2016 Benefit Guide Aubrey ISD by Higginbotham Public Sector

AUBREY ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2016 - 8/31/2017 www.mybenefitshub.com/aubreyisd

Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. HSA vs FSA Comparison TRS-ActiveCare Aetna TRS Aetna and Scott & White Rate Sheet HSA Bank Health Savings Account NBS Flexible Spending Account Cigna Dental QCD Discount Dental Superior Vision Unum Disability Loyal American Cancer Loyal American Accident AUL a OneAmerica Company Term Life Axis Global AD&D Texas Life Permanent Life MDLIVE Telehealth

3 4-5 6-11 6 7 8 9 10 11 12-15 16-17 18-21 22-25 26-28 29 30-31 32-35 36-39 40-43 44-47 48-49 50-51 52-53

FLIP TO... PG. 4 HOW TO ENROLL

PG. 6 YOUR BENEFIT UPDATES: WHATâ&#x20AC;&#x2122;S NEW

PG. 12 YOUR MEDICAL BENEFITS

Benefit Contact Information

Benefit Contact Information BENEFIT ADMINISTRATORS

VISION

HEALTH SAVINGS ACCOUNTS (HSA’S)

Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/aubreyisd

Superior Vision (866) 265-0517 www.superiorvision.com

HSA Bank

AUBREY ISD ADMINISTRATOR

DISABILITY

FLEXIBLE SPENDING ACCOUNTS (FSA’S)

Betty Henderson (940) 668-0063 bhenderson@aubreyisd.net

Unum (800) 583-6908 www.unum.com Unum Claims (800) 858-6843

National Benefit Services (800) 274-0503 opt 4 www.nbsbenefits.com

TRS ACTIVECARE MEDICAL

CANCER

COBRA (Dental, Vision & Medical FSA Card)

Aetna (800) 222-9205 www.trsactivecareaetna.com

Loyal American (800) 366.8354 www.loyalamerican.com

National Benefit Services (800) 274-0503 www.nbsbenefits.com

TRS HMO MEDICAL

VOLUNTARY LIFE

COBRA (Medical)

Scott and White (800) 321-7947 www.trs.swhp.org

AUL a OneAmerica Company (800) 537-6442 www.oneamerica.com

WellSystems (844) 752-5146

PPO DENTAL

AD&D

TELEHEALTH

Dental Select (800) 999-9789 www.dentalselect.com

Axis Global (800) 583-6908 www.axisaccidentalhealth.com

MDlive (888) 365-1663 www.consultmdlive.com

DISCOUNT DENTAL

PERMANENT LIFE

QCD (800) 229-0304 www.qcdofamerica.com

Texas Life (800) 283-9233 www.texaslife.com

(800) 357-6246 www.hsabank.com

How to Enroll On Your Device Enrolling in your benefits just got a lot easier! Text “aubreyisd” to 313131 to receive everything you

TEXT

need to complete your enrollment.

“aubreyisd” Avoid typing long URLs and scan

directly to your benefits website,

313131

to access plan information, benefit guide, benefit videos, and more!

TRY ME

SCAN:

On Your Computer Access THEbenefitsHUB from your

Our online benefit enrollment

computer, tablet or smartphone!

platform provides a simple and easy to navigate process. Enroll at your own pace, whether at home or at work. www.mybenefitshub.com/ aubreyisd delivers important benefit information with 24/7 access, as well as detailed plan information, rates and product videos.

! 4

Open Enrollment Tip For your User ID: If you have less than six (6) characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.

Go to:

Click Login

Enter Username & Password

www.mybenefitshub.com/aubreyisd

All login credentials have been RESET to the default described below:

Username:

Sample Username

lincola1234 Sample Password

The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.

lincoln1234

If you have six (6) or less characters in your last name,

If you have trouble

use your full last name, followed by the first letter of

logging in, click on the

your first name, followed by the last four (4) digits of

“Login Help Video”

your Social Security Number.

for assistance.

Default Password: Last Name* (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.

Click on “Enrollment Instructions” for more information about how to enroll. 5

Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New:  Financial Benefit Services (FBS) is the Third Party

Administrator for Aubrey ISD. FBS will conduct the annual enrollment and provide benefit support for Aubrey ISD employees.  The Benefit elections will become effective 9/1/2016.

Elections requiring evidence of insurability, such as Life Insurance, may have a later effective date, if approved. After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 31 days of event).

 If you currently participate in a Health Care or

Dependent Care FSA, you MUST re-elect a new contribution amount every year to continue to participate. This benefit does not roll over. The 2016 FSA contribution limit is $2,550. If you are electing this benefit for the first time, you will receive your debit card by the end of September. You can manually submit claims prior to receiving your cards.

 UPDATE! Aetna remains the carrier for Medical Plans:

ActiveCare 1 HD,ActiveCare 2 and ActiveCare Select. All eligible employees, including active, contributing TRS members and employees regularly working 10 hours per week MUST either enroll for coverage or decline coverage in the Benefits HUB per ACA Mandates. For comprehensive TRS medical information, visit the website, www.trsactivecareaetna.com.  A Health Savings Account with HSA Bank is a tax-free

savings account available to those employees enrolled in ActiveCare 1 HD. These funds can be used to pay for medical, dental or vision expenses. The HSA annual contribution maximum is $3,350 for individuals and $6,750 for your family. For individuals who are between 55-65, there is an additional catch-up provision of $1,000 that can be contributed annually.

Don’t Forget!  Login and complete your benefit enrollment on 07/25/2016 - 08/22/2016  On-site enrollment assistance will be available on August 17th.  Add dependents to the system—please bring dependent Social Security numbers and date of birth. 6

SUMMARY PAGES

Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

CHANGES IN STATUS (CIS): Marital Status

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

QUALIFYING EVENTS A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).

A change in number of dependents includes the following: birth, adoption and placement for adoption. Change in Number of Tax You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a Dependents result of a valid change in status event. Change in Status of Employment Affecting Coverage Eligibility

Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.

An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements Gain/Loss of Dependents' under an employer's plan may include change in age, student, marital, employment or tax dependent Eligibility Status status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Eligibility for Government Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Programs

SUMMARY PAGES

Annual Enrollment During your annual enrollment period, you have the opportunity

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your benefit

Changes are not permitted during the plan year (outside of

website:

annual enrollment) unless a Section 125 qualifying event occurs.

www.mybenefitshub.com/aubreyisd. Click on the benefit plan you need information on (i.e., Dental) and you can find the



Changes, additions or drops may be made only during the

forms you need under the Benefits and Forms section.

annual enrollment period without a qualifying event. How can I find a Network Provider?

 Employees must review their personal information and verify that dependents they wish to provide coverage for are

benefit website: www.mybenefitshub.com/aubreyisd. Click on

included in the dependent profile. Additionally, you must

the benefit plan you need information on (i.e., Dental) and

notify your employer of any discrepancy in personal and/or

you can find provider search links under the Quick Links

benefit information.



For benefit summaries and claim forms, go to the Aubrey ISD

Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.

section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and

New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.

verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card.

SUMMARY PAGES

your 2016 benefits become effective on September 1, 2016, you

Employee Eligibility Requirements

must be actively-at-work on September 1, 2016 to be eligible for your new benefits.

Medical Plans. Employees must work 20 regularly scheduled

Dependent Eligibility Requirements

hours each week for all supplemental benefits..

Dependent Eligibility: You can cover eligible dependent

Medical and Supplemental Benefits: Eligible employees must work 10 or more regularly scheduled hours each week for TRS

children under a benefit that offers dependent coverage, Eligible employees must be actively at work on the plan effective

provided you participate in the same benefit, through the

date for new benefits to be effective, meaning you are physically

maximum age listed below. Dependents cannot be double

capable of performing the functions of your job on the first day

covered by married spouses within the Aubrey ISD or as both

of work concurrent with the plan effective date. For example, if

employees and dependents.

PLAN

CARRIER

MAXIMUM AGE

Accident

Loyal American

Cancer

Loyal American

19 (25 if Full-Time Student)

Dental

Dental Select

Discount Dental

QCD

Flexible Spending Accounts

National Benefit Services

26 (benefits terminate at the end of the plan year following the birthday)

Health Savings Accounts

HSA Bank

26 (benefits terminate at the end of the plan year following the birthday)

Individual Life

Texas Life

Medical

Aetna

Vision

Superior Vision

Voluntary Life

Dearborn National

If your dependent is disabled, coverage can continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physicianâ&#x20AC;&#x2122;s statement confirming your dependentâ&#x20AC;&#x2122;s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 9

SUMMARY PAGES

Helpful Definitions Actively at Work

In-Network

You are performing your regular occupation for the employer

Doctors, hospitals, optometrists, dentists and other providers

on a full-time basis, either at one of the employer’s usual

who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2016 please notify your benefits administrator.

Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.

Annual Deductible The amount you pay each plan year before the plan begins to pay covered expenses.

Out of Pocket Maximum The most an eligible or insured person can pay in co-insurance for covered expenses.

Plan Year September 1st through August 31st

Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services

Calendar Year January 1st through December 31st

Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.

Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.

(including diagnostic and/or consultation services).

SUMMARY PAGES

HSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223)

Flexible Spending Account (FSA) (IRC Sec. 125)

Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.

Allows employees to pay out-of-pocket expenses for copays, deductibles and certain services not covered by medical plan, tax-free. This also allows employees to pay for qualifying dependent care taxfree.

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source Account Owner Underlying Insurance Requirement

Employee and/or employer Individual

Employee and/or employer Employer

High deductible health plan

None

Description

Minimum Deductible Maximum Contribution

Permissible Use Of Funds Cash-Outs of Unused Amounts (if no medical expenses)

$1,300 single (2016) $2,600 family (2016) $3,350 single (2016) $6,750 family (2016) If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.

N/A Varies per employer Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).

Permitted, but subject to current tax rate plus Not permitted 20% penalty (penalty waived after age 65).

Year-to-year rollover of account balance?

Yes, will roll over to use for subsequent year’s health coverage.

No. Access to some funds can may be extended if your employer’s plan contains a 2 1/2 –month grace period or $500 rollover provision.

Does the account earn interest?

Yes

Portable?

Yes, portable year-to-year and between jobs.

FLIP TO… PG. 18

FLIP TO… PG. 22

FOR HSA INFORMATION

FOR FSA INFORMATION

TRS Aetna

Medical

YOUR BENEFITS PACKAGE

About this Benefit Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.

DID YOU KNOW?

More than 70% of adults across the United States are already being diagnosed with a chronic disease.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Aubrey ISD Benefits Website: www.mybenefitshub.com/aubreyisd 12

2016-2017 TRS-ActiveCare Plan Highlights Effective September 1, 2016 through August 31, 2017 | In-Network Level of Benefits* Type of Service

ActiveCare 1-HD

ActiveCare Select or ActiveCare Select Whole Health

ActiveCare 2

(Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Memorial Hermann Accountable Care Network; Seton Health Alliance) Deductible (per plan year)

$2,500 employee only $5,000 family

$1,200 individual $3,600 family

$1,000 individual $3,000 family

Out-of-Pocket Maximum (per plan year; does include medical deductible/ any medical copays/coinsurance/ any prescription drug deductible and applicable copays/coinsurance)

$6,550 individual $13,100 family (the individual out-of-pocket maximum only includes covered expenses incurred by that individual)

$6,850 individual $13,700 family

Coinsurance Plan pays (up to allowable amount) Participant pays (after deductible)

80% 20%

Office Visit Copay Participant pays

20% after deductible

$30 copay for primary $60 copay for specialist

$30 copay for primary $50 copay for specialist

Diagnostic Lab Participant pays

20% after deductible

Plan pays 100% (deductible waived) if performed at a Quest facility; 20% after deductible at other facility

Preventive Care See next page for a list of services

Plan pays 100%

Teladoc® Physician Services

$40 consultation fee (applies to deductible and out-of-pocket maximum)

Plan pays 100%

High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays

20% after deductible

$100 copay plus 20% after deductible

Inpatient Hospital (preauthorization required) (facility charges) Participant pays

20% after deductible

$150 copay per day plus 20% after deductible ($750 maximum copay per admission)

$150 copay per day plus 20% after deductible($750 maximum copay per admission; $2,250 maximum copay per plan year)

Emergency Room (true emergency use) Participant pays

20% after deductible

$150 copay plus 20% after deductible (copay waived if admitted)

Outpatient Surgery Participant pays

20% after deductible

$150 copay per visit plus 20% after deductible

Bariatric Surgery Physician charges (only covered if performed at an IOQ facility) Participant pays

$5,000 copay plus 20% after deductible

Not covered

$5,000 copay (does not apply to out -of-pocket maximum) plus 20% after deductible

Prescription Drugs Drug deductible (per plan year)

Subject to plan year deductible

$0 for generic drugs $200 per person for brand-name drugs

Retail Short-Term (up to a 31-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)

20% after deductible $20 $40** 50% coinsurance**

$20 $40** $65**

Retail Maintenance (after first fill; up to a 31-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)

20% after deductible $35 $60** 50% coinsurance**

$35 $60** $90**

Mail Order and Retail-Plus (up to a 90-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)

20% after deductible $45 $105*** 50% coinsurance

$45 $105*** $180***

Specialty Drugs Participant pays

20% after deductible

20% coinsurance per fill

$200 per fill (up to 31-day supply) $450 per fill (32- to 90-day supply)

A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. **If the patient obtains a brand-name drug when a generic equivalent is available, the patient will be responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug.

2016-2017 TRS-ActiveCare Plan Highlights Effective September 1, 2016 through August 31, 2017 | In-Network Level of Benefits* TRS-ActiveCare Plans—Preventive Care Network Benefits When Using In-Network Providers

(Provider must bill services as “preventive care”)

Preventive Care Services

ActiveCare 1-HD

ActiveCare Select or ActiveCare Select Whole Health

ActiveCare 2 Network

(Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Memorial Hermann Accountable Care Network; Seton Health Alliance) Evidence−based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (USPSTF) www. uspreventiveservicestaskforce.org/Page/Name/uspstf-a-andbrecommendations. Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved. Evidence−informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children and adolescents. Additional preventive care and screenings for women, not described above, as provided for in comprehensive guidelines supported by the HRSA www.hhs.gov/healthcare/factsand- features/fact-sheets/ preventive-services-covered-underaca/ index.html#CoveredPreventiveServicesforAdults. For purposes of this benefit, the current recommendations of the USPSTF regarding breast cancer screening and mammography and prevention will be considered the most current (other than those issued in or around November 2009). The preventive care services described above may change as USPSTF, CDC and HRSA guidelines are modified. (Examples of covered services included are: Routine annual physicals (one per year); immunizations; well-child care; breastfeeding support, services and supplies; cancer screening mammograms; bone density test; screening for prostate cancer and colorectal cancer (including routine colonoscopies); smoking cessation counseling services and healthy diet counseling; and obesity screening/counseling.

Plan pays 100% (deductible waived)

Plan pays 100% (deductible waived; no copay required)

Some examples of preventive care frequency and services:  Routine physicals – annually age 12 and over  Well-child care – unlimited up to age 12  Well woman exam & pap smear – annually age 18 and over  Mammograms – 1 every year age 35 and over  Colonoscopy – 1 every 10 years age 50 and over  Prostate cancer screening – 1 per year age 50 and over  Smoking cessation counseling – 8 visits per 12 months  Healthy diet/obesity counseling – unlimited to age 22; age 22 and over-26 visits per 12 months  Breastfeeding support – 6 lactation counseling visits per 12 months

Some examples of preventive care frequency and services:  Routine physicals – annually age 12 and over  Well-child care – unlimited up to age 12  Well woman exam & pap smear – annually age 18 and over  Mammograms – 1 every year age 35 and over  Colonoscopy – 1 every 10 years age 50 and over  Prostate cancer screening – 1 per year age 50 and over  Smoking cessation counseling – 8 visits per 12 months  Healthy diet/obesity counseling –unlimited to age 22; age 22 and over-26 visits per 12 months  Breastfeeding support – 6 lactation counseling visits per 12 months

Some examples of preventive care frequency and services:  Routine physicals – annually age 12 and over  Well-child care – unlimited up to age 12  Well woman exam & pap smear – annually age 18 and over  Mammograms – 1 every year age 35 and over  Colonoscopy – 1 every 10 years age 50 and over  Prostate cancer screening –1 per year age 50 and over  Smoking cessation counseling –8 visits per 12 months  Healthy diet/obesity counseling – unlimited to age 22; age 22 and over-26 visits per 12 months  Breastfeeding support –6 lactation counseling visits per 12 months

Examples of covered services for women with reproductive capacity are: Female sterilization procedures and specified FDA-approved contraception methods with a written prescription by a health care practitioner, including cervical caps, diaphragms, implantable contraceptives, intra-uterine devices, injectables, transdermal contraceptives and vaginal contraceptive devices. Prescription contraceptives for women are covered under the pharmacy benefits administered by Caremark. To determine if a specific contraceptive drug or device is included in this benefit, contact Customer Service at 1-800222-9205. The list may change as FDA guidelines are modified. Annual Vision Examination (one per plan year; performed by an opthalmologist or optometrist using calibrated instruments) Participant pays

After deductible, plan pays 80%; $60 copay for specialist participant pays 20%

$50 copay for specialist

Annual Hearing Examination Participant pays

After deductible, plan pays 80%; participant pays 20%

$30 copay for primary $50 copay for specialist

$30 copay for primary $60 copay for specialist

Note: Covered services under this benefit must be billed by the provider as “preventive care.” If you receive preventive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the ActiveCare 1-HD and ActiveCare 2. Non-network preventive care is not paid at 100%. There is no coverage for non-network services under the ActiveCare Select plan or ActiveCare Select Whole Health. TRS-ActiveCare is administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug 14benefits are administered by Caremark.

Aubrey ISD 2016 - 2017 TRS Medical Rates TRS-ActiveCare Plan 1HD

TRS Monthly Premium

Aubrey ISD Contribution

2016-2017 TRS Employee Premium

Employee Only

$341.00

$304.00

$37.00

Employee & Spouse

$914.00

$304.00

$610.00

Employee & Child(ren)

$615.00

$304.00

$311.00

Employee & Family

$1,231.00

$304.00

$927.00

Deductible: Employee Only $2500 & Employee Family $5000 Max Out of Pocket: Employee Only $6550 & Employee Family $13,100

TRS-ActiveCare SelectExclusive Provider Organization

TRS Monthly Premium

Aubrey ISD Contribution

2016-2017 TRS Employee Premium

Employee Only

$484.00

$304.00

$180.00

Employee & Spouse

$1,147.00

$304.00

$843.00

Employee & Child(ren)

$779.00

$304.00

$475.00

Employee & Family

$1,361.00

$304.00

$1,057.00

Deductible: Employee Only $1200 Ded & Employee Family $3600 Ded Max Out of Pocket: Employee Only $6850 & Employee Family $13,700

TRS-TRS-ActiveCare 2

TRS Monthly Premium

Aubrey ISD Contribution

2016-2017 TRS Employee Premium

Employee Only

$645.00

$304.00

$341.00

Employee & Spouse

$1,552.00

$304.00

$1,248.00

Employee & Child(ren)

$1,042.00

$304.00

$738.00

Employee & Family

$1,597.00

$304.00

$1,293.00

Deductible: Employee Only $1200 & Employee Family $3000 Max Out of Pocket: Employee Only $6850 & Employee Family $13,700

Scott and White HMO

TRS Monthly Premium

Aubrey ISD Contribution

2016-2017 TRS Employee Premium

Employee Only

$503.60

$304.00

$199.60

Employee & Spouse

$1,135.62

$304.00

$831.62

Employee & Child(ren)

$798.30

$304.00

$494.30

Employee & Family

$1,259.76

$304.00

$955.76

Deductible: Employee Only $1000 Ded & Employee Family $3000 Max Out of Pocket: Employee Only $5000 & Employee Family $10,000

2016-2017 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Fully Covered Health Care Services

Copay

Preventive Services

No Charge

Standard Lab and X-ray

No Charge

Disease Management and Complex Case Management

No Charge

Well Child Care Annual Exams

No Charge

Immunizations (age appropriate)

No Charge

Plan Provisions

Copay

Annual Deductible

$1,000 Individual/ $3,000 Family

Annual out-of-pocket maximum (including medical and prescription co-pays and coinsurance)

Lifetime Paid Benefit Maximum

Outpatient Services

$5,000 Individual/ $10,000 Family (includes combined Medical and RX copays, deductibles and coinsurance)

None

Copay $20 co-pay

Primary Care1

(First Primary Care Visit for Illness $0 Copay2)

Specialty Care

$50 co-pay

Other Outpatient Services

20% after deductible3

Diagnostic/Radiology Procedures

20% after deductible

Eye Exam (one annually) Allergy Serum & Injections

No Charge 20% after deductible

Outpatient Surgery

$150 co-pay and 20% of charges after deductible

Maternity Care

Copay

Prenatal Care

No Charge $150 per day4 and 20% of charges after deductible

Inpatient Delivery

Inpatient Services

Copay

Overnight hospital stay: includes all medical services including semi -private room or intensive care

Diagnostic & Therapeutic Services Physical and Speech Therapy 5

Manipulative Therapy

Equipment and Supplies

$150 per day4 and 20% of charges after deductible

Copay $50 copay 20% without office visit $40 plus 20% with office visit

Copay

Preferred Diabetic Supplies and Equipment

$3 copay; no deductible

Non-Preferred Diabetic Supplies and Equipment

30% after Rx deductible

Durable Medical Equipment/ Prosthetics

20% after deductible

2016-2017 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Home Health Services

Copay

Home Health Care Visit

$50 co-pay

Worldwide Emergency Care

Copay

Nurse Advice Line

1-877-505-7947

Online Services

No Charge â&#x20AC;&#x201D; go to www.trs.swhp.org

After Hours Primary Care Clinics

$20 co-pay

Ambulance and Helicopter

$40 copay and 20% of charges after deductible

Emergency Room6

$150 copay and 20% of charges after deductible

Urgent Care Facility

$55 copay

Prescription Drugs

Copay

Annual Benefit Maximum

Unlimited

Rx Deductible

$100

Does not apply to preferred generic drugs

Ask an SWHP Pharmacy representative how to save money on your prescriptions.

Maintenance Quantity

Retail Quantity (Up to a 30-day supply)

BSWH Pharmacies Only (Up to a 90-day supply)

$3 copay

$6 copay

Preferred Brand

30% after Rx deductible

Non-preferred

50% after Rx deductible

Non-formulary

Greater of $50 or 50% after deductible

Not available

Preferred Generic7

Mail Order

Specialty Medications (Up to a 30-day supply)

1-800-707-3477

Copay 20% after Rx deductible

Including all services billed with office visit Does not apply to wellness or preventive visits 3 Includes other services, treatments, or procedures received at time of office visit 4 $750 maximum copay per admission and 20% after deductible 5 5 visits max per month, 35 max visit per year 6 Copay waived if admitted within 24 hours 7 If a brand name drug is dispensed when a generic is available, 50% copay applies 2

HSA BANK

HSA (Health Savings Account)

YOUR BENEFITS PACKAGE

About this Benefit A Health Savings Account is a tax-advantaged medical savings account available to employees who are enrolled in a high-deductible health plan. The funds contributed to the account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent.

DID YOU KNOW? The interest earned in an HSA is tax free.

Money withdrawn for medical spending never falls under taxable income.

HSA (Health Savings Account) HSA Bank has teamed up with your employer to create an  Not enrolled in Medicare (if an accountholder enrolls in affordable health coverage option that helps you save on Medicare mid-year, catch contributions should be prorated) healthcare expenses. This plan is only available for those who are Authorized Signers who are 55 or older must have their own participating in the Active Care 1-HD medical plan. You may not HSA in order to make the catch-up contribution enroll in the MEDlink® plan if you participate in the HSA. Depending on your district, you may or may not be able to Monthly Fee: Your account will be charged a monthly fee of participate in the FSA plan if you participate in HSA. Medicare, $1.75, waived with an average daily balance at or above Medicaid, and Tricare participants are not eligible to participate $3,000. in an HSA. You can use your Health Savings Account (HSA) to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.

What is an HSA? 

 

A tax-advantaged savings account that you use to pay for eligible medical expenses as well as deductible, co-insurance, prescriptions, vision and dental care. Allows you to save while reducing your taxable income. Unused funds that will roll over year to year. There’s no “use it or lose it” penalty. A way to accumulate additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty.

Examples of Qualified Medical Expenses      

Surgery Braces Contact lenses Dentures Eyeglasses Vaccines

For a list of sample expenses, please refer to the Aubrey ISD website at www.mybenefitshub.com/aubreyisd

HSA Bank Contact Information 605 N. 8th Street, Ste 320 Sheboygan, WI 53081 Phone: 800-357-6246 www.hsabank.com

Using Funds Debit Card  You may use the card to pay merchants or service providers that accept VISA credit cards, so there is no need to pay cash up front and wait for reimbursements.  You can make a withdrawal at any time. Reimbursements for qualified medical expenses are tax free. If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distributions as taxable income. You may also use your funds for a spouse or tax dependent not covered by your HDHP.

2016 Annual HSA Contribution Limits Individual: $3,350 Family: $6,750 Catch-Up Contributions: Accountholders who meet the qualifications noted below are eligible to make an HSA catch-up contribution of an additional $1,000.  Health Savings accountholder  Age 55 or older (regardless of when in the year an accountholder turns 55)

How the HSA Plan Works A Health Savings Account (HSA) is an individually-owned, taxadvantaged account that you can use to pay for current or future IRS-qualified medical expenses. With an HSA, you’ll have the potential to build more savings for healthcare expenses or additional retirement savings through selfdirected investment options1.

How an HSA works:



 

You can contribute to your HSA via payroll deduction, online banking transfer, or by sending a personal check to HSA Bank. Your employer or third parties, such as a spouse or parent, may contribute to your account as well. You can pay for qualified medical expenses with your HSA Bank Debit Card directly to your medical provider or pay out-of-pocket. You can either choose to reimburse yourself or keep the funds in your HSA to grow your savings. Unused funds will roll over year to year. After age 65, funds can be withdrawn for any purpose without penalty (subject to ordinary income taxes). Check balances and account information via HSA Bank’s Internet Banking 24/7.

Are you eligible for an HSA? If you have a qualified High Deductible Health Plan (HDHP) either through your employer, through your spouse, or one you’ve purchased on your own - chances are you can open an HSA. Additionally:  You cannot be covered by any other non-HSA-compatible health plan, including Medicare Parts A and B.  You cannot be covered by TriCare.  You cannot have accessed your VA medical benefits in the past 90 days (to contribute to an HSA).  You cannot be claimed as a dependent on another person’s tax return (unless it’s your spouse).  You must be covered by the qualified HDHP on the first day of the month. When you open an account, HSA Bank will request certain information to verify your identity and to process your application.

What are the annual IRS contribution limits? Contributions made by all parties to an HSA cannot exceed the annual HSA limit set by the Internal Revenue Service (IRS). Anyone can contribute to your HSA, but only the accountholder and employer can receive tax deductions on those contributions. Combined annual contributions for the accountholder, employer, and third parties (i.e., parent, spouse, or anyone else) must not exceed these limits2.

2016 Annual HSA Contribution Limits Individual = $3,350 Family = $6,750

Catch-up Contributions Accountholders who meet these qualifications are eligible to make an HSA catch-up contribution of $1,000: Health Savings accountholder; age 55 or older (regardless of when in the year an accountholder turns 55); not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated). Authorized signers who are 55 or older must have their own HSA in order to make the catchup contribution. According to IRS guidelines, each year you have until the tax filing deadline to contribute to your HSA (typically April 15 of the following year). Online contributions must be submitted by 2:00 p.m., Central Time, the business day before the tax filing deadline. Wire contributions must be received by noon, Central Time, on the tax filing deadline, and contribution forms with checks must be received by the tax filing deadline.

How can you benefit from tax savings? An HSA provides triple tax savings3. Here’s how:  Contributions to your HSA can be made with pre-tax dollars and any after-tax contributions that you make to your HSA are tax deductible.  HSA funds earn interest and investment earnings are tax free.  When used for IRS-qualified medical expenses, distributions are free from tax.

IRS-Qualified Medical Expenses You can use your HSA to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse, or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always taxfree. HSA funds can be used to reimburse yourself for past medical expenses if the expense was incurred after your HSA was established. While you do not need to submit any receipts to HSA Bank, you must save your bills and receipts for tax purposes.

How the HSA Plan Works Examples of IRS-Qualified Medical Expenses4: Acupuncture Alcoholism treatment Ambulance services Annual physical examination Artificial limb or prosthesis Birth control pills (by prescription) Chiropractor Childbirth/delivery Convalescent home (for medical treatment only) Crutches Doctor’s fees Dental treatments (including x-rays, braces, dentures, fillings, oral surgery) Dermatologist Diagnostic services Disabled dependent care Drug addiction therapy Fertility enhancement (including in-vitro fertilization) Guide dog (or other service animal)

Gynecologist Hearing aids and batteries Hospital bills Insurance premiums5 Laboratory fees Lactation expenses Lodging (away from home for outpatient care) Nursing home Nursing services Obstetrician Osteopath Oxygen Pregnancy test kit Podiatrist Prescription drugs and medicines (over-the-counter drugs are not IRSqualified medical expenses unless prescribed by a doctor) Prenatal care & postnatal treatments Psychiatrist Psychologist Smoking cessation programs

Special education tutoring Surgery Telephone or TV equipment to assist the hearing or vision impaired Therapy or counseling Medical transportation expenses Transplants Vaccines Vasectomy Vision care (including eyeglasses, contact lenses, lasik surgery) Weight loss programs (for a specific disease diagnosed by a physician – such as obesity, hypertension, or heart disease) Wheelchairs X-rays

For assistance, please contact the Client Assistance Center 800-357-6246 Monday – Friday, 7 a.m. – 9 p.m., and Saturday, 9 a.m. - 1 p.m., CT www.hsabank.com | 605 N. 8th Street, Ste. 320, Sheboygan, WI 53081

1 Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank. Investment losses which are replaced are subject to the annual contribution limits of the HSA. 2 HSA funds contributed in excess of these limits are subject to penalty and tax unless the excess and earnings are withdrawn prior to the due date, including any extensions for filing Federal Tax returns. Accountholders should consult with a qualified tax advisor in connection with excess contribution removal. The Internal Revenue Service requires HSA Bank to report withdrawals that are considered refunds of excess contributions. In order for the withdrawal to be accurately reported, accountholders may not withdraw the excess directly. Instead, an excess contribution refund must be requested from HSA Bank and an Excess Contribution Removal Form completed. 3 Federal Tax savings are available no matter where you live and HSAs are taxable in AL, CA, and NJ. HSA Bank does not provide tax advice. Consult your tax professional for tax‐related questions. 4 This list is not comprehensive. It is provided to you with the understanding that HSA Bank is not engaged in rendering tax advice. The information provided is not intended to be used to avoid Federal tax penalties. For more detailed information, please refer to IRS Publication 502 titled, “Medical and Dental Expenses”. Publications can be ordered directly from the IRS by calling 1-800-TAXFORM. If tax advice is required, you should seek the services of a professional. 5 Insurance premiums only qualify as an IRS-qualified medical expense: while continuing coverage under COBRA; for qualified long-term care coverage; coverage while receiving unemployment compensation; for any healthcare coverage for those over age 65 including Medicare (except Medicare supplemental coverage).

NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

About this Benefit A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a pre-established amount of money per plan year in a Healthcare Flexible Spending Account (FSA). Funds allocated to a healthcare FSA must be used during the plan year or are forfeited unless your plan contains a $500 rollover or grace period provision.

Unlimited FSA (Non HSA Compatible) The funds in the unlimited healthcare FSA can be used to pay for eligible medical expenses like deductibles, co-payments, orthodontics, glasses and contacts.

FSA (Flexible Spending Account) NBS Flexcard

When Will I Receive My Flex Card?

You may use the card to pay merchants or service providers that accept MasterCard® credit cards, so there is no need to pay cash up front, then wait for reimbursement. If you are participating in the Dependent Care portion, the money isn’t loaded to the card. You must file web or paper claims or enroll in continual reimbursement.

NBS Prepaid MasterCard® Debit Card

Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years. If you throw away your cards, there is a $5.00 fee to replace them.

Expect Flex Cards to be delivered to the address listed in THEbenefitsHUB near the end of September. Don’t forget, Flex Cards Are Good For 3 Years! For a list of sample expenses, please refer to the Aubrey ISD benefit website: www.mybenefitshub.com/aubreyisd

NBS Contact Information: 8523 South Redwood Road West Jordan, UT 84088 Phone (800) 274‐0503 Fax (800) 478‐1528 Email: claims@nbsbenefits.com

New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in unmarked envelopes so please watch for them as they should arrive within 21 business days of effective date. NBS debit cards are good for 3 years.

FSA Annual Contribution Max:

DID YOU KNOW? FSAs use tax-free funds to help pay for your Health Care Expenses.

$2,550

Dependent Care Annual Max: $5,000

Account Information: Participant Account Web Access: www.participant.nbsbenefits.com Participants may call NBS and talk to a representative during regular business hours, Monday-Friday, 8 am to 7 pm Central Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to the NBS website: www.NBSbenefits.com    

Detailed claim history and processing status Health Care and Dependent Care account balances Claim forms, Direct Deposit form, worksheets, etc. Online claim FAQs

FSA Frequently Asked Questions What is a Flexible Spending Account? A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend.

How does a Flexible Spending Account Benefit Me? A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. You may save as much as 35 percent on the cost of each benefit option! Eligible expenses must be incurred within the plan year and contributions are use-it-or- lose-it. Remember to retain all your receipts.

Health Care Expense Account Example Expenses:          

Acupuncture Body scans Breast pumps Chiropractor Co-payments Deductible Diabetes Maintenance Eye Exam & Glasses Fertility treatment First aid

        

Hearing aids & batteries Lab fees Laser Surgery Orthodontia Expenses Physical exams Pregnancy tests Prescription drugs Vaccinations Vaporizers or humidifiers

Dependent Care Expense Account Example Expenses:    

Before and After School and/or Extended Day Programs The actual care of the dependent in your home. Preschool tuition. The base costs for day camps or similar programs used as care for a qualifying individual.

What Can I Use My Flexible Spending Account On? For a full list of eligible expenses, please refer to www.mybenefitshub.com/aubreyisd

What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? Eligible expenses must be incurred within the plan year +75 day grace period. Contributions are use-it-or- lose-it. Remember to retain all your receipts (including receipts for card swipes).

How Do I File A Claim? In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to receive one, you can visit www.mybenefitshub.com/aubreyisd and complete the “Claim Form” to send to NBS or use the web or phone app to file online.

How To Receive Your Dependent Care Reimbursement Faster. A Direct Deposit form is available on the Benefits Website which will help you get reimbursed quicker!

How the FSA Plan Works You designate an annual election of pre-tax dollars to be deposited into your health and dependent-care spending accounts. Your total election is divided by the number of pay periods in the Plan year and deducted equally from each paycheck before taxes are calculated. By the end of the Plan year, your total election will be fully deposited. However, you may make a claim for eligible health FSA expenses as soon as they are incurred during the Plan year. Eligible claims will be paid up to your total annual election even if you have not yet contributed that amount to your account.

Get Your Money 1. 2. 3. 4.

Complete and sign a claim form (available on our website) or an online claim. Attach documentation; such as an itemized bill or an Explanation of Benefits (EOB) statement from a health insurance provider. Fax or mail signed form and documentation to NBS. Receive your non-taxable reimbursement after your claim is processed either by check or direct deposit.

NBS Flexcard—FSA Pre-paid Benefit Card Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.

Account Information Participants may call NBS and talk to a representative during our regular business hours, Monday–Friday, 7am to 6pm Mountain Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to our website: www.NBSbenefits.com Information includes:  Detailed claim history and processing status  Health Care and Dependent Care account balances  Claim forms, worksheets, etc.  Online Claim Submission

Enrollment Considerations After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year. Your employer may allow a short grace period after the Plan year ends for you to submit qualified claims for any unused funds.

DENTAL SELECT

QCD

Dental

Discount Dental

YOUR BENEFITS PACKAGE

About this Benefit Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, treatment and dental disease.

DID YOU KNOW?

Good dental care may improve your overall health. Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.

Dental Select Employee

Employee + 1

Employee + Family

$36.68

$68.69

$115.00

Indemnity Classic Plan - Max Plan Platinum Network

PREVENTIVE Routine exams, cleanings (2 per year), topical fluoride, x-rays

Contracted Dentist

Non-Contracted Dentist

100%

100% of R&C

BASIC Composite fillings, extractions, oral surgery, sealants, space maintainers

80%

80% of R&C No Waiting Period

MAJOR Crowns, bridges, dentures, endodontics, periodontics

50%

50% of R&C 12 Month Waiting Period

ORTHODONTICS Children under 19

50%

50% 12 Month Waiting Period

Waiting Period Lifetime Maximum

$1000.00

20% Discount

No Discount

MAXIMUM BENEFIT Applies to Preventative , Basic and Major Services

Benefit Period is: $1000.00

Per Calendar Year

DEDUCTIBLE Applies to Basic and Major Services

Per Benefit Period Per Person Family Maximum

$50.00 $150.00

SPECIALISTS

Endodontists, Oral Surgeons, Pediatric, Periodontists, Prosthodontists

Contracted Specialist payment: 1) You receive a 20% discount off the Specialist fee 2) Plan pays according to the Reasonable and Customary fees 3) Member pays the difference between plan payment and discounted Specialist fee Non-contracted Specialist payment: Paid the same as non-contracted dentists

Dental Select Notes Network Access

Max Rewards™

For every consecutive year on the plan, each member will receive increased maximums by the schedule outlined below. The annual maximum benefit of each member will never exceed $2,000. Year 2 - $100 Year 3 - $200 Specialists (Include Pediatric, Endodontist, Prosthodontist, Year 4 - $300 Oral Surgeon, Periodontist, Orthodontist*) Year 5 - $400 Coinsurance Plans *Contracted Orthodontist: The member may receive a discount This summary of benefits is current as of 09/01/2016. To verify of up to 20% off of the contracted Orthodontist’s fee. up to date benefits, please contact Dental Select Member Services (1-800-999-9789) or refer to your current Certificate of Contracted Specialists: The plan will pay based on a contracted Insurance. fee schedule. Contracted specialist providers accept the fee schedule as payment in full with no balance billing.

General Dentists

Dental Select participating general dentists accept the Platinum or Gold fee schedule as payment in full.

Non-Contracted Specialists: MAC- No discount - including Orthodontists. The plan will pay from our contracted fee schedule. The Member is responsible for the difference between the plan’s payment and the Specialist’s fee. UCR- No discount - including Orthodontists. The plan will pay based on Reasonable & Customary fees. The Member is responsible for the difference between the plan’s payment and the Specialist’s fee. Co-Pay Plans - See Schedule of co-payments for member responsibility

Minnesota Dental Select participating general dentists utilize the Premier network. Services rendered will be reimbursed according to the Premier network fee schedule as payment in full.

Plan Notes UCR CONTRACTED: General Dentists & Specialists: All payments made by the plan are based on the Platinum contracted fee schedule. NON-CONTRACTED: Dental Select will allow up to the reasonable and customary charge for the dental procedures and services after the required deductible amount, as shown. Charges above the plan payment are the member's responsibility. DISCOUNT: Discount only; no benefit will be paid.

QCD Discount Dental MONTHLY Employee Only

No Charge

Employee and One Dependent

$8.00

Employee and Entire Household

$12.00

No Claim Forms, Deductibles or Coverage Maximums Immediate Coverage for all Pre-Existing Conditions Orthodontics (Braces) for Children and Adults

SAMPLE DENTAL PROCEDURE

FEE PAID WITH QCD NATIONAL AVERAGE OF AMERICA DENTAL FEES2

SAVINGS WITH QCD OF AMERICA

Oral Exam

$35

74%

Full Mouth X-ray

$28

$77

64%

Teeth Cleaning

$24

$54

56%

Amalgam (1Surface)

$28

$79

65%

Simple Extraction

$36

$80

55%

Root Canal (1Canal)

$185

$387

55%

Porcelain w/ Metal Crown

$350

$652

46%

Complete Upper or Lower Denture

$400

$770

48%

1 2

A fee of $8.00 is charged per appointment for infection control costs. There will be an additional charge for all lab fees less a 20% discount. The schedule represents a sample of highly utilized dental procedures. The average costs are estimated from data gathered by the U.S. Bureau of Labor Statistics, the American Dental Association, and the American Chamber of Commerce Research Association.

    

After you sign and turn in your enrollment form, QCD will send you a membership card. Please select any dentist within the QCD Affiliated Dentist Team and make an appointment. Please be sure to identify yourself as a QCD member and the reduced fee schedule will apply to all charges. Please call the QCD Member Services Department at 972.726.0444 or 1.800.229.0304 for assistance. Information may be obtained from the website at www.qcdofamerica.com

SUPERIOR VISION YOUR BENEFITS PACKAGE

Vision

About this Benefit Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan.

DID YOU KNOW?

75% of U.S. residents between age 25 and 64 require some sort of vision correction.

Vision Benefits Exam (ophthalmologist) Frames Contact Lenses2 Medically Necessary Contact Lenses Lasik Vision Correction

In-Network

Out-of-Network

Covered in full

Up to $35 retail

EE Only

$7.83

$125 retail allowance

Up to $70 retail

EE + spouse

$13.27

$150 retail allowance

Up to $80 retail

EE + child(ren)

$14.05

EE + family

$21.01

Covered in full

Up to $150 retail

$200 allowance3

Lenses (standard) per pair Single Vision Bifocal Trifocal Progressive Lenticular

Covered in full Covered in full Covered in full See description 1 Covered in full

Monthly Premiums

Up to $25 retail Up to $40 retail Up to $45 retail Up to $45 retail Up to $80 retail

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements.

Co-Pays Exam

$10

Materials₁

$25

Services/Frequency Exam

12 months

Frame

12 months

Lenses

12 months

Contact Lenses

12 months

(Based on date of service)

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 2 Contact lenses and related professional services (fitting, evaluation and followup) are covered in lieu of eyeglass lenses and frames benefit 3 Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations

Discount Features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy

The Plan discount features are not insurance. All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan. Discounts are subject to change without notice. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions

UNUM YOUR BENEFITS PACKAGE

Long Term Disability

About this Benefit Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.

DID YOU KNOW?

Just over 1 in 4 of today's 20 year -olds will become disabled before they retire.

34.6 months is the duration of the average disability claim.

Long Term Disability Please read carefully the following description of your Unum Educator Select Income Protection Plan insurance.

Eligibility You are eligible for disability coverage if you are an active employee in the United States working a minimum of 18.75 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.

Guarantee Issue Current Employees: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may enroll on or before the enrollment deadline. After the initial enrollment period, you can apply only during an annual enrollment period. New Hires: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may apply for coverage within 60 days after your eligibility date. If you do not apply within 60 days after your eligibility date, you can apply only during an annual enrollment period. Benefits will not be paid for disabilities caused by, contributed to by, or resulting from a pre-existing condition. You have a pre-existing condition if: you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and the disability begins in the first 12 months after your effective date of coverage.

Benefit Amount You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $7,500. Please see your Plan Administrator for the definition of monthly earnings.

Elimination Period The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits. You may choose an Elimination Period (injury/sickness) of 0/7, 14/14, 30/30, 60/60, 90/90 or 180/180 days. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)

Benefit Duration Your duration of benefits is based on your age when the disability occurs. Plan: ADEA II: Your duration of benefits is based on the following table: Age at Disability Less than age 60 Age 60 through 64 Age 65 through 69 Age 70 and over

Maximum Duration of Benefits To age 65, but not less than 5 years 5 years To age 70, but not less than 1 year 1 year

Next Steps How to Apply/Effective Date of Coverage Current Employees: To apply for coverage, complete your enrollment form by the enrollment deadline. Your effective date of coverage is 9/01. New Hires: To apply for coverage, complete your enrollment form within 60 days of your eligibility date. Please see your Plan Administrator for your effective date. If you do not enroll during the initial enrollment period, you may apply only during an annual enrollment.

Delayed Effective Date of Coverage If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will not take effect until you return to active employment. Please contact your Plan Administrator after you return to active employment for when your coverage will begin.

Questions If you should have any questions about your coverage or how to enroll, please contact your Plan Administrator. This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Some provisions may vary or not be available in all states. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. For complete details of coverage, please refer to policy form number C.FP-1, et al. Underwritten by: Unum Life Insurance Company of America 2211 Congress Street, Portland, Maine 04122, www.unum.com ÂŠ2007 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Long Term Disability AUBREY INDEPENDENT SCHOOL DISTRICT Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year)

Product: Educator Select Income Protection Plan

Annual Earnings

Monthly Earnings

3600 5400 7200 9000 10800 12600 14400 16200 18000 19800 21600 23400 25200 27000 28800 30600 32400 34200 36000 37800 39600 41400 43200 45000 46800 48600 50400 52200 54000 55800 57600 59400 61200 63000 64800 66600 68400 70200 72000 73800 75600 77400 79200 81000 82800 84600 86400 88200 90000 91800 93600

300 450 600 750 900 1050 1200 1350 1500 1650 1800 1950 2100 2250 2400 2550 2700 2850 3000 3150 3300 3450 3600 3750 3900 4050 4200 4350 4500 4650 4800 4950 5100 5250 5400 5550 5700 5850 6000 6150 6300 6450 6600 6750 6900 7050 7200 7350 7500 7650 7800

Injury (Days) Sickness (Days) Maximum Monthly Benefit 200 300 400 500 600 700 800 900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400 2500 2600 2700 2800 2900 3000 3100 3200 3300 3400 3500 3600 3700 3800 3900 4000 4100 4200 4300 4400 4500 4600 4700 4800 4900 5000 5100 5200

14* 14*

5.88 8.82 11.76 14.70 17.64 20.58 23.52 26.46 29.40 32.34 35.28 38.22 41.16 44.10 47.04 49.98 52.92 55.86 58.80 61.74 64.68 67.62 70.56 73.50 76.44 79.38 82.32 85.26 88.20 91.14 94.08 97.02 99.96 102.90 105.84 108.78 111.72 114.66 117.60 120.54 123.48 126.42 129.36 132.30 135.24 138.18 141.12 144.06 147.00 149.94 152.88

30* 30*

Plan A ADEA II Duration of Benefits Elimination Period (Days) 60 60

90 90

180 180

5.08 7.62 10.16 12.70 15.24 17.78 20.32 22.86 25.40 27.94 30.48 33.02 35.56 38.10 40.64 43.18 45.72 48.26 50.80 53.34 55.88 58.42 60.96 63.50 66.04 68.58 71.12 73.66 76.20 78.74 81.28 83.82 86.36 88.90 91.44 93.98 96.52 99.06 101.60 104.14 106.68 109.22 111.76 114.30 116.84 119.38 121.92 124.46 127.00 129.54 132.08

4.08 6.12 8.16 10.20 12.24 14.28 16.32 18.36 20.40 22.44 24.48 26.52 28.56 30.60 32.64 34.68 36.72 38.76 40.80 42.84 44.88 46.92 48.96 51.00 53.04 55.08 57.12 59.16 61.20 63.24 65.28 67.32 69.36 71.40 73.44 75.48 77.52 79.56 81.60 83.64 85.68 87.72 89.76 91.80 93.84 95.88 97.92 99.96 102.00 104.04 106.08

2.30 3.45 4.60 5.75 6.90 8.05 9.20 10.35 11.50 12.65 13.80 14.95 16.10 17.25 18.40 19.55 20.70 21.85 23.00 24.15 25.30 26.45 27.60 28.75 29.90 31.05 32.20 33.35 34.50 35.65 36.80 37.95 39.10 40.25 41.40 42.55 43.70 44.85 46.00 47.15 48.30 49.45 50.60 51.75 52.90 54.05 55.20 56.35 57.50 58.65 59.80

1.62 2.43 3.24 4.05 4.86 5.67 6.48 7.29 8.10 8.91 9.72 10.53 11.34 12.15 12.96 13.77 14.58 15.39 16.20 17.01 17.82 18.63 19.44 20.25 21.06 21.87 22.68 23.49 24.30 25.11 25.92 26.73 27.54 28.35 29.16 29.97 30.78 31.59 32.40 33.21 34.02 34.83 35.64 36.45 37.26 38.07 38.88 39.69 40.50 41.31 42.12

Long Term Disability AUBREY INDEPENDENT SCHOOL DISTRICT Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year)

Product: Educator Select Income Protection Plan Injury (Days) Sickness (Days) Annual Earnings 95400 97200 99000 100800 102600 104400 106200 108000 109800 111600 113400 115200 117000 118800 120600 122400 124200 126000 127800 129600 131400 133200 135000 136800 138600 140400 142200 144000

Monthly Earnings 7950 8100 8250 8400 8550 8700 8850 9000 9150 9300 9450 9600 9750 9900 10050 10200 10350 10500 10650 10800 10950 11100 11250 11400 11550 11700 11850 12000

14* 14*

30* 30*

Plan A ADEA II Duration of Benefits Elimination Period (Days) 60 60

155.82 158.76 161.70 164.64 167.58 170.52 173.46 176.40 179.34 182.28 185.22 188.16 191.10 194.04 196.98 199.92 202.86 205.80 208.74 211.68 214.62 217.56 220.50 223.44 226.38 229.32 232.26 235.20

134.62 137.16 139.70 142.24 144.78 147.32 149.86 152.40 154.94 157.48 160.02 162.56 165.10 167.64 170.18 172.72 175.26 177.80 180.34 182.88 185.42 187.96 190.50 193.04 195.58 198.12 200.66 203.20

108.12 110.16 112.20 114.24 116.28 118.32 120.36 122.40 124.44 126.48 128.52 130.56 132.60 134.64 136.68 138.72 140.76 142.80 144.84 146.88 148.92 150.96 153.00 155.04 157.08 159.12 161.16 163.20

90 90

180 180

60.95 62.10 63.25 64.40 65.55 66.70 67.85 69.00 70.15 71.30 72.45 73.60 74.75 75.90 77.05 78.20 79.35 80.50 81.65 82.80 83.95 85.10 86.25 87.40 88.55 89.70 90.85 92.00

42.93 43.74 44.55 45.36 46.17 46.98 47.79 48.60 49.41 50.22 51.03 51.84 52.65 53.46 54.27 55.08 55.89 56.70 57.51 58.32 59.13 59.94 60.75 61.56 62.37 63.18 63.99 64.80

Maximum Monthly Benefit 5300 5400 5500 5600 5700 5800 5900 6000 6100 6200 6300 6400 6500 6600 6700 6800 6900 7000 7100 7200 7300 7400 7500 7600 7700 7800 7900 8000

* If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Find your Annual/Monthly Earnings above to determine your Maximum Monthly Benefit. If your Annual/Monthly Earnings are not shown, use the next lower Annual/Monthly Earnings and corresponding Maximum Monthly Benefit. Or, you may refer to the Plan Highlights to calculate your Maximum Monthly Benefit based on your earnings.

LOYAL AMERICAN

Cancer

YOUR BENEFITS PACKAGE

About this Benefit Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.

DID YOU KNOW? Breast Cancer is the most commonly diagnosed cancer in women.

If caught early, prostate cancer is one of the most treatable malignancies.

Cancer ADDITIONAL BENEFIT AMOUNTS

PLAN A Maximum

PLAN B Maximum

ANNUAL CANCER SCREENING BENEFIT RIDER (form LG-6041) A. Basic Benefit We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, once per calendar year per Insured Person for screening tests performed to determine whether Cancer exists in an Insured Person. Covered annual Cancer screening tests include but are not limited to: mammogram, pap smear, breast ultrasound, ThinPrep, biopsy, chest x-ray, thermography, colonoscopy, flexible sigmoidoscopy, hemocult stool specimen, PSA (blood test for prostate cancer), CEA (blood tests for colon cancer), CA125 (blood test for ovarian cancer), CA15-3 (blood test for breast cancer), serum protein electrophesis (blood test for myeloma).

$50 $50 Per Calendar Per Calendar Year Year

Additional Benefit

$100 We will pay the expense incurred, but not to exceed two times the maximum benefit amount per calendar year as shown on the Certificate Schedule, for one additional invasive diagnostic procedure required as the result of an abnormal cancer screening test Per Calendar Year for which benefits are payable under the Basic Benefit above for an Insured Person. This additional benefit is payable regardless of the results of the additional diagnostic procedure. However, the amount payable will be reduced dollar for dollar for any amount payable under the Positive Diagnosis Benefit contained in the base Certificate. FIRST OCCURRENCE BENEFIT RIDER (form LG-6043) If an Insured Person receives a positive diagnosis of Internal Cancer, We will pay the First Occurrence benefit amount shown on the Certificate Schedule. If the Insured Person receiving the positive diagnosis of Internal Cancer is a child under the age of 21, we will pay one and onehalf times the First Occurrence benefit amount shown on the Certificate Schedule.

$100 Per Calendar Year

$2,000 Once per Lifetime $3,000 Once per Lifetime

$500 Once per Lifetime $750 Once per Lifetime

$400 Per Day

$200 Per Day

$5,000 Procedure Maximum

$500 Procedure Maximum

$1,250 Procedure Maximum

$125 Procedure Maximum

$4,500 Procedure Maximum

$450 Procedure Maximum

DAILT RADIATION, CHEMOTHERAPY, IMMUNOTHERAPY and EXPERIMENTAL TREATMENT BENEFIT RIDER (form LG-6046) We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule for each day that an Insured Person receives one or more of the following treatments for Cancer: (1) Chemotherapy (including Hormonal Therapy) or Immunotherapy; (2) Self-injected Chemotherapy or Immunotherapy drugs, limited to the maximum daily benefit amount per treatment; (3) Chemotherapy or Immunotherapy drugs dispensed by a pump or implant, limited to the maximum daily benefit amount for the initial prescription and an equal amount for each refill; (4) Oral Chemotherapy or Immunotherapy, limited to the maximum daily benefit amount per prescription; (5) Radiation Treatment. Benefits payable for interstitial or intracavitary applications of Radiation Treatments are payable on the day of insertion only and not for each day the Radiation Treatment remains in the body; or (6) Experimental Treatment. The benefit amount shown on the Certificate Schedule is the maximum daily benefit available per Insured Person regardless of the number or types of Cancer treatments received on the same day.

SURGICAL BENEFIT RIDER (form LG-6048) Surgical Expense We will pay the Surgical Expense benefit for a surgical procedure for the treatment of an Insured Personâ&#x20AC;&#x2122;s Cancer (except Skin Cancer) according to the Surgical Schedule shown in this rider. However, in no event will the amount payable exceed the maximum Surgical Expense benefit shown on the Certificate Schedule, nor will it exceed the expense incurred.

Anesthesia Expense We will pay the anesthesia expense incurred, not to exceed 25% of the covered Surgical Expense benefit for the operation performed. This includes the services of an anesthesiologist or of an anesthetist under supervision of a physician for the purpose of administering anesthesia.

Breast Reconstruction With transverse rectus adominis myocutaneous flap (TRAM), single pedicle, including closure of donor site, with microvascular anastomosis (supercharging) is one of the surgical procedures listed in the Surgical Schedule. If this procedure is performed on an Insured Person as the result of a mastectomy for which We paid a Surgical Expense benefit for the treatment of Breast Cancer, We will pay the expense incurred not to exceed $900 per $1,000 of the Surgical Benefit issued.

Skin Cancer Surgery Expense We will pay the expense incurred, not to exceed the procedure amount listed in this rider ($125 to $750 depending on the procedure) when a surgical operation is performed on an Insured Person for treatment of a diagnosed Skin Cancer. This benefit is Per Procedure Per Procedure payable in lieu of any benefits for Surgical Expense and Anesthesia Expense which are not applicable to Skin Cancer.

DAILY HOSPITAL CONFINEMENT BENEFIT RIDER (form LG-6042) Confinements of 30 Days or Less We will pay the Daily Hospital Confinement benefit amount shown on the Certificate Schedule for each of the first 30 days in each period of hospital confinement during which an Insured Person is confined to a hospital, including a government or charity hospital, for the treatment of Cancer.

Confinements of 31 Days or More If an Insured Person is continuously confined to a hospital, including a government or charity hospital, for longer than 30 consecutive days for the treatment of Cancer, We will pay two times the Daily Hospital Confinement benefit amount shown on the Certificate Schedule. This benefit payment will begin on the 31st continuous day of such confinement and continue for each day of confinement until the Insured Person is discharged from the Hospital.

Benefits for an Insured Dependent Child under Age 21 The amount payable under this benefit will be double the Daily Hospital Confinement benefit shown on the Certificate Schedule if the Insured Person so confined is a dependent child under the age of 21.

$200 Per Day

$100 Per Day

$400 Per Day

$200 Per Day

$400/ $800 Per Day

$200/ $400 Per Day 37

Cancer Additional Benefits Amounts SPECIFIED DISEASE BENEFIT RIDER (form LG-6052) If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider. Covers These 38 Specified Diseases Addison’s Disease Amyotrophic Lateral Sclerosis Botulism Bovine Spongiform Encephalopathy Budd-Chiari Syndrome Cystic Fibrosis Diptheria Encephalitis Epilepsy Hansen’s Disease Histoplasmosis Legionnaire’s Disease Lyme Disease

Lupus Erythematosus Malaria Meningitis Multiple Sclerosis Muscular Dystrophy Myasthenia Gravis Neimann-Pick Disease Osteomyelitis Poliomyelitis Q Fever Rabies Reye’s Syndrome Rheumatic Fever

Rocky Mountain Spotted Fever Sickle Cell Anemia Tay-Sachs Disease Tetanus Toxic Epidermal Necrolysis Tuberculosis Tularemia Typhoid Fever Undulant Fever West Nile Virus Whipple’s Disease Whooping Cough

Benefits If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider. An applicant may select 1, 2 or 3 units of coverage. Initial Hospitalization Benefit We will pay a benefit of $1,500 per unit of coverage selected when an Insured Person is confined to a hospital (for 12 or more hours, not applicable in SD) as a result of receiving treatment for a Specified Disease. This benefit is payable only once per period of confinement and once per calendar year for each Insured Person. Hospital Confinement Benefit We will pay a benefit of $300 per day per unit of coverage selected when an Insured Person is hospitalized during any continuous period of 30 days or less for the treatment of a covered Specified Disease. Benefits will double per day beginning with the 31st day of continuous confinement. If the hospital confinement follows a previously covered confinement, it will be deemed a continuation of the first confinement unless it is the result of an entirely different Specified Disease, or unless the confinements are separated by 30 days or more.

Monthly Rates

Employee

Single Parent

Family

Base Plan A

$20.41

$25.00

$34.46

Base Plan B

$12.05

$15.46

$20.85

Cancer

OPTIONAL BENEFITS YOU MAY SELECT FOR ADDITIONAL PREMIUM

HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER (form LG-6047)* Intensive Care Unit Benefit We will pay the daily Hospital Intensive Care Unit Benefit shown on the Certificate Schedule for an Insured Person’s confinement in an ICU for sickness or injury.

$1000 Per Day

Double Intensive Care Unit Benefit We will pay double the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person’s confinement in an ICU as a result of Cancer. We will also double this ICU benefit for only the initial ICU confinement resulting from an Insured Person’s travel related injury, provided that the ICU confinement begins within 24 hours of the accident causing the travel related injury. A travel related injury includes being struck by an automobile, bus, truck, van, motorcycle, train or airplane; or being involved in an accident where the Insured Person was the operator or passenger in or on such vehicle.

$2,000 Per Day

Step Down Unit Benefit We will pay one-half of the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person’s confinement in a Step Down Unit for a sickness or injury.

$500 Per Day

*Additional Limitations and Exclusions for the Hospital Intensive Care Unit Benefit Rider If the rider is issued and coverage is in force, it will provide benefits if an Insured Person goes into a hospital Intensive Care Unit (including a Cardiac Intensive Care Unit or Neonatal Intensive Care Unit). Benefits start the first day of confinement in an ICU for sickness or injury. Any combination of benefits payable under this rider is limited to a maximum of 45 days per each period of confinement. ALL BENEFITS CONTAINED IN THIS HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER REDUCE BY ONE-HALF AT AGE 75. Benefits are not payable for any ICU or Step Down Unit confinement that results from intentional self-inflicted injury; or the Insured Person’s being intoxicated or under the influence of alcohol, drugs or any narcotics, unless administered on and according to the advice of a medical practitioner. THIS IS A LIMITED RIDER.

Monthly Rates

Employee

Single Parent

Family

Base Plan A + ICU

$25.06

$31.39

$43.26

Base Plan B + ICU

$16.69

$21.85

$29.65

LOYAL AMERICAN YOUR BENEFITS PACKAGE

Accident

About this Benefit Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-so-serious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.

DID YOU KNOW?

2/3 of disabling injuries suffered by American workers are not work related. American workers 36% ofreport they always or usually live paycheck to paycheck.

Accident Group #1575



Plan pays benefit amounts for covered medical expenses as a result of an accident, directly to you! Coverage is available for ages 18-64 and is portable, you can choose to keep your benefit even if you leave the district or retire.

 

This policy does not pay for losses resulting from sickness, only accident. Always refer to your policy for detailed terms and conditions. This policy is guaranteed renewable.

Plan B Monthly Premiums Available for Issue Ages 18-64

Plan A Monthly Premiums Available for Issue Ages 18-64 Individual

$12.70

Individual

$9.00

Single Parent

$20.40

Single Parent

$14.20

Insured + Spouse

$19.50

Insured + Spouse

$13.50

Family

$27.20

Family

$18.70

Summary of Benefits

Plan A

Plan B

$150

$75

$600

$300

Ambulance Ground Ambulance Benefit: Loyal American will pay this benefit if you require transportation by a licensed professional ambulance company to or from a hospital or between medical facilities within 90 days for injuries sustained after a covered accident. Payable once per accident. Air Ambulance Benefit: Loyal American will pay this benefit if you require transportation by a license professional air ambulance company to or from a hospital or between medical facilities within 48 hours for injuries sustained after a covered accident. Payable once per accident.

Indemnity Benefits Insured/Spouse: Insured/Spouse: Emergency Room Treatment Benefit: Loyal American will pay this benefit if you received hospital emergency room treatment within 72 hours of injuries sustained in a covered accident $75 $150 and for which charges are submitted. Child: $40 Child: $75 Accident Follow-Up Treatment Benefit: Loyal American will pay this benefit for three additional treatments of injuries sustained in a covered accident over and above emergency treatment administered during the first 72 hours following the accident. Treatment must begin within 30 days of the covered accident and must be within the 6 month period following the covered accident. Blood, Plasma, Platelets Benefit: Loyal American will pay this benefit if you require transfusion, administration, cross matching, typing and processing of blood, plasma or platelets when administered within 90 days for injuries sustained in a covered accident. Payable once per accident.

$50 per visit

$25 per visit

$100

$50

$500

$250

$200 per day

$100 per day

$400 per day

$200 per day

Hospital Benefits Initial Accident Hospitalization Benefit: Loyal American will pay this benefit if hospital confinement is required within six (6) months for injuries sustained in a covered accident. Payable once per accident. Hospital Confinement Benefit: Loyal American will pay this benefit for a maximum of 180 days per confinement.* if you require confinement in a hospital or in a hospital intensive care unit– sub acute within six (6) months for injuries sustained in a covered accident.

Intensive Care Hospital Intensive Care Unit Confinement Benefit: Loyal American will pay this benefit for a maximum of 15 days per confinement* if you are confined in a hospital intensive care unit within 30 days because of injuries received in a covered accident. *Confinements separated by less than 90 days will be considered as the same period of confinement.

Accident Summary of Benefits

Plan A

Plan B

$50 per treatment

$25 per treatment

Physical Therapy Physical Therapy Benefit: Loyal American will pay this benefit, not to exceed five treatments per accident, for services prescribed by a doctor and rendered by a licensed physical therapist. Physical therapy must be for injuries sustained in a covered accident and must start within 60 days after the accident. Treatment must be completed within 6 months after the accident.

Prostheses Benefit: Loyal American will pay this benefit if a doctor prescribes the use of a 1 prosthetic prosthetic device due to the loss of a hand, foot or sight of an eye in a covered accident. device/artificial The prosthetic must be received within 1 year of the covered accident. This benefit is limb: $100 payable once per accident and is not payable for hearing aids, dental aids, false teeth or More than 1: for cosmetic prosthesis (e.g. hair wigs). We will not pay for joint replacement (e.g. artificial $500 hip or knee). Appliance Benefit: Loyal American will pay this benefit if a doctor advises you to use a medical appliance as an aid to personal locomotion within 90 days as a result of injuries sustained in a covered accident. Benefits are payable for crutches, wheelchairs, braces, etc. Benefits are payable for crutches and wheelchairs once per accident.

1 prosthetic device/artificial limb: $50 More than 1: $250

$50

$25

$100 per day

$50 per day

$300

$150

Family Lodging & Transportation Family Lodging Benefit: Loyal American will pay this benefit for a maximum of 30 days per accident, during the time you are confined in a hospital, for one motel/hotel room for a family member to accompany you if injuries sustained in a covered accident require hospital confinement, and if the hospital and motel/hotel are more than 100 miles from your residence. Transportation Benefit: Loyal American will pay this benefit for a maximum of three trips per calendar year if you require special treatment and confinement in a hospital located more than 100 miles from your residence or site of the accident for injuries sustained in a covered accident.

Accidental Death Accidental Death* Benefit: This policy will pay the following benefit for death if it is the result of injuries sustained in a covered accident. Death must occur within 90 days of a covered accident.

Insured: Common-Carrier: You must be a fare paying passenger on a common-carrier. CommonInsured: $50,000 $100,000 Spouse: carrier vehicles are limited to commercial airplanes, trains, buses, trolleys, subways, ferries and boats that operate on a regular scheduled basis between predetermined points $50,000 Child: Spouse: $25,000 Child: $7,500 or cities. Taxies and privately chartered vehicles are not included. $15,000 Other Accidents: Other Accidents are those not classified as common-carrier and are not specifically excluded in the limitations and exclusions section of the policy.

Insured: $25,000 Insured: $12,500 Spouse: $10,000 Spouse: $5,000 Child: $5,000 Child: $2,500

Dismemberment Accidental Dismemberment* Benefit This policy will pay a percentage of the AccidentalDeath-Other Accidents Benefit for the selected plan.

Both arms and both legs Two arms or legs Sight of two eyes, hands, or feet Sight of one eye, hand, foot, arm, or leg One or more fingers and/or one or more toes

100% 50% 50% 20% 5%

*Death or dismemberment must occur within 90 days of the accident. Only the highest single benefit will be paid for accidental dismemberment. 42

Accident This is a limited benefit policy. This policy does not pay for losses resulting from sickness. RENEWABILITY CONDITIONS: The policy is guaranteed renewable. Premium rates may be changed on a class basis. A class may be defined by age, sex, occupation, premium payment method, issue state,elimination period, benefit period, etc. WHAT IS NOT COVERED BY THIS POLICY. We will not pay benefits for any injury as a result of you(r):  Operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft. Aircraft includes those which are not motor-driven.  Engaging in hang gliding, bungee jumping, parachuting, sailgliding , parakiting, or hot-air ballooning.  Participating or attempting to participate in an illegal activity.  Riding in or driving any motor-driven vehicle in a race, stunt show, or speed test.  Intentionally causing a self-inflicted injury.  Having any sickness or declining process caused by a sickness, including physical or mental infirmity. We also will not pay benefits to diagnose or treat the sickness. Sickness means any disease or disorder that is not caused by an injury.  Practicing for or participating in any semi-professional or professional competitive athletic contest for which any type of compensation or remuneration is received.  Committing or trying to commit suicide, whether sane or insane.  Being in an accident which occurs more than 40 miles outside the territorial limits of the United States, Canada, Puerto Ri‐ co,and Virgin Islands.  Involvement in any period of armed conflict, even if it is not declared. This brochure contains a summary of the Accident Insurance Policy form L-6020. Coverage as described in the brochure is pro‐ vided only through the issuance of a policy. The policy should be consulted for full terms and conditions of coverage.

AUL A ONEAMERICA COMPANY

Voluntary Life

YOUR BENEFITS PACKAGE

About this Benefit Life insurance provides a cash death benefit to your beneficiary upon your death. Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the wellbeing of your family. If you are covered, you may apply for coverage on your spouse and eligible dependent children.

DID YOU KNOW? Experts recommend at least

x 10 your gross annual income in coverage when purchasing life insurance.

Voluntary Life AUL's Group Voluntary Term Life Insurance Terms and Definitions

be aware Guaranteed Increase in Benefits will not be made avail‐ able to you in the future.

Continuation of Coverage Options:

Eligible Employees: This benefit is available for employees who are actively at work on the effective date and working a minimum of 20 hours per week.

Flexible Choices:

Portability Should your coverage terminate for any reason, you may be eligi‐ ble to take this term life insurance with you without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible. The Portability option is available until you reach age 70.

Since everyone's needs are different, this plan offers flexibility for you to choose a benefit amount that fits your needs and budget. OR Conversion Should your life insurance coverage, or a portion of it, cease for This is the most coverage you can purchase without having to any reason, you may be eligible to convert your Group Term Cov‐ answer any health questions. If you decline insurance coverage now and decide to enroll later, you will need to provide Evidence erage to Individual Coverage without providing Evidence of Insur‐ ability. You must apply within 31 days from the last day you are of Insurability eligible.

Guaranteed Issue Amounts:

Under Age 60 Age 60-69 Employee Guaranteed Issue Amount

$100,000

Spouse Guaranteed Issue Amount

$50,000

Child Guaranteed Issue Amount

$10,000

$20,000

Age 70+ None

Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose. Waiver of Premium: If approved, this benefit waives your and your dependents' insur‐ ance premium in case you become totally disabled and are una‐ ble to collect a paycheck.

Evidence of Insurability: Enrolling timely means you have enrolled during the initial enroll‐ ment period when benefits were first offered by AUL, or as a newly hired employee within 31 days following completion of any applicable waiting period.

Timely Enrollment: If you elect a benefit amount over the Guaranteed Issue Amount shown above for you or your eligible dependents, or you do not enroll timely, you will need to submit a Statement of Insurability form for review. Based on health history, you and / or your de‐ pendents will be approved or declined for insurance coverage by AUL.

Guaranteed Increase in Benefit: If eligible, this benefit allows you to increase your coverage every year as your life insurance needs change. You may be able to increase your benefit amount by $10,000 every year until you reach the guaranteed issue amount, without providing Evidence of Insurability. NOTE: If Evidence of Insurability is applied for and denied, please

Voluntary Life Monthly Payroll Deduction Illustration About your benefit options:    

You may select a minimum benefit of $10,000 up to a maximum amount of $500,000, in increments of $10,000. Amounts requested above $100,000 for an Employee under age 60, above $20,000 for an Employee age 60-69, any amount for an Employee age 70+ and $50,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability. Employee must select coverage to select any Dependent coverage. Dependent coverage cannot exceed 100% of the Voluntary Term Life amount selected by the Employee.

EMPLOYEE ONLY OPTIONS (based on Employee's age as of 09/01) Life Options

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

$10,000

$.60

$.80

$.90

$1.00

$1.50

$2.30

$4.30

$6.60

$12.70

$20.60

$24.50

$20,000

$1.20

$1.60

$1.80

$2.00

$3.00

$4.60

$8.60

$13.20

$25.40

$41.20

$49.00

$30,000

$1.80

$2.40

$2.70

$3.00

$4.50

$6.90

$12.90

$19.80

$38.10

$61.80

$73.50

$40,000

$2.40

$3.20

$3.60

$4.00

$6.00

$9.20

$17.20

$26.40

$50.80

$82.40

$98.00

$50,000

$3.00

$4.00

$4.50

$5.00

$7.50

$11.50

$21.50

$33.00

$63.50 $103.00 $122.50

$60,000

$3.60

$4.80

$5.40

$6.00

$9.00

$13.80

$25.80

$39.60

$76.20 $123.60 $147.00

$70,000

$4.20

$5.60

$6.30

$7.00

$10.50

$16.10

$30.10

$46.20

$88.90 $144.20 $171.50

$80,000

$4.80

$6.40

$7.20

$8.00

$12.00

$18.40

$34.40

$52.80 $101.60 $164.80 $196.00

$90,000

$5.40

$7.20

$8.10

$9.00

$13.50

$20.70

$38.70

$59.40 $114.30 $185.40 $220.50

$100,000

$6.00

$8.00

$9.00

$10.00 $15.00

$23.00

$43.00

$66.00 $127.00 $206.00 $245.00

SPOUSE ONLY OPTIONS (based on Employee's Age as of 09/01 Life Options

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

$10,000

$.60

$.80

$.90

$1.00

$1.50

$2.30

$4.30

$6.60

$12.70

$20.60

$24.50

$20,000

$1.20

$1.60

$1.80

$2.00

$3.00

$4.60

$8.60

$13.20

$25.40

$41.20

$49.00

$30,000

$1.80

$2.40

$2.70

$3.00

$4.50

$6.90

$12.90

$19.80

$38.10

$61.80

$73.50

$40,000

$2.40

$3.20

$3.60

$4.00

$6.00

$9.20

$17.20

$26.40

$50.80

$82.40

$98.00

$50,000

$3.00

$4.00

$4.50

$5.00

$7.50

$11.50

$21.50

$33.00

$63.50 $103.00 $122.50

Voluntary Life CHILD(REN) OPTIONS (Premium shown for Child(ren) reflects the cost for all eligible dependent children) Child(ren) 6 months to age 26 Option 1:

$10,000

Child(ren) live birth to 6 months $1,000

Monthly Payroll Deduction Life Amount $2.00

About Premiums: The premiums shown above may vary slightly due to rounding; actual premiums will be calculated by American United Life Insurance CompanyÂŽ (AUL), and may increase upon reaching certain age brackets, according to contract terms, and are subject to change.

Axis Global YOUR BENEFITS PACKAGE

AD&D

About this Benefit Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

DID YOU KNOW? Motor vehicle crashes are the

cause of accidental deaths in the US, followed by poisoning, falls, drowning, and choking.

AD&D Principal Sum: Employee - $10,000 to $500,000 in $10,000 increments. Amounts over $250,000 may not exceed 10 times Base Earnings. Spouse – 60% of the employee’s benefit without child coverage, 50% of the employee’s benefit with child coverage. Spouse Maximum Principal Sum: $300,000. Child – 10% of the employee’s benefit with spouse coverage,

15% of the employee’s benefit without spouse coverage. Child (ren) Maximum Principal Sum: $30,000. Eligibility: All active full time Employees of the Employer working 20 plus hours per week who are domiciled in the United States, its territories and protectorates, excluding temporary, lease or seasonal employees.

Core Benefits Accidental Death & Dismemberment Schedule of Benefits Loss of Life 100% of the Principal Sum Loss of or Loss of use of Two or more Hands or Feet 100% of the Principal Sum Loss of Sight Both Eyes 100% of the Principal Sum Loss of One Hand or One Foot and Sight in One Eye 100% of the Principal Sum Loss of Speech and Hearing (both ears) 100% of the Principal Sum 1% of the Principal Sum for the first 11 Coma months, 100% in the 12th Month Loss of or Loss of use of One Hand or Foot 50% of the Principal Sum Loss of Sight in One Eye 50% of the Principal Sum Loss of Speech Loss of Hearing (both ears) Loss of Thumb and Index Finger of the Same Hand Loss of all Four Fingers of the Same Hand Loss of all the Toes of the Same Foot Quadriplegia (total paralysis of both upper and lower limbs) Paraplegia (total paralysis of both lower limbs) Hemiplegia (total paralysis of upper and lower limbs on one side of body Uniplegia (total paralysis of one upper or lower limb) Exposure and Disappearance Benefit

50% of the Principal Sum 50% of the Principal Sum 25% of the Principal Sum 25% of the Principal Sum 20% of the Principal Sum 100% of the Principal Sum 75% of the Principal Sum 50% of the Principal Sum 25% of the Principal Sum Included

Additional Benefits Travel Assistance Services – You and your family have access to travel assistance services for emergencies that occur while traveling almost anywhere in the world, at least 100 miles from home. Comprehensive services are available locally in over 200 countries and through 35 assistance centers open 24/7, these comprehensive services offer support to help travelers in an emergency. Refer to the travel assurance flyer provided by your employer which includes information on the services available, as well as a wallet card with important contact information Your coverage includes Additional Benefits beyond the Principal Sum that can be paid if an Accidental Death Benefit is payable under the Policy. Certain other conditions may apply.



Bereavement & Trauma 

Seatbelt and Airbag Benefits 

If you were traveling in a private passenger vehicle and properly wearing a seatbelt, you could qualify for an

If bereavement and trauma counseling is needed due to a covered loss, you could qualify for 10 - $100 sessions with a maximum benefit of $1,000

Home Alteration and Vehicle Modification Benefit 

Special Education Benefits Surviving Dependent Child  Your Dependent Child attending school could qualify for an additional 5% of the Principal Sum, up to a maximum of $5,000 per year for up to 4 years Spouse Retraining Benefit  Your surviving Spouse attending school could qualify for an additional 5% of the Principal Sum, up to a maximum of $5,000.

additional 10% of the Principal Sum, up to a maximum of $50,000 If you were traveling in a private passenger vehicle equipped with a properly functioning airbag, you could qualify for an additional 5% of the Principal Sum, up to a maximum of $10,000.

If you suffer a covered loss and require home alteration and vehicle modification, you could qualify for an additional 10% of the Principal Sum, up to a maximum of $10,000

Medical Evacuation and Repatriation Benefits 

If a covered accident occurs while traveling that results in the need for your emergency medical evacuation or a repatriation of your remains, you could qualify for an additional benefit of 100% of the Usual and Customary charges for such an expense. COBRA  Reimburses COBRA Insurance Continuation expenses if you die in a covered accident and are survived by a spouse or dependent child(ren). You could qualify for 3% of the Principal Sum, up to a maximum of $3,000 per policy year for a maximum of 3 years. 49

TEXAS LIFE

Individual Life

YOUR BENEFITS PACKAGE

About this Benefit Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.

DID YOU KNOW?

1/3 of Americans would be financially impacted by the loss of the primary wage earner in just one month.

Individual Life Life Insurance Highlights Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually costs more and declines in death benefit.

DID YOU KNOW? Those with no life insurance think it’s 3 times more expensive than it actually is.

The policy, PureLife-plus, is underwritten by Texas Life Insurance Company, and it has these outstanding features: 

High Death Benefit. With one of the highest death benefit available at the worksite,1 PureLife-plus gives your loved ones peace of mind, knowing there will be significant life insurance in force should you die prematurely.



Minimal Cash Value. Designed to provide high death benefit, PureLife-plus does not compete with the cash accumulation in your employer-sponsored retirement plans.



Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up).



Refund of Premium. Unique in the marketplace, PureLife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)



Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.)

You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren. Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details. 1

Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2008

MDLIVE YOUR BENEFITS PACKAGE

Telehealth

About this Benefit Telehealth provides 24/7/365 access to boardcertified doctors via telephone consultations that can diagnose, recommend treatment and prescribe medication. Whether you are at home, traveling or at work, Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.

DID YOU KNOW?

75%

of all doctor, urgent care, and ER visits could be handled safely and effectively via telehealth.

Telehealth When should I use MDLIVE?

 If you’re considering the ER or urgent care for a non-emergency medical issue  Your primary care physician is not available  At home, traveling, or at work  24/7/365, even holidays!

What can be treated?         

Allergies Asthma Bronchitis Cold and Flu Ear Infections Joint Aches and Pain Respiratory Infection Sinus Problems And More!

Pediatric Care related to:       

Cold & Flu Constipation Ear Infection Fever Nausea & Vomiting Pink Eye And More!

Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.

How much does it cost? $10 Covers you, your spouse, and children up to age 26, with unlimited phone consultations.

Download the App Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today. www.mdlive.com/getapp     

Access to a doctor anywhere: at home, at work, or on the go Choose doctors from one of the nation's largest telehealth networks Available 24/7 by video or phone Private, secure and confidential visits Connect instantly with MDLIVE Assist

Who are our doctors? MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.

Scan with your smartphone to get the app.

Call us at (888) 365-1663 or visit us at www.consultmdlive.com

Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/pages/terms.html 010113

NOTES