7-Attachment G City of Leander Census BCBS Enrollment as of 072026.pdf

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Attached to
EMPLOYEE HEALTH, DENTAL, AND VISION BENEFITS
Solicitation number
S26-014
Issued by
Williamson County, Texas

About this file

Written by GovTribe AI ·

This is a census enrollment document for the City of Leander's benefits program, demonstrating current employee health, dental, and vision insurance enrollment as of July 2026. The City of Leander is soliciting proposals from vendors for fully insured Medical, Dental, and Vision Plans from a single provider for the benefit period of January 1, 2027, through December 31, 2027. Proposals are due by Friday, August 19, 2026, at 2:00 p.m. CST, with proposal documents available through the City of Leander's Bonfire website at https://leandertx.bonfirehub.com/projects. The City has engaged HUB International as its consultant and agent of record and is not soliciting services from additional consultants, agents, or brokers.

The document provides enrollment baseline data necessary for vendors to develop competitive proposals based on the City's existing covered population. This enrollment information enables prospective vendors to calculate pricing and plan design recommendations tailored to Leander's employee demographic and current benefit utilization. The census data serves as the foundation for cost projections and allows vendors to structure comprehensive fully insured offerings that address the City's existing employee base and anticipated coverage needs for the 2027 benefit year.

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Other files

File Type Posted
3-Attachment B- Conflict of Interest Questionnaire Form.pdf PDF
2-Attachment A- Reference Sheet 2025.pdf PDF
8-Attachment D SoBC Medical.pdf PDF
Attachment F SoBC Dental.pdf PDF
4-Attachment C- Subcontracting.pdf PDF
5-Attachment H Historical Claims Information.pdf PDF
Attachment C- Subcontracting.pdf PDF
Attachment E SoBC Vision.pdf PDF
6-Attachment E SoBC Vision.pdf PDF
Attachment D SoBC Medical.pdf PDF
9-Attachment F SoBC Dental.pdf PDF
Attachment B- Conflict of Interest Questionnaire Form.pdf PDF
CITY OF LEANDER S26-014 Employee Health Benefits 6.18.pdf PDF
Attachment A- Reference Sheet 2025.pdf PDF
1-CITY OF LEANDER S26-014 Employee Health Benefits 6.18.pdf PDF
Attachment G City of Leander Census BCBS Enrollment as of 072026.pdf PDF
Attachment H Historical Claims Information.pdf PDF
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Attachment G

2026 Enrollment Census

Relationshi p

(EE, SP,

CH)

EE Status (Active, Retired) Gender Zip Code DOB Medical BenClass

Medical Tier Dental BenClass Dental Tier Vision BenClass Vision Tier

E A M 78641 8/10/1966 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 78641 1/18/2004 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 7/24/2007 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 76542 3/3/1971 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES S A F 76542 4/16/1969 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES E A M 78754 5/12/1954 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A F 78641 2/16/1979 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A M 78681 7/10/1970 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78681 9/13/1966 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78681 4/2/2001 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78681 2/24/2003 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78665 4/3/1975 BCBS PPO Medical Plan EO BlueCare Dental High Plan FA BCBS Vision FA S A F 78665 01/10/1970 BlueCare Dental High Plan FA

C A F 78665 06/24/2004 BlueCare Dental High Plan FA

E A F 786602849 7/5/1972 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision EO S A M 786602849 5/11/1968 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES E A F 78613 4/18/1981 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EC C A M 78613 09/05/2013 BCBS Vision EC C A M 78613 02/08/2016 BCBS Vision EC E A F 78641 8/5/1983 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EC C A M 78641 3/15/2006 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EC C A F 78641 9/21/2009 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EC E A M 78641 7/24/1968 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78641 1/23/1970 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 5/29/2001 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 786417873 5/2/1976 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 786417873 5/22/1981 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 786417873 9/24/2008 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 6/7/1977 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 5/18/2015 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC BCBS Vision EC E A M 78717 2/1/1973 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC C A F 78717 1/21/2002 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC C A M 78717 10/23/2003 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC C A F 78717 6/25/2005 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC E A M 78734 2/3/1970 Blue Essentials HMO EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78734 2/25/2005 Blue Essentials HMO EC BlueCare Dental High Plan EC BCBS Vision EC

E A F 78613 2/14/1973 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA C A M 78613 11/29/2002 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA C A F 78613 11/29/2002 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA C A F 78613 5/24/2005 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA C A F 78613 5/27/2011 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA S A M 78613 09/04/1970 BlueCare Dental High Plan FA

E A F 78646 2/22/1963 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A M 78641 2/27/1990 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO E A M 78641 10/27/1985 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA BCBS Vision FA S A F 78641 3/3/1987 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 1/25/2012 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA BCBS Vision FA C A M 78641 9/11/2013 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 7/23/2016 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA BCBS Vision FA C A M 78641 4/25/2023 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 7/5/1991 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 76578 5/29/1981 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A M 78626 8/7/1980 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC C A M 78626 2/9/2010 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC C A M 78626 7/28/2012 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC E A M 786419757 4/2/1971 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78642 3/11/1968 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES S A F 78642 2/11/1969 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES E A M 76844 9/3/1984 BCBS PPO Medical Plan FA BlueCare Dental Base EO S A F 76844 8/1/1989 BCBS PPO Medical Plan FA C A M 76844 1/8/2010 BCBS PPO Medical Plan FA C A F 76844 1/17/2017 BCBS PPO Medical Plan FA C A M 76844 12/3/2019 BCBS PPO Medical Plan FA E A M 78711 6/9/1978 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78711 4/13/1979 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78711 4/17/2008 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78711 2/10/2010 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78711 7/25/2013 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 8/27/1986 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A M 786813875 9/1/1969 Blue Essentials HMO EO BlueCare Dental High Plan EO BCBS Vision FA E A M 765715820 6/9/1980 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 765715820 3/22/1983 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 765715820 9/28/2007 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 765715820 12/12/2008 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 765715820 7/26/2010 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 76401 10/5/1981 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA

S A F 76401 6/13/1979 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 76401 3/8/2006 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 76401 9/24/2006 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 76401 6/3/2008 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 76401 9/1/2009 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 12/8/1980 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 8/30/2007 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 8/11/2010 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 7/28/2019 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC S A F 786813875 08/04/1967 BCBS Vision FA C A M 786813875 01/01/2003 BCBS Vision FA E A M 78641 4/11/1969 BCBS PPO Medical Plan EC BlueCare Dental Base FA BCBS Vision EO C A M 78641 4/15/2004 BCBS PPO Medical Plan EC BlueCare Dental Base FA S A F 78641 01/19/1971 BlueCare Dental Base FA

E A M 78613 10/16/1971 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78646 11/20/1970 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A F 78646 12/28/2001 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A M 78646 5/26/2011 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 3/26/1985 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A M 78641 2/6/2013 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 3/4/2015 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 9/30/1968 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA S A F 78641 8/5/1970 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA C A M 78641 8/2/2006 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA S A F 78641 12/31/1983 BlueCare Dental High Plan FA

S A F 78646 11/20/1975 BlueCare Dental High Plan FA

E A M 78641 6/11/1988 Blue Essentials HMO FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78641 2/10/1994 Blue Essentials HMO FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78641 12/29/2022 Blue Essentials HMO FA BlueCare Dental High Plan FA BCBS Vision FA E A M 765509638 3/15/1999 BCBS High Deductible Health PlanEO BlueCare Dental High Plan EO BCBS Vision EO E A F 78641 5/13/1979 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 78641 2/10/2005 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 6/5/2006 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A F 786603442 5/8/1974 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 786603442 7/11/2001 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 786603442 7/26/2010 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 78628 9/27/1968 BCBS PPO Medical Plan EO BlueCare Dental High Plan ES BCBS Vision ES S A F 78628 07/06/1968 BlueCare Dental High Plan ES

E A M 78641 11/20/1974 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 765305462 11/24/1976 BCBS PPO Medical Plan EO BlueCare Dental High Plan ES BCBS Vision ES

S A F 765305462 02/21/1974 BlueCare Dental High Plan ES

E A M 78657 03/24/1966 BlueCare Dental High Plan ES

S A F 78657 11/13/1961 BlueCare Dental High Plan ES

E A F 78641 4/6/1968 BCBS High Deductible Health PlanEC BlueCare Dental High Plan FA BCBS Vision FA C A M 78641 11/9/2000 BCBS High Deductible Health PlanEC BlueCare Dental High Plan FA BCBS Vision FA C A M 78641 7/10/2003 BCBS High Deductible Health PlanEC BlueCare Dental High Plan FA BCBS Vision FA S A M 78641 01/03/1970 BlueCare Dental High Plan FA

E A M 78676 3/18/1981 BCBS PPO Medical Plan EO BlueCare Dental High Plan FA BCBS Vision FA S A F 78676 08/07/1980 BlueCare Dental High Plan FA

C A M 78676 02/20/2007 BlueCare Dental High Plan FA

C A F 78676 07/17/2008 BlueCare Dental High Plan FA

C A M 78676 12/17/2010 BlueCare Dental High Plan FA

E A M 78642 6/29/1980 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES S A F 78642 12/15/1973 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES E A M 76844 12/6/1979 Blue Essentials HMO ES BlueCare Dental Base EO S A F 76844 9/15/1970 Blue Essentials HMO ES E A M 78641 1/6/1989 BCBS High Deductible Health PlanEO BlueCare Dental Base EO E A M 786418717 9/29/1968 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 786424228 6/2/1981 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 786424228 2/2/2015 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 786424228 9/7/2022 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 78642 4/10/1987 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A F 78642 7/12/2019 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A M 78642 12/31/2021 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA E A M 786414903 1/10/1980 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 786414903 2/23/1973 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 786414903 7/10/2007 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 786414903 6/26/2008 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78642 06/26/1989 BlueCare Dental High Plan FA

E A F 78642 10/9/1980 BCBS PPO Medical Plan EO BlueCare Dental High Plan EC BCBS Vision EC C A M 78642 01/26/2001 BlueCare Dental High Plan EC

C A F 78642 03/25/2004 BlueCare Dental High Plan EC

C A F 78642 09/27/2005 BlueCare Dental High Plan EC

E A M 78640 3/15/1985 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78640 11/2/1981 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78640 6/14/2023 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 786281019 9/23/1964 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EC C A F 786281019 12/26/2000 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EC C A F 786281019 2/7/2008 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EC E A M 78641 1/3/1956 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO

E A M 78628 7/5/1966 BCBS High Deductible Health PlanEO BlueCare Dental High Plan EO BCBS Vision EO E A F 78641 2/23/1971 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A M 786082000 11/13/1970 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 786082000 6/18/1976 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 786082000 6/23/2003 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 76643 6/16/1977 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 76643 6/8/1978 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 76643 1/4/2001 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 76643 12/16/2002 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 76643 2/5/2009 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 76643 3/6/2011 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78613 4/26/1986 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 78613 5/28/2012 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78613 6/25/2021 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A F 786414410 6/16/1980 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 786608127 11/13/1991 BCBS High Deductible Health PlanEO BlueCare Dental High Plan EO BCBS Vision EO E A F 786655711 8/13/1983 BCBS PPO Medical Plan EO BlueCare Dental High Plan EC BCBS Vision EO C A M 786655711 07/22/2011 BlueCare Dental High Plan EC

C A M 786655711 04/17/2015 BlueCare Dental High Plan EC

C A M 786655711 12/17/2019 BlueCare Dental High Plan EC

E A F 78634 6/4/1976 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A F 78132 6/9/1977 Blue Essentials HMO EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78132 2/13/2006 Blue Essentials HMO EC BlueCare Dental High Plan EC BCBS Vision EC C A M 78132 6/2/2008 Blue Essentials HMO EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78132 11/28/2010 Blue Essentials HMO EC BlueCare Dental High Plan EC BCBS Vision EC E A F 786413469 7/25/1969 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 786654637 11/13/1961 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 787322025 2/25/1977 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 787322025 3/3/2013 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 787322025 11/28/2016 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 78641 1/12/1970 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A F 78641 7/4/1989 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EO C A F 78641 5/23/2018 BCBS PPO Medical Plan EC BlueCare Dental Base EC E A M 78641 8/2/1992 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA BCBS Vision ES S A F 78641 7/17/1993 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA BCBS Vision ES C A F 78641 3/24/2020 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA C A M 78641 9/28/2022 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA E A M 78634 7/19/1985 BCBS PPO Medical Plan EO E A M 78641 4/10/1987 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78641 2/23/1991 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA

C A M 78641 11/20/2022 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 786134050 8/26/1975 BCBS High Deductible Health PlanEC BlueCare Dental High Plan FA BCBS Vision FA C A F 786134050 9/1/2003 BCBS High Deductible Health PlanEC BlueCare Dental High Plan FA BCBS Vision FA C A F 786134050 4/29/2006 BCBS High Deductible Health PlanEC BlueCare Dental High Plan FA BCBS Vision FA E A M 78642 5/22/1984 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision ES S A F 78642 9/25/1984 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision ES C A F 78642 12/31/2018 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA E A M 76502 11/23/1992 BCBS PPO Medical Plan EO BlueCare Dental High Plan FA BCBS Vision FA S A F 76502 01/06/1994 BlueCare Dental High Plan FA

C A M 76502 05/19/2022 BlueCare Dental High Plan FA

S A F 786134050 11/25/1971 BlueCare Dental High Plan FA

E A F 78653 3/6/1974 Blue Essentials HMO EO BlueCare Dental Base EO BCBS Vision EO E A F 78633 2/6/1982 BCBS PPO Medical Plan EC BlueCare Dental Base EC C A M 78633 1/21/2005 BCBS PPO Medical Plan EC BlueCare Dental Base EC C A M 78633 3/18/2013 BCBS PPO Medical Plan EC BlueCare Dental Base EC E A M 78681 2/19/1979 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A M 78681 5/13/2008 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A M 78681 8/16/2010 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A M 78681 3/9/2015 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 12/28/1976 BCBS PPO Medical Plan ES BlueCare Dental Base ES BCBS Vision ES S A F 78641 10/20/1977 BCBS PPO Medical Plan ES BlueCare Dental Base ES BCBS Vision ES E A M 78641 4/7/1977 BCBS PPO Medical Plan EC BlueCare Dental High Plan EO BCBS Vision EO C A F 78641 12/27/2006 BCBS PPO Medical Plan EC C A M 78641 8/27/2009 BCBS PPO Medical Plan EC S A F 78681 05/23/1978 BlueCare Dental High Plan FA

E A M 78628 9/3/1967 BCBS PPO Medical Plan EO BlueCare Dental High Plan EC BCBS Vision EC E A M 78642 9/9/1978 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78642 9/11/1977 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78642 12/18/2002 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78642 12/1/2008 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78642 3/6/2012 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78645 4/28/1980 Blue Essentials HMO ES BlueCare Dental High Plan ES BCBS Vision ES S A F 78645 1/31/1980 Blue Essentials HMO ES BlueCare Dental High Plan ES BCBS Vision ES E A M 78641 8/26/1984 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC BCBS Vision EC C A M 78641 8/13/2007 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 9/21/2009 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 12/12/2012 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC BCBS Vision EC C A F 78628 12/10/2010 BlueCare Dental High Plan EC

E A M 786424476 8/14/1988 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EO C A F 786424476 8/26/2022 BCBS PPO Medical Plan EC BlueCare Dental Base EC

C A F 786424476 7/14/2026 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC E A M 786457506 7/17/1980 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78641 11/18/1986 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 786414435 2/15/1990 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 786414435 8/5/2008 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 786414435 2/14/2012 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 78642 4/12/1988 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision EO S A F 78642 2/10/1988 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA C A M 78642 9/8/2016 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA C A M 78642 9/30/2019 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA E A M 786054569 11/6/1987 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A M 786054569 6/16/2014 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A F 786054569 9/7/2017 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA S A F 786054569 09/20/1987 BlueCare Dental High Plan FA

E A F 786603004 5/19/1968 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 786425830 7/25/1964 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 786105185 7/9/1980 BCBS PPO Medical Plan FA BlueCare Dental Base EO BCBS Vision FA S A F 786105185 10/15/1978 BCBS PPO Medical Plan FA BCBS Vision FA C A M 786105185 5/7/2008 BCBS PPO Medical Plan FA BCBS Vision FA C A M 786105185 5/6/2010 BCBS PPO Medical Plan FA BCBS Vision FA E A M 786413159 4/12/1983 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 786413159 2/23/1983 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 786413159 12/4/2015 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 786413159 9/24/2022 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 76528 10/17/1988 BCBS PPO Medical Plan EC BlueCare Dental Base EO C A F 76528 7/8/2013 BCBS PPO Medical Plan EC C A F 76528 1/18/2018 BCBS PPO Medical Plan EC E A F 786422278 5/11/1994 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A F 78758 3/23/1992 BCBS High Deductible Health PlanEO BlueCare Dental High Plan EO BCBS Vision EO E A F 786419486 3/11/1963 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EC C A M 786419486 5/25/1998 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EC E C M 78732 1/11/1973 BCBS High Deductible Health Plan COBRAEC C C F 78732 7/8/2004 BCBS High Deductible Health Plan COBRAEC C C F 78732 9/6/2007 BCBS High Deductible Health Plan COBRAEC E A M 786415040 6/12/1976 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision EO S A F 786415040 1/19/1979 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES E A M 78621 6/19/1981 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A M 787262322 11/1/1984 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A F 787262322 3/27/2018 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A F 787262322 4/20/2026 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision FA

E A M 78628 2/25/1980 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 76570 11/4/1985 BCBS High Deductible Health PlanEO BlueCare Dental Base EO BCBS Vision EO E A M 78602 11/25/1997 BCBS High Deductible Health PlanEC BlueCare Dental Base EC BCBS Vision EC C A F 78602 11/16/2023 BCBS High Deductible Health PlanEC BlueCare Dental Base EC BCBS Vision EC C A M 78602 3/12/2026 BCBS High Deductible Health PlanEC BlueCare Dental Base EC E A M 78642 10/23/1960 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES S A F 78642 10/26/1962 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES E A M 78642 5/25/1982 Blue Essentials HMO EO BlueCare Dental High Plan FA BCBS Vision EO E A M 78641 8/8/1988 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EO C A M 78641 10/2/2024 BCBS PPO Medical Plan EC BlueCare Dental Base EC S A F 78642 11/22/1982 BlueCare Dental High Plan FA

C A M 78642 06/18/2011 BlueCare Dental High Plan FA

C A F 78642 08/12/2015 BlueCare Dental High Plan FA

E A F 78642 5/20/1986 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A M 78641 8/3/1982 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 786425539 10/27/1985 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 786425539 8/13/1987 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 786425539 1/13/2012 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 786425539 3/30/2014 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 3/9/1974 BCBS PPO Medical Plan ES BlueCare Dental High Plan EO S A F 78641 12/4/1973 BCBS PPO Medical Plan ES E A M 76708 4/28/1984 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 76708 5/15/1984 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 76708 1/23/2012 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 76708 12/30/2014 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 76708 2/13/2023 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78639 5/13/1985 Blue Essentials HMO EO BlueCare Dental High Plan EO BCBS Vision EO E A M 76527 2/15/1972 BCBS PPO Medical Plan EO BlueCare Dental High Plan ES BCBS Vision ES S A F 76527 01/14/1966 BlueCare Dental High Plan ES

E A M 78641 1/8/1979 Blue Essentials HMO EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 9/16/2005 Blue Essentials HMO EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 11/10/2011 Blue Essentials HMO EC BlueCare Dental High Plan EC BCBS Vision EC E A M 786411867 3/26/1974 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA C A F 786411867 8/26/2003 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA C A F 786411867 6/1/2009 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA S A F 786411867 05/09/1974 BlueCare Dental High Plan FA

E A M 78641 9/19/1990 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 4/28/2021 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 78642 6/15/1992 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA S A F 78642 6/10/1992 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA

C A M 78642 11/14/2017 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA C A F 78642 12/15/2021 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA E A M 78602 3/28/1966 BCBS PPO Medical Plan ES BlueCare Dental Base ES S A F 78602 2/14/1963 BCBS PPO Medical Plan ES BlueCare Dental Base ES E A M 78641 11/29/1992 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78641 12/5/1982 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78641 12/13/2002 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 5/12/2017 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78645 7/27/1989 BCBS High Deductible Health PlanEO BlueCare Dental Base EO E A M 78628 11/27/1965 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A F 78641 1/25/1989 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 2/17/2007 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 78641 5/18/2013 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A F 786412777 12/17/1974 BCBS PPO Medical Plan EO BlueCare Dental High Plan ES BCBS Vision ES E A M 78633 10/8/1975 BCBS PPO Medical Plan EO BlueCare Dental Base FA BCBS Vision FA E A M 786283706 7/23/1969 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 786283706 5/4/1977 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 786283706 4/23/2002 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 786283706 4/17/2007 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78633 01/08/1971 BlueCare Dental Base FA

C A F 78633 02/23/2007 BlueCare Dental Base FA

E A M 78626 10/21/1982 BCBS PPO Medical Plan EO BlueCare Dental Base FA E A M 765023121 7/18/1998 BCBS High Deductible Health PlanES BlueCare Dental High Plan ES BCBS Vision ES S A F 765023121 3/19/2001 BCBS High Deductible Health PlanES BlueCare Dental High Plan ES BCBS Vision ES E A M 78947 6/1/1994 BCBS PPO Medical Plan FA S A F 78947 10/13/1991 BCBS PPO Medical Plan FA C A F 78947 9/3/2023 BCBS PPO Medical Plan FA C A M 78947 7/22/2025 BCBS PPO Medical Plan FA E A M 76710 11/13/1989 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 76710 12/16/1988 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 76710 8/9/2015 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 76710 9/7/2021 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78642 9/10/1989 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78642 1/7/1990 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78642 11/2/2016 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78642 9/27/2018 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78626 01/11/1984 BlueCare Dental Base FA

C A M 78626 03/18/2008 BlueCare Dental Base FA

C A F 78626 09/08/2010 BlueCare Dental Base FA

C A F 78626 11/05/2014 BlueCare Dental Base FA

C A M 78626 12/22/2018 BlueCare Dental Base FA

C A F 78626 10/16/2021 BlueCare Dental Base FA

E A M 78605 12/21/1989 Blue Essentials HMO FA BlueCare Dental High Plan FA S A F 78605 9/20/1991 Blue Essentials HMO FA BlueCare Dental High Plan FA C A M 78605 9/6/2017 Blue Essentials HMO FA BlueCare Dental High Plan FA C A F 78605 5/4/2020 Blue Essentials HMO FA BlueCare Dental High Plan FA C A M 78605 12/31/2022 Blue Essentials HMO FA BlueCare Dental High Plan FA E A M 786342376 4/12/1991 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 786342376 5/24/2017 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 786411763 3/6/1981 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 786411763 3/13/2019 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 78634 10/20/1992 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78634 5/26/1994 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78634 5/7/2025 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78642 8/30/1994 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EC C A F 78642 3/12/2024 BCBS PPO Medical Plan EC BlueCare Dental Base EC BCBS Vision EC E A M 76539 4/11/1995 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A M 78641 10/3/1968 BCBS PPO Medical Plan ES BlueCare Dental Base ES BCBS Vision ES S A F 78641 2/1/1967 BCBS PPO Medical Plan ES BlueCare Dental Base ES BCBS Vision ES E A M 78605 8/21/1969 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO E A M 78642 12/26/1986 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A F 786413858 5/31/1969 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES S A M 786413858 1/23/1962 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES E A M 78641 11/3/1968 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO E A F 786422352 6/23/1983 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78750 2/6/1992 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A M 78641 11/9/1975 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78641 6/29/1970 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 5/16/2008 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78641 12/1/2009 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 6/1/2011 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 12/23/1985 BCBS High Deductible Health PlanEO BlueCare Dental High Plan EO BCBS Vision EO E A M 78628 1/9/1963 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO E A M 78641 1/24/1990 BCBS PPO Medical Plan FA BlueCare Dental Base FA S A F 78641 9/14/1989 BCBS PPO Medical Plan FA BlueCare Dental Base FA C A M 78641 12/23/2021 BCBS PPO Medical Plan FA BlueCare Dental Base FA C A F 78641 8/3/2023 BCBS PPO Medical Plan FA BlueCare Dental Base FA E A F 786136837 12/21/1957 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A M 786136837 1/3/2001 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA S A M 786136837 03/29/1961 BlueCare Dental High Plan FA

E A F 78628 6/13/1991 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78628 1/30/2014 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78628 12/24/2017 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 78681 11/19/1973 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78665 11/17/1978 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A M 78641 5/11/1986 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78641 9/2/1986 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 2/20/2008 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78641 10/19/2009 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 12/2/2014 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 76548 9/16/1994 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EO C A M 76548 2/12/2021 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC C A F 76548 4/2/2025 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC E A M 78642 5/29/1995 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78642 3/29/1996 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78642 10/7/2022 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78642 2/12/2024 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 76528 7/2/1999 BCBS High Deductible Health PlanES BlueCare Dental High Plan ES S A F 76528 10/21/2001 BCBS High Deductible Health PlanES BlueCare Dental High Plan ES E A F 78681 6/8/1977 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO E A F 78641 10/30/1967 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES S A M 78641 6/4/1962 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES E A F 78641 9/7/1968 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A F 78613 6/22/1961 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78628 8/25/1988 Blue Essentials HMO FA BlueCare Dental Base FA S A F 78628 8/23/1994 Blue Essentials HMO FA BlueCare Dental Base FA C A M 78628 10/9/2012 Blue Essentials HMO FA BlueCare Dental Base FA C A M 78628 12/5/2017 Blue Essentials HMO FA BlueCare Dental Base FA C A M 78628 1/11/2019 Blue Essentials HMO FA BlueCare Dental Base FA E A M 78641 10/13/1989 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision ES S A F 78641 9/29/1992 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision ES C A M 78641 5/1/2020 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA C A F 78641 8/25/2022 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA E A M 78252 5/8/1997 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A F 787593146 7/16/1984 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A M 787593146 2/10/1984 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 787593146 4/10/2010 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 787593146 10/8/2013 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 787593146 7/17/2016 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 787593146 9/30/2020 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA

E A M 78642 3/12/1995 BCBS PPO Medical Plan EC BlueCare Dental Base FA C A M 78642 6/14/2022 BCBS PPO Medical Plan EC BlueCare Dental Base FA C A M 78642 5/27/2026 BCBS PPO Medical Plan EC BlueCare Dental Base FA S A F 78642 08/24/1995 BlueCare Dental Base FA

E A M 78745 10/4/1981 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78605 11/29/1983 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A F 78642 4/2/1957 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78641 6/20/1997 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78641 10/6/1995 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78641 8/23/2024 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78611 4/20/1998 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO E A M 78613 3/15/1971 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES S A F 78613 5/15/1966 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision ES E A M 78613 8/6/1987 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC C A F 78613 11/17/2010 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC C A M 78613 5/31/2017 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC E A F 76513 11/20/1965 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO E A F 786412391 3/19/1980 BCBS PPO Medical Plan EO BlueCare Dental High Plan EC BCBS Vision EC C A F 786412391 12/21/2001 BlueCare Dental High Plan EC

C A M 786412391 06/23/2003 BlueCare Dental High Plan EC

E A M 786542399 6/7/1993 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A M 78641 11/5/1987 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 4/25/2019 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 10/27/2023 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 78634 5/13/1998 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA S A F 78634 10/24/1996 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA C A M 78634 5/27/2021 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA C A M 78634 1/18/2024 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA E A F 78641 9/25/1984 Decline Medical EO E A M 78613 11/6/1979 BCBS PPO Medical Plan EO BlueCare Dental High Plan FA BCBS Vision EC S A F 78613 08/13/1982 BlueCare Dental High Plan FA

C A M 78613 11/07/2007 BlueCare Dental High Plan FA

C A F 78613 10/06/2011 BlueCare Dental High Plan FA

C A F 78613 01/06/2021 BlueCare Dental High Plan FA

E A M 76550 8/25/1999 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78626 5/26/1992 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A M 78717 8/18/1984 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78717 4/24/1985 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78717 8/3/2002 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 6/18/1997 BCBS High Deductible Health PlanEO BlueCare Dental Base EO

E A M 78641 4/10/1986 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC BCBS Vision EC C A M 78641 1/3/2022 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC BCBS Vision EC C A F 78641 3/27/2023 BCBS High Deductible Health PlanEC BlueCare Dental High Plan EC BCBS Vision EC E A M 78626 1/10/1989 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 78626 8/26/2020 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 78626 9/22/2022 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 78634 10/3/1975 BCBS High Deductible Health PlanEO BlueCare Dental Base EO BCBS Vision EO E A M 78641 9/10/1974 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision FA C A M 78641 7/31/2003 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision FA C A M 78641 1/12/2006 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision FA S A F 78641 12/06/1974 BCBS Vision FA E A M 76537 11/15/1990 BCBS High Deductible Health PlanEO BlueCare Dental Base EO E A F 76539 1/12/1999 BCBS High Deductible Health PlanEO BlueCare Dental Base EO BCBS Vision EO E A F 786412971 5/3/1996 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A F 786412971 8/21/2014 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 786412971 3/5/2020 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 786412927 11/20/1972 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 786412927 2/26/1978 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 786412927 6/7/2004 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 786412927 7/21/2005 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 786412927 2/24/2021 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 8/20/1982 BCBS PPO Medical Plan EO BlueCare Dental High Plan FA BCBS Vision FA S A F 78641 12/03/1988 BlueCare Dental High Plan FA

C A M 78641 12/22/2011 BlueCare Dental High Plan FA

C A F 78641 03/15/2016 BlueCare Dental High Plan FA

E A F 78641 5/12/1975 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78641 7/8/1971 BCBS PPO Medical Plan EC BlueCare Dental High Plan EO BCBS Vision EO C A M 78641 1/31/2000 BCBS PPO Medical Plan EC C A F 78641 3/5/2002 BCBS PPO Medical Plan EC E A F 78681 11/1/1984 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO E A M 76689 7/15/1994 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO E A M 786605049 4/19/2000 BCBS High Deductible Health PlanEO BlueCare Dental Base EO BCBS Vision EO E A M 76537 12/15/1990 BCBS High Deductible Health PlanEO BlueCare Dental High Plan FA BCBS Vision EO S A F 76537 06/02/1992 BlueCare Dental High Plan FA

C A F 76537 03/18/2015 BlueCare Dental High Plan FA

C A M 76537 10/02/2019 BlueCare Dental High Plan FA

E A M 78642 6/9/1994 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision EC S A F 78642 6/7/1996 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA C A F 78642 7/20/2019 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision EC C A F 78642 3/23/2021 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision EC

E A F 78628 7/26/1988 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 78628 3/23/2013 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC C A M 78628 1/27/2015 BCBS PPO Medical Plan EC BlueCare Dental High Plan EC BCBS Vision EC E A M 78641 4/19/2001 BCBS High Deductible Health PlanEO BlueCare Dental High Plan ES E A M 786417826 3/13/1998 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78674 7/17/1999 Blue Essentials HMO FA BlueCare Dental Base FA BCBS Vision FA S A F 78674 2/4/2000 Blue Essentials HMO FA BlueCare Dental Base FA BCBS Vision FA C A M 78674 3/25/2026 Blue Essentials HMO FA BlueCare Dental Base FA BCBS Vision FA S A F 78641 03/21/1987 BlueCare Dental High Plan ES

E A F 78681 5/10/1977 BCBS PPO Medical Plan EO BlueCare Dental High Plan EC BCBS Vision EO C A F 78681 04/03/2007 BlueCare Dental High Plan EC

E A M 78613 1/11/2002 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78641 6/2/1982 BCBS High Deductible Health PlanEC BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 1/30/2001 BCBS High Deductible Health PlanEC BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 10/24/2005 BCBS High Deductible Health PlanEC BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 3/3/2007 BCBS High Deductible Health PlanEC BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 7/25/1995 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO S A F 78641 03/14/1980 BlueCare Dental High Plan FA

E A M 78734 2/25/1994 BCBS PPO Medical Plan EC BlueCare Dental Base FA BCBS Vision EC C A M 78734 1/4/2024 BCBS PPO Medical Plan EC BlueCare Dental Base FA BCBS Vision EC C A F 78734 2/8/2025 BCBS PPO Medical Plan EC BlueCare Dental Base FA BCBS Vision EC E A M 78956 11/5/1992 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78956 3/18/1995 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78956 9/30/2019 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78956 3/13/2025 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 76537 4/18/1997 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A M 78641 8/9/1991 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA BCBS Vision EO S A F 78641 9/1/1992 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA C A M 78641 6/22/2025 BCBS High Deductible Health PlanFA BlueCare Dental High Plan FA E A M 78223 2/21/2001 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 76537 4/29/1995 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO S A F 78734 08/29/1994 BlueCare Dental Base FA

E A M 78634 9/28/2001 BCBS High Deductible Health PlanFA BlueCare Dental Base ES BCBS Vision ES S A F 78634 5/20/1997 BCBS High Deductible Health PlanFA BlueCare Dental Base ES BCBS Vision ES C A M 78634 2/8/2026 BCBS High Deductible Health PlanFA E A M 78642 3/7/1974 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision EO S A F 78642 9/17/1973 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES E A F 78641 12/24/1992 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A M 78642 11/23/1988 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78642 7/28/1982 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA

C A F 78642 11/12/2010 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78642 12/14/2011 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78642 6/4/2015 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 10/2/1992 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO E A M 78641 12/6/1999 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78626 5/5/2000 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A M 78641 8/21/1996 BCBS High Deductible Health PlanEO BlueCare Dental Base EO E A F 786425830 8/25/1969 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A F 78717 12/12/1968 BCBS High Deductible Health PlanEO BlueCare Dental High Plan EO BCBS Vision EO E A F 765221062 11/22/1985 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A M 765221062 1/17/2013 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A F 765221062 5/26/2016 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA C A M 765221062 10/26/2019 BCBS PPO Medical Plan EC BlueCare Dental High Plan FA BCBS Vision FA E A F 786114972 2/20/1981 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A M 786114972 3/26/1984 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 786114972 3/16/2001 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 786114972 12/1/2008 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 786114972 7/2/2009 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 786114972 12/17/2012 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A F 78641 10/2/1968 BCBS PPO Medical Plan EO BlueCare Dental High Plan EC BCBS Vision EO E A M 78641 10/3/1995 BCBS PPO Medical Plan EO BlueCare Dental Base EO BCBS Vision EO C A M 78641 06/22/2006 BlueCare Dental High Plan EC

C A F 78641 08/20/2009 BlueCare Dental High Plan EC

E A M 78734 9/25/1990 BCBS PPO Medical Plan EO E A M 78735 5/15/1997 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES BCBS Vision EO S A F 78735 6/25/2002 BCBS PPO Medical Plan ES BlueCare Dental High Plan ES E A M 78725 5/28/1996 BCBS High Deductible Health PlanEO BlueCare Dental High Plan EO BCBS Vision EO E A F 78748 7/12/1987 BCBS PPO Medical Plan EO BlueCare Dental High Plan FA E A M 78758 2/23/1995 BCBS High Deductible Health PlanEO BlueCare Dental High Plan EO BCBS Vision EO S A F 78748 09/21/1981 BlueCare Dental High Plan FA

C A F 78748 09/29/2013 BlueCare Dental High Plan FA

C A F 78748 03/28/2016 BlueCare Dental High Plan FA

E A M 78641 2/2/1998 BCBS PPO Medical Plan FA BlueCare Dental Base ES BCBS Vision ES S A F 78641 9/13/1997 BCBS PPO Medical Plan FA BlueCare Dental Base ES BCBS Vision ES C A F 78641 9/30/2025 BCBS PPO Medical Plan FA E A M 76537 4/12/1999 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A M 78641 8/9/1986 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA S A F 78641 7/29/1987 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A M 78641 5/1/2012 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA C A F 78641 3/6/2015 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA

C A M 78641 6/28/2018 BCBS PPO Medical Plan FA BlueCare Dental High Plan FA BCBS Vision FA E A M 78641 4/13/1994 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO BCBS Vision EO E A M 78642 5/24/1990 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A M 78641 10/11/1998 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A M 78605 11/30/2000 BCBS High Deductible Health PlanES BlueCare Dental Base EO S A F 78605 9/6/2000 BCBS High Deductible Health PlanES E A M 78641 3/5/2000 BCBS PPO Medical Plan EO BlueCare Dental High Plan EO E A M 78641 7/16/2002 BCBS PPO Medical Plan EO BlueCare Dental Base EO E A M 78633…

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