2018 Benefit Guide ESC Region 11 - Trivium Academy

ESC REGION 11 EMPLOYEE BENEFITS COOPERATIVE

BENEFIT GUIDE EFFECTIVE: 10/01/2018 - 08/31/2019 WWW.REGION11BC.COM

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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. Benefit Rates NBS Flexible Spending Account (FSA) APL MEDlink® Medical Supplement MDLIVE Telehealth Cigna Dental Superior Vision Cigna Disability APL Cancer Voya Accident UNUM Life and AD&D ID Watchdog Identity Theft

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3 4-5 6-13 6 7 8 9 12 13 14-15 18-21 22-23 24-29 30-31 32-35 36-39 40-43 44-47 48-49

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PG. 4 HOW TO HOW TO ENROLL ENROLL

PG. 6 SUMMARY PAGES

PG. 14 YOUR BENEFITS

Benefit Contact Information ESC REGION 11 EBC BENEFITS

MEDICAL SUPPLEMENT—MEDLINK ® CANCER

Financial Benefit Services (800) 583-6908 www.region11bc.com

Group # 13180 American Public Life (800) 256-8606 www.ampublic.com

Group # 13060 American Public Life (800) 256-8606 www.ampublic.com

FLEXIBLE SPENDING ACCOUNT

TELEHEALTH

ACCIDENT

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

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

Voya Group # 700681 (800) 955-7736 www.voya.com

VISION

DENTAL

LIFE AND AD&D

Group # 320580 Superior Vision (800) 507-3800 www.superiorvision.com

Group # 3335872 Cigna (800) 244-6224 www.mycigna.com

UNUM (800) 583-6908 www.unum.com

DISABILITY

IDENTITY THEFT

Group # SLH100007 Cigna (800) 362-4462 www.cigna.com

ID Watchdog (800) 237-1521 www.idwatchdog.com

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MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet.

Text “FBS BC11” to 313131 and get access to everything you need to complete your benefits enrollment: 

Benefit Information

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Online Support

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Interactive Tools

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And more.

PLAY VIDEO

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Text “FBS BC11” to 313131 OR SCAN

How to Log In

BENEFIT INFO

INTERACTIVE TOOLS

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www.region11bc.com SELECT YOUR SCHOOL FROM THE DROP DOWN LIST

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

ONLINE SUPPORT

last four (4) digits of your Social Security Number.

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.

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Annual Benefit Enrollment Benefit Updates - What’s New: 

If you currently participate in a Healthcare or Dependent Care FSA, you MUST re-elect a new contribution amount every year to continue to participate. IT DOES NOT ROLL OVER! Eligible expenses must be incurred within the plan year (10/01/18 to 8/31/19) and contributions are “use it or lose it” unless your district has a rollover or grace period. You can view your account balance using the CHECK FSA link on the benefit website or use the NBS smart phone app.

The medical reimbursement annual maximum is $2,650 per plan year.

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The cancer coverage offers two options to you with optional ICU coverage. Cancer insurance is designed to be a supplement and pays for many costs not covered by your major medical plan. Pre-existing limitations apply.

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You have the option to choose from three dental plans through Cigna: PPO High plan, MAC plan, or the DHMO plan. The High plan offers you the flexibility to select your own provider and includes orthodontia for children. The MAC plan will provide more benefits on Basic/Major care than the High plan but only if you use an In-Network provider. The DHMO does not have any out of network benefits. If you would like to change your Primary Care dentist, please reach out to Cigna directly at 800-244-6224. All DHMO services are paid per the plan schedule so there are no surprise costs and there are no maximums on the DHMO plan.   

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 AM3 PM. 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 and date of birth in the HUB. If you have questions, please contact your Benefits Administrator.

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SUMMARY PAGES

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.

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.

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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.region11bc.com. Click on your

annual enrollment) unless a Section 125 qualifying event occurs.

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

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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

Go to the ESC Region 11 EBC benefit website:

that dependents they wish to provide coverage for are

www.region11bc.com. Click on your district, then click on the

included in the dependent profile. Additionally, you must

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

notify your employer of any discrepancy in personal and/or

can find provider search links under the Quick Links section.

benefit information.

When will I receive ID cards?

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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.

If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that

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.

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.

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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.

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 17.5 or

Dependent Eligibility: You can cover eligible dependent

more 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 11 EBC or as

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

both employees and dependents.

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

PLAN

CARRIER

MAXIMUM AGE

Dental

Cigna

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Vision

Superior Vision

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Cancer

American Public Life

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Accident

VOYA

26

Voluntary Term Life/AD&D

UNUM

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ID Theft Protection

ID Watchdog

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MEDlink®

American Public Life

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Telehealth

MDLIVE

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Flexible Spending Account

National Benefit Services

26 (benefits terminate at the end of the plan year following the birthday)

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 physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.

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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 10/1/2018 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 October 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.

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(including diagnostic and/or consultation services).

ESC Region 11 EBC Rates

SUMMARY PAGES

Plan Year October 1, 2018 - August 31, 2019

CIGNA DENTAL

NBS FLEXIBLE SPENDING ACCOUNT

High PPO

Healthcare Reimbursement Maximum: $2,650 Dependent Care Reimbursement Maximum: $2,500 or $5,000 (Dependent Care Maximum is based on marital/tax filing status.)

Employee Only Employee + Spouse Employee + Children Employee + Family

$33.69 $70.20 $76.38 $113.72

AMERICAN PUBLIC LIFE MEDLINK®

MAC Plan

Rates: 45 year old participant

Employee Only Employee + Spouse Employee + Children Employee + Family

$25.64 $51.31 $53.87 $82.43

Employee Only Employee + Spouse Single Parent Family Family

DHMO Plan Employee Only Employee + Spouse Employee + Children Employee + Family

Employee Only Employee + Family

Voluntary Term Life Employee Guarantee Issue: Spouse Guarantee Issue: Child Guarantee Issue:

High Plan Employee Only Single Parent Fam. Family

Employee Only Single Parent Fam. Family

$19.60 $27.30 $35.90

High Plan w/ ICU Rider $32.40 $44.60 $56.60

Employee Only Single Parent Fam. Family

$35.70 $49.10 $63.50

0-30 31-34 35-39 40-44 45-49 50-54 55-59 60-64

$0.45 $0.60 $0.70 $0.80 $1.20 $2.00 $3.30 $5.10 Children

$5,000 $10,000

VOYA ACCIDENT Employee Only Employee + Spouse Employee + Children Employee + Family

$230,000 $50,000 $10,000

Employee and Spouse Rates per $10,000

Low Plan w/ ICU Rider $16.30 $22.80 $29.00

$8.00 $16.00

UNUM TERM LIFE/AD&D $8.86 $15.09 $15.97 $23.95

AMERICAN PUBLIC LIFE CANCER Employee Only Single Parent Fam. Family

$28.00 $51.50 $45.50 $69.00

Check with your district to see if your employer offers this benefit at no cost.

SUPERIOR VISION

Low Plan

$21.50 $39.50 $36.50 $54.50

MDLIVE TELEHEALTH $12.78 $20.21 $27.71 $32.91

Employee Only Employee + Spouse Employee + Children Employee + Family

$1,500 Benefit $2,500 Benefit

$12.20 $19.00 $19.90 $26.70

$0.90 $1.80

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

$0.40 $0.70

CIGNA LONG-TERM DISABILITY

ID WATCHDOG IDENTITY THEFT PROTECTION

Rates per/$200

1B Plan

Elimination Period 0/7 14/14 30/30 60/60 90/90 180/180

Premium Plan $7.60 $6.44 $5.50 $4.40 $2.50 $1.74

Select Plan $6.26 $5.08 $3.96 $2.64 $1.36 $0.82

Employee Only Employee + Family

$7.95 $14.95 Platinum Plan

Employee Only Employee + Family

$11.9511 $22.95

NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 12 ESC Region 11 EBC Benefits Website: www.region11bc.com

FSA (Flexible Spending Account) 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?

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!

What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)?

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.

Eligible expenses must be incurred within the plan year and contributions are use-it-or- lose-it unless your district offers a rollover or grace period. Remember to retain all your receipts.

What Can I Use My Flexible Spending Account On?

In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to received one you can visit www.region11bc.com and complete the “Claim Form” to send to NBS.

For a list of sample expenses, please refer to the ESC Region 11 EBC benefit website: www.region11bc.com

How Do I File a Claim?

A few examples are listed below:

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

How Do I View My Account Balance?

Go to: http://my.nbsbenefits.com

New User?

Create a username and password.

Employee ID: Please enter your Social Security Number Employer ID: Contact your benefits administrator for your districts Employer ID.

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 13

AMERICAN PUBLIC LIFE YOUR BENEFITS PACKAGE

MEDlinkÂŽ

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 14 ESC Region 11 EBC Benefits Website: www.region11bc.com

MEDlink® Limited Benefit Medical Expense Supplemental Insurance ESC Region 11 THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

SUMMARY OF BENEFITS Base Policy

Option 1

Option 2

In-Hospital Benefit - Maximum In-Hospital Benefit

$1,500 per confinement

$2,500 per confinement

Outpatient Benefit

up to $200 per treatment

up to $200 per treatment

$25 per treatment; $125 max per family per Calendar Year

$25 per treatment; $125 max per family per Calendar Year

Physician Outpatient Treatment Benefit

Option 1 Total Monthly Premiums by Plan* Issue Ages 17-54

Issue Ages 55-59

Issue Ages 60-69

Employee Only

$21.50

$32.00

$49.00

Employee + Spouse

$39.50

$59.00

$88.00

Employee + Child(ren)

$36.50

$47.00

$64.00

Family Coverage

$54.50

$74.00

$103.00

Issue Ages 17-54

Issue Ages 55-59

Issue Ages 60-69

Employee Only

$28.00

$44.50

$68.50

Employee + Spouse

$51.50

$81.50

$122.50

Employee + Child(ren)

$45.50

$62.00

$86.00

Family Coverage

$69.00

$99.00

$140.00

Option 2 Total Monthly Premiums by Plan* Hospital Emergency Room

Plans available to employees age 70 and over if You work for an employer employing 20 or more employees on a typical workday in the preceding Calendar Year. *Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice.

APSB-22330(TX)-0116 MGM/FBS ESC Region 11

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MEDlink® Limited Benefit Medical Expense Supplemental Insurance Limitations Eligibility This policy will be issued to those persons who meet American Public Life Insurance Company’s insurability requirements. Evidence of insurability acceptable to us may be required. If our underwriting rules are met, you are on active service, you are covered under your Employer’s Medical Plan and premium has been paid, your insurance will take effect on the requested Effective Date or the Effective Date assigned by us upon approval of your written application, whichever is later.

Covered Charges mean those charges that are incurred by a Covered Person because of an Accident or Sickness; are for necessary treatment, services and medical supplies and recommended by a Physician; are not more than any dollar limit set forth in the Schedule; are incurred while insured under the Policy, subject to any Extension of Benefits; and are not excluded under the Policy.

A Hospital is not any institution used as a place for rehabilitation; a place for rest, or for the aged; a nursing or convalescent home; a long term nursing unit or geriatrics ward; or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients.

In-Hospital Benefit Benefits payable are limited to any out-of-pocket deductible amount; any out-of-pocket co-payment or coinsurance amounts the Covered Person actually incurs after the Employer’s Medical Plan has paid; any out-of-pocket amount the Covered Person actually incurs for surgery performed by a Physician after the Employer’s Medical Plan has paid; and the Maximum In-Hospital Benefit shown in the Policy Schedule. The Covered Person must be an Inpatient and covered by your Employer’s Medical Plan when the Covered Charges are incurred.

Outpatient Benefits Treatment is for the same or related conditions, unless separated by a period of 90 consecutive days. After 90 consecutive days, a new Outpatient Benefit will be payable. The Covered Person must be covered by your Employer’s Medical Plan when the Covered Charges are incurred.

Physician Outpatient Treatment Benefit Benefit maximum of $125 per family per Calendar Year. The Covered Person must be covered by your Employer’s Medical Plan when the Covered Charges are incurred. The Covered Person must not be an Inpatient when the Covered Charges are incurred.

Premiums The premium rates may be changed by Us. If the rates are changed, We will give You at least 31 days advance written notice. If a change in benefits increases Our liability, premium rates may be changed on the date Our liability is increased.

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

APSB-22330(TX)-0116 MGM/FBS ESC Region 11 16

Exclusions We will pay no benefits for any expenses incurred during any period the Covered Person does not have coverage under your Employer’s Medical Plan, except as provided in the Absence of your Employer’s Medical Plan provision or which result from: (a) suicide or any attempt, thereof, while sane or insane; (b) any intentionally self-inflicted injury or Sickness; (c) rest care or rehabilitative care and treatment; (d) outpatient routine newborn care; (e) voluntary abortion except, with respect to You or Your covered Dependent spouse: (1) where Your or Your Dependent spouse’s life would be endangered if the fetus were carried to term; or (2) where medical complications have arisen from abortion; (f) pregnancy of a Dependent child; (g) participation in a riot, civil commotion, civil disobedience, or unlawful assembly. This does not include a loss which occurs while acting in a lawful manner within the scope of authority; (h) commission of a felony; (i) participation in a contest of speed in power driven vehicles, parachuting, or hang gliding; (j) air travel, except: (1) as a fare-paying passenger on a commercial airline on a regularly scheduled route; or (2) as a passenger for transportation only and not as a pilot or crew member; (k) intoxication; (Whether or not a person is intoxicated is determined and defined by the laws and jurisdiction of the geographical area in which the loss occurred.) (l) alcoholism or drug use, unless such drugs were taken on the advice of a Physician and taken as prescribed; (m) sex changes; (n) experimental treatment, drugs, or surgery; (o) an act of war, whether declared or undeclared, or while performing police duty as a member of any military or naval organization; (This exclusion includes Accident sustained or Sickness contracted while in the service of any military, naval, or air force of any country engaged in war. We will refund the pro rata unearned premium for any such period the Covered Person is not covered.) (p) Accident or Sickness arising out of and in the course of any occupation for compensation, wage or profit; (This does not apply to those sole proprietors or partners not covered by Workers’ Compensation.) (q) mental illness or functional or organic nervous disorders, regardless of the cause; (r) dental or vision services, including treatment, surgery, extractions, or x-rays, unless: (1) resulting from an Accident occurring while the Covered Person’s coverage is in force and if performed within 12 months of the date of such Accident; or (2) due to congenital disease or anomaly of a covered newborn child. (s) routine examinations, such as health exams, periodic check-ups, or routine physicals, except when part of Inpatient routine newborn care; (t) any expense for which benefits are not payable under the Covered Person’s Employer’s Medical Plan; or (u) air or ground ambulance.

MEDlink® Limited Benefit Medical Expense Supplemental Insurance Termination of Coverage Your Insurance coverage will end on the earliest of these dates: the date You no longer qualify as an Insured; the end of the last period for which premium has been paid; the date the Policy is discontinued; the date You retire; if You work for an employer employing less than 20 employees on a typical work day in the preceding Calendar Year, the date You attain age 70; the date You cease to be on Active Service; the date Your coverage under Another Medical Plan ends; or the date You cease employment with the employer through whom You originally became insured under the Policy.

Insurance coverage on a Dependent will end on the earliest of these dates: the date Your coverage terminates; the end of the last period for which premium has been paid; the date the Dependent no longer meets the definition of Dependent; the date the Dependent’s coverage under Another Medical Plan ends; or the date the Policy is modified so as to exclude Dependent coverage.

We may end the coverage of any Covered Person who submits a fraudulent claim.

We may end the coverage of a Subscribing Unit if fewer persons are insured than the Policyholder’s application requires.

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 and riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form MEDlink® Series | Texas | Limited Benefit Medical Expense Supplemental Insurance | (10/14) | ESC Region 11

APSB-22330(TX)-0116 MGM/FBS ESC Region 11

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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 18 ESC Region 11 EBC Benefits Website: www.region11bc.com

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

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

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

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

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

How much does it cost? $8 for Employee Only. $16 for Family coverage.

If you are an eligible employee in the following districts, this benefit is offered to you at no cost: Chico ISD CityScape Schools Garner ISD Huckabay ISD Lake Dallas ISD Palmer ISD Palo Pinto ISD Santo ISD Treetops School International Trinity Basin Preparatory Trivium Academy Valley View ISD Van Alstyne ISD Westlake Academy Whitesboro ISD

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

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.

  

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

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.

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 19 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

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 20 ESC Region 11 EBC Benefits Website: www.region11bc.com

Cigna Dental PPO - High Plan Monthly PPO Premiums Tier

Rate

EE Only

$33.69

EE + Spouse

$70.20

EE + Child(ren)

$76.38

Family Coverage

$113.72

Receiving regular dental care can not only catch minor problems before they become major and expensive to treat - it may even help improve your overall health. Gum disease is increasingly being linked to complications for pre-term birth, heart disease, stroke, diabetes, osteoporosis and other health issues. That’s why this dental plan includes Cigna Dental WellnessPlusSM features.

When you or your family members receive any preventive care in one plan year, the annual dollar maximum will increase in the following plan year. When you or your family members remain enrolled in the plan and continue to receive preventive care, the annual dollar maximum will increase in the following plan year, until it reaches the level specified below. Please refer to your plan materials for additional information on this plan feature.

Benefits Network Plan Year Maximum (Class I, II, and III expenses)

Cigna Dental Choice In-Network Cigna Total DPPO Year 1: $1,000 Year 2: $1,100# Year 3: $1,200+ Year 4: $1,300

Annual Deductible Individual Family Reimbursement Levels**

Out-of-Network Cigna Total DPPO Year 1: $1,000 Year 2: $1,100# Year 3: $1,200+ Year 4: $1,300

$50 per person $150 per family

$50 per person $150 per family

Based on Reduced Contracted Fees

Maximum Reimbursable Charge

Plan Pays

You Pay

Plan Pays

You Pay

Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Bitewing X-rays Fluoride Application Space Maintainers

100%

No Charge

100%

No Charge

Class II - Basic Restorative Care Fillings Sealants Non Routine X-Rays Emergency Care to Relieve Pain Brush Biopsies Oral Surgery – Simple Extractions

70%*

30%*

70%*

30%*

Class III - Major Restorative Care Crowns/Bridges/Dentures Root Canal Therapy/Endodontics Minor/Major Periodontics Surgical Extractions of Impacted Teeth Oral Surgery - all except simple extractions Anesthetics Denture Repairs Denture Relines, Rebases and Adjustments Repairs to Bridges, Crowns and Inlays Inlays/Onlays Prosthesis Over Implant

40%*

60%*

40%*

60%*

Class IV - Orthodontia Lifetime Maximum—$1,000 Limited to Dependent Children only

50%

50%

50%

50% 21

Cigna Dental - MAC Plan Monthly PPO Premiums Tier

Rate

EE Only

$25.64

EE + Spouse

$51.31

EE + Child(ren)

$53.87

Family Coverage

$82.43

Receiving regular dental care can not only catch minor problems before they become major and expensive to treat - it may even help improve your overall health. Gum disease is increasingly being linked to complications for pre-term birth, heart disease, stroke, diabetes, osteoporosis and other health issues. That’s why this dental plan includes Cigna Dental WellnessPlusSM features.

When you or your family members receive any preventive care in one plan year, the annual dollar maximum will increase in the following plan year. When you or your family members remain enrolled in the plan and continue to receive preventive care, the annual dollar maximum will increase in the following plan year, until it reaches the level specified below. Please refer to your plan materials for additional information on this plan feature.

Benefits Network Plan Year Maximum (Class I, II, and III expenses)

Cigna Dental Choice In-Network Cigna Total DPPO Year 1: $1,000 Year 2: $1,100# Year 3: $1,200+ Year 4: $1,300

Annual Deductible Individual Family Reimbursement Levels** Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Bitewing X-rays Fluoride Application Space Maintainers Class II - Basic Restorative Care Fillings Sealants Full Mouth X-rays Panoramic X-ray Periapical X-rays Emergency Care to Relieve Pain Root Canal Therapy/Endodontics Osseous Surgery Periodontal Scaling and Root Planning Brush Biopsies Oral Surgery Class III - Major Restorative Care Crowns/Bridges/Dentures Anesthetics Stainless Steel/Resin Crowns Surgical Extractions of Impacted Teeth Denture Repairs Denture Relines, Rebases and Adjustments Repairs to Bridges, Crowns and Inlays Inlays/Onlays Prosthesis Over Implant Class IV - Orthodontia 22

Out-of-Network Cigna Total DPPO Year 1: $1,000 Year 2: $1,100# Year 3: $1,200+ Year 4: $1,300

$50 per person No Limit

$50 per person No Limit

Based on Reduced Contracted Fees

Based on Maximum Allowable Charge (In-network fee level) Plan Pays You Pay

Plan Pays

You Pay

100%

No Charge

100%

No Charge

80%*

20%*

80%*

20%*

50%*

50%*

50%*

50%*

Not Covered

100% of your dentist’s usual fees

Not Covered

100% of your dentist’s usual fees

Cigna Dental - High and MAC Plan Dependent/Student age limitation 26/26. Dental Network Savings Program(DNSP): Using an out-of-network dental health care professional will cost you more than using in-network care. You may be able to save some money on out-of-pocket expenses if you use a dental health care professional that participates in Cigna’s Dental Network Savings Program. 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. # Increase contingent upon receiving Preventive Services in Plan Year 1 + Increase contingent upon receiving Preventive Services in Plan Years 1 and 2

Procedure

Exclusions and Limitations

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

50% coverage on Class III and IV for 12 months Two per Plan year Two per Plan year 1 per Plan year for people under 19 Various limits per Plan year depending on specific test Bitewings: 2 per Plan year Full mouth: 1 every 36 consecutive months., Panorex: 1 every 36 consecutive months Payable only when in conjunction with Ortho workup Various limitations depending on the service Various limitations depending on the service Replacement every 5 years Replacement every 5 years Replacement every 5 years Covered if more than 6 months after installation Covered if more than 6 months after installation Reviewed if more than once Reviewed if more than once Limited to posterior tooth. One treatment per tooth every three years 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

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 23 available by your Employer.

Dental - DHMO 



This Patient Charge Schedule applies only when covered dental services are performed by your Network Dentist, unless otherwise authorized by Cigna Dental as described in your plan documents. Not all Network Dentists perform all listed services and it is suggested to check with your Network Dentist in advance of receiving services.

This Patient Charge Schedule applies to Specialty Care when an appropriate referral is made to a Network Specialty Periodontist or Oral Surgeon. You must verify with the Network Specialty Dentist that your treatment plan has been authorized for payment by Cigna Dental.

Prior authorization is not required for specialty referrals for Pediatric, Orthodontic and Endodontic services. You may select a Network Pediatric Dentist for your child under the age of 7 by calling Customer Service at 1.800.Cigna24 to get a list of Network Pediatric Dentists in your area. Coverage for treatment by a Pediatric Dentist ends on your child’s 7th birthday; however, exceptions for medical reasons may be considered on an individual basis. Your Network General Dentist will provide care upon your child’s 7th birthday.

DHMO Premiums Tier

Rate

EE Only

$12.78

EE + Spouse

$20.21

EE + Children

$27.71

EE + Family

$32.91



Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/certificate of coverage and/or group contract.



All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated.



The American Dental Association may periodically change CDT Codes or definitions. Different codes may be used to describe these covered procedures.



The administration of IV sedation, general anesthesia, and/or nitrous oxide is not covered except as specifically listed on this Patient Charge Schedule. The application of local anesthetic is covered as part of your dental treatment.



Cigna Dental considers infection control and/or sterilization to be incidental to and part of the charges for services provided and not separately chargeable.



This Patient Charge Schedule is subject to annual change in accordance with the terms of the group agreement.

After your enrollment is effective: Call the dental office identified in your Welcome Kit. If you wish to change dental offices, a transfer can be arranged at no charge by calling Cigna Dental at the toll free number listed on your ID card or plan materials. Multiple ways to locate a DHMO Network General Dentist:  Online provider directory at www.Cigna.com  Online provider directory on www.myCigna.com  Call the number located on your ID card to: - Use the Dental Office Locator via Speech Recognition - Speak to a Customer Service Representative For full Patient Charge Schedule, go to www.region11bc.com Code

Procedure Description

Member Pays

Office visit fee (per patient, per office visit in addition to any other applicable patient charges) Office visit fee

$ 5.00

Diagnostic/preventive – Oral evaluations are limited to a combined total of 4 of the following evaluations during a 12 consecutive month period: Periodic oral evaluations (D0120), comprehensive oral evaluations (D0150), comprehensive periodontal evaluations (D0180), and oral evaluations for patients under 3 years of age (D0145).

Code

Procedure Description

Member Pays

Diagnostic/preventive (cont.)

D0145

Oral evaluation for a patient under 3 years of age and counseling with primary caregiver

$0.00

D0150

Comprehensive oral evaluation – New or established patient

$0.00

D0210

X-rays intraoral – Complete series of radiographic images (limit 1 every 3 years)

$0.00

D9310

Consultation (diagnostic service provided by dentist or physician other than requesting dentist or physician)

$0.00

D0240

X-rays intraoral – Occlusal radiographic image

$0.00

D9430

Office visit for observation – No other services performed

$0.00

D0270

X-rays (bitewing) – Single radiographic image

$0.00

D0120

Periodic oral evaluation – Established patient

$0.00

D0330

X-rays (panoramic radiographic image) – (limit 1 every 3 years)

$0.00

Limited oral evaluation – Problem focused

$0.00

D0431

Oral cancer screening using a special light source

$50.00

D0140

24

Dental - DHMO Code

Procedure Description

Member Pays

Diagnostic/preventive (cont.)

Prophylaxis (cleaning) – Adult (limit 2 per calendar year) D1110

D1120

Additional Prophylaxis (Cleaning) – In Addition to the 2 Prophylaxes (Cleanings) Allowed per Calendar Year Prophylaxis (cleaning) – Child (limit 2 per calendar year) Additional Prophylaxis (Cleaning) – In Addition to the 2 Prophylaxes (Cleanings) Allowed per Calendar Year

Code

Procedure Description

Member Pays

Periodontics (cont.) $0.00

D4341

Periodontal scaling and root planing – 4 or more teeth per quadrant (limit 4 quadrants per consecutive 12 months)

$55.00

D4342

Periodontal scaling and root planing – 1 to 3 teeth per quadrant (limit 4 quadrants per consecutive 12 months)

$30.00

D4910

Periodontal maintenance (limit 4 per calendar year) (only covered after active periodontal therapy)

$35.00

$41.00

$0.00 $30.00

D1206

Topical application of fluoride varnish (limit 2 per calendar year). There is a combined limit of a total of 2 D1206s and/or D1208s per calendar year.

$0.00

D1351

Sealant – Per tooth

$10.00

Restorative (fillings, including polishing) D2140

Amalgam – 1 surface, primary or permanent

$10.00

D2330

Resin-based composite – 1 surface, anterior

$15.00

D2390

Resin-based composite crown, anterior

$45.00

Crown and bridge – All charges for crowns and bridges (fixed partial dentures) are per unit (each replacement or supporting tooth equals 1 unit). Coverage for replacement of crowns and bridges is limited to 1 every 5 years. For single crowns, retainer (“abutment”) crowns, and pontics: The charges below include the cost of predominantly base metal alloy. You may be charged up to these additional amounts, based on the type of material the dentist uses for your restoration.

• No more than $80.00 per tooth for any noble metal alloys • No more than $130.00 per tooth for any high noble metal alloys, titanium or titanium alloys • No more than $100.00 per tooth for any porcelain fused to metal (only on molar teeth) • Porcelain/ceramic substrate crowns on molar teeth are not covered D2740

Crown – Porcelain/ceramic substrate

$255.00

D2792

Crown – Full cast noble metal

$255.00

D2950

Core buildup – Including any pins

$80.00

Endodontics (root canal treatment, excluding final restorations) D3310

Anterior root canal – Permanent tooth (excluding final restoration)

$70.00

D3330

Molar root canal – Permanent tooth (excluding final restoration)

$280.00

Prosthetics (removable tooth replacement – dentures) includes up to 4 adjustments within first 6 months after insertion – Replacement limit 1 every 5 years. Characterization is considered an upgrade with maximum additional charge to the member of $200.00 per denture.

D5110

Full upper denture

$275.00

D5120

Full lower denture

$275.00

D5211

Upper partial denture – Resin base (including clasps, rests and teeth)

$275.00

D5212

Lower partial denture – Resin base (including clasps, rests and teeth)

$275.00

Oral surgery (includes routine postoperative treatment) Surgical removal of impacted tooth – Not covered for ages below 15 unless pathology (disease) exists.

D7111

Extraction of coronal remnants – Deciduous tooth

$10.00

D7140

Extraction, erupted tooth or exposed root – Elevation and/or forceps removal

$10.00

D7220

Removal of impacted tooth – Soft tissue

$40.00

D7240

Removal of impacted tooth – Completely bony

$115.00

Orthodontics (tooth movement) Orthodontic treatment (maximum benefit of 24 months of interceptive and/or comprehensive treatment. Atypical cases or cases beyond 24 months require an additional payment by the patient.)

D8670

Periodic orthodontic treatment visit – As part of contract Children – Up to 19th birthday: 24-month treatment fee Charge per month for 24 months

$1,800.00 $75.00

Adults: 24-month treatment fee Charge per month for 24 months

$2,400.00 $75.00

Periodontics (treatment of supporting tissues [gum and bone] of the teeth) periodontal regenerative procedures are limited to 1 regenerative procedure per site (or per tooth, if applicable), when covered on the Patient Charge Schedule. The relevant procedure codes are D4263, D4264, D4266 and D4267. Localized delivery of antimicrobial agents is limited to 8 teeth (or 8 sites, if applicable) per 12 consecutive months when covered on the Patient Charge Schedule. If your Network Dentist certifies to Cigna Dental that, due to medical necessity, you require certain Covered Services more frequently than the limitation allows, Cigna Dental will waive the applicable limitation. The relevant Covered Services are identified with a ❂.

D4211

Gingivectomy or gingivoplasty – 1 to 3 teeth per quadrant

$60.00

D4240

Gingival flap (including root planing) – 4 or more teeth per quadrant

$135.00 25

SUPERIOR VISION YOUR BENEFITS PACKAGE

Vision

PLAY VIDEO

About this Benefit Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan.

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 26 ESC Region 11 EBC Benefits Website: www.region11bc.com

Vision - Superior Select Southwest Network Benefits Exam Frames Contact Lenses1 Medically Necessary Contact Lenses Lasik Vision Correction

In-Network

Out-of-Network

Covered in full $125 retail allowance $150 retail allowance

Up to $35 retail Up to $70 retail Up to $80 retail

Emp. Only

$8.86

Emp. + Spouse

$15.09

Covered in full

Up to $150 retail

Emp. + Child(ren)

$15.97

Emp. + Family

$23.95

$200 allowance2

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

Monthly Premiums

Co-Pays Covered in full Covered in full Covered in full See description3 Covered in full

Up to $25 retail Up to $40 retail Up to $45 retail Up to $45 retail Up to $80 retail

Exam

$10

Materials

$10

Services/Frequency

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements.

Exam

12 months

Frame

12 months

1

Lenses

12 months

Contact Lenses

12 months

Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 2 Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations. ₃ Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay

(Based on date of service)

Discount Features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings.

Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.

SuperiorVision.com Customer Service 800.507.3800

The Plan discount features are not insurance.

All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan.

Discounts are subject to change without notice.

Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions 27

CIGNA 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 28 ESC Region 11 EBC Benefits Website: www.region11bc.com

Educator Disability Disability Insurance For Educators Employee-Paid Eligibility

Eligibility Waiting Period

Monthly Benefit Elimination Period

Benefit Duration

If you are an active employee who works at least 17.5 hours per week, you are eligible on the first of the month coincident with or next following the date of hire of actively at work.

Select from Six Options: Accident/Sickness 0 days/7 days* 14 days/14 days* 30 days/30 days* 60 days/60 days 90 days/90 days 180 days/180 days Flat dollar benefit in $100 increments between $200 and $7,500 that cannot exceed Benefit Amount 66 2/3% of your current monthly earnings Maximum $7,500 per month You must be continuously Disabled for your elected benefit waiting period before benefits will be payable for a covered Disability.

Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit or until you no longer qualify for benefits, whichever occurs first. Should you remain Disabled, your benefits continue according to one of the following schedules, depending on your age at the time you become Disabled and the plan you select.

*If because of your disability, you are hospital confined an inpatient, benefits begin on the first day of inpatient confinement

Select Plan—Maximum Benefit Period Schedule Age at Disability

Prior to age 65

Age 65 through 68

Age 69 and over

24 months

To age 70, but not less than 12 months

12 months

Duration of Payments (Accident and Sickness)

Premium Plan—Maximum Benefit Period Schedule Age at Disability Duration of Payments (Accident and Sickness)

Prior to age 63 To age 65 or 48 months, whichever is greater

63 To age 65 or 42 months, whichever is greater

64

65

66

67

68

69+

36 months

30 months

27 months

24 months

24 months

18 months

Definition of Disability

Covered Earnings

“Disability” or “Disabled” means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 80% or more of your indexed earnings. We will require proof of earnings and continued disability.

“Covered Earnings” means your wages or salary, not including bonuses, commissions, and other extra compensation.

When Coverage Takes Effect Your coverage takes effect on the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit evidence of good health, your coverage takes effect on the date we agree, in writing, to cover you.

29

Educator Disability Effects of Other Income Benefits

Termination of Disability Benefits

This plan is structured to prevent your total benefits and postdisability earnings from equaling or exceeding pre-disability earnings. Therefore, we reduce this plan’s benefits by Other Income Benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Disability benefits maybe reduced by amounts received through Social Security disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will also be reduced by amounts received through other government programs, sick leave, employer’s sabbatical leave, employer’s assault leave plan, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no-fault, and damages for wage loss. For details, see your outline of coverage, policy certificate, or your employer’s summary plan description. Note: Some of the Other Income Benefits, as defined in the group policy, will not be considered until after disability benefits are payable for 12 months.

Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, or on the following events: (1) the date you earn from any occupation more than 80% of your Covered Earnings, or the date you fail to cooperate with us in a rehabilitation plan, or transitional work arrangement, or the administration of the claim.

Earnings While Disabled During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of pre-disability Covered Earnings. After that, benefits will be reduced by 50% of earnings from employment.

Limited Benefit Period Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months for outpatient treatment: Anxiety-disorders, delusional (paranoid) or depressive disorders, eating disorders, mental illness, somatoform disorders (including psychosomatic illnesses) ,alcoholism, drug addiction or abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 24-month lifetime outpatient limit is exhausted.

Pre-existing Condition Limitation Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures,) during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after you have been insured under this plan for at least 12 months after your most recent effective date of insurance.

30

Rehabilitation Requirement To be eligible for Disability benefits under this plan, you may be required to participate in a rehabilitation plan at the sole discretion and expense of the insurance company or company administering benefits under this plan. If you fail to fully cooperate with the rehabilitation plan, no Disability benefits will be paid, and coverage will end. For details, see your Certificate of Insurance.

Exclusions This plan does not pay benefits for a Disability which results, directly or indirectly, from any of the following:  Suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane.  war or any act of war, whether or not declared.  active participation in a riot;  commission of a felony;  the revocation, restriction or non-renewal of an Employee’s license, permit or certification necessary to perform the duties of his or her occupation unless due solely to Injury or Sickness otherwise covered by the Policy.  any cosmetic surgery or surgical procedure that is not Medically Necessary.  an Injury or Sickness for which the Employee is entitled to benefits from Workers’ Compensation or occupational disease law.  an Injury or Sickness that is work related.

In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution.

Educator Disability Premium Plan

Select Plan

Max. Option 1 Option 2 Option 3 Option 4 Option 5 Option 6 Option 1 Option 2 Option 3 Option 4 Option 5 Option 6 Select Select Select Select Select Benefit % 66.67% Premium Premium Premium Premium Premium Premium Select Elimination Period: Injury (Days) 0 14 30 60 90 180 0 14 30 60 90 180 Sickness (Days) 7 14 30 60 90 180 7 14 30 60 90 180 Gross Max. Annual Monthly Premium Plan Monthly Cost Select Plan Monthly Cost Salary Benefit $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 $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

$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 $3,400 $3,500 $3,600 $3,700 $3,800 $3,900 $4,000 $4,100 $4,200 $4,300 $4,400 $4,500 $4,600 $4,700 $4,800 $4,900 $5,000

$7.60 $11.40 $15.20 $19.00 $22.80 $26.60 $30.40 $34.20 $38.00 $41.80 $45.60 $49.40 $53.20 $57.00 $60.80 $64.60 $68.40 $72.20 $76.00 $79.80 $83.60 $87.40 $91.20 $95.00 $98.80 $102.60 $106.40 $110.20 $114.00 $117.80 $121.60 $125.40 $129.20 $133.00 $136.80 $140.60 $144.40 $148.20 $152.00 $155.80 $159.60 $163.40 $167.20 $171.00 $174.80 $178.60 $182.40 $186.20 $190.00

$6.44 $9.66 $12.88 $16.10 $19.32 $22.54 $25.76 $28.98 $32.20 $35.42 $38.64 $41.86 $45.08 $48.30 $51.52 $54.74 $57.96 $61.18 $64.40 $67.62 $70.84 $74.06 $77.28 $80.50 $83.72 $86.94 $90.16 $93.38 $96.60 $99.82 $103.04 $106.26 $109.48 $112.70 $115.92 $119.14 $122.36 $125.58 $128.80 $132.02 $135.24 $138.46 $141.68 $144.90 $148.12 $151.34 $154.56 $157.78 $161.00

$5.50 $8.25 $11.00 $13.75 $16.50 $19.25 $22.00 $24.75 $27.50 $30.25 $33.00 $35.75 $38.50 $41.25 $44.00 $46.75 $49.50 $52.25 $55.00 $57.75 $60.50 $63.25 $66.00 $68.75 $71.50 $74.25 $77.00 $79.75 $82.50 $85.25 $88.00 $90.75 $93.50 $96.25 $99.00 $101.75 $104.50 $107.25 $110.00 $112.75 $115.50 $118.25 $121.00 $123.75 $126.50 $129.25 $132.00 $134.75 $137.50

$4.40 $6.60 $8.80 $11.00 $13.20 $15.40 $17.60 $19.80 $22.00 $24.20 $26.40 $28.60 $30.80 $33.00 $35.20 $37.40 $39.60 $41.80 $44.00 $46.20 $48.40 $50.60 $52.80 $55.00 $57.20 $59.40 $61.60 $63.80 $66.00 $68.20 $70.40 $72.60 $74.80 $77.00 $79.20 $81.40 $83.60 $85.80 $88.00 $90.20 $92.40 $94.60 $96.80 $99.00 $101.20 $103.40 $105.60 $107.80 $110.00

$2.50 $3.75 $5.00 $6.25 $7.50 $8.75 $10.00 $11.25 $12.50 $13.75 $15.00 $16.25 $17.50 $18.75 $20.00 $21.25 $22.50 $23.75 $25.00 $26.25 $27.50 $28.75 $30.00 $31.25 $32.50 $33.75 $35.00 $36.25 $37.50 $38.75 $40.00 $41.25 $42.50 $43.75 $45.00 $46.25 $47.50 $48.75 $50.00 $51.25 $52.50 $53.75 $55.00 $56.25 $57.50 $58.75 $60.00 $61.25 $62.50

$1.74 $2.61 $3.48 $4.35 $5.22 $6.09 $6.96 $7.83 $8.70 $9.57 $10.44 $11.31 $12.18 $13.05 $13.92 $14.79 $15.66 $16.53 $17.40 $18.27 $19.14 $20.01 $20.88 $21.75 $22.62 $23.49 $24.36 $25.23 $26.10 $26.97 $27.84 $28.71 $29.58 $30.45 $31.32 $32.19 $33.06 $33.93 $34.80 $35.67 $36.54 $37.41 $38.28 $39.15 $40.02 $40.89 $41.76 $42.63 $43.50

$6.26 $9.39 $12.52 $15.65 $18.78 $21.91 $25.04 $28.17 $31.30 $34.43 $37.56 $40.69 $43.82 $46.95 $50.08 $53.21 $56.34 $59.47 $62.60 $65.73 $68.86 $71.99 $75.12 $78.25 $81.38 $84.51 $87.64 $90.77 $93.90 $97.03 $100.16 $103.29 $106.42 $109.55 $112.68 $115.81 $118.94 $122.07 $125.20 $128.33 $131.46 $134.59 $137.72 $140.85 $143.98 $147.11 $150.24 $153.37 $156.50

$5.08 $7.62 $10.16 $12.70 $15.24 $17.78 $20.32 $22.86 $25.40 $27.94 $30.48 $33.02 $35.56 $38.10 $40.64 $43.18 $45.72 $48.26 $50.80 $53.34 $55.88 $58.42 $60.96 $63.50 $66.04 $68.58 $71.12 $73.66 $76.20 $78.74 $81.28 $83.82 $86.36 $88.90 $91.44 $93.98 $96.52 $99.06 $101.60 $104.14 $106.68 $109.22 $111.76 $114.30 $116.84 $119.38 $121.92 $124.46 $127.00

$3.96 $5.94 $7.92 $9.90 $11.88 $13.86 $15.84 $17.82 $19.80 $21.78 $23.76 $25.74 $27.72 $29.70 $31.68 $33.66 $35.64 $37.62 $39.60 $41.58 $43.56 $45.54 $47.52 $49.50 $51.48 $53.46 $55.44 $57.42 $59.40 $61.38 $63.36 $65.34 $67.32 $69.30 $71.28 $73.26 $75.24 $77.22 $79.20 $81.18 $83.16 $85.14 $87.12 $89.10 $91.08 $93.06 $95.04 $97.02 $99.00

$2.64 $3.96 $5.28 $6.60 $7.92 $9.24 $10.56 $11.88 $13.20 $14.52 $15.84 $17.16 $18.48 $19.80 $21.12 $22.44 $23.76 $25.08 $26.40 $27.72 $29.04 $30.36 $31.68 $33.00 $34.32 $35.64 $36.96 $38.28 $39.60 $40.92 $42.24 $43.56 $44.88 $46.20 $47.52 $48.84 $50.16 $51.48 $52.80 $54.12 $55.44 $56.76 $58.08 $59.40 $60.72 $62.04 $63.36 $64.68 $66.00

$1.36 $0.82 $2.04 $1.23 $2.72 $1.64 $3.40 $2.05 $4.08 $2.46 $4.76 $2.87 $5.44 $3.28 $6.12 $3.69 $6.80 $4.10 $7.48 $4.51 $8.16 $4.92 $8.84 $5.33 $9.52 $5.74 $10.20 $6.15 $10.88 $6.56 $11.56 $6.97 $12.24 $7.38 $12.92 $7.79 $13.60 $8.20 $14.28 $8.61 $14.96 $9.02 $15.64 $9.43 $16.32 $9.84 $17.00 $10.25 $17.68 $10.66 $18.36 $11.07 $19.04 $11.48 $19.72 $11.89 $20.40 $12.30 $21.08 $12.71 $21.76 $13.12 $22.44 $13.53 $23.12 $13.94 $23.80 $14.35 $24.48 $14.76 $25.16 $15.17 $25.84 $15.58 $26.52 $15.99 $27.20 $16.40 $27.88 $16.81 $28.56 $17.22 $29.24 $17.63 $29.92 $18.04 $30.60 $18.45 $31.28 $18.86 $31.96 $19.27 $32.64 $19.68 $33.32 $20.09 $34.00 31$20.50

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 32 ESC Region 11 EBC Benefits Website: www.region11bc.com

GC3 Limited Benefit Group Cancer Indemnity Insurance ESC Region 11 Benefits Co-op Group

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

SUMMARY OF BENEFITS Benefits

Level 1 Plan

Level 2 Plan

Radiation Therapy/Chemotherapy/ Immunotherapy Benefit

$500 per calendar month of treatment

$1,500 per calendar month of treatment

Hormone Therapy Benefit

$50 per treatment, up to 12 per calendar year

$50 per treatment, up to 12 per calendar year

Surgical Schedule Benefit

$1,600 max per operation; $15 per surgical unit

$4,800 max per operation; $45 per surgical unit

Anesthesia Benefit

25% of the amount paid for covered surgery

25% of the amount paid for covered surgery

Hospital Confinement Benefit

$100 per day 1-90 days; $100 per day, 91+ days in lieu of other benefits

$300 per day 1-90 days; $300 per day, 91+ days in lieu of other benefits

US Government/Charity Hospital/HMO

$100 per day in lieu of most other benefits

$300 per day in lieu of most other benefits

Outpatient Hospital or Ambulatory Surgical Center Benefit

$200 per day of surgery

$600 per day of surgery

Drugs & Medicine Benefit - Inpatient

$150 per confinement

$150 per confinement

Drugs & Medicine Benefit - Outpatient

$50 per prescription, up to $50 per cal month

$50 per prescription, up to $150 per cal month

Transportation & Outpatient Lodging Benefit

$0.50 per mile per round trip $100 per day, up to 100 days per calendar year

$0.50 per mile per round trip $100 per day, up to 100 days per calendar year

Family Member Transportation & Lodging Benefit

$0.50 per mile per round trip $100 per day, up to 100 days per calendar year

$0.50 per mile per round trip $100 per day, up to 100 days per calendar year

Blood, Plasma & Platelets Benefit

$150 per day, up to $7,500 per calendar year

$250 per day, up to $12,500 per calendar year

Bone Marrow/Stem Cell Transplant

Autologous - $500 per calendar year Non-Autologous - $1,500 per calendar year

Autologous - $1,500 per calendar year Non-Autologous - $4,500 per calendar year

Experimental Treatment Benefit

Pays as any non-experimental benefit

Pays as any non-experimental benefit

Attending Physician Benefit

$30 per day of confinement

$50 per day of confinement

Surgical Prosthesis Benefit

$1,000 per device (includes surgical fee); max 1 device per site, 2 lifetime max

$3,000 per device (includes surgical fee); max 1 device per site, 2 lifetime max

Hair Prosthesis Benefit

$50 per hair prosthetic, 2 lifetime max

$50 per hair prosthetic, 2 lifetime max

Dread Disease Benefit

$100 per day, 1-90 days of hospital confinement

$300 per day, 1-90 days of hospital confinement

Hospice Care Benefit

$50 per day, $9,000 lifetime max

$100 per day, $18,000 lifetime max

Inpatient Special Nursing Services

$150 per day of confinement

$150 per day of confinement

Ambulance Ground Benefit

$200 per ground trip

$200 per ground trip

Ambulance Air Benefit

$2,000 per air trip; up to 2 trips per hospital confinement (any combination of ground/air)

$2,000 per air trip; up to 2 trips per hospital confinement (any combination of ground/air)

Extended Care Benefit

$100 per day

$300 per day

Home Health Care Benefit

$100 per day

$300 per day

Second & Third Surgical Opinions

$300 per diagnosis; additional $300 if third opinion required

$300 per diagnosis; additional $300 if third opinion required

Waiver of Premium

Premium waived after 90 days of primary insured continuous total disability due to cancer

Premium waived after 90 days of primary insured continuous total disability due to cancer

Physical/Speech Therapy Benefit

$25 per visit, up to 4 visits per calendar month, $1,000 lifetime max

$25 per visit, up to 4 visits per calendar month, $1,000 lifetime max

Diagnostic Testing Benefit Rider

$50; 1 person, per calendar year

$50; 1 person, per calendar year

Critical Illness Rider: Heart Attack/Stroke

$2,500 lump sum benefit

$2,500 lump sum benefit

$600 up to a max of 30 days per confinement

$600 up to a max of 30 days per confinement

Riders

Optional Benefit Rider Intensive Care Unit Rider

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APSB-22356(TX) MGM/FBS ESC Region 11 Benefits Co-op

GC3 Limited Benefit Group Cancer Indemnity Insurance Monthly Premium

Level 1

Level 1 + ICU Rider

Level 2

Level 2 + ICU Rider

Individual

$16.30

$19.60

$32.40

$35.70

One-Parent Family

$22.80

$27.30

$44.60

$49.10

Two-Parent Family

$29.00

$35.90

$56.60

$63.50

*Premium and amount of benefits provided vary dependent upon the level selected at time of application.

Eligibility

Diagnostic Testing Benefit Rider

If You are working either under contract to or as a Full-Time Employee for the Policyholder, or You are a member in or employed by the association, You are eligible for insurance provided You qualify for coverage as defined in the Master Application. You must apply for insurance within thirty (30) days of the Policy Effective Date or the date that You become eligible for coverage. If You do not apply within thirty (30) days of the Policy Effective Date or the date You become eligible for coverage, You may be subject to additional underwriting by Us.

Critical Illness Rider

This policy/certificate will be issued only to those persons who meet American Public Life Insurance Company’s insurability requirements. The policy/certificate and the Internal Cancer coverage under the Critical Illness Rider will not be issued to anyone who has been diagnosed or treated for Cancer in the previous ten years. The Heart Attack or Stroke coverage under the Critical Illness Rider will not be issued to anyone who has been diagnosed or treated for any heart or stroke related conditions. The Hospital Intensive Care Unit Rider will not cover heart conditions for a period of two years following the Effective Date of coverage for anyone who has been diagnosed or treated for any heart related condition prior to the 30th day following the Covered Person’s Effective Date of coverage.

Base Policy

All diagnosis of cancer must be positively diagnosed by a legally licensed doctor of medicine certified by the American Board of Pathology or American Board of Osteopathic Pathology. This policy/certificate pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. This policy/certificate also covers other conditions or diseases directly caused by cancer or the treatment of cancer.

No benefits are payable for any covered person for any loss incurred during the first year of this policy/certificate as a result of a Pre-Existing Condition. A PreExisting Condition is a specified disease for which, within 12 months prior to the covered person’s effective date of coverage, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession, or for which symptoms manifested in such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment. Pre-Existing Conditions specifically named or described as excluded in any part of this contract are never covered.

This policy/certificate contains a 30-day waiting period during which no benefits will be paid under this policy/certificate. If any covered person has a specified disease diagnosed before the end of the 30-day 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 effective date of such person’s coverage. If any covered person is diagnosed as having a specified disease during the 30-day period immediately following the effective date, you may elect to void the policy/certificate from the beginning and receive a full refund of premium. All benefits payable only up to the maximum amount listed in the schedule of benefits in the policy/certificate.

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

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APSB-22356(TX) MGM/FBS ESC Region 11 Benefits Co-op

We will pay the indemnity amount for one generally medically recognized internal cancer screening test per covered person per calendar year.

Screening test include, but limited to: mammogram; breast ultrasound; breast thermography; breast cancer blood test (CA15-3); colon cancer blood test (CEA); prostate-specific antigen blood test (PSA); flexible sigmoidoscopy; colonoscopy; virtual colonoscopy; ovarian cancer blood test (CA-125); pap smear (lab test required); chest x-ray; hemocult stool specimen; serum protein electrophoresis (blood test for myeloma); thin prep pap test. Screening tests payable under this benefit will only be paid under this benefit. Benefits will only be paid for tests performed after the 30-day period following the covered person’s effective date of coverage.

Benefits will only be paid for a covered critical illness as shown on the policy/ certificate schedule page in the policy. No benefits will be provided for any loss caused by or resulting from: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; or alcoholism or drug addiction; or any act of war, declared or undeclared , or any act related to war; or military service for any country at war; or a pre-existing condition; or a covered critical illness when the date of diagnosis occurs during the waiting period; or 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 as defined by the law of the jurisdiction in which the activity takes place). Internal cancer does not include: other conditions that may be considered pre-cancerous or having malignant potential such as: acquired immune deficiency syndrome (AIDS); or actinic keratosis; or myelodysplastic and non-malignant myeloproliferative disorders; or aplastic anemia; or atypia; or non-malignant monoclonal gamopathy; or Leukoplakia; or Hyperplasia; or Carcinold; or Polycythemia; or carcinoma in situ or any skin cancer other than invasive malignant melanoma into the dermis or deeper. For a pre-existing condition no benefits are payable.

Hospital Intensive Care Unit Rider

No benefits will be provided during the first two years of this rider for hospital intensive care unit confinement caused by any heart condition when any heart condition was diagnosed or treated prior to the 30th day following the covered person’s effective date of this rider. The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date. No benefits will be provided if the loss results from: attempted suicide, whether sane or insane; or intentional self-injury; or alcoholism or drug addiction; or any act of war, declared or undeclared, or any act related to war; or military service for a country at war. No benefits will be paid for confinements in units such as surgical recovery rooms, progressive care, burn units, intermediate care, private monitored rooms, observation units, telemetry units or psychiatric units not involving intensive medical care; or other facilities which do not meet the standards for intensive care unit as defined in the rider. For a newborn child born within the tenmonth period following the effective date of this rider, no benefits will be provided for hospital intensive care unit confinement that begins within the first 30 days following the birth of such child.

GC3 Limited Benefit Group Cancer Indemnity Insurance Conditionally Renewable

This policy/certificate is conditionally renewable. This means that We have the right to terminate your policy/certificate on any premium due date after the first Policyholder’s Anniversary Date. We must give the Policyholder at least 60 days written notice prior to cancellation. We cannot cancel Your coverage because of a change in Your age or health.

We can change Your premiums if We change premiums for all similar Certificates issued to the Policyholder. We must give the Policyholder at least 60 days written notice before We change Your premiums.

Continuation Rider Continuation

Coverage is continued when the Insured (You) cease employment with the employer through whom You originally became insured under the Policy.

You will have the option to continue this Certificate (including any Riders, if applicable) by paying the premiums directly to Us at Our home office.

Premiums must be paid within thirty-one (31) days after employment with your employer terminates. Premium rates required under this Continuation provision will be the same rates as those charged under the Employer’s Policy as if You had continued employment. We will bill You for these premiums after You notify Us to continue this coverage. Coverage will continue until the earlier of: (1) the Policy under which You originally became insured ends; or (2) You stop paying premiums under this option (subject to the terms of the Grace Period).

Termination of Coverage

Your Insurance coverage will end on the earliest of these dates: (a) the date You no longer qualify as an Insured; (b) the last day of the period for which a premium has been paid, subject to the Grace Period; (c) the date the Policy terminates (See Conversion provision); (d) the date You retire; (e) the date You cease employment, or terminate Your contract with the employer through whom You originally became insured under the Policy (See Conversion provision); or (f) the date We receive Your written request for termination. Termination of Dependent(s) Insurance coverage on Your Dependent(s) will end on the earliest of these dates: (a) the date the coverage under the Certificate terminates; (b) the date the Dependent no longer meets the definition of Dependent, as defined in the Policy/Certificate (See Conversion provision); (c) the date We receive Your written request for termination.

Termination of Rider Coverage

This rider terminates: (a) when Your coverage terminates under the Policy/ Certificate to which this Rider is attached; or, (b) when any premium for this rider is not paid before the end of the Grace Period; or, (c) when You give Us a written request to do so. Coverage on a Dependent terminates under this rider when such person ceases to meet the definition of Dependent, as defined in the Policy.

Conversion

If the Employer’s Policy is terminated, this Certificate will terminate. Upon termination of the Employer’s Policy, the employee (You) will be entitled to convert to an individual policy of insurance issued by Us without evidence of insurability provided the required premiums have been paid on your behalf and You notified Us in writing within thirty-one (31) days of the Employer’s Policy termination. Premiums for the individual policy of insurance will be figured from the premium rate table in effect on the date of conversion.

Subject to the terms of this provision, a covered child who ceases to be eligible may convert to an individual policy of insurance and a covered spouse who ceases to be eligible for coverage because of divorce or annulment may convert to an individual policy.

Terms of this provision include: (1) Application for the individual policy and payment of the first premium must be made within 60 days after coverage ceases under the Policy/Certificate. Premiums will be figured from the premium rate table in effect on the date of conversion. (2) The individual policy will be issued without proof of insurability. It will provide benefits that most nearly approximates those of the Policy/Certificate.

(3) The individual policy will take effect the day after coverage ceases under the Policy/Certificate. However, no benefits will be payable under the individual policy for any loss for which benefits are payable under the Policy/Certificate. (4) The Pre-Existing Condition Limitation and Time Limit on Certain Defenses provisions for the individual policy will be figured from the Covered Person’s Effective Date of coverage under the Policy/ Certificate. (5) Any benefit maximums will be figured from the Effective Date of the Policy/Certificate.

This rider is subject to all the provisions of the Policy and Certificate to which it is attached that are not in conflict with this rider.

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 and riders.

This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC-3 Series | Texas | Limited Benefit Group Cancer Indemnity Insurance Policy | (11/14) | ESC Region 11 Benefits Co-op

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APSB-22356(TX) MGM/FBS ESC Region 11 Benefits Co-op

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 36 ESC Region 11 EBC Benefits Website: www.region11bc.com

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.

EVENT

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.

BENEFIT

Accident Hospital Care Surgery Open abdominal, thoracic Surgery exploratory or without repair 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 Coma Duration of 14 or more days Transportation per trip, up to 3 per accident Lodging Per day, up to 30 days Family care per child, up to 45 days Accident Care Initial doctor visit Urgent care facility treatment Emergency room treatment Ground ambulance Air ambulance Follow-up doctor treatment Chiropractic treatment up to 6 per accident Medical equipment Physical or occupational therapy up to six per accident Speech therapy up to 6 per accident Prosthetic device (one) Prosthetic device (two or more) Major diagnostic exam Outpatient surgery (one per accident) X-ray Common Injuries Burns second degree, at least 36% of the body Burns 3rd degree, at least 9 but less than 35 square inches of the body Burns 3rd degree, 35 or more square inches of the body Skin Grafts Emergency dental work Eye Injury removal of foreign object Eye Injury surgery Torn Knee Cartilage surgery with no repair or if cartilage is shaved Torn Knee Cartilage surgical repair Laceration1 treated no sutures Laceration1 sutures up to 2” Laceration1 sutures 2” – 6” Laceration1 sutures over 6” Ruptured Disk surgical repair

$1,200 $175 $600 $1,250 $375 $600 $200 $17,000 $750 $180 $25 90 225 225 360 1,500 90 45 $120 $45 $45 $750 $1,200 $240 $225 $45 $1,250 $7,500 $15,000 25% of the burn benefit $350 crown, $90 extraction $100 $350 $225 $800 $30 $60 $240 $480 37 $800

Accident BENEFIT

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 quadriplegia Paralysis paraplegia 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 – simple Except bones of face Skull – depressed Except bones of face Sternum Shoulder blade Chip fractures

$425 $825 $1,225 $225 $16,000 $24,000 Closed/open reduction2 $3,850/$7,700 $2,400/$4,800 $1,500/$3,000 $1,600/$3,200 $1,100/$2,200 $1,100/$2,200 $275/$550 $1,100/$2,200 $1,100/$2,200 $1,100/$2,200 25% of the closed reduction amount Closed/open reduction3 $3,000/$6,000 $2,500/$5,000 $1,800/$3,600 $1,800/$3,600 $1,800/$3,600 $2,100/$4,200 $1,800/$3,600 $240/$480 $3,360/$6,720 $1,440/$2,880 $3,200/$6,400 $400/$800 $1,200/$2,400 $600/$1,200 $1,500/$3,000 $1,440/$2,880 $1,440/$2,880 $400/$800 $1,400/$2,800 $3,000/$6,000 $360/$720 $1,800/$3,600 25% of the closed reduction amount

1 Laceration benefits are a total of all lacerations per accident.

2 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.

38

Accident 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



Benefit $100,000 $50,000 $25,000 $50,000 $20,000 $10,000 Benefit $28,000 $22,000 $22,000 $12,500

Loss of Two or more fingers or toes

$1,800

Loss of one finger or one toe

$1,250

How much does Accident Insurance cost?

All employees pay the same rate, no matter their age. See the chart below for the premium amounts. Rates shown are guaranteed until September 2020.

Monthly Rates (12 Pay Periods) Employee

Employee and Spouse

Employee and Children

Family

$12.20

$19.00

$19.90

$26.70

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.  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.  Spouse Accident Insurance: If you have coverage on yourself, you may enroll your spouse, as long as your spouse is not covered under your employer’s plan as an employee. Your spouse will be covered for the same Accident benefits as you are.  Your spouse will be covered for the same Accident benefits as you are.  Guaranteed issue: No medical questions or tests are required for coverage.  Children’s** Accident Insurance: If you have coverage on yourself, your natural children, stepchildren, adopted children or children for whom you are a legal guardian will also be covered under your employer’s plan, up to the age of 26.  Your children will be covered for the same Accident benefits as you are.  Guaranteed issue: No medical questions or tests are required for coverage.  One premium amount covers all of your eligible children.

If both you and your spouse are covered under your employer’s plan as an employee, then only one, but not both, may cover the same children for Accident Insurance. If the parent who is covering the children stops being insured as an employee, then the other parent may apply for children’s coverage.

**The definition of “child” may vary by state. Please contact your employer for more information.



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 self-inflicted 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.

39

UNUM 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

#1

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 40 ESC Region 11 EBC Benefits Website: www.region11bc.com

Life and AD&D Basic Group Term Life and AD&D All full time active employees working at least 17.5 hours each week are eligible for Basic Group Life and Accidental Death and Dismemberment (AD&D). Life and AD&D benefits reduce to 65% at age 70; and 50% at age 75.

Conversion Privilege: When an insured employee’s group coverage ends, employees and their dependents may convert their coverage to individual life policies without providing evidence of insurability.

See contract for additional plan and coverage details.

Option Based Per District

Coverage is equal to the following

Option 1

$10,000

Term Life and AD&D

Option 2

$30,000

Option 3

$40,000

Please read carefully the following description of your Unum Term Life and AD&D insurance plan.

Option 4

$50,000

Your Basic Group Term Life Insurance automatically includes: Life Planning Financial & Legal Resources: This personalized financial counseling service provides expert, objective financial counseling to survivors and terminally ill employees at no cost to you. This service is also extended to you upon the death or terminal illness of your covered spouse.

Work/Life Balance Employee Assistance Program: Work‐life balance is a comprehensive resource providing access to professional assistance for a wide range of personal and work‐ related issues.

Worldwide Emergency Travel Assistance Services: Whether your travel is for business or pleasure, our worldwide emergency travel assistance program is there to help you when an unexpected emergency occurs.

Waiver of Premium: Life insurance premiums will be waived for insured employees who become disabled prior to a specified age, and who remain disabled during an elimination period.

Accelerated Death Benefit: Pays a portion of the insured employee’s or dependent’s Life benefit in the event the insured employee or dependent becomes terminally ill and the employee’s or dependent’s life expectancy has been reduced to less than 12 months. The employee’s or dependent’s death benefit will be reduced by the Accelerated Life Benefit paid.

Portability Privilege: Allows an insured employee and their dependents to elect portable coverage at group rates, if the employee terminates employment, reduces hours or retires from the employer. Employees and their dependents are not eligible for portable coverage if they have an injury or sickness, under the terms of this plan, that has a material effect on life expectancy.

Eligibility All employees working at least 17.5 hours each week in active employment in the U.S. with the employer, and their eligible spouses and children to age 26.

Coverage Amounts Your Term Life coverage options are: Employee: Up to 7 times salary in increments of $10,000. Not to exceed $500,000.

Spouse*: Up to 100% of employee amount in increments of $10,000.

Not to exceed $500,000. Benefits will be paid to the employee.

Child*: Two options available.  Option 1: $5,000 or  Option 2: $10,000 Not to exceed 100% of employee amount, to a maximum of $10,000.

Your AD&D coverage options are: Employee: Up to 7 times salary in increments of $10,000. Not to exceed $500,000. You may purchase AD&D coverage for yourself regardless of whether you purchase Life coverage.

Employee and Family: Spouse*: 50% of employee amount, not to exceed $250,000.

Benefits will be paid to the employee.

Child*: 10% of employee amount, not to exceed $10,000. *Child age is 6 months to 26 years. The maximum death benefit for a child between the ages of live birth and 6 months is $1,000. Benefits will be paid to the employee. In order to purchase AD&D coverage for your spouse and/or child, you must purchase AD&D coverage for yourself.

41

Life and AD&D AD&D Benefit Schedule: The full benefit amount is paid for loss of:  Life  Both hands or both feet or sight of both eyes  One hand and one foot  One hand and the sight of one eye  One foot and the sight of one eye  Speech and hearing Other losses may be covered as well. Please see your Plan Administrator.

Coverage amount(s) will reduce according to the following schedule: Age: 70 75

Insurance Amount Reduces to: 65% of original amount 50% of original amount

Coverage may not be increased after a reduction.

Guarantee Issue Current Employees: If you and your eligible dependents enroll on or before the enrollment deadline, you may apply for any amount of Life insurance coverage up to $230,000 or 7x your salary for yourself and any amount of coverage up to $50,000 for your spouse. Any Life insurance coverage over the Guarantee Issue amount(s) will be subject to evidence of insurability. If you and your eligible dependents do not enroll on or before the enrollment deadline, you can apply for coverage only during an annual enrollment period and will be required to furnish evidence of insurability for the entire amount of Life insurance coverage. AD&D coverage does not require evidence of insurability.

If you and your eligible dependents enroll on or before the enrollment deadline, and later wish to increase your Life insurance coverage, you may increase your coverage with evidence of insurability at anytime during the year. However, you may wait until the next annual enrollment and only coverage over the Guarantee Issue amount(s) will be subject to evidence of insurability.

of insurability, at anytime during the year. However, you may wait until the next annual enrollment and only Life insurance coverage over the Guarantee Issue amount(s) will be subject to evidence of insurability.

Please see your Plan Administrator for your eligibility date.

How to Apply Current employees: To apply for coverage, complete your enrollment form by the enrollment deadline.

New Hires: To apply for coverage, complete your enrollment form within 31 days of your eligibility date.

All employees: If you apply for coverage after your effective date, or if you choose coverage over the guarantee issue amount, you will need to complete a medical questionnaire which you can get from your Plan Administrator. You may also be required to take certain medical tests at Unum’s expense.

Effective Date of Coverage Please see your Plan Administrator for your effective date.

Delayed Effective Date of Coverage Employee: 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.

Dependent: Insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Exception: infants are insured from live birth.

“Totally disabled” means that, as a result of an injury, a sickness or a disorder, your dependent is confined in a hospital or similar institution; is unable to perform two or more activities of daily living (ADLs) because of a physical or mental incapacity resulting from an injury or a sickness; is cognitively impaired; or has a life threatening condition.

Changes to Coverage

New Hires: If you and your eligible dependents enroll within 31 days of your eligibility date, you may apply for any amount of Life insurance coverage up to $230,000 for yourself and any amount of coverage up to $50,000 for your spouse. Any Life insurance coverage over the Guarantee Issue amount(s) will be subject to evidence of insurability. If you and your eligible dependents do not enroll within 31 days of your eligibility date, you can apply for coverage only during an annual enrollment period and will be required to furnish evidence of insurability for the entire amount of coverage. AD&D coverage does not require evidence of insurability.

Each year you and your spouse will be given the opportunity to change your Life coverage and AD&D coverage. You and your spouse may purchase additional Life coverage up to the Guarantee Issue amounts without evidence of insurability if you are already enrolled in the plan. Life coverage over the Guarantee Issue amounts will be medically underwritten and will require evidence of insurability and approval by Unum’s Medical Underwriters. The suicide exclusion will apply to any increase in coverage. AD&D coverage does not require evidence of insurability for increase amounts.

If you and your eligible dependents enroll within 31 days of your eligibility date, and later, wish to increase your coverage, you may increase your Life insurance coverage, with evidence

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

42

Questions

Life and AD&D Monthly Payroll Deduction EMPLOYEE $10,000

$20,000

$30,000

$40,000

$50,000

$70,000

$100,000

$130,000

$150,000

$0.45 $0.45 $0.60 $0.70 $0.80 $1.20 $2.00 $3.30 $5.10 $9.50 $15.50 $20.60

$0.90 $0.90 $1.20 $1.40 $1.60 $2.40 $4.00 $6.60 $10.20 $19.00 $31.00 $41.20

$1.35 $1.35 $1.80 $2.10 $2.40 $3.60 $6.00 $9.90 $15.30 $28.50 $46.50 $61.80

$1.80 $1.80 $2.40 $2.80 $3.20 $4.80 $8.00 $13.20 $20.40 $38.00 $62.00 $82.40

$2.25 $2.25 $3.00 $3.50 $4.00 $6.00 $10.00 $16.50 $25.50 $47.50 $77.50 $103.00

$3.15 $3.15 $4.20 $4.90 $5.60 $8.40 $14.00 $23.10 $35.70 $66.50 $108.50 $144.20

$4.50 $4.50 $6.00 $7.00 $8.00 $12.00 $20.00 $33.00 $51.00 $95.00 $155.00 $206.00

$5.85 $5.85 $7.80 $9.10 $10.40 $15.60 $26.00 $42.90 $66.30 $123.50 $201.50 $267.80

$6.75 $6.75 $9.00 $10.50 $12.00 $18.00 $30.00 $49.50 $76.50 $142.50 $232.50 $309.00

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

$230,000 IS THE MAXIMUM THAT MAY BE ISSUED WITHOUT ANSWERING HEALTH QUESTIONS.

EMPLOYEE ONLY ACCIDENTAL DEATH & DISMEMBERMENT RATES 0-79+

$0.40

$0.80

$1.20

$1.60

$2.00

$10,000

$20,000

$30,000

$40,000

$0.45 $0.45 $0.60 $0.70 $0.80 $1.20 $2.00 $3.30 $5.10 $9.50 $15.50 $20.60

$0.90 $0.90 $1.20 $1.40 $1.60 $2.40 $4.00 $6.60 $10.20 $19.00 $31.00 $41.20

$1.35 $1.35 $1.80 $2.10 $2.40 $3.60 $6.00 $9.90 $15.30 $28.50 $46.50 $61.80

$1.80 $1.80 $2.40 $2.80 $3.20 $4.80 $8.00 $13.20 $20.40 $38.00 $62.00 $82.40

$2.80

$4.00

$5.20

$6.00

$50,000

$70,000

$100,000

$130,000

$150,000

$2.25 $2.25 $3.00 $3.50 $4.00 $6.00 $10.00 $16.50 $25.50 $47.50 $77.50 $103.00

$3.15 $3.15 $4.20 $4.90 $5.60 $8.40 $14.00 $23.10 $35.70 $66.50 $108.50 $144.20

$4.50 $4.50 $6.00 $7.00 $8.00 $12.00 $20.00 $33.00 $51.00 $95.00 $155.00 $206.00

$5.85 $5.85 $7.80 $9.10 $10.40 $15.60 $26.00 $42.90 $66.30 $123.50 $201.50 $267.80

$6.75 $6.75 $9.00 $10.50 $12.00 $18.00 $30.00 $49.50 $76.50 $142.50 $232.50 $309.00

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

$50,000 IS THE MAXIMUM THAT MAY BE ISSUED WITHOUT ANSWERING HEALTH QUESTIONS.

CHILD(REN)* $5,000

$10,000

$0.90

$1.80

*NOTE: The premium paid for child coverage is based on the cost of coverage for one child, regardless of how many children you have.

FAMILY ACCIDENTAL DEATH & DISMEMBERMENT RATES $10,000

$20,000

$30,000

$40,000

$50,000

$70,000

$100,000

$130,000

$150,000

$0.70

$1.40

$2.10

$2.80

$3.50

$4.90

$7.00

$9.10

$10.50

NOTE: FINAL RATES MAY VARY SLIGHTLY DUE TO ROUNDING. THESE GRIDS ARE PRICES OF FREQUENTLY SELECTED AMOUNTS. YOU MAY CHOOSE ANY INCREMENT OF $10,000 UP TO $500,000 (NOT TO EXCEED 5 TIMES YOUR ANNUAL SALARY). TO PURCHASE AN AMOUNT OTHER THAN THOSE LEVELS INDICATED ABOVE, SIMPLY COMPLETE THE FOLLOWING. x # of 10,000 units

= Your age cost per 10,000 unit

MONTHLY COST

* AGE = AGE ON POLICY ANNIVERSARY 43

ID WATCHDOG

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 44 ESC Region 11 EBC Benefits Website: www.region11bc.com

Identity Theft Identity theft can strike anyone, at any time.

How ID Theft Protection Helps You

More than 11 million Americans were victimized by identity theft in 2011, including more than 500,000 children.

Identity theft devastates its victims financially.

 Monitor for signs of fraud across credit cards, bank accounts, loans, billions of public records, the Dark Web, and more.  Take immediate action by receiving alerts you customize.  Up to $1 million Identity Theft Insurance that helps pay certain out-of-pocket expenses in the event you are a victim of identity theft.

ID Watchdog Services

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

Repairing the damage caused by identity theft is frustrating and time consuming.

The average victim spends 330 hours repairing the damage from identity theft—the equivalent of working a full-time job for more than 2 months.

The impact of identity theft follows victims for years.

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

Who’s Evaluating your Credit Report?

      

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

ID Watchdog Monthly Rates 1B Plan

Platinum

Individual Plan

$7.95

$11.95

Family Plan

$14.95

$22.95

Potential Creditors, Potential Employers, Insurance Companies, Current Creditors, Government Agencies

Features Available in All our Products: Credit Services  Credit Monitoring  Credit Report and Scores  Credit Score Tracker  Credit Freeze Assistance  Fraud Alert Assistance & Expiration Reminders  Credit Score Simulator Identity Monitoring  Advanced Identity Monitoring  Dark Web Monitoring  Subprime Loan Monitoring  High-Risk Application & Transaction Monitoring

Advanced Tools  Threshold Monitoring  Mobile App  Registered Sex Offender Reporting & Notifications  Social Network Alerts  National Provider Identifiers (NPI) Alerts  Lost Wallet Vault & Replacement  Solicitation Reduction Customer Care  Case Management & Resolution  Identity Theft Insurance  Highly Trained Staff  24/7 U.S. Based Customer Care Center

45

NOTES

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NOTES

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