boise State University Centri’s Risk Management Bankers and Merchants State Bank Boom Vang Consulting Century Aluminum Bankers Life and Casualty Company Bowling Green State University Ceonseco Medical Ins. Co Bankers Security Life Insurance Boy Cote IMT, Inc. Certified Temporary Services Company Boyd Brothers Trucking Chas F. Williams Company, Inc. Barney Holland Oil Company Boyd-Veigel-Attorneys Checkered Flag Transportation Barrier Resources Brammer Supply Chek Cash Bartush – Schnitzuis Company Breen Color/ACF10140 Cher A Bumps & Assoc. Basic Benefits, Inc. Brennans Ltd. Designers Workshop Chicago Tire And Auto Service Basland, Bouch and Lee Associates Briarwood - Brookwood, Inc Chiropractic Strategies Bass Engineering Company Bricklayers & Allied Craftsman Choice Net Batteries Plus Health & Christ Chapel Bible Church Baxter and Sons Elevator Company Welfare Fund of Indiana Citizens National Bank – Henderson Baylor Trucking – 178 Bridgestone/Firestone Americas City of Fort Wayne Fire & Police Ins Bayside Manor Holding City of NF – OOA Travel Beacon Risk Strategies Brokerage Concepts, Inc. City of Siloam Springs Bearcom Operating L. P. Brown & Roberts Classic Products Corp. Bearder Furniture Company Browning Oil Company, Inc Cleveland Group Beckwith-Hightower and Renberg Brynwood Center #526 Cliffstar – OOA Travel Ins Bumper to Bumper, Inc Clouse Trucking Beefers Systems, Inc Burton Buildings CMAC Belmont-OOA Travel Burznski Research CNC Global Resources, Inc. Benborrk Family Practice Bush (Colorworks) – OOA Travel CNG Communications Bencor Corporation Byar’s Mobile Homes Coalition of America Marketing Benefit Administrators Systems, Inc C & G Tele-Wiring Services Group Benefit Claims Payers C & M Fine Pack, Inc. Coastal Lumber Company Benefit Concepts Human Resrce C & S Trailer Cochise County Group Health Trust Mgnt C I MI College Station Church of Christ Benefit Design Administrators C. R. Sign Company Collin Street Bakery Benefit Group C. A. S. A. Church and School Collins Entertainment Corporation Benefit Life and Casualty Association Combined Benefit Administrators, Corporation Calcasieu Parish School Board Inc.

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 19 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Comcar Industries, Inc. Srvcs Eikenberry & Associates, Inc Commerce Medical Group Custom Sprayed On Liners, Inc El Campo Newspaper Commerce National Bank Cyclone Manufacturing Company Electrio Acoustics & Video Commercial Bank of Texas, N. A. D & M Fertilization Elkhart State Bank Commercial National Bank of Dallas / Fort Worth Roofing Supply Employee Benefit Administrators Beeville Dallas Bankers Life Insurance Co. Employee Benefit Services Commercial National Bank of Brady Dallas General Life Insurance Co. Employee Benefit Trust Commercial Underwriters Dallas Production, Inc Employee Benefits Management CompFirst Damon’s International Services Complete Book and Media Supply Dan’s Furniture and Butane Employee Security, Inc. Compro Systems, Inc. Darling International Employer Planning Services Computer King, Inc. Dart Construction Employers Mutual Concho Construction Company, Inc. Dave’s Supermarket Encon International, L. P. Conley, Lott, Nichols Machinery David Knight and Associates Energy Partners Group Con-Serv David Lewis Builder Entrust Risk Management Conservco Décor Gravure Entrust, Inc. Consolidated Employee Benefits Delores Water Conservancy District EPIC Administrators Consolidated International Group, Delta Health Group Epic Insurance Company Inc. Design Benefit Administrators Episcopal School of Dallas Consolidated Tex-Pack, Inc. Devon Health Services Equitable Plan Service, Inc. Consumer Benefit Services, Inc Dexide, Inc. Equity Benefit Services Continental Carbonics Diesel Diagnostics Erin Group Administrators Continental General Insurance Co. Digioia Brothers Excavating Estrada & Associates Continental Life and Accident Dincon, Inc. Evolutions Healthcare Sys (Guardian Control and Connector Specialty Discount Loser Products Resources) Control Tech – OOA Travel Diversified Benefit Plans Excalibur Construction Conveying and Mining Equipment Dixon Plumbing Exodyne/KC Life Conwae, Inc. Don J. Holt, MD Express Doctors, Inc Cooper Institute of Aerobics Donald Vardman Extended Benefits (West Chemical) Research Donley and Horan F. W. Garner Coordinated Benefits Dos Gringos, Inc F. C. E. Benefit Administrators Administration, Inc Double J Installation Services Fabulous Foods Cornerstone Preferred Resources Dowcraft – OOA Travel Fairmont Management Company, Corning, Inc. DRX, Inc. Inc. Corporate Benefit Consultants DS Supply FARA Benefit Services Corporate Dynamics Dublin National Bank Farmers and Merchants State Bank Corporate Health Administrators Dunn and Associates Farmers and Merchants – Burleson Corporate Staffing Resources Durmax Farnell & Smith Inc. Corporate Systems Administration DVCC, Inc. Farouk Systems, Inc. Costco, Inc Dyersburg Corporation Farrago Farms Cotter Member Insurance Company DYI Group Farris Point of Sale, Inc. Cougar Trucking, Inc. Dynamic Dies, Inc. Fas-Tronics, Inc Country Life Insurance Company Dynamic Products Fincastle Cattle Company Covenant Administrators, Inc. Eagle Communications, Inc Fine Lines Automotive Cox Insurance Company East Texas Bancshares, Inc. First American Administrators Cran Technologies East Texas Fabrication, Inc. First Bank Cross Plains/Sanderson East Texas Seals, Inc. First Benefit Administrators Crown Auto Company Eastern Benefit System First Benefit Services Crown Life Eclipse Medical First Integrated Health, Inc. CSA Edison Project First National Bank of Ballinger CTA LLC Edward B. Morris First National Bank of Beeville Cuero Community Hospital Edward Equipment Sales, Inc. First National Bank of Burkburnett Cuna Mutual Insurance Group Edward N. Bitter, D.D.S First National Bank of Dublin Custom Design Benefits EEDP Enterprises, Inc First National Bank of Fairfield Custom Logistics & Warehouse EGS Electrical Group First National Bank of Gilmer

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 20 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee First National Bank of Graham Greenvile Bearing Healthcare Management Services First National Bank of Granbury Greg Booth and Associates,Inc. Healthcare Management, Inc. First National Bank of Lake Jackson Griffin Industrial Services Healthcare Solutions Group First National Bank of Livingston Group Administration Services Healthchoice, Inc. First National Bank of McGregor Group Benefit Services Healthcore First National Bank of Mertzon Group Benefits Unlimited, Inc Healthfirst TPA First National Bank of Mexia Group Health Administrators Healthguard First National Bank of Port La Vaca Group Health Cooperative Claims HealthNet of Arizona First National Bank of Whitewright Group Resource HealthPlans, Inc. First National Bank of Winnsboro Grove Motors Henry G. Salzer First Place Financial Corp/Capitol GSB Investments, Inc. Herb’s Tire Service Bank GSF Claims Heritage National Bank First Security State Bank Guarantee Insurance Resources Heritage Village – OOA Travel First State Bank and Trust Guarantee Mutual Life Company High Power Aviation, Inc. First State Bank of Burnet Guarantee Trust Life Insurance Co. Highgate Products, Inc. First State Bank of Clute Guaranty National Bank Highland Lakes Bank First State Bank of Graham Guardian Life Insurance Company Highmark Life & Casualty Group Flat Rolled Steal, Inc. Guardian Resources, Inc. Hi-Ho Store & Café Florida Health Administrators (Evolutions Healthcare System) HIS Enterprises Florida Health Alliance Gulf Atlantic Group Hitch Enterprises, Inc. Food Sales Systems Gulf Breeze HMO – El Salvador Food Sales West Gulf Industries Hodges Brothers Fort Pierce Public Utilities Gulf South Administrators Holidair Insurance Services, Ltd. Fort Wayne Mack Sales and Service Gulf South Health Plus Holman Robertson Eldridge Fortis Benefit Insurance Company Gulf South Medical Supply Holzer Medical Center Foundation Health Systems Habasit – OOA Travel Home Life Group Benefits and Foundation Steel and Wire Hadd Machine Tools of Texas Service Four Wheel Drive Hardware Hadden National Administrators Inc Hood Corporation FOW / KES Equipment, Inc. Haffle America Company Hopson Lodging Fred Anderson & Son Drilling, Inc Hagemeyer Horace Mann Insurance Company Fredonia State Bank Halifax Health Plan Hospital Benefits, Inc. Freeport Welding and Fabricating, Halliburton Swimming Pools Hospital Staffing Services Inc. Halls Lumber Hospital Television Network Fucillo Automotive Dealership Hancock Medical Center Hospitality Partners / ACF 10143 Future Point Administrative Services Handley Chiropractic Center Houghton – OOA Travel G. T. I Haney Group Services Houston A-1 Car Stereo Plus, Inc. Gainesville Products Hansen Beverage Company Houston Cardiovascular Associates Gardner and White Hards Marine Service HR America Garrett and Garrett Harvey’s Hotel and Casino HR Services Gateway Financial Haswe & Hauser Hulcher Services, Inc. Gem Insurance Group Hayes and Stolz Human Resource Benefit GEMI HB Zachary Company Administrators Gilsbar Inc. HCH Administration Hunt Insurance Group, Inc. Glen Oaks Health Care Center HCRS Hygeia World Health Global Claims Management Health Access I A C/ Reliance #560 Global Excess RE Health Alliance I O A – RE Global Ins Mngmnt & Consultants Health and Life of America IBEW/NECA Health and Welfare Global Management Health Headquarters LLC Fund Global Training Academy Health Management Assoc. ICM, Inc. Gloria Jeans Gourmet Coffee Health Plans of America Ideon, Inc. GNT International Health Plans, Inc. IEES, Inc. Gohio: Adams – Brown Counties Health Special Risk IHC Health Plans Gowdwins, Brooke and Dickerson Health Spring Management Illinois Manufacturers Association Graue-Haws, Inc. Healthcare Administrators Group Ins. Greenbriar Architectural Healthcare Benefits, Inc. Imageware, Inc.

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 21 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee INC James Cable Law Office of Michael O’Briant Inchlor Services, Inc. Jason Components Law Offices of Ken Willford Independent Bankers Association of Jasper Engines & Transmission Co LBA Health Plans Texas (Woods & Grooms) Lectric Lites Company, Inc. Independent Life Insurance Jay Tex Aviation Lefevre Agency Company Jefferson Life Insurance Company Legal Security Life Insurance Co. Indiana Lumbermans Jefferson Pilot Life Insurance Leica – OOA Travel Industrial Packaging Services Jefferson Pilot Network Leon Jones Seed & Grain Ingersoll Enterprises Jerry’s Chevrolet–Buick Inc & Lerson Advisory Services Inman Mills Affiliates Letsos Company Innovations in Home Theater Jess and Gross Company Levenson, Levenson and Hill, Inc Innovative Resource Group Jet Foods Life Care Centers of America Input/Output Jewelry Market, Inc. Life of the South Instrumental Control Services Jiffy Signs & Decals LifeCourse Management Services Insurance Risk Management Johnson Benefit Administration Lifeline Underwriters Life Ins Co Insurance Claim Services Joiner Food Services, Inc. Life-Tech, Inc. Insurance Design Administration Jon’s Windshield Lift Technologies Insurance Management Services Jonad, Inc. Lincoln University Insurex K & K Insurance Company Lloyd’s of London Integral Strategies, Inc. Kanawha Employee Benefit Local 854 Integrated Clinical Data Admin,Inc Lockhard & Williams Insurance Integrated Healthcare Solutions, Kansas City Life Insurance Co. Srvcs LLC Kappa Benefit Services Lone Star Transportation, Inc. Integrated Living Communities KCS Management Services Lone Star Truck & Equipment Svcs, Integrated Practice Management KD, Inc. Inc. Integrity Administrators, Inc Keiser, Inc. Longdale Industries, Inc. Inter Rail Transport Keller State Bank Love Technologies Intercare Benefit Systems Kenneth W. Jack M B R K International Aviation Services, Kepple and Company MacNeal Memorial Hospital Limited Ketchum Maggie Breen, Inc. International Benefits Kettle Restaurants, Inc. Magna Administrative Services Administrators Key Benefit Administrators Magnacare PPO – Local 617 International Benefits Services Corp. Key Partners, Inc. Magnacare PPO # 556 International Fidelity Group Kids “R” Us of Copperfield Magnacare TPA International Group Services Kinetico, Inc. Mahoney Consulting International Healthcare, Inc. Kingdom – OOA Travel Managed Benefit Administration International MedCare Kingsley Group, Inc. Managed Care Administrators International Medical Group Kirk Patrick Managed Care of America International Recifier Kitiles Home Furnishings, Inc. Managed Med Group Intervalley Health Plan Klais- Non Reliance – Tricor #675 Managed Underwriters, Inc. Intile Designs, Inc KLLM Trucking Management Counsel for Inverness Walden Knockdown, Inc Employee Benefits Iron Man Welding Works Kondos & Kondos Management Services Ironworkers District Council KRI Growth Stocks Managing Underwriters, Inc. Island Group Administrators KS Electric Health Insurance Mandell IUPIW Benefit Fund L. J. Underwriting and Associates Manhattan Life Insurance Company IvoClar – OOA Travel Labor & Beyond, Inc. Manual Woodworkers & Weavers, J & A Vending Lackland Properties Inc J. Allen Hall & Associates, Inc. Lake Eustis Care Center Marco Display Specialists, Inc. J. L. Brantley, Inc. Landmark Community/Image Marion General J. B. Parks Wholesale Florist, Inc. Technlgy Marketing Services Associates Jabin Industries Landmark Tower Corporation Marriot International, Inc. Jack Harrison & Associates Lane McDuff Sales Company Marshall Collision Repair Jack’s Appliance Center Lantech of America, Inc. Marvin Enterprises Jackson LEA Larson Associates USA Mashantucket Pequot Tribal Nation

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 22 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee MAUMEE Montgomery Management Nils Sefeld Volvo & Tattoe Maury Donnelly & Parr, Inc. Monton Buildings Management Mays Chemical Company Montrose Ford – Nissan Nitram Energy – OOA Travel Mc Crone Design / ACF 10139 Morris Associates NJ America, Inc. McBee Company Morrow Buick – Pontiac, Inc. Norcraft Companies McConackie Financial Services Morton Custom Plastic of Kentucky Normandy, Inc. McFarland, Ferguson & McMillian Mouzon Bass Company North America Administrators McGriff Industries Mr. Bill Motor Company North Central Texas Laborers McKenzie Medical Benefit Plan Trust Mrs. Leepers, Inc. Health and Welfare Fund McKinney Lumber and Hawk Munsch Hardt Kopf Harr and Dinan Northeast Frozen Foods Company PC Northern Automotive McKinstry Enterprises Muscle Technology Northwestern National Life McLaren’s Toplis Mustang Financial Corporation Norton Lilly international Mechanical Interiors, Inc. Mutual of Omaha Nova Healthcare Admin Medex Assistance Corporation Napata Ace Hardware Novia Underwriters H R M Claim Medex Insurance Services National Accident Ins Underwriters Mgmt Media General National Allied Workers – 831 Oak Hill Medical Benefits Mutual National Assoc of Preferred Oak Tree Administrators, Inc. Medical Care Management Services Providers Oasis Pipeline Company Medical Claims Services National Benefit Administrators, Inc. Obersfield’s, Inc. Medical Claims Solutions, Inc. National Benefit Resources, Inc. Okaloosa Gas District Medical Express National Care Network Olivery Lumber Company Medical Resource Marketing Group National Claims Administrative Svcs OMS Medina Valley State Bank National Employee Benefit Admin, One Stop Copy and Printing Medreview Inc. Ontod Ltd. Meiden & Hunt, Inc. National Financial Life Ins Co Opportunity Resources, Inc. Mel Stevenson Associates, Inc. National Foundation Life Ins Co Options Publishing Melange Fine Cuisine National Group Insurance Company ORMAT Technologies Member Insurance Program National Group Life ORMAT, Inc. Memphis Light Gas & Water National Health Benefit Corp. OSF Healthplans, Inc. Memphis State Bank National Health Insurance Company O’Steen Adjusting Services Mercury International National Insurance Services Otis Spunkmeyer, Inc. Mervis Industries National Property Casualty Outdoor Lumber & Hardware Metal Processing National Risk Transfer P. J. Welding and Fabrication Metronics National Rural Electric Coop Assoc PACE Metronics – OOA Travel National Seating & Mobility Pacific Coast Claim Consulting Co Mi Cocina National Security Life Pacific Health and Life Insurance Co Miami Medical Centers, USA Inc. National Spirit Group, Limited Pacific Heritage Administrator Michael McCulloch, MD Nauticon, Inc. Pacific Hospital Association Micron Industries, Inc. NCAS – Pleasant Hardware Pacific Preferred Mid America Benefits Company Pacific Risk Management Midas Rex Pneumatic Tools, Inc NCAS – Security Finance Company Pacific Western Excess Midland Life Insurance Company Neuroscience Centers, Incorporated Pailet Financial Services Millennium Health Group New Century Underwriters Paint Sundry – OOA Travel Miller & Long New Deal Independent School Pairgain Technologies, Inc Miller and Herring P. C. District Panada Energy International, Inc. Miller Veterinary Supply New Era Life Insurance Companies Panama Beverage Co. Mills County State Bank New Jersey Auto Wholesalers Panola Lights and Signal Miracle Machine New Mexico Foundation for Medical Paradigm-Macon Mobiech, Inc. Care Paradigm Administrators, Inc. Modern Art Museum of Fort Worth New Millenium – OOA Travel Parkway Communications Module Truck Systems, Inc. News – Journal Corp. Paslay Services, Inc. Momentum Holdings, CSI.Net Next USA, Inc. Pay & Save, Inc. Monroe’s Carpet & Furniture Nextel Pechiney Rolled Products Montana Unified School Trust-Must NGS American, Inc. Pecos County State Bank

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 23 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Pedding House Corporation Professional Advocates & Crafts & Rockwell Management Group Pentacon – D – Bolt Corporation Trades Rocky Mountain Elk Foundation Perico Professional Benefit Administrators Roe’s Furniture & Appliance Periodical Services Inc. Professional Benefits & Service Rogue Garcia Corporation Personnel Network Progressive Concepts Russer – OOA Travel Pete Durant & Associates Prompt Associates, Inc. RX Relief, Inc. Petro Tech, Inc. Propane Continental dba S & S Fleet Subrogation, Inc. Pettigrew Welding P. C. A. Z. Graves Propane S I H O PFMC Protective Consumer Direct Sackner Products Pharmacy Systems # 510 Providence of St. Joseph’s of Safetywear, Inc. Phelps Dodge Corporation Capuchin Safeway Door Philadelphia American Life Ins Co Provident American Insurance Dalerno/Duane Auto Group Philip Vogel Company, P.C. Company Salud National, Inc. Phoenix Communicants Mstr Provident Life and Accident San Antonio Fleet & Auto Service Graphics Prudent Risk Management San Antonio Shoe Repair Phoenix Excess Risk Underwriters Pulau Electronics Sanders Valve, Inc. Piedmont Administrators Pyramid Life Saot Travel Piedmont College Qual-Choice Scherer Industrial Pierce Public Utilities Quality Electronics Schilli Transportation Pilgrim Congregational United Quality Service Group Script Company Church of Christ Quantum Film Products Seaboard Life Pine Forest Jewelry R & R Fencing Seager Bros./AC345 Pineland State Bank R. Hixon, Inc. Self Funded Plans Pioneer Financial Service R. C. Martin, Inc. Self Insured Benefit Administrators, Pioneer Life Insurance Company R. T. Nelson and Associates Inc. Pisano Group R. W. Management Company, Inc. Self Insured Group Marketing & Pittman & Associates RAB Products & Services Administration, Inc. Pizza Boy of Oxford, Inc. Radio Lab Sells Printing Plan Handlers, Inc. Radiology Associates of Tarrant Selman & Co. Plan Service, Inc. County Sema Planned Administrators Rafter J. Trucking Seneca Foods – OOA Travel Plant Rash Construction Center Sevenson – OOA Travel Plumbers Local Union No. 68 Recipricol – OOA Travel Shake and Shingle Supply, Inc. Pointbank, N. A. Recovery Campuses of TX Shared Medical Alternatives Pope Exploration Red River Farm Shelton Trucking Services Posters, Inc. Regency Employee Benefits Shumate & Dean Law Firm Pounds Surveying Group, Inc. Regional Benefit Plans Shuttleworth, Inc. Powerhouse Technologies Regional Care, Inc. Sights & Sounds Practical Healthcare Solutions, Inc. Rehab Consultants, Inc. Silver State Medical Administrators Prairiland Independent School Reid Lockhart Golf Company Silvercrest Manor District Reliable Life Insurance Company Simmons & Associates Precision Landscape Management, Remist, Inc. Siplast, Inc. Inc. Renco – OOA Travel Sirianni Auto Sales Preferred Care Rentco Sisco Preferred Providers, Inc. Republic American Life Ins. Co Sixto Custom Finishing Premier Engineering, Inc. RH Administrators Sixx Holding, Inc Primary Physicians Care Richardson Eagle Inc. Skin Correction Prime Benefits, Inc. Riley Gear Corporation Smith Mattress Company Primenet, Inc. Ring-Can Corporation Smorasbord Management Co. Print Assist Rip Griffin Truck Services Center Snider Tire Company Print Tex Office Products Risk Benefit Management Snider’s Drugs PRNA Services River Chase Care Center Software Technology International Pro-Claim Plus, Inc. Robert M. Rosson, DDS South Plains Financial, Inc. Producers Exchange Benefit Robert R. Romack, DDS South Texas Design Services, Inc Rocket Air Supply, Inc. South Texas Hats, Inc.

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 24 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Southern Adventist University TDC Tiseo Paving Company Southern California Pipe Trades Teamsters Industrial Employers Today’s Merchandising Southern Companies Welfare Fnd Todd Mechanical Southern Industrial Constructors Technical Resources International Total Plan Services Southern Ins Management Teletech Holdings, Inc. Tour & Med Assistance Associates Texas Bank and Trust Tower Life Southwest Auto Sales, Inc. Texas Bed Company Town & Country Concrete, Inc. Southwest Motors, Inc. Texas Community Park Town Square Furniture Southwest Service Life Ins Co Texas Digital Systems Townes Wear, Inc. Sovran – OOA Travel Texas Heat Treating, Inc. TPA of Georgia (Brook Properties) Specialized Plans Texas Society of CPA’s TPA of Illinois Sponsored Marketing Ins Admin Texas Sterling Construction Transfund Mortgage Corporation Sports Radio Partnership, Inc. The Benefit Group Transitional Learning Community Springfield Public Schools The Blender Company Transport – OOA Travel SSI The Brice Legal Group PC Transworld Healthcare, Inc. St. John’s College/ACF 10142 The Capella Group – Care Entrée Travis, Wolff and Company, L. L. P. St. Joseph Professional Building The Champion Group Tremont Floral Supplies St. Martin & Williams The Cooper Clinic P. A. Triconex Corporation Standard Automation & Control LLC The Crew Plan Triconex Systems, Inc. Starrchecx LLC The Deyhle Trip-Tees State Bank of Dekalb The Elite Group Tripod, Inc. State National Bank of Caddo Mills The Eye Center TRIUNE Resources, Inc. Stateline TPA, Inc. The Fix-Your-Well Co. TRL Trucking States General The Gladney Center Tru Services Statesman National Life Ins Co The Hockaday School Trucking Employees of North Jersey Stellar Enterprises The Liberty National Bank in Paris Welfare Fund Stephens Health Care, Inc. The M. J. Daniel Corporation Trussel Electric Sterling Care Center The Mallory Group Tucker and Clark, Inc Stolt Parcel Tankers, Inc. The Marketing Continuum, Inc. Turbine Industries Stone Bennett Corporation The May Department Stores Turner, Meehan, & Williams Stop Loss International Company Tylers Auto Stowe Administrators, Inc. The People’s State Bank of Clyde U. S. Benefits Corporation Strategic Health # 486 The People’s State Bank of U. S. Benefits, Inc. Strategic Medical Hallettsville U. S. Intec, Inc. Student Advantage The Place U.S.A. Health Services, Inc. Sullivan Builders The Preston Group, Inc. U-First, LLC Summit Administrators The Resource Group UHC/NRLC Sun Life of Canada Ins Co The Sleep Disorder Clinic of Union Bankers Insurance Company Sun Roller Corporation Houston United American Insurance Co. Sun Bank The State Bank of Texas United Art & Education, Inc. Superior Insurance Services The State National Bank United Benefit Group Supreme Plastics, Inc. The Stephan’s Company United Health, Inc. Swatzell Communications The Summit Publishing Group United Knitting Swiss RE The Trade Group United States Life Insurance Co Syndicate Healthcare The Vintage Apartments United Teamsters Fund Synergy/ACFSYNG The Wayne Companies, Inc Unitron, Inc. Syracuse Research Group Thermo Manufacturing Company, Universal Opthamalic System Printers, Inc. L.P. Upstate Administrative Services, T & C Centers, Ltd. Third Party Advantage Inc. T. R. Bartholomeu Architects & Administrators Upstate-Redstar Associates Thomas Jewelers U-Race Corporation T. L. Groseclose Assoc. Inc. Three Rivers Benefit Corp US Benefit Corporation Taylor Benefit Resources Three Rivers Provider Network USA Services Group Tayson Insurance Administrators TIA USI Administrators-Capitol Title TC3 Time Services, Inc. Group #505

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 25 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee USI Admin-Columbus McKinnon Watauga Wood Products Wilder Contract Well Service Value Options Weaver and Tidwell, L. L. P. Wiley Sanders Trucklines Variable Protection Administrators Webb, Murray & Associates William C. Beeler and Company Vasa Brougher Welmark William Hydraulics Venezia Wendy’s – OOA Travel Willis Corron of Kansas Venezia – OOA Travel West Texas Legal Services Wilson Air Conditioning, Inc Veteran’s Memorial Westar Mortgage Wilson Automotive Video Post and Transfer, Inc. Westbridge Capital Corporation Wilson, Cantell, and Moody Virgin Mason Health Plan Western Benefits Wilton Krayse Septic Viva Health Western Electronics Windsor Manor VolMed Western Petroleum Marketers Wins Paper Products, Inc. W. J. Haynes and Company Association Wisconsin Automobile and Truck Waggoner National Bank of Vernon Western Reserve Benefit Dealers Associates Wake Forest University Administrators Agency, Inc. Wisconsin Evangelical Lutheran Walchop, Inc. Western Southern Life Systems Walgreen Western States Administrators, Inc. Wood and Grooms Wallace Bargain Block Westside Cellular Woodman Life and Accident Wally Clayton Builder Weyco, Inc. Insurance Wal-Mart (Specific Policies Only) Wheeler Companies-Insurance World Insurance Want Ads of Longview Claim Srvcs Wrenn Handling/Brungart Warren Steinborn Associates Whisperwood National Bank Equipment Washington Homes White Knight Yaga, Inc. Washington National Insurance Co Wick Communication Company Yorkshire Global Restaurants Waskon Automotive Wil Jef Transportation Zoria Farms, Inc.

THREE RIVERS PROVIDER NETWORK (TRPN) – WORKERS COMPENSATION Fee Schedule: 85% of the existing fee schedule as total reimbursement for Workers Compensation. Where a state or federal government fee schedule exists, such schedule shall serve as an index for all payments without exception. For states that do not possess a fee schedule for workers compensation, the Medicare fee schedule shall serve as the index for all payments without exception. States applicable: All States* (*not available in California) Specialties applicable: All specialties Reimbursement: Fee for Service. Claims Submission: Submit claim to address on patient form. Patient Identification: Contact employer / see incident report Payer clients:

AAA Minnesota Iowa Fair Isaac Safeco AIG Insurance Co FCCI Insurance Group Sedgwick CMS Auto Injury Solutions Gallagher Bassett Selective Insurance Co. Avis Budget Group, LLC Geico Corp State Farm Broadspire Genex The Hartford Buckeye Insurance Group Ingenix Travelers Insurance Cambridge Integrated Services Intracorp Tristar Risk Management Chubb Insurance Co Key Risk Management Unitrin Auto and Home COMPIQ Liberty Mutual Insurance Co USAA Crawford and Co Met Life Work Comp Bill Review Service Dollar General Ohio Mutual Insurance Co Zenith Insurance Company E S I S Reviewworks PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 26 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee FEDMED INC. – WORKERS COMPENSATION Fee Schedule: 15% discount off providers usual charge for covered services less any applicable co- payments, co-insurance, or deductibles. Where a state mandated fee schedule exists, provider agrees to accept a 10% discount below the state schedule.

States applicable: All States* (*not available in California) Specialties applicable: All specialties Reimbursement: Fee for Service. Claims Submission: Submit claim to address on patient form. Patient Identification: Contact employer / see incident report. Payer clients: The following list of Payer clients are FedMed Payers

American Benefit Plan Administrators First Agency National Health Benefit Corporation (ABPA) GlobalCare (NHBC) Aetna - National Advantage Program Global Excel Management Olympus Managed HealthCare (NAP) HealthRisk Resource Group Preferred Medical Claim Solutions Carpenters Southwest Administrators Healthsmart (PMCS) Coalition America Health Care Services International Premier Healthcare Exchange (PHX) Comprehensive Benefit & Health Systems International (HSI) Principal Financial Group Claim Administration (CBCA) Integrated Health Plan (IHP) SelectCare Worldwide Devon Health Meritain Health TC3 Health Federated Mutual Insurance Company National Claims Administrative United Medical Resources (UMR) Services (NCAS)

AMERICA’S CHOICE PROVIDER NETWORK (ACPN) – WORKER’S COMPENSATION Fee Schedule: 20% off providers usual charge for covered services less any applicable co-payments, co- insurance, or deductibles. Where a state mandated fee schedule exists, provider agrees to accept a 10% discount below the state schedule.

States applicable: All States* (*not available in California) Specialties applicable: All specialties Reimbursement: Fee for Service. Claims Submission: Submit claim to address on patient form. Patient Identification: ACPN should will apear on patient ID card.

Acadia Insurance Company, American National Life Insurance AultCare ACS - Comp IQ CompanyAmerisure Insurance Babb, Inc. Adjustment Services, Inc. Amerisure Insurance Company Berkly AIG Benefit Solutions AmeriTrust Insurance Corporation Berkshire Hathaway Homestate Alabama Insurance Guaranty ANPAC Companies Association Ariel Third Party Administrators Bibb County Public Schools Alabama Trucking Association Aspen Administrators Bituminous Insurance Companies ALFA Virginia Mutual Insurance Association Casualty Insurance Blalock Construction Alfa Vision Company Bollinger/Fowler Alliant Insurance ASU Group Boyd Brothers Transportation Alternative Service Concepts Atlanta Public Schools Bragg and Associates, Inc,

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 27 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Brentwood Services Fair Isaac JW Terrill Brethren Mutual Insurance Company Farm Bureau - Iowa Kentucky League of Cities Bunch & Associates, Inc Federated Mutual Insurance Co Kentucky School Board Insurance Business Insurance Group, LLC Federated Rural Trust California Indemnity Federated Liberty Mutual Cambridge Insurance Co Fidelity Insurance Linn County Risk Management Canal Insurance Co Fireman’s Fund Lion Insurance Company CCMSI First Benefits Insurance Manage Care Manage Cost (MCMC) CCS Holdings, Ltd. Partnership Freeman Admin Solutions, Inc Marriott International Chesapeake Employers Insurance Fulton County MCAudit Company Future Care Meadowbrook Insurance Group Chubb Insurance GAB Robins Medata Cincinnati Insurance Gallagher Bassett Merchants Insurance Group CIS Risk Management Services, Inc. Gaurantee Insurance Company Michigan Property & Casualty Cities and Villages Mutual Insurance Genex Gaurantor City of Amarillo Georgia Insurers Insolvency Pool Midlands Claim Administrators City of Davenport Gray and Company, Inc. Mitchell International City of Montgomery Great American Insurance Co Montgomery Mutual Insurance Claim Management Services Great West Casualty Company Company Claims Administrative Services Great West Risk Management National Liability Colonial Healthcare Incorporated Guarantee Insurance Resources New Mexico Association of Counties Columbia County Guide One Insurance Niagara County Comp IQ Hanover Insurance Niagara Frontier Transit Metro Companion Hastings Mutual Insurance System, Inc. Compfirst Company North Carolina Electric Cooperative Comprehensive Cost Solutions Health Administration Services, Inc. Ohio Casualty Group CompStar Systems, Inc HealthCare Solutions Group, Inc. Old Republic Insurance CompTech Group LLC Healthcare Workers Comp Fund One Beacon Insurance Co Consolidated Benefits Resources Hines & Associates, Inc. PCE Systems Continental Western Group HM Benefits Administrators, Inc. Penn National Insurance Co Continental! Western Insurance Co. HM Insurance Group Philadelphia America Life Insurance Contract Claims Services, Inc IMT Insurance Co Core Risk IMWCA PMA Cottingham & Butler Indiana Insurance Prairie State Insurance Cooperative CPC Logistics ING - Medical Risk Solutions Premier Comp Solutions Creative Risk Solutions Ingenex Pro Century Insurance Company Dallas National Injured Workers Insurance Fund Qmedtrix Definiti Healthcare Management Innovative Claim Solutions Ram Mutual Insurance EM Risk Management Insura Property & Casualty Co Reny Company EMC Insurance Companies Integra Group Republic Group Employee Benefit Claims of Inter-Americas Insurance Review Works Wisconsin Corporation Risk Management Services Co Employee Benefit Services Intracorp Rockwood Casualty Insurance Enterprise Rent-a-Car Jefferson County Schools Risk Company Exam Works Management Roofers & Waterproofer Local 136

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 28 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Royal Insurance State National Insurance Co United Insurance Companies, Inc. Ruan State of Georgia, DOAS University of Colorado-University Savers Property & Casualty Steadfast Insurance Company Risk Mgmt Scottish Rite Health Plan National Stonewood Insurance Company US Administrator Claims Seabury & Smith Stratacare Washington State Department of Secura Insurance Company Sun Life Financial Transport Secure Comp Sutherland Food Service West Bend Mutual Insurance Sedgwick Technology Insurance Company Western Guaranty Fund Services Selective Insurance The Gray Insurance Company, Inc. Williamsburg National Insurance Co. Sheakley Vocational Services The Harleysville Insurance Wilson Mutual Insurance Sheffield Insurance Companies Wisconsin Insurance Security Fund Sheffield Risk Management Service The Hartford WJ Cox Associates, Inc. Society Insurance The Peninsula Insurance Company WR Berkley Corp Southeastern Insurance Group Tranguard Insurance Yusen Transportation Southwire Company Travelers Insurance Zurich Services Corp Spectrum Risk Union Insurance Company Star Insurance Company Union Standard Insurance Group

THREE RIVERS PROVIDER NETWORK (TRPN) - AUTO INJURY Fee Schedule: 85% of the existing fee schedule as total reimbursement for Auto Injury. Where a state or federal government fee schedule exists, such schedule shall serve as an index for all payments without exception. For states that do not possess a fee schedule for auto injury, the Medicare fee schedule shall serve as the index for all payments without exception.

States applicable: All States Specialties applicable: All specialties Reimbursement: Fee for Service. Claims Submission: Submit claim to address on patient form. Patient Identification: Contact carrier / see incident report. Payer clients:

AAA Minnesota Iowa Fair Isaac Safeco AIG Insurance co FCCI Insurance Group Sedgwick CMS Auto Injury Solutions Gallagher Bassett Selective Ins Co Avis Budget Group, LLC Geico Corp State Farm Broadspire Genex The Hartford Buckeye Insurance Group Ingenix Travelers Insurance Cambridge Integrated Services Intracorp Tristar Risk Management Chubb Insurance Co Key Risk Management Unitrin Auto and Home COMPIQ Liberty Mutual Ins Co USAA Crawford and Co. Met Life Work Comp Bill Review Service Dollar General Ohio Mutual Ins Co Zenith Insurance Co. E S I S Reviewworks

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 29 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee FEDMED - AUTO ACCIDENT INJURY Fee Schedule: 15% discount off of providers usual charge for covered services less any applicable co-payments, co-insurance, or deductibles. Where a state mandated fee schedule exists, provider agrees to accept a 10% discount below the state schedule.

States applicable: All States Specialties applicable: All specialties Reimbursement: Fee for Service. Claims Submission: Submit claim to address on patient form. Patient Identification: Contact employer / see incident report. Payer clients: The following list of Payer clients are FedMed Payers.

American Benefit Plan Company National Claims Administrative Administrators (ABPA) United Medical Resources (UMR) Services (NCAS) Aetna - National Advantage First Agency National Health Benefit Corporation Program (NAP) GlobalCare (NHBC) Carpenters Southwest Global Excel Management Olympus Managed HealthCare Administrators HealthRisk Resource Group Preferred Medical Claim Solutions Coalition America Healthsmart (PMCS) Comprehensive Benefit & Claim Health Care Services International Premier Healthcare Exchange (PHX) Administration (CBCA) Health Systems International (HSI) Principal Financial Group Devon Health Integrated Health Plan (IHP) SelectCare Worldwide Federated Mutual Insurance Meritain Health TC3 Health

AMERICA’S CHOICE PROVIDER NETWORK (ACPN) – AUTO ACCIDENT INJURY Fee Schedule: 20% off of providers’ billed charges or where a federal or state mandated fee schedule applies, provider agrees to 10% below federal or state mandated fee schedule.

States applicable: All States Specialties applicable: All specialties Reimbursement: Fee for Service. Service’s less any applicable co-payments, co-insurance, or deductible’s. Claims Submission: Submit claim to address on patient form. Patient Identification: ACPN will appear on patient ID card.

Adjustment Services, Inc. Auto Club Association Hastings Mutual Insurance AIG Benefit Solutions Bituminous Insurance Companies Company AIG Hawaii Brotherhood Mutual Hines & Associates, Inc. ALFA Virginia Mutual Insurance Carey International Indiana Insurance Allstate Insurance Company Columbia Insurance Group Kemper Insurance Alpha Vision Insurance Comp IQ Medata American National Life Insurance Farmers Insurance Merchants Insurance Group Company Fidelity Insurance Mercury Insurance Ameriprise Fireman’s Fund Michigan Property & Casualty Ameriprise Frankenmuth Insurance Company Guarantor Association AK AmeriSafe Future Care Michigan Property & Casualty Amerisure Insurance General Insurance Guarantor ANPAC Grange Insurance Group Mitchell International Armed Forces Insurance Gray and Company, Inc. Nationwide Insurance PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 30 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Orion Auto, CO Selective Insurance The Peninsula Insurance Company PCE Systems Shelter Insurance Companies Total Claims Management Pilgram Risk Management Southeastern Insurance Group Travelers Insurance Reny Company Spectrum Risk Tri-State Insurance Company Seabury & Smith State Farm USAA Secura Insurance Company The Hartford West Bend Mutual Insurance

NATIONAL ASSOCIATION OF PREFERRED PROVIDERS (NAPP) / FAMILY CARE - DISCOUNT PRODUCT Fee Schedule: Medicare plus 25% or 80% of billed charges, whichever is less.

Patients enrolled: 80,000+ nationwide States applicable: All States Specialties applicable: All specialties Reimbursement: Fee for Service. Claims Submission: Not applicable. Patient Identification: NAPP indicated on member ID card. Payer clients: Individuals.

COVERDELL AND COMPANY, INC. - DISCOUNT PRODUCT Fee Schedule: 50% discount on initial visit, 20% on subsequent visits.

Patients enrolled: 30,000+ nationwide States applicable: All States Specialties applicable: Podiatry Only Reimbursement: Fee for Service. Claims Submission: Not applicable. Patient Identification: Each card will vary. Discount program’s name indicated on member ID card. Providers will receive a copy of discount program names in advance.

CARD NAMES Healthcare Savings Plan BANK/MARKETING LaSalle ORGANIZATIONS All Risk Health Care MedPlan Program 10 in 10 Biz Plus Card American Healthcard MedStrong ABN Amro Americard North Bank of Commerce Advantage Benefits Best Benefits Perpetual Business Resource Air France Care One Plan Plus AIS Insurance Careinton Savings/Podiatry Primed All Risk Healthcare Cathedral Rock Reassurance Health Amcard Services Central Carolina Bank Senior First American Benefits Alliance Chiro Access Senior Healthcare Partners American Income Life Insurance Enhanced Benefits Solutions Healthcare Company Family Care Plus Standard Federal American Whole Health Guardian Health THN Discount Card Americans for Fair Pricing HCNP Unicare One Americard Health Advocates Alliance USI Affinity At your business.com Health Plan Extras Vantage America Banco Poplar Healthcare America Bank of America PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 31 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee Bankers Life & Casualty EZ Senior Care NAPE-Basic Bank of the West Family Care Plus Plan National Association of Consultants BB Comp all Benefits Family Shared Success National Bank of Commerce BB Coverdell First Tennessee Bank National Bank of Canada BB Coverdell Comp Fleet National Benefit Services BB&T Framing Contracts Assoc. National City BBVA Compass Genesis Healthcare National Education Association BENEX Genworth Life Insurance Company Nationwide Blue Cross and Blue Shield of Geocare Benefits Northpoint Florida Global Coreplus Optimum + Counseling MO Blue Print Health Guarantee Trust Life Insurance Ocwen Mortgage BOA Company Passport to Wealth Card Benefit Services Harvard Health & Welfare Plan PEAG Care One HCNP Perpetual Business Resource Careington Savings/Podiatry Health Market Insights Plan Plus 7 Benefit Cathedral Rock Health Provider Plan Plan Plus Assoc Central Carolina Bank Health Quest Benefit Group Plan Plus Deposit CHAS Mitchell Family LTD Healthcare Privileges Plan Plus Mortgage Parnership Healthcare Savings Plan Regions Chiro Access Helping Handz Platinum Retirement Association HMD Best Benefits Sauer and Assoc. Commonwealth Benefit Plan Senior Access Card Combined Insurance Hudson’s Bay Company Senior Care Card Comerica HSBC Senior First – State Mutual Community Value Level- Level 5 Independence Senior Healthcare Network Compass Bank Key Bank Standard Bank TD Bank Complete Care Plan Kirkwood Insurance Service Transamerica Life Insurance Demo All Benefits LaSalle Company Dental Plus Deluxe Plan M&T Bank Union Bank Desjardins Discount Card Services MBNA United American Insurance eBay Medstrong PDQ VIP Plus Company Eclipse Coreplus Michigan Democratic Party United Marketing Group E-Hanced Benefits Michael Edwards Direct Wells Fargo E-Hanced Optimum Missouri Assoc. of State Employ Zurich American Insurance EZ Discount Card Namasta Standard Company

NATIONAL BENEFIT BUILDERS, INC. (NBBI) - DISCOUNT PRODUCT Fee Schedule: 20% off patients out of pocket expenses.

Patients enrolled: 200,000+ nationwide States applicable: All States Specialties applicable: Podiatry Only Reimbursement: Fee for Service. Patient Identification: NBBI will be indicated on the patients ID card. Claims submission: Not applicable. Payer clients: Individuals Notes: The NBBI Program may not be used in conjunction with any other discount, sale or other promotion offer accepted by provider, nor in conjunction with any managed care benefit program.

PO 71717 PHOENIX, AZ 85050 • TEL 877.311.3338 • FAX 602.485.3100 • WWW.HNA-NET.COM 32 2021 Health Plan List and Fee Schedule 2021 Health Plan List and Fee