2019 Keller ISD Benefit Guide by Higginbotham Public Sector

KELLER ISD

BENEFIT GUIDE EFFECTIVE: 01/01/2019 - 12/31/2019 WWW.MYBENEFITSHUB.COM/KELLERISD

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. KISD Frequently Asked Questions 7. KISD Rates The Hartford Basic Life UnitedHealthcare Medical Voya Hospital Indemnity Voya Critical Illness Voya Accident Cigna Dental Superior Vision QCD Discount Dental & Vision The Hartford Long Term Disability The Hartford Voluntary Life and AD&D NBS Flexible Spending Account (FSA) UHC Health Savings Account 2

3 4-5 6-11 6 7 8 9 10 11 12-17 18-19 20-33 34-37 38-41 42-45 46-51 52-53 54-55 56-59 60-65 66-69 70-73

FLIP TO... PG. 4 HOW TO HOW TO ENROLL ENROLL

PG. 6 SUMMARY PAGES

PG. 18 YOUR BENEFITS

Benefit Contact Information KELLER ISD HUMAN RESOURCES/ BENEFITS

DENTAL

FLEXIBLE SPENDING ACCOUNT

Keller ISD (817) 744-1080 www.kellerisd.net

Cigna (800) 244-6224 www.mycigna.com

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

FBS/ENROLLMENT

VISION

KELLER POINTE FITNESS PROGRAM

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

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

City of Keller (817) 743-4386 www.cityofkeller.com/services/the-kellerpointe

HOSPITAL INDEMNITY

DISCOUNT DENTAL & VISION

MEDICAL

Voya (800) 955-7736 www.voya.com

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

CRITICAL ILLNESS

LONG TERM DISABILITY

Voya (800) 955-7736 www.voya.com

Policy # 395309 The Hartford (800) 523-2233 File a claim: (866) 278-2655 www.thehartford.com

Group # 715197 United Healthcare (800) 241-1658 www.uhc.com COBRA Services: (877) 797-7475 Member Services: (877) 311-7849 Card Services: (866) 755-2648

ACCIDENT

LIFE AND AD&D

HEALTH SAVNGS ACCOUNT

Voya (800) 955-7736 www.voya.com

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

United Healthcare (800) 241-1658 www.uhc.com

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

Benefit Information



Online Support



Interactive Tools



And more. PLAY VIDEO

Text “FBS KISD”

to 313131 OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/kellerisd

CLICK LOGIN

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

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

ONLIINE SUPPORT

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

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

Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New: 

Benefit elections will become effective 01/01/2019 (elections requiring evidence of insurability, such as life insurance, may have a later effective date, if approved). After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 30 days of the event).

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Keller ISD takes their premiums a month in advance, so if you elect benefits during Open Enrollment, you first premium payments will come out of your December paycheck, except for your disability, Health Savings (HSA), healthcare or dependent care Flexible Spending (FSA) premiums.

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Medical rates are increasing for the 2019 plan year. There have also been slight changes to the medical plans, please refer to the Medical benefit summary for details.

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If you completed all activities of the Premium Incentive Program you will receive a $60.00 monthly discount on your medical premiums for 2019.

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If you need further assistance with your enrollment, please contact: Natalie Nolan, Benefit Specialist at 817-744-1080 Sheri Rich, Director of Employee Benefits at 817-744-1087

Don’t Forget!  Login and complete your benefit enrollment from 10/09/2018—10/23/2018.  Refer to Keller ISD’s Employee Benefit Website “THEbenefitsHUB” for all your benefit plan summaries, rates & options: www.mybenefitshub.com/kellerisd or K-Connect: Functions; Workforce-HR; Benefits.  Due to Affordable Care Act (ACA) every employee must decline or elect benefits during open enrollment.  Update beneficiary information.  Update your profile information: home address, phone numbers, email through the Employee Access Center (EAC).  Update dependent information; social security number & student status for college aged children.

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 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

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.

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

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

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/kellerisd.

annual enrollment) unless a Section 125 qualifying event occurs.

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



Changes, additions or drops may be made only during 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 website: www.mybenefitshub.com/kellerisd. Click on

included in the dependent profile. Additionally, you must

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

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

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 any benefit question, you can contact KISD Human Resources Department/Benefits at 817-744-1080 or Financial Benefit Services at 800-583-6908 for assistance.

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more

Dependent Eligibility: You can cover eligible dependent

regularly scheduled hours each work week.

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

Eligible employees must be actively at work on the plan effective

maximum age listed below. Dependents cannot be double

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

covered by married spouses within Keller ISD or as both

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

employees and dependents.

work concurrent with the plan effective date. For example, if your 2019 benefits become effective on January 1, 2019, you must be actively-at-work on January 1, 2019 to be eligible for your new benefits.

PLAN

CARRIER

MAXIMUM AGE

Medical

UnitedHealthcare

Dental

Cigna

Vision

Superior Vision

Hospital Indemnity

Voya

Critical Illness

Voya

Accident

Voya

Voluntary Life and AD&D

The Hartford

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

SUMMARY PAGES

Helpful Definitions Actively at Work

In-Network

You are performing your regular occupation for the employer

Doctors, hospitals, optometrists, dentists and other providers

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

who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 1/1/2019 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 January 1st through December 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).

2019 Keller Pointe (Workout Facility) 1.

What are the prices for The Keller Pointe passes? Keller Pointe

SUMMARY PAGES

What does a family consist of? Those individuals you claim as your dependent on your tax

Rates

form, can be placed on your family pass. Be ready to give

Employee w/o Aerobics (RES)

$33.15

Employee w/o Aerobics (Non-Res)

$42.23

Employee with Aerobics (RES)

$39.97

Employee with Aerobics (Non-Res)

$49.05

Employee + Family w/o Aerobics (RES)

$52.23

Employee + Family w/o Aerobics (Non-Res)

$66.30

Employee + Family with Aerobics (RES)

$59.05

Employee + Family with Aerobics (Non-Res)

$73.12

You may register at The Keller Pointe Customer Service

Senior Employee with Aerobics (RES)

$29.52

Desk, with your KISD badge, and pay monthly through

Senior Employee with Aerobics (Non-Res)

$35.88

electronic funds transfer using your bank account, Visa or

Senior Employee + Spouse with Aerobics (RES)

$59.04

MasterCard and The Keller Pointe will waive the $60

Senior Employee + Spouse with Aerobics (Non-Res)

$73.11

Senior Employee + Senior Spouse with Aerobics (RES)

$59.03

Senior Employee + Senior Spouse with Aerobics (Non-Res)

$71.76

What is the benefit to KISD employees by joining The Keller Pointe through payroll deduction?

proof of dependency if asked by The Keller Pointe. 5.

What is a group exercise add-on? Group exercise add-on allows all members on the pass to participate in both land and water aerobics offered at The Keller Pointe.

What if I want to purchase a Keller Pointe pass outside of the annual benefit enrollment?

service fee. However, your fee will be the standard published monthly rates for residents at the resident rate or non-residents at the resident business rate. Please contact The Keller Pointe for rates. 7.

Where is the facility? The address is 405 Rufe Snow Dr. Keller, TX 76248.

The City of Keller and KISD have an agreement to provide KISD employees annual passes to The Keller Pointe and you pay through payroll deduction. 3.

Who qualifies as a resident vs. non-resident? A resident is one who lives within the city limits of the City of Keller. Look at your property tax record and see if you pay City of Keller taxes. Your postal address does not necessarily coincide with your city residency.

Keller ISD Rates

SUMMARY PAGES

Plan Year January 1, 2019 - December 31, 2019

Keller Independent School District’s Benefit Plan Year is from January 1, 2019 to December 31, 2019 Keller ISD Medical Plans –United Healthcare Member Line: 800-241-1658; Group #715197   

Visit www.myuhc.com for detailed information on covered/non-covered items, prescriptions, benefits, as well as to check on claims, and out of pocket maximums. All Summary Plan Documents and other benefit information can be found on THEbenefitsHUB at www.mybenefitshub.com/kellerisd or on our Intranet Site (Staff Site) under Human Resources. Benefit Plan Updates:  UnitedHealthcare Nexus Narrow Network (utilizing Tier 1 doctors)  Tailored Prescription Drug Network (Target/CVS removed)  Changes to Deductibles on all plans  Imaging will change to Deductible/Coinsurance on the Essential Plan  District will offer three medical plans: High Deductible, Major Medical and the Essential Plan  District will offer four tiers: Employee Only, Employee + Spouse, Employee + Child(ren) and Employee + Family

High Deductible Plan 2018 Incentive Rate

2018 Monthly Rate

Employee Only Employee + Spouse

$538.42

$598.42

Employee + Child(ren)

$377.00

$437.00

Employee + Family

$892.91

$952.91

2019 Incentive Rate

2019 Monthly Rate

$42.78

$102.78

Highlights of the 2019 High Deductible Plan:  You will pay the full amount of all charges until you have met your deductible.  $3,000 Individual Deductible/$6,000 Family Deductible  Total Out of Pocket Limit: $6,650 Individual/$13,300 Family  80/20 Coinsurance - once you have met the $3,000/$6,000 deductible, the plan pays 80% of In- Network charges and you pay 20%

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Medical Pharmacy/Prescription Emergency Room Visit and/or Urgent Care Center There are no Out of Network Benefits 100% Wellness Benefit - every covered member receives routine wellness and other preventive care services 100% Lab Benefit – preventative lab work done at a participating In-Network lab facility is paid at 100% If you go to the KISD Employee Health and Wellness Center you will be assessed a $25.00 fee for an acute visit. You will not have to pay a fee for wellness or coaching visits. You can partner this plan with a Health Savings Account (HSA)

SUMMARY PAGES

Major Medical Plan 2018 Incentive Rate

2018 Monthly Rate

2019 Incentive Rate

2019 Monthly Rate

Employee Only

$129.25

$189.25

$152.91

$212.91

Employee + Spouse

$578.42

$638.42

$658.22

$718.22

Employee + Child(ren)

$498.91

$558.91

$521.27

$581.27

Employee + Family

$932.91

$992.91

$1,057.02

$1,117.02

Highlights of the 2019 Major Medical Plan:  $4,000 Individual Deductible/$8,000 Family Deductible  Total Out of Pocket Limit: $7,350 Individual/$14,700 Family70/30 Coinsurance - once you have met the $4,000/$8,000 deductible, the         

plan pays 70% of In- Network charges and you pay 30% Primary Care Physician Copays are $25/$45 and Specialist Copays are $45/$65 There are no Out of Network Benefits $200.00 Prescription Deductible - per covered member, per year (deductible does not apply to generic or mail order) Emergency Room – Deductible/Coinsurance - per visit Urgent Care Center $100.00 Copay - per visit (ex: Care Now) 100% Wellness Benefit - every covered member receives routine wellness and other preventive care services 100% Lab Benefit - preventative lab work done at a participating In-Network lab facility is paid at 100% If you go to the KISD Employee Health and Wellness Center you will not be assessed a fee for an acute, wellness or coaching visit. You can partner this plan with a Flexible Spending Account (FSA).

2018 Incentive Rate

2018 Monthly Rate

2019 Incentive Rate

2019 Monthly Rate

$1,613.07

$1,673.07

Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

Essential Medical Plan Highlights of the 2019 Essential Plan:  $2,000 Individual Deductible/$4,000 Family Deductible  Total Out of Pocket Limit: $7,350 Individual/$14,700 Family  70/30 Coinsurance - once you have met the $2,000/$4,000 deductible, the plan pays 70% of In- Network charges and you pay 30%  Primary Care Physician Copays $25/$45 and Specialist Copays $45/$65  There are no Out of Network Benefits  $150 Prescription Deductible - per covered member, per year (deductible does not apply to generic or mail order)  Emergency Room - Deductible/Coinsurance - per visit  Urgent Care Center $100.00 Copay - per visit (ex: Care Now)  100% Wellness Benefit - every covered member receives routine wellness and other preventive care services  100% Lab Benefit - preventative lab work done at a participating In-Network lab facility is paid at 100%  If you go to the KISD Employee Health and Wellness Center you will not be assessed a fee for an acute, wellness or coaching visit. 13  You can partner this plan with a Flexible Spending Account (FSA).

Keller ISD Rates Plan Year January 1, 2019 - December 31, 2019

SUMMARY PAGES

Additional Benefits for Employees who elect one of our three Medical Plans:  KISD Employee Health and Wellness Center - - Employees are eligible to go the KISD Employee Health and Wellness Center for acute and/or coaching visits. If you elect the Essential or Major Medical Plan there is no cost; if you elect the High Deductible Plan there will be a $25.00 fee per visit for acute care visits.  The address to the Wellness Center is 5308 N. Tarrant Parkway Fort Worth, TX 76244  Phone number for the Wellness Center is 817-993-6889  Marathon Health Website: my.marathon-health.com  Virtual Visits – Log into myuhc.com and choose from provider sites where you can register for a virtual visit; payments are $50.00 a visit.  Premium Incentive Plan – Complete 3 activities for the 2019 Premium Incentive Plan between September 1, 2018 through August 31, 2019: Health Risk Assessment, Biometric Screening and an Annual Wellness Exam; Employee only will receive a $60.00 incentive monthly for an annual savings of $720.00 for the Benefit Plan Year in 2020. In addition, for the 2019 Incentive, employees must have “Three in the Green”. This would require employees to have 3 out of 5 metrics in range in order to be eligible for the Premium Incentive. The five areas that will be assessed are Cholesterol, LDL, HDL, Waist Circumference and Blood Pressure. Anyone that does not meet that criteria will need to have a Health Coaching Visit at the KISD Employee Health and Wellness Center by August 31, 2019 to receive the Premium Incentive. 2019 Dental Insurance: Cigna Low Plan Monthly Rates

High Plan Monthly Rates

DHMO Rates

Employee Only

$28.44

$35.78

$17.44

Employee + Spouse

$55.53

$69.85

$34.02

Employee + Child(ren)

$67.93

$85.42

$41.69

Employee + Family

$89.96

$112.97

$55.12

Highlights of the Dental Insurance Low and High Plans (PPO):  Cleanings – 2 included per year, per covered member (covered at 100% on the High Plan and 90% on the Low Plan)  Child Orthodontia - ONLY covered on the High Plan with a 50% benefit up to Lifetime Max of $1000  Deductible - $50 per individual; $150 per family; in or out of network on both plans Highlights of the DHMO Dental Insurance Plan:  No dollar Maximums  No claim forms or waiting periods for coverage to begin  Services based on a fee schedule; most fees are covered with copays  Orthodontic coverage for children and adults with no dollar maximum  Must use a Cigna In-Network DHMO Provider only; No out of network benefits

Keller ISD Rates Plan Year January 1, 2018 - December 31, 2018

SUMMARY PAGES

2019 Vision Insurance: Superior Vision Monthly Rates Employee Only

$9.96

Employee + Spouse

$19.30

Employee + Family

$28.37

Highlights of the Vision Insurance Plan:  Vision Exam every 12 months  Either glasses or contact lenses every 12 months (up to a $130 allowance)  Frames every 12 months  Progressive lenses are covered in full at lined trifocal level  UV, polycarbonate and tint anti-reflective coating are all covered in full  Discounts for anything you choose to purchase in addition to the glasses or contacts every 12 months 2019 Dental & Vision Discount Plan: QCD of America Monthly Rates Employee Only

FREE

Employee + One Dependent

$10.00

Employee + Family

$14.00

Highlights of the QCD of America Discount Dental and Vision Plan:  This is not an insurance plan; it only provides discounted fees.  Participating network of dentists  Discounts on all dental services  Includes a discount vision plan through Davis 2019 Accidental Insurance: Voya Monthly Rates Employee Only

$2.85

Employee + One Dependent

$5.00

Employee + Child(ren)

$6.41

Employee + Family

$8.56

Highlights of the Accidental Insurance Plan:  For each covered individual a set reimbursement is paid for each accident occurrence. This does not apply to work related injuries.  Accident coverage covers child accidental injuries while participating in organized sports  True Annual Open Enrollment without medical question requirement up to guarantee issue amount 2019 In-Hospital Indemnity Insurance – Voya  Insurance pays lump sum benefit amounts based on the number of days spent in a hospital, critical care unit, or rehabilitation facility.  You can use this benefit for any purpose you like and the coverage is portable.  Coverage is available for you, your spouse and/or children. 15

Keller ISD Rates Plan Year January 1, 2019 - December 31, 2019

SUMMARY PAGES

2019 Critical Illness Insurance: Voya Attained Age

EE Tobacco

EE Non-Tobacco

<25

$0.74

$0.43

25-29

$0.78

$0.45

30-34

$0.92

$0.51

35-39

$1.19

$0.65

40-44

$1.73

$0.92

45-49

$1.35

50-54

$1.91

55-59

$2.61

60-64

$3.65

Highlights of the Critical Insurance Plan:  Monthly Rates per $1,000; 100% benefit for recurrence  Cancer is included in this policy  Employees can obtain $20,000 of guaranteed Critical Illness coverage with no medical questions required  Voya’s Critical Illness policy does include a wellness benefit of $50.00 annually 2019 Flexible Spending Accounts (FSA): National Benefit Services (NBS)  Tax-sheltered flexible spending accounts allow an individual to set aside dollars to pay for future health care and dependent care expenses.  Monthly fee: $2.85  Health Care Contributions are use-it-or-lose-it; Gain selected amount all up front for the year beginning in January  Healthcare reimbursement maximum: $2,400/plan year  Dependent Care Reimbursement maximum: $5,000 (married) or $2,500 (single) per year  An FSA account can only be partnered with the Essential or Major Medical Plan 2019 Health Savings Accounts (HSA) - UnitedHealthcare  Tax-sheltered Health Savings Accounts and you can only use it with the High Deductible Medical Plan  Monthly fee: $2.75  Health Care Contributions accumulate month by month and can roll from one year to another  Healthcare reimbursement maximum: $7,000 for family and $3,500 for individual per plan year  Employees cannot participate in the FSA if they have an HSA account  An HSA account can only be partnered with the High Deductible Plan

SUMMARY PAGES

2019 Disability Insurance - The Hartford  A disability plan will pay you, based on what you elect, while you are off work due to a disability.  These payments are in addition to pay you may or may not receive through the district.  Choices are as follows: Plan A: Premium Plan

Plan B: Select Plan

Plan A—Injury 0/Sickness 3

Plan B—Injury 0/Sickness 3

Plan A—Injury 14/Sickness 14

Plan B—Injury 14/Sickness 14

Plan A—Injury 30/Sickness 30

Plan B—Injury 30/Sickness 30

Plan A—Injury 60/Sickness 60

Plan B—Injury 60/Sickness 60

Plan A—Injury 90/Sickness 90

Plan B—Injury 90/Sickness 90

Plan A—Injury 180/Sickness 180

Plan B—Injury 180/Sickness 180

  

Plan A is our premium plan and the payment period prior to age 63 is to normal retirement age, for disabilities resulting from sickness or injury. Plan B is our select plan and the payment period prior to age 63 is to normal retirement age, for disabilities resulting from injury and prior to age 65 is 5 years, for disabilities resulting from sickness. If you choose an elimination period of 0/3, 14/14 or 30/30 and if you are confined to the hospital for more than 24 hours your elimination period is waived.

Sick Leave Bank  To become a member, a one-time donation of 2 sick days are required, unless the Sick Leave Bank goes below a certain level. Once the donation has been made, the membership will continue the duration of the employment. You can enroll in the Sick Leave Bank during your Annual Open Enrollment.  The purpose of the Sick Leave Bank is to provide additional sick leave days to members of the bank in the event of the employee or the employee's spouse, parent, son, or daughter experience a catastrophic illness or injury. To request days from the bank, an employee must have exhausted all paid leave, vacation and must have been absent at least 5 workdays without pay.  Sick leave days from the bank must be approved by the District's Sick Leave Bank Committee. Leave shall not be granted for a pre-existing condition.

THE HARTFORD YOUR BENEFITS PACKAGE

Basic 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 18 Keller ISD Benefits Website: www.mybenefitshub.com/kellerisd

Basic Life and AD&D Benefit Highlights Your Employer provides, at no cost to you, Basic Life and AD&D Insurance in an amount equal to $15,000. Life Insurance pays your beneficiary (please see below) a benefit if you die while you are What is Basic Life and AD&D covered. This highlight sheet is an overview of your Basic Life and AD&D Insurance. Once a group policy is Insurance? issued to your employer, a certificate of Insurance will be available to explain your coverage in detail.

Am I eligible?

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

When can I enroll?

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

When is it effective?

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

Benefit Reductions

To 65% at age 65; 45% at age 70; 30% at age 75; 20% at age 80. All coverage cancels at retirement.

What is a beneficiary?

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

AD&D Coverage

AD&D provides benefits due to certain injuries or death from an accident. The covered injuries or death can occur up to 365 days after that accident. The insurance pays:  100% of the amount of coverage you purchase in the event of accidental loss of life, two limbs, the sight of both eyes, one limb and the sight of one eye, or speech and hearing in both ears or quadriplegia.  75% for paraplegia or triplegia (paralysis of three limbs).  One-half (50%) for accidental loss of one limb, sight of one eye, or speech or hearing in both ears or hemiplegia.  One-quarter (25%) for accidental loss of thumb and index finger of the same hand or uniplegia. Your total benefit for all losses due to the same accident will not be more than 100% of the amount of coverage you purchase.

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

Yes, subject to the contract, you have the option of:  Converting your group Life coverage to your own individual policy (policies). As is standard with most term life Insurance, this Insurance coverage includes certain limitations and exclusions:  The amount of your coverage may be reduced when you reach certain ages.

Important Details

AD&D insurance does not cover losses caused by or contributed by:  sickness; disease; or any treatment for either;  any infection, except certain ones caused by an accidental cut or wound;  intentionally self-inflicted injury, suicide or suicide attempt;  war or act of war, whether declared or not;  injury sustained while in the armed forces of any country or international authority;  taking prescription or illegal drugs unless prescribed for or administered by a licensed physician;  injury sustained while committing or attempting to commit a felony;  the injured person’s intoxication.

Other exclusions may apply depending upon your coverage. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. This benefit highlights sheet is an overview of the insurance being offered and is provided for illustrative purposes only and is not a contract. It in no way changes or affects the policy as actually issued. Only the insurance policy issued to the policyholder (your employer) can fully describe all of the provisions, terms, conditions, limitations and exclusions of your insurance coverage. In the event of any difference between the benefit highlights sheet and the insurance policy, 19 the terms of the insurance policy apply.

UNITEDHEALTHCARE

Medical

YOUR BENEFITS PACKAGE

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 20 Keller ISD Benefits Website: www.mybenefitshub.com/kellerisd

Major Medical Plan United HealthCare Services, Inc. and Keller ISD want to help you take control and make the most of your health care benefits. That’s why we provide convenient services to get your health care questions answered quickly and accurately:

  

myuhc.com® - Take advantage of easy, time-saving online tools. You can check your eligibility, benefits, claims, claim payments, search for a doctor and hospital and more. 24-hour nurse support – A nurse is a phone call away and you have other health resources available 24-hours a day, 7 days a week to provide you with information that can help you make informed decisions. Just call the number on the back of your ID card. Customer Care telephone support – Need more help? Call a customer care professional using the toll-free number on the back of your ID card. Get answers to your benefit questions or receive help looking for a doctor or hospital.

The Benefit Summary is intended only to highlight your Benefits and should not be relied upon to fully determine your coverage. If this Benefit Summary conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your SPD for an exact description of the services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage.

Keller ISD Major Medical Plan 2019 PLAN HIGHLIGHTS PLAN HIGHLIGHTS Types of Coverage Designated Network and Network Benefits Annual Deductible Individual Deductible $4,000 per year Family Deductible $8,000 per year  Member Copayments do not accumulate towards the Deductible unless otherwise notated within the specific benefit category below. Out-of-Pocket Maximum Individual Out-of-Pocket Maximum $7,350 per year Family Out-of-Pocket Maximum $14,700 per year  The Out-of-Pocket Maximum includes the Annual Deductible.  Copayments, Coinsurance and Deductibles accumulate towards the Out-of-Pocket Maximum.  Prescription Drug cost shares are included in the Medical Out-of-Pocket Maximum. Benefit Plan Coinsurance – The Amount the Plan Pays Designated Network: 70% after Deductible has been met. Network: 50% after Deductible has been met. Prescription Drug Benefits  Prescription drug benefits are shown under separate cover. Information on Benefit Limits  The Annual Deductible, Out-of-Pocket Maximum and Benefit limits are calculated on a calendar year basis.  Refer to your Summary Plan Description for a definition of Eligible Expenses and information on how benefits are paid.  In order to obtain the highest level of Benefits, you should confirm the Network status of all providers prior to obtaining Covered Health Services. BENEFITS Types of Coverage Network Benefits Ambulance Services – Emergency and Non-Emergency Emergency: 70% after Deductible has been met. Non-Emergency: 70% after Deductible has been met. Prior Authorization is required for Non-Emergency Ambulance. Dental Services – Accident Only 70% after Deductible has been met. Durable Medical Equipment (DME) Benefits are limited as follows: 70% after Deductible has been met. A single purchase of a type of Durable Medical Equipment (including repair and replacement) every three years. This limit doesnot apply to wound vacuums. Emergency Health Services - Outpatient 70% after Deductible has been met. 21

Major Medical Plan BENEFITS Types of Coverage Gender Dysphoria Sex transformation is not covered

Network Benefits Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in the Schedule of Benefits.

Hearing Aids 70% after Deductible has been met. Home Health Care Beneﬁts are limited as follows: 60 visits per year Hospice Care

70% after Deductible has been met.

70% after Deductible has been met. Hospital – Inpatient Stay Designated Network: 70%after the Annual Deductible is met. Network: 50% after the Annual Deductible is met. Lab, X-Ray and Diagnostics – Outpatient For Preventive Lab, X-Ray and Diagnostics, 100% refer to the Preventive Care Services category. Lab Testing - Outpatient X-Ray and Other Diagnostic Testing - Outpa70% after the Annual Deductible is met. tient Lab, X-Ray and Major Diagnostics – CT, PET, MRI, MRA and Nuclear Medicine - Outpatient 70% after the Annual Deductible is met Mental Health Services Inpatient: 70% after the Annual Deductible is met. Outpatient: 100% after you pay a $45 SPC Copayment per visit. 70%, no deductible, for Partial Hospitalization/Intensive Outpatient Treatment. Beneﬁts for outpatient visits for medication management will be paid at 100%. Neurobiological Disorders - Mental Health Services for Autism Spectrum Disorders Inpatient: 70% after the Annual Deductible is met. Outpatient: 100% after you pay a $45 SPC Copayment per visit. 70%, no deductible, for Partial Hospitalization/Intensive Outpatient Treatment. Beneﬁts for outpatient visits for medication management will be paid at 100%. Pharmaceutical Products – Outpatient This includes medications administered in an 70% after Deductible has been met. outpatient setting, in the Physician’s Office or in a Covered Person’s home. Physician Fees for Surgical and Medical Services Primary Physician Designated Network: 70% after Deductible has been met. Network: 50% after Deductible has been met. Specialist Physician Designated Network: 70% after Deductible has been met. Network: 50% after Deductible has been met. Physician’s Office Services – Sickness and Injury Primary Physician Office Visit Designated Network: 100% after you pay a $25 PRCD Copayment per visit. Network: 100% after you pay a $45 PRC Copayment per visit. Specialist Physician Office Visit Designated Network: 100% after you pay a $45 SPCD Copayment per visit. Network: 100% after you pay a $65 SPC Copayment per visit. > In addition to the Copayment stated in this section, the Copayment/Coinsurance and any deductible applies when these services are done: CT, PET, MRI, MRA, Nuclear Medicine; Pharmaceutical Products, Scopic Procedures; Surgery; Therapeutic Treatments.

Pregnancy – Maternity Services Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each covered Health Service category in this Benefit Summary. Preventive Care Services Physician Office Services Lab, X-Ray or other Preventive Tests Prosthetic Devices Benefits are limited as follows: A single purchase of each type of prosthetic device every three years. 22

100% Deductible does not apply. 100% Deductible does not apply. 70% after Deductible has been met.

Major Medical Plan BENEFITS Types of Coverage Reconstructive Procedures

Network Beneﬁts

Skilled Nursing Facility / Inpatient Rehabilitation Facility Services Beneﬁts are limited as follows: 60 days per year Substance Use Disorder Services

Designated Network: 70%after the Per Occurrence Deductible of $150 per date of service is met. The Annual Deductible does not apply Network: 50%after the Per Occurrence Deductible of $150 per date of service is met. The Annual Deductible does not apply 70% after Deductible is met.

Inpatient: 70% after the Annual Deductible is met. Outpatient: 100% after you pay a $45 SPC Copayment per visit. 70%, no deductible, for Partial Hospitalization/Intensive Outpatient Treatment.] Beneﬁts for outpatient visits for medication management will be paid at 100%. Surgery – Outpatient Designated Network:70%after the Annual Deductible is met. Network:50%after the the Annual Deductible is met. Therapeutic Treatments – Outpatient 70% after Deductible has been met. Transplantation Services For Network Beneﬁts, services must be received at a Designated Facility.

Depending upon where the Covered Health Service is provided, Beneﬁts will be the same as those stated under each Covered Health Service category in this Beneﬁt Summary. Prior Authorization is required.

Urgent Care Center Services 100% after you pay a $100 UCC Copayment per visit. > In addition to the Copayment stated in this section, the Copayment/Coinsurance and any deductible applies when these services are done: CT, PET, MRI, MRA, Nuclear Medicine; Pharmaceutical Products, Scopic Procedures; Surgery; Therapeutic Treatments.

Virtual Visits Network Beneﬁts are available only when services are delivered through a Designated Virtual Visit Network Provider. Find a Designated Virtual Visit Network Provider Group at myuhc.com or by calling Customer Care at the telephone number on your ID card. Access to Virtual Visits and prescription services may not be available in all states or for all groups. Vision Examinations Beneﬁts are limited as follows: 1 exam every 2 years

100% after you pay a $40 VIR Copayment per visit. Deductible does not apply.]

100% after you pay a $25 PRC Copayment per visit.

Essential Medical Plan United HealthCare Services, Inc. and Keller ISD want to help you take control and make the most of your health care benefits. That’s why we provide convenient services to get your health care questions answered quickly and accurately:

  

Keller ISD Essential Medical Plan 2019 PLAN HIGHLIGHTS Types of Coverage Designated Network and Network Benefits Annual Deductible Individual Deductible $2,000 per year Family Deductible $4,000 per year  Member Copayments do not accumulate towards the Deductible unless otherwise notated within the specific benefit category below. Out-of-Pocket Maximum Individual Out-of-Pocket Maximum $7,350 per year Family Out-of-Pocket Maximum $14,700 per year  The Out-of-Pocket Maximum includes the Annual Deductible.  Copayments, Coinsurance and Deductibles accumulate towards the Out-of-Pocket Maximum.  Prescription Drug cost shares are included in the Medical Out-of-Pocket Maximum. Benefit Plan Coinsurance – The Amount the Plan Pays Designated Network: 70% after Deductible has been met. Network: 50% after Deductible has been met. Prescription Drug Benefits  Prescription drug benefits are shown under separate cover. Information on Benefit Limits  The Annual Deductible, Out-of-Pocket Maximum and Benefit limits are calculated on a calendar year basis.  Refer to your Summary Plan Description for a definition of Eligible Expenses and information on how benefits are paid.  In order to obtain the highest level of Benefits, you should confirm the Network status of all providers prior to obtaining Covered Health Services. BENEFITS Types of Coverage Network Benefits Ambulance Services – Emergency and Non-Emergency Emergency: 70% after Deductible has been met. Non-Emergency: 70% after Deductible has been met. Prior Authorization is required for Non-Emergency Ambulance. Dental Services – Accident Only 70% after Deductible has been met. Durable Medical Equipment (DME) Benefits are limited as follows: 70% after Deductible has been met. A single purchase of a type of Durable Medical Equipment (including repair and replacement) every three years. This limit doesnot apply to wound vacuums. Emergency Health Services - Outpatient 70% after Deductible has been met. 24

Essential Medical Plan BENEFITS Types of Coverage Gender Dysphoria Sex transformation is not covered

Network Benefits Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in the Schedule of Benefits.

Hearing Aids 70% after Deductible has been met. Home Health Care Beneﬁts are limited as follows: 60 visits/year Hospice Care

70% after Deductible has been met. 70% after Deductible has been met.

Hospital – Inpatient Stay Designated Network: 70% after the Per Occurrence Deductible of $150 per Inpatient Stay is met and after the Annual Deductible is met. Network: 50% after the Per Occurrence Deductible of $150 per Inpatient Stay is met and after the Annual Deductible is met. Lab, X-Ray and Diagnostics – Outpatient For Preventive Lab, X-Ray and Diagnostics, 100% refer to the Preventive Care Services category. Lab Testing - Outpatient X-Ray and Other Diagnostic Testing - Outpa70% after you pay a $150 Copayment per date of service. The Annual Deductible does not tient apply Lab, X-Ray and Major Diagnostics – CT, PET, MRI, MRA and Nuclear Medicine - Outpatient 70% after the Annual Deductible is met Mental Health Services Inpatient: 70% after you pay a $150 HSP Copayment per Inpatient Stay. Deductible does not apply Outpatient: 100% after you pay a $45 SPC Copayment per visit. 70%, no deductible, for Partial Hospitalization/Intensive Outpatient Treatment. Beneﬁts for outpatient visits for medication management will be paid at 100%. Neurobiological Disorders - Mental Health Services for Autism Spectrum Disorders Inpatient: 70% after you pay a $150 HSP Copayment per Inpatient Stay. Deductible does not apply Outpatient: 100% after you pay a $45 SPC Copayment per visit. 70%, no deductible, for Partial Hospitalization/Intensive Outpatient Treatment. Beneﬁts for outpatient visits for medication management will be paid at 100%. Pharmaceutical Products – Outpatient This includes medications administered in an 70% after Deductible has been met. outpatient setting, in the Physician’s Office or in a Covered Person’s home. Physician Fees for Surgical and Medical Services Primary Physician Designated Network: 70% after Deductible has been met. Network: 50% after Deductible has been met. Specialist Physician Designated Network: 70% after Deductible has been met. Network: 50% after Deductible has been met. Physician’s Office Services – Sickness and Injury Primary Physician Office Visit Designated Network: 100% after you pay a $25 PRCD Copayment per visit. Network: 100% after you pay a $45 PRC Copayment per visit. Specialist Physician Office Visit Designated Network: 100% after you pay a $45 SPCD Copayment per visit. Network: 100% after you pay a $65 SPC Copayment per visit. > In addition to the Copayment stated in this section, the Copayment/Coinsurance and any deductible applies when these services are done: CT, PET, MRI, MRA, Nuclear Medicine; Pharmaceutical Products, Scopic Procedures; Surgery; Therapeutic Treatments.

100% Deductible does not apply. 100% Deductible does not apply. 70% after Deductible has been met. 25

Essential Medical Plan BENEFITS Types of Coverage Reconstructive Procedures

Network Beneﬁts

Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in this Benefit Summary. Rehabilitation Services – Outpatient Therapy and Manipulative Treatment Benefits are limited as follows: 70% after Deductible has been met 100 combined visits of physical therapy; occupational therapy; speech therapy; pulmonary rehabilitation; cardiac rehabilitation; post-cochlear implant aural therapy; and cognitive rehabilitation therapy. 20 visits of manipulative treatment The limits stated above include habilitative services. Scopic Procedures – Outpatient Diagnostic and Therapeutic Diagnostic scopic procedures include, but are not limited Designated Network: 70% after the Per Occurrence Deductible of $150 per date to: Colonoscopy; Sigmoidoscopy; Endoscopy of service is met. The Annual Deductible does not apply For Preventive Scopic Procedures, refer to the Preventive Network: 50% after the Per Occurrence Deductible of $150 per date of service is Care Services category. met. The Annual Deductible does not apply Skilled Nursing Facility / Inpatient Rehabilitation Facility Services Benefits are limited as follows: 70% after Deductible is met. 60 days per year Substance Use Disorder Services Inpatient: 70% after you pay a $150 HSP Copayment per Inpatient Stay. Deductible does not apply. Outpatient: 100% after you pay a $45 SPC Copayment per visit. 70%, no deductible, for Partial Hospitalization/Intensive Outpatient Treatment.] Benefits for outpatient visits for medication management will be paid at 100%. Surgery – Outpatient Designated Network: 70% after the Per Occurrence Deductible of $150 per date of service is met. Deductible does not apply. Network: 50% after the Per Occurrence Deductible of $150 per date of service is met. The Annual Deductible does not apply Therapeutic Treatments – Outpatient 70% after Deductible has been met. Transplantation Services For Network Benefits, services must be received at a Designated Facility.

100% after you pay a $40 VIR Copayment per visit. Deductible does not apply.]

100% after you pay a $25 PRC Copayment per visit.

High Deductible Medical Plan (HSA Choice Medical Plan) United HealthCare Services, Inc. and Keller ISD want to help you take control and make the most of your health care benefits. That’s why we provide convenient services to get your health care questions answered quickly and accurately:

  

Keller ISD High Option Medical Plan 2019 PLAN HIGHLIGHTS PLAN HIGHLIGHTS Types of Coverage Designated Network and Network Benefits Annual Deductible Individual Deductible $3,000 per year Family Deductible $6,000 per year  Member Copayments do not accumulate towards the Deductible unless otherwise notated within the specific benefit category below. Out-of-Pocket Maximum Individual Out-of-Pocket Maximum $6,650 per year Family Out-of-Pocket Maximum $13,300 per year  The Out-of-Pocket Maximum includes the Annual Deductible.  Copayments, Coinsurance and Deductibles accumulate towards the Out-of-Pocket Maximum.  Prescription Drug cost shares are included in the Medical Out-of-Pocket Maximum. Benefit Plan Coinsurance – The Amount the Plan Pays Designated Network: 80% after Deductible has been met. Network: 60% after Deductible has been met. Prescription Drug Benefits  Prescription drug benefits are shown under separate cover. Information on Benefit Limits  The Annual Deductible, Out-of-Pocket Maximum and Benefit limits are calculated on a calendar year basis.  Refer to your Summary Plan Description for a definition of Eligible Expenses and information on how benefits are paid.  In order to obtain the highest level of Benefits, you should confirm the Network status of all providers prior to obtaining Covered Health Services. BENEFITS Types of Coverage Network Benefits Ambulance Services – Emergency and Non-Emergency Emergency: 80% after Deductible has been met. Non-Emergency: 80% after Deductible has been met. Prior Authorization is required for Non-Emergency Ambulance. Dental Services – Accident Only 80% after Deductible has been met. Durable Medical Equipment (DME) Benefits are limited as follows: 80% after Deductible has been met. A single purchase of a type of Durable Medical Equipment (including repair and replacement) every three years. This limit doesnot apply to wound vacuums. Emergency Health Services - Outpatient 80% after Deductible has been met.

High Deductible Medical Plan (HSA Choice Medical Plan) ENEFITS Types of Coverage Gender Dysphoria Sex transformation is not covered

Network Benefits Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in the Schedule of Benefits.

Hearing Aids 80% after Deductible has been met. Home Health Care Beneﬁts are limited as follows: 60 visits per year Hospice Care

80% after Deductible has been met.

80% after Deductible has been met. Hospital – Inpatient Stay Designated Network: 80% after the Annual Deductible is met. Network: 60% after the Annual Deductible is met. Lab, X-Ray and Diagnostics – Outpatient For Preventive Lab, X-Ray and Diagnostics, 80% after Deductible has been met. refer to the Preventive Care Services category. Lab Testing - Outpatient X-Ray and Other Diagnostic Testing - Outpa80% after Deductible has been met. tient Lab, X-Ray and Major Diagnostics – CT, PET, MRI, MRA and Nuclear Medicine - Outpatient 80% after Deductible has been met. Mental Health Services Inpatient: 80% after Deductible has been met. Outpatient: 80% after Deductible has been met. Partial Hospitalization/Intensive Outpatient Treatment: 80% after Deductible has been met. Beneﬁts for outpatient visits for medication management will be paid at 100%. Neurobiological Disorders - Mental Health Services for Autism Spectrum Disorders Inpatient: 80% after Deductible has been met. Outpatient: 80% after Deductible has been met. Partial Hospitalization/Intensive Outpatient Treatment: 80% after Deductible has been met. Beneﬁts for outpatient visits for medication management will be paid at 100%. Pharmaceutical Products – Outpatient This includes medications administered in an 80% after Deductible has been met. outpatient setting, in the Physician’s Office or in a Covered Person’s home. Physician Fees for Surgical and Medical Services Primary Physician Designated Network: 80% after Deductible has been met. Network: 60% after Deductible has been met. Specialist Physician Designated Network: 80% after Deductible has been met. Network: 60% after Deductible has been met. Physician’s Office Services – Sickness and Injury Primary Physician Office Visit Designated Network: 80% after Deductible has been met. Network: 60% after Deductible has been met. Specialist Physician Office Visit Designated Network: 80% after Deductible has been met. Network: 60% after Deductible has been met. > In addition to the Copayment stated in this section, the Copayment/Coinsurance and any deductible applies when these services are done: CT, PET, MRI, MRA, Nuclear Medicine; Pharmaceutical Products, Scopic Procedures; Surgery; Therapeutic Treatments.

100% Deductible does not apply. 100% Deductible does not apply. 80% after Deductible has been met.

High Deductible Medical Plan (HSA Choice Medical Plan) BENEFITS Types of Coverage Reconstructive Procedures

Network Beneﬁts

Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in this Benefit Summary. Rehabilitation Services – Outpatient Therapy and Manipulative Treatment Benefits are limited as follows: 80% after Deductible has been met.  20 visits of physical therapy  20 visits of occupational therapy  20 visits of manipulative treatment  20 visits of speech therapy  20 visits of pulmonary rehabilitation  36 visits of cardiac rehabilitation  30 visits of post-cochlear implant aural therapy  20 visits of cognitive rehabilitation therapy The limits stated above include habilitative services. Scopic Procedures – Outpatient Diagnostic and Therapeutic Diagnostic scopic procedures include, but are Designated Network: 80% after Deductible has been met. not limited to: Colonoscopy; Sigmoidoscopy; Network: 60% after Deductible has been met. Endoscopy For Preventive Scopic Procedures, refer to the Preventive Care Services category. Skilled Nursing Facility / Inpatient Rehabilitation Facility Services Benefits are limited as follows: 80% after Deductible is met. 60 days per year Substance Use Disorder Services Inpatient: 80% after Deductible has been met. Outpatient: 80% after Deductible has been met. Partial Hospitalization/Intensive Outpatient Treatment: 80% after Deductible has been met. Benefits for outpatient visits for medication management will be paid at 100%. Surgery – Outpatient Designated Network: 80% after the Annual Deductible is met.Network: 60% after the the Annual Deductible is met. Therapeutic Treatments – Outpatient 80% after Deductible has been met. Transplantation Services For Network Benefits, services must be received at a Designated Facility.

Urgent Care Center Services 80% after Deductible has been met. > In addition to the Copayment stated in this section, the Copayment/Coinsurance and any deductible applies when these services are done: CT, PET, MRI, MRA, Nuclear Medicine; Pharmaceutical Products, Scopic Procedures; Surgery; Therapeutic Treatments. Virtual Visits Network Beneﬁts are available only when ser$40 per visit after Deductible is met. vices are delivered through a Designated Virtual Visit Network Provider. Find a Designated Virtual Visit Network Provider Group at myuhc.com or by calling Customer Care at the telephone number on your ID card. Access to Virtual Visits and prescription services may not be available in all states or for all groups. Vision Examinations Beneﬁts are limited as follows: 100% after you pay a $25 PRC Copayment per visit. 1 exam every 2 years 29

Major Medical Plan Rx Coverage Your Copayment and/or Coinsurance is determined by the tier to which the Prescription Drug List Management Committee has assigned the Prescription Drug. All Prescription Drugs on the Prescription Drug List are assigned to Tier-1, Tier-2, Tier-3 or Tier-4. Find individualized information on your benefit coverage, determine tier status, check the status of claims and search for network pharmacies by logging on to www.myuhc.com® or calling Customer Care at the telephone number on the back of your ID card This summary of Benefits is intended only to highlight your Benefits for Prescription Drugs and should not be relied upon to determine coverage. Your plan may not cover all of your Prescription Drug expenses. Please refer to the Prescription Drug section of the Summary Plan Description (SPD) for a complete listing of services, limitations, exclusions and a description of all the terms and conditions of coverage. If this description conflicts in any way with the Prescription Drug section of the SPD, the Prescription Drug section of SPD shall prevail. Annual Drug Deductible Individual Deductible Family Deductible

$ 200 (Deductible applies to Tier 2 and 3 ONLY) $ 200 for each individual (Deductible applies to Tier 2 and 3 ONLY)

Out-of-Pocket Drug Maximum Individual Out-of-Pocket Maximum Family Out-of-Pocket Maximum

See Medical Beneﬁt Summary See Medical Beneﬁt Summary Retail Up to 31-day supply Network

*Mail Order Up to 90-day supply Network

Tier 1

Greater of $15 or 20%, no deductible applies

$25

Tier 2

Greater of $40 or 20%, after Rx deductible

$75

Tier 3

Greater of $60 or 20%, after Rx deductible

$125

Specialty Medications

20% to a maximum of $150

Tier Level

* Only certain Prescription Drugs are available through mail order; please visit www.myuhc.com® or call Customer Care at the telephone number on the back of your ID card for more information. An Ancillary Charge may apply when a covered Prescription Drug is dispensed at your [or your provider’s] request and there is another drug that is chemically the same available at a lower tier. When you choose the higher tiered drug of the two, you will pay the difference between the higher tiered drug and the lower tiered drug in addition to your Copayment and/or Coinsurance that applies to the lower tier drug. Effective 1/1/2017, medical necessity and strategic exclusions are added. Current utilizers of any medications included on the strategic exclusion list will be grandfathered for the 2017 plan year. Effective 1/1/2019, moving to Standard network with Walgreens. Other Important Information about your Outpatient Prescription Drug Benefits You are responsible for paying the lower of the applicable Copayment and/or Coinsurance or the retail Network Pharmacy’s Usual and Customary Charge, or the lower of the applicable Copayment and/or Coinsurance or the mail order Network Pharmacy’s Prescription Drug Cost. For a single Copayment and/or Coinsurance, you may receive a Prescription Drug up to the stated supply limit. Some Prescription Drugs are subject to additional supply limits Some Prescription Drug or Pharmaceutical Products for which Benefits are described under the Prescription Drug section of the Summary Plan Description (SPD) are subject to step therapy requirements. This means that in order to receive Benefits for such Prescription Drug or Pharmaceutical Products you are required to use a different Prescription Drug(s) or Pharmaceutical Product(s) first. Also note that some Prescription Drugs require that you obtain prior authorization from us in advance to determine whether the Prescription Drug meets the definition of a Covered Health Service and is not Experimental, Investigational or Unproven. You may be required to fill an initial Prescription Drug Product order and obtain one refill through a retail pharmacy prior to using a mail order Network Pharmacy.

Essential Medical Plan Rx Coverage Your Copayment and/or Coinsurance is determined by the tier to which the Prescription Drug List Management Committee has assigned the Prescription Drug. All Prescription Drugs on the Prescription Drug List are assigned to Tier-1, Tier-2, Tier-3 or Tier-4. Find individualized information on your benefit coverage, determine tier status, check the status of claims and search for network pharmacies by logging on to www.myuhc.com® or calling Customer Care at the telephone number on the back of your ID card This summary of Benefits is intended only to highlight your Benefits for Prescription Drugs and should not be relied upon to determine coverage. Your plan may not cover all of your Prescription Drug expenses. Please refer to the Prescription Drug section of the Summary Plan Description (SPD) for a complete listing of services, limitations, exclusions and a description of all the terms and conditions of coverage. If this description conflicts in any way with the Prescription Drug section of the SPD, the Prescription Drug section of SPD shall prevail. Annual Drug Deductible Individual Deductible Family Deductible

$ 150 (Deductible applies to Tier 2 and 3 ONLY) $ 150 for each individual (Deductible applies to Tier 2 and 3 ONLY)

Out-of-Pocket Drug Maximum Individual Out-of-Pocket Maximum Family Out-of-Pocket Maximum

See Medical Beneﬁt Summary See Medical Beneﬁt Summary Retail Up to 31-day supply Network

*Mail Order Up to 90-day supply Network

Tier 1

Greater of $15 or 20%, no deductible applies.

$25

Tier 2

Greater of $40 or 20%, after Rx deductible.

$75

Tier 3

Greater of $60 or 20%, after Rx deductible.

$125

Specialty Medications

20% to a maximum of $150

Tier Level

High Deductible Medical Plan Rx Coverage Your Copayment and/or Coinsurance is determined by the tier to which the Prescription Drug List Management Committee has assigned the Prescription Drug. All Prescription Drugs on the Prescription Drug List are assigned to Tier-1, Tier-2 or Tier-3. Find individualized information on your benefit coverage, determine tier status, check the status of claims and search for network pharmacies by logging on to www.myuhc.com® or calling Customer Care at the telephone number on the back of your ID card A deductible and out-of-pocket maximum may apply. Please refer to the medical plan documents for the annual deductible and out-of-pocket maximum amounts, which include both medical and pharmacy expenses. This means that you will pay the full amount we have contracted with the pharmacy to charge for your prescriptions (not just your copayment), until you have satisfied the deductible. Once the deductible is satisfied, your prescriptions will be subject to the copayments outlined below. If you reach the Out-of-Pocket maximum, you will not be required to pay a copayment. This summary of Benefits is intended only to highlight your Benefits for Prescription Drugs and should not be relied upon to determine coverage. Your plan may not cover all of your Prescription Drug expenses. Please refer to the Prescription Drug section of the Summary Plan Description (SPD) for a complete listing of services, limitations, exclusions and a description of all the terms and conditions of coverage. If this description conflicts in any way with the Prescription Drug section of the SPD, the Prescription Drug section of SPD shall prevail. Annual Drug Deductible Individual Deductible Family Deductible

See Medical Beneﬁt Summary See Medical Beneﬁt Summary

Out-of-Pocket Drug Maximum Individual Out-of-Pocket Maximum Family Out-of-Pocket Maximum Tier Level Tier 1 Tier 2 Tier 3

See Medical Beneﬁt Summary See Medical Beneﬁt Summary Retail Up to 31-day supply Network 80% after Deductible 80% after Deductible 80% after Deductible

*Mail Order Up to 90-day supply Network 80% after Deductible 80% after Deductible 80% after Deductible

* Only certain Prescription Drugs are available through mail order; please visit www.myuhc.com® or call Customer Care at the telephone number on the back of your ID card for more information. An Ancillary Charge may apply when a covered Prescription Drug is dispensed at your [or your provider’s] request and there is another drug that is chemically the same available at a lower tier. When you choose the higher tiered drug of the two, you will pay the difference between the higher tiered drug and the lower tiered drug in addition to your Copayment and/or Coinsurance that applies to the lower tier drug. Effective 1/1/2019, moving to Standard network with Walgreens. Other Important Information about your Outpatient Prescription Drug Benefits For Prescription Drug Products at a retail Network Pharmacy, you are responsible for paying the lowest of the following: (i) The applicable Copayment and/or Co-insurance. (ii) The Network Pharmacy's Usual and Customary Charge for the Prescription Drug Product. (iii) The Prescription Drug Charge for that Prescription Drug Product. For Prescription Drug Product from a mail order Network Pharmacy, you are responsible for paying the lower of: (i) The applicable Co-payment and/or Co-insurance. (ii)The Prescription Drug Charge for that particular Prescription Drug Product.] For a single Copayment and/or Coinsurance, you may receive a Prescription Drug up to the stated supply limit. Some Prescription Drugs are subject to additional supply limits. Some Prescription Drug or Pharmaceutical Products for which Benefits are described under the Prescription Drug section of the Summary Plan Description (SPD) are subject to step therapy requirements. This means that in order to receive Benefits for such Prescription Drug or Pharmaceutical Products you are required to use a different Prescription Drug(s) or Pharmaceutical Product(s) first. Also note that some Prescription Drugs require that you obtain prior authorization from us in advance to determine whether the Prescription Drug meets the definition of a Covered Health Service and is not Experimental, Investigational or Unproven. You may be required to fill an initial Prescription Drug Product order and obtain one refill through a retail pharmacy prior to using a mail order Network Pharmacy. Benefits are available for refills of Prescription Drug Products only when dispensed as ordered by a duly licensed health care provider and only after 3/4 of the original Prescription Drug Product has been used. If you require certain Maintenance Medications, we may direct you to the Mail Order Network Pharmacy to obtain those Maintenance Medications. If you choose not to obtain your Maintenance Medications from the Mail Order Network Pharmacy, you may opt-out of the Maintenance Medication Program each year through the Internet at myuhc.com or by calling Customer Care at the telephone number on your ID card.

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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 34 Keller ISD Benefits Website: www.mybenefitshub.com/kellerisd

Hospital Indemnity Consider the following:

 The average cost per day for an hospital stay in the United States is more than $4,000.1  About 1 in 16 U.S. residents age 18 to 44 required one or more hospital stays in 2012. For ages 45 to 64, it was about 1 in 13.2 1

“As Hospital Prices Soar, a Stitch Tops $500.” New York Times, Dec. 2, 2013. 2 “Health, United States.” National Center for Health Statistics, Centers for Disease Control and Prevention, 2013. The costs of a hospital stay aren’t confined to hospital bills, either. There’s transportation, parking, food and drink for visitors, rehabilitation expenses, and potentially lost work time. Compass Hospital Confinement Indemnity Insurance can help reduce your financial stress during recovery.

About Compass Hospital Confinement Indemnity Insurance Compass Hospital Confinement Indemnity Insurance is a limited benefit policy. This is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. Hospital confinement indemnity insurance pays lump sum benefit amounts based on the number of days spent in a hospital*, critical care unit, or rehabilitation facility. You can use this benefit for any purpose you like, for example: to help pay for expenses not covered by your medical plan, lost wages, child care, travel, home health care costs, or any of your regular household expenses. *A hospital does not include an institution or part of an institution used as: a hospice unit; a convalescent home; a rest or nursing facility; a free-standing surgical center; a rehabilitative facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.

This policy is portable – which means that if you leave your employer, you can maintain your coverage. If you choose to keep your coverage, you will be billed directly.

Your Compass Hospital Confinement Indemnity Insurance Plan The plan pays a daily benefit based on the coverage level you select. See accompanying rate sheet for available coverage levels. You will be asked for supporting documentation in order for a benefit to be paid. Please see the complete certificate and any applicable rider(s) for details. Please refer to the back pages of this document for a list of the exclusions and limitations that apply to this coverage.

Spouse Hospital Confinement Indemnity Insurance Rider The spouse/domestic partner daily benefit may or may not match the employee benefit amount, so see your available election choices on the accompanying rate sheet or review the complete certificate for details. You must have coverage for yourself in order to select this rider. Please refer to the back pages of this document for a list of the exclusions and limitations that apply to this coverage.

Children’s Hospital Confinement Indemnity Insurance Rider You may elect hospital confinement indemnity insurance coverage for your child or children, up to age 26. One rider covers all of your eligible children. The child daily benefit amount may be different from what is available to employees and spouses, so see your election choices on the accompanying rate sheet or the complete certificate for details. You must have coverage for yourself in order to select this rider. Please refer to the back pages of this document for a list of the exclusions and limitations that apply to this coverage.

If you are an employee who works at least 20 hours a week you qualify for this insurance. There are no medical questions you need to answer or medical tests you need to take to get coverage. This is an optional benefit that you can purchase. Premium payments will be made through automatic deduction from your paycheck. This brochure will describe the coverage and options available to you. 35

Hospital Indemnity Exclusions and Limitations* Benefits are not payable for any loss caused in whole or directly by any of the following: Exclusions and Limitations

Applies To

Participation or attempt to participate in a felony or illegal activity.