ESBD_360338_1716477853396_Attachment B - Hays County Census (April 2024).pdf

RR = Retiree SC = Stepchild OT=Grandchild as legal dependent

RELATIONSHIP

CODE LAST NAME FIRST NAME

MIDDLE

INITIAL

BIRTH

DATE

MARITAL

STATUS

GENDER

PERM ADDR STREET PERM ADDR STREET 2 PERM ADDR CITY

PERM

ADDR

STATE

PERM

ADDR

ZIP

COVERAGE

TYPE PLAN NAME

COVERAGE

STATUS COVERAGE TIER

EE ELLIOT KENNETH W 9/9/1958 M 1023 CHERRY STONE LOOP BUDA TX 78610 D Dental DHMO Plan D094C A SUBSCRIBER/RECIPIENT ONLY EE MADDOCKS DAVID W 1/17/1991 M M 166 AMBER OAK DRIVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE MADDOCKS DAVID W 1/17/1991 M M 166 AMBER OAK DRIVE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP MADDOCKS BRIDGETTE C 9/18/1987 M F 166 AMBER OAK DRIVE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP MADDOCKS BRIDGETTE C 9/18/1987 M F 166 AMBER OAK DRIVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SC MADDOCKS LILY B 7/16/2010 U F 166 AMBER OAK DRIVE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SC MADDOCKS LILY B 7/16/2010 U F 166 AMBER OAK DRIVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH MADDOCKS CHARLES A 8/3/2015 U M 166 AMBER OAK DRIVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH MADDOCKS CHARLES A 8/3/2015 U M 166 AMBER OAK DRIVE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SC MADDOCKS ETHAN C 6/12/2009 U M 166 AMBER OAK DRIVE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SC MADDOCKS ETHAN C 6/12/2009 U M 166 AMBER OAK DRIVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE COSTA BRADLEY J 6/21/1992 M 359 BLACKTAIL DR NEW BRAUNFELS TX 78130 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE COSTA BRADLEY J 6/21/1992 M 359 BLACKTAIL DR NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE GARCIA JOEL 5/27/1989 M 225 BELLA VISTA CIR KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE GARCIA JOEL 5/27/1989 M 225 BELLA VISTA CIR KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH GARCIA-MEDINA KIARA 10/17/2010 F 120 FINN TRAIL SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH GARCIA-MEDINA KIARA 10/17/2010 F 120 FINN TRAIL SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH GARCIA SEBASTIAN L 3/7/2022 M 225 BELLA VISTA CIR KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH GARCIA SEBASTIAN L 3/7/2022 M 225 BELLA VISTA CIR KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE SIDI RAM 5/29/1967 M 1624 AQUARENA SPRINGS DR APT 6456 SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE SIDI RAM 5/29/1967 M 1624 AQUARENA SPRINGS DR APT 6456 SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE POPE THOMAS R 10/14/1958 U M 5435 HILLIARD ROAD SAN MARCOS TX 78666 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT ONLY EE POPE THOMAS R 10/14/1958 U M 5435 HILLIARD ROAD SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1ASO CH EP1 Plan 2 R SUBSCRIBER/RECIPIENT ONLY EE MAYVILLE KERRY M 2/5/1986 S M APT 81 1606 N. IH 35 SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE MAYVILLE KERRY M 2/5/1986 S M APT 81 1606 N. IH 35 SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE LACASSE BETHANY D 2/13/1995 F 2917 SUNSET SMT NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE LACASSE BETHANY D 2/13/1995 F 2917 SUNSET SMT NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE WINCHESTER BRIAN G 8/28/1979 M 11001 S 1ST APT 925 AUSTIN TX 78748 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE WINCHESTER BRIAN G 8/28/1979 M 11001 S 1ST APT 925 AUSTIN TX 78748 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE CANTALUPO LEANNE J 1/27/1993 F UNIT 101 411 W. SAN ANTONIO ST SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE EE CANTALUPO LEANNE J 1/27/1993 F UNIT 101 411 W. SAN ANTONIO ST SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND SPOUSE SP CHAPA RIOS ALONSO D 8/22/1985 M UNIT 101 411 W. SAN ANTONIO ST SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE SP CHAPA RIOS ALONSO D 8/22/1985 M UNIT 101 411 W. SAN ANTONIO ST SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND SPOUSE EE SCHMIDT ELIZABETH J 4/3/1987 F 608 LANTANA LOCKHART TX 78644 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE SCHMIDT ELIZABETH J 4/3/1987 F 608 LANTANA LOCKHART TX 78644 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE KOPEC KEITH M 4/13/1987 M 3861 LEGEND HILL NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE KOPEC KEITH M 4/13/1987 M 3861 LEGEND HILL NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP KLEMANN ASHLEY 8/29/1989 F 3861 LEGEND HILL NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP KLEMANN ASHLEY 8/29/1989 F 3861 LEGEND HILL NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH KOPEC KEITH S 6/15/2006 M 3861 LEGEND HILL NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH KOPEC KEITH S 6/15/2006 M 3861 LEGEND HILL NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH KOPEC JACKSON J 2/16/2011 M 3861 LEGEND HILL NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH KOPEC JACKSON J 2/16/2011 M 3861 LEGEND HILL NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH KOPEC JAMES C 5/23/2014 M 3861 LEGEND HILL NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH KOPEC JAMES C 5/23/2014 M 3861 LEGEND HILL NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH KOPEC SADIE G 5/23/2014 F 3861 LEGEND HILL NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH KOPEC SADIE G 5/23/2014 F 3861 LEGEND HILL NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH KOPEC SCARLETT R 3/17/2021 S F 3861 LEGEND HILL NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH KOPEC SCARLETT R 3/17/2021 S F 3861 LEGEND HILL NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE KOTZUR JILL E 1/20/1970 F 111 LONGHORN RD STOCKDALE TX 78160 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE KOTZUR JILL E 1/20/1970 F 111 LONGHORN RD STOCKDALE TX 78160 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE HALLAS CHRISTOPHER J 8/1/1971 M 1417 PAMS PATH NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE SPENCER RANDALL K 4/23/1992 M LOT 122 130 ELM ST MAXWELL TX 78656 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND ONE CHILD EE SPENCER RANDALL K 4/23/1992 M LOT 122 130 ELM ST MAXWELL TX 78656 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND ONE CHILD CH SPENCER PAIGE A 4/24/2016 F LOT 122 130 ELM ST MAXWELL TX 78656 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND ONE CHILD CH SPENCER PAIGE A 4/24/2016 F LOT 122 130 ELM ST MAXWELL TX 78656 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND ONE CHILD EE HALL DWAINE A 9/13/1984 M APT 10202 501 FM 3009 SCHERTZ TX 78154 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND ONE CHILD CH HALL DORIAN A 10/21/2006 M APT 10202 501 FM 3009 SCHERTZ TX 78154 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND ONE CHILD EE AVONA BRITTANY R 3/3/1999 F 2013 LISA LANE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE AVONA BRITTANY R 3/3/1999 F 2013 LISA LANE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE ANCTIL THOMAS R 11/22/1959 M M 325 VORTEX PASS KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE ANCTIL THOMAS R 11/22/1959 M M 325 VORTEX PASS KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE JOKINEN BILLIE J 4/2/1967 F 711 STAMPEDE RD SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 16 A SUBSCRIBER/RECIPIENT ONLY EE JOKINEN BILLIE J 4/2/1967 F 711 STAMPEDE RD SAN MARCOS TX 78666 D ASO CH EP1 Plan 20 A SUBSCRIBER/RECIPIENT ONLY

RFP 2024-P11 Employee Group Health, Denta, and Employee Assistance Plan Attachment B: Hays County Census (April 2024)

EE HART TAYLOR M 7/20/1995 F 2217 STONELEIGH DR NEW BRAUNFELS TX 78130 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT ONLY EE HART TAYLOR M 7/20/1995 F 2217 STONELEIGH DR NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE JOHNSON CHRISTOPHER P 3/6/1974 M M 1681 HAWTHORNE LOOP DRIFTWOOD TX 78619 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE JOHNSON CHRISTOPHER P 3/6/1974 M M 1681 HAWTHORNE LOOP DRIFTWOOD TX 78619 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH JOHNSON CHRISTIAN G 9/12/2007 U M 1681 HAWTHORNE LOOP DRIFTWOOD TX 78619 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH JOHNSON CHRISTIAN G 9/12/2007 U M 1681 HAWTHORNE LOOP DRIFTWOOD TX 78619 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH JOHNSON MATTHEW M 9/12/2007 U M 1681 HAWTHORNE LOOP DRIFTWOOD TX 78619 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH JOHNSON MATTHEW M 9/12/2007 U M 1681 HAWTHORNE LOOP DRIFTWOOD TX 78619 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH JOHNSON ALEXANDER M 9/12/2007 U M 1681 HAWTHORNE LOOP DRIFTWOOD TX 78619 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH JOHNSON ALEXANDER M 9/12/2007 U M 1681 HAWTHORNE LOOP DRIFTWOOD TX 78619 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE CUADROS BRYANT 4/1/1991 M 147 LYNDON DRIVE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A CHILDREN ONLY EE CUADROS BRYANT 4/1/1991 M 147 LYNDON DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP CUADROS NINA E 3/22/1991 F 147 LYNDON DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CUADROS ZION E 8/2/2018 M 147 LYNDON DRIVE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A CHILDREN ONLY CH CUADROS ZION E 8/2/2018 M 147 LYNDON DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CUADROS KALEB A 7/16/2021 M 147 LYNDON DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CUADROS KALEB A 7/16/2021 M 147 LYNDON DRIVE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A CHILDREN ONLY CH CUADROS ARIA R 2/19/2024 F 147 LYNDON DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CUADROS ARIA R 2/19/2024 F 147 LYNDON DRIVE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A CHILDREN ONLY EE VIANA JENNIE E 7/27/1991 F 194 DEW DROP COVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE VIANA JENNIE E 7/27/1991 F 194 DEW DROP COVE KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH VIANA ARIALYNN R 3/31/2016 F 194 DEW DROP COVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH VIANA ARIALYNN R 3/31/2016 F 194 DEW DROP COVE KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH VIANA AUDREY M 8/8/2023 F 194 DEW DROP COVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH VIANA AUDREY M 8/8/2023 F 194 DEW DROP COVE KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE TEREZ JORGE 4/13/1994 M 378 AMBER GLEN MAXWELL TX 78656 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT ONLY EE TEREZ JORGE 4/13/1994 M 378 AMBER GLEN MAXWELL TX 78656 D Dental DHMO Plan D094C A SUBSCRIBER/RECIPIENT ONLY EE WILLS LAURIE A 8/24/1956 U F 201 ROCKWOOD DRIVE WIMBERLEY TX 78676 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT ONLY EE WILLS LAURIE A 8/24/1956 U F 201 ROCKWOOD DRIVE WIMBERLEY TX 78676 M ASO CH+ PS1 Plan 1ASO CH+ PS1 Plan 1 R SUBSCRIBER/RECIPIENT ONLY EE GUTIERREZ DENNIS 11/2/1963 U M PO BOX 1164 SAN MARCOS TX 78667 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD EE GUTIERREZ DENNIS 11/2/1963 U M PO BOX 1164 SAN MARCOS TX 78667 M ASO CH+ PS1 Plan 1ASO CH EP1 Plan 2 R SUBSCRIBER/RECIPIENT AND ONE CHILD SP GUTIERREZ SHARLA 3/19/1969 U F PO BOX 1164 SAN MARCOS TX 78667 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD CH GUTIERREZ DENNIS M 2/21/2003 U M PO BOX 1164 SAN MARCOS TX 78667 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD CH GUTIERREZ DENNIS M 2/21/2003 U M PO BOX 1164 SAN MARCOS TX 78667 M ASO CH+ PS1 Plan 1ASO CH EP1 Plan 2 R SUBSCRIBER/RECIPIENT AND ONE CHILD EE LUONGO GRETCHEN 11/26/1962 F 732 WILLOW RIDGE DR SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE LUONGO GRETCHEN 11/26/1962 F 732 WILLOW RIDGE DR SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE RANA MICHAEL 6/25/1983 U M APT 7104 1350 SADLER DR SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE RANA MICHAEL 6/25/1983 U M APT 7104 1350 SADLER DR SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE FIORE SHARON K 7/10/1949 F 2910 PHILO ST SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE SP FIORE ROBERT W 1/15/1954 M 2910 PHILO ST SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE EE KAUFFMAN CHRISTOPHER P 2/14/1982 M 4133 MATHER KYLE TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE KAUFFMAN CHRISTOPHER P 2/14/1982 M 4133 MATHER KYLE TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP KAUFFMAN CHRISTINA M 4/1/1984 U F 4133 MATHER KYLE TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH KAUFFMAN JAYDEN 2/2/2012 M 4133 MATHER KYLE TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH KAUFFMAN JAYDEN 2/2/2012 M 4133 MATHER KYLE TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH KAUFFMAN ZACHARY 11/30/2009 M 4133 MATHER KYLE TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH KAUFFMAN ZACHARY 11/30/2009 M 4133 MATHER KYLE TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE CHEN JAMES 10/6/1960 M 218 E TANGLEWOOD DR NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE CHEN JAMES 10/6/1960 M 218 E TANGLEWOOD DR NEW BRAUNFELS TX 78130 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT ONLY EE FILE STEVEN R 6/29/1992 M 149 HORSEMINT WAY SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE FILE STEVEN R 6/29/1992 M 149 HORSEMINT WAY SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) SP FILE KELSEY 1/15/1992 U F 149 HORSEMINT WAY SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH FILE DEAN R 10/23/2018 M 149 HORSEMINT WAY SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH FILE DEAN R 10/23/2018 M 149 HORSEMINT WAY SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH FILE LOGAN R 10/23/2018 M 149 HORSEMINT WAY SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH FILE LOGAN R 10/23/2018 M 149 HORSEMINT WAY SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE WASKO MATTHEW J 4/22/1968 M M 176 J MARYES LANE KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD EE WASKO MATTHEW J 4/22/1968 M M 176 J MARYES LANE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD SP WASKO WENDY S 4/22/1968 M F 176 J MARYES LANE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD SP WASKO WENDY S 4/22/1968 M F 176 J MARYES LANE KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD CH WASKO SCOT J 4/30/1999 U M 176 J MARYES LANE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD CH WASKO SCOT J 4/30/1999 U M 176 J MARYES LANE KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD EE TORRES JOSE A 3/19/1998 M 317 MALLARD LOOP SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE TORRES JOSE A 3/19/1998 M 317 MALLARD LOOP SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE RAMCHARAN GERALD I 8/2/1962 U M 5549 COLUMBIA DR CIBOLO TX 78108 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE SP RAMCHARAN HYE C 3/15/1961 U F 5549 COLUMBIA DR CIBOLO TX 78108 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE EE MCDONNELL BRIAN M 3/15/1994 M 3305 MAYFAIR DR SCHERTZ TX 78108 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND SPOUSE EE MCDONNELL BRIAN M 3/15/1994 M 3305 MAYFAIR DR SCHERTZ TX 78108 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE SP MCDONNEL ALLI A 5/3/1998 F 3305 MAYFAIR DR SCHERTZ TX 78108 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE SP MCDONNEL ALLI A 5/3/1998 F 3305 MAYFAIR DR SCHERTZ TX 78108 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND SPOUSE EE BARKLEY JESSICA A 4/11/1978 M F 811 NEW BRIDGE DR KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE BARKLEY JESSICA A 4/11/1978 M F 811 NEW BRIDGE DR KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH BARKLEY JACOB T 12/18/2001 U M 811 NEW BRIDGE DR KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH BARKLEY JACOB T 12/18/2001 U M 811 NEW BRIDGE DR KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN)

CH BARKLEY BENJAMIN J 5/8/2010 U M 811 NEW BRIDGE DR KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH BARKLEY BENJAMIN J 5/8/2010 U M 811 NEW BRIDGE DR KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH BARKLEY CATHERINE A 10/8/2003 U F 811 NEW BRIDGE DR KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH BARKLEY CATHERINE A 10/8/2003 U F 811 NEW BRIDGE DR KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH BARKLEY JOSHUA I 1/3/2006 U M 811 NEW BRIDGE DR KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH BARKLEY JOSHUA I 1/3/2006 U M 811 NEW BRIDGE DR KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE CUMBERLAND MARK W 4/4/1970 M M 136 KNOLL COVE AUSTIN TX 78737 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE CUMBERLAND MARK W 4/4/1970 M M 136 KNOLL COVE AUSTIN TX 78737 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH CUMBERLAND JORDAN R 3/4/2005 F 136 KNOLL COVE AUSTIN TX 78737 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH CUMBERLAND JORDAN R 3/4/2005 F 136 KNOLL COVE AUSTIN TX 78737 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH CUMBERLAND RAEGAN K 7/20/2007 F 136 KNOLL COVE AUSTIN TX 78737 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH CUMBERLAND RAEGAN K 7/20/2007 F 136 KNOLL COVE AUSTIN TX 78737 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE CHYNOWETH ROXANA L 10/29/1980 F 212 TERON DR SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE CHYNOWETH ROXANA L 10/29/1980 F 212 TERON DR SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE MYERS SIERRA A 4/17/1997 F 506 SHADOWPOINT SAN MARCOS TX 78666 D ASO CH EP1 Plan 20 A SUBSCRIBER/RECIPIENT ONLY EE MYERS SIERRA A 4/17/1997 F 506 SHADOWPOINT SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 17 A SUBSCRIBER/RECIPIENT ONLY EE SPERRY SHELBY N 2/18/1994 F 1012 FOUR SEASONS FARM KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE SPERRY SHELBY N 2/18/1994 F 1012 FOUR SEASONS FARM KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE RITCHIE HALEY L 11/27/1998 F 200 SILVER WING CIBOLO TX 78108 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE RITCHIE HALEY L 11/27/1998 F 200 SILVER WING CIBOLO TX 78108 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE SAMPSON MARY 10/5/1961 F 664 BLUE OAK BLVD SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND ONE CHILD CH SAMPSON JULIANNA 11/10/1999 F 664 BLUE OAK BLVD SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND ONE CHILD EE CAVENDER TERESA D 9/27/1963 F 501 DUNCAN DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY EE CAVENDER TERESA D 9/27/1963 F 501 DUNCAN DRIVE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP CAVENDER JOHN R 2/22/1971 M 501 DUNCAN DRIVE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP CAVENDER JOHN R 2/22/1971 M 501 DUNCAN DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CAVENDER MICAH J 7/29/1998 M 501 DUNCAN DRIVE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH CAVENDER MICAH J 7/29/1998 M 501 DUNCAN DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CAVENDER CALEB T 2/21/2001 M 501 DUNCAN DRIVE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH CAVENDER CALEB T 2/21/2001 M 501 DUNCAN DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CAVENDER SARAH R 8/21/2003 F 501 DUNCAN DRIVE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH CAVENDER SARAH R 8/21/2003 F 501 DUNCAN DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CAVENDER ISAAC B 10/28/2005 M 501 DUNCAN DRIVE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH CAVENDER ISAAC B 10/28/2005 M 501 DUNCAN DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY EE ALANIZ CLAIRE M 1/3/1995 F 4003 BELDEN TRAIL NEW BRAUNFELS TX 78132 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE ALANIZ CLAIRE M 1/3/1995 F 4003 BELDEN TRAIL NEW BRAUNFELS TX 78132 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE SZLACHTOWSKI SEAN C 1/28/1995 M APT 10103 4700 CROMWELL DRIVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE SZLACHTOWSKI SEAN C 1/28/1995 M APT 10103 4700 CROMWELL DRIVE KYLE TX 78640 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT ONLY EE PHILLIPS KELLY A 5/20/1997 F 6435 COOKSEY RD ADKINS TX 78101 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE PHILLIPS KELLY A 5/20/1997 F 6435 COOKSEY RD ADKINS TX 78101 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE LOWE WESLEY R 1/2/1972 M M 6329 A NEGLEY KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD EE LOWE WESLEY R 1/2/1972 M M 6329 A NEGLEY KYLE TX 78640 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD SP LOWE JO A 7/13/1970 M F 6329 A NEGLEY KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD SP LOWE JO A 7/13/1970 M F 6329 A NEGLEY KYLE TX 78640 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD CH LOWE WESLEY M 10/8/1997 U M 6329 A NEGLEY KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD CH LOWE WESLEY M 10/8/1997 U M 6329 A NEGLEY KYLE TX 78640 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD EE GOMES TORRES AMANDA 7/28/1994 F 312 PERRY ST SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE GOMES TORRES AMANDA 7/28/1994 F 312 PERRY ST SAN MARCOS TX 78666 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT ONLY EE ROBINSON STEPHANIE B 5/28/1985 F 2166 HAZELWOOD NEW BRAUNFELS TX 78130 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT ONLY EE ROBINSON STEPHANIE B 5/28/1985 F 2166 HAZELWOOD NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE DRAKE JUSTIN S 4/30/1984 S M 710 LOST VALLEY ROAD DRIPPING SPRINGS TX 78620 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT AND FAMILY EE DRAKE JUSTIN S 4/30/1984 S M 710 LOST VALLEY ROAD DRIPPING SPRINGS TX 78620 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP DRAKE CHRISTINA M 5/14/1988 F 710 LOST VALLEY ROAD DRIPPING SPRINGS TX 78620 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT AND FAMILY SP DRAKE CHRISTINA M 5/14/1988 F 710 LOST VALLEY ROAD DRIPPING SPRINGS TX 78620 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH DRAKE WESSON S 3/12/2015 M 710 LOST VALLEY ROAD DRIPPING SPRINGS TX 78620 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT AND FAMILY CH DRAKE WESSON S 3/12/2015 M 710 LOST VALLEY ROAD DRIPPING SPRINGS TX 78620 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH DRAKE WADE L 6/27/2017 M 710 LOST VALLEY ROAD DRIPPING SPRINGS TX 78620 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH DRAKE WADE L 6/27/2017 M 710 LOST VALLEY ROAD DRIPPING SPRINGS TX 78620 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT AND FAMILY CH DRAKE WHITAKER E 7/10/2020 S F 710 LOST VALLEY ROAD DRIPPING SPRINGS TX 78620 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT AND FAMILY CH DRAKE WHITAKER E 7/10/2020 S F 710 LOST VALLEY ROAD DRIPPING SPRINGS TX 78620 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE LINDESAY EMMANUEL U 8/5/1991 M 7225 MCLEOD DR ABILENE TX 79602 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND ONE CHILD EE LINDESAY EMMANUEL U 8/5/1991 M 7225 MCLEOD DR ABILENE TX 79602 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND ONE CHILD CH LINDESAY AALIYAH J 6/22/2020 F 7225 MCLEOD DR ABILENE TX 79602 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND ONE CHILD CH LINDESAY AALIYAH J 6/22/2020 F 7225 MCLEOD DR ABILENE TX 79602 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND ONE CHILD EE ZOERB DEBRA C 5/5/1955 M F 607 COUNTRY ESTATES DRIVE SAN MARCOS TX 78666 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT AND SPOUSE SP ZOERB DENNIS R 1/3/1939 M 607 COUNTRY ESTATES DRIVE SAN MARCOS TX 78666 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT AND SPOUSE EE LANE MARISSA F 7/25/1997 F 425 SHADOW POINT DR SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE LANE MARISSA F 7/25/1997 F 425 SHADOW POINT DR SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE CARPENTER KENNETH J 6/14/1972 S M 3011 CENTERPOINT ROAD SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE CARPENTER KENNETH J 6/14/1972 S M 3011 CENTERPOINT ROAD SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP SKROCKI JERLYN M 5/4/1966 F 3011 CENTERPOINT ROAD SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP SKROCKI JERLYN M 5/4/1966 F 3011 CENTERPOINT ROAD SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH CARPENTER ALEXIS G 6/28/2005 U F 3011 CENTERPOINT ROAD SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CARPENTER ALEXIS G 6/28/2005 U F 3011 CENTERPOINT ROAD SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY

CH CARPENTER CHASE N 6/28/2005 U M 3011 CENTERPOINT ROAD SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CARPENTER CHASE N 6/28/2005 U M 3011 CENTERPOINT ROAD SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE RAYMOND YOHANA 11/9/1986 F 132 SNOW OWL HOLLOW BUDA TX 78610 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE RAYMOND YOHANA 11/9/1986 F 132 SNOW OWL HOLLOW BUDA TX 78610 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP RAYMOND JASON J 1/4/1986 M 132 SNOW OWL HOLLOW BUDA TX 78610 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP RAYMOND JASON J 1/4/1986 M 132 SNOW OWL HOLLOW BUDA TX 78610 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH RAYMOND JOSHUA E 5/10/2006 M 132 SNOW OWL HOLLOW BUDA TX 78610 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH RAYMOND JOSHUA E 5/10/2006 M 132 SNOW OWL HOLLOW BUDA TX 78610 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH RAYMOND ISAIAH A 8/24/2007 M 132 SNOW OWL HOLLOW BUDA TX 78610 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH RAYMOND ISAIAH A 8/24/2007 M 132 SNOW OWL HOLLOW BUDA TX 78610 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH RAYMOND EMMA L 12/22/2010 F 132 SNOW OWL HOLLOW BUDA TX 78610 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH RAYMOND EMMA L 12/22/2010 F 132 SNOW OWL HOLLOW BUDA TX 78610 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE MORGAN CYRUS 9/25/1988 M 1612 SUGARBERRY LANE AUSTIN TX 78748 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND SPOUSE EE MORGAN CYRUS 9/25/1988 M 1612 SUGARBERRY LANE AUSTIN TX 78748 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE SP BOYKIN SKYLAR M 3/8/1994 F 1612 SUGARBERRY LANE AUSTIN TX 78748 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND SPOUSE SP BOYKIN SKYLAR M 3/8/1994 F 1612 SUGARBERRY LANE AUSTIN TX 78748 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE EE MCDONALD BRADLEY W 9/23/1990 M 2280 HAWK DRIVE NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY EE MCDONALD BRADLEY W 9/23/1990 M 2280 HAWK DRIVE NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP MCDONALD MERIDETH N 12/16/1988 F 2280 HAWK DRIVE NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP MCDONALD MERIDETH N 12/16/1988 F 2280 HAWK DRIVE NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH MCDONALD KAVERRA 2/27/2015 F 2280 HAWK DRIVE NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH MCDONALD KAVERRA 2/27/2015 F 2280 HAWK DRIVE NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH MCDONALD KENDRIC W 1/17/2016 M 2280 HAWK DRIVE NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH MCDONALD KENDRIC W 1/17/2016 M 2280 HAWK DRIVE NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH MCDONALD GUNNER A 1/25/2019 M 2280 HAWK DRIVE NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH MCDONALD GUNNER A 1/25/2019 M 2280 HAWK DRIVE NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY RR BROWN BILLY B 8/16/1953 U M P O BOX 633 DRIPPING SPRINGS TX 78620 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT AND SPOUSE SP BROWN CONNIE 7/15/1952 M F P O BOX 633 DRIPPING SPRINGS TX 78620 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT AND SPOUSE EE VILLALOBOS ALEXANDER 3/1/1972 M 136 FIREWHEEL COVE KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE VILLALOBOS ALEXANDER 3/1/1972 M 136 FIREWHEEL COVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE GLOVER CARMEN A 1/9/1997 F 101 CONCHO ST APT 1121-A SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE GLOVER CARMEN A 1/9/1997 F 101 CONCHO ST APT 1121-A SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE MCKINNEY JEFFREY T 11/7/1976 M M 233 TURTLE CREEK DRIVE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY EE MCKINNEY JEFFREY T 11/7/1976 M M 233 TURTLE CREEK DRIVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP MCKINNEY ALEXANDRA L 6/1/1980 U F 233 TURTLE CREEK DRIVE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP MCKINNEY ALEXANDRA L 6/1/1980 U F 233 TURTLE CREEK DRIVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH MCKINNEY WYATT W 2/28/2014 U F 233 TURTLE CREEK DRIVE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH MCKINNEY WYATT W 2/28/2014 U F 233 TURTLE CREEK DRIVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH MCKINNEY DUKE A 6/27/2018 M 233 TURTLE CREEK DRIVE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH MCKINNEY DUKE A 6/27/2018 M 233 TURTLE CREEK DRIVE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY EE HOUSE VRONICA K 12/1/1990 F APT L 2 1048 COUNTRY CLUB SEGUIN TX 78155 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE HOUSE VRONICA K 12/1/1990 F APT L 2 1048 COUNTRY CLUB SEGUIN TX 78155 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE PHILLIPS JARED C 2/14/1994 M 434 HARVEST POINT SELMA TX 78154 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE PHILLIPS JARED C 2/14/1994 M 434 HARVEST POINT SELMA TX 78154 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE JONES JANICE L 1/24/1966 M F 2632 ROLLING OAKS SAN MARCOS TX 78666 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD EE JONES JANICE L 1/24/1966 M F 2632 ROLLING OAKS SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND ONE CHILD SP JONES STEPHEN M 9/24/1961 M M 2632 ROLLING OAKS SAN MARCOS TX 78666 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD CH JONES MARK W 7/23/1998 U M 2632 ROLLING OAKS SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND ONE CHILD CH JONES MARK W 7/23/1998 U M 2632 ROLLING OAKS SAN MARCOS TX 78666 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD EE STAMMZACHARY JENNIFER L 10/10/1957 S F 327 FRIO STREET LOCKHART TX 78644 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE STAMMZACHARY JENNIFER L 10/10/1957 S F 327 FRIO STREET LOCKHART TX 78644 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY RR ROBERTS RICHARD A 6/23/1948 U M 1500 HUNTERS ROAD LOCKHART TX 78644 M ASO CH+ PS1 Plan 1ASO CH+ PS1 Plan 1 R SUBSCRIBER/RECIPIENT ONLY RR ROBERTS RICHARD A 6/23/1948 U M 1500 HUNTERS ROAD LOCKHART TX 78644 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT ONLY RR BROWN PAULETTE 11/12/1950 U F 921 HAWK DR MANCHACA TX 78652 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT ONLY EE THOMAS BRYAN M 7/23/1991 M 379 STONE PT NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE THOMAS BRYAN M 7/23/1991 M 379 STONE PT NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP THOMAS KAITLIN M 7/15/1994 F 379 STONE PT NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP THOMAS KAITLIN M 7/15/1994 F 379 STONE PT NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH THOMAS BRANSON M 6/8/2015 M 379 STONE PT NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH THOMAS BRANSON M 6/8/2015 M 379 STONE PT NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH THOMAS JAXON D 9/6/2017 M 379 STONE PT NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH THOMAS JAXON D 9/6/2017 M 379 STONE PT NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SC RIVERA TREY D 1/9/2014 M 379 STONE PT NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SC RIVERA TREY D 1/9/2014 M 379 STONE PT NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SC RIVERA MYA M 5/18/2017 F 379 STONE PT NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SC RIVERA MYA M 5/18/2017 F 379 STONE PT NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SC RIVERA BO A 7/19/2018 M 379 STONE PT NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SC RIVERA BO A 7/19/2018 M 379 STONE PT NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE POZUC JOHN A 7/30/1988 M P.O. BOX 2673 SEGUIN TX 78156 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND SPOUSE EE POZUC JOHN A 7/30/1988 M P.O. BOX 2673 SEGUIN TX 78156 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE SP POZUC DORA E 11/26/1973 F P.O. BOX 2673 SEGUIN TX 78156 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND SPOUSE SP POZUC DORA E 11/26/1973 F P.O. BOX 2673 SEGUIN TX 78156 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE EE MASON LISA D 3/11/1968 U F 152 CADDIS CV KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE MASON LISA D 3/11/1968 U F 152 CADDIS CV KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY

EE VANDENBROEK NICHOLAS P 2/13/1982 M 212 CALIXTO CT SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE VANDENBROEK NICHOLAS P 2/13/1982 M 212 CALIXTO CT SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE ZEDIKER ERIC S 3/13/1969 M M 201 PURPLE MARTIN AVENUE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE EE ZEDIKER ERIC S 3/13/1969 M M 201 PURPLE MARTIN AVENUE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND SPOUSE SP ZEDIKER SUSAN 6/10/1965 M F 201 PURPLE MARTIN AVENUE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND SPOUSE SP ZEDIKER SUSAN 6/10/1965 M F 201 PURPLE MARTIN AVENUE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND SPOUSE EE SHEPHERD ANTHONY G 5/20/1982 M APT 6111 1476 E. MCCARTY LN SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE SHEPHERD ANTHONY G 5/20/1982 M APT 6111 1476 E. MCCARTY LN SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE WILCOX JOSEPH M 1/23/1991 M 2713 IBERIA CT SEGUIN TX 78155 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE JENKINS CAMERON A 8/6/1992 M 56 DEER RIDGE RD WIMBERLEY TX 78676 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE JENKINS CAMERON A 8/6/1992 M 56 DEER RIDGE RD WIMBERLEY TX 78676 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE GRAYCKOWSKI JOSHUA C 10/27/1986 M APT 1503 63005 CONGRESS AVE AUSTIN TX 78745 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE GRAYCKOWSKI JOSHUA C 10/27/1986 M APT 1503 63005 CONGRESS AVE AUSTIN TX 78745 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT AND FAMILY SP GRAYCKOWSKI KATIE R 11/7/1984 F APT 1503 63005 CONGRESS AVE AUSTIN TX 78745 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT AND FAMILY CH GRAYCKOWSKI BRAYDEN C 2/17/2012 M APT 1503 63005 CONGRESS AVE AUSTIN TX 78745 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT AND FAMILY CH GRAYCKOWSKI BRAYDEN C 2/17/2012 M APT 1503 63005 CONGRESS AVE AUSTIN TX 78745 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH GRAYCKOWSKI RYLEE L 11/12/2014 F APT 1503 63005 CONGRESS AVE AUSTIN TX 78745 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH GRAYCKOWSKI RYLEE L 11/12/2014 F APT 1503 63005 CONGRESS AVE AUSTIN TX 78745 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT AND FAMILY CH GRAYCKOWSKI JACOB J 2/10/2016 M APT 1503 63005 CONGRESS AVE AUSTIN TX 78745 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH GRAYCKOWSKI JACOB J 2/10/2016 M APT 1503 63005 CONGRESS AVE AUSTIN TX 78745 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT AND FAMILY EE LOOTENS RANDY A 4/30/1974 M 281 SUNDOWN AVE BUDA TX 78610 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE LOOTENS RANDY A 4/30/1974 M 281 SUNDOWN AVE BUDA TX 78610 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE WILBURN ANTHONY B 3/12/1968 M M 6707 FOSTER FIELDS CONVERSE TX 78109 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY EE WILBURN ANTHONY B 3/12/1968 M M 6707 FOSTER FIELDS CONVERSE TX 78109 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP WILBURN MIKOL 7/30/1966 M F 6707 FOSTER FIELDS CONVERSE TX 78109 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP WILBURN MIKOL 7/30/1966 M F 6707 FOSTER FIELDS CONVERSE TX 78109 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH WILBURN JOSEPH 4/14/1998 U M 6707 FOSTER FIELDS CONVERSE TX 78109 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH WILBURN JOSEPH 4/14/1998 U M 6707 FOSTER FIELDS CONVERSE TX 78109 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH WILBURN CALASCA 6/28/2006 U F 6707 FOSTER FIELDS CONVERSE TX 78109 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH WILBURN CALASCA 6/28/2006 U F 6707 FOSTER FIELDS CONVERSE TX 78109 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE DEGENEFFE BEVERLY N 2/10/1988 F APT 103 302W. SAN ANTONIO ST SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE DEGENEFFE BEVERLY N 2/10/1988 F APT 103 302W. SAN ANTONIO ST SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE DELEON RODRIGO D 1/23/1989 M M 3485 COMPOS DR NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY EE DELEON RODRIGO D 1/23/1989 M M 3485 COMPOS DR NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP DELEON SASHA N 11/28/1990 M F 2485 COMPOS DR NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP DELEON SASHA N 11/28/1990 M F 2485 COMPOS DR NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH DELEON RODRIGO D 6/25/2014 U M 2485 COMPOS DR NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH DELEON RODRIGO D 6/25/2014 U M 2485 COMPOS DR NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH DELEON LYLA N 4/29/2009 U F 2485 COMPOS DR NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH DELEON LYLA N 4/29/2009 U F 2485 COMPOS DR NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH DELEON LYNN G 9/14/2010 U F 2485 COMPOS DR NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH DELEON LYNN G 9/14/2010 U F 2485 COMPOS DR NEW BRAUNFELS TX 78130 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY EE CORPREW SIMONE E 2/8/1997 F 418 PIN CHERRY PASS SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE CORPREW SIMONE E 2/8/1997 F 418 PIN CHERRY PASS SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH CORPREW LIAM A 3/23/2017 M 418 PIN CHERRY PASS SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH CORPREW LIAM A 3/23/2017 M 418 PIN CHERRY PASS SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH CORPREW SOPHIA D 6/6/2023 F 418 PIN CHERRY PASS SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH CORPREW SOPHIA D 6/6/2023 F 418 PIN CHERRY PASS SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND CHILD(REN) RR RODRIGUEZ ROSEMARY 5/10/1948 U F P O BOX 372 SAN MARCOS TX 78666 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT ONLY RR RODRIGUEZ ROSEMARY 5/10/1948 U F P O BOX 372 SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1ASO CH+ PS1 Plan 1 R SUBSCRIBER/RECIPIENT ONLY EE CARTER TERENCE 12/19/1960 U M 125 SAWTOOTH DRIVE SAN MARCOS TX 78666 D ASO CH+ PS1 Plan 1Dental PPO Plan 4P648 R SUBSCRIBER/RECIPIENT ONLY EE CARTER TERENCE 12/19/1960 U M 125 SAWTOOTH DRIVE SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1ASO CH+ PS1 Plan 1 R SUBSCRIBER/RECIPIENT ONLY EE LOOS LANCE L 6/24/1967 M 140 FALCON DR LULING TX 78648 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE LOOS LANCE L 6/24/1967 M 140 FALCON DR LULING TX 78648 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE ZESATI JUAN J 3/16/1990 M M 5511 AIRPORT HIGHWAY 21 MAXWELL TX 78656 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE ZESATI JUAN J 3/16/1990 M M 5511 AIRPORT HIGHWAY 21 MAXWELL TX 78656 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE TRISTAN SAMANTHA A 1/30/1992 F 5024 RAINWOOD DR SAN MARCOS TX 78666 D ASO CH EP1 Plan 20 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE TRISTAN SAMANTHA A 1/30/1992 F 5024 RAINWOOD DR SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 17 A SUBSCRIBER/RECIPIENT ONLY CH TRISTAN NATALIE L 11/16/2011 F 5024 RAINWOOD DR SAN MARCOS TX 78666 D ASO CH EP1 Plan 20 A SUBSCRIBER/RECIPIENT AND CHILD(REN) CH TRISTAN DIEGO 6/11/2008 M 5024 RAINWOOD DR SAN MARCOS TX 78666 D ASO CH EP1 Plan 20 A SUBSCRIBER/RECIPIENT AND CHILD(REN) EE DOUGLAS ONDRA 4/4/1994 M APT 224 250 S. STAGECOACH TRL SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE DOUGLAS ONDRA 4/4/1994 M APT 224 250 S. STAGECOACH TRL SAN MARCOS TX 78666 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT ONLY EE ELLIOTT BRANDON L 8/1/1992 M 140 MAROON LANE KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE ELLIOTT BRANDON L 8/1/1992 M 140 MAROON LANE KYLE TX 78640 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE RAMIREZ BOBBY L 2/11/1978 M M 585 WINCLIFF DR BUDA TX 78610 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE RAMIREZ BOBBY L 2/11/1978 M M 585 WINCLIFF DR BUDA TX 78610 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE MURILLO NICTEL M 4/13/1994 F 1674 SUNSPUR DR NEW BRAUNFELS TX 78130 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE MURILLO NICTEL M 4/13/1994 F 1674 SUNSPUR DR NEW BRAUNFELS TX 78130 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND ONE CHILD CH MURILLO JAVIER 10/5/2023 M 1674 SUNSPUR DR NEW BRAUNFELS TX 78130 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT AND ONE CHILD EE MARTINEZ JUAN M 7/3/1980 S M 114 FORT GRIFFIN DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND ONE CHILD EE MARTINEZ JUAN M 7/3/1980 S M 114 FORT GRIFFIN DRIVE SAN MARCOS TX 78666 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY CH MARTINEZ IAN 4/23/2015 M 114 FORT GRIFFIN DRIVE SAN MARCOS TX 78666 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND ONE CHILD EE LOOS DEBRA A 3/5/1969 M F 140 FALCON DRIVE LULING TX 78648 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE LOOS DEBRA A 3/5/1969 M F 140 FALCON DRIVE LULING TX 78648 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY

EE BREWER-HALL ANNALISE A 9/4/1997 F 2625 CLOVERBROOK LN SCHERTZ TX 78108 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT ONLY EE BREWER-HALL ANNALISE A 9/4/1997 F 2625 CLOVERBROOK LN SCHERTZ TX 78108 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE CAMPBELL HALEY Y 8/23/1992 S F P.O. BOX 520 KYLE TX 78640 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE CAMPBELL HALEY Y 8/23/1992 S F P.O. BOX 520 KYLE TX 78640 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE GRAHAM DAVID J 3/27/1964 M 187 SENNA DRIVE DRIPPING SPRINGS TX 78620 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE GRAHAM DAVID J 3/27/1964 M 187 SENNA DRIVE DRIPPING SPRINGS TX 78620 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE AGUE TERRANCE W 4/7/1972 M 1021 WALNUT VALLEY NEW BRAUNFELS TX 78132 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE AGUE TERRANCE W 4/7/1972 M 1021 WALNUT VALLEY NEW BRAUNFELS TX 78132 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE CARRERA JOSE C 7/16/1966 M M 2910 FOX LN LOCKHART TX 78644 D Dental DHMO Plan D094C A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD EE CARRERA JOSE C 7/16/1966 M M 2910 FOX LN LOCKHART TX 78644 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT ONLY SP CARRERA TERESA 9/8/1970 M F 504 PINE SISKIN DR BUDA TX 78610 D Dental DHMO Plan D094C A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD CH CARRERA MISTY 6/23/1996 U F 504 PINE SISKIN DR BUDA TX 78610 D Dental DHMO Plan D094C A SUBSCRIBER/RECIPIENT, SPOUSE AND ONE CHILD EE FILCEK PRESTEN 6/29/2001 M 1451 SADLER DRIVE APT 2310 SAN MARCOS TX 78666 M ASO CH+ HSA Plan 3 A SUBSCRIBER/RECIPIENT ONLY EE FILCEK PRESTEN 6/29/2001 M 1451 SADLER DRIVE APT 2310 SAN MARCOS TX 78666 D Dental DHMO Plan D094C A SUBSCRIBER/RECIPIENT ONLY EE CHARLTON CODY L 6/26/1988 M M 319 ABBEY LN LOCKHART TX 78644 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY EE CHARLTON CODY L 6/26/1988 M M 319 ABBEY LN LOCKHART TX 78644 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP CHARLTON JOSEANA P 10/19/1987 F 319 ABBEY LN LOCKHART TX 78644 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP CHARLTON JOSEANA P 10/19/1987 F 319 ABBEY LN LOCKHART TX 78644 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH CHARLTON ETHAN C 10/12/2013 M 319 ABBEY LN LOCKHART TX 78644 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH CHARLTON ETHAN C 10/12/2013 M 319 ABBEY LN LOCKHART TX 78644 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CHARLTON JEFFREY L 8/30/2018 M 319 ABBEY LN LOCKHART TX 78644 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CHARLTON JEFFREY L 8/30/2018 M 319 ABBEY LN LOCKHART TX 78644 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH CHARLTON ADELENA M 3/1/2024 F 319 ABBEY LN LOCKHART TX 78644 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH CHARLTON ADELENA M 3/1/2024 F 319 ABBEY LN LOCKHART TX 78644 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY RR INGALSBE GARRY L 1/2/1945 U M 4909 OLD BASTROP ROAD SAN MARCOS TX 78666 M ASO CH+ PS1 Plan 1ASO CH+ PS1 Plan 1 R SUBSCRIBER/RECIPIENT ONLY EE RIVERA JULISSA L 7/8/1991 F 2005 GLENEWINKEL SEGUIN TX 78155 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT ONLY EE RIVERA JULISSA L 7/8/1991 F 2005 GLENEWINKEL SEGUIN TX 78155 M ASO CH+ PS1 Plan 1 A SUBSCRIBER/RECIPIENT ONLY EE BEAR ABIGAIL 1/21/1985 F 9907 CAPITOL VIEW DR AUSTIN TX 78747 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY EE BEAR ABIGAIL 1/21/1985 F 9907 CAPITOL VIEW DR AUSTIN TX 78747 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY SP BEAR EDWIN 3/9/1987 M 9907 CAPITOL VIEW DR AUSTIN TX 78747 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY SP BEAR EDWIN 3/9/1987 M 9907 CAPITOL VIEW DR AUSTIN TX 78747 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH BEAR BRIANNA 1/25/2005 F 9907 CAPITOL VIEW DR AUSTIN TX 78747 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH BEAR BRIANNA 1/25/2005 F 9907 CAPITOL VIEW DR AUSTIN TX 78747 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH BEAR VIANNEY 6/21/2006 F 9907 CAPITOL VIEW DR AUSTIN TX 78747 D Dental PPO Plan 4P648 A SUBSCRIBER/RECIPIENT AND FAMILY CH BEAR VIANNEY 6/21/2006 F 9907 CAPITOL VIEW DR AUSTIN TX 78747 M ASO CH EP1 Plan 2 A SUBSCRIBER/RECIPIENT AND FAMILY CH BEAR MIA 9/8/2016 F 9907 CAPITOL VIEW DR AUSTIN TX 78747 M ASO CH EP1 Plan 2 A…