2019-20 ESC Region 11 EBC Benefit Guide - Little Elm ISD by Higginbotham Public Sector

ESC REGION 11 EMPLOYEE BENEFITS COOPERATIVE

BENEFIT GUIDE EFFECTIVE: 09/01/2019 - 8/31/2020 WWW.REGION11BC.COM 1

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. HSA and FSA Plan Availability 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 7. Helpful Definitions 8. Benefit Rates TRS-ActiveCare and Scott & White HMO NBS Flexible Spending Account (FSA) EECU Health Savings Account (HSA) Aetna Hospital Indemnity MDLIVE Telehealth Cigna Dental Superior Vision OneAmerica Disability APL Cancer Voya Accident UNUM Life and AD&D ID Watchdog Identity Theft MASA Emergency Transportation Texas Individual Life 2

3 4-5 6-13 6 7 8 9 10

FLIP TO... PG. 4

HOW TO ENROLL

PG. 6

SUMMARY PAGES

PG. 14

YOUR BENEFITS

11 12 13 14-21 22-23 24-25 26-31 32-33 34-39 40-41 42-45 46-49 50-53 54-57 58-59 60-61 62-63

Benefit Contact Information ESC REGION 11 EBC BENEFITS Financial Benefit Services (800) 583-6908 www.region11bc.com

HOSPITAL INDEMNITY Aetna (800) 607-3366 http://www.aetna.com/

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

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

TRS HMO MEDICAL Scott & White HMO (800) 321-7947 www.trs.swhp.org

DENTAL Group # 3335872 Cigna (800) 244-6224 www.mycigna.com VISION Group # 320580 Superior Vision (800) 507-3800 www.superiorvision.com DISABILITY OneAmerica Group #618369 (800) 553-5318 https://www.oneamerica.com

FLEXIBLE SPENDING ACCOUNT National Benefit Services (800) 274-0503 www.nbsbenefits.com HEALTH SAVINGS ACCOUNT EECU (817) 882-0800 www.eecu.org

CANCER Group # 13060 American Public Life (800) 256-8606 www.ampublic.com ACCIDENT Voya Group # 700681 (800) 955-7736 www.voya.com LIFE AND AD&D UNUM (800) 583-6908 www.unum.com IDENTITY THEFT ID Watchdog (800) 237-1521 www.idwatchdog.com EMERGENCY MEDICAL TRANSPORT MASA (800) 423-3226 https://www.masamts.com/

INDIVIDUAL LIFE

Texas Life (866) 283-9233 www.texaslife.com 3

MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet. Text “FBS BC11” to 313131 and get access to everything you need to complete your benefits enrollment:

•

Benefit Information

•

Online Support

•

Interactive Tools

•

And more.

Text “FBS BC11” to 313131 OR SCAN

How to Log In

BENEFIT INFO

INTERACTIVE TOOLS

1 2 3 4

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

CLICK LOGIN

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

Username: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the

ONLINE SUPPORT

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

Default Password: Last Name (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number. 5

Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New: New Hospital Indemnity PLAN! While medical plans typically cover hospitalization, they don’t cover everything. This plan by Aetna can help you and your family with out of pocket costs associated with an inpatient hospital stay. If the hospital admits you, you will get a lump-sum payment, a per-day payment, and an additional per-day payment for an ICU stay. Aetna pays plan members directly, by check, and claims can be filed online. If you are a TRS Medical member with Aetna, you don’t need to submit any additional supporting paperwork to get paid. Coverage is guaranteed issue, meaning you can never be turned away for prior health problems. New Disability CARRIER! Plan provides a monthly income to an individual that is disabled due to an accident or illness. Employees will be able to elect 45%, 55% or 65% of their salary as a disability benefit. All new or increases in coverage are subject to pre-existing condition exclusions, including the 4-week pre-existing condition benefit.

New PLAN! 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 so you are covered anywhere nationwide. The Emergent plan covers your family for $14.00 month. TRS Medical All of the TRS medical plans will experience a rate increase effective 09/01/2019 except for Scott and White HMO which had a rate decrease. Current ActiveCare 2 participants may elect to remain on the plan, no new enrollments will be allowed. The deductibles for ActiveCare 1 HD and ActiveCare Select have increased as well as the out of pocket maximum. As a reminder, ActiveCare 1 HD & ActiveCare 2 have In Network and Out of Network Deductibles. For more info on plan design changes for all TRS ActiveCare plans, please visit www.trsactivecareaetna.com.

Don’t Forget! • •

• •

Login and complete your supplemental benefit enrollment from 07/22/2019 - 08/23/2019 Enrollment assistance is available by calling Financial Benefit Services at 866-914-5202 to speak to an enrollment representative Monday-Thursday, 8AM-5:30PM & Friday 8AM-3PM. Bilingual assistance is available! Update your profile information: home address, phone numbers, email. IMPORTANT!! Due to the Affordable Care Act (ACA) reporting requirements, please add your dependent’s social security numbers and date of birth in the HUB. If you have questions, please contact your Benefits Administrator.

SUMMARY PAGES

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

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

CHANGES IN STATUS (CIS):

QUALIFYING EVENTS

Marital Status

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

Change in Number of Tax Dependents

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

Change in Status of Employment Affecting Coverage Eligibility

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

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

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

SUMMARY PAGES

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

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your school

Changes are not permitted during the plan year (outside of

district’s benefit website: www.region11bc.com. Click on your

annual enrollment) unless a Section 125 qualifying event occurs.

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

•

Changes, additions or drops may be made only during the

Benefits and Forms section.

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

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

Go to the ESC Region 11 EBC benefit website: www.region11bc.com. Click on your district, then click on the

included in the dependent profile. Additionally, you must

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

notify your employer of any discrepancy in personal and/or

can find provider search links under the Quick Links section.

benefit information. When will I receive ID cards?

•

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

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

New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

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

time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 15 or more

Dependent Eligibility: You can cover eligible dependent

regularly scheduled hours each work week.

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

Eligible employees must be actively at work on the plan effective

maximum age listed below. Dependents cannot be double

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

covered by married spouses within ESC Region 11 EBC or as

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

both employees and dependents.

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

your new benefits. PLAN

CARRIER

MAXIMUM AGE

Medical

Aetna

Medical

Scott & White HMO

Dental

Cigna

Vision

Superior Vision

Cancer

American Public Life

Accident

VOYA

Voluntary Term Life/AD&D

UNUM

ID Theft Protection

ID Watchdog

Hospital Indemnity

Aetna

Telehealth

MDLIVE

Flexible Spending Account

National Benefit Services

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

Health Savings Account

EECU

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

Emergency Medical Transportation

MASA

Through 26

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

HSA and FSA Plan Availability

SUMMARY PAGES

Employees of the following districts may participate in either the HSA or FSA, but not both: Alvord ISD

Erath Excels Academy

Palo Pinto ISD

Argyle ISD

Garner ISD

Ponder ISD

Arlington Classics Academy

Gainesville ISD

Poolville ISD

Bonham ISD

Gateway Charter

Santo ISD

Bluff Dale ISD

Graford ISD

Sivells Bend ISD

Callisburg ISD

Huckabay ISD

Stephenville ISD

Brock ISD

Lake Dallas ISD

Three Way ISD

Chico ISD

Lingleville ISD

Trinity Basin Preparatory

CityScape Schools

Little Elm ISD

Trivium Academy

Decatur ISD

Maypearl ISD

UME Prepatory

East Fort Worth Montessori Education Center International Academy

Morgan Mill ISD

Valley View ISD

Muenster ISD

Van Alstyne ISD

Palmer ISD

Whitesboro ISD

Are you currently enrolled in an FSA? Do you want to elect an HSA next year? Just keep in mind, if you choose to waive the FSA and enroll in the HSA (and have funds under $500 remaining in FSA), those funds are not eligible for rollover and are forfeited.

Employees of the following districts may enroll in both the HSA and FSA where FSA becomes a limited expense account*: Era ISD Evolution Academy Lindsay ISD Lipan ISD Treetops International *If your district offers this FSA, then you are only eligible to use funds towards dental, vision, and preventative care expenses.

Selected districts have elected to offer their employees a $500 rollover for unused funds. These funds can roll into the next plan year. Check with your benefit admin to see if this applies to you. Selected districts have elected to offer a 75-day grace period that you can use funds from the prior plan year up to 75 days after the plan ends. If you have additional questions about the differences between the limited and unlimited FSA plans, please call (800)274-0503. 10

SUMMARY PAGES

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

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

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source Account Owner Underlying Insurance Requirement

Employee and/or employer Individual

Employee and/or employer Employer

High deductible health plan

None

Description

Minimum Deductible Maximum Contribution

$1,350 single (2019) $2,700 family (2019) $3,500 single (2019) $7,000 family (2019)

N/A Varies per employer

Permissible Use Of Funds

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

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

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

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

Not permitted

Year-to-year rollover of account balance?

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

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

Does the account earn interest?

Yes

Portable?

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

FLIP TO FOR HSA INFORMATION

PG. 24

FLIP TO FOR FSA INFORMATION

PG. 22 11

Helpful Definitions

SUMMARY PAGES

Actively at Work

In-Network

You are performing your regular occupation for the employer

Doctors, hospitals, optometrists, dentists and other providers

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

who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2019 please notify your benefits administrator.

Annual Enrollment The period during which existing employees are given the

opportunity to enroll in or change their current elections.

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

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

Plan Year 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).

ESC Region 11 EBC Rates

SUMMARY PAGES

Plan Year September 1, 2019 - August 31, 2020

CIGNA DENTAL

NBS FLEXIBLE SPENDING ACCOUNT

High PPO

Healthcare Reimbursement Maximum: $2,700 Dependent Care Reimbursement Maximum: $2,500 or $5,000 (Dependent Care Maximum is based on marital/tax filing status.)

Employee Only Employee + Spouse Employee + Children Employee + Family

$33.69 $70.20 $76.38 $113.72

EECU HEALTH SAVINGS ACCOUNT Employee Only Maximum Family Maximum

MAC Plan Employee Only Employee + Spouse Employee + Children Employee + Family

$25.64 $51.31 $53.87 $82.43

AETNA HOSPITAL INDEMNITY Employee Only Employee + Spouse Single Parent Family Family

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

$12.78 $20.21 $27.71 $32.91

Employee Only Employee + Family

High Plan Employee Only Single Parent Fam. Family

Employee Only Single Parent Fam. Family

$19.60 $27.30 $35.90

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

Employee Only Single Parent Fam. Family

$35.70 $49.10 $63.50

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

$12.20 $19.00 $19.90 $26.70

ONEAMERICA LONG-TERM DISABILITY Percentage of Salary Elimination Period 0/7 14 / 14 30 / 30 60 / 60 90 / 90 180 / 180

45% $2.24 $1.89 $1.62 $1.29 $0.73 $0.51

55% $2.43 $2.06 $1.76 $1.41 $0.80 $0.56

Rates shown are per $100 of benefit

$8.00 $16.00

UNUM TERM LIFE/AD&D

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

Plan 3 $19.36 $45.12 $30.06 $51.86

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

AMERICAN PUBLIC LIFE CANCER Employee Only Single Parent Fam. Family

Plan 2 $8.99 $25.18 $15.47 $28.81

MDLIVE TELEHEALTH

$8.86 $15.09 $15.97 $23.95

Low Plan

Plan 1* $0.00 $7.10 $2.68 $8.34

*Only available to employer paid groups

SUPERIOR VISION Employee Only Employee + Spouse Employee + Children Employee + Family

$3,500 $7,000

65% $2.70 $2.28 $1.95 $1.56 $0.89 $0.62

Voluntary Term Life Employee Guarantee Issue: $230,000 Spouse Guarantee Issue: $50,000 Child Guarantee Issue: $10,000 Employee and Spouse Rates per $10,000 0-30 $0.45 31-34 $0.60 35-39 $0.70 40-44 $0.80 45-49 $1.20 50-54 $2.00 55-59 $3.30 60-64 $5.10 Children $5,000 $0.90 $10,000 $1.80 AD&D Rates per $10,000 Employee Only $0.40 Family $0.70

ID WATCHDOG IDENTITY THEFT PROTECTION Employee Only Employee + Family

1B Plan $7.95 $14.95

Platinum Plan $11.95 $22.95

MASA EMERGENCY MEDICAL TRANSPORTATION Employee + Family

Emergent Plus $14.00

Platinum $39.00

AETNA

Medical

YOUR BENEFITS PACKAGE

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

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

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

ESC Region 11 EBC Plan Year September 1, 2019â&#x20AC;&#x201D;August 31, 2020

TRS Medical Insurance These rates do NOT include state and employer contributions. Monthly (12 pay)

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

ActiveCare 1-HD

ActiveCare Select

ActiveCare 2

Scott & White HMO

FirstCare

$378.00

$556.00

$852.00

$558.54

$560.50

$1,066.00

$1,367.00

$2,020.00

$1,306.58

$1,416.52

$722.00

$902.00

$1,267.00

$876.76

$892.16

$1,415.00

$1,718.00

$2,389.00

$1,457.28

$1,454.80

2019 – 20 TRS-ActiveCare Plan Highlights Effective Sept. 1, 2019 through Aug. 31, 2020 | In-Network Level of Benefits1 TRS-ActiveCare 1-HD

TRS-ActiveCare Select or TRS-ActiveCare Select Whole Health

TRS-ActiveCare 2

(Baptist Health System and HealthTexas Medical Group; Baylor Scott and White Quality Alliance; Kelsey Select; Memorial Hermann Accountable Care Network; Seton Health Alliance)

NOTE: If you’re currently enrolled in TRSActiveCare 2, you can remain in this plan. However, as of Sept. 1, 2018, TRS-ActiveCare 2 is closed to new enrollees.

$500 copay per visit plus 20% after deductible

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 Facility Charges Only (preauthorization required) In-Network

Out-of-Network

Urgent Care 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 (only covered if performed at an 10Q facility) Physician charges; Participant pays Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist)Participant pays Annual Hearing Examination Participant pays Preventive Care Some examples of preventive care frequency and services: • • • •

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 – one every 10 years age 50 and over Healthy diet/obesity counseling – unlimited to age 22; age 22 and over – 26 visits per 12 months Well woman exam & pap smear – annually age 18 and over

• •

Prostate cancer screening – one per year age 50 and over Breastfeeding support – six lactation counseling visits per 12 months

Note: Covered services under this benefit must be billed by the provider as “preventive care.” Non-network preventive care is not paid at 100%. If you receive preventive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the TRS-ActiveCare 1-HD and TRS-ActiveCare 2. There is no coverage for non-network services under the TRS-ActiveCare Select plan or TRS-ActiveCare Select Whole Health. For more information, please view the Benefits Booklet at www.trsactivecareaetna.com. TRS-ActiveCare is 16administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered by Caremark

2019 – 20 TRS-ActiveCare Plan Highlights TRS-ActiveCare 1-HD

TRS-ActiveCare Select or ActiveCare Select Whole Health

TRS- ActiveCare 2

(Baptist Health System and HealthTexas Medical Group; Baylor Scott and White Quality Alliance; Kelsey Select; Memorial Hermann Accountable Care Network; Seton Health Alliance)

NOTE: If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan. However, as of Sept. 1, 2018, TRS-ActiveCare 2 is closed to new enrollees.

Drug Deductible Short-Term Supply at a Retail Location 20% coinsurance after deductible, except for certain generic preventive $15 copay drugs that are covered at 100%.2 3 25% coinsurance after deductible 25% coinsurance (min. $404; max. $80)3 3 50% coinsurance after deductible 50% coinsurance3 Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to 90-day supply)5 20% coinsurance after deductible $45 copay 25% coinsurance after deductible3 25% coinsurance (min. $1054; max. $210)3 3 50% coinsurance after deductible 50% coinsurance3 Specialty Medications (up to a 31-day supply)

$20 copay 25% coinsurance (min. $404; max. $80)3 50% coinsurance (min. $1004; max. $200)3 $45 copay 25% coinsurance (min. $1054; max. $210)3 50% coinsurance (min. $2154; max. $430)3 20% coinsurance (min. $2004 , max $900)

Specialty Medications

20% coinsurance after deductible 20% coinsurance Short-Term Supply of a Maintenance Medication at Retail Location up to a 31-day supply

The second time a participant fills a short-term supply of a maintenance medication at a retail pharmacy, they will be charged the coinsurance and copays in the rows below. Participants can save more over the plan year by filling a larger day supply of a maintenance medication through mail order or at a Retail-Plus location.

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

20% coinsurance after deductible 25% coinsurance after deductible3 50% coinsurance after deductible3

$30 copay 25% coinsurance (min. $604; max. $120)3 50% coinsurance3

$35 copay 25% coinsurance (min. $604; max. $120)3 50% coinsurance (min. $1054; max. $210)3

What is a maintenance medication? Maintenance medications 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 $15, then you will pay $30 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 $180 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 TRS-ActiveCare Select or TRS-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 TRS-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.

Monthly Premiums

Full monthly premium*

Premium with min. state/ district contribution**

$378

+Spouse +Children +Family

Individual

Your Monthly Premium***

Full monthly premium*

Premium with min. state/ district contribution**

$153

$556

$1,066

$841

$722

$497

$1,415

$1,190

Your Monthly Premium***

Full monthly premium*

Premium with min. state/ district contribution**

$331

$852

$627

$1,367

$1,142

$2,020

$1,795

$902

$677

$1,267

$1,042

$1,718

$1,493

$2,389

$2,164

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 may 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. 17

2019-2020 TRS-FirstCare Plan Highlights Plan Summary 2019 -2020 Medical Plan Year Deductible Out-of-Pocket Maximum (includes medical & drug deductibles, copayments & coinsurance) Annual Maximum

$950 Individual; $2,850 Family $7,450 Individual; $14,900 Family Unlimited

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

$20 copayment

PCP Office Visit-Dependents, through age 19

$0 copayment

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

$70 copayment

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

No copayment

Surgical Procedures Performed in the Physician's Office Urgent Care

25% coinsurance1 $50 copayment

Emergency Room

$500 copayment1

Ambulance Air/Ground

25% coinsurance1

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

25% coinsurance1

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

25% coinsurance1

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

$250 copayment1

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

25% coinsurance1

Home Health Care Limited to 60 visits per plan year

25% coinsurance1

Hospice Care

25% coinsurance1

Skilled Nursing Facility Limited to 30 days per plan year

25% coinsurance1

Accidental Dental Care

25% coinsurance1

Durable Medical Equipment

25% coinsurance1

All Other Covered Services

25% coinsurance1

Prescription Drug Plan Year Deductible

$150 Per Individual

Participating Retail Pharmacy (Standard drugs/30-day supply) • ACA Preventative • Preferred Generic • Preferred Brand • Non-preferred Brand/Non-preferred Generics • Specialty Medications Tier 1 and 2 Tier 3

$0 copayment $5 copayment 30% coinsurance2 50% coinsurance2 15% coinsurance2 25% coinsurance2

Maintenance (up to 90-day supply at BSW pharmacies, in-network retail, and mail order for maintenance eligible drugs) • • • • 1 2

$0 copayment $12.50 copayment 30% coinsurance2 50% coinsurance2

ACA Preventative Preferred Generic Preferred Brand Non-preferred Brand/Non-preferred Generics

Subject to medical deductible Subject to prescription drug deductible

Gross Monthly Cost for Coverage Effective September 1, 2019 - August 31, 2020 Coverage Category Employee only Employee and spouse Employee and child(ren) Employee and family

Total Cost* $560.50 $1,416.52 $892.16 $1,454.80

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

2019-2020 Scott & White Health Plan Highlights Summary of Benefits for TRS-ActiveCare Fully Covered Health Care Services

Home Health Services

Preventive Services

No Charge

Home Healthcare Visit

Standard Lab and X-Ray

No Charge

Worldwide Emergency Care

Disease Management and Complex Case Management

No Charge

Nurse Advice Line

Well Child Care Annual Exams

No Charge

Online Services

Immunizations (age appropriate)

No Charge

After-Hours Primary Care Clinics

$70 copay

1-877-505-7947 No Charge â&#x20AC;&#x201D; go to trs.swhp.org $20 copay

Plan Provisions Annual Deductible

$950 Individual/ $2,850 Family

Annual out-of-pocket maximum

$7,450 Individual/ $14,900 Family

(including medical and prescription copays and coinsurance)

(includes combined Medical and Rx copays, deductibles and coinsurance)

Lifetime Paid Benefit Maximum

None

Primary Care1

$20 copay (First Primary Care Visit for Illness - $0 Copay2) / $0 Copay for primary visit for dependents age 19 and under)

Specialty Care

$70 copay

Other Outpatient Services

20% after deductible3

Diagnostic/Radiology Procedures

20% after deductible

Eye Exam (one annually) Allergy Serum & Injections Outpatient Surgery

No Charge 20% after deductible $150 copay and 20% of charges after deductible

$500 copay after deductible

Urgent Care Facility

$50 copay

Annual Benefit Maximum

Prenatal Care

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

Inpatient Delivery

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

$150 per day4 and 20% of charges after deductible

Diagnostic & Therapeutic Services Physical and Speech Therapy 5

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

Equipment and Supplies Preferred Diabetic Supplies and Equipment

$5/$12.50 copay; no deductible

Non-Preferred Diabetic Supplies and Equipment

30% after Rx deductible

Durable Medical Equipment/ Prosthetics

20% after deductible

Unlimited

Rx Deductible

$150

Does not apply to preferred generic drugs

Ask an SWHP Pharmacy Retail Quantity representative how to (Up to a 30-day supply) save money on your prescriptions. Preferred Generic Preferred Brand Non-Preferred

Maternity Care

Emergency Room6

Prescription Drugs

Outpatient Services

Manipulative Therapy

$40 copay and 20% of charges after deductible

Ambulance and Helicopter

$5 copay 30% after Rx deductible 50% after Rx deductible

Online Refills Mail Order

(Up to a 90-day supply) Available at BSW Pharmacies, in-network retail pharmacies and mail order

$12.50 copay 30% after Rx deductible 50% after Rx deductible trs.swhp.org

BSWH: 1-817-388-3090 OptumRx: 1-855-205-9182

Specialty Medications (Up to a 30-day supply)

Maintenance Quantity

Copay Tier 1: 15% after Rx deductible Tier 2: 15% after Rx deductible Tier 3: 25% after Rx deductible

The SWHP MOMS Program provides you with specialized nurses who are notified of the delivery of your baby. These licensed professionals will contact you after you return home and help you with everything from the general well-being of both you and your baby, to breast/bottle feeding, to information on how to add your baby to your health plan. 1 Including all services billed with office visit 2 Does not apply to wellness or preventive visits 3 Includes other services, treatments, or procedures received at time 4 $750 maximum copay per admission and 20% after deductible 5 35 maximum visits per year 6

Copay waived if admitted within 24 hours

of office visit

TRS - Scott & White Health Plan Service Area

NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

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

FLIP TOâ&#x20AC;Ś FOR HSA INFORMATION

PG. 11

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 22 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 11 EBC Benefits Website: www.region11bc.com

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

How does a Flexible Spending Account Benefit Me?

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

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

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

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

What Can I Use My Flexible Spending Account On?

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

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

How Do I File a Claim?

A few examples are listed below:

Health Care Expense Account Example Expenses: • • • • • • • • • •

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

• • • • • • • • •

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

How Do I View My Account Balance? Go to: http://my.nbsbenefits.com

New User? Create a username and password. Employee ID: Please enter your Social Security Number Employer ID: Contact your benefits administrator for your districts Employer ID.

Dependent Care Expense Account Example Expenses: • • • •

Before and After School and/or Extended Day Programs The actual care of the dependent in your home Preschool tuition The base costs for day camps or similar programs used as care for a qualifying individual 23

EECU

HSA (Health Savings Account)

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.

YOUR BENEFITS PACKAGE

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 This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 24 details on covered expenses, limitations areWebsite: includedwww.region11bc.com in the summary plan description located on the ESC Regionand 11 exclusions EBC Benefits ESC Region 11 EBC Benefits Website: www.region11bc.com

HSA (Health Savings Account) What is an HSA?

How to Use Your Funds

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

•

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

•

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

EECU HSA Benefits •

•

Save money tax-free for healthcare expenses – contributions are not subject to federal income taxes and can be made by • you, your employer or a third party* • No monthly service fee – so you can save more and earn more • Earn competitive dividends on your entire balance – Save your receipts – for all qualified medical expenses. compounded daily and paid monthly from deposit to EECU does not verify eligibility. You are responsible for withdrawal making sure payments are for qualified medical expenses. • Conveniently pay for qualified healthcare expenses – with a free, no annual fee EECU HSA Debit Mastercard® or via EECU’s free online bill pay. (HSA checks are also available How To Manage Your Account upon request, for a nominal fee**) • Online - check your balance, pay healthcare providers and • Free online, mobile and branch access – allows you to arrange deposits; sign-up for online banking at actively manage your account however you prefer www.eecu.org. • Comprehensive service and support – to assist you in • Mobile - EECU’s mobile app allows you to manage your optimizing your healthcare saving and spending account on the go; download “EECU Mobile Banking” in • Federally insured – to at least $250,000 by NCUA Apple’s App Store and Google Play. • Contact Member Service – call 817-882-0800 for help with 2019 Annual HSA Contribution Limits your HSA questions or transactions. You can also chat with Individual: $3,500 us online at eecu.org or use our secure email. Member Family: $7,000 Service is available Monday through Friday from 8:00am – Catch-Up Contributions: Accountholders who meet the 7:00pm CT, Saturdays from 9am – 1pm CT and closed on qualifications noted below are eligible to make an HSA Sunday. catch-up contribution of an additional $1,000. • Account Statements – monthly statements show all your • Health Savings accountholder account activity for that period. You can receive free online • Age 55 or older (regardless of when in the year an statements or pay $2 per printed statement. accountholder turns 55) * Contributions, investment earnings, and distributions are tax free for federal tax purposes if • Not enrolled in Medicare (if an accountholder enrolls in used to pay for qualified medical expenses, and may or may not be subject to state taxation. Medicare mid-year, catch-up contributions should be A list of Eligible Medical Expenses can be found in IRS Publication 502, http://www.irs.gov/ pub/irs-pdf/p502.pdf. As described in IRS publication 969, http://www.irs.gov/pub/irs-pdf/ prorated) p969.pdf, certain over-the-counter medications (when prescribed by a doctor) are Authorized Signers who are 55 or older must have their own considered eligible medical expenses for HSA purposes. If an individual is 65 or older, there is no penalty to withdraw HSA funds. However, income taxes will apply if the distribution is not HSA in order to make the catch-up contribution used for qualified medical expenses. For more information consult a tax adviser or your state department of revenue. All contributions and distributions are your responsibility and must be within IRS regulatory limits. ** Call 817-882-0800 or stop-by an EECU branch to order standard checks at no charge (excludes shipping and handling) or order custom checks - prices vary.

AETNA YOUR BENEFITS PACKAGE

Hospital Indemnity

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

The median hospital costs per stay have steadily grown to over $10,500 per day.

$9,600

$10,400

$10,700

2008

2012

2018

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 26 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 11 EBC Benefits Website: www.region11bc.com

Hospital Indemnity Extra coverage to help pay for the unexpected!

Aetna’s simplified online claims process

For medical costs or everyday living expenses Medical plans help you pay for covered out-of-pocket costs when you’re in the hospital. But they don’t cover all expenses. For a little help paying these other costs, there’s the Aetna Hospital Indemnity Plan. You can use it to cover your deductible and coinsurance costs. Or for things like a mortgage, child care or utility bills.

If you are an Aetna medical plan member, we can retrieve your medical information to process your Hospital Indemnity claim. Here’s how it works.

More features you’ll like • • • •

It's affordable and you won't be turned down for health reasons. Covered benefits include payments for planned and unplanned events. Payments are made directly to you. Your premium payments can be made through payroll deductions at work.

Why is a Hospital Indemnity plan important?

Covered benefits Submit your Hospital Indemnity claim using the online claim form Our system matches this claim to your medical claim and retrieves the necessary medical information Your Hospital Indemnity claim is processed

Payments are sent directly to you Not an Aetna medical plan member? Just upload your medical paperwork when submitting your claim.

Here's How: 1. Go to myaetnasupplemental.com. 2. Click the "Create a new claim" button, answer a few quick questions, and submit. Your payment for covered services will be on the way. That’s all there is to it! Claims can be completed online at myaetnasupplemental.com or printed and mailed to: Aetna Voluntary Plans, PO Box 14079, Lexington, KY 405124079.

63% Of Americans Don't Have Enough Savings To Cover A $500 Emergency3 ¹American Hospital Association. Fast Facts on US Hospitals 2017. Article online. Available at: http://www.aha.org/research/rc/stat-studies/fast-facts.shtml. Accessed March 16, 2017. 2 The Kaiser Family Foundation, Health Research & Educational Trust. 2014 Employer Health Benefits Survey. September 10, 2014. 3Americans Don't Have Enough Savings To Cover A $500 Emergency. Article online. January 6, 2016. Available at: https://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-ofamericans-dont-have-enough-savings-to-cover-a-500emergency/#3d59d4cd4e0d. Accessed March 2017.

THIS PLAN DOES NOT COUNT AS MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT. THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL TAX PAYMENT BY EMPLOYEES. This plan provides limited benefits. The benefit payments are not intended to cover the full cost of medical care. Members are responsible for making sure the providers’ bills get paid. These benefits are paid in addition to any other health coverage members may have. Health insurance plans are offered and/or underwritten by Aetna Life Insurance Company (Aetna). This material is for information only. Health insurance plans contain exclusions and limitations. Not all health services are covered, and coverage is subject to applicable laws and regulations, including economic and trade sanctions. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features, rates, eligibility and availability may vary by location and are subject to change. Aetna does not provide care or guarantee access to health services. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com. Policy form numbers issued in Oklahoma and Missouri include: AL VOL HPOL-Hosp 01 and AL VOL HCOC-Hosp 01. 27

Hospital Indemnity BENEFIT SUMMARY ESC Region 11 Employee Benefits Cooperative 802465 Aetna Hospital Indemnity Insurance plans are underwritten by Aetna Life Insurance Company. Unless otherwise indicated, all benefits and limitations are per covered person. The Aetna Hospital Indemnity Plan is a hospital confinement indemnity plan with other fixed indemnity benefits. THESE PLANS DO NOT COUNT AS MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT. THESE PLANS ARE A SUPPLEMENT TO HEALTH INSURANCE AND ARE NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. These plans provide limited benefits. They pay fixed dollar benefits for covered services without regard to the health care provider's actual charges. These benefit payments are not intended to cover the full cost of medical care. You are responsible for making sure the provider's bills get paid. These benefits are paid in addition to any other health coverage you may have. THIS IS NOT A MEDICARE SUPPLEMENT (MEDIGAP) PLAN. If you are or will become eligible for Medicare, review the free Guide to Health Insurance for People with Medicare available at www.medicare.gov. This policy, alone, does not meet Massachusetts Minimum Creditable Coverage standards.

Inpatient Stays Covered Benefit Hospital stay - Admission Provides a lump sum benefit for the initial day of your stay in a hospital. Maximum 1 stay per plan year Hospital stay - Daily Pays a daily benefit, beginning on day two of your stay in a non-ICU room of a hospital. Maximum 30 days per plan year Hospital stay - (ICU) Daily Pays a daily benefit, beginning on day two of your stay in an ICU room of a hospital. Maximum 30 days per plan year

Plan 1

Plan 2

$500

$1,000 $2,000

$100

Exclusions and Limitations: This plan has exclusions and limitations. Refer to the actual policy and certificate to determine which benefits are not payable. The following is a partial list of services and supplies that are generally not covered. However, the plan may contain exceptions to this list based on state mandates or the plan design purchased. Benefits will not be paid for any stay or other service for an illness or accidental injury related to the following:

• Any semi-professional or professional competitive athletic contest, including officiating or coaching, for which you receive any payment • Act of war, riot, war • Operating, learning to operate or serving as a pilot or crew member of any aircraft, whether motorized or not

$200

• Assault, felony, illegal occupation, or other criminal act • Care provided by a spouse, parent, child, sibling or any other household member • Cosmetic services and plastic surgery, with certain exceptions

$100

$200

• Custodial Care • Hospice services, except as specifically provided in the Benefits under your plan section of the certificate • Self-harm, suicide, except when resulting from a diagnosed disorder

$100

$200

Important Note: All daily inpatient stay benefits begin on day two and count toward the plan year maximum. 28

Waiver of premium: If you are in a hospital for more than 30 days in a row, we will waive the premium beginning on the first premium due date that occurs after the 30th day of your stay, through the next 6 months of coverage. During your stay, you must remain employed with the policyholder.

• Certain competitive or recreational activities, including but not limited to: ballooning, bungee jumping, parachuting, skydiving

Newborn routine care Provides a lump-sum benefit after $100 the birth of your newborn. This will not pay for an outpatient birth. Observation unit Provides a lump sum benefit for the initial day of your stay in an observation unit as the result of an illness or accidental injury. Maximum 1 day per plan year

Plan 3

Portability: Your plan includes a Portability option which allows you to keep your existing coverage by making direct payments to the carrier. You may exercise this option, if your employment ceases for any reason. Refer to your Certificate for additional Portability provisions.

• Violating any cellular device use laws of the state in which the accident occurred, while operating a motor vehicle • Care or services received outside the United States or its territories • Education, training or retraining services or testing • Mental disorders

Hospital Indemnity • Treatment of substance abuse in a hospital or substance abuse What should I do in case of an emergency? treatment facility In case of emergency, call 911 or your local emergency hotline, or go directly to an emergency care facility. • Accidental injury sustained while intoxicated or under the influence of any drug intoxicant What if I don’t understand something I’ve read here, or have • Exams except as specifically provided in the Benefits under more questions? your plan section of the certificate Please call us. We want you to understand these benefits before • Dental and orthodontic care and treatment you decide to enroll. You may reach one ofour Customer Service • Family planning services representatives Monday through Friday, 8 a.m. to 6 p.m., by • Any care, prescription drugs, and medicines related to calling 1-800-607-3366. We’re here to answer questions before infertility and after you enroll. • Nutritional supplements, including but not limited to: food items, infant formulas, vitamins • •

Outpatient cognitive rehabilitation, physical therapy, occupational therapy, or speech therapy for any reason Vision-related care

Questions and Answers Do I have to be actively at work to enroll in coverage? Yes, you must be actively at work in order to enroll and for coverage to take effect. You are actively at work if you are working, or are available to work, and meet the criteria set by your employer to be eligible to enroll. Can I enroll in the Aetna Hospital Indemnity plan even though I have a Health Savings Account (HSA)? Yes, you can still enroll in the Aetna Hospital Indemnity plan if you have a Health Savings Account.

Important information about your benefits IN ORDER FOR THE HOSPITAL INDEMNITY BENEFITS TO BE PAYABLE, THE INITIAL DAY OF YOUR STAY AND OTHER SERVICES MUST BE ON OR AFTER YOUR EFFECTIVE DATE OF COVERAGE. Complaints and appeals Please tell us if you are not satisfied with a response you received from us or with how we do business. Call Member Services to file a verbal complaint or to ask for the address to mail a written complaint. You can also e-mail Member Services through the secure member website. If you’re not satisfied after talking to a Member Services representative, you can ask us to send your issue to the appropriate department. If you don’t agree with a denied claim, you can file an appeal. To file an appeal, follow the directions in the letter or explanation of benefits statement that explains that your claim was denied. The letter also tells you what we need from you and how soon we will respond.

What is considered a hospital stay?

We protect your privacy

A stay is a period during which you are admitted as an inpatient; and are confined in a hospital or non-hospital residential facility; and are charged for room, board and general nursing services. A stay does not include time in the hospital because of custodial or personal needs that do not require medical skills or training. A stay specifically excludes time in the hospital for observation or in the emergency room unless this leads to a stay.

We consider personal information to be private. Our policies protect your personal information from unlawful use. By “personal information,” we mean information that can identify you as a person, as well as your financial and health information. Personal information does not include what is available to the public. For example, anyone can access information about what the plan covers. It also does not include reports that do not identify you.

If I lose my employment, can I take the Hospital Indemnity Plan with me? Yes, you are able to continue coverage under the Portability provision. You will need to pay premiums directly to Aetna. How do I file a claim?

Go to www.myaetnasupplemental.com and either “Log In” or “Register”, depending on if you’ve set up your account. Click the “Create a new claim” button and answer a few quick questions. You can even save your claim to finish later. You can also print/ mail in form(s) to: Aetna Voluntary Plans, PO Box 14079, Lexington, KY 40512- 4079, or you can ask us to mail you a printed form.

When necessary for your care or treatment, the operation of our health plans or other related activities, we use personal information within our company, share it with our affiliates and may disclose it to: your doctors, dentists, pharmacies, hospitals and other caregivers, other insurers, vendors, government departments and third-party administrators (TPAs).

We obtain information from many different sources — particularly you, your employer or benefits plan sponsor if applicable, other insurers, health maintenance organizations or TPAs, and health care providers. These parties are required to keep your information private as required by law. Some of the ways in which we may use your information include: Paying claims, making decisions about what 29

Hospital Indemnity the plan covers, coordination of payments with other insurers, quality assessment, activities to improve our plans and audits.

We consider these activities key for the operation of our plans. When allowed by law, we use and disclose your personal information in the ways explained above without your permission. Our privacy notice includes a complete explanation of the ways we use and disclose your information. It also explains when we need your permission to use or disclose your information. We are required to give you access to your information. If you think there is something wrong or missing in your personal information, you can ask that it be changed. We must complete your request within a reasonable amount of time. If we don’t agree with the change, you can file an appeal. If you’d like a copy of our privacy notice, call 1-800-607-3366 or visit us at www.aetna.com. If you require language assistance, please call Member Services at 1-800-607-3366 and an Aetna representative will connect you with an interpreter. If you’re deaf or hard of hearing, use your TTY and dial 711 for the Telecommunications Relay Service. Once connected, please enter or provide the Aetna telephone number you’re calling.

Si usted necesita asistencia lingüística, por favor llame al Servicios al Miembro a 1-800-607-3366, y un representante de Aetna le conectará con un intérprete. Si usted es sordo o tiene problemas de audición, use su TTY y marcar 711 para el Servicio de Retransmisión de Telecomunicaciones (TRS). Una vez conectado, por favor entrar o proporcionar el número de teléfono de Aetna que está llamando. ATTENTION MASSACHUSETTS RESIDENTS: As of January 1, 2009, the Massachusetts Health Care Reform Law requires that Massachusetts residents, eighteen (18) years of age and older, must have health coverage that meets the Minimum Creditable Coverage standards set by the Commonwealth Health Insurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more information call the Connector at 1-877-MA-ENROLL (1877-623-6765) or visit the Connector website (www.mahealthconnector.org) . THIS POLICY, ALONE, DOES NOT MEET MINIMUM CREDITABLE COVERAGE STANDARDS. If you have questions about this notice, you may contact the Division of Insurance by calling 1-617-521-7794 or visiting its website at www.mass.gov/doi. Financial Sanctions Exclusions Clause

If coverage provided by this policy violates or will violate any US economic or trade sanctions, the coverage is immediately considered invalid. For example, Aetna companies cannot make payments or reimburse for health care or other claims or services if it violates a financial sanction regulation. This includes sanctions related to a blocked person or entity, or a country under sanction by the United States, unless permitted under a 30

valid written Office of Foreign Assets Control (OFAC) license. For more information on OFAC, visit http://www.treasury.gov/ resource-center/sanctions/Pages/default.aspx. Plans are underwritten by Aetna Life Insurance Company (Aetna). This material is for information only and is not an offer or invitation to contract. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com. Hospital Indemnity Policy forms issued in Idaho, Oklahoma and Missouri include: AL VOL HPOL-Hosp 01 and AL VOL HCOC-Hosp 01.

Hospital Indemnity Non-Discrimination Notice

Availability of Language Assistance Services

MDLIVE

Telehealth

About this Benefit Telehealth provides 24/7/365 access to boardcertified doctors via telephone consultations that can diagnose, recommend treatment and prescribe medication. Whether you are at home, traveling or at work, Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.

YOUR BENEFITS PACKAGE

75%

of all doctor, urgent care, and ER visits could be handled safely and effectively via telehealth.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 32 details on covered expenses, limitations areWebsite: includedwww.region11bc.com in the summary plan description located on the ESC Regionand 11 exclusions EBC Benefits ESC Region 11 EBC Benefits Website: www.region11bc.com

Telehealth When should I use MDLIVE?

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

What can be treated? • • • • • • • • •

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

Pediatric Care related to: • • • • • • •

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

How much does it cost? $8 for Employee Only. $16 for Family coverage. If you are an eligible employee in the following districts, this benefit is offered to you at no cost: Chico ISD CityScape Schools Garner ISD Huckabay ISD Lake Dallas ISD Palmer ISD Palo Pinto ISD Santo ISD Treetops School International Trinity Basin Preparatory Valley View ISD Van Alstyne ISD Westlake Academy Whitesboro ISD

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

Who are our doctors? MDLIVE has the nation’s largest network of telehealth doctors. On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.

Are children eligible? Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.

• • •

Access to a doctor anywhere: at home, at work, or on the go Choose doctors from one of the nation's largest telehealth networks Available 24/7 by video or phone Private, secure and confidential visits Connect instantly with MDLIVE Assist

Scan with your smartphone to get the app.

Call us at (888) 365-1663 or visit us at www.consultmdlive.com Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for 33 abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/terms-of-use/ 010113

CIGNA

Dental

YOUR BENEFITS PACKAGE

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 This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 34 details on covered expenses, limitations areWebsite: includedwww.region11bc.com in the summary plan description located on the ESC Regionand 11 exclusions EBC Benefits ESC Region 11 EBC Benefits Website: www.region11bc.com

Cigna Dental PPO - High Plan Monthly PPO Premiums Tier

Rate

EE Only

$33.69

EE + Spouse

$70.20

EE + Child(ren)

$76.38

Family Coverage

$113.72

Receiving regular dental care can not only catch minor problems before they become major and expensive to treat - it may even help improve your overall health. Gum disease is increasingly being linked to complications for pre-term birth, heart disease, stroke, diabetes, osteoporosis and other health issues. That’s why this dental plan includes Cigna Dental WellnessPlusSM features. When you or your family members receive any preventive care in one plan year, the annual dollar maximum will increase in the following plan year. When you or your family members remain enrolled in the plan and continue to receive preventive care, the annual dollar maximum will increase in the following plan year, until it reaches the level specified below. Please refer to your plan materials for additional information on this plan feature.

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

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

Annual Deductible Individual Family Reimbursement Levels**

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

$50 per person $150 per family

Based on Reduced Contracted Fees

Maximum Reimbursable Charge

Plan Pays

You Pay

Plan Pays

You Pay

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

100%

No Charge

100%

No Charge

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

70%*

30%*

70%*

30%*

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

40%*

60%*

40%*

60%*

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

50%

50% 35

Cigna Dental - MAC Plan Monthly PPO Premiums

Tier

Rate

EE Only

$25.64

EE + Spouse

$51.31

EE + Child(ren)

$53.87

Family Coverage

$82.43

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

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

Annual Deductible Individual Family Reimbursement Levels** Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Bitewing X-rays Fluoride Application Space Maintainers Class II - Basic Restorative Care Fillings Sealants Full Mouth X-rays Panoramic X-ray Periapical X-rays Emergency Care to Relieve Pain Root Canal Therapy/Endodontics Osseous Surgery Periodontal Scaling and Root Planning Brush Biopsies Oral Surgery Class III - Major Restorative Care Crowns/Bridges/Dentures Anesthetics Stainless Steel/Resin Crowns Surgical Extractions of Impacted Teeth Denture Repairs Denture Relines, Rebases and Adjustments Repairs to Bridges, Crowns and Inlays Inlays/Onlays Prosthesis Over Implant Class IV - Orthodontia 36

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

$50 per person No Limit

Based on Reduced Contracted Fees

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

Plan Pays

You Pay

100%

No Charge

100%

No Charge

80%*

20%*

80%*

20%*

50%*

Not Covered

100% of your dentist’s usual fees

Not Covered

100% of your dentist’s usual fees

Cigna Dental - High and MAC Plan Dependent/Student age limitation 26/26. Dental Network Savings Program(DNSP): Using an out-of-network dental health care professional will cost you more than using in-network care. You may be able to save some money on out-of-pocket expenses if you use a dental health care professional that participates in Cigna’s Dental Network Savings Program. Missing Tooth Limitation – The amount payable is 50% of the amount otherwise payable until insured for 12 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible. Dental Oral Health Integration Program (OHIP) - All dental customers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP)® is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides: 100% coverage for certain dental procedures, Guidance on behavioral issues related to oral health, Discounts on prescription and non-prescription dental products. For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees. # Increase contingent upon receiving Preventive Services in Plan Year 1 + Increase contingent upon receiving Preventive Services in Plan Years 1 and 2

Procedure

Exclusions and Limitations

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

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

Alternate Benefit

Benefit Exclusions • • • • • • • • • • • • • • • • • • • • • • • • •

Services performed primarily for cosmetic reasons Replacement of a lost or stolen appliance Replacement of a bridge or denture within five years following the date of its original installation Replacement of a bridge or denture which can be made useable according to accepted dental standards Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, diagnose or treat conditions of TMJ, stabilize periodontally involved teeth, or restore occlusion Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars Bite registrations; precision or semi-precision attachments; splinting A surgical implant of any type Instruction for plaque control, oral hygiene and diet Dental services that do not meet common dental standards Services that are deemed to be medical services Services and supplies received from a hospital Charges which the person is not legally required to pay Charges made by a hospital which performs services for the U.S. Government if the charges are directly related to a condition connected to a military service Experimental or investigational procedures and treatments Any injury resulting from, or in the course of, any employment for wage or profit Any sickness covered under any workers’ compensation or similar law Charges in excess of the reasonable and customary allowances To the extent that payment is unlawful where the person resides when the expenses are incurred; Procedures performed by a Dentist who is a member of the covered person’s family (covered person’s family is limited to a spouse, siblings, parents, children, grandparents, and the spouse’s siblings and parents); For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; To the extent that you or any of your Dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; To the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a “no fault” insurance law or an uninsured motorist insurance law. Cigna HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents. In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made 37 available by your Employer.

Dental - DHMO •

•

This Patient Charge Schedule applies only when covered dental services are performed by your Network Dentist, unless otherwise authorized by Cigna Dental as described in your plan documents. Not all Network Dentists perform all listed services and it is suggested to check with your Network Dentist in advance of receiving services. This Patient Charge Schedule applies to Specialty Care when an appropriate referral is made to a Network Specialty Periodontist or Oral Surgeon. You must verify with the Network Specialty Dentist that your treatment plan has been authorized for payment by Cigna Dental. Prior authorization is not required for specialty referrals for Pediatric, Orthodontic and Endodontic services. You may select a Network Pediatric Dentist for your child under the age of 7 by calling Customer Service at 1.800.Cigna24 to get a list of Network Pediatric Dentists in your area. Coverage for treatment by a Pediatric Dentist ends on your child’s 7th birthday; however, exceptions for medical reasons may be considered on an individual basis. Your Network General Dentist will provide care upon your child’s 7th birthday.

DHMO Premiums

Tier

Rate

EE Only

$12.78

EE + Spouse

$20.21

EE + Children

$27.71

EE + Family

$32.91

•

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

•

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

•

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

•

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

•

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

•

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

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

Procedure Description

Member Pays

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

$ 5.00

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

Code

Procedure Description

Member Pays

Diagnostic/preventive (cont.) D0145

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

$0.00

D0150

Comprehensive oral evaluation – New or established patient

$0.00

D0210

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

$0.00

D9310

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

$0.00

D0240

X-rays intraoral – Occlusal radiographic image

$0.00

D9430

Office visit for observation – No other services performed

$0.00

D0270

X-rays (bitewing) – Single radiographic image

$0.00

D0120

Periodic oral evaluation – Established patient

$0.00

D0330

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

$0.00

Limited oral evaluation – Problem focused

$0.00

D0431

Oral cancer screening using a special light source

$50.00

D0140

Dental - DHMO Code

Procedure Description

Member Pays

Diagnostic/preventive (cont.)

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

D1120

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

Code

Procedure Description

Member Pays

Periodontics (cont.) $0.00

D4341

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

$55.00

D4342

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

$30.00

D4910

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

$35.00

$41.00

$0.00 $30.00

D1206

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

$0.00

D1351

Sealant – Per tooth

$10.00

Restorative (fillings, including polishing) D2140

Amalgam – 1 surface, primary or permanent

$10.00

D2330

Resin-based composite – 1 surface, anterior

$15.00

D2390

Resin-based composite crown, anterior

$45.00

Crown and bridge – All charges for crowns and bridges (fixed partial dentures) are per unit (each replacement or supporting tooth equals 1 unit). Coverage for replacement of crowns and bridges is limited to 1 every 5 years. For single crowns, retainer (“abutment”) crowns, and pontics: The charges below include the cost of predominantly base metal alloy. You may be charged up to these additional amounts, based on the type of material the dentist uses for your restoration. • No more than $80.00 per tooth for any noble metal alloys • No more than $130.00 per tooth for any high noble metal alloys, titanium or titanium alloys • No more than $100.00 per tooth for any porcelain fused to metal (only on molar teeth) • Porcelain/ceramic substrate crowns on molar teeth are not covered D2740

Crown – Porcelain/ceramic substrate

$255.00

D2792

Crown – Full cast noble metal

$255.00

D2950

Core buildup – Including any pins

$80.00

Endodontics (root canal treatment, excluding final restorations) D3310

Anterior root canal – Permanent tooth (excluding final restoration)

$70.00

D3330

Molar root canal – Permanent tooth (excluding final restoration)

$280.00

Prosthetics (removable tooth replacement – dentures) includes up to 4 adjustments within first 6 months after insertion – Replacement limit 1 every 5 years. Characterization is considered an upgrade with maximum additional charge to the member of $200.00 per denture. D5110

Full upper denture

$275.00

D5120

Full lower denture

$275.00

D5211

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

$275.00

D5212

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

$275.00

Oral surgery (includes routine postoperative treatment) Surgical removal of impacted tooth – Not covered for ages below 15 unless pathology (disease) exists. D7111

Extraction of coronal remnants – Deciduous tooth

$10.00

D7140

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

$10.00

D7220

Removal of impacted tooth – Soft tissue

$40.00

D7240

Removal of impacted tooth – Completely bony

$115.00

Orthodontics (tooth movement) Orthodontic treatment (maximum benefit of 24 months of interceptive and/or comprehensive treatment. Atypical cases or cases beyond 24 months require an additional payment by the patient.) D8670

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

$1,800.00 $75.00

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

$2,400.00 $75.00

Periodontics (treatment of supporting tissues [gum and bone] of the teeth) periodontal regenerative procedures are limited to 1 regenerative procedure per site (or per tooth, if applicable), when covered on the Patient Charge Schedule. The relevant procedure codes are D4263, D4264, D4266 and D4267. Localized delivery of antimicrobial agents is limited to 8 teeth (or 8 sites, if applicable) per 12 consecutive months when covered on the Patient Charge Schedule. If your Network Dentist certifies to Cigna Dental that, due to medical necessity, you require certain Covered Services more frequently than the limitation allows, Cigna Dental will waive the applicable limitation. The relevant Covered Services are identified with a ❂. D4211

Gingivectomy or gingivoplasty – 1 to 3 teeth per quadrant

$60.00

D4240

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

$135.00 39

SUPERIOR VISION

Vision

YOUR BENEFITS PACKAGE

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 This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 40 details on covered expenses, limitations areWebsite: includedwww.region11bc.com in the summary plan description located on the ESC Regionand 11 exclusions EBC Benefits ESC Region 11 EBC Benefits Website: www.region11bc.com

Vision - Superior Select Southwest Network Benefits

In-Network

Out-of-Network

Exam Covered in full Up to $35 retail Frames $125 retail allowance Up to $70 retail Contact Lenses1 $150 retail allowance Up to $80 retail Medically Necessary Covered in full Up to $150 retail Contact Lenses Lasik Vision $200 allowance2 Correction

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

Monthly Premiums Emp. Only

$8.86

Emp. + Spouse

$15.09

Emp. + Child(ren)

$15.97

Emp. + Family

$23.95

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

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

Exam

$10

Materials

$10

Services/Frequency

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

Exam

12 months

Frame

12 months

Lenses

12 months

Contact Lenses

12 months

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

(Based on date of service)

Discount Features Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.

SuperiorVision.com Customer Service 800.507.3800

The Plan discount features are not insurance. All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan. Discounts are subject to change without notice. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions 41

ONEAMERICA YOUR BENEFITS PACKAGE

Disability

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 42 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 11 EBC Benefits Website: www.region11bc.com

Educator Disability What you need to know: • Are you eligible? Benefits are available to employees who are actively at work on the effective date of coverage and working the minimum number of hours per week stated in the contract. • Your premiums and benefits may vary. Actual premiums and benefit amounts will be calculated by OneAmerica and may change upon reaching certain ages, according to contract terms, and are subject to change. Volumes and benefit amounts shown may be subject to reductions due to age. • Enroll timely for guaranteed issue coverage. You may be eligible for coverage without having to answer any health questions if you enroll during the initial enrollment period when benefits are first offered by OneAmerica®, or if you enroll as a newly hired employee within 31 days after any applicable waiting period. • Enrolling later requires approval. If you decline coverage now, you will lose your only chance to apply for group insurance coverage without having to first undergo medical underwriting. If you decide to enroll later, you will need to submit a Statement of Insurability form for review. OneAmerica will then decide to approve or deny your coverage based on your health history. You may not be approved for any type of coverage at a later date if you have any current or future medical conditions. What you need to do: • Carefully review the contents of this packet. Enclosed is personal information about the benefits offered to you by OneAmerica on behalf of your employer. This is your opportunity to learn more about group insurance from OneAmerica, but it is not a complete explanation of benefits. For more information, consult the contract about exclusions, limitations, reduction of benefits, and terms under which the contract may be continued in force or discontinued. • Review the Notices and Limitations. Visit www.employeebenefits.aul.com to find the Notices and Limitations, G-14320 (05 NonPrudent) 12/28/12. Go to Forms, Policy/Employee Admin, and Notices and Limitations. • Submit your enrollment form. Please return your completed enrollment form to your employer. Note: Products issued and underwritten by American United Life Insurance Company® (AUL), a OneAmerica company. Not available in all states or may vary by state.

THE NEED FOR DISABILITY INSURANCE Protect your paycheck You insure your home, car and other valuable possessions, so why not also protect what pays for all those things? Your income. Without it, think about how your mortgage/rent, groceries or credit card bills would get paid. That’s where

disability insurance can help. A disability can happen to anyone at any time and it can last for a short or long period of time. Purchasing disability insurance through your workplace is a way to replace a portion of your pre-disability earnings if you get sick or hurt and are unable to work. Being prepared can help ease the financial burden for you. Things to think about A severe injury or illness can leave you unable to work for years. Workers’ compensation only covers injuries that happen on the job and, to qualify for coverage, you must meet certain eligibility requirements. Additionally, medical insurance will only help cover your medical costs. You might be able to dip into savings or borrow money from loved ones, but if you don’t have these options, can you really afford not to have disability insurance? Protect yourself and your income with disability insurance. Disability insurance can provide you with the income protection you need. Consider purchasing it today. Let’s figure it out Everyone’s circumstances are different. This calculator can help you figure out how much you need to protect your lifestyle and the lifestyles of those you love if you become disabled.

Estimate your essential monthly expenses Living expenses Monthly housing (e.g., mortgage, rent, insurance, taxes) Utilities (e.g., telephone, electricity, gas, oil, cable, TV, Internet) Food Transportation (e.g., car payments, gasoline, insurance) Subtotal = Debt expenses Education (e.g., tuition, books, supplies) Health care (e.g., out-of-pocket costs, insurance premiums) Debt payments (e.g., credit cards, other debt) Subtotal = Other expenses Dependent care Life insurance premiums Subtotal = Minimum monthly amount to cover with $ disability insurance

Amount

Educator Disability What you need to know about your Educator Disability Benefits Eligible Employees: This benefit is available for employees who are actively at work on the effective date and working a minimum of 15 hours per week. Flexible Choices: Since everyone's needs are different, these plans offer flexibility for you to choose a benefit option that fits your income replacement needs and budget. You are able to enroll and/or change plans during each scheduled enrollment. Guaranteed Issue: If you enroll timely, you may be eligible for coverage without having to answer any health questions. If you decline insurance coverage now and decide to enroll later, you may need to provide Evidence of Insurability. Timely Enrollment: Enrolling timely means you have enrolled during the initial enrollment period when benefits were first offered by AUL, or as a newly hired employee within 31 days following completion of any applicable waiting period. Portability: Should your coverage terminate, you may be eligible to take this disability insurance with you without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible. Waiver of Premium: If approved, this benefit waives your Disability insurance premium in case you become disabled and are unable to collect a paycheck. Total Disability: You are considered disabled if, because of injury or sickness, you cannot perform the material and substantial duties of any gainful occupation, you are not working in any occupation and are under the regular attendance of a physician for that injury or sickness. Partial Disability: You may be paid a partial disability benefit, if because of injury or sickness, you are unable to perform every material and substantial duty of any gainful occupation on a fulltime basis, are performing at least one of the material and substantial duties of any gainful occupation, or another occupation, on a full or part-time basis, and are earning less than 50% of your pre-disability earnings due to the same injury or sickness. Residual: The elimination period can be satisfied by total disability, partial disability, or a combination of both. Return to Work: You may be able to return to work for a specified time period without having your partial disability benefits reduced according to the contract. The Return to Work Benefit is offered up to a maximum of 24 months.

Integration: The method by which your benefit may be reduced by Other Income Benefits. Offset: An offset is an amount that reduces your benefit amount by amounts you receive from other sources for your disability and will be specified in the contract. 44

First Day Hospital: If a Person is Totally Disabled and hospital confined for 24 hours or more with room and board charges during the Elimination Period due to an Injury or Sickness resulting in a covered Disability, benefits are payable from the first day of that confinement. Applies to plans with Elimination Periods of 30 days or less. About Your Benefits: Educator Disability benefits are illustrated and paid on a monthly basis. Elimination Period: This is a period of consecutive days of disability before benefits may become payable under the contract. Maximum Benefit Duration: This is the length of time that you may be paid benefits if continuously disabled as outlined in the contract. Pre-Existing Condition Period: Certain disabilities are not covered if the cause of the disability is traceable to a condition existing prior to your effective date of coverage.

Educator Disability Options Elimination Period Option 1: 0 days / 7 days Option 2: 14 days / 14 days Option 3: 30 days / 30 days Option 4: 60 days /60 days Option 5: 90 days / 90 days Option 6: 180 days/180 days Maximum Benefit Duration Age When Total Disability Begins

Maximum Duration

Less than age 60

Greater of Social Security Full Retirement Age or to age 65

5 years

4 years

3.5 years

3Years

2.5 years

2 years

21 months

18 months

15 months

69 and over

12 months

Educator Disability

Monthly Rate Per $100 of Benefit 45% Benefit Option:

Option 1 0 days/ 7 days

Rate:

$2.24

55% Benefit Option:

Option 1 0 days / 7 days

Rate:

$2.43

65% Benefit Option:

Option 1 0 days / 7 days

Rate:

$2.70

Option 2 Option 3 Option 4 Option 5 Option 6 14 days / 14 days 30 days / 30 days 60 days / 60 days 90 days / 90 days 180 days / 180 days $1.89

$1.62

$1.29

$0.73

Option 2 Option 3 Option 4 Option 5 14 days / 14 days 30 days / 30 days 60 days / 60 days 90 days / 90 days $2.06

$1.76

$1.41

$0.80

Option 2 Option 3 Option 4 Option 5 14 days / 14 days 30 days / 30 days 60 days / 60 days 90 days / 90 days $2.28

$1.95

$1.56

$0.89

$0.51 Option 6 180 days/ 180 days $0.56 Option 6 180 days/ 180 days $0.62

OneAmericaÂ® is the marketing name for the companies of OneAmerica.

AMERICAN PUBLIC LIFE

Cancer

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.

YOUR BENEFITS PACKAGE

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 46 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 11 EBC Benefits Website: www.region11bc.com

American Public Life Group Cancer Plan (APL GC AP GC-3 5/1/06)- Region XI Employee Benefit Cooperative - with Continuation Rider This coverage is offered on a guarantee issue basis. However, no benefits are payable for any loss during the first year of a Covered Personâ&#x20AC;&#x2122;s coverage as the result of a Pre-Existing Specified Disease. A Pre-Existing Specified Disease is defined as one for which, within twelve (12) months prior to the Covered Personâ&#x20AC;&#x2122;s effective date of coverage, medical advice, consultation, or treatment, including prescribed medications, was recommended or received from a member of the medical profession, or for which symptoms manifested ins such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment. Benefit

Low Option Base Plan

High Option Base Plan

Radiation/Chemotherapy/Immunotherapy Hormone Therapy

$500/month of treatment $50/treatment; 12/year

$1500/month of treatment $50/treatment; 12/year

Surgical Schedule Anesthesia Reconstructive Surgery Skin Cancer

$1,600 Schedule; $15/unit 25% of schedule Included in schedule Included in schedule

$4,800 Schedule; $45/unit 25% of schedule Included in schedule Included in schedule

Hospital Confinement Government/Charity Hospital/HMO Ambulatory Surgical Facility

$100/day 1-90; $100/day 91+ in lieu of other benefits $100/day in lieu of other benefits $200/day

$300/day 1-90; $300/day 91+ in lieu of other benefits $300/day in lieu of other benefits $600/day

Drugs and Medicine - Inpatient Drugs and Medicine - Outpatient

$150/confinement $50/script; $50/month

$150/confinement $50/script; $150/month

Transportation and Lodging Patient Transportation Family Transportation Patient Lodging Family Lodging

$.50/mile up to 1,000 miles $.50/mile up to 1,000 miles $100/day up to 100 days/cal year (out) $100/day up to 100 days/cal year (in)

Blood and Plasma

$150/day; $7,500/cal year (50 days)

$250/day; $12,500/cal year (50 days)

Bone Marrow/Stem Cell Transplant autologous non-autologous for other type cancer Experimental Treatment Attending Physician Prosthesis - Surgical Prosthesis - hairpiece Dread Disease Hospice Care Private Nursing Ambulance - Ground Ambulance - Air Extended Care Home Health Care Second & Third Surgical Opinion Waiver of Premium Physical Therapy

$500/cal year $1,500/cal year Same as non-experimental $30/day of confinement $1,000/device; lifetime max 2 $50/hairpiece; lifetime max 2 $100/day up to 90 days $50/day; $9,000 lifetime max $150/day of confinement $200/trip; 2/confinement $2,000/air; 2/confinement $100/day up to confinement days $100/day up to confinement days $300/diagnosis 90 day elimination period $25/visit; 4/month; $1,000 life

$1500/cal year $4,500/cal year Same as non-experimental $50/day of confinement $3,000/device; lifetime max 2 $50/hairpiece; lifetime max 2 $300/day up to 90 days $100/day; $18,000 lifetime max $150/day of confinement $200/trip; 2/confinement $2,000/air; 2/confinement $300/day up to confinement days $300/day up to confinement days $300/diagnosis 90 day elimination period $25/visit; 4/month; $1,000 life

Diagnostic Testing Benefit

$50; 1per person, per year (30 day waiting period)

Critical Illness Rider: Heart Attack/Stroke and Cancer

$2500 Lump Sum Benefit; 30 day WP, no survival period Payable once for cancer and once for heart attack or stroke

$2500 Lump Sum Benefit; 30 day WP, no survival period - Payable once for cancer and once for heart attack or stroke

$600 - up to a maximum of 30 days per confinement

Plan Opt 1 - Low Option Base Only $16.30 $22.80 $29.00 Plan Opt 2 - Low Option Base Plan + Intensive Care Rider $19.60 $27.30 $35.90

Plan Opt 3 - High Option Base Plan Only $32.40 $44.60 $56.60 Plan Opt 4 - High Option Base Plan + Intensive Care Rider $35.70 $49.10 $63.50

Optional Benefit ICU Rider

Monthly Premiums

Individual Single Parent Family Family

LIMITATIONS AND EXCLUSIONS Only Loss For Cancer: This 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. This Policy also covers other conditions or diseases directly caused by Cancer or the treatment of Cancer. Pre-Existing Condition Limitation: No benefits are payable for any loss incurred during the first year of the Covered Person’s coverage under this Policy as the result of a Pre-Existing Specified Disease, as defined in this Certificate. Pre-Existing Conditions specifically named or described as excluded in any part of this contract are never covered. Waiting Period: This Policy/Certificate contains a 30-day Waiting Period during which no benefits will be paid under this Policy/Certificate. If any Covered Person has a Specified Disease diagnosed before the end of the 30-day period immediately following the Covered Person’s effective date, coverage for that person will apply only to loss that is incurred after one year from the effective date of such person’s coverage. If any Covered Person is diagnosed as having a Specified Disease during the 30-day period immediately following the effective date, the Insured may elect to void the Certificate from the beginning and receive a full refund of premium. If this Policy replaced Specified Disease Cancer coverage from another company that terminated within 30 days of the effective date of the Certificate, the 30-day Waiting Period will be waived for those Covered Persons that were covered under the prior coverage. However, the Pre-Existing Condition Limitation paragraph will still apply. Pre-Existing Condition Limitation - Optional Hospital Intensive Care Rider: No benefits will be provided during the first two years of this rider for hospital intensive care unit confinement caused by any heart condition when any heart condition was diagnosed or treated prior to the 30th day following the covered person’s effective date for this rider. Continuation Rider: Coverage is continued when the Insured (You) cease employment with the employer through whom You originally became insured under the Policy. You will have the option to continue this certificates (including any Riders, if applicable) by paying the premiums directly to Us at Our home office. Premiums must be paid within thirty-one (31) days after employment with your employer terminates. Premium rates required under this Continuation provision will be the same rates as those charged under the Employer’s Policy as if You had continued employment. We will bill You for these premiums after You notify Us to continue this coverage. Coverage will continue until the earlier of: (1) the Policy under which You originally became insured ends; or (2) You stop paying premiums under this option (subject to the terms of the Grace Period).

VOYA YOUR BENEFITS PACKAGE

Accident

About this Benefit 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.

2/3 of disabling injuries suffered by American workers are not work related. American workers 36% ofreport they always or

usually live 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 50 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 11 EBC Benefits Website: www.region11bc.com

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

EVENT

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

BENEFIT

Accident Hospital Care Surgery Open abdominal, thoracic Surgery exploratory or without repair Blood, plasma, platelets Hospital admission Hospital confinement Per day up to 365 Critical care unit confinement per day, up to 15 days Rehabilitation facility confinement per day for 90 days Coma Duration of 14 or more days Transportation per trip, up to 3 per accident Lodging Per day, up to 30 days Family care per child, up to 45 days

Accident Care Initial doctor visit Urgent care facility treatment Emergency room treatment Ground ambulance Air ambulance Follow-up doctor treatment Chiropractic treatment up to 6 per accident Medical equipment Physical or occupational therapy up to six per accident Speech therapy up to 6 per accident Prosthetic device (one) Prosthetic device (two or more) Major diagnostic exam Outpatient surgery (one per accident) X-ray Common Injuries Burns second degree, at least 36% of the body Burns 3rd degree, at least 9 but less than 35 square inches of the body Burns 3rd degree, 35 or more square inches of the body Skin Grafts Emergency dental work Eye Injury removal of foreign object Eye Injury surgery Torn Knee Cartilage surgery with no repair or if cartilage is shaved Torn Knee Cartilage surgical repair Laceration1 treated no sutures Laceration1 sutures up to 2” Laceration1 sutures 2” – 6” Laceration1 sutures over 6” Ruptured Disk surgical repair

$1,200 $175 $600 $1,250 $375 $600 $200 $17,000 $750 $180 $25 90 225 225 360 1,500 90 45 $120 $45 $45 $750 $1,200 $240 $225 $45 $1,250 $7,500 $15,000 25% of the burn benefit $350 crown, $90 extraction $100 $350 $225 $800 $30 $60 $240 $480 51 $800

Accident BENEFIT

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

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

$360/$720 $1,800/$3,600 25% of the closed reduction amount

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

Accident Accidental Death Benefits Employee Spouse Children Other Accident Employee Spouse Children Accidental Dismemberment Benefits Loss of both hand or both feet or sight in both eyes Loss of one hand or one foot AND the sight of one eye Loss of one hand AND one foot Loss of one hand OR one foot

•

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

Loss of Two or more fingers or toes

$1,800

Loss of one finger or one toe

$1,250

How much does Accident Insurance cost? All employees pay the same rate, no matter their age. See the chart below for the premium amounts. Rates shown are guaranteed until September 2020.

Monthly Rates (12 Pay Periods)

Employee

Employee and Spouse

Employee and Children

Family

$12.20

$19.00

$19.90

$26.70

What does my Accident Insurance include? The benefits listed below are included with your Accident Insurance coverage. For a list of standard exclusions and limitations, please refer to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any benefits. • Sports Accident Benefit: If your accident occurs while participating in an organized sporting activity as defined in the certificate; the accident hospital care, accident care or common injuries benefit will be increased by 25%; to a maximum additional benefit of $1000. • Spouse Accident Insurance: If you have coverage on yourself, you may enroll your spouse, as long as your spouse is not covered under your employer’s plan as an employee. Your spouse will be covered for the same Accident benefits as you are. • Your spouse will be covered for the same Accident benefits as you are. • Guaranteed issue: No medical questions or tests are required for coverage. • Children’s** Accident Insurance: If you have coverage on yourself, your natural children, stepchildren, adopted children or children for whom you are a legal guardian will also be covered under your employer’s plan, up to the age of 26. • Your children will be covered for the same Accident benefits as you are. • Guaranteed issue: No medical questions or tests are required for coverage. • One premium amount covers all of your eligible children.

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

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

•

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

Exclusions and limitations Exclusions for the Certificate, Spouse Accident Insurance, and Children’s Accident Insurance and AD&D are listed below. (These may vary by state.) Benefits are not payable for any loss caused in whole or directly by any of the following*: • Participation or attempt to participate in a felony or illegal activity. • An accident while the covered person is operating a motorized vehicle while intoxicated. Intoxication means the covered person’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred. • Suicide, attempted suicide or any intentionally self-inflicted injury, while sane or insane. • War or any act of war, whether declared or undeclared, other than acts of terrorism. • Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion. • Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor. • Riding in or driving any motor-driven vehicle in a race, stunt show or speed test. • Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded. Performing these acts as part of your employment with the employer is not excluded. • Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities. • Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received. • Any sickness or declining process caused by a sickness. • Work for pay, profit or gain. *See the certificate of insurance and riders for a complete list of available benefits, exclusions and limitations. 53

UNUM

Life and AD&D

YOUR BENEFITS PACKAGE

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 54 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 11 EBC Benefits Website: www.region11bc.com

Life and AD&D Employer-Paid Basic Life and AD&D Insurance Plan Highlights Who is eligible for this coverage? All actively employed employees working at least 15 hours each week for your employer in the U.S. What is the coverage amount? Your employer is providing you with $10,000, $20,000, $30,000, $40,000 or $50,000 of term life insurance and Accidental Death and Dismemberment insurance. The benefit amount will vary by District. Is it portable (can I keep it if I leave my employer)? If you retire, reduce your hours or leave your employer, you can continue coverage at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy. When is coverage effective?* Please see your plan administrator for your effective date.

What does my AD&D insurance pay for? The full benefit amount is paid for loss of: • Life • Both hands or both feet or sight of both eyes • One hand and one foot • One hand and the sight of one eye • Speech and hearing Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 70 65% of original amount 75 50% of original amount Coverage may not be increased after a reduction. Does this plan include help with work-life balance? Yes. Our work-life balance employee assistance program (EAP) provides professional advice for a wide range of personal and work-related issues. The service is available to you and your family members 24 hours a day, 365 days a year. It provides resources to help you find solutions to everyday issues — such as financing a car or selecting child care — as well as more serious problems, such as alcohol or drug addiction, divorce or relationship problems. There is no additional charge for using the program, and you do not have to have filed a disability claim or be receiving benefits to use the program.

*Delayed effective date of coverage Insurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. The Work-life Balance Employee Assistance Program, provided by HealthAdvocate, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details. The policy provisions may vary or not be available in all states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage, please refer to Policy Form C.FP-1 et al or contact your Unum representative. Underwritten by Unum Life Insurance Company of America, Portland, Maine © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. EN-1771 (6-18) FOR EMPLOYEES

Voluntary Life and AD&D Insurance Plan Highlights Who is eligible for this coverage? All actively employed employees working at least 15 hours each week for your employer in the U.S. and their eligible spouses and children to 26. What are the coverage amounts? Employee: up to 7 times salary in increments of $10,000; not to exceed $500,000. Spouse: up to 100% of employee amount in increments of $10,000; not to exceed $500,000. Child: Two options available: $5,000 or $10,000 not to exceed 100% of employee amount. The maximum death benefit for a child between the ages of live birth and six months is $1,000. What are the AD&D coverage amounts? Employee: up to 7 times salary in increments of $10,000; not to exceed $500,000. Spouse: 50% of the employee coverage amount to a maximum of $250,000. Child: 10% of the employee coverage amount to a maximum of $10,000. Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself. Can I be denied coverage? Current employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to $230,000 for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions. If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or 55

Life and AD&D before the enrollment deadline and will be required to answer health questions for any amount of coverage.

AD&D – Monthly Cost

New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.

Employee Employee and Family

How do I apply? Please see your plan administrator. When is coverage effective? Please see your plan administrator for your effective date. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness, or disorder, your dependent spouse and children: are confined in a hospital or similar institution; or are confined at home under the care of a physician for a sickness or injury. Exception: Infants are insured from live birth.

How much does the coverage cost? Term Life– Monthly Cost Employee rate Spouse rate per $10,000 per $10,000 <25 $0.45 $0.45 25-29 $0.45 $0.45 30-34 $0.60 $0.60 35-39 $0.70 $0.70 40-44 $0.80 $0.80 45-49 $1.20 $1.20 50-54 $2.00 $2.00 55-59 $3.30 $3.30 60-64 $5.10 $5.10 65-69 $9.50 $9.50 70-74 $15.50 $15.50 75+ $20.60 $20.60 Child life monthly rate is $.90 per $5,000. One life premium covers all children. Age band

AD&D cost Per $1,000 Per $1,000

Monthly Cost $0.04 $0.07

Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/ effective date. Spouse rate is based on Spouse’s insurance age. Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 70 65% of original amount 75 50% of original amount Coverage may not be increased after a reduction. Is the coverage portable (can I keep it if I leave my employer)? If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy. Are there any life insurance exclusions or limitations? Life insurance benefits will not be paid for deaths caused by suicide within the first 24 months after the date your coverage becomes effective. If you increase or add coverage, these enhancements will not be paid for deaths caused by suicide within the first 24 months after you make these changes. Will my premiums be waived if I’m disabled? If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends. What does my AD&D insurance pay for? The full benefit amount is paid for loss of: • life; • both hands or both feet or sight of both eyes; • one hand and one foot; • one hand or one foot and the sight of one eye; • speech and hearing. Other losses may be covered as well. Please contact your plan administrator.

Life and AD&D Are there any AD&D exclusions or limitations? Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from: • disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM); • suicide, self-destruction while sane, intentionally selfinflicted injury while sane or self-inflicted injury while insane; • war, declared or undeclared, or any act of war; • active participation in a riot; • committing or attempting to commit a crime under state or federal law; • the voluntary use of any prescription or nonprescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol; • intoxication – “being intoxicated” means you or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.

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 limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative. © 2017 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Underwritten by Unum Life Insurance Company of America, Portland, Maine EN-1773 (8-17) FOR EMPLOYEES

When does my coverage end? You and your dependents’ coverage under the Summary of Benefits ends on the earliest of: • the date the policy or plan is cancelled; • the date you no longer are in an eligible group; • the date your eligible group is no longer covered; • the last day of the period for which you made any required contributions; • the last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage. In addition, coverage for any one dependent will end on the earliest of: • the date your coverage under a plan ends; • the date your dependent ceases to be an eligible dependent; • for a spouse, the date of a divorce or annulment; • for dependent coverage, the date of your death. Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan. 57

ID WATCHDOG

Identity Theft

YOUR BENEFITS PACKAGE

About this Benefit Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.

An identity is stolen every 2 seconds, and takes over

300 hours

to resolve, causing an average loss of $9,650.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 58 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 11 EBC Benefits Website: www.region11bc.com

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

How ID Theft Protection Helps You

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

Identity theft devastates its victims financially.

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

ID Watchdog Services

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

Repairing the damage caused by identity theft is frustrating and time consuming. The average victim spends 330 hours repairing the damage from identity theft—the equivalent of working a full-time job for more than 2 months.

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

Who’s Evaluating your Credit Report?

• • • • • • •

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

ID Watchdog Monthly Rates 1B Plan

Platinum

Individual Plan

$7.95

$11.95

Family Plan

$14.95

$22.95

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

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

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

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 60 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 11 EBC Benefits Website: www.region11bc.com

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.

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. BENEFIT

EMERGENT PLUS $14/mo.

PLATINUM $39/mo.

Emergent Ground Transportation

U.S./Canada

Emergent Air Transportation

U.S./Canada

Non-Emergent Air Transportation

U.S./Canada

Worldwide

“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

Repatriation

U.S./Canada

Worldwide

MASA MTS for Employees Ensures...

Visitor Transportation

BCA*

Minor Children/ Grandchildren Return

BCA*

Vehicle Return

BCA*

Pet Return

BCA*

You face the possibility that your medical coverage will deny the claim leaving you responsible for the ENTIRE bill. MASA provides medical emergency transportation solutions AND cover your out of pocket medical transport cost when your insurance falls short.

• • • • • •

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

Escort Transportation

Worldwide

Mortal Remains Transportation

Worldwide

Organ Retrieval

U.S./Canada

Organ Recipient Transportation

U.S./Canada

*Basic Coverage Area (BCA) includes U.S., Canada, Mexico, and Caribbean (excluding Cuba)

TEXAS LIFE

Individual Life

About this Benefit Group termlife life the most to Individual is is a policy thatinexpensive provides a way specified purchase life insurance. You have at thethe freedom death benefit to your beneficiary time ofto select amount of lifeofinsurance death.an The advantage having ancoverage individualyou lifeneed to help protect theopposed well-being your family. insurance plan as to aofgroup supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.

YOUR BENEFITS PACKAGE

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 62 details on covered expenses, limitations and exclusions are included in the summary plan description located on the ESC Region 11 EBC Benefits Website: www.region11bc.com

Individual Life Life Insurance Highlights Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually costs more and declines in death benefit.

DID YOU KNOW? Those with no life insurance think it’s 3 times more expensive than it actually is.

The policy, PureLife-plus, is underwritten by Texas Life Insurance Company, and it has these outstanding features: •

High Death Benefit. With one of the highest death benefit available at the worksite,1 PureLife-plus gives your loved ones peace of mind, knowing there will be significant life insurance in force should you die prematurely.

•

Minimal Cash Value. Designed to provide high death benefit, PureLife-plus does not compete with the cash accumulation in your employer-sponsored retirement plans.

•

Long Guarantees. Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up).

•

Refund of Premium. Unique in the marketplace, PureLifeplus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)

•

Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.)

You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, minor children and grandchildren.

Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details. 1

Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2008