2017 Benefit Guide Beaumont ISD by Higginbotham Public Sector

BEAUMONT ISD

BENEFIT GUIDE EFFECTIVE:

09/01/2017 - 8/31/2018 WWW.MYBENEFITSHUB.COM/ BEAUMONTISD

Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. ACA Employee Responsibilities TRS Aetna Medical American Public Life MEDlinkÂ® Plan MDLIVE Telehealth MetLife Dental UnitedHealthCare Vision Aetna Long-Term Disability American Public Life Cancer American Public Life Accident AUL a OneAmerica Life and AD&D Texas Life Individual Life UNUM Critical Illness ID Watchdog Identity Theft LifeWorks EAP NBS Flexible Spending Account MASA Emergency Transportation 2

3 4-5 6-11 6 7 8 9 10 11 12-15 16-21 22-23 24-27 28-29 30-35 36-41 42-45 46-49 50-51 52-53 54-55 56-57 58-61 62-63

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PG. 4 HOW TO HOW TO ENROLL ENROLL

PG. 6 SUMMARY PAGES

PG. 12 YOUR BENEFITS

Benefit Contact Information

Benefit Contact Information BENEFIT ADMINISTRATORS

EAP

TELEHEALTH

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

Lifeworks (888) 456-1324 www.lifeworks.com

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

TRS ACTIVECARE MEDICAL

VISION

IDENTITY THEFT

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

UnitedHealthCare (800) 638-3120 www.myuhcvision.com

IDWatchdog (866) 513-1518 www.idwatchdog.com

LIFE AND AD&D

EDUCATOR DISABILITY

ACCIDENT

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

Aetna Claims (888) 266-2917 www.mybenefitshub.com/ beaumontisd

American Public Life (800) 256-8606 www.ampublic.com

MEDICAL SUPPLEMENT—MEDLINK ®

CANCER

FLEXIBLE SPENDING ACCOUNT (FSA)

American Public Life (800) 256-8606 www.ampublic.com

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

DENTAL

CRITICAL ILLNESS

COBRA (DENTAL, VISION, MEDLINK, FSA)

MetLife (800) 942-0854 www.metlife.com/dental

UNUM Claims (800)635-5597 www.mybenefitshub.com/ beaumontisd

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

EMERGENCY TRANSPORTATION

INDIVIDUAL LIFE

COBRA (Medical)

MASA (800) 423-3226 www.masamts.com

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

WellSystems (844) 752-5146

MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS BEAUMONT” to 313131 and get access to everything you need to complete your benefits enrollment: 

Benefit Information



Online Support



Interactive Tools



And more. PLAY VIDEO

Text “FBS BEAUMONT” to 313131 OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/ beaumontisd

CLICK LOGIN

ENTER USERNAME & PASSWORD All login credentials have been RESET to the default described below:

Username: 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.

ONLIINE SUPPORT

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.

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

Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New:  Benefit elections will become effective 9/01/2017

(elections requiring evidence of insurability, such as life  Due to the Affordable Care Act (ACA), every employee is Insurance, may have a later effective date, if approved). required to login and complete the enrollment process, After annual enrollment closes, benefit changes can only even if you are declining benefits. be made if you experience a qualifying event and changes must be made within 31 days of event.  Dental Carrier is changing from Cigna to MetLife with a

Low and High Plan Option. No dental card required!  NEW! MASA provides national medical emergency

ground and air transportation solutions and covers your out of pocket medical transport cost. $9/month premium covers you and your eligible dependents.  Medical Flexible spending annual maximum will increase

to $2600 effective 9/1/17. Please remember you MUST login on the online enrollment system each year during annual enrollment to re-elect your flex amount. Existing cards will be funded by mid September. New participants will receive cards mid-late September at the address provided during enrollment in THEbenefitsHUB.  Good News! OneAmerica Voluntary Life will allow

employees/spouses to increase existing life insurance coverage one step up to guarantee issue without evidence of insurability.  Please remember to review your beneficiaries each year

as there could be a need for updates and/or changes.

Don’t Forget!    

Login and complete your benefit enrollment from 08/01/2017 - 08/21/2017 Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202 between 8am – 5pm CST Update your profile information: home address, phone numbers, email, beneficiaries REQUIRED: Provide correct dependent social security numbers 6

SUMMARY PAGES

Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. All enrollments in pretax benefits are subject to Cafeteria Plan rules; all eligible benefits (medical, medlink, dental, vision, cancer, accident, and FSA) will be pre-taxed. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year. CHANGES IN STATUS (CIS): Marital Status

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

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

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

Change in Status of Employment Affecting Coverage Eligibility

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

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

SUMMARY PAGES

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

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your benefit

Changes are not permitted during the plan year (outside of annual

website:

enrollment) unless a Section 125 qualifying event occurs.

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



Changes, additions or drops may be made only during the

the forms you need under the Benefits and Forms section.

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

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

ISD benefit website: www.mybenefitshub.com/beaumontisd.

included in the dependent profile. Additionally, you must

Click on the benefit plan you need information on (i.e.,

notify your employer of any discrepancy in personal and/or benefit information.



For benefit summaries and claim forms, go to the Beaumont

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.

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

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.

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. New medical and pharmacy ID cards will be mailed only for employees with a name change or change in medical coverage. You may print a temporary card from the Aetna

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

Navigator and Quick Access Caremark links at www.trsactivecareaetna.com

SUMMARY PAGES

your 2017 benefits become effective on September 1, 2017, you

Employee Eligibility Requirements

must be actively-at-work on September 1, 2017 to be eligible for your new benefits.

Medical Plans. Employees must work 20 regularly scheduled

Dependent Eligibility Requirements

hours each week for all supplemental benefits.

Dependent Eligibility: You can cover eligible dependent

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

children under a benefit that offers dependent coverage,

Eligible employees must be actively at work on the plan effective

provided you participate in the same benefit, to the maximum

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

age listed below. Dependents cannot be double covered by

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

married spouses within Beaumont ISD as both employees and

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

dependents.

PLAN

CARRIER

MAXIMUM AGE

Dental

Metlife

Vision

United Healthcare

Unmarried to 26

Life

OneAmerica

Unmarried to 26

MEDlink® Gap

American Public Life

To 26

Cancer

APL

To 26

Accident

American Public Life

To 26

Critical Illness

UNUM

Unmarried to 26

Telehealth

MDLIVE

Unmarried to 26

ID Theft Protection

IDWatchdog

Unmarried to 26

To 26

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

SUMMARY PAGES

Helpful Definitions Actively at Work

In-Network

You are performing your regular occupation for the employer

Doctors, hospitals, optometrists, dentists and other providers

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

who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2017 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

ACA Employee Responsibilities Mandatory Medical Enrollment

ACA 101

After becoming eligible, you must elect or decline medical coverage offered through your employer.

Medical Election Employee chooses to elect on the Medical Plans offered.

Play or Pay Rules If you elect a medical plan offered through your employer, you will receive the IRS Tax Form 1095 -C. You will use this document to file your 1040 Tax Return. However, if you choose to decline medical coverage, you will be subject to the Individual Mandate Penalties, unless you have a minimum essential health plan.

Are you electing to enroll in the medical plan?

YES

RECEIVE 1095 -C NO PENALTIES

YES

RECEIVE 1095 -C NO PENALTIES

Are you receiving medical coverage elsewhere? *See examples below NO

ď&#x201A;ˇ

2017 & Beyond Penalty is $695 per adult and $347.50 per child ( up to $2,085 for a family) OR 2.5% of family income, whichever is greater.

PENALTIES ASSESSED

*Examples of other coverage: -Military -Medicare -Medicaid -Through a spouse -Marketplace exchange

AETNA

Medical

YOUR BENEFITS PACKAGE

About this Benefit Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. More than 70% of adults across the United States are already being diagnosed with a chronic disease.

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

Beaumont ISD 2017 - 2018 TRS Premiums and District Contributions TRS-ActiveCare Plan 1HD

Total Cost Benefit

District Pays

Employee Pays

Employee Only

$351.00

$0.00

Employee & Spouse

$991.00

$460.00

$531.00

Employee & Child(ren)

$671.00

$460.00

$211.00

Employee & Family

$1,316.00

$460.00

$856.00

TRS-ActiveCare Select-

Total Cost Benefit

District Pays

Employee Pays

Employee Only

$514.00

$460.00

$54.00

Employee & Spouse

$1,264.00

$460.00

$804.00

Employee & Child(ren)

$834.00

$460.00

$374.00

Employee & Family

$1,589.00

$460.00

$1,129.00

TRS-ActiveCare 2

Total Cost Benefit

District Pays

Employee Pays

Employee Only

$714.00

$460.00

$254.00

Employee & Spouse

$1,694.00

$460.00

$1,234.00

Employee & Child(ren)

$1,062.00

$460.00

$602.00

Employee & Family

$2,004.00

$460.00

$1,544.00

2017 – 2018 TRS-ActiveCare Plan Highlights Effective September 1, 2017 through August 31, 2018 | In-Network Level of Benefits*

Deductible (per plan year) In-Network Out-of-Network Out-of-Pocket Maximum (per plan year; medical and prescription drug deductibles, copays, and coinsurance count toward the out-of-pocket maximum) In-Network Out-of-Network Coinsurance In-Network Participant pays (after deductible) Out-of-Network Participant pays (after deductible) Office Visit Copay Participant pays Diagnostic Lab Participant pays

Preventive Care See below for examples Teladoc® Physician Services

High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays Inpatient Hospital (preauthorization required) (facility charges) Participant pays Emergency Room (true emergency use) Participant pays Outpatient Surgery Participant pays Bariatric Surgery Physician charges (only covered if performed at an IOQ facility) Participant pays Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist using calibrated instruments) Participant pays Annual Hearing Examination Participant pays Preventive Care Routine physicals – annually age 12 and over Mammograms – 1 every year age 35 and over Smoking cessation counseling– 8 visits per 12 months

• Well-child care – unlimited up to age 12 • Colonoscopy – 1 every 10 years age 50 and over •Healthy diet/obesity counseling– unlimited to

• Well - woman exam & pap smear – annually age 18 and over • Prostate cancer screening–1 per year age 50 and over • Breastfeeding support – 6 lactation counseling visits

Drug Deductible Short-Term Supply at a Retail Location

Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to

90-day supply)****

Specialty Medications Short-Term Supply of a Maintenance Medication at Retail Location (up to a 31-day supply)

What is a maintenance medication? Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes.

When does the convenience fee apply? For example, if you are covered under TRS-ActiveCare Select, the first time you fill a 31-day supply of a generic maintenance drug at a retail pharmacy you will pay $20, then you will pay $35 each month that you fill a 31-day supply of that generic maintenance drug at a retail pharmacy. A 90-day supply of that same generic maintenance medication would cost $45, and you would save $225 over the year by filling a 90-day supply.

Premium Information for ALEX You will need to enter the applicable amount â&#x20AC;&#x201C; YOUR ANNUAL COST â&#x20AC;&#x201C; from the table below into ALEX when prompted. To determine this cost, ask your Benefits Administrator for your monthly cost (this is the amount you will owe each month after your employer contributes to your coverage). Then multiply your monthly cost by 12 to get YOUR ANNUAL COST (use this amount for ALEX) Individual

$351

$514

$714

+Spouse

$991

$1,264

$1,694

+Children

$671

$834

$1,062

+Family

$1,316

$1,589

$2,004

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. **For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,500 - individual, $5,000 - family) and they pay nothing out of pocket for these drugs. The list of drugs is on the TRS-ActiveCare website. ***If a participant obtains a brand-name drug when a generic equivalent is available, they are responsible for the generic copay plus the cost difference between the brand-name drug and the generic drug. 15 ****Participants can fill 32-day to 90-day supply through mail order.

AMERICAN PUBLIC LIFE YOUR BENEFITS PACKAGE

MEDlinkÂŽ

PLAY VIDEO

About this Benefit Medical supplement is designed to help supplement your Employer's major medical plan. This plan provides supplemental coverage to help offset outof-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your medical plan.

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

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 16 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

MEDlink® IV Enhanced

Limited Benefit Group Medical Expense Supplemental Insurance Beaumont ISD

THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

ENHANCED PLAN SUMMARY OF BENEFITS*

Base Policy

Option 1

Maximum In-Hospital Benefits

$1,500 per Covered Person per Confinement

In-Hospital Ambulance Benefit

Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person is Confined as an Inpatient. Limited to one trip per day.

In-Hospital Deductible

$0 per Covered Person per Confinement

Outpatient Benefit Rider Maximum Outpatient Benefits

$500 per Covered Person per Occurrence for Covered Outpatient Services

Outpatient Ambulance Benefit

Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person resides less than 18 hours. Limited to one trip per day.

Outpatient Deductible

$0 per Covered Person Per Occurrence

Covered Outpatient Services Hospital Emergency Room

Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Urgent Care Facility

Maximum of three Urgent Care visits per Covered Person per Calendar Year. Maximum of six Urgent Care visits per Calendar Year for all Covered Persons combined. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Outpatient Surgery

Outpatient Surgery in Hospital Outpatient Facility or Freestanding Outpatient Surgery Center. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Diagnostic Testing

Diagnostic Testing in a Hospital Outpatient Facility or MRI Facility. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Outpatient Treatment for a Serious Mental Illness in a Hospital Outpatient Facility

Maximum of 60 days of treatment per Covered Person per Calendar Year. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Benefit Rider Physician Outpatient Treatment Benefit Rider

$25 per visit; Maximum of four visits per Covered Person per Calendar Year and eight visits per Calendar Year for all Covered Persons combined for treatment in a: Hospital Outpatient Facility s s Freestanding Emergency Care Clinic s Urgent Care Facility/Clinic s Physician Office

Total Monthly Premiums by Plan* Ages 18-54 Ages 55+

Employee

Employee & Spouse

Employee & Child

Employee & Family

$29.44

$68.16

$53.59

$92.20

$42.14

$97.36

$75.18

$130.30

*Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice. The premium and amount of benefits vary dependent upon the Plan selected at time of application.

Important Policy Provisions Eligibility

You are eligible to be covered under this Policy/Certificate if you are Actively At Work, qualify for coverage as defined in the Master Application, are covered under your Employer’s Medical Plan and are under age 70 (if you work for an employer employing less than 20 employees). Your Eligible Dependents, as defined in the Policy/Certificate, are eligible for coverage if they are covered under the Employer’s Medical Plan. You must apply for insurance during the Initial Enrollment period or on the date the person first becomes eligible for coverage. If you do not apply during the Initial Enrollment period or on the date you become eligible for coverage, you may be subject to additional underwriting by APL. Evidence of coverage under your Employer’s Medical Plan is required. APSB-22354(TX) MGM/FBS Beaumont ISD

When Coverage Begins

Coverage will begin on the requested Certificate Effective Date or the Certificate Effective Date assigned by us, upon approval of your application, if our underwriting rules are met, the premium has been paid and all persons to be insured are covered under your Employer’s Medical Plan and you are Actively At Work on the Certificate Effective Date. If you are not Actively At Work on the Certificate Effective Date due to disability, Injury, Sickness, temporary layoff, leave of absence or Family and Medical Leave of Absence, coverage begins on the date you return to Actively At Work. 17

Limitations & Exclusions No benefits will be payable for expenses incurred during any period the Covered Person does not have coverage under your Employer’s Medical Plan, except as provided in the Absence of the Insured’s Employer’s Medical Plan provision, described in the Policy. A hospital is not an institution, or part thereof, used as: a place for rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a long term nursing unit or geriatrics ward, or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients.

Pre-Existing Condition Limitation

No benefits are payable during the Pre-Existing Condition Exclusion Period following the Covered Person’s Effective Date for any loss resulting from a Pre-Existing Condition. The Pre-Existing Condition Limitation will apply only if the Covered Person is subject to a Pre-Existing Condition Limitation under the Employer’s Medical Plan. Therefore, any Pre-Existing Condition Limitation applied to the Major Medical plan would, in effect, limit coverage under this plan.

Exclusions

No benefits are payable for any loss resulting from or caused, whether directly or indirectly, by: s war or any act of war, whether declared or undeclared, or active service in the armed forces; (This exclusion includes Accident sustained or Sickness contracted while in the service of any military, naval or air force of any country engaged in war. If coverage is suspended for any Covered Person during a period of military service, APL will refund the pro-rata portion of any premium paid for any such Covered Person upon receipt of your written request) s an intentionally self-inflicted Injury or Sickness; s suicide or attempted suicide, while sane or insane; s rest care or rehabilitative care and treatment; s outpatient routine newborn care; s voluntary abortion except, with respect to you or your covered Eligible Dependent spouse: s where you or your Dependent spouse’s life would be endangered if the fetus were carried to term; or s where medical complications have arisen from abortion; s pregnancy of an Eligible Dependent child; s participating in a riot, insurrection, rebellion, civil commotion, civil disobedience or unlawful assembly; (This does not include a loss which occurs while acting in a lawful manner within the scope of authority.) s committing, or attempting to commit, an illegal act that is defined as a felony; (Felony is as defined by the law of the jurisdiction in which the act takes place.) s participation in a contest of speed in power driven vehicles, parachuting or hang gliding; s air travel, except: s as a fare-paying passenger on a commercial airline on a regularly scheduled route; or s as a passenger for transportation only and not as a pilot or crew member; s being intoxicated or under the influence of any narcotic unless administered by a Physician or taken according to the Physician’s instructions; (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the event that caused the loss occurred.) s alcoholism or drug addiction; s sex changes; s experimental treatment, drugs or surgery; s Accident or Sickness arising out of, and in the course of, any occupation for compensation, wage or profit; (This does not apply to those sole proprietors or partners not covered by Workers’ Compensation.) s dental or vision services, including treatment, surgery, extractions or x-rays, unless:

s s s s s s s

s resulting from an Accident occurring while the Covered Person’s coverage is in force and if performed within 12 months of the date of such Accident; or s due to congenital disease or anomaly of a covered newborn child. routine examinations, such as health exams, periodic check-ups or routine physicals, except when part of Inpatient routine newborn care; elective cosmetic surgery; drugs (prescription and non-prescription for use outside of a covered facility as defined in this Policy/Certificate or any attached rider); sterilization and reversal of sterilization; an expense that does not meet the definition of Covered Charges; an expense or service that exceeds any of the Maximum Benefits, as shown in the Schedule of Benefits; or any expense for which benefits are not payable under your Other Medical Plan.

Premium Changes

The premium rates may be changed by APL at the first anniversary date of this Policy or any premium due date thereafter. No such increase in rates will be made unless 60 days prior notice is given to the Policyholder. Premiums will not increase during the initial 12 months of coverage.

Optionally Renewable

This Policy is renewable at the option of APL. The Policyholder or APL may terminate this Policy on any premium due date after the first anniversary following the Policy Effective Date, subject to 60 days written notice.

Termination of Certificate

Your insurance coverage under this Certificate and any attached riders will end on the earliest of these dates: s the date the Policy terminates; s the end of the grace period if the premium remains unpaid; s the date you no longer qualify as an Insured; s the date you attain age 70 (if you work for an employer employing less than 20 employees); s the date your coverage under your Employer’s Medical Plan ends; or s the date of your death.

Termination of Coverage

Your insurance coverage under this Certificate and any attached riders for a Covered Person will end as follows: s the date the Policy terminates; s the date the Certificate terminates; s the end of the Certificate Month in which APL receives a written request from you to terminate the Covered Person’s coverage; s the date a Covered Person no longer qualifies as an Insured or Eligible Dependent; or s the date of the Covered Person’s death. APL may end the coverage of any Covered Person who submits a fraudulent claim.

Cobra Continuation of Coverage

This plan may be continued in accordance with the Consolidated Omnibus Reconciliation Act of 1986.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606

Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the certificate/policy and riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form MEDlink® Series | Texas | Limited Benefit Group Medical Expense Supplemental Insurance | 18 ISD (10/14) | Beaumont

APSB-22354(TX)18 MGM/FBS Beaumont ISD

MEDlink® IV Enhanced

Limited Benefit Group Medical Expense Supplemental Insurance Beaumont ISD

ENHANCED PLAN SUMMARY OF BENEFITS*

Base Policy

Option 2

Maximum In-Hospital Benefits

$2,500 per Covered Person per Confinement

In-Hospital Ambulance Benefit

Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person is Confined as an Inpatient. Limited to one trip per day.

In-Hospital Deductible

$0 per Covered Person per Confinement

Outpatient Benefit Rider Maximum Outpatient Benefits

$500 per Covered Person per Occurrence for Covered Outpatient Services

Outpatient Ambulance Benefit

Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a Covered Person resides less than 18 hours. Limited to one trip per day.

Outpatient Deductible

$0 per Covered Person Per Occurrence

Covered Outpatient Services Hospital Emergency Room

Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Urgent Care Facility

Outpatient Surgery

Diagnostic Testing

Diagnostic Testing in a Hospital Outpatient Facility or MRI Facility. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Outpatient Treatment for a Serious Mental Illness in a Hospital Outpatient Facility

Maximum of 60 days of treatment per Covered Person per Calendar Year. Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.

Benefit Rider Physician Outpatient Treatment Benefit Rider

Total Monthly Premiums by Plan* Ages 18-54 Ages 55+

Employee

Employee & Spouse

Employee & Child

Employee & Family

$34.73

$80.30

$62.57

$108.05

$50.06

$115.58

$88.64

$154.06

Important Policy Provisions Eligibility

When Coverage Begins

Pre-Existing Condition Limitation

Exclusions

s s s s s s s

Premium Changes

Optionally Renewable

Termination of Certificate

Termination of Coverage

Cobra Continuation of Coverage

This plan may be continued in accordance with the Consolidated Omnibus Reconciliation Act of 1986.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606

APSB-22354(TX)20 MGM/FBS Beaumont ISD

MEDlinkÂŽ IV Enhanced Limited Benefit Group Medical Expense Supplemental Insurance Beaumont ISD

MDLIVE YOUR BENEFITS PACKAGE

Telehealth

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

75%

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

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 22 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

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

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

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

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

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

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

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

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

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

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

Scan with your smartphone to get the app.

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

Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for 23 abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/pages/terms.html 010113

METLIFE

Dental

YOUR BENEFITS PACKAGE

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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.

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.

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 24 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Dental - PPO - Low Plan In-Network1 % of PDP Fee2

Out-of-Network1 % of R&C Fee4

Type A - Preventive Type B - Basic Restorative Type C - Major Restorative Type D - Orthodontia

100% 70% 50% 50%

Individual Family

$50 $150

$750

Coverage Type:

Deductible†

Annual Maximum Benefit: Per Individual

Child to age 19

Orthodontia Lifetime Maximum Ortho applies to Child Only

$1000 per Person

Child(ren)’s eligibility for dental coverage is from birth up to age 26, regardless of student status. Orthodontia coverage for dependent children up to age 19. *Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. **R&C fee refers to the Reasonable and Customary (R&C) charge, which is based on the lowest of (1) the dentist’s actual charge, (2) the dentist’s usual charge for the same or similar services, or (3) the charge of most dentists in the same geographic area for the same or similar services as determined by MetLife. † Applies only to Type B & C Services.

TYPE A—Preventive

How Many/How Often:

Prophylaxis (cleanings) Oral Examinations Topical Fluoride Applications

Two per calendar year Two exams per calendar year One fluoride treatment per calendar year for dependent children up to his/her 19th birthday  Full mouth X-rays; one per 36 months  Bitewing X-rays; two sets per calendar year 1 per lifetime One application of sealant material every 3 calendar years for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to his/her 14th birthday Replacement once every 24 months

X-rays Space Maintainers Sealants Fillings

TYPE B—Basic Restorative

How Many/How Often:

Simple Extractions Oral Surgery General Anesthesia

When dentally necessary in connection with oral surgery, extractions or other covered dental services

TYPE C—Major Restorative

How Many/How Often:

Crown, Denture and Bridge Repair/ Recementations Bridges and Dentures Crowns, Inlays and Onlays Endodontics Periodontics

TYPE D—Orthodontia

    

  

Initial placement to replace one or more natural teeth, which are lost while covered by the plan Dentures and bridgework replacement; one every 5 calendar years Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed Replacement once every 10 calendar years Root canal treatment limited to once per tooth per lifetime  Periodontal scaling and root planing once per quadrant, every 24 months  Periodontal surgery once per quadrant, every 36 month period  Periodontal Maintenance: 2 perio treatments in 1 calendar yr, includes 2 cleanings (total comb: 2)

How Many/How Often:

You, your spouse and your children, up to age 19, are covered while Dental insurance is in effect All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia Payments are on a repetitive basis 20% of the Orthodontia Lifetime Maximum will be considered at initial placement of the appliance and paid based on the plan benefit’s coinsurance level for Orthodontia as defined in the plan summary Orthodontic benefits end at cancellation of coverage

The following monthly costs are effective through August 31, 2019. Your premium will be paid through convenient payroll deduction. Monthly cost covers all eligible children.

Monthly Rate

Employee $22.84

Employee & Spouse $44.54

Employee & Child(ren) $50.28

Employee & Family $70.80

Dental - PPO - High Plan In-Network1 % of PDP Fee2

Out-of-Network1 % of R&C Fee4

Type A - Preventive Type B - Basic Restorative Type C - Major Restorative Type D - Orthodontia

100% 80% 50% 50%

Individual Family

$50 $150

$1,250

Coverage Type:

Deductible†

Annual Maximum Benefit: Per Individual

Child to age 19

Orthodontia Lifetime Maximum Ortho applies to Child Only

$1,500 per Person

TYPE A—Preventive

How Many/How Often:

Prophylaxis (cleanings) Oral Examinations Topical Fluoride Applications

X-rays Space Maintainers Sealants Fillings

TYPE B—Basic Restorative

How Many/How Often:

Simple Extractions Oral Surgery General Anesthesia

When dentally necessary in connection with oral surgery, extractions or other covered dental services

TYPE C—Major Restorative

How Many/How Often:

Crown, Denture and Bridge Repair/ Recementations Bridges and Dentures Crowns, Inlays and Onlays Endodontics Periodontics

TYPE D—Orthodontia

    

  

How Many/How Often:

The following monthly costs are effective through August 31, 2019. Your premium will be paid through convenient payroll deduction. Monthly cost covers all eligible children.

Monthly Rate

Employee $27.24

Employee & Spouse $53.18

Employee & Child(ren) $59.94

Employee & Family $84.48

Exclusions This plan does not cover the following services, treatments and supplies:



Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature;

   

Services for which you would not be required to pay in the absence of Dental Insurance;

       

     

Services or supplies received by you or your Dependent before the Dental Insurance starts for that person; Services which are primarily cosmetic (for Texas residents, see notice page section in Certificate); Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for: i) Scaling and polishing of teeth; or ii) Fluoride treatments; Services or appliances which restore or alter occlusion or vertical dimension; Restoration of tooth structure damaged by attrition, abrasion or erosion; Restorations or appliances used for the purpose of periodontal splinting; Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco; Personal supplies or devices including, but not limited to: water picks, toothbrushes, or dental floss; Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work; Missed appointments; Services: i) Covered under any workers’ compensation or occupational disease law; ii) Covered under any employer liability law; iii) For which the employer of the person receiving such services is not required to pay; or iv) Received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital; Services covered under other coverage provided by the Employer; Temporary or provisional restorations; Temporary or provisional appliances; Prescription drugs; Services for which the submitted documentation indicates a poor prognosis; The following when charged by the Dentist on a separate basis: i) Claim form completion; ii) Infection control such as gloves, masks, and sterilization of supplies; or iii) Local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.

  

Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food;

  

Other fixed Denture prosthetic services not described elsewhere in the certificate;

Caries susceptibility tests; Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;

Precision attachments, except when the precision attachment is related to implant prosthetics; Initial installation of a full or removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;



Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;

   

Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it;

      

Fixed and removable appliances for correction of harmful habits;

Implants including, but not limited to any related surgery, placement, restorations, maintenance, and removal; Repair of implants; Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;

Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards; Diagnosis and treatment of temporomandibular joint (TMJ) disorders. This exclusion does not apply to residents of Minnesota; Repair or replacement of an orthodontic device; Duplicate prosthetic devices or appliances; Replacement of a lost or stolen appliance, Cast Restoration, or Denture; and Intra and extraoral photographic images

UNITEDHEALTHCARE YOUR BENEFITS PACKAGE

Vision

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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.

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

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 28 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

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

$7.74 $14.68 $17.22 $24.24

Co-Pays for In-Network Services Exam Materials

$10 $25

Benefit Frequency Comprehensive Exam Spectacle Lenses Frames Contact Lenses in Lieu of Eye Glasses

Once every 12 months Once every 12 months Once every 12 months Once every 12 months

Frame Benefit Private Practice Provider Retail Chain Provider

$150.00 retail frame allowance $150.00 retail frame allowance

Out-of-Network Reimbursements Up To: (copays do not apply) Exams Frames Single Vision Lenses Bifocal Lenses Trifocal Lenses Lenticular Lenses Elective Contacts in Lieu of Eye Glasses2 Necessary Contacts in Lieu of Eye Glasses3

 

Lens Options

Contact Lens Benefit

Laser Vision Benefit UnitedHealthcare Vision has partnered with the Laser Vision Network of America (LVNA) to provide our members with access to discounted laser vision correction providers. Members receive 15% off usual and customary pricing, 5% off promotional pricing at over 500 network provider locations and even greater discounts through set pricing at LasikPlus locations. For more information, call 1-888-563-4497 or visit us at www.uhclasik.com. 1Coverage for Covered Contact Lens Selection does not apply at Costco, Walmart or Sam’s Club locations. The allowance for non-selection contact lenses will be applied toward the fitting/ evaluation fee and purchase of all contacts. 2Necessary contact lenses are determined at the provider’s discretion for one or more of the following conditions: Following post cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be corrected with spectacle lenses; with certain conditions such as keratoconus, anisometropia, irregular corneal/astigmatism, aphakia, facial deformity or corneal deformity. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare Vision confirming reimbursement that UnitedHealthcare Vision will make before you purchase such contacts. 3The out-of-network reimbursement applies to materials only. The fitting/evaluation is not included.

$150.00 $210.00

Important to Remember

Standard scratch-resistant coating, Polycarbonate Lenses -covered in full. Other optional lens upgrades may be offered at a discount. (Discount varies by provider.) Covered-in-full elective contact lenses1 The fitting/evaluation fees, contact lenses, and up to two follow-up visits are covered in full (after copay). If you choose disposable contacts, up to 6 boxes are included when obtained from a network provider. All other elective contact lenses A $150.00 allowance is applied toward the fitting/evaluation fees and purchase of contact lenses outside the covered selection (materials copay does not apply). Toric, gas permeable and bifocal contact lenses are examples of contact lenses that are outside of our covered contacts. Necessary contact lenses2 Covered in full after applicable copay.

$40.00 $45.00 $40.00 $60.00 $80.00 $80.00



Benefit frequency based on last date of service. Your $150.00 contact lens allowance is applied to the fitting/evaluation fees as well as the purchase of contact lenses. For example, if the fitting/evaluation fee is $30, you will have $120.00 toward the purchase of contact lenses. The allowance may be separated at some retail chain locations between the examining physician and the optical store. You can log on to our website to print off your personalized ID card. An ID card is not required for service, but is available as a convenience to you should you wish to have an ID card to take to your appointment. Out-of-Network Reimbursement, when applicable: Receipts for services and materials purchased on different dates must be submitted together at the same time to receive reimbursement. Receipts must be submitted within 12 months of date of service to the following address: UnitedHealthcare Vision Attn. Claims Department P.O. Box 30978 Salt Lake City, UT 84130 FAX: 248.733.6060. At a participating network provider you will receive a 20% discount on an additional pair of eyeglasses or contact lenses. This program is available after your vision benefits have been exhausted. Please note that this discount shall not be considered insurance, and that UnitedHealthcare Vision shall neither pay nor reimburse the provider or member for any funds owed or spent. Not all providers may offer this discount. Please contact your provider to see if they participate. Discounts on contact lenses may vary by provider. Additional materials do not have to be purchased at the time of initial material purchase. Additional materials can be purchased at a discount any time after the insured benefit has been used.

AETNA YOUR BENEFITS PACKAGE

Long Term Disability

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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.

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.

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 30 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Long Term Disability Disability benefits replace a portion of your pay when you are unable to work due to illness, injury or pregnancy. You pay the full cost of this coverage.

Benefit Amount You may purchase a monthly benefit in $100 units, starting at a minimum of $200 and up to 66 2/3% of your monthly earnings to a maximum monthly benefit of $7,500, depending on your income.

Elimination Period The elimination period is the length of time of continuous disability due to a covered sickness or injury, which must be satisfied before you are eligible to receive benefits. Employees can choose from among four accident/sickness Benefit Elimination periods. Accident Sickness 0 days 7 days 14 days 14 days 30 days 30 days 60 days 60 days If you have selected an elimination period of 30 days or less, and if because of your disability you are hospital confined as an inpatient for 24 hours or more, benefits will begin immediately and the remainder of the elimination period will be waived.

Duration of Benefits Maximum Benefit Period is SSNRA for Disability due to Injury and Sickness: Your period of disability will end when the later of the following events occur:  The calendar month when you reach normal retirement age, as determined by the 1983 Amended Social Security Normal Retirement Age; or  The expiration of the number of months of disability, after the elimination period is met as figured from the Certificate Schedule, if your disability starts on or after the date you reach age 62.

Reduction of Benefits Your Long-Term Disability benefit is reduced by other sources of income that are payable to you, such as Social Security or TRS Retirement benefits. A Disability claim is not payable to the insured for any work-related injury.

Pre-Existing Condition Exclusion There is a 3/12 pre-existing conditions clause. This is a look back period to see if you were treatment-free for a 3-month period prior to the effective date of your coverage. If you weren’t treatment-free, the pre-existing condition is excluded from coverage if you’re disabled within 12-months of first becoming insured. In addition, if during an annual enrollment period you apply for additional benefits or select a shorter elimination period, this plan will not cover the increase in your coverage if you have a pre-existing condition.

How to File a Claim Call the Aetna Disability Service Center at 888-266-2917 to file your claim. Aetna will send a claim packet to your home address that includes an authorization form. Fax the completed authorization form to Aetna at 866-6671987. Forward a copy of the completed authorization form to your health care provider.

Limitations & Exclusions Benefits for Mental/Nervous/Substance Abuse/Self-Reported Illnesses are limited to 12 months lifetime combined Occupational Injury or Illness Exclusion: Long Term Disability coverage does not cover any disability that is due to an occupational illness or occupational injury.

Definitions Definition of Disability 2 Year Own Occ with Residual. Covers Non-Occupational disabilities – not in lieu of Workers Compensation. During the Elimination Period and the Own Occupation Period – any day that an individual is unable to perform the material duties of his/her own occupation; or while unable to perform the material duties of his/her own occupation, is performing at least one of the material duties of any occupation on a parttime or full-time basis and has lost at least 20% of their indexed pre-disability earnings due to a disable condition. During the any reasonable occupation period – any day that an individual is unable to perform the material duties of any occupation for which he/she is or may become fitted, based on training, education or experience; or while unable to perform the material duties of any reasonable occupation, is performing at least one of the material duties of any occupation on a part-time or full-time basis and has lost at least 40% of his/her pre-indexed earnings due to a disabling condition.

Long Term Disability Recurrent Disability If 2 or more separate periods of disability are due to the same or related causes they will be deemed to be one period of disability and only one elimination period will apply if the separation occurs during the elimination period and the periods are separated by less than 30 days of work or the separation occurs after the elimination period and the periods are separated by less than 6 months of work. Deductible Income Income benefit sources payable to the employee, employee’s spouse, children and/or dependents due to the employee’s disability or retirement. Sources include, but are not limited to, benefits payable from: unemployment compensation, Workers’ Comp, statutory disability plans, veteran’s benefits, Assault Leave Benefits, and any other group or association disability or retirement plans. The following Income benefit sources have a 6 month deferral in which no offset will be applied. Employer provided sick leave or salary continuation, Auto Liability Insurance, Social Security, 3rd party liability, statutory disability plans or any other group or association disability. All other offsets are immediate. 12 Month Return-to-Work Incentive This benefit gives an employee the opportunity to return to work part time earning some income plus receive LTD benefits allowing them to receive up to 100% income replacement during the first 12 months. Rehabilitation Program During the employee’s active participation in an Aetna approved Rehabilitation Program, Aetna will pay an additional 10% of the monthly benefit after all applicable reductions for other income benefits but not more than $500 per month. This incentive will be paid up to 6 consecutive months for each period of disability. Child/Dependent Care After 6 months of benefit are paid, a benefit is available to reimburse an employee for dependent care expenses while participating in an approved rehabilitation program. An amount of $350 per month per dependent to a maximum of $1,000 is payable for up to 24 months.

Continuity of Coverage Insured individuals do not lose coverage due to an employer’s change in group insurance carriers. EAP Enhanced EAP includes 3 face to face counseling sessions for covered members and their immediate household members per year and unlimited telephonic EAP consultations. 32

Survivor Benefit Pays a lump sum equal to 3 times the non-integrated LTD benefit. Must be disabled 180 days before benefit will be payable.

Social Security Assistance Assistance for eligible employees with the application process for Social Security disability benefits. Waiver of Premium If you become disabled, your premium payment for your insurance will be waived on any premium due date on which: (1) You remain Disabled for 90 consecutive days; and (2) Disability Benefits are being paid or are payable for the Disability. Worksite Modification Benefit This benefit allows Aetna to pay for expenses of worksite modifications that result in a disabled employee’s return to work.

Long Term Disability Accident/Sickness Benefit Waiting Period Monthly Cost

Beaumont Independent School District Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

0/7

$3,600

$300

$200.00

$12.00

$8.60

$6.88

$5.60

$5,400

$450

$300.00

$18.00

$12.90

$10.32

$8.40

$7,200

$600

$400.00

$24.00

$17.20

$13.76

$11.20

$9,000

$750

$500.00

$30.00

$21.50

$17.20

$14.00

$10,800

$900

$600.00

$36.00

$25.80

$20.64

$16.80

$12,600

$1,050

$700.00

$42.00

$30.10

$24.08

$19.60

$14,400

$1,200

$800.00

$48.00

$34.40

$27.52

$22.40

$16,200

$1,350

$900.00

$54.00

$38.70

$30.96

$25.20

$18,000

$1,500

$1,000.00

$60.00

$43.00

$34.40

$28.00

$19,800

$1,650

$1,100.00

$66.00

$47.30

$37.84

$30.80

$21,600

$1,800

$1,200.00

$72.00

$51.60

$41.28

$33.60

$23,400

$1,950

$1,300.00

$78.00

$55.90

$44.72

$36.40

$25,200

$2,100

$1,400.00

$84.00

$60.20

$48.16

$39.20

$27,000

$2,250

$1,500.00

$90.00

$64.50

$51.60

$42.00

$28,800

$2,400

$1,600.00

$96.00

$68.80

$55.04

$44.80

$30,600

$2,550

$1,700.00

$102.00

$73.10

$58.48

$47.60

$32,400

$2,700

$1,800.00

$108.00

$77.40

$61.92

$50.40

$34,200

$2,850

$1,900.00

$114.00

$81.70

$65.36

$53.20

$36,000

$3,000

$2,000.00

$120.00

$86.00

$68.80

$56.00

$37,800

$3,150

$2,100.00

$126.00

$90.30

$72.24

$58.80

$39,600

$3,300

$2,200.00

$132.00

$94.60

$75.68

$61.60

$41,400

$3,450

$2,300.00

$138.00

$98.90

$79.12

$64.40

$43,200

$3,600

$2,400.00

$144.00

$103.20

$82.56

$67.20

$45,000

$3,750

$2,500.00

$150.00

$107.50

$86.00

$70.00

$46,800

$3,900

$2,600.00

$156.00

$111.80

$89.44

$72.80

$48,600

$4,050

$2,700.00

$162.00

$116.10

$92.88

$75.60

$50,400

$4,200

$2,800.00

$168.00

$120.40

$96.32

$78.40

$52,200

$4,350

$2,900.00

$174.00

$124.70

$99.76

$81.20

$54,000

$4,500

$3,000.00

$180.00

$129.00

$103.20

$84.00

$55,800

$4,650

$3,100.00

$186.00

$133.30

$106.64

$86.80

$57,600

$4,800

$3,200.00

$192.00

$137.60

$110.08

$89.60

$59,400

$4,950

$3,300.00

$198.00

$141.90

$113.52

$92.40

$61,200

$5,100

$3,400.00

$204.00

$146.20

$116.96

$95.20

$63,000

$5,250

$3,500.00

$210.00

$150.50

$120.40

$98.00

$64,800

$5,400

$3,600.00

$216.00

$154.80

$123.84

$100.80

$66,600

$5,550

$3,700.00

$222.00

$159.10

$127.28

$103.60

14 /14

30/30

60/60

Long Term Disability Accident/Sickness Benefit Waiting Period Monthly Cost

Beaumont Independent School District Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

0/7

14 /14

30/30

60/60

$68,400

$5,700

$3,800.00

$228.00

$163.40

$130.72

$106.40

$70,200

$5,850

$3,900.00

$234.00

$167.70

$134.16

$109.20

$72,000

$6,000

$4,000.00

$240.00

$172.00

$137.60

$112.00

$73,800

$6,150

$4,100.00

$246.00

$176.30

$141.04

$114.80

$75,600

$6,300

$4,200.00

$252.00

$180.60

$144.48

$117.60

$77,400

$6,450

$4,300.00

$258.00

$184.90

$147.92

$120.40

$79,200

$6,600

$4,400.00

$264.00

$189.20

$151.36

$123.20

$81,000

$6,750

$4,500.00

$270.00

$193.50

$154.80

$126.00

$82,800

$6,900

$4,600.00

$276.00

$197.80

$158.24

$128.80

$84,600

$7,050

$4,700.00

$282.00

$202.10

$161.68

$131.60

$86,400

$7,200

$4,800.00

$288.00

$206.40

$165.12

$134.40

$88,200

$7,350

$4,900.00

$294.00

$210.70

$168.56

$137.20

$90,000

$7,500

$5,000.00

$300.00

$215.00

$172.00

$140.00

$91,800

$7,650

$5,100.00

$306.00

$219.30

$175.44

$142.80

$93,600

$7,800

$5,200.00

$312.00

$223.60

$178.88

$145.60

$95,400

$7,950

$5,300.00

$318.00

$227.90

$182.32

$148.40

$97,200

$8,100

$5,400.00

$324.00

$232.20

$185.76

$151.20

$99,000

$8,250

$5,500.00

$330.00

$236.50

$189.20

$154.00

$100,800

$8,400

$5,600.00

$336.00

$240.80

$192.64

$156.80

$102,600

$8,550

$5,700.00

$342.00

$245.10

$196.08

$159.60

$104,400

$8,700

$5,800.00

$348.00

$249.40

$199.52

$162.40

$106,200

$8,850

$5,900.00

$354.00

$253.70

$202.96

$165.20

$108,000

$9,000

$6,000.00

$360.00

$258.00

$206.40

$168.00

$109,800

$9,150

$6,100.00

$366.00

$262.30

$209.84

$170.80

$111,600

$9,300

$6,200.00

$372.00

$266.60

$213.28

$173.60

$113,400

$9,450

$6,300.00

$378.00

$270.90

$216.72

$176.40

$115,200

$9,600

$6,400.00

$384.00

$275.20

$220.16

$179.20

$117,000

$9,750

$6,500.00

$390.00

$279.50

$223.60

$182.00

$118,800

$9,900

$6,600.00

$396.00

$283.80

$227.04

$184.80

$120,600

$1,050

$6,700.00

$402.00

$288.10

$230.48

$187.60

$122,400

$10,200

$6,800.00

$408.00

$292.40

$233.92

$190.40

$124,200

$10,350

$6,900.00

$414.00

$296.70

$237.36

$193.20

$126,000

$10,500

$7,000.00

$420.00

$301.00

$240.80

$196.00

$127,800

$10,650

$7,100.00

$426.00

$305.30

$244.24

$198.80

$129,600

$10,800

$7,200.00

$432.00

$309.60

$247.68

$201.60

$131,400

$10,950

$7,300.00

$438.00

$313.90

$251.12

$204.40

$133,200

$11,100

$7,400.00

$444.00

$318.20

$254.56

$207.20

$135,000

$11,250

$7,500.00

$450.00

$322.50

$258.00

$210.00

Long Term Disability Find your annual/monthly earnings above to determine your Maximum Monthly Benefit. If your annual/monthly earnings are not shown, use the next lower annual/monthly earnings and corresponding Maximum Benefit.

This Summary of Benefits and the accompanying Brochure and Enrollment Form explain/explains the general purpose of the insurance described, but in no way changes or affects the policy as it is actually issued. In the event of any discrepancy between any of these documents and the policy, the terms of the policy apply. Life, AD&D Ultra, STD, and LTD products contain limitations and exclusions, complete coverage information can be found in your Booklet-Certificate if you become insured. Please read it carefully and keep it in a safe place with your other important papers.

APL

Cancer

YOUR BENEFITS PACKAGE

PLAY VIDEO

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.

Breast Cancer is the most commonly diagnosed cancer in women.

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

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 36 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

GC14 Limited Benefit Group Cancer Indemnity Insurance Beaumont ISD THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NONSUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

SUMMARY OF BENEFITS

Option 1

Option 2

Cancer Treatment Policy Benefits

Level 1

Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12-month period

$10,000

$50 per treatment

Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment Cancer Screening Rider Benefits Diagnostic Testing - 1 test per calendar year Follow-Up Diagnostic Testing - 1 test per calendar year Medical Imaging - per calendar year Surgical Rider Benefits Surgical Anesthesia Bone Marrow Transplant - Maximum per lifetime Stem Cell Transplant - Maximum per lifetime Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime Patient Care Rider Benefits Hospital Confinement Per day of Hospital Confinement (1-30 days) Per day for Eligible Dependent Children (1-30 days) Per day of Hospital Confinement (31+ days) Per day for Eligible Dependent Children (31+ days) Outpatient Facility - Per day surgery is performed Attending Physician - Per day of Hospital Confinement Dread Disease - Per day of Hospital Confinement (1-30 days / 31+ days)

paid in same manner and under the same maximums as any other benefit Level 1 Level 1 $50 per test

$50 per test

$100 per test

$500 per test / 1 per calendar year Level 1

$30 unit dollar amount Max $3,000 per operation

25% of amount paid for covered surgery $6,000

$6,000

$600

$1,000 / $100

Level 1

$100 $200 $100 $200 $200

$30

$100 / $100

Extended Care Facility - Up to the same number of Hospital Confinement Days

$100 per day

Donor

$100 per day

Home Health Care - Up to the same number of Hospital Confinement Days

$100 per day

Hospice Care - Up to maximum of 365 days per lifetime

$100 per day

US Government, Charity Hospital or HMO Per day of Hospital Confinement (1-30 days / 31+ days) Miscellaneous Care Rider Benefits

$100 / $100 Level 1

Cancer Treatment Center Evaluation or Consultation - 1 per lifetime

Not Included

Evaluation or Consultation Travel and Lodging - 1 per lifetime

Not Included

Second / Third Surgical Opinion - per diagnosis of cancer

$300 / $300

$150 per confinement $50 per prescription $150

actual coach fare or $.40 per mile $.40 per mile $50 per day actual coach fare or $.40 per mile $.40 per mile $50 per day

Drugs and Medicine - Inpatient / Outpatient (maximum $150 per month) Hair Piece (Wig) - 1 per lifetime Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Lodging - up to a maximum of 100 days per calendar year Family Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Family Lodging - up to a maximum of 100 days per calendar year

APSB-22339(TX)-0615 MGM/FBS Beaumont ISD

GC14 Limited Benefit Group Cancer Indemnity Insurance Option 1

Option 2

$300 per day

$200 / $2,000 per trip $150 per day

Outpatient Special Nursing Services - Up to same number of Hospital Confinement days

$150 per day

Medical Equipment - Maximum of 1 benefit per calendar year

Not Included

$25 per visit / $1,000

Waive Premium

Internal Cancer First Occurrence Rider Benefits

Level 1

Level 2

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

$2,500

$5,000

Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime

$3,750

$7,500

Intensive Care Unit

$600 per day

Step Down Unit - Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit

$300 per day

Miscellaneous Care Rider Benefits Con’t. Blood, Plasma and Platelets Ambulance - Ground/Air - Maximum of 2 trips per Hospital Confinement for all modes of transportation combined Inpatient Special Nursing Services - per day of Hospital Confinement

Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year Waiver of Premium

Hospital Intensive Care Unit Rider Benefits

TOTAL MONTHLY PREMIUMS BY PLAN** Issue Ages 18+

Individual

Individual & Spouse

1 Parent Family

2 Parent Family

Option 1

Option 2

Option 1

Option 2

Option 1

Option 2

Option 1

Option 2

$19.80

$22.70

$41.70

$48.00

$25.78

$29.14

$47.62

$54.40

**Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice. The premium and amount of benefits vary dependent upon the Plan selected at time of application.

Benefits are only payable following a diagnosis of cancer for a loss incurred for the treatment of cancer while covered under the policy. A charge must be incurred for benefits to be payable. When coverage terminates for loss incurred after the coverage termination date, our obligation to pay benefits also terminates for a specified disease that manifested itself while the person was covered under the policy. All benefits are subject to the benefit maximums.

Pre-Existing Condition Exclusion

Cancer Treatment Benefits

No benefits are payable for any loss incurred during the pre-existing condition exclusion period, following the covered person’s effective date as the result of a pre-existing condition. Pre-existing conditions specifically named or described as excluded in any part of the policy are never covered. If any change to coverage after the certificate effective date results in an increase or addition to coverage, the time limit on certain defenses and pre-existing condition exclusion for such increase will be based on the effective date of such increase.

Eligibility

Waiting Period

You and your eligible dependents are eligible to be insured under this certificate if you and your eligible dependents meet our underwriting rules and you are actively at work with the policyholder and qualify for coverage as defined in the master application.

Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date regardless of when specified disease was diagnosed.

Only Loss for Cancer

The policy pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The policy also covers other conditions or diseases directly caused by cancer or the treatment of cancer. The policy does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer. 38 38 APSB-22339(TX)-0615 MGM/FBS Beaumont ISD

The policy and any attached riders contain a waiting period during which no benefits will be paid. If any covered person has a specified disease diagnosed before the end of the waiting period immediately following the covered person’s effective date, coverage for that person will apply only to loss that is incurred after one year from the covered person’s effective date. If any covered person is diagnosed as having a specified disease during the waiting period immediately following the covered person’s effective date, you may elect to void the certificate from the beginning and receive a full refund of premium. If the policy replaced group specified disease cancer coverage from any company that terminated within 30 days of the certificate effective date, the waiting period will be waived for those covered persons that were covered under the prior coverage. However, the pre-existing condition exclusion provision will still apply.

GC14 Limited Benefit Group Cancer Indemnity Insurance Termination of Certificate

Insurance coverage under the certificate and any attached riders will end on the earliest of these dates: the date the policy terminates; the end of the grace period if the premium remains unpaid; the date insurance has ceased on all persons covered under this certificate; the end of the certificate month in which the policyholder requests to terminate this coverage; the date you no longer qualify as an insured; or the date of your death.

Termination of Coverage

Insurance coverage for a covered person under the certificate and any attached riders for a covered person will end as follows: the date the policy terminates; the date the certificate terminates; the end of the grace period if the premium remains unpaid; the end of the certificate month in which the policyholder requests to terminate the coverage for an eligible dependent; the date a covered person no longer qualifies as an insured or eligible dependent; or the date of the covered person’s death. We may end the coverage of any Covered Person who submits a fraudulent claim.

Cancer Screening Benefits Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Surgical Benefits Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Patient Care Benefits A hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended-care facility; or a facility primarily affording custodial, educational care, or care of treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.

Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Only Loss for Cancer or Dread Disease

Pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. This rider also covers other conditions or diseases directly caused by cancer or the treatment of cancer. This rider does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer except for conditions specifically provided in the dread disease benefit.

You must remain disabled for 60 continuous days before this benefit will begin. The waiver of premium will begin on the next premium due date following the 60 consecutive days of disability. This benefit will continue for as long as you remain disabled until the earliest of either of the following: the date you are no longer disabled; the date coverage ends according to the termination provisions in the certificate; or the date coverage ends according to the termination provisions in this rider. Proof of disability must be provided for each new period of disability before a new waiver of premium benefit is payable.

Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Termination of Cancer Screening, Surgical, Patient Care & Miscellaneous Benefit Rider(s) The above listed rider(s) will terminate and coverage will end for all covered persons on the earliest of: the end of the grace period if the premium for the rider remains unpaid; the date the policy or certificate to which the rider is attached terminates; the end of the certificate month in which APL receives a request from the policyholder to terminate the rider; or the date of your death. Coverage on an eligible dependent terminates under the rider when such person ceases to meet the definition of eligible dependent.]

Internal Cancer First Occurrence Benefits Pays a lump sum benefit amount when a covered person receives a first diagnosis of internal cancer and the date of diagnosis occurs after the waiting period. Only one benefit per covered person, per lifetime is payable under this benefit and the lump sum benefit amount will reduce by 50% at age 70.

Limitations and Exclusions

We will not pay benefits for a diagnosis of internal cancer received outside the territorial limits of the United States or a metastasis to a new site of any cancer diagnosed prior to the covered person’s effective date, as this is not considered a first diagnosis of an internal cancer.

Pre-Existing Condition Exclusion

No benefits are payable for any loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as the result of a pre-existing condition.

Waiting Period

This rider contains a 30-day waiting period during which no benefits will be paid. If any internal cancer is diagnosed before the end of the waiting period immediately following the covered person’s effective date of this rider, coverage will apply only to loss that is incurred after one year from the covered person’s effective date of this rider.

Termination

This rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider; the date of covered person’s death or the date the lump sum benefit amount for internal cancer has been paid for all covered persons under this rider. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent.

Miscellaneous Benefits Waiver of Premium

When the certificate is in force and you become disabled, we will waive all premiums due including premiums for any riders attached to the certificate. Disability must be due to cancer and occur while receiving treatment for such cancer.

APSB-22339(TX)-0615 MGM/FBS Beaumont ISD

GC14 Limited Benefit Group Cancer Indemnity Insurance Hospital Intensive Care Unit Benefits

Portability (Voluntary Plans Only)

Pays a daily benefit amount, up to the maximum number of days for any combination of confinement, for each day charges are incurred for room and board in an intensive care unit (ICU) or step-down unit due to an accident or sickness. Benefits will be paid beginning on the first day a covered person is confined in an ICU or step-down unit due to an accident or sickness that begins after the effective date of this rider. This benefit will reduce by 50% at age 70.

When you no longer meet the definition of Insured, you will have the option to continue this coverage, including any attached riders. No Evidence of Insurability will be required. Portability must meet all of the following conditions: the certificate has been continuously in force for the last 12 months; we receive a request and payment of the first premium for the portability coverage no later than 30 days after the date you no longer qualify as an eligible insured; and the policy, under which this certificate was issued, continues to be in force on the date you cease to qualify for coverage. All future premiums due will be billed directly to you. You are responsible for payment of all premiums for the portability coverage.

Limitations and Exclusions

For a newborn child born within the 10-month period following the effective date, no benefits under this rider will be provided for confinements that begin within the first 30 days following the birth of such child. No benefits under this rider will be provided during the first two years following the effective date for confinements caused by any heart condition when any heart condition was diagnosed or treated prior to the end of the 30-day period following the covered person’s effective date. The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date. We will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war; participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).

The benefits, terms and condition of the portability coverage will be the same as those elected under the certificate immediately prior to the date you exercised portability. Portability coverage may include any eligible dependents who were covered under the certificate at the time you ceased to qualify as an eligible insured. No new eligible dependents may be added to the portability coverage except as provided in the New Born and Adopted Children provision. No increases in coverage will be allowed while you are exercising your rights under this rider. The premium for the portability coverage will be based on the premium tables used for such coverage at the time of the portability request. Coverage under this rider will terminate in accordance with the provisions of the Termination of Coverage in the certificate. If the policy is no longer in force, then portability coverage is not available.

Termination

This rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider or the date of the covered person’s death. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent.

Optionally Renewable This policy/riders are optionally renewable. The policyholder or we have the right to terminate the policy/riders on any premium due date after the first anniversary following the policy/riders effective date. We must give at least 60 days written notice to the policyholder prior to cancellation.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For detailed benefits, limitations, exclusions and other provisions, please refer to the policy/certificate/riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC14 Series | TX | Limited Benefit Group Cancer Indemnity Insurance | (10/14) | MGM/FBS | Beaumont ISD 40

APSB-2233 TX)-0615 MGM/FBS Beaumont ISD

GC14 Limited Benefit Group Cancer Indemnity Insurance

APL YOUR BENEFITS PACKAGE

Accident

PLAY VIDEO

About this Benefit

2/3

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

of disabling injuries suffered by American workers are not work related.

American workers 36% ofreport they always or

usually live paycheck to paycheck.

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 42 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

A-3 Supplemental Limited Benefit Accident Expense Insurance Beaumont ISD

AMERICAN PUBLIC LIFE YOUR BENEFITS

Accident

Summary of Benefits* High Plan / Level 4 – 4 Units

Accidental Death - per unit

Low Plan / Level 1 - 1 Unit $5,000

Medical Expense Accidental Injury Benefit - per unit

actual charges up to $500

actual charges up to $2,000

$75 per day

$300 per day

actual charges up to $1,250

actual charges up to $5,000

$500 $500 $2,500 $5,000

$2,000 $2,000 $10,000 $20,000

$2,500 $5,000

$10,000 $20,000

$100 upon admission $100 per unit

$400 upon admission $100 per unit

$150 per day / $150 per unit

$600 per day / $150 per unit

once per 24 hours $1,000 benefit

Benefit Description

Daily Hospital Confinement Benefit Air and Ground Ambulance Benefit Accidental Dismemberment Benefit Single finger or toe Multiple fingers or toes Single hand, arm, foot or leg Multiple hands, arms, feet or legs Accidental Loss of Sight Benefit - per unit Loss of Sight in one eye Loss of Sight in both eyes

$20,000

Optional Benefit Riders Hospital Admission Benefit Accident Only - Intensive Care Benefit Gunshot Wound Benefit Rider (Primary Insured Only/Public Safety Personnel Only)

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

DID YOU KNOW?

2/3

of disabling injuries suffered by American workers are not work related.

American workers 36% ofreport they always or usually live paycheck to paycheck.

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 Beaumont ISD Website: www.mybenefitshub.com/beaumontisd

Individual

Individual & Spouse

1 Parent Family

2 Parent Family

Level 1 - 1 Unit

$10.80

$19.40

$21.20

$29.80

Level 4 - 4 Units

$24.50

$44.90

$52.00

$72.40

Optional Benefit Riders Hospital Admission Benefit

Accident Only –Intensive Care Benefit

$100

$400

Individual

$0.45

$1.80

Individual & Spouse

$0.65

One-Parent Family Two-Parent Family

$150

$600

Individual

$0.45

$2.60

Individual & Spouse

$0.75

$3.00

$0.95

$3.80

Gunshot Wound Benefit Rider

$1.80

Monthly Premium

Benefit per 24 Hour Period

$0.65

$2.60

$1.00

$1,000

One-Parent Family

$0.75

$3.00

Two-Parent Family

$0.95

$3.80

*The premium and amount of benefits vary dependent upon the Plan selected at time of application. Premiums are subject to increase with notice. 43

APSB-22329(TX)-MGM/FBS Beaumont ISD

A-3 Supplemental Limited Benefit Accident Expense Insurance

Eligibility

Gunshot Wound Benefit Rider Only

(8)

This policy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.

This Rider does not pay benefits for: any non-fatal Gunshot Wound received in a non - occupational related shooting; or, non - fatal Gunshot Wounds received while on active duty in the armed services (the company will return any premium paid past the time of entry into the armed forces when notice is received).

(9)

No benefits are payable for a pre-existing condition. Pre-existing condition means an Injury that pertains solely to an Accidental Bodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre-Existing Conditions specifically named or described as permanently excluded in any part of this contract are never covered.

This Rider does not pay benefits for self-inflected Gunshot Wound.

(11)

A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex-members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward.

Gunshot Wound Benefit Rider is only available through payroll deduction.

Medical Expense Accidental Injury Benefit

The maximum benefit is 4 units.

Base Policy and Optional Benefits

Expenses must commence within 60 days of the covered accident. The maximum benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.

This Rider is subject to all the Provisions, Conditions, Limitations and Exclusions of the Policy to which it is attached, which are not in conflict with those of the Rider.

The Gunshot Wound Benefit Rider is guaranteed renewable to age 65 or age 70, if actively at work. While this Rider is in effect, premiums are due according to the terms of the Policy. We reserve the right to change premium rates by class.

Hospital Admission Benefit Accident Only – Intensive Care Benefit The maximum benefit is 4 units. The maximum benefit period for this benefit is up to 30 days for any one accident.

Air and Ground Ambulance Benefit

Exclusions

Emergency transportation must occur within 21 calendar days of the accident causing such Injury.

Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with:

Daily Hospital Confinement Benefit The maximum benefit period for this benefit is 30 days per covered accident.

Accidental Death Accidental Death must result within 90 days of the covered accident causing the injury.

Accidental Dismemberment Benefit The total amount payable for all Losses resulting from the same accident will not exceed the Maximum Dismemberment Benefit of $5,000 cumulative per unit, per Accident. Loss must be within 90 days of the accident causing such Injury.

(1) (2) (3) (4) (5) (6)

(7)

sickness, illness or bodily infirmity; suicide, attempted suicide or intentional self-inflicted Injury, whether sane or insane; dental care or treatment unless due to accidental Injury to natural teeth; war or any act of war (whether declared or undeclared) or participating in a riot or felony; alcoholism or drug addiction; travel or flight in or descent from any aircraft or device which can fly above the earth’s surface in any capacity other than as a fare paying passenger on a regularly scheduled airline; Injury originating prior to the effective date of the Policy;

(10)

(12) (13) (14)

(15)

(16)

Injury occurring while intoxicated (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss is incurred.); Voluntary inhalation of gas or fumes or taking of poison or asphyxiation; Voluntary ingestion or injection of any drug, narcotic or sedative, unless administered on the advice and taken in such doses as prescribed by a Physician; Injury sustained or sickness which first manifests itself while on full-time duty in the armed forces; (Upon notice, We will refund the proportion of unearned premium while in such forces.) Injury incurred while engaging in an illegal occupation; Injury incurred while attempting to commit a felony or an assault; Injury to a covered person while practicing for or being a part of organized or competitive rodeo, sky diving, hang gliding, parachuting or scuba diving; driving in any race or speed test or while testing an automobile or any vehicle on any racetrack or speedway; hernia, carpal tunnel syndrome or any complication therefrom;

If You are entitled to benefits under this Policy as a result of sprained or lame back, or any intervertebral disk conditions, such benefits shall be payable for a maximum period of time, not exceeding in the aggregate three (3) months for any Injury.

Guaranteed Renewable You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correct premium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606

Underwritten by American Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the certificate/policy and riders. This coverage does not replace Workers’ Compensation Insurance. | This product is inappropriate for people who are eligible for Medicaid coverage. | Policy Form A3 Series | Texas | Supplemental Limited Benefit Accident Expense Insurance Policy | (10/14) | Beaumont ISD

APSB-22329(TX)-MGM/FBS Beaumont ISD

A-3 Supplemental Limited Benefit Accident Expense Insurance

Eligibility

Gunshot Wound Benefit Rider Only

(8)

(9)

This Rider does not pay benefits for self-inflected Gunshot Wound.

(11)

Gunshot Wound Benefit Rider is only available through payroll deduction.

Medical Expense Accidental Injury Benefit

The maximum benefit is 4 units.

Base Policy and Optional Benefits

Expenses must commence within 60 days of the covered accident. The maximum benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.

This Rider is subject to all the Provisions, Conditions, Limitations and Exclusions of the Policy to which it is attached, which are not in conflict with those of the Rider.

Hospital Admission Benefit Accident Only – Intensive Care Benefit The maximum benefit is 4 units. The maximum benefit period for this benefit is up to 30 days for any one accident.

Air and Ground Ambulance Benefit

Exclusions

Emergency transportation must occur within 21 calendar days of the accident causing such Injury.

Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with:

Daily Hospital Confinement Benefit The maximum benefit period for this benefit is 30 days per covered accident.

Accidental Death Accidental Death must result within 90 days of the covered accident causing the injury.

(1) (2) (3) (4) (5) (6)

(7)

(10)

(12) (13) (14)

(15)

(16)

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606

APSB-22329(TX)-MGM/FBS Beaumont ISD

AULA ONE AMERICA COMPANY YOUR BENEFITS PACKAGE

Life and AD&D

PLAY VIDEO

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.

Motor vehicle crashes are the

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

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 46 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

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

Continuation of Coverage Options:

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

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

Flexible Choices:

Eligible Employees:

Since everyone's needs are different, this plan offers flexibility for you to choose a benefit amount that fits your needs and budget. Conversion Should your life insurance coverage, or a portion of it, cease for any reason, you may be eligible to convert your Group Term Accidental Death & Dismemberment (AD&D): If approved for this benefit, additional life insurance benefits may Coverage to Individual Coverage without providing Evidence of Insurability. You must apply within 31 days from the last day you be payable in the event of an accident which results in death or are eligible. dismemberment as defined in the contract.

Guaranteed Issue Amounts: This is the most coverage you can purchase without having to answer any health questions. If you decline insurance coverage now and decide to enroll later, you will need to provide Evidence of Insurability. Employee Guaranteed Issue Amount

$200,000

Spouse Guaranteed Issue Amount

$50,000

Child(ren) Guaranteed Issue Amount

$10,000

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

Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose. Waiver of Premium: If approved, this benefit waives your and your dependents' insurance premium in case you become totally disabled and are unable to collect a paycheck. Reductions: Upon reaching certain ages, your original benefit amount will reduce to a percentage as shown in the following Age: 70 75 schedule. Reduces To: 67% 45%

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

Annual Increase in Benefit:

This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and is limited to a brief description of any losses for which benefits are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be continued in force or discontinued.

If eligible, this benefit allows you to increase your coverage every year as your life insurance needs change. You and your spouse may be able to increase your benefit amount by $10,000 every year until you reach the guaranteed issue amount, without providing Evidence of Insurability. NOTE: If Evidence of Insurability is applied for and denied, please be aware Annual Increase in Benefits will not be made available to you in the future. 47

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

 

You may select a minimum benefit of $20,000 up to a maximum amount of $500,000, in increments of $10,000, not to exceed 7 times your annual base salary plus permanent stipends, rounded to the next higher $10,000. You may select an amount in $10,000 increments for your spouse not to exceed your benefit amount. Voluntary AD&D amounts are available for you and your spouse to a maximum of $500,000. Your spouses Voluntary AD&D amount cannot exceed your benefit amount. The child(ren) Voluntary AD&D amount is $10,000. Voluntary Life Amounts requested above $200,000 for an Employee, $50,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability. Voluntary AD&D amounts are all guaranteed issue. Employee must select coverage to select any Dependent coverage.

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

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

AD&D

$20,000

$1.08

$1.30

$1.94

$2.16

$2.38

$3.46

$5.40

$9.94

$15.12

$29.60

$.52

$30,000

$1.62

$1.95

$2.91

$3.24

$3.57

$5.19

$8.10

$14.91

$22.68

$44.40

$.78

$40,000

$2.16

$2.60

$3.88

$4.32

$4.76

$6.92

$10.80

$19.88

$30.24

$59.20

$1.04

$50,000

$2.70

$3.25

$4.85

$5.40

$5.95

$8.65

$13.50

$24.85

$37.80

$74.00

$1.30

$60,000

$3.24

$3.90

$5.82

$6.48

$7.14

$10.38

$16.20

$29.82

$45.36

$88.80

$1.56

$70,000

$3.78

$4.55

$6.79

$7.56

$8.33

$12.11

$18.90

$34.79

$52.92 $103.60

$1.82

$80,000

$4.32

$5.20

$7.76

$8.64

$9.52

$13.84

$21.60

$39.76

$60.48 $118.40

$2.08

$100,000

$5.40

$6.50

$9.70

$10.80 $11.90

$17.30

$27.00

$49.70

$75.60 $148.00

$2.60

$150,000

$8.10

$9.75

$14.55 $16.20 $17.85

$25.95

$40.50

$74.55 $113.40 $222.00

$3.90

$200,000

$10.80 $10.80 $10.80 $13.00 $19.40 $21.60 $23.80

$34.60

$54.00

$99.40 $151.20 $296.00

$5.20

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

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

AD&D

$20,000

$1.08

$1.30

$1.94

$2.16

$2.38

$3.46

$5.40

$9.94

$15.12

$29.60

$.52

$30,000

$1.62

$1.95

$2.91

$3.24

$3.57

$5.19

$8.10

$14.91

$22.68

$44.40

$.78

$40,000

$2.16

$2.60

$3.88

$4.32

$4.76

$6.92

$10.80

$19.88

$30.24

$59.20

$1.04

$50,000

$2.70

$3.25

$4.85

$5.40

$5.95

$8.65

$13.50

$24.85

$37.80

$74.00

$1.30

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

$10,000

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

Monthly Payroll Deduction Child Life

Monthly Payroll Deduction Child AD&D

$1.51

$0.26

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

TEXAS LIFE

Individual Life

YOUR BENEFITS PACKAGE

PLAY VIDEO

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

Experts recommend at least

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

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 50 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

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

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

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

 



High Death Benefit. With one of the highest death benefit available at the worksite,1 PureLife-plus gives your loved ones peace of mind, knowing there will be significant life insurance in force should you die prematurely. Minimal Cash Value. Designed to provide high death benefit, PureLife-plus does not compete with the cash accumulation in your employer-sponsored retirement plans. Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up). Refund of Premium. Unique in the marketplace, PureLife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.) Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.)

You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren.

Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details. 1

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

UNUM

Critical Illness

YOUR BENEFITS PACKAGE

PLAY VIDEO

About this Benefit Critical illness insurance is designed to supplement your medical and disability coverage easing the financial impacts by covering some of your additional expenses. It provides a benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke.

$16,500 Is the aggregate cost of a hospital stay for a heart attack.

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 52 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Critical Illness Coverage Amounts

Portability



Included

 

Employee - $10,000 to $30,000 in increments of $5,000 Spouse - $5,000 to $15,000 in increments of $5,000 Child – 25% of Employee Coverage Amount

Guarantee Issue  

Employee – $30,000 Spouse - $15,000

Pre-Existing Condition

Recurrence Benefit Included – 25% of the coverage amount for an additional payout for a subsequent occurrence of benign brain tumor, coma, heart attack or stroke.

Premium Paid by the Employee

Employee 12/12 exclusion

Benefit Waiting Period 30 days

Without Cancer Monthly Rates per $1,000 Issue Ages

Non-Tobacco

Tobacco

< 25

.29

25 - 29

.30

30 - 34

.44

35 - 39

.60

40 - 44

.89

45 - 49

1.17

50 - 54

1.53

55 - 59

1.98

60 - 64

2.54

65 - 69

2.91

70 +

5.44

This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Details may differ from state to state. 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. 53

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. An identity is stolen every 2 seconds, and takes over

300 hours

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

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 54 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Identity Theft ADVANCED TOOLS

DUAL MONTHLY PRICING Plus

Platinum



Breach Notification

Individual

$7.95

$11.95



Solicitation Reduction

Family

$14.95

$22.95

CREDIT PROTECTION SERVICES



  

Monthly Credit Score Tracker Historical view of TransUnion scores.



Credit Freeze Assistance with putting a security freeze on your credit report. Credentials are securely stored for easy access.

Fraud Alert Assistance & Reminders



Assistance with setting credit bureau fraud alerts and reminders.

PROACTIVE IDENTITY MONITORING 



Public Records & NCOA Monitoring We monitor the National Change of Address Registry and public records databases (over 37 billion consumer records). Direct network access enables us to detect potential fraud faster.



Payday Loan Monitoring We work directly with alternative credit bureaus that service the under-banked market. Our network monitors the largest database so we can alert faster.

Enhanced Non-Credit Loan Monitoring

Our expanded fraud detection network includes monitoring of  auto pawn, rent-to-own, sub-prime, and cell phone accounts. Protection is increased by scanning for these common transactions that require minimal information to obtain.

High-Risk Application & Transaction Monitoring Real-time alerts cover new account applications such as financial and wireless. Real-time alerts inform you of critical transactions including bank password resets, online healthcare, payroll account, or insurance records access. We catch potential identity theft up to 90 days sooner.

Cyber Monitoring



Instant-On promptly activates all monitoring on the benefit effective date without any further action required by the employee.

2-Step Authentication

Identity Profile Report Our report helps surface any pre-existing conditions going back 30 years or more.

Social Network Alerts Add alert customizations to Facebook, LinkedIn, Instagram, and Twitter accounts to stay on top of potential cyberbullying, cyber predators, and reputation-damaging items directed at you and your family. Our exclusive identity exposure report highlights PHI published on social sites and calls out increased potential for identity theft.

Registered Sex Offender Reporting & Alerts Run a report for a specific address showing location, photo ID, and the offense committed. Search for sex offenders in your area and receive alerts when new offenders move into your neighborhood. We track and report offenders who move from state to state who can be missed in an online state search. Real-time reporting is available for all ID Watchdog plans. Collect maximum information from one source to keep loved ones safe.

National Provider Identifier (NPI) Alerts We monitor the NPI database for activity that indicates potential fraud. We are the only vendor who monitors this database and provides alerts to physicians, pharmacists, and more if their credentials are compromised.

Password Manager Securely store and use login information and access it with a single master password. COMING IN 2017

ADVANCED CUSTOMER CARE CENTER 

Underground websites are scanned daily in search of personal information being sold. When detected in our scans, we send a compromised credentials alert.

Instant-On™ Monitoring

Lost Wallet Vault & Replacement

To ensure your information is accurate and secure, we require a 2-step authentication process when logging in to and registering your account.

Rapid Credit Alerts Credit alerts provided within minutes of detected activity change.

Opt in or out of the National Do Not Call Registry, preapproved credit offers, junk mail, or email. Store your wallet contents in our secure digital vault. Lost Wallet Replacement will assist with cancelling and replacing contents from the Lost Wallet Vault.

Credit Monitoring, Report & Score(s) Tri-bureau monitoring and TransUnion® report and score.



Receive email notification of prominent data breaches.

  

Fully Managed Resolution Service Dedicated CITRMS work with you to assess your identity theft situation and will manage your case until it is completely restored.

$1M Expense Reimbursement Insurance The plan covers financial damages incurred as a result of the theft.

Call Center Commitment to Excellence Real-time language support ensures clear communication with over 100 languages.

24/7 Call Center Reach an identity theft protection specialist when you need help. 55

LIFEWORKS

EAP (Employee Assistance Program)

YOUR BENEFITS PACKAGE

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.

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 56 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

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 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 for 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 Lifeworks employees who are trained clinical consultants with master’s/doctorate degrees. LifeWorks is a 24/7 operation, so there are no changes in service delivery during non-business hours — you 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 

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



Lifeworks develops close relationships and carefully evaluates the national network of EAP providers who deliver in-person counseling. 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. Lifeworks 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. Call Lifeworks at 888-456-1324 anytime En espanol: 888-732-9020 TTY: 800-999-3004 You can also visit www.lifeworks.com Username: Beaumont Password: lifeworks 57

NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

PLAY VIDEO

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

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

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 58 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

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.

New Participants can 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!

NBS Prepaid MasterCard® Debit Card

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

For a list of sample expenses, please refer to the Beaumont ISD benefit website: www.mybenefitshub.com/beaumontisd

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.

Medical FSA Annual Contribution Max:

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

$2,600, 75 day Grace Period

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 59

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 medical FSA 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, including payments made with your flex card.

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/beaumontisd

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 payments made with your flex card.

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/beaumontisd 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! Dependent Care reimbursements can only be made after your deductions are received by NBS. Dependent Care accounts are not prefunded.

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.

MASA YOUR BENEFITS PACKAGE

Medical Transport

About this Benefit Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It includes emergency transportation via ground ambulance, air ambulance and helicopter.

A ground ambulance can cost up to

$2,400

and a helicopter transportation fee can cost

over $30,000

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 62 Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Medical Transport MASA provides medical emergency transportation solutions and covers your out of pocket medical transport cost when your insurance falls short. MASA does not use a network, which means you are covered anywhere.

THE TRUTH... Americans today suffer from a false sense of security that their medical coverage will pay for all costs associated with emergency or critical care transport. The reality is that a majority of Americans are only partially covered for these high costs. Most healthcare policies will only pay based off of the “Usual and Customary Charges” while Medicare pays based off a set fee schedule, both leaving you with the remainder of the bill. You face the possibility that your medical coverage will deny the claim leaving you responsible for the ENTIRE bill. We provide medical emergency transportation solutions AND cover your out of pocket medical transport cost when your insurance falls short.

MASA MTS for Employees Ensures...       

NO health questions NO age limits Children covered to age 26 NO claim forms NO deductibles NO provider network limitations NO dollar limits on emergency transport costs

What is Covered?  

Emergency Helicopter Transport Emergency Ground Ambulance Transport

How Much Does It Cost? MASA Emergent rates are $9 a month, per employee/family coverage.

Emergent Card Example:

“All I had to do was send the bill which was never paid by Medicare and TriCare for Life --- and the rest is history. When MASA received that bill, it was paid and all amounts owed satisfied.” --- MASA Member, 2015