2016 Benefit Guide Prosper ISD by Higginbotham Public Sector

PROSPER ISD

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

Table of Contents

Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Annual Enrollment 2. Eligibility Requirements 3. Helpful Definitions 4. Section 125 Cafeteria Plan Guidelines TRS-ActiveCare Scott & White HMO LifeWorks Employee Assistance Program (EAP) Cigna Dental Superior Vision UNUM Disability Loyal American Cancer The Hartford Basic Life and AD&D The Hartford Voluntary Life The Hartford Voluntary AD&D ID Watchdog Identity Theft NBS Flexible Spending Account (FSA)

3 4-5 6-9 6 7 8 9 10-11 12-13 14-15 16-21 22-23 24-27 28-31 32-33 34-37 38-41 42-43 44-47

FLIP TO... PG. 4 HOW TO ENROLL

PG. 8 HELPFUL DEFINITIONS

PG. 10 YOUR BENEFITS PACKAGE

Benefit Contact Information

Benefit Contact Information PROSPER ISD BENEFITS

EMPLOYEE ASSISTANCE PROGRAM

CANCER

Financial Benefit Services (469) 385-4685 www.mybenefitshub.com/prosperisd

Ceridian LifeWorks (800) 729-7655 www.portal.lifeworks.com

Loyal American (800) 366-8354

PROSPER ISD BENEFITS OFFICE

DENTAL

LIFE AND AD&D

(469) 219-2010 www.prosper-isd.net

Group # 3336125 Cigna (800) 244-6224 www.mycigna.com

The Hartford (800) 523-2233 www.thehartford.com

TRS ACTIVECARE MEDICAL

VISION

IDENTITY THEFT

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

Group # 322100 Superior Vision (800) 507-3800 www.superiorvision.com

ID Watchdog (800) 970-5182 www.idwatchdog.com

TRS HMO MEDICAL

DISABILITY

FLEXIBLE SPENDING ACCOUNT

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

Policy # 147312 UNUM (800) 858-6843 www.unum.com

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

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

TEXT

need to complete your enrollment.

“prosperisd”

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/ prosperisd 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/prosperisd

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

Annual Enrollment

Q&A

During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.

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.



Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.

 Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.



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.

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.

Where can I find forms? For benefit summaries and claim forms, go to your school district’s benefit website: www.mybenefitshub.com/prosperisd. Click on the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section. How can I find a Network Provider? For benefit summaries and claim forms, go to your school district’s benefit website: www.mybenefitshub.com/prosperisd. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links 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 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. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

Don’t Forget!   

Login and complete your benefit enrollment from 08/01/2016 - 08/22/2016 Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202 to speak to a representative Monday—Friday between 8am – 5pm CST Update your profile information: home address, phone numbers, email, beneficiaries

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more

Dependent Eligibility: You can cover eligible dependent

regularly scheduled hours each work week.

children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the

Eligible employees must be actively at work on the plan effective

maximum age listed below. Dependents cannot be double

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

covered by married spouses within the Prosper ISD or as both

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

employees and dependents.

work concurrent with the plan effective date. For example, if your 2016 benefits become effective on September 1, 2016, you must be actively-at-work on September 1, 2016 to be eligible for your new benefits.

PLAN

CARRIER

MAXIMUM AGE

Medical

Aetna

To age 26

Dental

Cigna

To age 26

Vision

Superior Vision

To age 26

Cancer

Loyal American

To age 26

Life

The Hartford

To age 26

AD&D

The Hartford

To age 25

Identity Theft

ID Watchdog

To age 26

If your dependent is disabled, coverage may be able to 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.

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

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):

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

Marital Status

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

Change in Number of Tax Dependents

A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a 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 Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Government Programs

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.

TRS-ActiveCare Plans—Preventive Care Network Benefits When Using In-Network Providers

(Provider must bill services as “preventive care”)

ActiveCare 1-HD Preventive Care Services

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-aand-b-recommendations . Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved.

Plan pays 100% (deductible waived)

Some examples of preventive care frequency and services:  Routine physicals – annually age 12 and over  Well-child care – unlimited up to age 12 Evidence−informed preventive care and screenings provided  Well woman exam & pap for in the comprehensive guidelines supported by the Health smear – annually age 18 and Resources and Services Administration (HRSA) for infants, over children and adolescents. Additional preventive care and  Mammograms – 1 every year screenings for women, not described above, as provided for in age 35 and over comprehensive guidelines supported by the HRSA  Colonoscopy – 1 every 10 www.hhs.gov/healthcare/facts-and-features/fact-sheets/ years age 50 and over preventive-services-covered-under-aca/  Prostate cancer screening – 1 #CoveredPreventiveServicesforAdults. per year age 50 and over For purposes of this benefit, the current recommendations of  Smoking cessation the USPSTF regarding breast cancer screening and counseling – 8 visits per 12 mammography and prevention will be considered the most months current (other than those issued in or around November  Healthy diet/obesity 2009). counseling – unlimited to age 22; age 22 and over-26 visits The preventive care services described above may change as per 12 months USPSTF, CDC and HRSA guidelines are modified.  Breastfeeding support – 6 lactation counseling visits per (Examples of covered services included are: 12 months 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; 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

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 benefits are administered by Caremark.

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

Copay

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

LIFEWORKS YOUR BENEFITS PACKAGE

EAP (Employee Assistance Program)

About this Benefit An Employee Assistance Plan (EAP) is an employee benefit program offered to help employees manage personal and professional problems that might adversely impact their work performance, health, and well-being. Employee Assistance Plans generally include short-term counseling and referral services for employees and their household members. Your Employee Assistance Program benefit is provided to you by your employer.

DID YOU KNOW?

38%

of employees have missed life events because of bad worklife balance.

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 Prosper ISD Benefits Website: www.mybenefitshub.com/prosperisd

Employee Assistance Program With LifeWorks Integrated EAP and Work-life services, employees and their families will have access to confidential assistance and support on a wide range of issues in the areas of life, health, family, work and money. Topic

Description

Emotions and Stress

Relationship issues, depression and anxiety – even an online “calm room

Parenting

Parenting skills, adoption, talking with your teenager, help in finding child care

Midlife and Retirement

Financial considerations, work and career in midlife, relationships with adult children, growing as a couple

Addictive Behaviors

Drug and alcohol abuse, eating disorders, gambling

Education

Applying to college, understanding financial aid and scholarships, advocating in the schools

Caring of older adults

Caregiver support, referrals to in-home and other services, and federally funded programs

Disability

Special needs programs, advocacy and specific disabilities information

Everyday Issues

Community resources and consumer information

Financial Issues

Credit management, budget analysis, 401(k) plan questions, basic estate planning, and questions about federal tax planning and preparation

Legal Issues

On-staff attorneys provide information and referrals for family matters, real estate, consumer credit and criminal matters. Also online program with forms, guides and simple wills.

Work

Special content for managers includes employee relations, interpersonal conflicts, performance issues, discrimination and workplace change. Also general support for co-worker relationships and stress.

Employees and their families have anytime access to LifeWorks Integrated EAP and Work-life services in a variety of ways that fit their preferences and unique needs.



Telephone   

All calls are answered live by Ceridian employees who are trained clinical consultants with master’s/doctorate degrees. LifeWorks is a 24/7 operation, so there are no changes in our  service delivery during non-business hours — your employees will not be directed to leave messages. A fully staffed bilingual clinical consultant team answers calls from service centers in St. Petersburg, FL; Minneapolis, MN;  Blue Bell, PA; Toronto, Winnipeg and Montreal, Canada.

Mobile 

An app for mobile devices makes the LifeWorks.com site accessible from anywhere at any time for iPhone, Android and Blackberry users.

In-Person 



Ceridian develops close relationships and carefully evaluates the national network of EAP providers who deliver in-person counseling to your employees. This cohesive team includes consultants that complete the initial screening assessment and connect participants to the EAP provider and EAP affiliate managers to ensure a high quality experience. Ceridian also employs a Clinical Supervisor within Provider Network Services for case consultation and assistance to the local EAP affiliate. Our North American network of 11,300 EAP providers includes all 50 U.S. states, Puerto Rico, the Virgin Islands, Mexico, Canada and U.S. Territories. Our entire network is composed of licensed mental health professionals. Minimum qualifications include a license to practice independently in the state in which services are provided along with five years post graduate experience and three years providing EAP services. Our counselors and providers possess strong EAP and worklife skills, and we aggressively recruit Certified Employee Assistance Professionals (CEAPs) whose focus is on helping employees quickly resolve issues that may interfere with their work.

Employees and their families will have access to face-to-face assessments and short- term, solution-focused counseling with EAP clinicians.

CIGNA

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 PPO - High Option Benefits Network Policy Year Maximum (Class I, II, and III expenses) Annual Deductible Individual Family Reimbursement Levels**

Cigna Dental PPO In-Network Out-of-Network Total Cigna DPPO $1,500

$1,500

$50 per person $150 per family

Based on Reduced Contracted Fees

90th percentile of Reasonable and Customary Allowances

Plan Pays

You Pay

Plan Pays

You Pay

Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Bitewing X-rays Full Mouth X-rays Panoramic X-ray Emergency Care to Relieve Pain Fluoride Application Sealants Space Maintainers

100%

No Charge

100%

No Charge

Class II - Basic Restorative Care Fillings Brush Biopsies Anesthetics Oral Surgery – Simple Extractions

80%*

20%*

80%*

20%*

Class III - Major Restorative Care Crowns Root Canal Therapy/Endodontics Osseous Surgery Periodontal Scaling and Root Planing Oral Surgery - all except simple extractions Denture Repairs Denture Relines, Rebases and Adjustments Repairs to Bridges, Crowns and Inlays Dentures Bridges Inlays/Onlays Prosthesis Over Implant

50%*

50%

50% $1,000 Dependent children to age 19

50%

Class IV - Orthodontia Lifetime Maximum

50% $1,000 Dependent children to age 19

Monthly PPO Premiums Tier

Rate

EE Only

$47.18

EE + Spouse

$97.94

EE + Child(ren)

$105.04

Family Coverage

$166.22

Missing Tooth Limitation – The amount payable is 50% of the amount otherwise payable until insured for 24 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP)® is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides:  100% coverage for certain dental procedures  guidance on behavioral issues related to oral health  discounts on prescription and non-prescription dental products For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees. 17

Dental PPO - Low Option Benefits Network Policy Year Maximum (Class I, II, and III expenses) Annual Deductible Individual Family Reimbursement Levels**

Cigna Dental PPO In-Network Out-of-Network Cigna DPPO Advantage $1,000

$1,000

$50 per person $150 per family

Based on Reduced Contracted Fees

Based on Maximum Allowable Charge (In-network fee level)

Plan Pays

You Pay

Plan Pays

You Pay

Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Bitewing X-rays Full Mouth X-rays Panoramic X-ray Emergency Care to Relieve Pain Fluoride Application Sealants Space Maintainers

100%

No Charge

100%

No Charge

Class II - Basic Restorative Care Fillings Brush Biopsies Anesthetics Oral Surgery – Simple Extractions

80%*

20%*

80%*

20%*

50%*

Not covered

100% of your dentist’s usual fees

Not covered

100% of your dentist’s usual fees

Class IV - Orthodontia

Monthly PPO Premiums Tier

Rate

EE Only

$32.95

EE + Spouse

$66.96

EE + Child(ren)

$80.18

Family Coverage

$127.14

Missing Tooth Limitation – The amount payable is 50% of the amount otherwise payable until insured for 24 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP)® is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides:  100% coverage for certain dental procedures  guidance on behavioral issues related to oral health  discounts on prescription and non-prescription dental products For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to the Contracted Fee Schedule but the dentist may balance bill up to their usual fees. 18

Dental PPO - High and Low Option Procedure

Exclusions and Limitations

Late Entrants Limit Exams Prophylaxis (Cleanings) Fluoride Histopathologic Exams X-Rays (routine) X-Rays (non-routine) Model Minor Perio (non-surgical) Perio Surgery Crowns and Inlays Bridges Dentures and Partials Relines, Rebases Adjustments Repairs - Bridges Repairs - Dentures Sealants Space Maintainers Prosthesis Over Implant

50% coverage on Class III and IV for 24 months Two per policy year Two per policy year 1 per policy year for people under 19 Various limits per policy year depending on specific test Bitewings: 2 per policy year Full mouth: 1 every 36 consecutive months., Panorex: 1 every 36 consecutive months Payable only when in conjunction with Ortho workup Various limitations depending on the service Various limitations depending on the service Replacement every 5 years Replacement every 5 years Replacement every 5 years Covered if more than 6 months after installation Covered if more than 6 months after installation Reviewed if more than once Reviewed if more than once Limited to posterior tooth. One treatment per tooth every three years Limited to non-Orthodontic treatment 1 per 60 consecutive months if unserviceable and cannot be repaired. Benefits are based on the amount payable for nonprecious metals. No porcelain or white/tooth colored material on molar crowns or bridges When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses

Alternate Benefit

Benefit Exclusions     

                  



Services performed primarily for cosmetic reasons Replacement of a lost or stolen appliance Replacement of a bridge or denture within five years following the date of its original installation Replacement of a bridge or denture which can be made useable according to accepted dental standards Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, diagnose or treat conditions of TMJ, stabilize periodontally involved teeth, or restore occlusion Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars Bite registrations; precision or semi-precision attachments; splinting A surgical implant of any type Instruction for plaque control, oral hygiene and diet Dental services that do not meet common dental standards Services that are deemed to be medical services Services and supplies received from a hospital Charges which the person is not legally required to pay Charges made by a hospital which performs services for the U.S. Government if the charges are directly related to a condition connected to a military service Experimental or investigational procedures and treatments Any injury resulting from, or in the course of, any employment for wage or profit Any sickness covered under any workers’ compensation or similar law Charges in excess of the reasonable and customary allowances To the extent that payment is unlawful where the person resides when the expenses are incurred; Procedures performed by a Dentist who is a member of the covered person’s family (covered person’s family is limited to a spouse, siblings, parents, children, grandparents, and the spouse’s siblings and parents); For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; To the extent that you or any of your Dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; To the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a “no-fault” insurance law or an uninsured motorist insurance law. Cigna HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents. In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer.

This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance certificate or plan description. Benefits are insured and/or administered by Connecticut General Life Insurance Company. "Cigna HealthCare" refers to various operating subsidiaries of Cigna Corporation. Products and services are provided by these subsidiaries and not by Cigna Corporation. These subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. DPPO insurance coverage is set forth on the following policy form numbers: AR: HP-POL77; CA: HP-POL57; CO: HP-POL78; CT: HP-POL58; DE: HP-POL79; FL: HP-POL60; ID: HPPOL82; IL: HP-POL62; KS: HP-POL84; LA: HPPOL86: MA: HP-POL 63; MI: HP-POL88; MO: HP- POL65; MS: HP-POL90; NC: HP-POL96; NE: HP-POL92; NH: HP-POL94; NM: HP-POL95; NV: HP-POL93; NY: HP-POL67; OH: HP-POL98; OK: HP-POL99; OR: HP-POL68; PA: HP-POL100; RI: HP-POL101; SC: HP-POL102; SD: HP-POL103; TN: HP-POL69; TX: HP-POL70; UT: HP-POL104; VA: HP-POL72; VT: HP-POL71; WA: POL-07/08; WI: HP-POL107; WV: HP-POL106; and WY: HP-POL108. “Cigna,” the “Tree of Life” logo and “Cigna Dental Care” are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Cigna Dental PPO plans are underwritten or administered by CGLIC or CHLIC, with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Arizona and Louisiana, the insured Dental PPO plan offered by CGLIC is known as the “CG Dental PPO”. In Texas, the insured dental product offered by CGLIC and CHLIC is referred to as the Cigna Dental Choice Plan, and this plan utilizes the national Cigna Dental PPO network. Cigna Dental Care (DHMO) plans are underwritten or administered by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc. (Kentucky and Illinois), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, Cigna Dental Care plans are underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc. and administered by Cigna Dental Health, Inc. BSD46380 © 2015 Cigna

Dental - DHMO What You’ll Pay Sampling of covered procedures

Cost with Cigna Dental Care

Estimated cost without dental coverage

$70–$136 each

$53–$102 each

$0 $0

$40–$76 $62–$118

$28–$53

$0 $0 $20 $35 $45 $415

$33–$63 $84–$161 $42–$80 $118–$226 $120–$231 $852–$1,640

$400

$1,042–$2,005

$60 $45 $35 $150 $365

$179–$344 $109–$209 $120–$231 $370–$712 $849–$1,634

$665

$1,097–$2,112

$256

$640–$1,233

Adult cleaning (two per policy year each at $0) (additional cleanings available at $45 each) Child cleaning (two per policy year each at $0) (additional cleanings available at $30 each) Periodic oral evaluation Comprehensive oral evaluation Topical fluoride (two per policy year each at $0) (additional topical fluoride available at $15 each) X–rays – (bitewings) 2 films X–rays – panoramic film Sealant – per tooth Amalgam filling (silver colored) – 2 surfaces Composite filling (tooth–colored) – 1 surface, Anterior Molar root canal (excluding final restoration) Comprehensive orthodontics – child (up to 19th birthday) – Banding Periodontal (gum) scaling & root planing – 1 quadrant Periodontal (gum) maintenance Removal/extraction of erupted tooth Removal/extraction of impacted tooth Crown – porcelain fused to high noble metal Implant supported retainer for porcelain fused to metal fixed partial denture Occlusal appliance, by report (for treatment of TMJ)

Monthly DHMO Premiums

EXCEPTIONS

Procedure

Limit

Exams

Two per policy year

X-rays (routine)

Bitewings: 2 per policy year

X-rays (non-routine)

Full mouth: 1 every 3 policy years Panorex: 1 every 3 policy years

Crowns and inlays

Replacement every 5 years

Bridges

Replacement every 5 years

Dentures and partials

Replacement every 5 years

Relines, rebases

One every 36 months

Adjustments

Four within the first 6 months after installation

Prosthesis over implant

Replacement every 5 years if unserviceable and cannot be repaired

Temporomandibular Joint (TMJ) treatment

One occlusal orthotic device per 24 months

Athletic mouth guard

One athletic mouth guard per 12 months when listed on your PCS

Tier

Rate

EE Only

$13.30

EE + Spouse

$21.02

EE + Child(ren)

$27.72

Family Coverage

$32.90

Finding a network dentist is easy. There are several ways to choose your network general dentist:  Find a dentist at www.cigna.com. Our online dental directory is updated weekly.  Call 1.800.Cigna24 (1.800.244.6224) to speak with a customer service representative. Our representatives can send you a customized dental directory listing via email.

Dental - DHMO Under your plan, you have coverage for hundreds of dental procedures. This overview shows you a small sampling of covered services and what you will pay compared to your estimated cost without coverage. Review your plan materials to understand how your plan works. For questions on the plan before enrollment, call 1.800.Cigna24 (1.800.244.6224) and select the “Enrollment Information” prompt.

      

Key plan features  There is a $5 office visit fee associated with your plan.  No deductibles – you don’t have to reach a certain level of out-of-pocket expenses before your insurance kicks in.  No dollar maximums – you don’t have to worry about your coverage running out after your covered expenses reach a certain dollar amount.  Easy to understand plan – the fees you pay your dentist are clearly listed on your Patient Charge Schedule (PCS).  There are no claim forms to fill and no waiting periods for coverage.  The network general dentist you choose will manage your overall dental care.  Covered family members can choose their own network general dentists – near home, work or school.  You don’t need a referral for children under seven to visit a network pediatric dentist. And you don’t need a referral to see a network orthodontist.  There’s no age limit on sealants, which help prevent tooth decay.  Your plan covers certain procedures to help detect oral cancer in its early stages.  24/7 access to the Dental Information Line—this line is staffed by trained professionals who can help you if you have questions about dental treatment and clinical symptoms.



Referrals are required for specialty care services. Specialty treatment plans require payment authorization for services to be covered under your plan, except for Pediatrics, Orthodontics and Endodontics. You should verify with your Network Specialty Dentist that your treatment plan has been authorized for payment by Cigna before treatment begins.



Listed below are the services or expenses which are NOT covered under your Dental Plan and which are your responsibility at the dentist’s usual fees. There is no coverage for:   

Or in connection with an injury arising out of, or in the course of, any employment for wage or profit Charges which would not have been made in any facility, other than a hospital or a correctional institution owned or operated by the United States government or by a state or municipal government if the person had no insurance To the extent that payment is unlawful where the person resides when the expenses are incurred or the services are received

             

         

The charges which the person is not legally required to pay Charges which would not have been made if the person had no insurance Due to injuries which are intentionally self-inflicted Services not listed on the PCS Services provided by a non-network dentist without Cigna Dental’s prior approval (except emergencies, as described in your plan documents) Services related to an injury or illness paid under workers’ compensation, occupational disease or similar laws Services provided or paid by or through a federal or state governmental agency or authority, political subdivision or a public program, other than Medicaid Services required while serving in the armed forces of any country or international authority or relating to a declared or undeclared war or acts of war Services performed primarily for cosmetic reasons unless specifically listed on your PCS General anesthesia, sedation and nitrous oxide, unless specifically listed on your PCS Prescription medications Replacement of filled and/or removable appliances (including filled and removable orthodontic appliances) that have been lost, stolen, or damaged due to patient abuse, misuse or neglect Surgical implant of any type unless specifically listed on your PCS Services considered to be unnecessary or experimental in nature or do not meet commonly accepted dental standards Procedures or appliances for minor tooth guidance or to control harmful habits Services and supplies received from a hospital The completion of crowns, bridges, dentures, or root canal treatment already in progress on the effective date of your Cigna Dental coverage The completion of implant supported prosthesis (including crowns, bridges and dentures) already in progress on the effective date of your Cigna Dental coverage, unless specifically listed on your PCS4 Consultations and/or evaluations associated with services that are not covered Endodontic treatment and/or periodontal (gum tissue and supporting bone) surgery of teeth exhibiting a poor or hopeless periodontal prognosis Bone grafting and/or guided tissue regeneration when performed at the site of a tooth extraction unless specifically listed on your PCS Bone grafting and/or guided tissue regeneration when performed in conjunction with an apicoectomy or periradicular surgery Intentional root canal treatment in the absence of injury or disease to solely facilitate a restorative procedure Services performed by a prosthodontist Localized delivery of antimicrobial agents when performed alone or in the absence of traditional periodontal therapy Any localized delivery of antimicrobial agent procedures when more than eight (8) of these procedures are reported on the same date of service. Infection control and/or sterilization The recementation of any inlay, onlay, crown, post and core or filled bridge within 180 days of initial placement The recementation of any implant supported prosthesis (including crowns, bridges and dentures) within 180 days of initial placement Services to correct congenital malformations, including the replacement of congenitally missing teeth The replacement of an occlusal guard (night guard) beyond one per any 24 consecutive month period, when this limitation is noted on the PCS Crowns, bridges and/or implant supported prosthesis used solely for splinting Resin bonded retainers and associated pontics 21

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 Frames Contact Lenses1

In-Network

Out-of-Network

Covered in full

Up to $35 retail

$125 retail allowance $150 retail allowance

Up to $70 retail Up to $80 retail

Covered in full

Up to $150 retail

Medically Necessary Contact Lenses Lasik Vision Correction

$200 allowance2

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

Covered in full Covered in full Covered in full See description3 Covered in full

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.

Monthly Premiums EE Only EE + Spouse EE + Child(ren) EE + Family

$7.42 $12.56 $13.30 $19.93

Co-Pays Exam Materials

$10 $25

Services/Frequency Exam Frame Lenses Contact Lenses

12 months 12 months 12 months 12 months

(Based on date of service)

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

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.

SuperiorVision.com Customer Service 800.507.3800

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 23

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.

Disability Policy # 147312 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 20 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. Newly Hired Employees: 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 are subject to the pre-existing condition exclusion referenced later in this document.

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

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.

Waiver of Premium After you have received disability payments under the plan for 90 consecutive days, from that point forward you will not be required to pay premiums as long as you are receiving benefits.

Please see your Plan Administrator for your eligibility date.

Questions

If you do not enroll during the initial enrollment period, you may apply only during an annual enrollment.

If you should have any questions about your coverage or how to enroll, please contact your Plan Administrator.

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. The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment. However, if you are participating in Unumâ&#x20AC;&#x2122;s Rehabilitation and Return to Work Assistance program, the total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 110% of your monthly earnings (unless the excess amount is payable as a Cost of Living Adjustment).

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.

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 25

Disability PROSPER INDEPENDENT SCHOOL DISTRICT Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year) Plan A

Product: Educator Select Income Protection Plan

Injury (Days) Sickness (Days) Maximum Annual Monthly Monthly Earnings Earnings Benefit 3600 300 200 5400 450 300 7200 600 400 9000 750 500 10800 900 600 12600 1050 700 14400 1200 800 16200 1350 900 18000 1500 1000 19800 1650 1100 21600 1800 1200 23400 1950 1300 25200 2100 1400 27000 2250 1500 28800 2400 1600 30600 2550 1700 32400 2700 1800 34200 2850 1900 36000 3000 2000 37800 3150 2100 39600 3300 2200 41400 3450 2300 43200 3600 2400 45000 3750 2500 46800 3900 2600 48600 4050 2700 50400 4200 2800 52200 4350 2900 54000 4500 3000 55800 4650 3100 57600 4800 3200 59400 4950 3300 61200 5100 3400 63000 5250 3500 64800 5400 3600 66600 5550 3700 68400 5700 3800 70200 5850 3900 72000 6000 4000 73800 6150 4100 75600 6300 4200 77400 6450 4300 26

ADEAII Duration of Benefits Elimination Period (Days) 0* 7*

14* 14*

30* 30*

60 60

90 90

180 180

9.02 13.53 18.04 22.55 27.06 31.57 36.08 40.59 45.10 49.61 54.12 58.63 63.14 67.65 72.16 76.67 81.18 85.69 90.20 94.71 99.22 103.73 108.24 112.75 117.26 121.77 126.28 130.79 135.30 139.81 144.32 148.83 153.34 157.85 162.36 166.87 171.38 175.89 180.40 184.91 189.42 193.93

7.20 10.80 14.40 18.00 21.60 25.20 28.80 32.40 36.00 39.60 43.20 46.80 50.40 54.00 57.60 61.20 64.80 68.40 72.00 75.60 79.20 82.80 86.40 90.00 93.60 97.20 100.80 104.40 108.00 111.60 115.20 118.80 122.40 126.00 129.60 133.20 136.80 140.40 144.00 147.60 151.20 154.80

5.94 8.91 11.88 14.85 17.82 20.79 23.76 26.73 29.70 32.67 35.64 38.61 41.58 44.55 47.52 50.49 53.46 56.43 59.40 62.37 65.34 68.31 71.28 74.25 77.22 80.19 83.16 86.13 89.10 92.07 95.04 98.01 100.98 103.95 106.92 109.89 112.86 115.83 118.80 121.77 124.74 127.71

4.06 6.09 8.12 10.15 12.18 14.21 16.24 18.27 20.30 22.33 24.36 26.39 28.42 30.45 32.48 34.51 36.54 38.57 40.60 42.63 44.66 46.69 48.72 50.75 52.78 54.81 56.84 58.87 60.90 62.93 64.96 66.99 69.02 71.05 73.08 75.11 77.14 79.17 81.20 83.23 85.26 87.29

3.52 5.28 7.04 8.80 10.56 12.32 14.08 15.84 17.60 19.36 21.12 22.88 24.64 26.40 28.16 29.92 31.68 33.44 35.20 36.96 38.72 40.48 42.24 44.00 45.76 47.52 49.28 51.04 52.80 54.56 56.32 58.08 59.84 61.60 63.36 65.12 66.88 68.64 70.40 72.16 73.92 75.68

2.72 4.08 5.44 6.80 8.16 9.52 10.88 12.24 13.60 14.96 16.32 17.68 19.04 20.40 21.76 23.12 24.48 25.84 27.20 28.56 29.92 31.28 32.64 34.00 35.36 36.72 38.08 39.44 40.80 42.16 43.52 44.88 46.24 47.60 48.96 50.32 51.68 53.04 54.40 55.76 57.12 58.48

Disability PROSPER INDEPENDENT SCHOOL DISTRICT Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year) Plan A Product: Educator Select Income Protection Plan Injury (Days) Sickness (Days) Maximum Annual Monthly Monthly Earnings Earnings Benefit 79200 6600 4400 81000 6750 4500 82800 6900 4600 84600 7050 4700 86400 7200 4800 88200 7350 4900 90000 7500 5000 91800 7650 5100 93600 7800 5200 95400 7950 5300 97200 8100 5400 99000 8250 5500 100800 8400 5600 102600 8550 5700 104400 8700 5800 106200 8850 5900 108000 9000 6000 109800 9150 6100 111600 9300 6200 113400 9450 6300 115200 9600 6400 117000 9750 6500 118800 9900 6600 120600 10050 6700 122400 10200 6800 124200 10350 6900 126000 10500 7000 127800 10650 7100 129600 10800 7200 131400 10950 7300 133200 11100 7400 135000 11250 7500

ADEAII Duration of Benefits Elimination Period (Days) 0* 7*

14* 14*

30* 30*

60 60

90 90

180 180

198.44 202.95 207.46 211.97 216.48 220.99 225.50 230.01 234.52 239.03 243.54 248.05 252.56 257.07 261.58 266.09 270.60 275.11 279.62 284.13 288.64 293.15 297.66 302.17 306.68 311.19 315.70 320.21 324.72 329.23 333.74 338.25

158.40 162.00 165.60 169.20 172.80 176.40 180.00 183.60 187.20 190.80 194.40 198.00 201.60 205.20 208.80 212.40 216.00 219.60 223.20 226.80 230.40 234.00 237.60 241.20 244.80 248.40 252.00 255.60 259.20 262.80 266.40 270.00

130.68 133.65 136.62 139.59 142.56 145.53 148.50 151.47 154.44 157.41 160.38 163.35 166.32 169.29 172.26 175.23 178.20 181.17 184.14 187.11 190.08 193.05 196.02 198.99 201.96 204.93 207.90 210.87 213.84 216.81 219.78 222.75

89.32 91.35 93.38 95.41 97.44 99.47 101.50 103.53 105.56 107.59 109.62 111.65 113.68 115.71 117.74 119.77 121.80 123.83 125.86 127.89 129.92 131.95 133.98 136.01 138.04 140.07 142.10 144.13 146.16 148.19 150.22 152.25

77.44 79.20 80.96 82.72 84.48 86.24 88.00 89.76 91.52 93.28 95.04 96.80 98.56 100.32 102.08 103.84 105.60 107.36 109.12 110.88 112.64 114.40 116.16 117.92 119.68 121.44 123.20 124.96 126.72 128.48 130.24 132.00

59.84 61.20 62.56 63.92 65.28 66.64 68.00 69.36 70.72 72.08 73.44 74.80 76.16 77.52 78.88 80.24 81.60 82.96 84.32 85.68 87.04 88.40 89.76 91.12 92.48 93.84 95.20 96.56 97.92 99.28 100.64 102.00

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

Maximum

ANNUAL CANCER SCREENING BENEFIT RIDER (form LG-6041) A. Basic Benefit We will pay the Actual Charge, 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 $50 Person. Covered annual Cancer screening tests include but are not limited to: mammogram, pap smear, breast Per Calendar Year 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). $100 B. Additional Benefit Per Calendar Year We will pay the Actual Charge, 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 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) $2,000 If an Insured Person receives a positive diagnosis of Internal Cancer, We will pay the First Occurrence benefit amount Once per Lifetime shown on the Certificate Schedule. $3,000 If the Insured Person receiving the positive diagnosis of Internal Cancer is a child under the age of 21, we will pay one Once per Lifetime and one-half times the First Occurrence benefit amount shown on the Certificate Schedule. DAILY RADIATION, CHEMOTHERAPY, IMMUNOTHERAPY and EXPERIMENTAL TREATMENT BENEFIT RIDER (form LG6046) We will pay the Actual Charge, but not to exceed the maximum benefit amount shown on the Certificate Schedule, per $600 calendar year per Insured Person for Radiation Treatment, Chemotherapy, Hormonal Therapy, Immunotherapy or Per Day Experimental Treatment. The Radiation Treatment, Chemotherapy, Hormonal Therapy, Immunotherapy or Experimental Treatment must be for the treatment of an Insured Personâ&#x20AC;&#x2122;s Cancer. The benefit amount shown on the Certificate Schedule is the maximum calendar year benefit available per Insured Person regardless of the number or types of Cancer treatments received in the same year. 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 $5,000 (except Skin Cancer) according to the Surgical Schedule shown in this rider. However, in no event will the amount Procedure Maximum 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 $1,250 operation performed. This includes the services of an anesthesiologist or of an anesthetist under supervision of a Procedure Maximum 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 $4,500 procedure is performed on an Insured Person as the result of a mastectomy for which We paid a Surgical Expense Procedure Maximum 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 Per Procedure 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 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 $200 We will pay the Daily Hospital Confinement benefit amount shown on the Certificate Schedule for each of the first 30 Per Day 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 $400 If an Insured Person is continuously confined to a hospital, including a government or charity hospital, for longer than 30 Per Day 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. $400/ Benefits for an Insured Dependent Child under Age 21 $800 The amount payable under this benefit will be double the Daily Hospital Confinement benefit shown on the Certificate Per Day Schedule if the Insured Person so confined is a dependent child under the age of 21. 29

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

Employee and Children

Employee and Family

Base Plan

$22.86

$27.86

$38.50

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.

$500 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 $1,000 that the ICU confinement begins within 24 hours of the accident causing the travel related injury. A travel related Per Day 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.

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.

$250 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

Employee and Children

Employee and Family

Base Plan with ICU

$25.18

$31.06

$42.90

THE HARTFORD YOUR BENEFITS PACKAGE

Basic Life and AD&D

About this Benefit 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 well-being of your family. 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.

Basic Life and AD&D Benefit Highlights What is Basic Life and AD&D Insurance?

Your Employer provides, at no cost to you, Basic Life and AD&D Insurance in an amount equal to $10,000. Life Insurance pays your beneficiary (please see below) a benefit if you die while you are covered. This highlight sheet is an overview of your Basic Life and AD&D Insurance. Once a group policy is issued to your employer, a certificate of Insurance will be available to explain your coverage in detail.

Am I eligible?

You are eligible if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis.

When can I enroll?

As an eligible Employee, you are automatically covered by Basic Life and AD&D Insurance; you do not have to enroll. If you have not already done so, you must designate a beneficiary as described below.

When is it effective?

Coverage goes into effect subject to the terms and conditions of the policy. In no case will benefits become effective sooner than 9/1/2012 or first of the month coincident with or next following date of hire. You must be Actively at Work with your employer on the day your coverage takes effect.

Am I guaranteed coverage?

You must provide evidence of insurability and be approved by The Hartford to receive coverage above the guaranteed issue amount of $10,000. You may need to complete a Personal Health Application. These are available from The Hartford or your employer.

Benefit Reductions

By 35% @ 65 and 50% of original amount at 70. All coverage cancels at retirement.

What is a beneficiary?

Your beneficiary is the person (or persons) or legal entity (entities) who receives a benefit payment if you die while you are covered by the policy. You must select your beneficiary when you complete your enrollment application; your selection is legally binding.

Can I keep my Life Coverage if I leave my employer?

Yes, subject to the contract, you have the option of:  Converting your group Life coverage to your own individual policy (policies).  If you leave your employer, Portability is an option that allows you to continue your Life Insurance coverage. To be eligible, you must terminate your employment prior to Social Security Normal Retirement Age. This option allows you to continue all or a portion of your Life Insurance coverage under a separate Portability term policy. Portability is subject to a minimum of $5,000 and a maximum of $10,000 and does not include coverage for your dependents. To elect Portability, you must apply and pay the premium within 31 days of the termination of your Life Insurance. Evidence of Insurability will not be required.

What is the Living Benefits Option?

If you are diagnosed as terminally ill with a 12 month life expectancy, you may be eligible to receive payment of a portion of your Life Insurance. The remaining amount of your Life Insurance would be paid to your beneficiary when you die.

Important Details

As is standard with most term life Insurance, this Insurance coverage includes certain limitations and exclusions:  The amount of your coverage may be reduced when you reach certain ages.

THE HARTFORD

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 Benefit Highlights What is Voluntary Life Insurance?

Why do I need Voluntary Life Insurance?

Voluntary Life Insurance is coverage that you pay for. Voluntary Life Insurance pays your beneficiary (please see below) a benefit if you die while you are covered. This highlight sheet is an overview of your Voluntary Life Insurance. Once a group policy is issued to your employer, a certificate of Insurance will be available to explain your coverage in detail. Voluntary Life Insurance provides affordable financial security for your loved ones, although when it comes down to it, contemplating some pretty unpleasant things is hard to do. But when you consider the fact that between 1995 and 1997, almost 40% of all deaths that occurred were people between the ages of 25 and 641, it’s harder to ignore. Especially when your family depends on your income. 1

Death Rates by Age, Sex and Race: 1970 to 1997, U.S. Census Bureau, Statistical Abstract of the United States, 1999, page 95.

Am I eligible?

You are eligible if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis.

When can I enroll?

You can enroll during your scheduled enrollment period, within 31 days of the date you have a change in family status, or within 31 days of the completion of your eligibility waiting period as stated in your group policy.

When is it effective?

Coverage goes into effect subject to the terms and conditions of the policy. You must be Actively at Work with your employer on the day your coverage takes effect.

How much Voluntary Life Insurance can I purchase?

You can purchase Voluntary Life Insurance in increments of $10,000. The maximum amount you can purchase cannot be more than the lesser of 5 times your annual Earnings or $500,000. Annual Earnings are as defined in The Hartford’s contract with your employer.

I already have Voluntary Life Insurance coverage; do I have to do anything?

If you take no action, your coverage and coverage for your eligible dependents will automatically continue with The Hartford subject to the terms of the contract.

Am I guaranteed coverage?

If you are newly eligible and elect an amount that exceeds the guaranteed issue amount of $150,000, you will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you were previously eligible and are electing coverage for the first time or electing to increase your current coverage, you will need to provide evidence of insurability that is satisfactory to The Hartford before coverage can become effective.

What is a beneficiary?

Are there other limitations to enrollment?

If you do not enroll within 31 days of your first day of eligibility, you will be considered a “late entrant.” Typically, late entrants must show evidence of insurability and may be responsible for the cost of physical exams or other associated costs if they are required. This coverage, like most group benefit insurance, requires that a certain percentage of eligible employees participate. If that group participation minimum is not met, the Insurance coverage that you have elected may not be in effect.

Voluntary Life Benefit Highlights

Spouse Voluntary Life Insurance

If you elect Voluntary Life Insurance for yourself, you may choose to purchase Spouse Voluntary Life Insurance in increments of $10,000, to a maximum of $250,000. Coverage cannot exceed 100% of the amount of your Employee Voluntary/Supplemental Life Insurance coverage. You may not elect coverage for your Spouse if they are an active member of the armed forces of any country or international authority, or is already covered as an Employee under this policy. If your Spouse is confined in a hospital or elsewhere because of disability on the date his or her Insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive days. If you are newly eligible and elect an amount that exceeds the guaranteed issue amount of $20,000, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before the excess can become effective. If you were previously eligible and are electing coverage for the first time or electing to increase your spouse's current coverage, your spouse will need to provide evidence of insurability that is satisfactory to The Hartford before coverage can become effective.

Child(ren) Voluntary Life Insurance

If you elect Voluntary Life Insurance for yourself, you may choose to purchase Child(ren) Voluntary Life Insurance coverage in the amount(s) of $5,000 or $10,000 for each Child– no medical information is required. You may not elect coverage for your Child if your Child is an active member of the armed forces of any country or international authority.  If your dependent Child is confined in a hospital or elsewhere because of disability on the date his or her Insurance would normally have become effective, coverage (or an increase in coverage) will be deferred until that dependent is no longer confined and has performed all the normal activities of a healthy person of the same age for at least 15 consecutive days.  Child(ren) must be unmarried and are covered from 15 days to 26 years old.  Unmarried Child(ren) over age 26 may be covered if they are disabled and primarily dependent upon the Employee for financial support.  Child(ren) from 15 days to 6 months are limited to a reduced benefit of $100.

Does my coverage reduce as I get older?

By 35% @ 65 and 50% of original amount at 70. All coverage cancels at retirement.

Can I keep my Life Coverage if I leave my employer?

Yes, subject to the contract, you have the option of:  Converting your group Life coverage to your own individual policy (policies).  If you leave your employer, Portability is an option that allows you to continue your Life Insurance coverage. To be eligible, you must terminate your employment prior to Social Security Normal Retirement Age. This option allows you to continue all or a portion of your Life Insurance coverage under a separate Portability term policy. Portability is subject to a minimum of $5,000 and a maximum of $250,000 and does include coverage for your Spouse and Child(ren). To elect Portability, you must apply and pay the premium within 31 days of the termination of your Life Insurance. Evidence of Insurability will not be required. Dependent Spouse Portability is subject to a maximum of $50,000. Dependent Child Portability is subject to a maximum of $10,000.

What is the Living Benefits Option?

Do I still pay my Life Insurance premiums if I become disabled?

If you become totally disabled before age 60 and your disability lasts for at least 6 months, your Life Insurance premium may be waived. The premium for your dependent’s coverage will also be waived if you are disabled and approved for waiver of premium. Coverage for your dependents will end if the policy terminates.

Important Details

As is standard with most term life Insurance, this Insurance coverage includes limitations and exclusions:  The amount of your coverage may be reduced when you reach certain ages.  Death by suicide (two years). Other exclusions may apply depending upon your coverage. Once a group policy is issued to your employer, a certificate of Insurance will be available to explain your coverage in detail.

Voluntary Life Employee Life Rates Age Band 0-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

$10,000

$20,000

$30,000

$40,000

$50,000

$70,000

$100,000

$130,000 $150,000

$0.40 $0.50 $0.65 $0.70 $0.80 $1.20 $1.80 $3.40 $5.20 $12.50 $20.30 $20.30

$0.80 $1.00 $1.30 $1.40 $1.60 $2.40 $3.60 $6.80 $10.40 $25.00 $40.60 $40.60

$1.20 $1.50 $1.95 $2.10 $2.40 $3.60 $5.40 $10.20 $15.60 $37.50 $60.90 $60.90

$1.60 $2.00 $2.60 $2.80 $3.20 $4.80 $7.20 $13.60 $20.80 $50.00 $81.20 $81.20

$2.00 $2.50 $3.25 $3.50 $4.00 $6.00 $9.00 $17.00 $26.00 $62.50 $101.50 $101.50

$2.80 $3.50 $4.55 $4.90 $5.60 $8.40 $12.60 $23.80 $36.40 $87.50 $142.10 $142.10

$4.00 $5.00 $6.50 $7.00 $8.00 $12.00 $18.00 $34.00 $52.00 $125.00 $203.00 $203.00

$5.20 $6.50 $8.45 $9.10 $10.40 $15.60 $23.40 $44.20 $67.60 $162.50 $263.90 $263.90

$6.00 $7.50 $9.75 $10.50 $12.00 $18.00 $27.00 $51.00 $78.00 $187.50 $304.50 $304.50

Spouse Life Rates (Spouse rate is based on Employee Age) SPOUSE AMOUNT CANNOT EXCEED 100% OF EMPLOYEE AMOUNT Age Band 0-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

$10,000

$20,000

$30,000

$40,000

$50,000

$70,000

$100,000

$130,000 $150,000

$0.50 $0.60 $0.80 $0.90 $1.00 $1.50 $2.30 $4.20 $6.50 $12.50 $20.30 $20.30

$1.00 $1.20 $1.60 $1.80 $2.00 $3.00 $4.60 $8.40 $13.00 $25.00 $40.60 $40.60

$1.50 $1.80 $2.40 $2.70 $3.00 $4.50 $6.90 $12.60 $19.50 $37.50 $60.90 $60.90

$2.00 $2.40 $3.20 $3.60 $4.00 $6.00 $9.20 $16.80 $26.00 $50.00 $81.20 $81.20

$2.50 $3.00 $4.00 $4.50 $5.00 $7.50 $11.50 $21.00 $32.50 $62.50 $101.50 $101.50

$3.50 $4.20 $5.60 $6.30 $7.00 $10.50 $16.10 $29.40 $45.50 $87.50 $142.10 $142.10

$5.00 $6.00 $8.00 $9.00 $10.00 $15.00 $23.00 $42.00 $65.00 $125.00 $203.00 $203.00

$6.50 $7.80 $10.40 $11.70 $13.00 $19.50 $29.90 $54.60 $84.50 $162.50 $263.90 $263.90

$7.50 $9.00 $12.00 $13.50 $15.00 $22.50 $34.50 $63.00 $97.50 $187.50 $304.50 $304.50

Child Life Rates Child(ren)

$5,000 $1.00

$10,000 $2.00

NOTE: FINAL RATES MAY VARY SLIGHTLY DUE TO ROUNDING. Employee Maximum is Lesser of 5x Salary or $500,00

THE HARTFORD YOUR BENEFITS PACKAGE

Voluntary 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?

33% of total healthcare costs are paid out-of-pocket.

Voluntary AD&D Benefit Highlights

What is Voluntary Accidental Death and Dismemberment Insurance?

What does Voluntary AD&D Insurance cover?

Voluntary Accidental Death and Dismemberment Insurance pays your beneficiary (please see below) a death benefit if you die due to a covered accident while you are insured. It also pays you a benefit for certain accidental losses. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. Death benefits are paid in addition to any life insurance benefits. Voluntary Accidental Death and Dismemberment Insurance pays benefits for accidental loss of limbs, thumb and index finger, speech, hearing, and sight. Voluntary Accidental Death and Dismemberment Insurance covers losses that occur away from work or at work. Benefits are paid regardless of any worker’s compensation benefits you collect. This highlight sheet is an overview of your Voluntary Accidental Death and Dismemberment Insurance. You may receive benefits due to certain losses or death from an accident. The covered losses or death can occur up to 365 days after that accident. The policy pays for:  100% of the amount of coverage you purchase in the event of accidental loss of life, or speech and hearing in both ears.  One-half (50%) for accidental loss of one hand or foot, sight of one eye, or speech or hearing in both ears.  One-quarter (25%) for accidental loss of thumb and index finger of the same hand. Additionally, your employer may have elected optional/supplemental benefits as part of your AD&D coverage. Refer to the certificate of insurance for further information. Your total benefit for all losses due to the same accident will not be more than 100% of the amount of coverage you purchase.

What optional benefits has my employer selected as part of my Voluntary AD&D Insurance?

       

Am I eligible?

You are eligible if you are an active full time employee who works at least 20 hours per week on a regularly scheduled basis.

When can I enroll?

When is it effective?

Coverage goes into effect subject to the terms and conditions of the policy. You must be actively at work with your employer on the day your coverage takes effect.

How much Voluntary AD&D Insurance can I purchase?

You can purchase Voluntary Accidental Death and Dismemberment Insurance in increments of $10,000. The maximum amount you can purchase cannot be more than 5 times your annual Earnings or $500,000. Earnings are as defined in The Hartford’s contract with your employer.

Adaptive Home and Vehicle Benefit Child Education Benefit Common Disaster Benefit Day Care Benefit Rehabilitation Benefit Repatriation Benefit Seat Belt & Air Bag Spouse Education Benefit

Voluntary AD&D Benefit Highlights Does my coverage reduce as I get By 35% @ 65 and 50% of original amount at 70. older? Do I have to provide medical information to receive coverage?

No medical information is required. You are guaranteed the amount of coverage that you select, subject to maximum amounts defined in your policy.

Are there other limitations to enrollment?

What is a beneficiary?

Are there other limitations to enrollment?

This coverage, like most group benefit insurance, requires that a certain percentage of eligible employees participate. If that group participation minimum is not met, the insurance coverage that you have elected may not be in effect. You may also choose Voluntary Accidental Death and Dismemberment Insurance for your spouse and/or dependent child(ren).

Voluntary Accidental Death and Dismemberment Insurance for your Dependents

You may choose Voluntary Accidental Death and Dismemberment Insurance for your spouse in the following amounts:  50% of the amount you select for yourself if you do not have any child(ren) whom you cover under this Voluntary Accidental Death and Dismemberment Insurance policy.  50% if you have child(ren) whom you cover under this Voluntary Accidental Death and Dismemberment Insurance policy. You may not elect coverage for your spouse if your spouse is already covered as an employee under this policy. You may choose guaranteed Voluntary Accidental Death and Dismemberment Insurance for each child at least 15 days but under age 25 in the following amounts:  10% of the amount you select for yourself if you do not have a spouse whom you cover under this Voluntary Accidental Death and Dismemberment Insurance policy  10% if you have a spouse whom you cover under this Voluntary Accidental Death and Dismemberment Insurance policy

Employee Only AD&D per $10,000 $0.30 Family AD&D per $10,000

$0.60

Voluntary AD&D Important Details As is standard with most insurance, this Voluntary Accidental Death and Dismemberment Insurance includes limitations and exclusions. Voluntary Accidental Death and Dismemberment Insurance does not cover losses caused by or contributed by:        

Sickness; disease; or any treatment for either; Any infection, except certain ones caused by an accidental cut or wound; Intentionally self-inflicted injury, suicide or suicide attempt; War or act of war, whether declared or not; Injury sustained while in the armed forces of any country or international authority; Taking prescription or illegal drugs unless prescribed for or administered by a licensed physician; Injury sustained while committing or attempting to commit a felony; The injured person’s intoxication.

Other exclusions may apply depending upon the terms of your policy and other requirements. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. This benefit highlights sheet is an overview of the general purposes of the Voluntary Accidental Death and Dismemberment Insurance being offered and is provided for illustrative purposes only and is not a contract. It in no way changes or affects the policy as actually issued. Only the insurance policy issued to the policyholder (your employer) can fully describe all of the provisions, terms, conditions, limitations and exclusions of your insurance coverage. In the event of any difference between the benefit highlights sheet and the policy, the terms of the insurance policy apply.

ID WATCHDOG

Identity Theft

YOUR BENEFITS PACKAGE

About this Benefit Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.

DID YOU KNOW?

An identity is stolen every 2 seconds, and takes over

300 hours

to resolve, causing an average loss of $9,650.

Identity Theft Identity theft can strike anyone, at any time. More than 11 million Americans were victimized by identity theft in 2011, including more than 500,000 children.

Identity theft devastates its victims financially. The average victim will lose $4,841, and spend an additional $1,400 in out-of-pocket expenses resolving their case.

Repairing the damage caused by identity theft is frustrating and time consuming. The average victim spends 330 hours repairing the damage from identity theftâ&#x20AC;&#x201D;the equivalent of working a full-time job for more than 2 months.

ID Watchdog Monthly Rates Plus

Platinum

Individual Plan

$7.95

$11.95

Family Plan

$14.95

$22.95

ID Watchdog Services Basic & Advanced Identity Monitoring Cyber Monitoring Full-Service Identity Restoration Non-Credit Loan Monitoring Address Monitoring Credit Report Monitoring 100% Resolution Guarantee

The impact of identity theft follows victims for years. 50% of identity theft victims experience trouble getting loans or credit cards as a result of identity theft. 12% of identity theft victims end up having warrants issued by law enforcement in their name for crimes committed by the identity thief.

Whoâ&#x20AC;&#x2122;s Evaluating your Credit Report? Potential Creditors, Potential Employers, Insurance Companies, Current Creditors, Government Agencies

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.

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.

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 Prosper ISD benefit website: www.mybenefitshub.com/prosperisd

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.

DID YOU KNOW?

FSA Annual Contribution Max:

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/prosperisd

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/ prosperisd 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.