2017 Benefit Guide Lockney ISD by Higginbotham Public Sector

LOCKNEY ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2017 - 08/31/2018 WWW.MYBENEFITSHUB.COM/ LOCKNEYISD

Table of Contents Benefit Contact Information

How to Enroll

4-5

Annual Benefit Enrollment

6-9

FLIP TO...

2. Section 125 Cafeteria Plan Guidelines

3. Annual Enrollment

4. Eligibility Requirements

PG. 4

5. Helpful Definitions

HOW TO HOW TO ENROLL ENROLL

TRS Medical

10-13

MDLIVE Telehealth

14-15

Dental Select Dental

16-17

Dental Select Vision

18-19

UNUM Educator Disability

20-27

PG. 6

5Star Voluntary Group Life and AD&D

28-31

5Star Individual Life

32-35

SUMMARY PAGES

PG. 10 YOUR BENEFITS

Benefit Contact Information LOCKNEY ISD BENEFITS

TELEHEALTH

EDUCATOR DISABILITY

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

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

UNUM (800) 583-6908 Claim Status: (800) 858-6843 www.mybenefitshub.com/lockneyisd

LOCKNEY ISD BENFITS OFFICE

DENTAL

LIFE AND AD&D

(806) 652-2104 www.lockneyisd.net

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

5Star Life (800) 863-9753 www.5starima.com

TRS MEDICAL

VISION

FAMILY PROTECTION PLAN

TRS ActiveCare (800) 222-9205 FirstCare (800) 884-4901 www.TRS.State.Tx.us

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

5Star Life (866) 863-9753 www.5starima.com

MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS LKNY” 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 LKNY” to 313131 OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

mybenefitshub.com/lockneyisd

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

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

CHANGES IN STATUS (CIS): Marital Status

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

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

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

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

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

SUMMARY PAGES

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

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your benefit

Changes are not permitted during the plan year (outside of

website: www.mybenefitshub.com/lockneyisd. Click on the

annual enrollment) unless a Section 125 qualifying event occurs.

benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms



Changes, additions or drops may be made only during the

section.

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

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

benefit website: www.mybenefitshub.com/lockneyisd. Click

included in the dependent profile. Additionally, you must

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

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



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

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

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

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.

eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

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

SUMMARY PAGES

must be actively-at-work on September 1, 2017 to be eligible for

Employee Eligibility Requirements

your new benefits.

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.

Dependent Eligibility: You can cover eligible dependent Eligible employees must be actively at work on the plan effective

children under a benefit that offers dependent coverage,

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

provided you participate in the same benefit, through the

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

maximum age listed below. Dependents cannot be double

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

covered by married spouses within Lockney ISD or as both

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

employees and dependents.

PLAN

DEPENDENT ELIGIBILITY

CONTINUATION AFTER TERMINATION OR RETIREMENT*

Dental

Legal Spouse, children to age 26

COBRA

Vision

Legal Spouse, children to age 26

COBRA

Disability

Not applicable

Not Applicable

Base Life

Not applicable

Group Term Life/ AD&D

Legal Spouse, unmarried dependent children to age 26

Portable or convertible, excluding AD&D

5Star Family Protection Plan

Legal Spouse, children & grandchildren to age 24

Individual plan, direct bill

Telehealth

Legal Spouse, children to age 26

Individual Plan

*COBRA notices will be mailed to your address on file from National Benefit Services. Contact Carrier within 30 days of termination for portability or continuation instructions on non-COBRA coverage. Portability & Conversion forms available online at www.mybenefitshub.com/lockneyisd.com 8

Helpful Definitions

SUMMARY PAGES

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

(including diagnostic and/or consultation services).

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.

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

ActiveCare 1-HD

ActiveCare Select or ActiveCare Select Whole Health

ActiveCare 2

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

$2,500 employee only $5,000 family

$1,200 individual $3,600 family

$1,000 individual $3,000 family

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

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

$6,850 individual $13,700 family

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

80% 20%

Office Visit Copay Participant pays

20% after deductible

$30 copay for primary $60 copay for specialist

$30 copay for primary $50 copay for specialist

Diagnostic Lab Participant pays

20% after deductible

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

Preventive Care See next page for a list of services

Plan pays 100%

Teladoc® Physician Services

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

Plan pays 100%

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

20% after deductible

$100 copay plus 20% after deductible

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

20% after deductible

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

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

Emergency Room (true emergency use) Participant pays

20% after deductible

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

Outpatient Surgery Participant pays

20% after deductible

$150 copay per visit plus 20% after deductible

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

$5,000 copay plus 20% after deductible

Not covered

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

Prescription Drugs Drug deductible (per plan year)

Subject to plan year deductible

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

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

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

$20 $40** $65**

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

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

$35 $60** $90**

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

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

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

Specialty Drugs Participant pays

20% after deductible

20% coinsurance per fill

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

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

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

(Provider must bill services as “preventive care”)

ActiveCare 1-HD Preventive Care Services

ActiveCare Select or ActiveCare Select Whole Health

ActiveCare 2 Network

(Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Memorial Hermann Accountable Care Network; Seton Health Alliance) Evidence−based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (USPSTF) www. uspreventiveservicestaskforce.org/Page/Name/uspstf-a-andbrecommendations.

Plan pays 100% (deductible waived)

Some examples of preventive care frequency and services:  Routine physicals – annually Immunizations recommended by the Advisory Committee on age 12 and over Immunization Practices of the Centers for Disease Control and  Well-child care – unlimited Prevention (CDC) with respect to the individual involved. up to age 12 Evidence−informed preventive care and screenings provided  Well woman exam & pap for in the comprehensive guidelines supported by the Health smear – annually age 18 and Resources and Services Administration (HRSA) for infants, over children and adolescents. Additional preventive care and  Mammograms – 1 every year screenings for women, not described above, as provided for in age 35 and over comprehensive guidelines supported by the HRSA  Colonoscopy – 1 every 10 www.hhs.gov/healthcare/factsand- features/fact-sheets/ years age 50 and over preventive-services-covered-underaca/  Prostate cancer screening – 1 index.html#CoveredPreventiveServicesforAdults. per year age 50 and over  Smoking cessation For purposes of this benefit, the current recommendations of counseling – 8 visits per 12 the USPSTF regarding breast cancer screening and months mammography and prevention will be considered the most  Healthy diet/obesity current (other than those issued in or around November counseling – unlimited to age 2009). 22; age 22 and over-26 visits The preventive care services described above may change as per 12 months USPSTF, CDC and HRSA guidelines are modified.  Breastfeeding support – 6 lactation counseling visits per (Examples of covered services included are: 12 months Routine annual physicals (one per year); immunizations; well-child care; breastfeeding support, services and supplies; cancer screening mammograms; bone density test; screening for prostate cancer and colorectal cancer (including routine colonoscopies); smoking cessation counseling services and healthy diet counseling; and obesity screening/counseling.

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

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

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

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

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

$50 copay for specialist

Annual Hearing Examination Participant pays

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

$30 copay for primary $50 copay for specialist

$30 copay for primary $60 copay for specialist

Note: Covered services under this benefit must be billed by the provider as “preventive care.” If you receive preventive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the ActiveCare 1-HD and ActiveCare 2. Non-network preventive care is not paid at 100%. There is no coverage for non-network services under the ActiveCare Select plan or ActiveCare Select Whole Health. 11 TRS-ActiveCare is administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered by Caremark.

2016-2017 TRS-FirstCare Plan Highlights Plan Summary 2016 -2017 Medical Plan Year Deductible Out-of-Pocket Maximum (includes medical & drug deductibles, copayments & coinsurance) Annual Maximum

$500 Individual; $1,500 Family $6,000 Individual: $12,000 Family Unlimited

Primary Care Provider (PCP) Office Visit  Includes routine lab/X-ray services, injectables, and supplies  Other services provided in a physician’s office are subject to additional deductible and copayments/coinsurance

$20 copayment

PCP Office Visit-Dependents, through age 19

$0 copayment

Specialist Office Visit  Includes routine lab/X-ray services  Other services provided in a physician’s office are subject to additional deductible and copayments/coinsurance

$60 copayment

Preventive Care Well-woman exam, immunizations, physicals, mammograms, colorectal cancer screening

No copayment

Surgical Procedures Performed in the Physician's Office

25% copayment1

Minor Emergency/Urgency Care Visit

$75 copayment

Emergency Room

$500 copayment1

Ambulance Air/Ground

25% copayment1

Inpatient Services Facility charges, physician services, surgical procedures, pre-admission testing, operating/recovery room, newborn delivery and nursery, ICU/coronary care units, laboratory tests/X-rays, rehabilitation facility, behavioral health (mental health/chemical dependency)

25% copayment1

Outpatient Services Facility charges, physician services, surgical procedures, observation unit

25% copayment1

MRI, CT Scan, PET Scan (Facility/Physician)

$250 copayment1

Diagnostic Tests Sleep study; Stress test; EKG; Ultrasound; Cardiac imaging; Genetic testing; Non-preventive Colonoscopy (Facility/Physician)

25% copayment1

Home Health Care Limited to 60 visits per plan year

25% copayment1

Hospice Care

25% copayment1

Skilled Nursing Facility Limited to 30 days per plan year

25% copayment1

Accidental Dental Care

25% copayment1

Prosthetics

25% copayment1

Orthotics

25% copayment1

Spinal Manipulation Limited to 10 visits per year

25% copayment1

Durable Medical Equipment

25% copayment1

All Other Covered Services

25% copayment1

Prescription Drug Plan Year Deductible

$100 Individual: $300 Family

Annual Maximum

Unlimited

Participating Retail Pharmacy  Select Generic/ACA (Tier 1) deductible waived  Preferred Generic (Tier 2) deductible waived  Preferred Brand/Non-Preferred Generic (Tier 3)  Non-Preferred Brand/Non-Preferred Generic (Tier 4)  Specialty/Injectables (Tier 5)

Standard Drugs/30-day supply $0 per prescription $15 per prescription $40 per prescription2 $100 per prescription2 20% per prescription2

Participating Mail Order Pharmacy  Select Generic/ACA (Tier 1) deductible waived  Preferred Generic (Tier 2) deductible waived  Preferred Brand/Non-Preferred Generic (Tier 3)  Non-Preferred Brand/Non-Preferred Generic (Tier 4)  Specialty/Injectables (Tier 5)

Maintenance Drugs/90-day supply $0 per prescription $45 per prescription $120 per prescription2 $300 per prescription2 20% per prescription2

Subject to medical deductible

Subject to prescription drug deductible

Gross Monthly Cost for Coverage Effective September 1, 2016 - August 31, 2017 Coverage Category Employee only Employee and spouse Employee and child(ren) Employee and family

Total Cost - Active* $472.50 $1,180.50 $748.50 $1,190.50

*District and state fund are provided each month to active contributing TRS members to use toward the cost of TRS-ActiveCare coverage. State funding is subject to appropriation by the Texas Legislature. Please contact your Benefits Administrator to determine your net monthly cost for your coverage.

MDLIVE YOUR BENEFITS PACKAGE

Telehealth

PLAY VIDEO

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 14 Lockney ISD Benefits Website: www.mybenefitshub.com/lockneyisd

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? $10.00 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 15 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

DENTAL SELECT

Dental

YOUR BENEFITS PACKAGE

PLAY VIDEO

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 16 Lockney ISD Benefits Website: www.mybenefitshub.com/lockneyisd

Dental High and Low Plans Indemnity Classic Plan - MaxRewards

High Plan

Platinum Network

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

Contracted Dentist

Non-Contracted Dentist

100%

100% of R&C

BASIC Composite fillings, extractions, oral surgery

80%

80% of R&C No Waiting Period

MAJOR Crowns, bridges, dentures, endodontics, periodontics

50%

50% of R&C No Waiting Period

ORTHODONTICS Children under 19

50%

50% No Waiting Period

Waiting Period

$1000.00

Lifetime Maximum All Members

20% Discount

MAXIMUM BENEFIT Applies to Preventative, Basic and Major Services

Benefit Period is: Per Memberâ&#x20AC;&#x2122;s Effective Date

$1000.00

DEDUCTIBLE Per Benefit Period Per Person Family Maximum

Applies to Basic and Major Services

$50.00 $150.00

SPECIALISTS Endodontists, Oral Surgeons, Pediatric, Periodontists, Prosthodontists

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

Indemnity Classic Plan - MaxRewards

Low Plan

Platinum Network

PREVENTIVE

Contracted Dentist

Non-Contracted Dentist

Routine exams, cleanings (2 per year), topical fluoride, x-rays, space maintainers, sealants

100%

100% of R&C

BASIC Composite fillings, extractions, oral surgery, endodontics, periodontics

80%

80% of R&C No Waiting Period

MAJOR 0% Contracted Rates Apply

Crowns, bridges, dentures,

No Benefit 12 Month Waiting Period

ORTHODONTICS Children under 19 Waiting Period Lifetime Maximum All Members

20% Discount No Waiting Period

No Benefit

No Maximum 20% Discount

MAXIMUM BENEFIT Applies to Preventative, Basic and Major Services

Benefit Period is: Per Memberâ&#x20AC;&#x2122;s Effective Date

$1000.00

DEDUCTIBLE Applies to Basic and Major Services

Per Benefit Period Per Person: Family Maximum:

$50.00 $150.00

SPECIALISTS Endodontists, Oral Surgeons, Pediatric, Periodontists, Prosthodontists

DENTAL SELECT YOUR BENEFITS PACKAGE

Vision

PLAY VIDEO

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 18 Lockney ISD Benefits Website: www.mybenefitshub.com/lockneyisd

Vision Access Choice Vision 7 In-Network

Out-of-Network

(Member Cost)

(Reimbursement)

$10

Up to $45

Up to $55

N/A

10% off Retail

N/A

Single Vision

$25

Up to $40

Bifocal

$25

Up to $60

Trifocal

$25

Up to $80

$0 CoPay, $130 allowance; 20% off balance over $130

Up to $45

Exam with Dilation as Necessary Contact Lens Options Standard fit and follow-up Premium fit and follow-up

Standard Plastic Lenses

Frames Any frame at provider location

Lens Options UV Coating

Tint (Solid and Gradient)

Standard Scratch-Resistance

Standard Polycarbonate

N/A

Standard Progressive (Add-on to Bifocal) Standard Anti-Reflective Other Add-ons and Services

Contact Lenses

$0 $45 20% Discount

Declining Balance Allowance

Conventional

$0 CoPay: $150 Allowance; 15% off balance over $150

Up to $150

$0 CoPay: $150 Allowance; member responsible for balance over $150

Up to $150

Disposables

$0 CoPay: Paid in Full

Up to $210

15% off retail price -or- 5% off promotional price

Not Covered

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

Medically Necessary

Laser Correction (US Laser Network) Lasik or PRK

Frequency Examination Frame Lenses or Contact Lenses

UNUM YOUR BENEFITS PACKAGE

Educator 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 20 Lockney ISD Benefits Website: www.mybenefitshub.com/lockneyisd

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

Eligibility

You may choose an Elimination Period (injury/sickness) of 0/7, 14/14, 30/30, 60/60, 90/90 or 180/180 days.

You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.

If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)

Guarantee Issue

Benefit Duration

Current Employees: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may enroll on or before the enrollment deadline. After the initial enrollment period, you can apply only during an annual enrollment period. Employees hired on or after 2010: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may apply for coverage within 60 days after your eligibility date. If you do not apply within 60 days after your eligibility date, you can apply only during an annual enrollment period. Benefits are subject to the pre-existing condition exclusion referenced later in this document. Please see your Plan Administrator for your eligibility date.

Benefit Amount You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $7,500. Please see your Plan Administrator for the definition of monthly earnings. The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment. However, if you are participating in Unumâ&#x20AC;&#x2122;s Rehabilitation and Return to Work Assistance program, the total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 110% of your monthly earnings (unless the excess amount is payable as a Cost of Living Adjustment).

Elimination Period The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits.

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

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

Federal Income Taxation The taxability of benefits depends on how premium was taxed during the plan year in which you become disabled. If you paid 100% of the premium for the plan year with post-tax dollars, your benefits will not be taxed. If premium for the plan year is paid with pre-tax dollars, your benefits will be taxed. If premium for the plan year is paid partially with post-tax dollars and partially with pre-tax dollars, or if you and your Employer share in the cost, then a portion of your benefits will be taxed.

Next Steps Work/Life Balance Employee Assistance Program1 Work-life balance is a comprehensive resource providing access to professional assistance for a wide range of personal and workrelated issues. The service is available to you and your family members twenty- four hours a day, 365 days a year, and provides resources to help employees find solutions to everyday issues such as financing a car or selecting child care, as well as more serious problems such as alcohol or drug addiction, divorce, or relationship problems. Services include: toll-free phone access to masterâ&#x20AC;&#x2122;s-level consultants, up to three face-to-face sessions to help with more serious issues; and online resources. There is no additional charge for utilizing the program. Participation is confidential and strictly voluntary, and employees do not have to have filed a disability claim or be receiving benefits to use the program. 21

Educator Disability However, if you become disabled and are receiving benefits, Unum's On Claim Support can provide additional resources including: coaching on how to communicate effectively with medical personnel, conducting consumer research for medical equipment and supplies, assessing emotional needs and locating counseling resources.

Return to Work/ Work Incentive Benefit Unum supports efforts that enable a disabled employee to remain on the job or return to work as soon as possible. If you are disabled but working part time with monthly disability earnings of 20% or more of your indexed monthly earnings, during the first 12 months, the monthly benefit will not be reduced by any earnings until the gross disability payment plus your disability earnings, exceeds 100% of your indexed monthly earnings. The monthly benefit will then be reduced by that amount.

Rehabilitation and Return to Work Assistance Unum has a vocational Rehabilitation and Return to Work Assistance program available to assist you in returning to work. We will make the final determination of your eligibility for participation in the program, and will provide you with a written Rehabilitation and Return to Work Assistance plan developed specifically for you. This program may include, but is not limited to the following benefits:  coordination with your Employer to assist your return to work;  adaptive equipment or job accommodations to allow you to work;  vocational evaluation to determine how your disability may impact your employment options;  job placement services;  resume preparation;  job seeking skills training; or  education and retraining expenses for a new occupation. If you are participating in a Rehabilitation and Return to Work Assistance program, we will also pay an additional disability benefit of 10% of your gross disability payment to a maximum of $1,000 per month. In addition, we will make monthly payments to you for 3 months following the date your disability ends, if we determine you are no longer disabled while:  you are participating in a Rehabilitation and Return to Work Assistance program; and  you are not able to find employment. (This benefit is not allowed in New Jersey.)

Worksite Modification Unum If a worksite modification will enable you to remain at work or return to work, a designated Unum professional will assist in identifying what’s needed. A written agreement must be signed by you, your employer and Unum, and we will reimburse your employer for the greater of $1,000 or the equivalent of two months of your disability benefit.

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

Survivor Benefit Unum will pay your eligible survivor a lump sum benefit equal to 3 months of your gross disability payment. This benefit will be paid if, on the date of your death, your disability had continued for 180 or more consecutive days, and you were receiving or were entitled to receive payments under the plan. If you have no eligible survivors, payment will be made to your estate, unless there is none. In that case, no payment will be made. However, we will first apply the survivor benefit to any overpayment which may exist on your claim. You may receive your survivor benefit prior to your death if you are receiving monthly payments and your physician certifies in writing that you have been diagnosed as terminally ill and your life expectancy has been reduced to less than 12 months. This benefit is only payable once and if you elect to receive this benefit, no survivor benefit will be payable to your eligible survivor upon your death. (Note this “Accelerated Survivor Benefit” is not available in Connecticut.)

Dependent Care Expense Benefit If you are disabled and participating in Unum’s Rehabilitation and Return to Work Assistance program, Unum will pay a Dependent Care Expense Benefit when you are disabled and you provide satisfactory proof that you:  are incurring expenses to provide care for a child under the age of 15;  and/or start incurring expenses to provide care for a child age 15 or older or a family member who needs personal care assistance. The payment will be $350 per month per dependent, to a maximum of $1,000 per month for all dependent care expenses combined.

Education Benefit If you are disabled and receiving monthly disability benefits, you 22

Educator Disability may receive an additional monthly Education Benefit of $200 for each child who is an eligible student. Benefits will be payable in between terms provided the eligible student is enrolled for the next scheduled term.

prior carrier’s policy, the claim will be administered according to the Unum policy. However,  the payments will be the lesser of the benefit payable under the terms of the prior plan or the benefit under the Eligible student means your unmarried dependent child(ren) who Unum plan; are:  the elimination period will be the shorter of the elimination  less than 25 years of age; and period under the prior plan or the elimination period under  attending an accredited post-secondary school beyond the the Unum plan; and 12th grade level on a full-time basis.  benefits will end on the earlier of the end of the maximum period of payment under the Unum plan or the date benefits would have ended under the prior plan.

Worldwide Emergency Travel Assistance Services2 Definition of Disability

Whether your travel is for business or pleasure, our worldwide emergency travel assistance program is there to help you when an unexpected emergency occurs. With one phone call anytime of the day or night, you, your spouse and dependent children can get immediate assistance anywhere in the world3. Emergency travel assistance is available to you when you travel to any foreign country, including neighboring Canada or Mexico. It is also available anywhere in the United States for those traveling more than 100 miles from home. Your spouse and dependent children do not have to be traveling with you to be eligible. However, spouses traveling on business for their employer are not covered by this program.

Other Important Provisions Pre-existing Condition Exclusion Benefits will not be paid for disabilities caused by, contributed to by, or resulting from a pre-existing condition. You have a preexisting condition if:  you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and  the disability begins in the first 12 months after your effective date of coverage.

Continuity of Coverage If you are actively at work at the time you convert to Unum’s plan and become disabled due to a pre-existing condition, benefits may be payable if you were:  in active employment and insured under the plan on its effective date; and  insured by the prior plan at the time of change. To receive a payment, you must satisfy the pre-existing condition under the Unum policy or the prior carrier’s policy. If you satisfy Unum’s pre-existing condition provision, payments will be determined by the Unum policy. If you only satisfy the pre-existing condition provision for the

You are disabled when Unum determines that:  you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury;  you have a 20% or more loss in indexed monthly earnings due to the same sickness or injury; and  during the elimination period you are unable to perform any of the material and substantial duties of your regular occupation. After benefits have been paid for 24 months, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. You must be under the regular care of a physician in order to be considered disabled.

Gainful Occupation Gainful occupation means an occupation that is or can be expected to provide you with an income within 12 months of your return to work, that exceeds 80% of your indexed monthly earnings if you are working or 60% of your indexed monthly earnings if you are not working.

Benefit Integration Your disability benefit will be reduced by deductible sources of income and any earnings you have while disabled. Your gross disability payment will be reduced immediately by such items as disability income or other amounts you receive or are entitled to receive from workers compensation or similar occupational benefit laws, sabbatical or assault leave plans and the amount of earnings you receive from an extended sick leave plan as described in Louisiana Revised Statutes or any other act or law with similar intent. After you have received monthly disability payments for 12 months, your gross disability payment will be reduced by such items as additional deductible sources of income you receive or 23

Educator Disability are entitled to receive under: state compulsory benefit laws; automobile liability insurance; legal judgments and settlements; certain retirement plans; salary continuation or sick leave plans; other group or association disability programs or insurance; and amounts you or your family receive or are entitled to receive from Social Security or similar governmental programs. Regardless of deductible sources of income, an employee who qualifies for disability benefits is guaranteed to receive a minimum benefit amount of 25% of the gross disability payment.

Mental Illness/Self-Reported Symptoms

Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

Next Steps How to Apply/Effective Date of Coverage Current Employees: To apply for coverage, complete your enrollment form by the enrollment deadline. Your effective date of coverage is 9/01. New Hires: To apply for coverage, complete your enrollment form within 60 days of your eligibility date. Please see your Plan Administrator for your effective date.

The lifetime cumulative maximum benefit period for all disabilities due to mental illness and disabilities based primarily on self-reported symptoms is 24 months. Only 24 months of If you do not enroll during the initial enrollment period, you may benefits will be paid for any combination of such disabilities apply only during an annual enrollment. even if the disabilities are not continuous and/or are not related. Payments would continue beyond 24 months only if you are confined to a hospital or institution as a result of the disability. If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will not take effect until you return to active employment. Please contact your Plan Administrator after you return to active employment for when your coverage will begin. Benefits will not be paid for disabilities caused by, contributed

Delayed Effective Date of Coverage

Instances When Benefits Would Not Be Paid

to by, or resulting from: intentionally self-inflicted injuries;  active participation in a riot;  commission of a crime for which you have been convicted;  loss of professional license, occupational license or certification;  pre-existing conditions (see definition). 

Unum will not cover a disability due to war, declared or undeclared, or any act of war. Unum will not pay a benefit for any period of disability during which you are incarcerated.

Termination of Coverage Your coverage under the policy ends on the earliest of the following:  The date the policy or plan is cancelled;  The date you no longer are in an eligible group;  The date your eligible group is no longer covered;  The last day of the period for which you made any required contributions;  The later of the last day you are in active employment except as provided under the covered layoff or leave of absence provision; or if applicable, the last day of your contract with your Employer but not beyond the end of your Employer’s current school contract year. 24

Questions If you should have any questions about your coverage or how to enroll, please contact your Plan Administrator. This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Some provisions may vary or not be available in all states. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. For complete details of coverage, please refer to policy form number C.FP-1, et al. 1,2 Work-life balance employee assistance program and On-Claim Support services are provided by Ceridian Corporation. Worldwide emergency travel assistance services are provided by Assist America, Inc. Services are available with selected Unum insurance offerings. Exclusions, limitations and prior notice requirements may apply, and service features, terms and eligibility criteria are subject to change. The services are not valid after termination of coverage and may be withdrawn at any time. Please contact your Unum representative for full details. 3 All Worldwide emergency travel assistance must be arranged by Assist America, which pays for all services it provides. Medical expenses such as prescriptions or physician, lab or medical facility fees are paid by the employee or the employee’s health insurance. Underwritten by: Unum Life Insurance Company of America 2211 Congress Street, Portland, Maine 04122, www.unum.com ©2007 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Educator Disability LOCKNEY INDEPENDENT SCHOOL DISTRICT Product: Educator Select Income Protection Plan Injury (Days) Sickness (Days)

0* 7*

14* 14*

Plan A ADEA II Duration of Benefits Elimination Period (Days) 30* 60 30* 60

90 90

180 180

Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

3600

300

200

7.30

6.18

5.36

4 .38

2.52

1.80

5400

450

300

10.95

9.27

8.04

6.57

3.78

2.70

7200

600

400

14.60

12.36

10.72

8.76

5.04

3.60

9000

750

500

18.25

15.4 5

13.40

10.95

6 .30

4.50

10800

900

600

21.90

18.54

16.08

13.14

7.56

5.40

12600

1050

700

25.55

21.63

18.76

15.33

8.82

6.30

14400

1200

800

29.20

24.72

21.44

17.52

10.08

7.20

16200

1350

900

32.85

27.81

24.12

19.71

11.34

8.10

18000

1500

1000

36.50

30.90

26 .80

21.90

12.60

9.00

19800

1650

1100

40.15

33.99

29.48

24.09

13.86

9.90

21600

1800

1200

43.80

37 .08

32.16

26.28

15.12

10.80

23400

1950

1300

47.45

40.17

34.84

28.47

16.38

11.70

25200

2100

1400

51.10

43.26

37.52

30.66

17.64

12 .60

27000

2250

1500

54.75

46 .35

40.20

32.85

18.90

13.50

28800

2400

1600

58.40

49 .44

42.88

35.04

20.16

14.40

30600

2550

1700

62.05

52 .53

45.56

37.23

21.42

15.30

32400

2700

1800

65.70

55.62

48.24

39.42

22.68

16.20

34200

2850

1900

69.35

58.71

50.92

41.61

23.94

17.10

36000

3000

2000

73.00

61.80

53.60

43.80

25.20

18.00

37800

3150

2100

76.65

64.89

56.28

45.99

26.46

18.90

39600

3300

2200

80.30

67.98

58.96

48.18

27.72

19.80

41400

3450

2300

83.95

71.07

61.64

50.37

28.98

20 .70

43200

3600

2400

87.60

74.16

64.32

52.56

30.24

21.60

45000

3750

2500

91.25

77.25

67.00

54 .75

31.50

22.50

46800

3900

2600

94.90

80.34

69.68

56 .94

32.76

23.40

48600

4050

2700

98.55

83.43

72.36

59.13

34.02

24.30

50400

4200

2800

102.20

86.52

75.04

61.32

35.28

25.20 25

Educator Disability LOCKNEY INDEPENDENT SCHOOL DISTRICT Product: Educator Select Income Protection Plan Injury (Days) Sickness (Days)

0* 7*

14* 14*

Plan A ADEA II Duration of Benefits Elimination Period (Days) 30* 60 30* 60

90 90

180 180

Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

52200

4350

2900

105.85

89.61

77.72

63.51

36.54

26.10

54000

4500

3000

109.50

92.70

80.40

65.70

37.80

27 .00

55800

4650

3100

113.15

95.79

83.08

67.89

39.06

27.90

57600

4800

3200

116.80

98.88

85.76

70.08

40.32

28.80

59400

4950

3300

120 .45

101.97

88.44

72.27

41.58

29.70

61200

5100

3400

124 .10

105.06

91.12

74.46

42 .84

30.60

63000

5250

3500

127 .75

108.15

93.80

76.65

44 .10

31.50

64800

5400

3600

131.40

111.24

96.48

78.84

45.36

32.40

66600

5550

3700

135.05

114.33

99.16

81.03

46.62

33.30

68400

5700

3800

138.70

117.42

101.84

83.22

47.88

34.20

70200

5850

3900

142 .35

120.51

104.52

85.41

49.14

35.10

72000

6000

4000

146 .00

123.60

107.20

87.60

50.40

36.00

73800

6150

4100

149.65

126.69

109.88

89.79

51.66

36.90

75600

6300

4200

153.30

129.78

112.56

91.98

52.92

37.80

77400

6450

4300

156.95

132.87

115.24

94.17

54.18

38.70

79200

6600

4400

160.60

135.96

117.92

96.36

55.44

39.60

81000

6750

4500

164.25

139.05

120 .60

98.55

56.70

40.50

82800

6900

4600

167.90

142.14

123.28

100.74

57.96

41.40

84600

7050

4700

171.55

145.23

125.96

102.93

59.22

42.30

86400

7200

4800

175.20

148.32

128.64

105.12

60.48

43.20

88200

7350

4900

178.85

151.41

131.32

107.31

61.74

44 .10

90000

7500

5000

182.50

154.50

134 .00

109.50

63.00

45.00

91800

7650

5100

186.15

157 .59

136.68

111.69

64.26

45 .90

93600

7800

5200

189.80

160.68

139.36

113.88

65.52

46 .80

95400

7950

5300

193.45

163.77

142.04

116.07

66.78

47.70

97200

8100

5400

197.10

166.86

144.72

118.26

68.04

48.60

Educator Disability LOCKNEY INDEPENDENT SCHOOL DISTRICT Product: Educator Select Income Protection Plan Injury (Days) Sickness (Days)

0* 7*

14* 14*

Plan A ADEA II Duration of Benefits Elimination Period (Days) 30* 60 30* 60

90 90

180 180

Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

99000

8250

5500

200.75

169.95

147.40

120.45

69.30

49.50

100800

8400

5600

204.40

173.04

150.08

122.64

70 .56

50.40

102600

8550

5700

208.05

176.13

152.76

124.83

71.82

51.30

104400

8700

5800

211.70

179.22

155.44

127.02

73.08

52.20

106200

8850

5900

215.35

182.31

158.12

129.21

74.34

53.10

108000

9000

6000

219.00

185.40

160.80

131.40

75.60

54.00

109800

9150

6100

222.65

188.49

163.48

133.59

76 .86

54.90

111600

9300

6200

226.30

191.58

166.16

135.78

78.12

55.80

113400

9450

6300

229.95

194.67

168.84

137.97

79.38

56.70

115200

9600

6400

233.60

197.76

171.52

140.16

80.64

57.60

117000

9750

6500

237.25

200.85

174.20

142.35

81.90

58.50

118800

9900

6600

240.90

203.94

176.88

144.54

83.16

59.40

120600

10050

6700

244.55

207 .03

179.56

146.73

84.42

60.30

122400

10200

6800

248.20

210.12

182.24

148.92

85.68

61.20

124200

10350

6900

251.85

213.21

184.92

151.11

86.94

62.10

126000

10500

7000

255.50

216.30

187.60

153.30

88.20

63.00

127800

10650

7100

259.15

219.39

190.28

155.49

89.46

63.90

129600

10800

7200

262.80

222.48

192.96

157.68

90.72

64.80

131400

10950

7300

266.45

225.57

195.64

159.87

91.98

65.70

133200

11100

7400

270.10

228.66

198.32

162.06

93.24

66.60

135000

11250

7500

273.75

231.75

201.00

164.25

94.50

67.50

5STAR

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 28 Lockney ISD Benefits Website: www.mybenefitshub.com/lockneyisd

Life and AD&D It may never be easier to add important coverage to your life insurance program—all you have to do is sign up now to receive a guaranteed amount of coverage without providing evidence of insurability (a completed health application and/or physical examination). This insurance is available to you at competitive group rates. And, you can buy this insurance through the convenience of automatic payroll deduction. By electing coverage during this initial enrollment period, you also protect your ability to buy additional insurance in the future. If your needs change due to marriage or divorce, adoption or birth of a child, death of a spouse, or a spouse’s termination of employment, you can add coverage (up to the Guarantee Issue Limit) to your plan without a health application and/or physical examination. If coverage is waived during the initial enrollment period, satisfactory evidence of insurability, including a completed health application will be required. A physical examination may also be required. Fortunately, you don’t have to die to discover you don’t have enough life insurance. Evaluate your life insurance needs today.

Employee

Spouse

Child

Minimum

$10,000

$5,000

$2,000

Maximum

5 times Annual Salary (up to) $500,000

50% of Employee Benefit (up to) $250,000

50% of Employee Benefit (up to) $10,000

Guarantee Issue Limit

5 times Annual Salary (up to) $150,000

50% of Employee Benefit (up to) $50,000

50% of Employee Benefit (up to) $10,000

Note: Securing coverage up to the guarantee issue limit amounts assumes at least 25% of eligible employees participate in the plan. Lower participation may cause guarantee issue amounts to be reduced, a rate adjustment, or benefit offer to be withdrawn from the group. Your Employer has selected the following features to be included in your plan. A complete description of each provision will be provided in a certificate booklet, which will be issued to you, should you decide to select Voluntary Term Life coverage. 

Your plan includes the option to select Spouse and Dependent Children coverage. Dependent children include those 14 days old, up to age 21 (25 if a full-time student). Minimums, maximums and guarantee issue limits are listed above. To determine your cost, use the rate calculation worksheet provided in these materials.



Your Plan includes Continuation of Life Insurance Benefits Due to Total Disability. If you became totally and continuously disabled through the Disability Elimination Period, this feature will keep your life insurance policy in force – without payment of premium.



Your plan includes Portability. This feature allows you to continue this insurance program for you and your dependents should you leave your employer for any reason – without providing information about your health.

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Your plan includes an Accelerated Death Benefit of up to 50% of your life benefit not to exceed a maximum of $50,000.

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Benefits are reduced when the insured reaches age 70, and will continue to decrease every five years thereafter. (See the chart below.) Spouse coverage, if available, terminates at age 70. AGE 70 75 80 85 90

% PAYABLE 65% 45% 30% 20% 15% 29

Life and AD&D Employee <30 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80+ Employee

$10,000 0.60 0.70 0.90 1.30 2.20 3.60 5.70 8.90 16.00 28.70 47.20 47.20 $10,000

$20,000 1.20 1.40 1.80 2.60 4.40 7.20 11.40 17.80 32.00 57.40 94.40 94.40 $20,000

$30,000 1.80 2.10 2.70 3.90 6.60 10.80 17.10 26.70 48.00 86.10 141.60 141.60 $30,000

$40,000 2.40 2.80 3.60 5.20 8.80 14.40 22.80 35.60 64.00 114.80 188.80 188.80 $40,000

$50,000 3.00 3.50 4.50 6.50 11.00 18.00 28.50 44.50 80.00 143.50 236.00 236.00 $50,000

$60,000 3.60 4.20 5.40 7.80 13.20 21.60 34.20 53.40 96.00 172.20 283.20 283.20 $60,000

$70,000 4.20 4.90 6.30 9.10 15.40 25.20 39.90 62.30 112.00 200.90 330.40 330.40 $70,000

$80,000 4.80 5.60 7.20 10.40 17.60 28.80 45.60 71.20 128.00 229.60 377.60 377.60 $80,000

AD&D

0.30

0.60

0.90

1.20

1.50

1.80

2.10

2.40

$90,000 $100,000 5.40 6.00 6.30 7.00 8.10 9.00 11.70 13.00 19.80 22.00 32.40 36.00 51.30 57.00 80.10 89.00 144.00 160.00 258.30 287.00 424.80 472.00 424.80 472.00 $90,000 $100,000 2.70

3.00

Note: Spouse / Child coverage amounts cannot be more than 50% of the Employee coverage amounts selected. Spouse <30 31 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69

$5,000 0.30 0.35 0.45 0.65 1.05 1.80 2.80 4.30 7.75

$10,000 0.60 0.70 0.90 1.30 2.10 3.60 5.60 8.60 15.50

$15,000 0.90 1.05 1.35 1.95 3.15 5.40 8.40 12.90 23.25

$20,000 1.20 1.40 1.80 2.60 4.20 7.20 11.20 17.20 31.00

$25,000 1.50 1.75 2.25 3.25 5.25 9.00 14.00 21.50 38.75

$30,000 1.80 2.10 2.70 3.90 6.30 10.80 16.80 25.80 46.50

$35,000 2.10 2.45 3.15 4.55 7.35 12.60 19.60 30.10 54.25

$40,000 2.40 2.80 3.60 5.20 8.40 14.40 22.40 34.40 62.00

$45,000 2.70 3.15 4.05 5.85 9.45 16.20 25.20 38.70 69.75

$50,000 3.00 3.50 4.50 6.50 10.50 18.00 28.00 43.00 77.50

Note: Spouse / Child coverage amounts cannot be more than 50% of the Employee coverage amounts selected. Child Per Child

$1,000 0.10

$2,000 0.20

$3,000 0.30

$4,000 0.40

$5,000 0.50

$6,000 0.60

$7,000 0.70

$8,000 0.80

$9,000 0.90

$10,000 1.00

Life and AD&D Voluntary Term Life Rate Worksheet To calculate monthly premium: 1. Locate the amount of coverage you wish to select along the top row of the Employee table. Then locate your age bracket along the left column of the table. Your monthly premium is the amount located where the row and column you have identified meet (down from top row and right from left column). If the amount you wish to select is greater than $100,000, select one of the top row numbers that when multiplied by another number, results in your desired life amount (e.g. - selecting the rate for $150,000 can be obtained by multiplying the appropriate rate for $50,000 times 3). Enter the employee rate in the space provided below. 2. Follow the same method to determine your spouse rate. Use the Spouse table (below the Employee table). Enter the spouse rate in the space provided below. 3. Follow the same method to determine your child rate. Use the Child table (below the Spouse table). Make sure you multiply the child rate by the number of children to be covered. Enter the Child rate in the space provided below. 4. Total the Employee, Spouse (if any) and Child (if any) rates to obtain your Total Monthly Premium.

_______________________ + _______________________ + _______________________ = _______________________ Employee Premium Spouse Premium Child(ren) Premium* Total Monthly Premium (*child rate x no. of children)

5STAR

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.

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

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 32 Lockney ISD Benefits Website: www.mybenefitshub.com/lockneyisd

Term Life with Terminal Illness and Quality of Life Rider The Family Protection Plan: Term Life Insurance with Terminal Illness Coverage to Age 100 Family Protection Plan Highlights This insurance is a voluntary benefit that is being provided through your employer to complement your overall benefit package. Most people are not prepared for the financial devastation that frequently accompanies death or the survival of a critical illness. The Family Protection Plan was developed to provide term life insurance protection and an instant emergency fund if an unexpected critical illness occurs, to age 100*. 

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Term Insurance to Age 100. Offers a guaranteed level premium to age 100 and a guaranteed level death benefit for the first 10 years. After 10 years the death benefit is projected to remain level to age 100 and we do not anticipate a reduction in the future. The coverage amount cannot be individually decreased on a particular insured due to a change in age, health, or employment status. Critical Illness Benefit pays the insured 30% of the policy coverage amount in a lump sum upon the occurrence of heart attack, life threatening cancer, stroke, cardiac bypass or heart transplant surgery or a terminal condition. Portability. You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid. Family Protection. Individual policies can be purchased on the employee, spouse, children and grandchildren . Children and Grandchildren Plan. Policies can also be purchased for children and grandchildren ages newborn through 23 for $4.98/month for a $10,000 policy or $9.97/ month for a $20,000 policy. Convenience. Premiums are taken care of simply and easily through payroll deductions. Easy Application Process. This insurance does not require a medical exam or blood profile. Eligibility for coverage is based on a few simple health questions on the application. Emergency Burial Benefit. Within 24 hours after receiving notice of an insured's death, an emergency death benefit of the lesser of 50% of the coverage amount, or $15,000 will be mailed to the insured's beneficiary, unless the death is within the two-year contestability period and/or under investigation.

DID YOU KNOW? Protecting your financial well being is easier than you think. It’s like trading in a daily latte for peace of mind.

$4.30 per day to start your morning with a $1.75

gourmet coffee OR per day to enrich your employee benefits package

It’s less expensive than you think.

Family Protection Plan Highlights Covered critical illnesses include:  Heart Attack  Life-Threatening Cancer  Stroke  Cardiac Bypass Surgery  Heart Transplant Surgery This benefit is also paid for terminal conditions.

Family Protection Plan - Terminal Illness MONTHLY PREMIUMS & INITIAL COVERAGE AMOUNTS - FPP - CI Coverage Age on Amount App. Date $10,000

Critical Illness Benefit $3,000

Coverage Amount $25,000

Critical Illness Benefit $7,500

Critical Critical Critical Critical Critical Coverage Illness Coverage Illness Coverage Illness Coverage Illness Coverage Illness Amount Benefit Amount Benefit Amount Benefit Amount Benefit Amount Benefit $50,000 $15,000 $75,000 $22,500 $100,000 $30,000 $125,000 $37,5000 $150,000 $45,000

18-25

$8.25

$14.13

$23.92

$33.71

$43.50

$53.29

$63.08

$8.28

$14.19

$24.04

$33.90

$43.75

$53.60

$63.46

$8.33

$14.33

$24.33

$34.33

$44.33

$54.33

$64.33

$8.43

$14.56

$24.79

$35.02

$45.25

$55.48

$65.71

$8.54

$14.85

$25.38

$35.90

$46.42

$56.94

$67.46

$8.68

$15.21

$26.08

$36.96

$47.83

$58.71

$69.58

$8.83

$15.56

$26.79

$38.02

$49.25

$60.48

$71.71

$8.97

$15.92

$27.50

$39.08

$50.67

$62.25

$73.83

$9.13

$16.31

$28.29

$40.27

$52.25

$64.23

$76.21

$9.32

$16.79

$29.25

$41.71

$54.17

$66.63

$79.08

$9.55

$17.38

$30.42

$43.46

$56.50

$69.54

$82.58

$9.87

$18.17

$32.00

$45.83

$59.67

$73.50

$87.33

$10.27

$19.17

$34.00

$48.83

$63.67

$78.50

$93.33

$10.75

$20.38

$36.42

$52.46

$68.50

$84.54

$100.58

$11.32

$21.79

$39.25

$56.71

$74.17

$91.63

$109.08

$11.93

$23.33

$42.33

$61.33

$80.33

$99.33

$118.33

$12.55

$24.88

$45.42

$65.96

$86.50

$107.04

$127.58

$13.18

$26.44

$48.54

$70.65

$92.75

$114.85

$136.96

$13.82

$28.04

$51.75

$75.46

$99.17

$122.88

$146.58

$14.48

$29.71

$55.08

$80.46

$105.83

$131.21

$156.58

$15.19

$31.48

$58.63

$85.77

$112.92

$140.06

$167.21

$15.96

$33.40

$62.46

$91.52

$120.58

$149.65

$178.71

$16.79

$35.48

$66.63

$97.77

$128.92

$160.06

$191.21

$17.68

$37.69

$71.04

$104.40

$137.75

$171.10

$204.46

$18.59

$39.98

$75.63

$111.27

$146.92

$182.56

$218.21

$19.53

$42.33

$80.33

$118.33

$156.33

$194.33

$232.33

$20.50

$44.75

$85.17

$125.58

$166.00

$206.42

$246.83

$21.50

$47.25

$90.17

$133.08

$176.00

$218.92

$261.83

$22.56

$49.90

$95.46

$141.02

$186.58

$232.15

$277.71

$24.96

$52.75

$101.17

$149.58

$198.00

$246.42

$294.83

$24.27

$55.90

$107.46

$159.02

$210.58

$262.15

$313.71

$26.36

$59.40

$114.46

$169.52

$224.58

$279.65

$334.71

$27.90

$63.25

$122.17

$181.08

$240.00

$298.92

$357.83

$29.57

$67.42

$130.50

$193.58

$256.67

$319.75

$382.83

58 34

Family Protection Plan - Terminal Illness MONTHLY PREMIUMS & INITIAL COVERAGE AMOUNTS - FPP - CI Coverage Age on Amount App. Date $10,000

Critical Illness Benefit $3,000

Coverage Amount $25,000

Critical Illness Benefit $7,500

$31.34

$71.85

$139.38

$206.90

$274.42

$341.94

$409.46

$33.20

$76.50

$148.67

$220.83

$293.00

$365.17

$437.33

$35.10

$81.25

$158.17

$235.08

$312.00

$388.92

$465.83

$37.04

$86.10

$167.88

$249.65

$331.42

$413.19

$494.96

$39.04

$91.10

$188.29

$264.65

$351.42

$438.19

$524.96

$41.13

$96.31

$199.67

$280.27

$372.25

$464.23

$556.21

$43.40

$102.00

$212.71

$297.33

$395.00

$492.67

$590.33

$46.01

$108.52

$207.29

$316.90

$421.08

$525.27

$629.46

$49.16

$116.40

$228.46

$340.52

$452.58

$564.65

$676.71

$53.10

$126.25

$248.17

$370.08

$492.00

$613.92

$735.83

$58.04

$138.60

$272.88

$407.15

$541.42

$675.69

$809.96

$64.23

$154.08

$303.83

$453.58

$603.33

$753.08

$902.83

Available only on children and grandchildren of employee: $4.98 monthly Age on application date: Full-term newborn to 23 years

$9.97 monthly Age on application date: Full-term newborn to 23 years

Coverage amount $10,000 Critical Illness benefits $3,000

Coverage amount $20,000 Critical Illness benefits $6,000