2018-19 Benefit Guide ESC Region 10 by Higginbotham Public Sector

ESC REGION 10

BENEFIT GUIDE EFFECTIVE: 09/01/2018 - 8/31/2019

www.mybenefitshub.com/escregion10

Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. HSA vs FSA Comparison

3 4-5 6-11 6

FLIP TO...

7 8 9 10

PG. 4 HOW TO HOW TO ENROLL ENROLL

TRS-ActiveCare Aetna

11 12-13

TRS Baylor Scott & White Health Plan EECU Health Savings Account

14-15 16-17

NBS Flexible Spending Account MDLive Teleheath The Hartford Hospital Indemnity Plan

18-21 22-23 24-25

PG. 6

EyeMed Vision Cigna Dental UNUM Critical Illness The Hartford Long Term Disability

26-27 28-31

SUMMARY PAGES

Voya Accident APL Cancer

40-43 44-47

OneAmerica Life, AD&D, and EAP 5 Star Individual Life

48-51 52-55

LegalEase Legal Services iLock360 Identity Theft Protection

56-57 58-59

32-33 34-39

PG. 12 YOUR BENEFITS

Benefit Contact Information

Benefit Contact Information MEDICAL– AETNA

MEDICAL– SWHP

CANCER

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

Scott & White Health Plan (877) 321-7947 https://trs.swhp.org/

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

TELEHEALTH

VISION

DENTAL

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

Group #1006968 EyeMed (866) 723-0513 www.eyemed.com

Group #3341882 Cigna (800) 244-6224 www.cigna.com

INDIVIDUAL LIFE

CRITICAL ILLNESS

DISABILITY

5 Star (800) 256-8606 www.5starima.com

UNUM (866) 679-3054 www.unum.com

The Hartford (800) 256-8606 www.thehartford.com

HOSPITAL INDEMNITY

VOLUNTARY GROUP LIFE

IDENTITY THEFT PROTECTION

The Hartford (800) 256-8606 www.thehartford.com

Group # 617246 OneAmerica (800) 256-8606 www.oneamerica.com

iLOCK360 (855) 287-8888 www.iLOCK360.com

FLEXIBLE SPENDING ACCOUNT

LEGAL

HEALTH SAVINGS ACCOUNT

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

Group #1000020 LegalEASE (800) 562-2929 www.legalease.com

EECU (817) 882-0800 www.eecu.org

EMPLOYEE ASSISTANCE PROGRAM OneAmerica (855) 365-4754 www.guidanceresources.com 3

MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS ESC10” to 313131 and get access to everything you need to

“FBS ESC10”

complete your benefits

to 313131

enrollment: 

Benefit Information



Online Support



Interactive Tools



And more. PLAY VIDEO

Text

OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/ escregion10

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.

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 school

Changes are not permitted during the plan year (outside of

district’s benefit website: www.mybenefitshub.com/

annual enrollment) unless a Section 125 qualifying event occurs.

escregion10. Click on the benefit plan you need information on (i.e., Dental) and you can find the forms you need under



Changes, additions or drops may be made only during the

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

district’s benefit website: www.mybenefitshub.com/

included in the dependent profile. Additionally, you must

escregion10. Click on the benefit plan you need information

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



For benefit summaries and claim forms, go to your school

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.

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

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. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

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

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 18 or more

Dependent Eligibility: You can cover eligible dependent

regularly scheduled hours each work week.

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

Eligible employees must be actively at work on the plan effective

maximum age listed below. Dependents cannot be double

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

covered by married spouses within ESC Region 10 as both

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

employees and dependents.

work concurrent with the plan effective date. For example, if your 2018 benefits become effective on September 1, 2018, you must be actively-at-work on September 1, 2018 to be eligible for your new benefits.

PLAN

CARRIER

MAXIMUM AGE

Medical

Aetna

To age 26

Telehealth

MDLIVE

To age 26

Dental High and Low (MAC)

Cigna Dental

To age 26

Vision

EyeMed

To age 26

Hospital Indemnity

The Hartford

To age 26

Cancer

American Public Life

To age 26

Voluntary Life & AD&D

OneAmerica

To age 26

ID Theft Protection

iLock360

To age 18

Critical Illness

UNUM

To age 26

Accident

Voya

To age 26

Individual Life

5Star Life

To age 24

Legal Services

LegalEASE

To age 26

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physicianâ&#x20AC;&#x2122;s statement confirming your dependentâ&#x20AC;&#x2122;s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 7

Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New: 

Financial Benefit Services (FBS) is the new Third Party Administrator for ESC Region 10. FBS conducts the annual enrollment and provides benefit support for ESC Region 10 employees. Benefits and insurance provides will remain the same with the exception of your HSA and FSA providers.



Dental by Cigna NEW! Cigna Dental offers two PPO options for eligible employees. The PPO plans allow you the freedom to choose your dentist. Each plan covers Preventive at 100%, Basic services are paid at 80% and Major services are paid at 50%. Orthodontics are covered only for children to age 19, with a $1,500 lifetime maximum on the High plan and $1,000 on the MAC. No waiting periods and a $1,500 annual maximum on the High plan and $1,000 annual maximum on the MAC plan. The Low option is a MAC plan, which means that if you visit an out-of-network provider, you may be responsible for some of the costs. Critical Illness by UNUM NEW! Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children are eligible for Guarantee Issue coverage. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. The following coverage amounts are available for you: $10,000 or $20,000. Your Spouse can elect up to 100% of employee coverage amount, and children receive 100% of employee coverage and premiums are included in the employee rate.



Basic Life and AD&D by OneAmerica NEW! ESC Region 10 now provides $30,000 in Basic Life coverage for all eligible employees. Additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. Additional AD&D benefits include seat belt, air bag, repatriation, child higher education, child care, paralysis/loss of use, severe burns, disappearance, and exposure.



Voluntary Life by OneAmerica NEW! OneAmerica is offering Guarantee Issue Term Life Insurance coverage for all eligible employees during Open Enrollment this year! Employee’s can elect up to $150,000 for themselves, $50,000 for Spouses and $10,000 for Child(ren) without answering health questions. Don’t forget to add/update beneficiary information!



Telehealth by MDLive NEW! ESC Region 10 provides Telehealth services at no cost for you. Telehealth provides 24/7/365 access to board-certified 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. You do not have to be enrolled in medical insurance to use this service! MDLIVE Toll free number (888) 365-

1663.

Don’t Forget!    

Login and complete your supplemental benefit enrollment from 07/11/2018- 08/17/2018 Enrollment assistance is available by calling Financial Benefit Services at 866-914-5202 to speak to an enrollment representative Monday—Thursday, 8 AM—5:30 PM & Friday 8 AM– 3PM. Bilingual assistance is available. Update your profile information: home address, phone numbers, email. IMPORTANT!! Due to the Affordable Care Act (ACA) reporting requirements, please add your dependent’s social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator. 8

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 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.

CHANGES IN STATUS (CIS):

QUALIFYING EVENTS

Marital Status

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

Change in Number of Tax Dependents

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

Change in Status of Employment Affecting Coverage Eligibility

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

Gain/Loss of Dependents' An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements under Eligibility Status an employer's plan may include change in age, student, marital, employment or tax dependent 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 Programs

Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.

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 9/1/2018 please notify your benefits administrator.

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

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

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

Plan Year September 1st through August 31st

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

Calendar Year January 1st through December 31st

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

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

(including diagnostic and/or consultation services).

SUMMARY PAGES

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

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

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source Account Owner Underlying Insurance Requirement

Employee and/or employer Individual

Employee and/or employer Employer

High deductible health plan

None

Description

Minimum Deductible Maximum Contribution

$1,350 single (2018) $2,700 family (2018) $3,450 single (2018) $6,900 family (2018)

N/A $2650

Permissible Use Of Funds

If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.

Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).

Cash-Outs of Unused Amounts (if no medical expenses)

Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65).

Not permitted

Year-to-year rollover of account balance?

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

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

Does the account earn interest?

Yes

Portable?

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

FLIP TO FOR HSA INFORMATION

PG. 16

FLIP TO FOR FSA INFORMATION

PG. 18

2018 – 2019 TRS-ActiveCare Plan Highlights Effective September 1, 2018 through August 31, 2019 | In-Network Level of Benefits1

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 Freestanding Emergency Room Participant pays

$500 copay per visit plus 20% after deductible

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 •Healthydiet/obesity counseling– unlimited to

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

Drug Deductible Short-Term Supply at a Retail Location 20% coinsurance after deductible, except for certain generic preventive drugs that are covered at 100%.2 20% coinsurance after deductible 50% coinsurance after deductible Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to 90-day supply)5 20% coinsurance after deductible

$20 for a 1- to 31-day supply $20 for a 1- to 31-day supply $40 for a 1- to 31-day supply3 $40 for a 1- to 31-day supply3 3 50% coinsurance for a 1- to 31-day supply 50% coinsurance for a 1- to 31-day supply (Min. $654; Max. $130)3

$45 for a 60- to 90-day supply

$105 for a 60- to 90-day supply3 $105 for a 60- to 90-day supply3 50% coinsurance for a 60- to 90-day supply3 50% coinsurance for a 60- to 90-day supply3 (min. $1804 , max $360)3 Specialty Medications 20% coinsurance after deductible 20% coinsurance 20% coinsurance (up to a 31-day supply) (min. $2004 , max $900) Short-Term Supply of a Maintenance Medication at Retail Location (up to a 31-day supply) 20% coinsurance after deductible 50% coinsurance after deductible

Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand

20% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible

$35 for a 1- to 31-day supply $35 for a 1- to 31-day supply $60 for a 1- to 31-day supply $60 for a 1- to 31-day supply 50% coinsurance for a 1- to 31-day supply3

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. A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. 1 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. 2 For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,750 - individual, $5,500 - family) and they pay nothing out of pocket for these drugs. Find the list of drugs at info.caremark.com/trsactivecare. 3 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. 4 If the cost of the drug is less than the minimum, you will pay the cost of the drug. 5 Participants can fill 32-day to 90-day supply through mail order.

Full monthly premium*

Premium with min. state/ district contribution**

$367

+Spouse

Your Monthly Premium***

Full monthly premium*

Premium with min. state/ district contribution**

$142

$540

$1,035

$810

+Children

$701

+Family

$1,374

Individual

Your Monthly Premium***

Full monthly premium*

Premium with min. state/ district contribution**

$315

$782

$557

$1,327

$1,102

$1,855

$1,630

$476

$876

$651

$1,163

$938

$1,149

$1,668

$1,443

$2,194

$1,969

Your Monthly Premium***

* If you are not eligible for the state/district subsidy, you will pay the full monthly premium. Please contact your Benefits Administrator for your monthly premium. ** The premium after state, $75 and district, $150 contribution is the maximum you pay per month. Ask your Benefits Administrator for your monthly cost. (This is the amount you will owe each month after all available subsidies are applied to your premium.) *** Completed by your benefits administrator. The state/district contribution may be greater than $225. 13

2018-2019 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Fully Covered Health Care Services

Copay

Preventive Services

No Charge

Standard Lab and X-ray

No Charge

Disease Management and Complex Case Management

No Charge

Well Child Care Annual Exams

No Charge

Immunizations (age appropriate)

No Charge

Plan Provisions

Copay

Annual Deductible

$1,000 Individual/ $3,000 Family

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

Lifetime Paid Benefit Maximum

Outpatient Services

$7,000 Individual/ $14,000 Family (includes combined Medical and RX copays, deductibles and coinsurance)

None

Copay $15 co-pay

Primary Care1

(First Primary Care Visit for Illness $0 Copay2)

Specialty Care

$70 co-pay

Other Outpatient Services

20% after deductible3

Diagnostic/Radiology Procedures

20% after deductible

Eye Exam (one annually) Allergy Serum & Injections

No Charge 20% after deductible

Outpatient Surgery

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

Maternity Care

Copay

Prenatal Care

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

Inpatient Delivery

Inpatient Services

Copay

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

Diagnostic & Therapeutic Services Physical and Speech Therapy Manipulative Therapy

Equipment and Supplies Preferred Diabetic Supplies and Equipment Non-Preferred Diabetic Supplies and Equipment Durable Medical Equipment/ Prosthetics 14

$150 per day4 and 20% of charges after deductible

Copay $70 copay 20% without office visit $40 plus 20% with office visit

Copay $5/$12.50 copay; no deductible 30% after Rx deductible 20% after deductible

2018-2019 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Home Health Services

Copay

Home Health Care Visit

$70 co-pay

Worldwide Emergency Care

Copay

Nurse Advice Line

1-877-505-7947

Online Services

No Charge â&#x20AC;&#x201D; go to http://trs.swhp.org

After Hours Primary Care Clinics

$20 co-pay

Ambulance and Helicopter

$40 copay plus 20% of charges after deductible

Emergency Room6

$250 copay plus 20% of charges after deductible

Urgent Care Facility

$50 copay per visit; deductible does not apply

Prescription Drugs (Group Value Formulary)

Copay

Annual Benefit Maximum

Unlimited

Rx Deductible

$150

Does not apply to preferred generic drugs

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

Maintenance Quantity Retail Quantity (Up to a 30-day supply)

BSW Pharmacies Only, including Mail Order (Up to a 90-day supply)

$5 copay

$12.50 copay

Preferred Brand

30% after Rx deductible

Non-preferred

50% after Rx deductible

Preferred Generic

Online Refills Mail Order

Specialty Medications

http://trs.swhp.org 1-817-388-3090

Copay Tier 1: 15% after Rx deductible

(Up to a 30-day supply)

Tier 2: 15% after Rx deductible Tier 3: 25% after Rx deductible

Including all services billed with office visit Does not apply to wellness or preventive visits 3 Includes other services, treatments, or procedures received at time of office visit 4 $750 maximum copay per admission and 20% after deductible 5 35 max visit per year 6 Copay waived if admitted within 24 hours 2

The SWHP MOMS Program provides you with professional staff who are notified of the delivery of your baby. These licensed professionals will contact you after you return home and help you with everything from the general well-being of both you and your baby, to breast/bottle feeding, to information on how to add your baby to your health plan.

EECU

HSA (Health Savings Account)

YOUR BENEFITS PACKAGE

PLAY VIDEO

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

The interest earned in an HSA is tax free.

Money withdrawn for medical spending never falls under taxable income.

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 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

HSA (Health Savings Account) What is an HSA?

How to Use Your Funds

Health Savings Account (HSA) enables you to save for and conveniently pay for qualified healthcare expenses, while you earn tax-free interest and pay no monthly service fees. Opening a Health Savings Account provides both immediate and long term benefits. The money in your HSA is always yours, even if you change jobs, switch your health plan, become unemployed or retire. Your unused HSA balance rolls over from year to year. And best of all, HSAs have tax-free deposits, tax-free earnings and tax-free withdrawals. And after age 65, you can withdraw funds from your HSA penalty-free for any purpose.



HSA Debit Card – use your EECU HSA Mastercard® debit card to pay healthcare providers at point-of-sale or by following the instructions provided on a bill from a medical provider.



Online Bill Pay – sign up, at eecu.org, and use EECU’s free online banking and bill pay to make payments to medical providers directly from your HSA. Online Transfers – use EECU’s online banking or mobile app; reimburse yourself for out-of-pocket expenses by making a transfer from your HSA to your personal checking or savings account. Check – optional HSA checks can be ordered upon request for a fee. You can use these checks to pay healthcare providers and suppliers.

EECU HSA Benefits

Save money tax-free for healthcare expenses – contributions are not subject to federal income taxes and  can be made by you, your employer or a third party*  No monthly service fee – so you can save more and earn more   Earn competitive dividends on your entire balance – compounded daily and paid monthly from deposit to withdrawal  Conveniently pay for qualified healthcare expenses – with Save your receipts – for all qualified medical a free, no annual fee EECU HSA Debit Mastercard® or via expenses. EECU does not verify eligibility. You EECU’s free online bill pay. (HSA checks are also available are responsible for making sure payments are upon request, for a nominal fee**) for qualified medical expenses.  Free online, mobile and branch access – allows you to actively manage your account however you prefer  Comprehensive service and support – to assist you in How To Manage Your Account optimizing your healthcare saving and spending • Online - check your balance, pay healthcare providers  Federally insured – to at least $250,000 by NCUA and arrange deposits; sign-up for online banking at www.eecu.org. 2018 Annual HSA Contribution Limits • Mobile - EECU’s mobile app allows you to manage your Individual: $3,450 account on the go; download “EECU Mobile Banking” in Family: $6,900 Apple’s App Store and Google Play. Catch-Up Contributions: Accountholders who meet the • Contact Member Service – call 817-882-0800 for help qualifications noted below are eligible to make an HSA with your HSA questions or transactions. You can also catch-up contribution of an additional $1,000. chat with us online at eecu.org or use our secure email.  Health Savings accountholder Member Service is available Monday through Friday from  Age 55 or older (regardless of when in the year an 8am – 6:30pm CT, Saturdays from 9am – 1pm CT and accountholder turns 55) closed on Sunday.  Not enrolled in Medicare (if an accountholder enrolls in • Account Statements – monthly statements show all your Medicare mid-year, catch-up contributions should be account activity for that period. You can receive free prorated) Authorized Signers who are 55 or older must have their own online statements or pay $2 per printed statement. HSA in order to make the catch-up contribution 

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.

FLIP TOâ&#x20AC;Ś PG. 11 FOR HSA VS. FSA COMPARISON

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 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

FSA (Flexible Spending Account) NBS Flexcard

When Will I Receive My Flex Card?

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

NBS Prepaid MasterCard® Debit Card

Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years. If you need a replacement card please contact NBS directly at (800) 274-0503.

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.

Expect Flex Cards to be delivered to the address listed in THEbenefitsHUB near the end of September. Don’t forget, Flex Cards Are Good For 3 Years!

For a list of sample expenses, please refer to the ESC Region 10 benefit website: www.mybenefitshub.com/escregion10

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

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

FSA Annual Contribution Max: $2,650

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 claims FAQs

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

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

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

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

        

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

Dependent Care Expense Account Example Expenses:    

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

What Can I Use My Flexible Spending Account On? For a full list of eligible expenses, please refer to www.mybenefitshub.com/escregion10

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

How Do I File A Claim? In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to receive one, you can visit www.mybenefitshub.com/ escregion10 and complete the “Claim Form” to send to NBS or use the web or phone app to file online.

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

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

Get Your Money 1. 2. 3. 4.

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

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

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

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

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 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

Telehealth When should I use MDLIVE?  If you’re considering the ER or urgent care for a nonemergency 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? $0. Employer Paid benefit covers entire family 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/terms-of-use/ 010113

THE HARTFORD YOUR BENEFITS PACKAGE

Hospital Indemnity

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About this Benefit Hospital Confinement Indemnity Insurance pays a daily benefit if you have a covered stay in a hospital*, critical care unit and rehabilitation facility. The benefit amount is determined based on the type of facility and the number of days you stay. Hospital Confinement Indemnity Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

The median hospital costs per stay have steadily grown to over $10,000.

$8,800

9,600

10,400

2003

2008

2012

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 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

Hospital Indemnity Region 10 Education Service Center Hospital indemnity (HI) insurance pays a cash benefit if you or an insured dependent (spouse or child) are confined in a hospital for a covered illness or injury. It also provides additional daily benefits for related services. Even with the best primary health insurance plan, out-of-pocket costs from a hospital stay can add up. The benefits are paid in lump sum amounts to you, and can help offset expenses that primary health insurance doesn’t cover (like deductibles, co-insurance amounts or copays), or benefits can be used for any non-medical expenses (like housing costs, groceries, car expenses, etc.).

Coverage Information You have a choice of two hospital indemnity plans, which allows you the flexibility to enroll for the coverage that best meets your current financial protection needs. Benefit amounts are based on the plan in effect for you or an insured dependent at the time the covered event occurs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s).

PLAN INFORMATION

Plan 1/Low Plan

Plan 3/High Plan

Coverage Type

On and off-job (24 hour)

Covered Events

Illness and Injury

HSA Compatible

Yes

BENEFITS HOSPITAL CARE

Plan 1/Low Plan

Plan 3/High Plan

$1,000

$2,000

First day hospital confinement

Up to 1 day per year

Daily hospital confinement (Day 2+)

Up to 90 days per year

$100

$200

Daily ICU confinement (Day 1+)

Up to 30 days per year

$150

$250

VALUE ADDED SERVICES

Plan 1/Low Plan

Plan 3/High Plan

Ability Assist® EAP1 – 24/7/265 access to help for financial, legal or emotional issues

Included

HealthChampionSM1 – Administrative & clinical support following serious illness or injury

Included

Premiums (Per Month) Rates and/or benefits can change. Tier

Plan 1/Low Plan

Plan 3/High Plan

Employee

$13.68 ($0.45 per day)

$27.22 ($0.78 per day)

EE +Spouse/Domestic Partner

$28.35 ($0.93 per day)

$56.41 ($1.62 per day)

EE + Children

$25.90 ($0.85 per day)

$51.53 ($1.47 per day)

EE + Family

$42.40 ($1.39 per day)

$84.35 ($2.41 per day)

EYEMED 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 26 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

Vision Vision Care Services In-Network Member Cost Out-of-Network Reimbursement Exam With Dilation as Necessary $10 Copay Up to $40 Contact Lens Fit and Follow-Up (Contact lens fit and two follow up visits are available once a comprehensive eye exam has been completed) Standard Contact Lens Fit & Follow-Up Up to $55 N/A Premium Contact Lens Fit & Follow-Up 10% off retail N/A Retinal Imaging Up to $39 N/A Frames $0 Copay; $130 allowance; Up to $91 20% off balance over $130 Standard Plastic Lenses Single Vision $25 Copay Up to $30 Bifocal $25 Copay Up to $50 Trifocal $25 Copay Up to $70 Standard Progressive Lens $90 Copay Up to $50 Premium Progressive Lens $110 Copay - $135 Copay Tier 1 $110 Copay Up to $50 Tier 2 $120 Copay Up to $50 Tier 3 $135 Copay Up to $50 Tier 4 $90 Copay, 80% of charge less $120 Allowance Up to $50 Lenticular $25 Copay Up to $70 Lens Options (paid by the member and added to the base price of lens) UV Treatment N/A $15 Tint (Solid and Gradient) $15 N/A Standard Plastic Scratch Coating N/A $15 Standard Polycarbonate N/A $40 Standard Polycarbonate - Kids under 19 N/A $40 Standard Anti-Reflective Coating N/A $45 Premium Anti-Reflective Coatingr N/A $57 - $68 Tier 1 $57 N/A Tier 2 $68 N/A Tier 3 N/A 80% of charge Photochromic/Transitions N/A $75 Polarized N/A 20% off retail price Other Add-Ons and Services N/A 20% off retail price Contact Lenses Conventional $130 allowance, 15% off balance over $130 Up to $130 Disposable

$0 Copay; $130 allowance; plus balance over $130 $0 copay, Paid in Full 15% off the retail price or 5% off the promotional price

Medically Necessary Laser Vision Correction Lasik or PRK from U.S. Laser Network Frequency Examination Lenses or Contact Lenses Frame

Up to $130 Up to $210 N/A RATES

Once every 12 months Once every 12 months Once every 24 months

EE Only EE + Family

$6.02 $15.35

Benefits Snapshot

With Us

Out-of-Network Reimbursement

Exam with dilation as necessary (Once every 12

$10 Copay

Up to $40

Frames (Once every 24 months)

$0 Copay: $130 allowance; 20% off balance over $130

Up to $91

Single Vision Lenses (Once every 12 months)

$25 Copay

Up to $30

$0 Copay; $130 allowance; plus balance over $130

Up to $130

months)

Or Contacts (Once every 12 months)

CIGNA

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 28 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

Dental PPO - Low (MAC) Plan Benefits Network Plan Year Maximum (Class I, II, III, & IX expenses) Annual Deductible Individual Family Reimbursement Levels**

RATES

Cigna Dental Choice In-Network Total Cigna DPPO

Out-of-Network

$2,000

$50 per person $150 per family

Based on Contracted Fees

Maximum Allowable Charge

Plan Pays

You Pay

Plan Pays

You Pay

100%

No Charge

100%

No Charge

80% After Deductible

20% After Deductible

50% 50% After After Deductible Deductible

50% After Deductible

50% 50% After After Deductible Deductible

50% After Deductible

50% 50% After After Deductible Deductible

50% After Deductible

EE Only

$36.68

EE + Spouse

$74.45

EE + Child(ren)

$70.64

EE + Family

$100.39

Class I - Preventive & Diagnostic Care Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain

Class II - Basic Restorative Care Restorative: fillings (amalgam and composite on all teeth) Endodontics: minor and major 80% 20% Periodontics: minor and major After After Oral Surgery: minor and major Deductible Deductible Anesthesia: general and IV sedation Repairs: Bridges, Crowns and Inlays Repairs: Dentures Denture Relines, Rebases and Adjustments

Class III - Major Restorative Care Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures

Class IV - Orthodontia

Class IX - Implants

Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP)® is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides: · 100% coverage for certain dental procedures · guidance on behavioral issues related to oral health · discounts on prescription and non-prescription dental products For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to the Contracted Fee Schedule but the dentist may balance bill up to their usual fees. 29

Dental PPO - High Plan Benefits

RATES

Cigna Dental Choice

Network Plan Year Maximum (Class I, II, III, & IX expenses) Annual Deductible Individual Family Reimbursement Levels**

In-Network Total Cigna DPPO

Out-of-Network

$2,000

$50 per person $150 per family

Based on Contracted Fees

Maximum Reimbursable Charge

Plan Pays

You Pay

Plan Pays

You Pay

100%

No Charge

100%

No Charge

80% After Deductible

20% After Deductible

50% 50% After After Deductible Deductible

50% After Deductible

50% 50% After After Deductible Deductible

50% After Deductible

50% 50% After After Deductible Deductible

50% After Deductible

EE Only

$45.37

EE + Spouse

$92.09

EE + Child(ren)

$87.35

EE + Family

$124.31

Class III - Major Restorative Care Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures

Class IV - Orthodontia

Class IX - Implants

Missing Tooth Limitation – The amount payable is 50% of the amount otherwise payable until insured for 12 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP)® is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides: · 100% coverage for certain dental procedures · guidance on behavioral issues related to oral health · discounts on prescription and non-prescription dental products For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees.

Dental PPO - High and Low (MAC) Procedure

Exclusions and Limitations

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

50% coverage on Class III and IV for 12 months Two per calendar year Two per calendar year 1 per calendar year for people under 19 Bitewings: 2 per calendar year Full mouth: 1 every 36 consecutive months., Panorex: 1 every 36 consecutive months Payable only when in conjunction with Ortho workup Various limitations depending on the service Various limitations depending on the service Replacement every 5 years Replacement every 5 years Replacement every 5 years Covered if more than 6 months after installation Covered if more than 6 months after installation Reviewed if more than once Repairs - Dentures Reviewed if more than once Limited to posterior tooth. One treatment per tooth every three years up to age 14 Limited to non-Orthodontic treatment 1 per 60 consecutive months if unserviceable and cannot be repaired. Benefits are based on the amount payable for nonprecious metals. No porcelain or white/tooth colored material on molar crowns or bridges When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses Dental Service on which payment will be based and the expenses that will be included as Covered Expenses

Alternate Benefit

Benefit Exclusions     

              

  

 Services performed primarily for cosmetic reasons Replacement of a lost or stolen appliance Replacement of a bridge or denture within five years following the date of its original installation Replacement of a bridge or denture which can be made useable according to accepted dental standards Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, diagnose or treat conditions of TMJ, stabilize periodontally involved teeth, or restore occlusion Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars Bite registrations; precision or semi-precision attachments; splinting A surgical implant of any type Instruction for plaque control, oral hygiene and diet Dental services that do not meet common dental standards Services that are deemed to be medical services Services and supplies received from a hospital Charges which the person is not legally required to pay Charges made by a hospital which performs services for the U.S. Government if the charges are directly related to a condition connected to a military service Experimental or investigational procedures and treatments Any injury resulting from, or in the course of, any employment for wage or profit Any sickness covered under any workers’ compensation or similar law Charges in excess of the reasonable and customary allowances To the extent that payment is unlawful where the person resides when the expenses are incurred; Procedures performed by a Dentist who is a member of the covered person’s family (covered person’s family is limited to a spouse, siblings, parents, children, grandparents, and the spouse’s siblings and parents); For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; To the extent that you or any of your Dependents is in any way paid or



entitled to payment for those expenses by or through a public program, other than Medicaid; To the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a “no-fault” insurance law or an uninsured motorist insurance law. Cigna HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents. In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer.

This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance certificate or plan description. Benefits are insured and/or administered by Connecticut General Life Insurance Company. "Cigna HealthCare" refers to various operating subsidiaries of Cigna Corporation. Products and services are provided by these subsidiaries and not by Cigna Corporation. These subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. DPPO insurance coverage is set forth on the following policy form numbers: AR: HP-POL77; CA: HP-POL57; CO: HP-POL78; CT: HP-POL58; DE: HP-POL79; FL: HP-POL60; ID: HP-POL82; IL: HP-POL62; KS: HP-POL84; LA: HP-POL86: MA: HP-POL 63; MI: HP-POL88; MO: HP- POL65; MS: HP-POL90; NC: HP-POL96; NE: HPPOL92; NH: HP-POL94; NM: HP-POL95; NV: HP-POL93; NY: HP-POL67; OH: HP-POL98; OK: HP-POL99; OR: HP-POL68; PA: HP-POL100; RI: HP-POL101; SC: HP-POL102; SD: HP-POL103; TN: HP-POL69; TX: HP-POL70; UT: HP-POL104; VA: HP-POL72; VT: HP-POL71; WA: POL-07/08; WI: HP-POL107; WV: HP-POL106; and WY: HP-POL108. “Cigna,” the “Tree of Life” logo and “Cigna Dental Care” are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Cigna Dental PPO plans are underwritten or administered by CGLIC or CHLIC, with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Arizona and Louisiana, the insured Dental PPO plan offered by CGLIC is known as the “CG Dental PPO”. In Texas, the insured dental product offered by CGLIC and CHLIC is referred to as the Cigna Dental Choice Plan, and this plan utilizes the national Cigna Dental PPO network. Cigna Dental Care (DHMO) plans are underwritten or administered by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc. (Kentucky and Illinois), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, Cigna Dental Care plans are underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc. and administered by Cigna Dental Health, Inc.

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 32 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

Critical Illness How can critical illness insurance help? Critical Illness insurance helps offset the financial effects of a catastrophic illness by paying a lump sum benefit when employees or their family members are diagnosed with a covered illness. The benefit is based on the amount of coverage inforce, the illness diagnosed and all other terms and provisions of the policy.

Benefit Overview Critical illness insurance is designed to help employees offset the financial effects of a catastrophic illness with a lump sum benefit if an insured is diagnosed with a covered critical illness. The Critical Illness benefit is based on the amount of coverage in effect on the date of diagnosis of a critical illness or the date treatment is received according to the terms and provisions of the policy. Coverage Amounts

Guarantee Issue

Pre-Existing Condition Benefit Waiting Period Portability Recurrence Benefit Premium Be Well Benefit Be Well Screening

Employee - $10,000 or $20,000 Spouse/Child - 100% of Employee Coverage Amount Employee - $30,000 Spouse /Child– 100% of Employee Coverage Amount 3/12 exclusion 0 days Included 100% Paid by the Employee $50 per calendar year Includes testing for cholesterol and diabetes, cancer and cardiovascular function. They also include imaging studies, immunizations and annual examinations by a physician.

Covered Conditions Critical Illnesses:  Coronary Artery Disease (major) (50%)  Coronary Artery Disease (minor) (10%)  End Stage Renal (Kidney) Failure  Heart Attack (Myocardial Infarction)  Major Organ Failure Requiring Transplant  Stroke Additional Critical Illnesses for your Children:  Cerebral Palsy  Cleft Lip or Palate  Cystic Fibrosis  Down Syndrome  Spina Bifida Supplemental Critical Illnesses:  Benign Brain Tumor  Coma  Loss of Hearing  Infectious Disease (25%)  Loss of Sight  Loss of Speech  Occupational Human Immunodeficiency Virus (HIV) or Hepatitis  Permanent Paralysis Progressive Diseases:  Amyotrophic Lateral Sclerosis (ALS)  Dementia (including Alzheimer's Disease)  Functional Loss  Multiple Sclerosis (MS)  Parkinson's Disease

Employee/Spouse Cost Age

$10,000

$20,000

<25 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+

$3.73 $4.73 $5.93 $7.93 $10.33 $13.53 $16.83 $22.53 $31.13 $44.83 $69.93 $103.63 $151.73 $244.93

$5.93 $7.93 $10.33 $14.33 $19.13 $25.53 $32.13 $43.53 $60.73 $88.13 $138.33 $205.73 $301.93 $488.33 33

THE HARTFORD YOUR BENEFITS PACKAGE

Disability

PLAY VIDEO

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 34 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

Long Term Disability Disability is designed to provide a monthly income to an individual that is disabled due to an accident or illness. There are different plans available with benefits becoming available from the 1st day of disability to as late as the 180th day. For specific details on how benefits are paid, refer to carrier brochure. Your disability coverage amount and premium can be accessed during your enrollment.



Pre-existing Conditions



Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have not received treatment for the disabling condition within 3 months, while insured under this policy, before the disability begins, or You have been insured under this policy for 12 months before your disability begins. You may also be covered if you have already satisfied the pre-existing condition requirement of your previous insurer. If your disability is a result of a pre-existing condition we will pay benefits for a maximum of 4 weeks.

Benefit Reductions Your benefit payments may be reduced by other income you receive or are eligible to receive due to your disability, such as:  Social Security Disability Insurance (please see www.mybenefitshub.com/escregion10 for exceptions)  Workers' Compensation  Other employer-based Insurance coverage you may have  Unemployment benefits  Settlements or judgments for income loss  Retirement benefits that your employer fully or partially pays for (such as a pension plan.)



Mental Illness, Alcoholism and Substance Abuse



Exclusions You cannot receive Disability benefit payments for disabilities that are caused or contributed to by:  War or act of war (declared or not)  Military service for any country engaged in war or other armed conflict  The commission of, or attempt to commit a felony  An intentionally self-inflicted injury

You can receive benefit payments for Long-Term Disabilities resulting from mental illness, alcoholism and substance abuse for a total of 24 months for all disability periods during your lifetime. Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24 month lifetime limit.

What other benefits are included in my disability coverage? 

 



Your benefit payments will not be reduced by certain kinds of other income, such as:  Retirement benefits if you were already receiving them before you became disabled  The portion of your Long -Term Disability payment that you place in an IRS-approved account to fund your future retirement.  Your personal savings, investment, IRAs or Keoghs  Profit-sharing  Most personal disability policies  Social Security increases Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.

Any case where your being engaged in an illegal occupation was a contributing cause to your disability You must be under the regular care of a physician to receive benefits

 

Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full-time employment. Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse, child or estate equal to three times the last monthly gross benefit. Travel Assistance Program – Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre-trip information, emergency medical assistance and emergency personal services. The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services. Waiver of Premium – Once your disability claim is approved and you have satisfied your elimination period, your coverage premiums will be waived. Identity Theft Protection – An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims. 35

Long Term Disability Premium Option: For the Premium benefit option â&#x20AC;&#x201C; the table below applies to disabilities resulting from injury or sickness: Age Disabled Prior to Age 63 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and older

Benefits Payable To Normal Retirement Age or 48 months if greater To Normal Retirement Age or 42 months if greater 36 months 30 months 27 months 24 months 21 months 18 months

MONTHLY PREMIUMS Accident / Sickness Elimination Period in Days Annual Earnings

Monthly Earnings

Monthly Benefit

0/7

14 / 14

30 / 30

60 / 60

90 / 90

180 / 180

$3,600 $5,400 $7,200 $9,000 $10,800 $12,600 $14,400 $16,200 $18,000 $19,800 $21,600 $23,400 $25,200 $27,000 $28,800 $30,600 $32,400 $34,200 $36,000 $37,800 $39,600 $41,400 $43,200 $45,000 $46,800 $48,600 $50,400 $52,200 $54,000 $55,800 $57,600 $59,400

$300 $450 $600 $750 $900 $1,050 $1,200 $1,350 $1,500 $1,650 $1,800 $1,950 $2,100 $2,250 $2,400 $2,550 $2,700 $2,850 $3,000 $3,150 $3,300 $3,450 $3,600 $3,750 $3,900 $4,050 $4,200 $4,350 $4,500 $4,650 $4,800 $4,950

$200 $300 $400 $500 $600 $700 $800 $900 $1,000 $1,100 $1,200 $1,300 $1,400 $1,500 $1,600 $1,700 $1,800 $1,900 $2,000 $2,100 $2,200 $2,300 $2,400 $2,500 $2,600 $2,700 $2,800 $2,900 $3,000 $3,100 $3,200 $3,300

$7.02 $10.53 $14.04 $17.55 $21.06 $24.57 $28.08 $31.59 $35.10 $38.61 $42.12 $45.63 $49.14 $52.65 $56.16 $59.67 $63.18 $66.69 $70.20 $73.71 $77.22 $80.73 $84.24 $87.75 $91.26 $94.77 $98.28 $101.79 $105.30 $108.81 $112.32 $115.83

$6.30 $9.45 $12.60 $15.75 $18.90 $22.05 $25.20 $28.35 $31.50 $34.65 $37.80 $40.95 $44.10 $47.25 $50.40 $53.55 $56.70 $59.85 $63.00 $66.15 $69.30 $72.45 $75.60 $78.75 $81.90 $85.05 $88.20 $91.35 $94.50 $97.65 $100.80 $103.95

$5.33 $8.00 $10.66 $13.33 $15.99 $18.66 $21.32 $23.99 $26.65 $29.32 $31.98 $34.65 $37.31 $39.98 $42.64 $45.31 $47.97 $50.64 $53.30 $55.97 $58.63 $61.30 $63.96 $66.63 $69.29 $71.96 $74.62 $77.29 $79.95 $82.62 $85.28 $87.95

$3.46 $5.19 $6.92 $8.65 $10.38 $12.11 $13.84 $15.57 $17.30 $19.03 $20.76 $22.49 $24.22 $25.95 $27.68 $29.41 $31.14 $32.87 $34.60 $36.33 $38.06 $39.79 $41.52 $43.25 $44.98 $46.71 $48.44 $50.17 $51.90 $53.63 $55.36 $57.09

$2.99 $4.49 $5.98 $7.48 $8.97 $10.47 $11.96 $13.46 $14.95 $16.45 $17.94 $19.44 $20.93 $22.43 $23.92 $25.42 $26.91 $28.41 $29.90 $31.40 $32.89 $34.39 $35.88 $37.38 $38.87 $40.37 $41.86 $43.36 $44.85 $46.35 $47.84 $49.34

$2.23 $3.35 $4.46 $5.58 $6.69 $7.81 $8.92 $10.04 $11.15 $12.27 $13.38 $14.50 $15.61 $16.73 $17.84 $18.96 $20.07 $21.19 $22.30 $23.42 $24.53 $25.65 $26.76 $27.88 $28.99 $30.11 $31.22 $32.34 $33.45 $34.57 $35.68 $36.80

Long Term Disability

Annual Earnings $61,200 $63,000 $64,800 $66,600 $68,400 $70,200 $72,000 $73,800 $75,600 $77,400 $79,200 $81,000 $82,800 $84,600 $86,400 $88,200 $90,000 $91,800 $93,600 $95,400 $97,200 $99,000 $100,800 $102,600 $104,400 $106,200 $108,000 $109,800 $111,600 $113,400 $115,200 $117,000 $118,800 $120,600 $122,400 $124,200 $126,000 $127,800 $129,600 $131,400 $133,200 $135,000 $136,800 $138,600 $140,400 $142,200 $144,000

Monthly Earnings $5,100 $5,250 $5,400 $5,550 $5,700 $5,850 $6,000 $6,150 $6,300 $6,450 $6,600 $6,750 $6,900 $7,050 $7,200 $7,350 $7,500 $7,650 $7,800 $7,950 $8,100 $8,250 $8,400 $8,550 $8,700 $8,850 $9,000 $9,150 $9,300 $9,450 $9,600 $9,750 $9,900 $10,050 $10,200 $10,350 $10,500 $10,650 $10,800 $10,950 $11,100 $11,250 $11,400 $11,550 $11,700 $11,850 $12,000

MONTHLY PREMIUMS Accident / Sickness Elimination Period in Days Monthly Benefit 0/7 14 / 14 30 / 30 60 / 60 90 / 90 180 / 180 $3,400 $119.34 $107.10 $90.61 $58.82 $50.83 $37.91 $3,500 $122.85 $110.25 $93.28 $60.55 $52.33 $39.03 $3,600 $126.36 $113.40 $95.94 $62.28 $53.82 $40.14 $3,700 $129.87 $116.55 $98.61 $64.01 $55.32 $41.26 $3,800 $133.38 $119.70 $101.27 $65.74 $56.81 $42.37 $3,900 $136.89 $122.85 $103.94 $67.47 $58.31 $43.49 $4,000 $140.40 $126.00 $106.60 $69.20 $59.80 $44.60 $4,100 $143.91 $129.15 $109.27 $70.93 $61.30 $45.72 $4,200 $147.42 $132.30 $111.93 $72.66 $62.79 $46.83 $4,300 $150.93 $135.45 $114.60 $74.39 $64.29 $47.95 $4,400 $154.44 $138.60 $117.26 $76.12 $65.78 $49.06 $4,500 $157.95 $141.75 $119.93 $77.85 $67.28 $50.18 $4,600 $161.46 $144.90 $122.59 $79.58 $68.77 $51.29 $4,700 $164.97 $148.05 $125.26 $81.31 $70.27 $52.41 $4,800 $168.48 $151.20 $127.92 $83.04 $71.76 $53.52 $4,900 $171.99 $154.35 $130.59 $84.77 $73.26 $54.64 $5,000 $175.50 $157.50 $133.25 $86.50 $74.75 $55.75 $5,100 $179.01 $160.65 $135.92 $88.23 $76.25 $56.87 $5,200 $182.52 $163.80 $138.58 $89.96 $77.74 $57.98 $5,300 $186.03 $166.95 $141.25 $91.69 $79.24 $59.10 $5,400 $189.54 $170.10 $143.91 $93.42 $80.73 $60.21 $5,500 $193.05 $173.25 $146.58 $95.15 $82.23 $61.33 $5,600 $196.56 $176.40 $149.24 $96.88 $83.72 $62.44 $5,700 $200.07 $179.55 $151.91 $98.61 $85.22 $63.56 $5,800 $203.58 $182.70 $154.57 $100.34 $86.71 $64.67 $5,900 $207.09 $185.85 $157.24 $102.07 $88.21 $65.79 $6,000 $210.60 $189.00 $159.90 $103.80 $89.70 $66.90 $6,100 $214.11 $192.15 $162.57 $105.53 $91.20 $68.02 $6,200 $217.62 $195.30 $165.23 $107.26 $92.69 $69.13 $6,300 $221.13 $198.45 $167.90 $108.99 $94.19 $70.25 $6,400 $224.64 $201.60 $170.56 $110.72 $95.68 $71.36 $6,500 $228.15 $204.75 $173.23 $112.45 $97.18 $72.48 $6,600 $231.66 $207.90 $175.89 $114.18 $98.67 $73.59 $6,700 $235.17 $211.05 $178.56 $115.91 $100.17 $74.71 $6,800 $238.68 $214.20 $181.22 $117.64 $101.66 $75.82 $6,900 $242.19 $217.35 $183.89 $119.37 $103.16 $76.94 $7,000 $245.70 $220.50 $186.55 $121.10 $104.65 $78.05 $7,100 $249.21 $223.65 $189.22 $122.83 $106.15 $79.17 $7,200 $252.72 $226.80 $191.88 $124.56 $107.64 $80.28 $7,300 $256.23 $229.95 $194.55 $126.29 $109.14 $81.40 $7,400 $259.74 $233.10 $197.21 $128.02 $110.63 $82.51 $7,500 $263.25 $236.25 $199.88 $129.75 $112.13 $83.63 $7,600 $266.76 $239.40 $202.54 $131.48 $113.62 $84.74 $7,700 $270.27 $242.55 $205.21 $133.21 $115.12 $85.86 $7,800 $273.78 $245.70 $207.87 $134.94 $116.61 $86.97 $7,900 $277.29 $248.85 $210.54 $136.67 $118.11 $88.09 $8,000 $280.80 $252.00 $213.20 $138.40 $119.60 $89.20 37

The Hartford Long Term Disability Select Option: For the Select benefit option â&#x20AC;&#x201C; see the tables below for the applicable benefit duration based on whether your disability is a result of injury or sickness. Schedule for disability caused by injury: Age Disabled Prior to Age 63 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and older

Benefits Payable To Normal Retirement Age or 48 months if greater To Normal Retirement Age or 42 months if greater 36 months 30 months 27 months 24 months 21 months 18 months

Schedule for disability caused by sickness: Age Disabled Prior to Age 65 Age 65 to 69 Age 69 and older

Annual Earnings $3,600 $5,400 $7,200 $9,000 $10,800 $12,600 $14,400 $16,200 $18,000 $19,800 $21,600 $23,400 $25,200 $27,000 $28,800 $30,600 $32,400 $34,200 $36,000 $37,800 $39,600 $41,400 $43,200 $45,000 $46,800 $48,600 $50,400 $52,200 $54,000 $55,800 $57,600 $59,400 38

Monthly Earnings $300 $450 $600 $750 $900 $1,050 $1,200 $1,350 $1,500 $1,650 $1,800 $1,950 $2,100 $2,250 $2,400 $2,550 $2,700 $2,850 $3,000 $3,150 $3,300 $3,450 $3,600 $3,750 $3,900 $4,050 $4,200 $4,350 $4,500 $4,650 $4,800 $4,950

Benefits Payable 5 Years To Age 70, but not less than one year 1 Year MONTHLY PREMIUMS Accident / Sickness Elimination Period in Days Monthly Benefit 0/7 14 / 14 30 / 30 60 / 60 90 / 90 180 / 180 $200 $6.39 $5.54 $4.79 $3.10 $2.65 $2.02 $300 $9.59 $8.31 $7.19 $4.65 $3.98 $3.03 $400 $12.78 $11.08 $9.58 $6.20 $5.30 $4.04 $500 $15.98 $13.85 $11.98 $7.75 $6.63 $5.05 $600 $19.17 $16.62 $14.37 $9.30 $7.95 $6.06 $700 $22.37 $19.39 $16.77 $10.85 $9.28 $7.07 $800 $25.56 $22.16 $19.16 $12.40 $10.60 $8.08 $900 $28.76 $24.93 $21.56 $13.95 $11.93 $9.09 $1,000 $31.95 $27.70 $23.95 $15.50 $13.25 $10.10 $1,100 $35.15 $30.47 $26.35 $17.05 $14.58 $11.11 $1,200 $38.34 $33.24 $28.74 $18.60 $15.90 $12.12 $1,300 $41.54 $36.01 $31.14 $20.15 $17.23 $13.13 $1,400 $44.73 $38.78 $33.53 $21.70 $18.55 $14.14 $1,500 $47.93 $41.55 $35.93 $23.25 $19.88 $15.15 $1,600 $51.12 $44.32 $38.32 $24.80 $21.20 $16.16 $1,700 $54.32 $47.09 $40.72 $26.35 $22.53 $17.17 $1,800 $57.51 $49.86 $43.11 $27.90 $23.85 $18.18 $1,900 $60.71 $52.63 $45.51 $29.45 $25.18 $19.19 $2,000 $63.90 $55.40 $47.90 $31.00 $26.50 $20.20 $2,100 $67.10 $58.17 $50.30 $32.55 $27.83 $21.21 $2,200 $70.29 $60.94 $52.69 $34.10 $29.15 $22.22 $2,300 $73.49 $63.71 $55.09 $35.65 $30.48 $23.23 $2,400 $76.68 $66.48 $57.48 $37.20 $31.80 $24.24 $2,500 $79.88 $69.25 $59.88 $38.75 $33.13 $25.25 $2,600 $83.07 $72.02 $62.27 $40.30 $34.45 $26.26 $2,700 $86.27 $74.79 $64.67 $41.85 $35.78 $27.27 $2,800 $89.46 $77.56 $67.06 $43.40 $37.10 $28.28 $2,900 $92.66 $80.33 $69.46 $44.95 $38.43 $29.29 $3,000 $95.85 $83.10 $71.85 $46.50 $39.75 $30.30 $3,100 $99.05 $85.87 $74.25 $48.05 $41.08 $31.31 $3,200 $102.24 $88.64 $76.64 $49.60 $42.40 $32.32 $3,300 $105.44 $91.41 $79.04 $51.15 $43.73 $33.33

The Hartford Long Term Disability

MONTHLY PREMIUMS Accident / Sickness Elimination Period in Days Monthly Benefit 0/7 14 / 14 30 / 30 60 / 60 90 / 90 180 / 180 $3,400 $108.63 $94.18 $81.43 $52.70 $45.05 $34.34 $3,500 $111.83 $96.95 $83.83 $54.25 $46.38 $35.35 $3,600 $115.02 $99.72 $86.22 $55.80 $47.70 $36.36 $3,700 $118.22 $102.49 $88.62 $57.35 $49.03 $37.37 $3,800 $121.41 $105.26 $91.01 $58.90 $50.35 $38.38 $3,900 $124.61 $108.03 $93.41 $60.45 $51.68 $39.39 $4,000 $127.80 $110.80 $95.80 $62.00 $53.00 $40.40 $4,100 $131.00 $113.57 $98.20 $63.55 $54.33 $41.41 $4,200 $134.19 $116.34 $100.59 $65.10 $55.65 $42.42 $4,300 $137.39 $119.11 $102.99 $66.65 $56.98 $43.43 $4,400 $140.58 $121.88 $105.38 $68.20 $58.30 $44.44 $4,500 $143.78 $124.65 $107.78 $69.75 $59.63 $45.45 $4,600 $146.97 $127.42 $110.17 $71.30 $60.95 $46.46 $4,700 $150.17 $130.19 $112.57 $72.85 $62.28 $47.47 $4,800 $153.36 $132.96 $114.96 $74.40 $63.60 $48.48 $4,900 $156.56 $135.73 $117.36 $75.95 $64.93 $49.49 $5,000 $159.75 $138.50 $119.75 $77.50 $66.25 $50.50 $5,100 $162.95 $141.27 $122.15 $79.05 $67.58 $51.51 $5,200 $166.14 $144.04 $124.54 $80.60 $68.90 $52.52 $5,300 $169.34 $146.81 $126.94 $82.15 $70.23 $53.53 $5,400 $172.53 $149.58 $129.33 $83.70 $71.55 $54.54 $5,500 $175.73 $152.35 $131.73 $85.25 $72.88 $55.55 $5,600 $178.92 $155.12 $134.12 $86.80 $74.20 $56.56 $5,700 $182.12 $157.89 $136.52 $88.35 $75.53 $57.57 $5,800 $185.31 $160.66 $138.91 $89.90 $76.85 $58.58 $5,900 $188.51 $163.43 $141.31 $91.45 $78.18 $59.59 $6,000 $191.70 $166.20 $143.70 $93.00 $79.50 $60.60 $6,100 $194.90 $168.97 $146.10 $94.55 $80.83 $61.61 $6,200 $198.09 $171.74 $148.49 $96.10 $82.15 $62.62 $6,300 $201.29 $174.51 $150.89 $97.65 $83.48 $63.63 $6,400 $204.48 $177.28 $153.28 $99.20 $84.80 $64.64 $6,500 $207.68 $180.05 $155.68 $100.75 $86.13 $65.65 $6,600 $210.87 $182.82 $158.07 $102.30 $87.45 $66.66 $6,700 $214.07 $185.59 $160.47 $103.85 $88.78 $67.67 $6,800 $217.26 $188.36 $162.86 $105.40 $90.10 $68.68 $6,900 $220.46 $191.13 $165.26 $106.95 $91.43 $69.69 $7,000 $223.65 $193.90 $167.65 $108.50 $92.75 $70.70 $7,100 $226.85 $196.67 $170.05 $110.05 $94.08 $71.71 $7,200 $230.04 $199.44 $172.44 $111.60 $95.40 $72.72 $7,300 $233.24 $202.21 $174.84 $113.15 $96.73 $73.73 $7,400 $236.43 $204.98 $177.23 $114.70 $98.05 $74.74 $7,500 $239.63 $207.75 $179.63 $116.25 $99.38 $75.75 $7,600 $242.82 $210.52 $182.02 $117.80 $100.70 $76.76 $7,700 $246.02 $213.29 $184.42 $119.35 $102.03 $77.77 $7,800 $249.21 $216.06 $186.81 $120.90 $103.35 $78.78 $7,900 $252.41 $218.83 $189.21 $122.45 $104.68 $79.79 $8,000 $255.60 $221.60 $191.60 $124.00 $106.00 $80.80 39

VOYA 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 40 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

Accident What accident benefits are available? The following list is a summary of the benefits provided by Accident Insurance. You may be required to seek care for your injury within a set amount of time.

Note that there may be some variations by state. For a list of standard exclusions and limitations, go to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any benefits.

EVENT

BENEFIT

Accident Hospital Care

Low Plan

High Plan

Surgery Open abdominal, thoracic

$800

$1,000

Surgery exploratory or without repair

$125

$140

Blood, plasma, platelets Hospital admission Hospital confinement Per day up to 365 Critical care unit confinement per day, up to 15 days Rehabilitation facility confinement per day for 90 days

$400

$500

$1,000

$1,125

$300 $475

$350 $525

$125

$150

$11,500

$14,500

Transportation per trip, up to 3 per accident

$500

$650

Lodging Per day, up to 30 days

$120

$150

Family care per child, up to 45 days Accident Care

$15

$20

Initial doctor visit

$60

$75

Urgent care facility treatment

$150

$200

Emergency room treatment

$150

$200

Coma Duration of 14 or more days

Ground ambulance Air ambulance Follow-up doctor treatment

$240

$300

$1,000 $60

$1,250 $75

Chiropractic treatment up to 6 per accident

$30

$40

Medical equipment

$40

$100

Physical or occupational therapy up to six per accident

$30

$40

Speech therapy up to 6 per accident Prosthetic device (one)

$30 $500

$40 $625

Prosthetic device (two or more)

$800

$1,000

Major diagnostic exam

$80

$200

Outpatient surgery (one per accident)

$150

$200

X-ray

$30

$40

Common Injuries Burns second degree, at least 36% of the body

$1,000

$1,125

Burns 3rd degree, at least 9 but less than 35 square inches of the body

$4,500

$6,000

Burns 3rd degree, 35 or more square inches of the body

$10,000

$12,500

Skin Grafts

25% of the burn benefit

$250 crown, $60 extraction

$300 crown, $75 extraction

Eye Injury removal of foreign object Eye Injury surgery

$60 $225

$80 $275

Torn Knee Cartilage surgery with no repair or if cartilage is shaved

$150

$175

Torn Knee Cartilage surgical repair

$500

$650

Laceration1 treated no sutures

$20

$25

Laceration1 sutures up to 2”

$40

$50

$160 $320 $500

$200 $400 $650

Emergency dental work

Laceration sutures 2” – 6” Laceration1 sutures over 6” Ruptured Disk surgical repair

Accident EVENT Tendon/Ligament/Rotator Cuff One, surgical repair Tendon/Ligament/Rotator Cuff Two or more, surgical repair Tendon/Ligament/Rotator Cuff Exploratory Arthroscopic Surgery with no repair Concussion Paralysis paraplegia Paralysis quadriplegia Dislocations Hip joint Knee Ankle or foot bone (s) Other than toes Shoulder Elbow Wrist Finger/toe Hand bone(s) Other than fingers Lower jaw Collarbone Partial dislocations Fractures Hip Leg Ankle Kneecap Foot Excluding toes, heel Upper arm Forearm, Hand, Wrist Except fingers Finger, Toe Vertebral body Vertebral processes Pelvis Except coccyx Coccyx Bones of face Except nose Nose Upper jaw Lower jaw Collarbone Rib or ribs Skull â&#x20AC;&#x201C; simple Except bones of face Skull â&#x20AC;&#x201C; depressed Except bones of face Sternum Shoulder blade Chip fractures

BENEFIT $275

$350

$550

$675

$800

$1,000

$150 $10,750 $16,000

$175 $13,500 $20,000

Closed/open reduction2

$2,550/$5,100 $1,600/$3,200

$3,200/$6,400 $2,000/$4,000

$1,000/$2,000

$1,200/$2,400

$1,000/$2,000 $750/$1,500 $750/$1,500 $175/$350

$1,500/$3,000 $900/$1,800 $900/$1,800 $250/$500

$750/$1,500

$900/$1,800

$750/$1,500 $750/$1,500 25% of the closed reduction amount Closed/open reduction3 $2,000/$4,000 $1,500/$3,000 $1,200/$2,400 $1,200/$2,400

$900/$1,800 $900/$1,800 25% of the closed reduction amount Closed/open reduction3 $2,500/$5,000 $1,800/$3,600 $1,500/$3,000 $1,500/$3,000

$1,200/$2,400

$1,500/$3,000

$1,400/$2,800

$1,750/$3,500

$1,200/$2,400

$1,500/$3,000

$160/$320 $2,240/$4,480 $960/$1,920

$200/$400 $2,800/$5,600 $1,200/$2,400

$2,250/$4,500

$2,750/$5,500

$200/$400

$300/$600

$800/$1,600

$1,000/$2,000

$400/$800 $1,000/$2,000 $960/$1,920 $960/$1,920 $300/$600

$500/$1,000 $1,250/$2,500 $1,200/$2,400 $1,200/$2,400 $350/$700

$1,000/$2,000

$1,250/$2,500

$2,000/$4,000

$2,500/$5,000

$240/$480 $1,200/$2,400 25% of the closed reduction amount

$300/$600 $1,500/$3,000 25% of the closed reduction amount

Laceration benefits are a total of all lacerations per accident. Closed Reduction of Dislocation = Non-surgical reduction of a completely separated joint. Open Reduction of Dislocation = Surgical reduction of a completely separated joint. 3 Closed Reduction of Fracture = Non-surgical. Open Reduction of Fracture = Surgical. 42 2

Accident Common Carrier: If the death occurs as a result of a covered accident on a common carrier, a higher benefit will be payable. Common carrier means any commercial transportation that operates on a regularly scheduled basis between predetermined points or cities. Accidental Death Benefits Employee Spouse Children Other Accident Employee Spouse Children Accidental Dismemberment Benefits Loss of both hand or both feet or sight in both eyes Loss of one hand or one foot AND the sight of one eye Loss of one hand AND one foot Loss of one hand OR one foot Loss of Two or more fingers or toes Loss of one finger or one toe

Low Plan $65,000 $30,000 $15,000

High Plan $85,000 $40,000 $20,000

$30,000 $12,500 $6,000 Low Plan

$40,000 $15,000 $8,000 High Plan

$20,000

$24,000

$14,000

$18,000

$14,000 $7,500 $1,200 $750

$18,000 $10,000 $1,500 $1,000

Monthly Rates (12 Pay Periods) Employee Employee and Spouse and Children

Benefit Plan

Employee

Family

Low

$11.72

$19.08

$22.64

$30.00

High

$14.44

$23.50

$27.92

$36.98

What does my Accident Insurance include? The benefits listed below are included with your Accident Insurance coverage. For a list of standard exclusions and limitations, please refer to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any benefits.  Wellness Benefit: This provides an annual benefit payment if you complete a health screening test. You may only receive a benefit payment once per year, even if you complete multiple health screening tests.  Examples of health screening tests include but are not limited to: Pap test, serum cholesterol test for HDL and LDL levels, mammography, colonoscopy, and stress test on bicycle or treadmill.  The annual benefit amount is $50 for completing a health screening test.  If your spouse and/or children are covered for Accident Insurance, they are also covered for the Wellness Benefit. Your spouse’s benefit amount is also $50. The benefit for child coverage is 50% of your benefit amount per child with an annual maximum of $100 for all children  Sports Accident Benefit: If your accident occurs while participating in an organized sporting activity as defined in



the certificate; the accident hospital care, accident care or common injuries benefit will be increased by 25%; to a maximum additional benefit of $1000. Accidental Death and Dismemberment (AD&D) coverage: If you are severely injured or die as a result of a covered accident, an AD&D benefit may be payable to you or your beneficiary.  Common carrier: If the death occurs as a result of a covered accident on a common carrier, a higher benefit will be payable. Common carrier means any commercial transportation that operates on a regularly scheduled basis between predetermined points or cities.

Exclusions and limitations Exclusions for the Certificate, Spouse Accident Insurance, and Children’s Accident Insurance and AD&D are listed below. (These may vary by state.) Benefits are not payable for any loss caused in whole or directly by any of the following*:  Participation or attempt to participate in a felony or illegal activity.  An accident while the covered person is operating a motorized vehicle while intoxicated. Intoxication means the covered person’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred.  Suicide, attempted suicide or any intentionally selfinflicted injury, while sane or insane.  War or any act of war, whether declared or undeclared, other than acts of terrorism.  Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.  Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor.  Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.  Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded. Performing these acts as part of your employment with the employer is not excluded.  Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities.  Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received.  Any sickness or declining process caused by a sickness.  Work for pay, profit or gain. *See the certificate of insurance and riders for a complete list of available benefits, exclusions and limitations. 43

AMERICAN PUBLIC LIFE

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 44 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

GC14 Limited Benefit Group Specified Disease Cancer Indemnity Insurance Region 10 Education Service Center THIS IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THIS POLICY, AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYER 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.

SUMMARY OF BENEFITS

Plan 1

Plan 2

Cancer Treatment Policy Benefits

Level 3

Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12-month period Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment

$15,000

$50 per treatment

paid in same manner and under the same maximums as any other benefit Level 4 Level 4

Cancer Screening Rider Benefits Diagnostic Testing - 1 test per calendar year

$100 per test

Follow-Up Diagnostic Testing - 1 test per calendar year

$100 per test

$500 per test / 2 per calendar year Level 1

$500 per test / 2 per calendar year Level 3

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

$45 unit dollar amount Max $4,500 per operation

Medical Imaging - per calendar year Surgical Rider Benefits Surgical

$100 per test

Anesthesia

25% of amount paid for covered surgery

Bone Marrow Transplant - Maximum per lifetime

$6,000

Stem Cell Transplant - Maximum per lifetime

$9,000

$600

$900

$1,000 / $100

$2,000 / $200

Internal Cancer First Occurrence Rider Benefits

Level 2

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

$5,000

Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime

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

$7,500

Heart Attack/Stroke First Occurrence Rider Benefits

Level 2

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

$5,000

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

$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

Hospital Intensive Care Unit Rider Benefits

TOTAL MONTHLY PREMIUMS BY PLAN** Issue Ages 18+

Individual

Individual & Spouse

1 Parent Family

2 Parent Family

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

$23.40

$26.04

$49.38

$54.92

$29.70

$33.00

$55.68

$61.86

**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.

APSB-22339(TX)-0518 FBS Region 10 Education Service Center

GC14 Limited Benefit Group Specified Disease Cancer Indemnity Insurance 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.

Cancer Treatment Benefits Eligibility

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.

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 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, incontestability and pre-existing condition exclusion for such increase will be based on the effective date of such increase.

Waiting Period

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.

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.

APSB-22339(TX)-0518 FBS Region 10 Education Service Center

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 preexisting 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 and Surgical 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.

Heart Attack/Stroke First Occurrence Benefits Pays a lump sum benefit amount when a covered person receives a first diagnosis of heart attack or stroke 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.

GC14 Limited Benefit Group Specified Disease Cancer Indemnity Insurance Limitations and Exclusions

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 [(if coverage is suspended for any covered person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request)]; 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; or 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).

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. Pre-Existing means a Specified Disease for which medical advice, consultation or treatment including prescribed medications, was recommended by or received from a member of the medical profession within the Pre-Existing Condition Period immediately preceding the Covered Person’s Effective Date.

Waiting Period

This rider contains a 30-day waiting period during which no benefits will be paid. If any heart attack or stroke 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.

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 a covered person’s death or the date the lump sum benefit amount for heart attack or stroke 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, as defined in the policy.

Hospital Intensive Care Unit Benefits 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.

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 [(if coverage is suspended for any covered person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request)]; 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).

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.

Portability (Voluntary Plans Only) 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. 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.

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 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 Specified Disease Cancer Indemnity Insurance | (09/17) | FBS | Region 10 Education Service Center

APSB-22339(TX)-0518 FBS Region 10 Education Service Center

AUL a ONEAMERICA 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 48 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

Life and AD&D Group Term Life Including matching AD&D Coverage     

ESC Region 10 provides all eligible employees with $30,000 Basic Life with AD&D. Waiver of premium benefit Accelerated life benefit Additional AD&D Benefits: Seat Belt, Air Bag, Repatriation, Child Higher Education, Child Care, Paralysis/Loss of Use, Severe Burns Optional Guaranteed issue amounts of dependent coverage as follows:

Eligible Employees This benefit is available for employees who are actively at work on the effective date and working a minimum of 18 hours per week.

Flexible Choices Since everyone's needs are different, this plan offers flexibility for you to choose a benefit amount that fits your needs and budget.

Accidental Death & Dismemberment (AD&D)

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

Continuation of Coverage Options 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. OR Conversion Should your life insurance coverage, or a portion of it, cease for any reason, you may be eligible to convert your Group Term Coverage to Individual Coverage without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible.

Additional life insurance benefits may be payable in the event of Accelerated Life Benefit an accident which results in death or dismemberment as defined If diagnosed with a terminal illness and have less than 12 in the contract. Additional AD&D benefits include seat belt, air months to live, you may apply to receive 25%, 50% or 75% of bag, repatriation, child higher education, child care, paralysis/ your life insurance benefit to use for whatever you choose. loss of use, severe burns, disappearance, and exposure.

Waiver of Premium

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. If you have existing coverage, you may increase your election amount by 2 increments without answering health questions (not to exceed the maximum the Guarantee Issue).

If approved, this benefit waives your insurance premium in case you become totally disabled and are unable to collect a paycheck.

Employee Guaranteed Issue Amount

$200,000

Spouse Guaranteed Issue Amount

$50,000

Child Guaranteed Issue Amount

$10,000

Upon reaching certain ages, your original benefit amount will reduce to a percentage as shown in the following schedule. The amounts of Dependent Life Insurance and Dependent AD&D Principal Sum will reduce according to the Employee's reduction schedule.

Age:

Reduces To:

50%

Reductions

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. 49

Life and AD&D Voluntary Term Life Coverage including matching AD&D coverage Monthly Payroll Deduction Illustration About your benefit options:    

You may select a minimum Life benefit of $10,000 up to a maximum amount of $500,000, in increments of $10,000. 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. Employees with existing coverage may increase 2 increments of coverage during open enrollment up to Guarantee Issue amount. Employee must select coverage to select any Dependent coverage. Spouse coverage cannot exceed 100% of the Voluntary Term Life amount selected by the Employee.

Age Category

EMPLOYEE OPTIONS Monthly Premium Rates Per $10,000 of Age Category Coverage

Monthly Premium Rates Per $10,000 of Coverage

0-24

$0.50

55-59

25-29

$0.50

60-64

$9.10

30-34

$0.80

65-69

$17.20

35-39

$1.10

70-74

$22.00

40-44

$1.60

75+

$22.00

45-49

$2.60

50-54

$4.00 Voluntary AD&D for all ages per $10,000 of coverage

Age Category

$6.20

$0.28

SPOUSE OPTIONS Monthly Premium Rates Per $5,000 of Age Category Coverage

Monthly Premium Rates Per $5,000 of Coverage

0-24

$0.25

55-59

$3.10

25-29

$0.25

60-64

$4.55

30-34

$0.40

65-69

$8.60

35-39

$0.55

70-74

$11.00

40-44

$0.80

75+

$11.00

45-49

$1.30

50-54

$2.00

Life & AD&D

Child(ren) 6 months to age 26

Child(ren) live birth to 6 months

Deduction amount

Option 1:

$5,000

$1,000

$1.00

Option 2:

$10,000

$1,000

$2.00

CHILD(REN) OPTIONS

Employee premiums are based on your age as of 09/01. Spouse premiums are based on your spouse's age as of 09/01. Child premiums are for all eligible children combined. 50

ComPsych GuidanceResources® Program “Employee Assistance Program" this benefit is provided by ESC Region 10 at no additional charge to the employee.

Confidential Counseling

Work-Life Solutions

This no-cost counseling service helps you address stress, relationship and other personal issues you and your family may face. It is staffed by GuidanceConsultantsSM—highly trained master’s and doctoral level clinicians who will listen to your concerns and quickly refer you to in-person counseling (up to 6 sessions per issue per year) and other resources for: › Stress, anxiety and depression › Job pressures › Relationship/marital conflicts › Grief and loss › Problems with children › Substance abuse

Our Work-Life specialists will do the research for you, providing qualified referrals and customized resources for: › Child and elder care › College planning › Moving and relocation › Pet care › Making major purchases › Home repair

Financial Information and Resources Speak by phone with our Certified Public Accountants and Certified Financial Planners on a wide range of financial issues including: › Getting out of debt › Retirement planning › Credit card or loan problems › Estate planning › Tax questions › Saving for college

Legal Support and Resources Talk to our attorneys by phone. If you require representation, we’ll refer you to a qualified attorney in your area for a free 30minute consultation with a 25% reduction in customary legal fees thereafter. Call about: › Divorce and family law › Real estate transactions › Debt and bankruptcy › Civil and criminal actions › Landlord/tenant issues › Contracts

GuidanceResources® Online GuidanceResources Online is your one stop for expert information on the issues that matter most to you… relationships, work, school, children, wellness, legal, financial, free time and more. › Timely articles, HelpSheetsSM, tutorials, streaming videos and self-assessments › “Ask the Expert” personal responses to your questions › Child care, elder care, attorney and financial planner searches

Free Online Will Preparation EstateGuidance® lets you quickly and easily write a will on your computer. Just go to www.guidanceresources.com and click on the EstateGuidance link. Follow the prompts to create and download your will at no cost. Online support and instructions for executing and filing your will are included. You can: › Name an executor to manage your estate › Choose a guardian for your children › Specify your wishes for your property › Provide funeral and burial instructions

Call 855.387.9727 OR GO TO www.guidanceresources.com Use Web ID: ONEAMERICA3

OneAmerica is the marketing name for American United Life Insurance Company® (AUL). AUL markets ComPsych services. ComPsych Corporation is not an affiliate of AUL and is not a OneAmerica company. 51

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.

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 52 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

Term Life with Terminal Illness and Quality of Life Rider The Family Protection Plan: Term Life Insurance with Terminal Illness Coverage to Age 100 Nearly 85% of Americans say most people need life insurance; unfortunately only 62% have coverage and a staggering 33% say they don’t have enough life insurance, including one-fourth who already have life insurance coverage.** Nobody wants to be a statistic - especially during a period of grief. That’s why 5Star Life Insurance Company developed its FPP policy - to ensure you and your loved ones are covered during a period of loss.

Affordability - With several options to choose from, select the coverage that best meets the needs of your family. Terminal Illness - This plan pays the insured 30% (25% in Connecticut and Michigan) of the policy coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months.

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.

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. If this happens, we can simply bill you directly. Coverage can never be cancelled by the insurance company or your employer unless you stop paying premiums. Family Protection - Individual policies can be purchased on the employee, their spouse, children and grandchildren (ages 15 days to age 24). Quality of Life Benefit - Following a diagnosis of either a chronic illness or cognitive impairment, this rider accelerates a portion of the death benefit on a monthly basis – 4%; up to 75% of your benefit, and payable directly to you on a tax favored basis for the following:  Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or  Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision. Convenience - Premiums are taken care of simply and easily through payroll deductions. Protection You Can Count On - 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 $10,000, will be mailed to the insured’s beneficiary, unless the death is within the twoyear contestability period and/or under investigation. This product also contains no war or terrorism exclusions.

* Life insurance product underwritten by 5Star Life insurance Company (a Baton Rouge, Louisiana company) with an administrative office at 909 N. Washington Street, Alexandria, VA 22314

Family Protection Plan - Terminal Illness MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT Age on Eff. Date 18-25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45

$10,000 $7.56 $7.59 $7.65 $7.74 $7.88 $8.07 $8.27 $8.50 $8.73 $9.01 $9.30 $9.64 $10.02 $10.41 $10.85 $11.31 $11.83 $12.41 $13.00 $13.63 $14.27

$20,000 $10.78 $10.83 $10.97 $11.15 $11.43 $11.80 $12.20 $12.65 $13.11 $13.67 $14.27 $14.95 $15.70 $16.48 $17.35 $18.29 $19.33 $20.48 $21.66 $22.91 $24.22

$30,000 $14.01 $14.09 $14.28 $14.56 $14.99 $15.53 $16.14 $16.81 $17.51 $18.34 $19.23 $20.26 $21.39 $22.56 $23.86 $25.26 $26.83 $28.56 $30.34 $32.21 $34.16

46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65

$14.97 $15.70 $16.43 $17.22 $18.08 $19.04 $20.16 $21.40 $22.79 $24.26 $25.94 $27.66 $29.42 $31.23 $33.12 $35.08 $37.12 $39.31 $41.68 $44.34

$25.60 $27.05 $28.51 $30.10 $31.82 $33.75 $35.98 $38.46 $41.25 $44.20 $47.53 $50.98 $54.50 $58.12 $61.90 $65.82 $69.91 $74.29 $79.04 $84.33

$36.24 $38.41 $40.61 $42.98 $45.56 $48.46 $51.81 $55.54 $59.71 $64.13 $69.14 $74.31 $79.58 $85.01 $90.69 $96.56 $102.71 $109.26 $116.38 $124.34

Employee/Spouse Coverage Amounts $40,000 $50,000 $75,000 $17.24 $20.46 $28.53 $17.33 $20.59 $28.71 $17.60 $20.92 $29.21 $17.96 $21.38 $29.90 $18.54 $22.09 $30.96 $19.27 $23.00 $32.34 $20.06 $24.00 $33.84 $20.97 $25.12 $35.52 $21.90 $26.29 $37.27 $23.00 $27.67 $39.33 $24.20 $29.17 $41.59 $25.57 $30.88 $44.15 $27.07 $32.76 $46.96 $28.64 $34.71 $49.89 $30.37 $36.87 $53.15 $32.23 $39.21 $56.65 $34.33 $41.83 $60.58 $36.63 $44.71 $64.90 $39.00 $47.67 $69.33 $41.50 $50.79 $74.02 $44.10 $54.05 $78.90 $46.87 $49.77 $52.70 $55.87 $59.30 $63.17 $67.63 $72.60 $78.17 $84.06 $90.73 $97.63 $104.67 $111.90 $119.46 $127.30 $135.50 $144.23 $153.73 $164.33

$57.51 $61.13 $64.79 $68.75 $73.04 $77.88 $83.46 $89.67 $96.63 $104.00 $112.34 $120.96 $129.75 $138.79 $148.25 $158.04 $168.29 $179.21 $191.09 $204.34

$84.09 $89.52 $95.03 $100.96 $107.39 $114.65 $123.02 $132.33 $142.77 $153.83 $166.33 $179.27 $192.46 $206.02 $220.21 $234.90 $250.27 $266.65 $284.46 $304.33

$100,000 $36.59 $36.83 $37.50 $38.41 $39.84 $41.67 $43.66 $45.92 $48.25 $51.00 $54.00 $57.42 $61.17 $65.09 $69.42 $74.08 $79.33 $85.08 $91.00 $97.25 $103.75

$125,000 $44.65 $44.96 $45.80 $46.94 $48.71 $51.01 $53.50 $56.31 $59.23 $62.67 $66.42 $70.69 $75.37 $80.27 $85.68 $91.52 $98.08 $105.27 $112.67 $120.48 $128.60

$150,000 $52.71 $53.09 $54.08 $55.46 $57.59 $60.33 $63.34 $66.71 $70.21 $74.34 $78.83 $83.96 $89.59 $95.46 $101.96 $108.96 $116.83 $125.46 $134.34 $143.71 $153.46

$110.67 $117.92 $125.25 $133.17 $141.75 $151.42 $162.58 $175.00 $188.92 $203.66 $220.33 $237.58 $255.17 $273.25 $292.16 $311.75 $332.25 $354.08 $377.83 $404.33

$137.25 $146.32 $155.48 $165.37 $176.10 $188.19 $202.15 $217.67 $235.07 $253.50 $274.34 $295.89 $317.87 $340.48 $364.13 $388.60 $414.23 $441.52 $471.21 $504.34

$163.84 $174.71 $185.71 $197.58 $210.46 $224.96 $241.71 $260.34 $281.21 $303.33 $328.34 $354.21 $380.58 $407.71 $436.09 $465.46 $496.21 $528.96 $564.58 $604.34

Family Protection Plan - Terminal Illness MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT Age on Eff. Date 66* 67* 68* 69* 70*

$10,000 $44.93 $48.25 $52.03 $56.33 $61.17

$20,000 $85.52 $92.17 $99.73 $108.32 $118.00

$30,000 $126.11 $136.08 $147.43 $160.31 $174.83

Employee/Spouse Coverage Amounts $40,000 $50,000 $75,000 $166.70 $207.29 $308.77 $180.00 $223.92 $333.71 $195.13 $242.83 $362.08 $212.30 $264.29 $394.27 $231.67 $288.50 $430.58

$100,000 $410.25 $443.50 $481.33 $524.25 $572.67

$125,000 $511.73 $553.29 $600.58 $654.23 $714.75

$150,000 $613.21 $663.08 $719.83 $784.21 $856.83

*Quality of Life not available ages 66 - 70. Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on effective date: age 14 days to 23 years). $4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 coverage.

LEGAL EASE YOUR BENEFITS PACKAGE

Legal Services

About this Benefit Finding the right type of attorney when a need arises can be one of the more stressful tasks when dealing with a legal matter. The right help is essential. There are many types of attorneys depending upon what type of issue someone may be facing. We help with this first step. We use our experience and relationships with our network providers to match you to the right type of attorney you need in the right location, with availability to set up a consultation with you. We see this step as a way to save you time, so you can get back to your busy schedule of work, kids or whatever may be just as important.

$1,500 Is the average cost of a basic will and estate planning package. The average yearly premium paid by Texas Legal Members is only $300.

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 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

Legal Services LegalGUARD Plan Benefits

Plan Cost:

Benefits are designed to meet the typical needs of an employee The LegalGUARD Plan is only $24.16 per month, via payroll and their family. There are no deductibles to worry about for deduction. covered services. Benefits cover the attorney’s time. Other costs, Who is Covered: such as filing fees, are not covered by legal benefits. Listed below  Employee are the types of matters that are covered by the LegalGUARD  Spouse Plan. The LegalGUARD plan offers convenience of In Network and  Dependent children Out of Network benefits. Many of the below areas are fully  Elder parents covered, unless noted.

Home and Residential

Auto & Traffic

Purchase of primary residence, Sale of primary residence, Refinancing of primary residence, Tenant dispute1,2, Foreclosure1,2

Serious traffic matters (resulting in suspension or revocation of license), License Suspension (Administrative proceeding)

Financial and Consumer

Family

Debt collection defense: pre-litigation activities & trial defense1,2, Bankruptcy (chapter 7 or 13) 1,2 , Tax audit1,2, Document preparation, Consumer dispute, Small claims court1, Life insurance claim1,2, Financial advisor3, Identity theft assiatance3

Separation1, Divorce1,2, Name change, Guardianship/conservatorship1, Adoptions1, Juvenile court proceedings, Elder law3

Estate Planning and Wills

General

Will or codicil, Living will or Health Care Power of Attorney, Complex will4, Probate of small estate1, Living trust document

LegalGUARD Covered Family Member Definition: The Member’s lawful spouse and children. Eligible Family Members are the Member’s spouse and Member’s unmarried dependent children, including stepchild, legally adopted child, child placed in the home for adoption and foster child, up to age 26 .

Civil litigation defense1,2, Initial law office consultation1, Review of simple documents1, Misdemeanor defense1,2

Limitations and Exclusions Apply. This benefit summary is intended only to highlight benefits and should not be relied upon to fully determine coverage. More complete descriptions of benefits and the terms under which they are provided are received upon enrolling in the plan. Group legal plans are administered by LegalEASE or The LegalEASE Group, Houston, Texas. Product available in all states. Underwritten by Virginia Surety Company, Inc. Please contact LegalEASE for complete details.

Limitations apply Subject to Managed Case Rules 3Additional Benefit 4Flat Rate Fee or discounted rate 1 2

iLock360

Identity Theft

YOUR BENEFITS PACKAGE

PLAY VIDEO

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 58 ESC Region 10 Benefits Website: www.mybenefitshub.com/escregion10

Identity Theft Essential Plan Features

Non-Credit Loans

CyberAlert™️ monitors:

See if your personal information becomes linked to payday loans that do not require hard credit inquiries.

   

one Social Security Number two Phone Numbers two Email Addresses five Credit/Debit Cards

   

two Medical ID Numbers five Bank Accounts one Drivers License Number one Passport

Scours Internet properties, including the dark web, websites, blogs, bulletin boards, peer-to-peer sharing networks and chat rooms to identify the illegal trading and selling of a subscriber’s personal information.

$1 Million of Identity Theft Insurance

ScoreTrackerTM Receive a month-after-month report that provides relevant information with trends and credit score insight. Plus

Premium

CyberAlert™️

✔✔

Social Security Trace

✔✔

Change of Address

✔

Sex Offender Registry

✔

Lost Wallet Protection

Payday Loans

✔

In the event that you lose your wallet, iLOCK360 agents will make all the calls necessary to replace missing cards and IDs: quick, easy, and less stress for you.

Court/Criminal Records Full Service restoration and lost wallet protection $1M Insurance Daily Monitoring of TransUnion Credit bureau Daily Monitoring of Equifax credit bureau

✔

✔✔

✔

For even more peace of mind, you are insured with a one million dollar insurance policy against expenses in the event that your identity is compromised.

Full-Service Identity Restoration Contact an iLOCK360 Certified Identity Theft Restoration Management Specialist, who’ll work on your behalf to restore your ID, and let you get on with your life.

Change of Address Prevent criminals from accessing your bank statements, credit card statements, and other identifying information by monitoring any changes to your address.

Sex Offender Reports Understand if and when any sex offend- ers reside or move into your zip code, and ensure that your identity isn’t being used fraudulently in the sex offender registry.

Court Records Know if and when your name, date of birth and Social Security number appear in court records for an offense or crime that you did not commit.

Service

✔ ✔

ScoreTrackerTM ✔ adults

✔ children to age 18 Coverage Plan (Monthly Rates)

Plus

Premium

Individual

$15

Individual and Spouse

$15

$22

Individual and Children

$13

$20

Individual and Family

$20

$27

Credit Report Monitoring Find out your credit score, analyze your credit report, and monitor your identity for credit-related activity

Social Security Number Trace Know if your Social Security number becomes associated with another individual’s name or address. 59