2018 Benefit Guide Friendswood ISD by Higginbotham Public Sector

FRIENDSWOOD ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2018 - 8/31/2019 WWW.MYBENEFITSHUB.COM/ FRIENDSWOODISD

Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. HSA vs FSA Comparison TRS ActiveCare NBS Health Savings Account NBS Flexible Spending Account APL MEDLINKtm Cigna Dental METLIFE Vision Lincoln Financial Short-Term Disability Lincoln Financial Long-Term Disability APL Cancer UNUM Critical Illness OneAmerica Life and AD&D 5Star FPP TI with Quality of Life Rider The Hartford Accident MASA Medical Transport 2

3 4-5 6-11 6 7 8 9 10 11 12-13 14-15 16-19 20-27 28-33 34-35 36-39 40-43 44-47 48-49 50-53 54-57 58-6162-63

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

PG. 6 SUMMARY PAGES

PG. 12 YOUR BENEFITS

Benefit Contact Information

Benefit Contact Information BENEFIT ADMINISTRATORS

VISION

FAMILY PROTECTION PLAN â&#x20AC;&#x201C; TERM LIFE WITH QUALITY OF LIFE RIDER

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

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

5Star Life Insurance Company (866) 863-9753 www.5starlifeinsurance.com

FRIENDSWOOD ISD ADMINISTRATOR SHORT & LONG TERM DISABILITY

MEDICAL TRANSPORT

Tara Langston (281) 996-6605 tlangston@fisdk12.net

Lincoln Financial Group (800) 423-2765 www.lincolnfinancial.com

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

HEALTH SAVINGS ACCOUNT (HSA)

CANCER

ACCIDENT

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

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

The Hartford (877) 248-5077 www.thehartfordatwork.com

FLEXIBLE SPENDING ACCOUNT (FSA) CRITICAL ILLNESS

MEDLINK

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

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

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

DENTAL

LIFE AND AD&D

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

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

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

Benefit Information



Online Support



Interactive Tools



And more. PLAY VIDEO

Text “FBS FRNDSWD” to 313131 OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/ friendswoodisd

CLICK LOGIN

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

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

ONLINE SUPPORT

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

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

Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New:  Financial Benefit Services (FBS) is the new Third Party Administrator for Friendswood ISD. FBS conducts the annual enrollment and provides benefit support for Friendswood ISD employees. Benefits and insurance providers have been selected by the district to provide the best in insurance coverage at affordable rates for you as an employee of Friendswood ISD.

 Benefit elections will become effective 9/1/2018. Elections

www.mybenefitshub.com/friendswoodisd. FISD offers a 60 day grace period.

 NEW MASA- MASA provides medical emergency transportation solutions and covers your out-of-pocket medical transport cost when your insurance falls short. You will have zero out of pocket expenses for any emergent air or ground transport from anywhere in the U.S., regardless who transports you.

requiring evidence of insurability, such as Life Insurance, may have a later effective date, if approved. After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 31 days of event).

 A Health Savings Account with National Benefit Services is a tax-free savings account available for those employees enrolled in ActiveCare 1 HD. These funds can be used to pay for medical, dental, vision or prescription expenses. The HSA annual contribution maximum is $3,450 for individuals and $6,900 for your family. For individuals who are between 5565, there is an additional catch-up provision of $1,000 that can be contributed annually.

 National Benefit Services is the FSA Administrator for Friendswood ISD. The 2018 FSA contribution limit is $2650. If you currently participate or are enrolling for the first time in an FSA or a Dependent Care FSA with Friendswood ISD, you will receive new debit cards with the new provider, National Benefit Services in September. Remember, you must re-elect a new contribution amount every year to continue to participate. You can manually submit claims prior to receiving your cards. Find the claim form on the benefits website at

Don’t Forget!  Login and complete your benefit enrollment from 07/23/2018 - 08/17/2018  Add dependents to the system—please bring dependent Social Security numbers and birth dates.

SUMMARY PAGES

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

CHANGES IN STATUS (CIS): Marital Status

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

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

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

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

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

SUMMARY PAGES

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

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your benefit

Changes are not permitted during the plan year (outside of

website:

annual enrollment) unless a Section 125 qualifying event occurs.

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



Changes, additions or drops may be made only during the

can find the forms you need under the Benefits and Forms

annual enrollment period without a qualifying event.

section.

 Employees must review their personal information and verify

How can I find a Network Provider?

that dependents they wish to provide coverage for are

For benefit summaries and claim forms, go to the

included in the dependent profile. Additionally, you must

Friendswood ISD benefit website: www.mybenefitshub.com/

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

friendswoodisd. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.



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.

When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the

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.

insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card.

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 18.75 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 Friendswood ISD as both

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

employees and dependents.

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

CARRIER

MAXIMUM AGE

Medical

Aetna

Through 25

Dental

Cigna

Through 25

Vision

Superior Vision

Through 25

Life

One America

Through 25

Cancer

American Public Life

Through 25

Critical Illness

UNUM

Through 25

AD&D

One America

Through 25

Permanent Life

5 Star

Through 24

If your dependent is disabled, coverage can continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physicianâ&#x20AC;&#x2122;s statement confirming your dependentâ&#x20AC;&#x2122;s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 9

SUMMARY PAGES

Helpful Definitions Actively at Work

In-Network

You are performing your regular occupation for the employer

Doctors, hospitals, optometrists, dentists and other providers

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

who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2018 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 will pay in co-insurance for covered expenses.

Plan Year September 1st through August 31st

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

Calendar Year January 1st through December 31st

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

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

(including diagnostic and/or consultation services).

SUMMARY PAGES

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

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

Approved by Congress in 2003, HSAs are actual bank accounts in employeeâ&#x20AC;&#x2122;s names that allow employees to save and pay for unreimbursed qualified medical expenses tax-free.

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source Account Owner Underlying Insurance Requirement

Employee and/or employer Individual

Employee and/or employer Employer

High deductible health plan

None

Description

Minimum Deductible Maximum Contribution

Permissible Use Of Funds

$1,300 single (2018) $2,600 family (2018) $3,450 single (2018) $6,900 family (2018) May be used for qualified medical, dental, and vision expenses. If used for nonqualified medical expenses, subject to current tax rate plus 20% penalty.

N/A $2,650 Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC).

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

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

Year-to-year rollover of account balance?

Yes, will roll over to use for subsequent yearâ&#x20AC;&#x2122;s health coverage.

Does the account earn interest?

Yes

Portable?

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

FLIP TO FOR HSA INFORMATION

PG. 14

Not permitted

No. Access to some funds may be extended if your employer's plan contains a 60 day grace period.

FLIP TO FOR FSA INFORMATION

PG. 16

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

Deductible (per plan year) In-Network Out-of-Network Out-of-Pocket Maximum (per plan year; medical and prescription drug deductibles, copays, and coinsurance count toward the out-of-pocket maximum) In-Network Out-of-Network Coinsurance In-Network Participant pays (after deductible) Out-of-Network Participant pays (after deductible) Office Visit Copay Participant pays Diagnostic Lab Participant pays Preventive Care See below for examples Teladoc® Physician Services

High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays Inpatient Hospital (preauthorization required) (facility charges) Participant pays Freestanding Emergency Room Participant pays

$500 copay per visit plus 20% after deductible

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

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

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

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

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

$45 for a 60- to 90-day supply

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

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

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

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

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

When does the convenience fee apply? For example, if you are covered under TRS-ActiveCare Select, the first time you fill a 31-day supply of a generic maintenance drug at a retail pharmacy you will pay $20, then you will pay $35 each month that you fill a 31-day supply of that generic maintenance drug at a retail pharmacy. A 90-day supply of that same generic maintenance medication would cost $45, and you would save $225 over the year by filling a 90-day supply. A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. 1 Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. 2 For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,750 - individual, $5,500 - family) and they pay nothing out of pocket for these drugs. Find the list of drugs at info.caremark.com/trsactivecare. 3 If a participant obtains a brand-name drug when a generic equivalent is available, they are responsible for the generic copay plus the cost difference between the brand-name drug and the generic drug. 4 If the cost of the drug is less than the minimum, you will pay the cost of the drug. 5 Participants can fill 32-day to 90-day supply through mail order.

Full monthly premium*

Premium with min. state/ district contribution**

$367

+Spouse +Children +Family

Individual

Your Monthly Premium***

Full monthly premium*

Premium with min. state/ district contribution**

$142

$540

$1,035

$810

$701

$476

$1,374

$1,149

Your Monthly Premium***

Full monthly premium*

Premium with min. state/ district contribution**

$315

$782

$557

$1,327

$1,102

$1,855

$1,630

$876

$651

$1,163

$938

$1,668

$1,443

$2,194

$1,969

Your Monthly Premium***

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

NBS

HSA (Health Savings Account)

YOUR BENEFITS PACKAGE

PLAY VIDEO

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

The interest earned in an HSA is tax free.

Money withdrawn for medical spending never falls under taxable income.

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

HSA (Health Savings Account) You can use your Health Savings Account (HSA) to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.

What is an HSA? 

 



A tax-advantaged savings account that you use to pay for eligible medical expenses as well as deductible, co-insurance, prescriptions, vision and dental care. Allows you to save while reducing your taxable income. Unused funds that will roll over year to year. There’s no “use it or lose it” penalty. Potential to build more savings through investing. If you maintain a minimum balance of $2,000, your additional funds may be invested in mutual funds yielding tax‐free earnings. A way to accumulate additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty.

Using Funds Pre-paid Debit Card: You may use the card to pay merchants or service providers that accept Master Card credit cards, so there is no need to pay cash up front and wait for reimbursements.

2018 Annual HSA Contribution Limits Individual: $3,450 Family: $6,900 Catch-Up Contributions: Account holders over the age of 55 who have not yet enrolled in Medicare are eligible to make an additional $1,000 “catch‐up” contribution to their HSA.

Participant Account Web Access www.nbsbenefits.com A Health Savings Account (HSA) works with a high deductible health plan (HDHP) and lets you set aside a portion of your paycheck ‐ before taxes– into an account to help you pay for medical expenses before you reach your deductible or that you aren’t covered by your plan. It can also help you pay for future medical expenses.

A Health Savings Account (HSA):  

Grows with you. If you maintain a balance of $2,000, your additional funds may be invested in mutual funds yielding tax‐free earnings. Helps you plan for the future. Until you turn 65, withdrawals used for eligible expenses are tax free. After you turn 65, or if you become disabled, your HSA account becomes similar to a regular IRA. Withdrawals you use for non-eligible expenses will be taxed at your regular income tax rate but won’t incur additional penalties.

For a list of sample expenses, please refer to the Friendswood ISD benefit website at www.mybenefitshub.com/ friendswoodisd

NBS Contact Information P.O. Box 6980 West Jordan, UT 84084 Phone‐800‐274‐0503 Fax‐800‐478‐1528 Email: service@nbsbenefits.com

Will my HSA Funds be up fronted to me? Like a savings account, you can only withdrawal what you’ve contributed to the account. Funds are not up fronted. Are there any monthly fees? No, there are no monthly fees.

NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

PLAY VIDEO

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

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 16 Friendswood ISD Benefits Website: www.mybenefitshub.com/friendswoodisd

FSA (Flexible Spending Account) NBS Flexcard

When Will I Receive My Flex Card?

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

NBS Prepaid MasterCard® Debit Card

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

Expect Flex Cards to be delivered to the address listed in THEbenefitsHUB mid-September. Don’t forget, Flex Cards Are Good For 3 Years! For a list of sample expenses, please refer to the Friendswood ISD benefit website: www.mybenefitshub.com/friendswoodisd

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

New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in unmarked envelopes so please watch for them as they should arrive within 21 business days of effective date. NBS debit cards are good for 3 years.

FSA Annual Contribution Max:

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

$2,650

Dependent Care Annual Max: $5,000

Account Information: Participant Account Web Access: www.participant.nbsbenefits.com Participants may call NBS and talk to a representative during regular business hours, Monday-Friday, 8 am to 7 pm Central Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to the NBS website: www.NBSbenefits.com    

Detailed claim history and processing status Health Care and Dependent Care Account balances Claim forms, direct deposit form, worksheets, etc. Online claim FAQs 17

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

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

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

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

        

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

Dependent Care Expense Account Example Expenses:    

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

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

What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)? Eligible expenses must be incurred within the plan year +60 day grace period. Remember to retain all your receipts (including receipts for card swipes).

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

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

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

Get Your Money 1. 2. 3. 4.

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

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

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

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

AMERICAN PUBLIC LIFE YOUR BENEFITS PACKAGE

MEDlinkÂŽ

PLAY VIDEO

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

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

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

MEDlink® 6 Supplemental Limited Benefit Group

Medical Expense Insurance Friendswood ISD

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

High Option Summary of Benefits for Separate In-Hospital Benefit and Outpatient Rider In-Hospital Benefit In-Hospital Benefit Maximum

$2,500 per covered person per confinement

In-Hospital Benefit

Benefits include in-hospital confinement, ambulance and in-hospital treatment for a serious mental illness (subject to a maximum of 45 days of a serious mental illness treatment per covered person per calendar year). All benefits are subject to the in-hospital benefit maximum

Outpatient Rider Outpatient Benefit Maximum

$500 per covered person per occurrence for covered outpatient services.

Outpatient Benefits

Covered outpatient services include hospital emergency room, urgent care facility, surgery in a hospital outpatient facility or freestanding outpatient surgery center, diagnostic testing in a hospital outpatient facility or MRI facility, physical therapy facility, ambulance and outpatient treatment for a serious mental illness (subject to a maximum of 60 days of a serious mental illness treatment per covered person per calendar year.) All benefits are subject to the outpatient benefit maximum.

Additional Outpatient Riders Office Visit Fee Rider

Physician Office Visit Fee: $25 per visit; Specialist Office Visit Fee: $50 per visit. Maximum of four visits per covered person per calendar year and eight visits per calendar year for all covered persons combined for any combination of physician or specialist visits. All benefits are subject to the outpatient benefit maximum.

Office Treatment Rider

All benefits are subject to the outpatient benefit maximum

Cancer Outpatient Treatment Rider

All benefits are subject to the outpatient benefit maximum

Independent Lab Facility Rider

All benefits are subject to the outpatient benefit maximum

Durable Medical Equipment Rider

All benefits are subject to the outpatient benefit maximum

Amendment Riders Dependent Child Maternity Amendment Rider

Included

Total Monthly Premiums* Ages

Employee

Employee & Spouse

Employee & Child(ren)

Employee & Family

18-54

$38.25

$68.87

$78.83

$109.42

55+

$57.40

$103.31

$97.94

$143.87

*Total premium includes the Plan selected and any applicable rider premium. The premium and amount of benefits vary dependent upon the Plan selected at time of application.

APSB-22470(TX)-0118 FBS

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MEDlink® 6 Supplemental Limited Benefit Group Medical Expense Insurance In-Hospital Benefit

The covered person must be covered by the other medical plan at the time any In-Hospital covered charges are incurred. The in-hospital benefit pays the out-of-pocket amount for inpatient covered charges incurred by a covered person for treatment while confined in a hospital as an inpatient. A hospital is not an institution, or part thereof, used as: a place for rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a long-term nursing unit or geriatrics ward, or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients. The ambulance benefit pays the out-of-pocket amount for air or ground transportation of a covered person by ambulance to a hospital or from one medical facility to another where a covered person is confined as an inpatient. A licensed ambulance company must provide the ambulance service.

Exclusions

No benefits will be payable for expenses incurred during any period the covered person does not have coverage under your Employer’s Medical Plan. If a claim is received after coverage under the Insured’s Employer’s Medical Plan has terminated, APL’s liability will be limited to a refund of any premium paid since coverage terminated. No benefits are payable for expenses incurred resulting from or caused by, whether directly or indirectly, by: war or any act of war, whether declared or undeclared, or any act related to war while serving in the military forces or any auxiliary unit thereto, (APL will refund the pro-rata portion of any premium paid for any such covered person upon receipt of your written request.); an intentionally self-inflicted injury or sickness; outpatient routine newborn care; rest care or rehabilitative care and treatment; voluntary abortion except, with respect to you or your covered eligible dependent: where you or your dependent’s life would be endangered if the fetus were carried to term or where medical complications have arisen from abortion; participating in a riot, insurrection, rebellion, civil commotion, civil disobedience or unlawful assembly (This does not include a loss which occurs while acting in a lawful manner within the scope of authority.); committing, or attempting to commit, an illegal act that is defined as a felony (Felony is as defined by the law of the jurisdiction in which the act takes place.); participation in a contest of speed in power driven vehicles, parachuting or hang gliding; air travel, except: as a fare-paying passenger on a commercial airline on a regularly scheduled route or as a passenger for transportation only and not as a pilot or crew member; being intoxicated or under the influence of any narcotic unless administered on the advice of a physician (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the event that caused the loss occurred.); alcoholism or drug addiction; sex changes; experimental treatment, drugs or surgery; 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.); dental or vision services, including treatment, surgery, extractions or x-rays, unless 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 due to congenital disease or anomaly of a covered newborn child; elective cosmetic surgery (except newborn circumcision); drugs (prescription and non-prescription for use outside of a covered facility as defined in this policy/certificate or any attached rider); sterilization and reversal of sterilization; an expense that does not meet the definition of inpatient covered charge or outpatient covered charges; an expense or service that exceeds any of the maximum benefits, as shown in the schedule of benefits in the policy/certificate; any expense for which benefits are not payable under the other medical plan.

Non-Duplication of Benefits

Duplication of benefits is not allowed under the policy and/or any attached riders. If a covered charge is payable under more than one benefit, only one benefit, the largest, will be payable.

Premium Changes

The premium rates may be changed by APL at the first anniversary date of the policy or any premium due date thereafter.

Optionally Renewable

The policy is renewable at the option of APL. The policyholder or APL may terminate this policy on any premium due date after the first anniversary following the policy effective date, subject to 60 days notice.

Termination of Certificate

Insurance coverage under the certificate, including any attached riders, will end on the earliest of these dates: the date the policy terminates; the end of the grace period if the premium remains unpaid; the date you no longer qualify as an insured; the date your coverage under the other medical plan ends; or the date of your death.

Termination of Coverage

Insurance coverage under the certificate and/or any attached riders for a covered person will end as follows: the date the policy terminates; the date the certificate terminates; the end of the grace period if the premium remains unpaid; the end of the certificate month in which we receive a written request from you to terminate the covered person’s coverage; the date a covered person no longer qualifies as an insured or eligible dependent; or the date of the covered person’s death. APL may end the coverage of any covered person who submits a fraudulent claim.

COBRA Continuation of Coverage

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

Benefit Riders

All riders are part of the policy/certificate to which it is attached and are subject to all the provisions of the policy/certificate that are not in conflict with the provisions of the rider.

APSB-22470(TX)-0118 FBS 22

Page 2 of 3

MEDlink® 6 Supplemental Limited Benefit Group Medical Expense Insurance Outpatient Rider

Pays the out-of-pocket amount for outpatient covered charges. The covered person must be covered by the other medical plan at the time any covered charges are incurred. The outpatient benefit per occurrence means treatment for the same or related condition, unless separated by a period of 90 days. Treatment for the same or related condition separated by 90 days, or an unrelated condition will be considered a new per occurrence. The ambulance benefit pays the out-of-pocket amount for air or ground transportation of a covered person by ambulance to a hospital or from one medical facility to another where a covered person resides less than 18 hours. A licensed ambulance company must provide the ambulance service.

Additional Outpatient Riders

For all Additional Outpatient Riders, the covered person must be covered by the other medical plan at the time any covered charges are incurred.

Office Visit Fee Rider

Pays the out-of-pocket amount, up to the benefit elected, for the physician’s office visit fee charged by a physician or specialist in the physician’s office. This benefit is only payable if billed separately from the treatment and is not subject to the certificate deductible.

Office Treatment Rider

Pays the out-of-pocket amount for physician covered charges. This rider does not pay any benefit for the physician’s office visit fee charged by a physician or specialist in a physician’s office.

Cancer Outpatient Treatment Rider

Pays the out-of-pocket amount for cancer treatment performed in a cancer treatment facility.

Independent Lab Facility Rider

Pays the out-of-pocket amount for diagnostic testing in an independent lab facility.

Durable Medical Equipment Rider

Pays the out-of-pocket amount incurred for durable medical equipment when recommended by a physician and covered by the other medical plan.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 Underwritten by American Public Life Insurance Company. All Riders are subject to all the Provisions, Conditions, Limitations and Exclusions of the Policy/Certificate to which it is attached, which are not in conflict with those of the Rider. | For complete benefits and other provisions, please refer to the policy/certificate/rider. 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® 6 Series | TX | Supplemental Limited Benefit Group Medical Expense Insurance | 01/18 | FBS | Friendswood ISD

APSB-22470(TX)-0118 FBS

23 Page 3 of 3

MEDlink® 6 Supplemental Limited Benefit Group

Medical Expense Insurance Friendswood ISD

Low Option Summary of Benefits for Separate In-Hospital Benefit and Outpatient Rider In-Hospital Benefit In-Hospital Benefit Maximum

$1,500 per covered person per confinement

In-Hospital Benefit

Outpatient Rider Outpatient Benefit Maximum

$500 per covered person per occurrence for covered outpatient services.

Outpatient Benefits

Additional Outpatient Riders Office Visit Fee Rider

Office Treatment Rider

All benefits are subject to the outpatient benefit maximum

Cancer Outpatient Treatment Rider

All benefits are subject to the outpatient benefit maximum

Independent Lab Facility Rider

All benefits are subject to the outpatient benefit maximum

Durable Medical Equipment Rider

All benefits are subject to the outpatient benefit maximum

Amendment Riders Dependent Child Maternity Amendment Rider

Included

Total Monthly Premiums* Ages

Employee

Employee & Spouse

Employee & Child(ren)

Employee & Family

18-54

$32.47

$58.46

$66.91

$92.88

55+

$48.72

$87.69

$83.13

$122.12

*Total premium includes the Plan selected and any applicable rider premium. The premium and amount of benefits vary dependent upon the Plan selected at time of application.

24 APSB-22470(TX)-0118 FBS

Page 1 of 3

MEDlink® 6 Supplemental Limited Benefit Group Medical Expense Insurance In-Hospital Benefit

Exclusions

Non-Duplication of Benefits

Duplication of benefits is not allowed under the policy and/or any attached riders. If a covered charge is payable under more than one benefit, only one benefit, the largest, will be payable.

Premium Changes

The premium rates may be changed by APL at the first anniversary date of the policy or any premium due date thereafter.

Optionally Renewable

Termination of Certificate

Termination of Coverage

COBRA Continuation of Coverage

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

Benefit Riders

All riders are part of the policy/certificate to which it is attached and are subject to all the provisions of the policy/certificate that are not in conflict with the provisions of the rider.

APSB-22470(TX)-0118 FBS

25 Page 2 of 3

MEDlink® 6 Supplemental Limited Benefit Group Medical Expense Insurance Outpatient Rider

Additional Outpatient Riders

For all Additional Outpatient Riders, the covered person must be covered by the other medical plan at the time any covered charges are incurred.

Office Visit Fee Rider

Office Treatment Rider

Pays the out-of-pocket amount for physician covered charges. This rider does not pay any benefit for the physician’s office visit fee charged by a physician or specialist in a physician’s office.

Cancer Outpatient Treatment Rider

Pays the out-of-pocket amount for cancer treatment performed in a cancer treatment facility.

Independent Lab Facility Rider

Pays the out-of-pocket amount for diagnostic testing in an independent lab facility.

Durable Medical Equipment Rider

Pays the out-of-pocket amount incurred for durable medical equipment when recommended by a physician and covered by the other medical plan.

26 APSB-22470(TX)-0118 FBS

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MEDlink® IV

CIGNA

Dental

YOUR BENEFITS PACKAGE

PLAY VIDEO

About this Benefit Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, treatment and dental disease.

Good dental care may improve your overall health. Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 28 Friendswood ISD Benefits Website: www.mybenefitshub.com/friendswoodisd

Dental PPO - High Plan Monthly PPO Premiums Tier

Rate

EE Only

$29.55

EE + Spouse

$57.23

EE + Child(ren)

$60.09

Family Coverage

$88.71

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. Thatâ&#x20AC;&#x2122;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.

Cigna Dental Choice Plan Network Options Reimbursement Levels

In-Network: Total Cigna DPPO Network

Out-of-Network: See Non-Network Reimbursement

Based on Contracted Fees

Maximum Reimbursable Charge

$1250

$50 Unlimited

Policy Year Benefits Maximum Applies to: Class I, II, and III expenses

Policy Year Deductible Individual Family

Benefit Highlights

Plan Pays

You Pay

Plan Pays

You Pay

100% No Deductible

No Charge

100% No Deductible

No Charge

80% After Deductible

20% After Deductible

80% After Deductible

20% After Deductible

50% After Deductible

50% No Deductible

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

Class II: Basic Restorative Restorative: fillings Oral Surgery: Simple Extraction Emergency Care to Relieve Pain X-rays: non-routine

Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Oral Surgery: all except simple extraction Periodontics: minor and major Endodontics: minor and major Denture Relines, Rebases and Adjustments Repairs: Bridges, Crowns and Inlays Repairs: Dentures Anesthesia: general and IV sedation

Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000

Dental PPO - Base Plan Monthly PPO Premiums Tier

Rate

EE Only

$25.46

EE + Spouse

$49.31

EE + Child(ren)

$51.77

Family Coverage

$76.43

Cigna Dental Choice Plan Network Options Reimbursement Levels

In-Network: Total Cigna DPPO Network

Out-of-Network: See Non-Network Reimbursement

Based on Contracted Fees

Maximum Reimbursable Charge

$750

$50 Unlimited

Policy Year Benefits Maximum Applies to: Class I, II, and III expenses

Policy Year Deductible Individual Family

Benefit Highlights

Plan Pays

You Pay

Plan Pays

You Pay

100% No Deductible

No Charge

100% No Deductible

No Charge

70% After Deductible

30% After Deductible

70% After Deductible

30% After Deductible

50% After Deductible

Class I: Diagnostic & Preventive Oral Evaluations Prophylaxis: routine cleanings X-rays: routine Fluoride Application Sealants: per tooth Space Maintainers: nonorthodontic

Class II: Basic Restorative Restorative: fillings Oral Surgery: Simple Extraction Emergency Care to Relieve Pain X-rays: non-routine

6 Month Waiting Period on all Class III Services Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Oral Surgery: all except simple extraction Periodontics: minor and major Endodontics: minor and major Denture Relines, Rebases and Adjustments Repairs: Bridges, Crowns and Inlays Repairs: Dentures Anesthesia: general and IV sedation

50% After Deductible

Dental PPO - High and Base Plans Benefit Plan Provisions In-Network Reimbursement Non-Network Reimbursement Cross Accumulation

For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule. For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge. The MRC is calculated at the 90th percentile of all provider charges in the geographic area. The dentist may balance bill up to their usual fees. All deductibles, plan maximums, and service specific maximums cross accumulate between in-network and out-of-network. Benefit frequency limitations are based on the date of service and cross accumulate between in and out of network.

Policy Year Benefits Maximum

The plan will only pay for covered charges up to the yearly Benefits Maximum, when applicable. Benefit-specific Maximums may also apply.

Policy Year Deductible

This is the amount you must pay before the plan begins to pay for covered charges, when applicable. Benefit-specific deductibles may also apply. Payment will be reduced by 50% for Class III and IV services for 12 months for eligible members that are allowed to enroll in this plan outside of the designated open enrollment period. This provision does not apply to new hires. Pretreatment review is available on a voluntary basis when dental work in excess of $200 is proposed. When more than one covered Dental Service could provide suitable treatment based on Common dental standards, Cigna will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses. Cigna Dental Oral Health Integration Program offers enhanced dental coverage for customers with the following medical conditions: diabetes, heart disease, stroke, maternity, head and neck cancer radiation, organ transplants and chronic kidney disease. Thereâ&#x20AC;&#x2122;s no additional charge for the program â&#x20AC;&#x201C; those who qualify get reimbursed 100% of coinsurance for certain related dental procedures. Eligible customers can also receive guidance on behavioral issues related to oral health and discounts on prescription and non-prescription dental products. Reimbursements under this program are not subject to the plan deductible, but will be applied to and are subject to the plan annual maximum. Discounts on certain prescription and non-prescription dental products are available through Cigna Home Delivery Pharmacy only, and you are required to pay the entire discounted charge. For more information including how to enroll in this program and a complete list of program terms and eligible medical conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. Out of network claims submitted to Cigna after 365 days from date of service will be denied.

Late Entrant Limitation Provision Pretreatment Review Alternate Benefit Provision

Oral Health Integration Program (OHIP)

Timely Filing Benefit Limitations: Missing Tooth Limitation Oral Evaluations X-rays (routine) X-rays (non-routine) Diagnostic Casts Cleanings Fluoride Application Sealants (per tooth) Space Maintainers Inlays, Crowns, Bridges, Dentures and Partials

Denture and Bridge Repairs Denture Adjustments, Rebases and Relines Prosthesis Over Implant

For teeth missing prior to coverage with Cigna, the amount payable is 50% of the amount otherwise payable until covered for 24 months; thereafter, considered a Class III expense. 2 per policy year Bitewings: 2 per policy year Complete series of radiographic images and panoramic radiographic images: Limited to a combined total of 1 per 36 consecutive months Payable only in conjunction with orthodontic workup 2 per policy year, including periodontal maintenance procedures following active therapy 1 per policy year for children under age 19 Limited to posterior tooth. 1 treatment per tooth every 36 months for children under age 14 Limited to non-orthodontic treatment for children under age 19 Replacement every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth-colored material on molar crowns or bridges. Reviewed if more than once Covered if more than 6 months after installation 1 every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth colored material on molar crowns or bridges.

Benefit Exclusions: Covered Expenses will not include, and no payment will be made for the following: Procedures and services not listed under Benefit Highlights; Diagnostic: cone beam imaging; Preventive Services: instruction for plaque control, oral hygiene and diet; Restorative: veneers of porcelain, ceramic, resin, or acrylic materials on crowns or pontics on or replacing the upper and or lower first, second and/or third molars; Periodontics: bite registrations; splinting; Prosthodontics: precision or semi-precision attachments; initial placement of a complete or partial denture per plan guidelines; Implants: implants or implant related services; Procedures, appliances or restorations, except full dentures, whose main purpose is to: change vertical dimension; diagnose or treat conditions or dysfunction of the temporomandibular joint (TMJ); stabilize periodontally involved teeth; or restore occlusion; Athletic mouth guards; Replacement of a lost or stolen appliance; Services performed primarily for cosmetic reasons; Personalization; Services that are deemed to be medical in nature; Services and supplies received from a hospital; Drugs: prescription drugs 31 Charges in excess of the Maximum Reimbursable Charge.

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.

Monthly DHMO Premiums Tier

Rate

EE Only

$11.85

EE + Spouse

$22.95

EE + Child(ren)

$24.10

Family Coverage

$35.57



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 For full Cigna DHMO Fee Schedule, go to  Call the number located on your ID card to: www.mybenefitshub.com/friendswoodisd - Use the Dental Office Locator via Speech Recognition - Speak to a Customer Service Representative 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

D0240

X-rays intraoral – Occlusal radiographic image

$0.00

D9310

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

$12.00

D9430

Office visit for observation (During regularly scheduled hours) – No other services performed

$6.00

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

D0140

Limited oral evaluation – Problem focused

$0.00

D0431

Oral cancer screening using a special light source

$50.00

Dental DHMO Code

Procedure Description

Member Pays

Diagnostic/preventive (cont.)

Procedure Description

Member Pays

Periodontics (cont.)

D1110

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

$0.00

D1120

Prophylaxis (cleaning) – Child (limit 2 per calendar year)

$0.00

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

Sealant – Per tooth

$12.00

D1351

Code

D4341

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

$50.00

D4342

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

$40.00

D4910

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

$40.00

$70.00

Restorative (fillings, including polishing) D2140

Amalgam – 1 surface, primary or permanent

$0.00

Additional periodontal maintenance procedures (beyond 4 per calendar year)

D2330

Resin-based composite – 1 surface, anterior

$0.00

Periodontal charting for planning treatment of periodontal disease

$0.00

D2390

Resin-based composite crown, anterior

$45.00

Periodontal hygiene instruction

$0.00

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 $150.00 per tooth for any noble metal alloys, high noble metal alloys, titanium or titanium alloys  No more than $75.00 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

$285.00

D2792

Crown – Full cast noble metal

$260.00

D2722

Crown – Resin with noble metal

$260.00

D2950

Core buildup – Including any pins

$65.00

Endodontics (root canal treatment, excluding final restorations) D3310

Anterior root canal – Permanent tooth (excluding final restoration)

$100.00

D3330

Molar root canal – Permanent tooth (excluding final restoration)

$305.00

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. D4211

Gingivectomy or gingivoplasty – 1 to 3 teeth per quadrant

$100.00

D4240

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

$185.00

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

$225.00

D5120

Full lower denture

$225.00

D5211

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

$225.00

D5212

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

$225.00

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

$6.00

D7140

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

$6.00

D7220

Removal of impacted tooth – Soft tissue

$65.00

D7240

Removal of impacted tooth – Completely bony

$110.00

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

$1,600.00 $67.00

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

$2,600.00 $108.00

For a complete list of fees and services please visit www.mybenefitshub.com/friendswoodisd

METLIFE YOUR BENEFITS PACKAGE

Vision

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 34 Friendswood ISD Benefits Website: www.mybenefitshub.com/friendswoodisd

Vision With your Vision Preferred Provider Organization Plan, you can:   

Go to any licensed vision specialist and receive coverage. Just remember your benefit dollars go further when you stay in network. Choose from a large network of ophthalmologists, optometrists and opticians, from private practices to retailers like Costco® Optical and Vision works. Take advantage of our service agreement with Walmart and Sam's Club—they check your eligibility and process claims even though they are out of network.

Monthly Premiums EE Only

$7.36

EE + 1

$15.87

EE + Children

$14.99

EE + Family

$20.68

IN-NETWORK BENEFITS There are no claims for you to file when you go to a participating vision specialist. Simply pay your copay and, if applicable, any amount over your allowance at the time of service

Service Eye Exam

Cost and Notes  

Frame

Frequency

Eye health exam, dilation, prescription and refraction for glasses: Covered in full after $10 copay. Retinal imaging:1 Up to a $39 copay on routine retinal screening when performed by a private practice provider.



Every 12 Months

Allowance: $150 after $25 eyewear copay. Costco: $85 allowance after $25 eyewear copay. You will receive an additional 20% savings on the amount that you pay over your allowance. This offer is available from all participating locations except Costco.1

Every 12 Months

Standard Corrective Lenses



Single vision, lined bifocal, lined trifocal, lenticular: Covered in full after $25 eyewear copay

Every 12 Months

Standard lens enhancements1



Polycarbonate (child up to age 18), Ultraviolet (UV) coating and Scratch-resistant coatings: Covered in full after $25 eyewear copay. Progressive, Polycarbonate (adult), Photochromic, Anti-reflective and Tints: Your cost will be limited to a copay that MetLife has negotiated for you. These copays can be viewed after enrollment at www.metlife.com/mybenefits.

Every 12 Months

Contact fitting and evaluation:1 Covered in full with a maximum copay of $0. Elective lenses: $150 Necessary lenses: Covered in full after eyewear copay.

Every 12 Months



Contacts in lieu of Glasses

  

IN-NETWORK VALUE ADDED FEATURES: Additional lens enhancements:1 Average 20-25% savings on all other lens enhancements. Savings on glasses and sunglasses: Get 20% savings on additional pairs of prescription glasses and nonprescription sunglasses, including lens enhancements. At times, other promotional offers may also be available. Laser vision correction: 2 Savings averaging 15% off the regular price or 5% off a promotional offer for laser surgery including PRK, LASIK and Custom LASIK. This offer is only available at MetLife participating locations.

OUT-OF-NETWORK REIMBURSEMENT

Eye exam: up to $45

Single vision lenses: up to $30

You pay for services and then submit a claim for reimbursement. The same benefit frequencies for In-network benefits apply. Once you enroll, visit www.metlife.com/mybenefitsfor detailed out-ofnetwork benefits information.

Frames: up to $70

Lined bifocal lenses: up to $50

Contact lenses:  Elective up to $105  Necessary up to $210

Lenticular lenses: up to $100 Lined trifocal lenses: up to $65 Progressive lenses: up to $50

All lens enhancements are available at participating private practices. Maximum copays and pricing are subject to change without notice. Please check with your provider for details and copays applicable to your lens choice. Please contact your local Costco to confirm the availability of lens enhancements and pricing prior to receiving services. Additional discounts may not be available in certain states. 2

Custom LASIK coverage only available using wavefront technology with the microkeratome surgical device. Other LASIK procedures may be performed at an additional cost to the member. Additional savings on laser vision care is only available at participating locations.

LINCOLN FINANCIAL

Short Term Disability

YOUR BENEFITS PACKAGE

PLAY VIDEO

About this Benefit Disability insurance protects one of your most valuable assets, your ability to earn a living. This insurance will replace a portion of your income in the event that you become physically unable to work. Short term disability coverage provides benefits when you are unable to work for a short period of time due to a covered sickness or injury.

60% of Americans do not have a â&#x20AC;&#x153;rainy dayâ&#x20AC;? fund to cover three months of unanticipated financial emergencies.

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 Friendswood ISD Benefits Website: www.mybenefitshub.com/friendswoodisd

Voluntary Short Term Disability Insurance Option One The Lincoln Short Term Disability Insurance Plan: a cash benefit when you are out of work for up to 12 weeks due to injury, illness, surgery, or recovery from childbirth

Short-term Disability Weekly benefit amount

 Provides

a partial cash benefit if you can only do part of your job or work part time

group rates for Friendswood Independent School District employees

Up to 60% of your weekly salary ($100 minimum, $1,700 maximum) per week, in a $100 increment

Sickness elimination period 7 days Accident elimination period 7 days Maximum coverage period 12 weeks

 Features

 Offers

a fast, no-hassle claims process

Additional Plan Benefits Included

Portability

Included

Premium Waiver

Included

Annual Salary Range

When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.

Sickness Elimination Period

5% Rehabilitation Assistance Included Family Income Benefit

Open Enrollment

You must be out of work for 7 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 8.

Accident Elimination Period

Weekly Benefit Premium Equivalent

8,666.67 - 17,332.99

100

$ 6.50

17,333.33 - 25,999.99

200

$ 13.00

26,000 - 34,666.66

300

$ 19.50

34,666.67 - 43,333.32

400

$ 26.00

43,333.33 - 51,999.99

500

$ 32.50

52,000 - 60,666.66

600

$ 39.00

60,666.67 - 69,333.32

700

$ 45.50

69,333.33 - 77,999.99

800

$ 52.00

78,000 - 86,666.66

900

$ 58.50

86,666.67 - 95,333.32

1,000

$ 65.00

95,333.33 - 103,999.99

1,100

$ 71.50

104,000 - 112,666.66

1,200

$ 78.00

112,666.67 - 121,333.32

1,300

$ 84.50

121,333.33 - 129,999.99

1,400

$ 91.00

130,000 - 138,666.66

1,500

$ 97.50

138,666.67 - 147,333.32

1,600

$104.00

147,333.33 - 9,99999.00

1,700

$110.50

You must be out of work for 7 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 8.

Pre-existing Condition If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 12 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months.

Benefits Integration 



Your short-term disability benefits can coordinate with income from other sources, such as vacation and PTO. It does not coordinate with sick leave. This allows you to receive up to 100% of your pre-disability income.

Voluntary Short Term Disability Insurance Option Two The Lincoln Short Term Disability Insurance Plan: 



Provides a cash benefit when you are out of work for up to 11 weeks due to injury, illness, surgery, or recovery from childbirth Provides a partial cash benefit if you can only do part of your job or work part time Features group rates for Friendswood Independent School District employees Offers a fast, no-hassle claims process

5% Rehabilitation Assistance Included Included

Portability

Included

Premium Waiver

Included

Annual Salary Range

Weekly benefit amount

Up to 60% of your weekly salary ($100 minimum, $1,700 maximum) per week, in a $100 increment

Sickness elimination period 14 days Accident elimination period 14 days First Day Hospitalization

0 days

Maximum coverage period 11 weeks

Open Enrollment When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.

Additional Plan Benefits Family Income Benefit

Short-term Disability

Sickness Elimination Period You must be out of work for 14 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 15.

Weekly Benefit Premium Equivalent

Accident Elimination Period

8,666.67 - 17,332.99

100

$ 4.70

You must be out of work for 14 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 15.

17,333.33 - 25,999.99

200

$ 9.40

First Day Hospitalization

26,000 - 34,666.66

300

$ 14.10

34,666.67 - 43,333.32

400

$ 18.80

The elimination period is reduced if you are hospitalized due to an illness or accidental injury. You can begin collecting benefits on the first day of hospitalization.

43,333.33 - 51,999.99

500

$ 23.50

52,000 - 60,666.66

600

$ 28.20

60,666.67 - 69,333.32

700

$ 32.90

69,333.33 - 77,999.99

800

$ 37.60

78,000 - 86,666.66

900

$ 42.30

If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 12 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months.

86,666.67 - 95,333.32

1,000

$ 47.00

Benefits Integration

95,333.33 - 103,999.99

1,100

$ 51.70



104,000 - 112,666.66

1,200

$ 56.40

112,666.67 - 121,333.32

1,300

$ 61.10

121,333.33 - 129,999.99

1,400

$ 65.80

130,000 - 138,666.66

1,500

$ 70.50

138,666.67 - 147,333.32

1,600

$ 75.20

147,333.33 - 9,99999.00

1,700

$ 79.90

Pre-existing Condition



Voluntary Short Term Disability Insurance Benefit Exclusions & Reductions for Short Term Disability Plans from Lincoln Financial Like any insurance, this short-term disability insurance policy does have some exclusions. You will not receive benefits if:  Your disability is the result of a self-inflicted injury or act of war  You are not under the regular care of a doctor when you request disability benefits Your benefits may be reduced if you are eligible to receive benefits from:  A state disability plan or similar compulsory benefit act or law  A retirement plan  Social Security  Any form of employment  Workers’ Compensation A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.

LINCOLN FINANCIAL YOUR BENEFITS PACKAGE

Long Term 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 40 Friendswood ISD Benefits Website: www.mybenefitshub.com/friendswoodisd

Long Term Disability The Lincoln Long Term Disability Insurance Plan:

Core Plan (Paid by Friendswood ISD) Weekly benefit amount

40% of your monthly salary, limited to $10,000 per month

Elimination period

90 Days

Coverage period for your occupation

36 Months

Maximum coverage period

Up to age 65 or Social Security Normal Retirement Age (SSNRA), whichever is later

 Provides a cash benefit after you are out

of work for 90 days or more due to injury, illness, or surgery  Starts with a “core plan” that is paid for by

Friendswood Independent School District  Offers a simple “buy-up” option that lets

you enhance your benefit with affordable group rates  Includes EmployeeConnectSM services,

which give you and your family confidential access to counselors as well as personal, legal, and financial assistance

Additional Plan Benefits

“Buy-Up” Option (paid by you through payroll deduction) Weekly benefit amount

Additional 26.67% of your monthly salary, limited to $10,000 per month

Elimination period

90 Days

Coverage period for your occupation

36 Months

Maximum coverage period

Up to age 65 or Social Security Normal Retirement Age (SSNRA), whichever is later

Premium Waiver

Included

Progressive Income Benefit

Included

Family Care Expense Benefit

Included

 This is the number of days you must be disabled before you

Family Income Benefit

Included

can collect disability benefits.  The elimination period can be met through either total disability (out of work entirely) or partial disability (working with a reduced schedule or performing different types of duties).

Portability

Included

Elimination Period

Coverage Period for Your Occupation  This is the coverage period for the trade or profession in

Open Enrollment When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.

Pre-existing Condition If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months.

which you were employed at the time of your disability (also known as your own occupation).  You may be eligible to continue receiving benefits if your disability prohibits you from any employment for which you are reasonably suited through your training, education, and experience. In this case, your benefits are extended through the end of your maximum coverage period (benefit duration).

Maximum Coverage Period  This is the total amount of time you can collect disability

benefits (also known as the benefit duration).  Benefits are limited to 24 months for mental illness; 24

months for substance abuse; and 24 months for specified illnesses. 41

Long Term Disability Monthly Rates per $100 of Monthly Earnings

Buy Up

< 20 Age 20-24 Age 25-29 Age 30-34 Age 35-39 Age 40-44 Age 45-49 Age 50-54 Age 55-59 Age 60-64 Age 65-69 Age 70-74 Age 75-79 Age 80+

$0.368 $0.368 $0.368 $0.368 $0.368 $0.368 $0.368 $0.368 $0.368 $0.368 $0.368 $0.368 $0.368 $0.368

Benefit Exclusions & Reductions Like any insurance, this long-term disability insurance policy does have some exclusions. You will not receive benefits if: • Your disability is the result of a self-inflicted injury or act of war • You are not under the regular care of a doctor when you request disability benefits • Your disability occurs while you are committing a felony or participating in a riot • Your disability occurs while you are imprisoned for committing a felony • Your disability occurs while you are residing outside of the United States or Canada for more than 12 consecutive months for a purpose other than work Your benefits may be reduced if you are eligible to receive benefits from: • A state disability plan or similar compulsory benefit act or law • A retirement plan • Social Security • Any form of employment • Workers’ Compensation • Salary continuance • Sick leave A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.

Long Term Disability

APL

Cancer

YOUR BENEFITS PACKAGE

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About this Benefit Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.

Breast Cancer is the most commonly diagnosed cancer in women.

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 44 Friendswood ISD Benefits Website: www.mybenefitshub.com/friendswoodisd

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

SUMMARY OF BENEFITS Cancer Treatment Policy Benefits Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12-month period Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment

Low Option

High Option

Level 1

Level 4

$10,000

$20,000

$50 per treatment

paid in same manner and under the same maximums as any other benefit Level 1 Level 1

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

$50 per test

Follow-Up Diagnostic Testing - 1 test per calendar year

$50 per test

$100 per test

$500 per test / 1 per calendar year Level 2

$500 per test / 1 per calendar year Level 4

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

$5,000

$10,000

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

$7,500

$15,000

Medical Imaging - per calendar year Internal Cancer First Occurrence Rider Benefits

TOTAL MONTHLY PREMIUMS BY PLAN** Issue Ages 18+

Individual

Individual & Spouse

1 Parent Family

2 Parent Family

Low Option

High Option

Low Option

High Option

Low Option

High Option

Low Option

High Option

$12.48

$21.62

$26.30

$45.44

$14.64

$25.44

$28.44

$49.28

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

APSB-22339(TX)-0917 MGM/FBS Friendswood ISD

GC14 Limited Benefit Group Specified Disease Cancer Indemnity Insurance Benefits are only payable following a diagnosis of cancer for a loss incurred for the treatment of cancer while covered under the policy. A charge must be incurred for benefits to be payable. When coverage terminates for loss incurred after the coverage termination date, our obligation to pay benefits also terminates for a specified disease that manifested itself while the person was covered under the policy. All benefits are subject to the benefit maximums.

Cancer Treatment Benefits Eligibility

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

Limitations and Exclusions

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

Only Loss for Cancer

Cancer Screening Benefits Limitations and Exclusions

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

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

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

Internal Cancer First Occurrence Benefits

Pre-Existing Condition Exclusion

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

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

Waiting Period

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

Termination of Certificate

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

Termination of Coverage

Insurance coverage for a covered person under the certificate and any attached riders for a covered person will end as follows: the date the policy terminates; the date the certificate terminates; the end of the grace period if the premium remains unpaid; the end of the certificate month in which the policyholder requests to terminate the coverage for an eligible dependent; the date a covered person no longer qualifies as an insured or eligible dependent; or the date of the covered person’s death. We may end the coverage of any Covered Person who submits a fraudulent claim. 46

APSB-22339(TX)-0917 MGM/FBS Friendswood ISD

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

Limitations and Exclusions

Pre-Existing Condition Exclusion

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

Waiting Period

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

Termination

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

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

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

GC14 Limited Benefit Group Specified Disease Cancer Indemnity Insurance The benefits, terms and condition of the portability coverage will be the same as those elected under the certificate immediately prior to the date you exercised portability. Portability coverage may include any eligible dependents who were covered under the certificate at the time you ceased to qualify as an eligible insured. No new eligible dependents may be added to the portability coverage except as provided in the New Born and Adopted Children provision. No increases in coverage will be allowed while you are exercising your rights under this rider. The premium for the portability coverage will be based on the premium tables used for such coverage at the time of the portability request. Coverage under this rider will terminate in accordance with the provisions of the Termination of Coverage in the certificate. If the policy is no longer in force, then portability coverage is not available.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the policy/certificate/riders. This coverage does not replace Workersâ&#x20AC;&#x2122; Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC14 Series | TX | Limited Benefit Group Specified Disease Cancer Indemnity Insurance | (09/17) | MGM/FBS | Friendswood ISD

APSB-22339(TX)-0917 MGM/FBS Friendswood ISD

UNUM

Critical Illness

YOUR BENEFITS PACKAGE

PLAY VIDEO

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 48 Friendswood ISD Benefits Website: www.mybenefitshub.com/friendswoodisd

Critical Illness How Does it Work? If you’re diagnosed with an illness that is covered by this insurance, you’ll receive a benefit payment in one lump sum. You can use the money however you want

Why is Coverage so Valuable?  



The money can help you pay out-of-pocket medical expenses, like co-pays and deductibles. You can use this coverage more than once. Even after you receive a payout for one illness, you’re still covered for the remaining conditions. If you have a different condition later, you can receive another benefit. This insurance pays you once for each eligible illness. However, the diagnoses must be at least 90 days apart, and the conditions can’t be related to each other.

Who Can Get Coverage? You Your spouse Your children

Choose from $10,000, $20,000, or $30,000, with no medical questions if you apply during this enrollment. 100% of employee coverage amount. 100% of employee coverage amount. Dependent children from newborns to age 26 are automatically covered at no extra cost. They are covered for all the same illnesses, plus these specific childhood conditions: cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome and spina bifida. The diagnosis must occur after the child’s coverage effective date.

Your paycheck deduction includes base coverage premium[s]. Actual billed amounts may vary. For illustrative purposes only.

Exclusions and limitations Individuals must have comprehensive medical coverage to be eligible for this critical illness insurance. Waiting period The benefit for this coverage is subject to a 30-day waiting period following the effective date of the insured’s coverage. This does not apply to coma, occupational HIV and permanent paralysis or specific covered childhood diseases. Pre-existing conditions Benefits for a pre-existing condition (defined as a sickness or injury, or symptoms of a sickness or injury, whether diagnosed or not, for which you received medical treatment, consultation, care or services, including diagnostic measures, took prescribed drugs or medicine, or had been prescribed drugs or medicine to be taken in the 12 months just prior to your effective date) will not be paid during the first 12 months the policy is inforce. Reduction of benefits Any coverage inforce prior to the insured’s 70th birthday will be reduced on the policy anniversary date following the insured’s 70th birthday. The insured’s face amount will be reduced to 50% of the face amount the insured had prior to the policy anniversary date. Any coverage inforce after the policy anniversary date following the insured’s 70th birthday will not be subject to a benefit reduction on subsequent policy anniversary dates. Exclusions and Limitations Unum will not pay benefits for a claim that is caused by, contributed to by or occurs as a result of: • Participating or attempting to participate in a felony or being engaged in an illegal occupation; or • Committing or trying to commit suicide or injuring oneself intentionally, whether sane or not; or • Participating in war or any act of war, whether declared or undeclared; or • Committing acts of terrorism; or

What’s Covered?            

Paid by the Employee Heart attack Blindness Major organ failure End-stage kidney failure Benign brain tumor Coronary artery bypass surgery Coma that lasts at least 14 consecutive days Stroke whose effects are confirmed at least 30 days after the event Dementia (including Alzheimer’s) Multiple Sclerosis Parkinson’s Disease

Monthly premium per $10,000 of coverage Age 0-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Uni Tobacco $2.62 $2.92 $3.32 $4.02 $4.92 $6.32 $8.12 $10.12 $14.12 $21.52 $38.82 $65.72 $112.32 $204.62

• Being under the influence of or addicted to intoxicants or narcotics. This would not include physician-prescribed medication, taken in the prescribed dosage; or • Having a date of diagnosis during the benefit waiting period. Termination of employee coverage If you choose to cancel your coverage under the policy, your coverage ends on the first of the month following the date you provide notification to your employer. Otherwise, your coverage under the policy ends on the earliest of the: • Date this policy is canceled; • Date you are no longer in an eligible group; • Date your eligible group is no longer covered; • Date of your death; • Last day of the period for which you made any required contributions; or • Last day you are in active employment. However, as long as premium is paid as required, coverage will continue if you elect to continue coverage under the portability provision or in accordance with the Layoff and Leave of Absence provisions of this policy. Coverage on your dependent children ends on the earliest of the date your coverage under this policy ends or the date a dependent child no longer meets the definition of dependent children. Unum will provide coverage for a payable claim which occurs while you are covered under this policy. THIS INSURANCE PROVIDES LIMITED BENEFITS This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and imitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form CI-1 or contact your Unum representative. 49

ONEAMERICA COMPANY YOUR BENEFITS PACKAGE

Life and AD&D

PLAY VIDEO

About this Benefit Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

Motor vehicle crashes are the

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 50 Friendswood ISD Benefits Website: www.mybenefitshub.com/friendswoodisd

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

Life Event Benefit:

You may be able to add coverage or increase your benefit amount if you apply within 31 days from the date of a life District provided Life and AD&D insurance coverage amount event. Examples of a life event include marriage, the birth of a child, or adoption. of $20,000 at no cost to you. Waiver of premium benefit. Accelerated life benefit. Additional AD&D Benefits: Seat Belt, Air Bag, Repatriation, Child Higher Education, Child Care, Paralysis/Loss of Use, Severe Burns.

Flexible Life Options Employee: $10,000 to $500,000, in $10,000 increments Spouse: $10,000 to $500,000, in $10,000 increments, not to exceed 100% of the employee’s amount.

Dependent Life Coverage

AUL's Group Voluntary Term Life Insurance Terms and Definitions

Optional dependent life coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren).

Eligible Employees:

Dependent AD&D Coverage

This benefit is available for employees who are actively at work If employee AD&D is declined, no dependent AD&D will be on the effective date and working a minimum of 18.75 hours per included. week.

Continuation of Coverage Options:

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

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

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

Employee Guaranteed Issue Amount

$250,000

Spouse Guaranteed Issue Amount

$50,000

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

Child Guaranteed Issue Amount

$10,000

Accelerated Life Benefit:

Timely Enrollment:

If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.

Enrolling timely means you have enrolled during the initial enrollment period when benefits were first offered by AUL, or as a newly hired employee within 31 days following completion of Waiver of Premium: If approved, this benefit waives your and your dependents' any applicable waiting period. insurance premium in case you become totally disabled and are Evidence of Insurability: unable to collect a paycheck. If you elect a benefit amount over the Guaranteed Issue Amount shown above for you or your eligible dependents, or you do not Reductions: enroll timely, you will need to submit a Statement of Insurability Upon reaching certain ages, your original benefit amount will reduce to a percentage as shown in the following schedule. form for review. Based on health history, you and/or your dependents will be approved or declined for insurance coverage Age: 70 by AUL. Reduces To:

50%

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

Friendswood ISD provides a $20,000 Basic Life Policy at no cost to you. Waiver of premium benefit. Additional AD&D Benefits: Seat Belt, Air Bag, Repatriation, Child Higher Education, Child Care, Paralysis/Loss of Use, Severe Burns.

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

You may select a minimum Life benefit of $10,000 up to a maximum amount of $500,000, in increments of $10,000. Life amounts requested above $250,000 for an Employee, $50,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability. Employee must select coverage to select any Dependent coverage. Dependent coverage cannot exceed 100% of the Voluntary Term Life amount selected by the Employee.

EMPLOYEE ONLY OPTIONS (based on Employee's age as of 09/01) 60-64

65-69

70-74

75+

AD&D All Ages

$4.60

$7.20

$13.70

$24.20

$0.20

$9.20

$14.40

$27.40

$48.40

$0.40

$9.30

$13.80

$21.60

$41.10

$72.60

$0.60

$8.00

$12.40

$18.40

$28.80

$54.80

$96.80

$0.80

$6.50

$10.00

$15.50

$23.00

$36.00

$68.50 $121.00 $121.00

$1.00

$6.40

$10.40

$16.00

$24.80

$36.80

$57.60 $109.60 $193.60 $193.60

$1.60

$7.00

$8.00

$13.00

$20.00

$31.00

$46.00

$72.00 $137.00 $242.00 $242.00

$2.00

$10.50

$12.00

$19.50

$30.00

$46.50

$69.00 $108.00 $205.50 $363.00 $363.00

$3.00

$14.00

$16.00

$26.00

$40.00

$62.00

$92.00 $144.00 $274.00 $484.00 $484.00

$4.00

$17.50

$20.00

$32.50

$50.00

$77.50 $115.00 $180.00 $342.50 $605.00 $605.00

$5.00

Life

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

$10,000

$0.50

$0.70

$0.80

$1.30

$2.00

$3.10

$20,000

$1.00

$1.40

$1.60

$2.60

$4.00

$6.20

$30,000

$1.50

$2.10

$2.40

$3.90

$6.00

$40,000

$2.00

$2.80

$3.20

$5.20

$50,000

$2.50

$3.50

$4.00

$80,000

$4.00

$5.60

$100,000

$5.00

$150,000

$7.50

$200,000

$10.00

$250,000

$12.50

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

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

AD&D All Ages

$10,000

$0.50

$0.70

$0.80

$1.30

$2.00

$3.10

$4.60

$7.20

$13.70

24.2

$0.20

$20,000

$1.00

$1.40

$1.60

$2.60

$4.00

$6.20

$9.20

$14.40

$27.40

$48.40

$0.40

$30,000

$1.50

$2.10

$2.40

$3.90

$6.00

$9.30

$13.80

$21.60

$41.10

$72.60

$0.60

$40,000

$2.00

$2.80

$3.20

$5.20

$8.00

$12.40

$18.40

$28.80

$54.80

$96.80

$0.80

$50,000

$2.50

$3.50

$4.00

$6.50

$10.00

$15.50

$23.00

$36.00

$68.50

$121.00

$1.00

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

Child(ren) live birth to 6 months

Monthly Payroll Deduction Life Amount

Life Option 1:

$5,000

$1,000

$0.50

Life Option 2:

$10,000

$1,000

$1.00

AD&D Option 1:

$5,000

$1,000

$0.05

AD&D Option 2:

$10,000

$1,000

$0.10

About Premiums: The premiums shown above may vary slightly due to rounding; actual premiums will be calculated by American United Life Insurance Company® (AUL), and may increase upon reaching certain age brackets, according to contract terms, and are subject to change. 52

Life and AD&D

5STAR

Individual Life

YOUR BENEFITS PACKAGE

PLAY VIDEO

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

Experts recommend at least

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 54 Friendswood ISD Benefits Website: www.mybenefitshub.com/friendswoodisd

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

Affordability - With several options to choose from, select the coverage that best meets the needs of your family. Terminal Illness - This plan pays the insured 30% (25% in Connecticut and Michigan) of the policy coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months. Portability - You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid. If this happens, we can simply bill you directly. Coverage can never be cancelled by the insurance company or your employer unless you stop paying premiums.

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

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

gourmet coffee OR per day to enrich your employee benefits package

It’s less expensive than you think.

Family Protection - Individual policies can be purchased on the employee, their spouse, children and grandchildren (ages 15 days to age 24). Quality of Life Benefit - Following a diagnosis of either a chronic illness or cognitive impairment, this rider accelerates a portion of the death benefit on a monthly basis – 4%; up to 75% of your benefit, and payable directly to you on a tax favored basis for the following:  Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or  Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision. Convenience - Premiums are taken care of simply and easily through payroll deductions. Protection You Can Count On - Within 24 hours after receiving notice of an insured’s death, an emergency death benefit of the lesser of 50% of the coverage amount, or $10,000, will be mailed to the insured’s beneficiary, unless the death is within the twoyear contestability period and/or under investigation. This product also contains no war or terrorism exclusions. * Life insurance product underwritten by 5Star Life insurance Company (a Baton Rouge, Louisiana company) with an administrative office at 909 N. Washington Street, Alexandria, VA 22314

Family Protection Plan - Terminal Illness Monthly Rates with Quality of Life Rider Defined Benefit Employee Coverage Amounts $30,000 $40,000 $50,000 $75,000

Age on App. Date

$10,000

$20,000

$25,000

$100,000

$125,000

$150,000

18-25

$7.56

$10.78

$12.39

$14.01

$17.24

$20.46

$28.53

$36.59

$44.65

$52.71

$7.59

$10.83

$12.46

$14.09

$17.33

$20.59

$28.71

$36.83

$44.96

$53.09

$7.65

$10.97

$12.62

$14.28

$17.60

$20.92

$29.21

$37.50

$45.80

$54.08

$7.74

$11.15

$12.85

$14.56

$17.96

$21.38

$29.90

$38.41

$46.94

$55.46

$7.88

$11.43

$13.20

$14.99

$18.54

$22.09

$30.96

$39.84

$48.71

$57.59

$8.07

$11.80

$13.67

$15.53

$19.27

$23.00

$32.34

$41.67

$51.01

$60.33

$8.27

$12.20

$14.17

$16.14

$20.06

$24.00

$33.84

$43.66

$53.50

$63.34

$8.50

$12.65

$14.73

$16.81

$20.97

$25.12

$35.52

$45.92

$56.31

$66.71

$8.73

$13.11

$15.32

$17.51

$21.90

$26.29

$37.27

$48.25

$59.23

$70.21

$9.01

$13.67

$16.00

$18.34

$23.00

$27.67

$39.33

$51.00

$62.67

$74.34

$9.30

$14.27

$16.75

$19.23

$24.20

$29.17

$41.59

$54.00

$66.42

$78.83

$9.64

$14.95

$17.60

$20.26

$25.57

$30.88

$44.15

$57.42

$70.69

$83.96

$10.02

$15.70

$18.54

$21.39

$27.07

$32.76

$46.96

$61.17

$75.37

$89.59

$10.41

$16.48

$19.52

$22.56

$28.64

$34.71

$49.89

$65.09

$80.27

$95.46

$10.85

$17.35

$20.61

$23.86

$30.37

$36.87

$53.15

$69.42

$85.68

$101.96

$11.31

$18.29

$21.77

$25.26

$32.23

$39.21

$56.65

$74.08

$91.52

$108.96

$11.83

$19.33

$23.08

$26.83

$34.33

$41.83

$60.58

$79.33

$98.08

$116.83

$12.41

$20.48

$24.52

$28.56

$36.63

$44.71

$64.90

$85.08

$105.27

$125.46

$13.00

$21.66

$26.00

$30.34

$39.00

$47.67

$69.33

$91.00

$112.67

$134.34

$13.63

$22.91

$27.57

$32.21

$41.50

$50.79

$74.02

$97.25

$120.48

$143.71

$14.27

$24.22

$29.19

$34.16

$44.10

$54.05

$78.90

$103.75

$128.60

$153.46

$14.97

$25.60

$30.91

$36.24

$46.87

$57.51

$84.09

$110.67

$137.25

$163.84

$15.70

$27.05

$32.73

$38.41

$49.77

$61.13

$89.52

$117.92

$146.32

$174.71

$16.43

$28.51

$34.56

$40.61

$52.70

$64.79

$95.03

$125.25

$155.48

$185.71

$17.22

$30.10

$36.55

$42.98

$55.87

$68.75

$100.96

$133.17

$165.37

$197.58

$18.08

$31.82

$38.69

$45.56

$59.30

$73.04

$107.39

$141.75

$176.10

$210.46

$19.04

$33.75

$41.11

$48.46

$63.17

$77.88

$114.65

$151.42

$188.19

$224.96

$20.16

$35.98

$43.90

$51.81

$67.63

$83.46

$123.02

$162.58

$202.15

$241.71

$21.40

$38.46

$47.00

$55.54

$72.60

$89.67

$132.33

$175.00

$217.67

$260.34

$22.79

$41.25

$50.48

$59.71

$78.17

$96.63

$142.77

$188.92

$235.07

$281.21

$24.26

$44.20

$54.16

$64.13

$84.06

$104.00

$153.83

$203.66

$253.50

$303.33

$25.94

$47.53

$58.34

$69.14

$90.73

$112.34

$166.33

$220.33

$274.34

$328.34

$27.66

$50.98

$62.64

$74.31

$97.63

$120.96

$179.27

$237.58

$295.89

$354.21

$29.42

$54.50

$67.05

$79.58

$104.67

$129.75

$192.46

$255.17

$317.87

$380.58

$31.23

$58.12

$71.56

$85.01

$111.90

$138.79

$206.02

$273.25

$340.48

$407.71

$33.12

$61.90

$76.30

$90.69

$119.46

$148.25

$220.21

$292.16

$364.13

$436.09

61 62 63 64 65 66* 67* 68* 69* 70*

$35.08 $37.12 $39.31 $41.68 $44.34 $44.93 $48.25 $52.03 $56.33 $61.17

$65.82 $69.91 $74.29 $79.04 $84.33 $85.52 $92.17 $99.73 $108.32 $118.00

$81.19 $86.31 $91.77 $97.71 $104.34 $105.81 $114.13 $123.58 $134.31 $146.42

$96.56 $102.71 $109.26 $116.38 $124.34 $126.11 $136.08 $147.43 $160.31 $174.83

$127.30 $135.50 $144.23 $153.73 $164.33 $166.70 $180.00 $195.13 $212.30 $231.67

$158.04 $168.29 $179.21 $191.09 $204.34 $207.29 $223.92 $242.83 $264.29 $288.50

$234.90 $250.27 $266.65 $284.46 $304.33 $308.77 $333.71 $362.08 $394.27 $430.58

$311.75 $332.25 $354.08 $377.83 $404.33 $410.25 $443.50 $481.33 $524.25 $572.67

$388.60 $414.23 $441.52 $471.21 $504.34 $511.73 $553.29 $600.58 $654.23 $714.75

$465.46 $496.21 $528.96 $564.58 $604.34 $613.21 $663.08 $719.83 $784.21 $856.83

*Quality of Life not available ages 66 - 70. Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on application date: 14 days to 24 years old). $4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 coverage. 56

Family Protection Plan - Terminal Illness

THE HARTFORD 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 58 Friendswood ISD Benefits Website: www.mybenefitshub.com/friendswoodisd

Accident What is accident insurance? Accident insurance offers financial protection by paying a cash benefit if you or an insured dependent are unexpectedly injured in a covered accident. This coverage is offered by your employer which you pay for through convenient deductions from your paycheck. The benefits are paid in lump sum amounts to you (or your beneficiary), and can be used to help pay for health care expenses not covered by your major medical insurance, help replace income lost while not working, or however you choose. This highlight sheet is an overview of your accident insurance. A certificate of insurance will be available after you enroll to explain your coverage in detail.

Who is eligible? You are eligible if you are an active employee who works at least 18.75 hours per week on a regularly scheduled basis, and are less than age 80. Your spouse (includes domestic partner) must also be less than age 80 to be eligible for coverage, and your dependent child(ren) must be under age 26 to be eligible.

When can I enroll? You can enroll during any scheduled enrollment period, within 31 days of the date you have a change in family status, or within 31 days of the completion of any eligibility waiting period established by your employer.

How much coverage can I purchase? Two accident plans are available to you, Option 1: Plan 2 and Option 2: Plan 3. You have the flexibility to enroll for the plan that best meets your financial protection needs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s).

Am I guaranteed coverage? During designated enrollment periods, this coverage is offered without having to provide information about your or your family’s health. This is called “guaranteed issue” coverage – all you have to do is check the box to enroll and become insured.

I already have medical and disability insurance. Why do I need this too? Costs associated with an accident can add up even with other types of insurance. Once treatment for an injury begins, deductibles and cost sharing (co-pays and/or

coinsurance), and limitations on benefits found in some medical insurance plans may quickly lead to high out-of-pocket costs. In addition, disability insurance will only replace a portion of your income, not all of it. Accident insurance benefits can help cover what other insurance products don’t.

What is covered? This insurance provides benefits for medical treatment and services related to accidental injuries Benefits for specific types of injuries and catastrophic injuries (including accidental death) are also available. Please refer to the benefits table on the following page for more detailed plan information.

Can I keep this insurance if I leave my employer? Yes, you can take this coverage with you. If you leave your employer, you may continue coverage for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances.

Exclusions This insurance does not provide benefits for any loss that results from or is caused by:  Suicide or attempted suicide, whether sane or insane, or intentionally self-inflicted injury  War or act of war, whether declared or undeclared, or a nuclear, chemical, biological, or radiological event  A covered person's participation in a felony, riot or insurrection  A covered person's service in the armed forces or units auxiliary to it  A covered person's taking drugs, unless as prescribed by or administered by a physician, or being intoxicated as defined by the jurisdiction in which the cause of loss was incurred  While a covered person is on any aircraft: as a pilot, crewmember or student pilot; as a flight instructor or examiner; if it is owned, operated or leased by or on behalf of the policyholder, or any employer or organization whose eligible persons are covered under the policy; or being used for tests, experimental purposes, stunt flying, racing or endurance tests  Operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft  Riding in or driving any motor-driven vehicle in a race, stunt show or speed test All exclusions may not be applicable, or may be adjusted, as required by state regulations in the situs state of a group. Please refer to the certificate for a full listing of exclusions. 59

Accident Plan Information Plan Type Coverage Type

Option 1

Option 2

Plan 2

Plan 3 On and off-job (24 hour)

On and off-job (24 hour)

Benefits Emergency, Hospital & Treatment Care

Option 1

Option 2

Plan 2

Plan 3

Accident Follow-Up

Up to 3 visits/accident within 90 days

$25

$50

Acupuncture /Chiropractic Care

Up to 10 visits each/accident within 365 days

$25

$50

Ambulance – Air

Once/accident within 72 hours

$750

$1,000

Ambulance – Ground

Once/accident within 90 days

$200

$300

Blood/Plasma/Platelets

Once/accident within 90 days

$200

Child Care

Up to 30 days/accident while insured is confined

$25

$30

Daily Hospital Confinement

Up to 365 days/lifetime (Total daily and ICU)

$150

$200

Daily ICU Confinement

Up to 30 days/accident

$200

$400

Diagnostic Exam

Once/accident within 90 days

$100

$200

Emergency Dental – Crown/Extraction

Once/accident within 90 days

Up to $100

Up to $200

Emergency Room

Once/accident within 72 hours

$50

$200

Hospital Admission

Once/accident within 90 days

$625

$1,250

Initial Physician Office Visit

Once/accident within 90 days

$75

$100

Lodging

Up to 30 nights/lifetime

$100

$200

Medical Appliance

Once/accident within 90 days

$100

$150

Rehabilitation Facility

Up to 15 days/lifetime

$50

$100

Transportation

Up to 3 trips/accident

$250

$500

Urgent Care

Once/accident within 72 hours

$50

$150

X-ray

Once/accident within 90 days

$50

$75

Plan 2

Plan 3

Specified Injury & Surgery Abdominal/Thoracic Surgery

Once/accident within 90 days

$1,500

$2,000

Arthroscopic Surgery

Once/accident within 90 days

$300

$400

Burn – 2nd & 3rd degree

Once/accident within 72 hours

Up to $5,000

Up to $10,000

Burn – Skin graft

Once/accident

Concussion

Up to 3/year

Dislocations

Once/joint/lifetime

Eye Injury – Surgery/Object Removal

Once/accident within 90 days

Fractures

Once/bone/accident within 90 days

Hernia Repair

25% of burn benefit $200

$400

Up to $4,000

Up to $8,000

Up to $400

Up to $600

Up to $6,000

Up to $9,000

Once/accident within 365 days

$150

$200

Joint Replacement

Once/accident within 90 days

$2,000

$3,000

Knee Cartilage

Highest benefit once/accident within 365 days

Up to $750

Up to $1,000

Laceration

Highest benefit once/accident within 72 hours

$200

$400

Ruptured Disc

Once/accident within 365 days

$750

$1,000

Tendon/Ligament/Cuff

Highest benefit once/accident within 365 days

Up to $1,000

Up to $1,500

Accident Benefits (cont.) Catastrophic

Option 1 Plan 2

Option 2 Plan 3

$25,000

$50,000

Accidental Death

Within 90 days; Spouse @ 50% and child @ 25%

Common Carrier Death

Within 90 days

Coma

Once per accident

$5,000

$10,000

Dismemberment

Once per accident

Up to $30,000

Up to $50,000

Home Health Care

Up to 30 days per accident

$50

Paralysis

Once per accident

Up to $5,000

Up to $10,000

Prosthesis

Up to 2 per accident

Up to $1,500

Up to $2,000

3 times death benefit

Notices THIS IS A LIMITED BENEFIT POLICY This limited health benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage. This benefit highlights sheet is an overview of the insurance being offered and is provided for illustrative purposes only and is not a contract. It in no way changes or affects the policy as actually issued. Only the insurance policy issued to the policyholder can fully describe all of the provisions, terms, conditions, limitations and exclusions of your insurance coverage. In the event of any difference between the benefit highlights sheet and the insurance policy, the terms of the insurance policy apply.

Rate Chart Employee

Employee & Spouse

Employee & Child(ren)

Employee & Family

Option 1 Monthly Cost

$9.10

$14.28

$14.92

$23.54

Option 2 Monthly Cost

$15.68

$24.57

$25.78

$40.62

MASA YOUR BENEFITS PACKAGE

Medical Transport

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

A ground ambulance can cost up to

$2,400

and a helicopter transportation fee can cost

over $30,000

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 62 Friendswood ISD Benefits Website: www.mybenefitshub.com/friendswoodisd

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

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

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

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

What is Covered?  

Emergency Helicopter Transport Emergency Ground Ambulance Transport

How Much Does It Cost? MASA Emergent rate is $14 a month and covers the employee, spouse and eligible dependents to age 26.

Emergent Card Example:

We provide medical emergency transportation solutions AND cover your out of pocket medical transport cost when your insurance falls short. “All I had to do was send the bill which was never paid by Medicare and TriCare for Life --- and the rest is history. When MASA received that bill, it was paid and all amounts owed satisfied.” --- MASA Member, 2015