2020-21 Socorro ISD Benefit Guide

SOCORRO ISD

BENEFIT GUIDE EFFECTIVE: 07/01/2020 - 6/31/2021 WWW.MYBENEFITSHUB.COM/SOCORROISD 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. Helpful Definitions 6. HSA vs. FSA Lincoln Financial Group Dental Superior Vision UNUM Disability UNUM Critical Illness UNUM Life and AD&D Mutual of Omaha Accident Deer Oaks Employee Assistance Program (EAP)

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3 4-5 6-11 6 7 8 9 10 11 12-17 18-21 22-25 26-29 30-35 36-39 40-41

FLIP TO...

PG. 4

HOW TO ENROLL

PG. 6

BENEFIT UPDATES

PG. 12

YOUR BENEFITS

Benefit Contact Information SISD BENEFITS ADMINISTRATION

DENTAL

VISION

Socorro ISD (915) 937-0000 www.sisd.net benefits@sisd.net

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

Superior Vision (800) 507-3800 www.superiorvision.com Group #33820

DISABILITY

CRITICAL ILLNESS

LIFE AND AD&D

UNUM (866) 679-3054 www.unum.com Group #474621

UNUM (866) 679-3054 www.unum.com Group #474620

UNUM (866) 679-3054 www.unum.com Group #474619

ACCIDENT

EMPLOYEE ASSISTANCE PROGRAM

MEDICAL

Mutual of Omaha 800-877-5176 ext. 4 www.mutualofomaha.com

Deer Oaks (866) 327-2400 www.deeroakseap.com eap@deeroaks.com

Cigna (800) 997-1654 www.mycigna.com

HOSPITAL INDEMNITY

HEALTH SAVINGS ACCOUNT (HSA)

REIMBURSEMENT PLANS (FSA)

Cigna (800) 997-1654 www.mycigna.com

HSA Bank (800) 357-6246 www.hsabank.com

Cigna (800) 997-1654 www.mycigna.com

RETIREMENT PLANS TSA Consulting Group (850) 362-6840

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MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet.

Text “FBS SOCORRO” to 313131 and get access to

everything you need to complete your benefits enrollment:

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•

Benefit Information

•

Online Support

•

Interactive Tools

•

And more.

Text “FBS SOCORRO”

to 313131 OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/ socorroisd

CLICK LOGIN

ENTER USERNAME & PASSWORD

All login credentials have been RESET to the default described below:

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

ONLINE SUPPORT

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

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

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Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates ‐ What’s New: DISABILITY Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a por on of your income in the event that you become physically unable to work due to sickness or injury for an extended period of me. You may choose up to 65% of your monthly covered earnings. Pre‐exis ng condi on limita ons apply however you may be able to receive a benefit of 90 days if you have a pre‐exis ng condi on. Review the plan documents on your benefit website for full details.

DENTAL Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of rou ne care, dental treatment and disease. You have the op on to choose either a high or low plan, both plans pay 100% towards preventa ve care such as your annual exam. Both plans work best if you go to an in ‐network den st but the high plan will pay more for out‐of‐network expenses than the low plan.

High Plan The high plan includes orthodon a benefits for dependent VISION children and adults.

Vision insurance provides coverage for rou ne eye Low Plan examina ons and can help with covering some of the costs The low plan only offers ortho for children to age 26, the for eyeglass frames, lenses or contact lenses. Look for ortho benefit does not apply to employee and spouse providers in the provider directory who accept discounts, coverage. Basic and major restora ve care will pay on a fee as some do not; please verify their services and discounts schedule based on services renders. This plan is best used if (range from 10%‐30%) prior to service as they vary. you use an in‐network den st. There are no wai ng Discounts are subject to change without no ce. This carrier periods on this plan. Review the plan documents on your did not change but the plan did change. benefit website for full details.



Update your profile informa on: home address, phone numbers, email.



IMPORTANT!! Due to the Affordable Care Act (ACA) repor ng requirements, please add your dependent’s social security numbers in the online enrollment system. If you have ques ons, please contact your Benefits Administrator.

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SUMMARY PAGES

Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer.

Enrollment is automatic unless you decline this benefit.

Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

CHANGES IN STATUS (CIS):

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefits Administrator within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change.

Benefit changes must be consistent with the qualifying event.

QUALIFYING EVENTS

Marital Status

A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation

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

Change in Status of Employment Affecting Coverage Eligibility

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

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

If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.

Eligibility for Government Programs

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

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SUMMARY PAGES

Annual Enrollment During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year.

Where can I find forms?

Changes are not permitted during the plan year (outside of

For benefit summaries and claim forms, go to your school

annual enrollment) unless a Section 125 qualifying event occurs.

district’s benefit website: www.mybenefitshub.com/ socorroisd. Click on the benefit plan you need information on

•

Changes, additions or drops may be made only during the

(i.e., Dental) and you can find the forms you need under the

annual enrollment period without a qualifying event.

Benefits and Forms section.

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

How can I find a Network Provider?

For benefit summaries and claim forms, go to your school

included in the dependent profile. Additionally, you must

district’s website: www.mybenefitshub.com/socorroisd. Click

notify your employer of any discrepancy in personal and/or

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

benefit information.

you can find provider search links under the Quick Links section.

•

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

When will I receive ID cards?

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

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

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

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

Q&A Who do I contact with Questions?

For supplemental benefit questions, you can contact your Socorror ISD Benefits Administrator at 915-937-0000, benefits@sisd.net, www.sisd.net, or you can call Financial Benefit Services at 866-914-5202 for assistance.

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card each year.

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 30 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 Socorro ISD or as both

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

employees and dependents.

work concurrent with the plan effective date. For example, if your 2020 benefits become effective on July 1, 2020, you must

be actively-at-work on July 1, 2020 to be eligible for your new benefits.

PLAN

CARRIER

MAXIMUM AGE

Accident

Mutual of Omaha

To age 26

Basic & Voluntary Life and AD&D

Unum

To age 26

Dental

Lincoln Financial Group

To age 26

Disability

Unum

To age 26

Critical Illness

Unum

To age 26

Vision

Superior Vision

To age 26

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your Benefit Administrator to request a continuation of coverage.

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Helpful Definitions

SUMMARY PAGES

Actively at Work

In-Network

You are performing your regular occupation for the employer

Doctors, hospitals, optometrists, dentists and other providers

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

who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 7/1/2020 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 July 1st through June 30th

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

Calendar Year January 1st through December 31st

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

Guaranteed Coverage The amount of coverage you can elect without answering any

medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period.

Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.

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(including diagnostic and/or consultation services).

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

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

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source

Employee and/or employer

Employee and/or employer

Account Owner

Individual

Employer

Underlying Insurance Requirement

High deductible health plan

None

Minimum Deductible

$1,350 single (2020) $2,700 family (2020)

N/A

Maximum Contribution

$3,550 single (2020) $7,100 family (2020)

$2,750 (2020)

Description

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

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

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

Year-to-year rollover of account balance?

Yes, will roll over to use for subsequent 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

No

Portable?

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

No

Permissible Use Of Funds

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

Not permitted

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LINCOLN FINANCIAL GROUP

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 12 details on covered expenses, limitations and exclusions included in the summary plan description located on the HEB ISD Benefits Website:are www.mybenefitshub.com/hebisd Socorro ISD Benefits Website: www.mybenefitshub.com/socorroisd

Dental PPO - High Option INF AAFTE of Socorro ISD Benefits At-A-Glance High Option The Lincoln DentalConnect® PPO Plan: • • • • •

Covers many preventive, basic, and major dental care services Also covers orthodontic treatment for children and adults Features group coverage for Socorro ISD employees Allows you to choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist Does not make you and your loved ones wait six months between routine cleanings

Visit LincolnFinancial.com/FindADentist

You can search by: • Location • Dentist name or office name • Distance you are willing to travel • Specialty, language and more Your search will automatically provide up to 100 dentists that most closely match your criteria. If your search does not locate the dentist you prefer, you can nominate one—just click the Nominate a Dentist link and complete the online form.

BENEFITS AT A GLANCE

CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

Calendar (Annual) Deductible

Individual: $50 Individual: $50 Family: $150 Family: $150 Waived for: Preventive Waived for: Preventive Deductibles are combined for basic and major Contracting Dentists’ services. Deductibles are combined for basic and major NonContracting Dentists’ services.

Annual Maximum

$2,000

$2,000

$1,500

$1,500

Annual Maximums are combined for preventive, basic, and major services.

Lifetime Orthodontic Max Orthodontic Coverage is available for dependent children and adults.

Waiting Period PREVENTIVE SERVICES Routine oral exams Bitewing X-rays Full-mouth or panoramic X-rays Other dental X-rays (including periapical films) Routine cleanings Fluoride treatments Sealants Palliative treatment (including emergency relief of dental pain) BASIC SERVICES Space maintainers for children Problem focused exams Consultations Injections of antibiotics and other therapeutic medications Fillings Prefabricated stainless steel and resin crowns Simple extractions Surgical extractions Oral surgery Biopsy and examination of oral tissue (including brush biopsy) General anesthesia and I.V. sedation MAJOR SERVICES Prosthetic repair and recementation services Endodontics (including root canal treatment) Periodontal maintenance procedures Non-surgical periodontal therapy Periodontal surgery Bridges Full and partial dentures Denture reline and rebase services Crowns, inlays, onlays and related services Implants & implant related services

There are no benefit waiting periods for any service types CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

100% No Deductible

100% No Deductible

CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

80% After Deductible

80% After Deductible

CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

50% After Deductible

50% After Deductible

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Dental PPO - High Plan ORTHODONTICS

CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

50%

50%

CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

Orthodontic exams X-rays Extractions Study models Appliances CONTRACTING DENTISTS/NON-CONTRACTING DENTISTS

… you pay a deductible (if applicable), then 50% of the usu…you pay a deductible (if al and customary fee, which is applicable), then 50% of the the maximum expense covThis plan lets you choose any dentist you wish. However, your out-of-pocket remaining discounted fee for ered by the plan. You are rePPO members. This is known sponsible for the difference costs are likely to be lower when you choose a contracting dentist. For exas a PPO contracted fee. between the usual and cusample, if you need a crown… tomary fee and the dentist’s billed charge.

To find a contracting dentist near you, visit www.LincolnFinancial.com/ FindADentist.

With the Lincoln Dental Mobile App • Find a network dentist near you in minutes • Have an ID card on your phone • Customize the app to get details of your plan • Find out how much your plan covers for checkups and other services • Keep track of your claims Lincoln DentalConnect® Online Health Center • Determine the average cost of a dental procedure • Have your questions answered by a licensed dentist • Learn all about dental health for children, from baby’s first tooth to dental emergencies • Evaluate your risk for oral cancer, periodontal disease and tooth decay Covered Family Members When you choose coverage for yourself, you can also provide coverage for: • Your spouse.

• Dependent children, up to age 26.

Benefit Exclusions Like any coverage, this dental coverage does have some exclusions.

• The plan does not cover services started before coverage begins or after it ends. Benefits are limited to appropriate and necessary procedures listed in the summary plan description.

Benefits are not payable for duplication of services. Covered expenses will not exceed the summary plan description’s usual and customary allowances.

• Plan benefits are not payable for a condition that is covered under Workers’ Compensation or a similar law; that occurs during the course of employment or military service or involvement in an illegal occupation, felony, or riot; or that results from a self-inflicted injury.

• The plan does not cover an orthodontia treatment plan started before coverage begins unless the member was receiving orthodontia benefits from the employer’s previous group 14

dental summary plan description. In this case, Lincoln Financial will continue orthodontia benefits until the combined benefit paid by both policies is equal to this summary plan description’s lifetime orthodontia maximum.

• In certain situations, there may be more than one method of treating a dental condition. This summary plan description includes an alternative benefits provision that may reduce benefits to the lowest- cost, generally effective, and necessary form of treatment.

• Certain conditions, such as age and frequency limitations, may impact your coverage. See the summary plan description for details.

A complete list of benefit exclusions is included in the summary plan description.

This is not intended as a complete description of the coverage offered. Controlling provisions are provided in the summary plan description, and this summary does not modify coverage. A summary plan description will be made available to you that describes the benefits in greater detail. Refer to your summary plan description for your maximum benefit amounts. Lincoln DentalConnect® health center Web content is provided by go2dental.com, Santa Clara, CA. Go2dental.com is not a Lincoln Financial Group® company.

Coverage is subject to actual summary plan description language. Each independent company is solely responsible for its own obligations. The Lincoln National Life Insurance Company (Fort Wayne, IN), does not conduct business in New York, nor is it licensed to do so. In New York, business is conducted by Lincoln Life & Annuity Company of New York (Syracuse NY). Both are Lincoln Financial Group Companies.2020 Lincoln National Corporation LCN-2012491-013118 R 1.0 – Group ID: SOCORROISD

Dental Rate Here’s how little you pay with group rates. As a Socorro ISD employee, you can take advantage of this dental coverage for less than $1.22 a day. Plus, you can add loved ones to the plan for just a little more.

Your estimated cost is itemized below.

COVERAGE

MONTHLY RATE

Employee only

$36.68

Employee & Spouse

$70.40

Employee & Child/children

$86.79

Employee & Family

$119.10 DTL-ENRO-BRC001-TX

Dental PPO - Low Option INF AAFTE of Socorro ISD Benefits At-A-Glance Low Option The Lincoln DentalConnect® PPO Plan: • • • • • •

Covers many preventive, basic, and major dental care services Also covers orthodontic treatment for children Features group coverage for Socorro ISD employees Allows you to choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist Does not make you and your loved ones wait six months between routine cleanings

Visit LincolnFinancial.com/FindADentist You can search by: • Location • Dentist name or office name • Distance you are willing to travel • Specialty, language and more Your search will automatically provide up to 100 dentists that most closely match your criteria. If your search does not locate the dentist you prefer, you can nominate one—just click the Nominate a Dentist link and complete the online form.

BENEFITS AT A GLANCE Calendar (Annual) Deductible

CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

Individual: $50 Family: $150 Waived for: Preventive

Individual: $50 Family: $150 Waived for: Preventive

Deductibles are combined for basic and major Contracting Dentists’ services. Deductibles are combined for basic and major NonContracting Dentists’ services.

Annual Maximum

$2,000

$2,000

$1,500

$1,500

Annual Maximums are combined for preventive, basic, and major services.

Lifetime Orthodontic Max Orthodontic Coverage is available for dependent children.

Waiting Period

PREVENTIVE SERVICES Routine oral exams Bitewing X-rays Full-mouth or panoramic X-rays Other dental X-rays (including periapical films) Routine cleanings Fluoride treatments Sealants Palliative treatment (including emergency relief of dental pain) BASIC SERVICES Space maintainers for children Problem focused exams Consultations Injections of antibiotics and other therapeutic medications Fillings Prefabricated stainless steel and resin crowns Simple extractions Surgical extractions Oral surgery Biopsy and examination of oral tissue (including brush biopsy) General anesthesia and I.V. sedation MAJOR SERVICES

Prosthetic repair and recementation services Endodontics (including root canal treatment) Periodontal maintenance procedures Non-surgical periodontal therapy Periodontal surgery Bridges Full and partial dentures Denture reline and rebase services Crowns, inlays, onlays and related services

There are no benefit waiting periods for any service types

CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

90% No Deductible

90% No Deductible

CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

50% After Deductible

50% After Deductible

CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

50% After Deductible

50% After Deductible

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Dental PPO - Low Plan ORTHODONTICS

CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

50%

50%

CONTRACTING DENTISTS

NON-CONTRACTING DENTISTS

Orthodontic exams X-rays Extractions Study models Appliances CONTRACTING DENTISTS/NON-CONTRACTING DENTISTS

… you pay a deductible (if applicable), then 50% of the usu…you pay a deductible (if al and customary fee, which is applicable), then 50% of the the maximum expense covThis plan lets you choose any dentist you wish. However, your out-of-pocket remaining discounted fee for ered by the plan. You are recosts are likely to be lower when you choose a contracting dentist. For exPPO members. This is known sponsible for the difference ample, if you need a crown… as a PPO contracted fee. between the usual and customary fee and the dentist’s billed charge.

To find a contracting dentist near you, visit www.LincolnFinancial.com/ FindADentist.

With the Lincoln Dental Mobile App • Find a network dentist near you in minutes • Have an ID card on your phone • Customize the app to get details of your plan • Find out how much your plan covers for checkups and other services • Keep track of your claims

Lincoln DentalConnect® Online Health Center • Determine the average cost of a dental procedure • Have your questions answered by a licensed dentist • Learn all about dental health for children, from baby’s first tooth to dental emergencies • Evaluate your risk for oral cancer, periodontal disease and tooth decay Covered Family Members When you choose coverage for yourself, you can also provide coverage for: • Your spouse.

• Dependent children, up to age 26.

Benefit Exclusions Like any coverage, this dental coverage does have some exclusions.

• The plan does not cover services started before coverage begins or after it ends. Benefits are limited to appropriate and necessary procedures listed in the summary plan description.

Benefits are not payable for duplication of services. Covered expenses will not exceed the summary plan description’s usual and customary allowances.

• Plan benefits are not payable for a condition that is covered under Workers’ Compensation or a similar law; that occurs during the course of employment or military service or involvement in an illegal occupation, felony, or riot; or that results from a self-inflicted injury.

• The plan does not cover an orthodontia treatment plan started before coverage begins unless the member was receiving orthodontia benefits from the employer’s previous group dental summary plan description. In this case, Lincoln Financial will continue orthodontia benefits until the combined benefit 16

•

•

paid by both policies is equal to this summary plan description’s lifetime orthodontia maximum. Plan benefits are not payable if the orthodontic appliance was installed after the age of 19.

In certain situations, there may be more than one method of treating a dental condition. This summary plan description includes an alternative benefits provision that may reduce benefits to the lowest- cost, generally effective, and necessary form of treatment.

Certain conditions, such as age and frequency limitations, may impact your coverage. See the summary plan description for details.

A complete list of benefit exclusions is included in the summary plan description.

This is not intended as a complete description of the coverage offered. Controlling provisions are provided in the summary plan description, and this summary does not modify coverage. A summary plan description will be made available to you that describes the benefits in greater detail. Refer to your summary plan description for your maximum benefit amounts. Lincoln DentalConnect® health center Web content is provided by go2dental.com, Santa Clara, CA. Go2dental.com is not a Lincoln Financial Group® company.

Coverage is subject to actual summary plan description language. Each independent company is solely responsible for its own obligations. The Lincoln National Life Insurance Company (Fort Wayne, IN), does not conduct business in New York, nor is it licensed to do so. In New York, business is conducted by Lincoln Life & Annuity Company of New York (Syracuse NY). Both are Lincoln Financial Group Companies.©2020 Lincoln National Corporation LCN-2012491-013118 R 1.0 – Group ID: SOCORROISD

Dental Rate Here’s how little you pay with group rates. As a Socorro ISD employee, you can take advantage of this dental coverage for less than $1.22 a day. Plus, you can add loved ones to the plan for just a little more.

Your estimated cost is itemized below.

COVERAGE

MONTHLY RATE

Employee only

$29.81

Employee & Spouse

$59.71

Employee & Child/children

$78.53

Employee & Family

$107.33 DTL-ENRO-BRC001-TX

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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 18 details on covered expenses, limitations and exclusions included in the summary plan description located on the HEB ISD Benefits Website:are www.mybenefitshub.com/hebisd Socorro ISD Benefits Website: www.mybenefitshub.com/socorroisd

Vision

Platinum Plan

Gold Plan

Copays

Vision plan benefits for Socorro ISD

Copays

Exam

$10

Exam

$10

Materials1

$25

Materials1

$25

Contact lens fitting

$25

Contact lens fitting

$25

Monthly premiums You may choose from two plans: Emp. only Platinum plan, or Gold plan Emp. + spouse Benefits through Superior Emp. + child(ren) National network Emp. + family

Monthly premiums $9.84

Emp. only

$6.82

$17.66

Emp. + spouse

$12.24

$18.78

Emp. + child(ren)

$13.01

$27.18

Emp. + family

$18.84

Services/frequency

Superiorvision.com (800) 507-3800

Services/frequency

Exam

12 months

Exam

12 months

Frames

12 months

Frames

12 months

Contact lens fitting

12 months

Contact lens fitting

12 months

Lenses

12 months

Lenses

12 months

Contact lenses

12 months

Contact lenses

12 months

One pair of glasses and one contact lens allowance are included within the above service frequencies

Benefits Exam (MD) Exam (OD)

Contact lenses are in lieu of eyeglass lenses and frames benefit

In-network

Out-of-network

In-network

Out-of-network

Covered in full

Up to $42

Covered in full

Up to $42

Covered in full

Up to $42

Covered in full

Up to $42

$130 retail allowance

Up to $52

$130 retail allowance

Up to $52

2

Covered in full

Not covered

Covered in full

Not covered

2

$50 retail allowance

Not covered

$50 retail allowance

Not covered

Single vision

Covered in full

Up to $26

Covered in full

Up to $26

Bifocal

Covered in full

Up to $34

Covered in full

Up to $34

Trifocal

Covered in full

Up to $50

Covered in full

Up to $50

Lenticular

Covered in full

Up to $80

Covered in full

Frames Contact lens fitting (standard ) Contact lens fitting (specialty ) Lenses (standard) per pair

Progressive lens upgrade Contact lenses

See description

3

$150 retail allowance

Up to $80 3

Up to $50

See description

Up to $100

$150 retail allowance

Up to $50 Up to $100

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Materials co-pay applies to lenses and frames only, not contact lenses.

2 Standard Contact Lens Fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty Contact Lens Fitting applies to new contact wearers and/or a member who wear toric, gas permeable, or multi-focal lenses.

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.

4 Discounts and maximums may vary by lens type. Please check with your provider

19

Vision Discount features Look for providers in the provider directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-30%) prior to service as they vary.

Discounts on covered materials Frames: 20% off amount over allowance Lens options: 20% off retail Progressives: 20% off amount over retail lined trifocal lens, including lens options Specialty contact lens fit: 10% off retail, then apply allowance Maximum member out-of-pocket The following options have out-of-pocket maximums5 on standard (not premium, brand, or progressive) lenses.

Single vision Bifocal & trifocal Scratch coat $13 $13 Ultraviolet coat $15 $15 Tints, solid or gradients $25 $25 Anti-reflective coat $50 $50 Polycarbonate $40 20% off retail High index 1.6 $55 20% off retail Photochromics $80 20% off retail Discounts on non-covered exam, services and materials Exams, frames, and prescription lenses: 30% off retail Lens options, contacts, miscellaneous options: 20% off retail Disposable contact lenses: 10% off retail Retinal imaging: $39 maximum out-of-pocket Refractive surgery Superior Vision has a nationwide network of independent refractive surgeons and partnerships with leading LASIK networks who offer members a discount. These discounts range from 10%-50%, and are the best possible discounts available to Superior Vision.

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.

The Guardian Life Insurance Company of America, AKA The Guardian or Guardian Life NVIGRP 5-07 0720-BSv2/TX

20

21

UNUM 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 22 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Socorro ISD Benefits Website: www.mybenefitshub.com/socorroisd

Disability Socorro Independent School District Voluntary Disability Insurance Plan Highlights Policy Number 474621 Who is eligible?

You are eligible for disability coverage if you are an active employee in the United States working a minimum of 30 hours per week.

What is my monthly benefit amount?

You can elect to purchase a benefit of 35%, 45%, 55% or 65% of your monthly earnings.

How long do I have to wait to receive benefits?

The elimination period is the length of time you must be continuously disabled before you can receive benefits.

Elimination Period Options: Option 1: 0 days/7 days first day hospital Option 2: 14 days/14 days first day hospital Option 2: 30 days/30 days first day hospital Option 3: 90 days/90 days Option 3: 180 days/180 days During your elimination period, you will be considered disabled if you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury, you are under the regular care of a physician and you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury.

If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. First day hospital applies to Elimina-tion Periods of 0/7, 14/14 and 30/30.

How long will my benefits last?

Age at Disability Less than age 62 Age 62 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 or older

Maximum Period of Payment To Social Security Normal Retirement Age* (see table below) 60 months 48 months 42 months 36 months 30 months 24 months 18 months 12 months

Year of Birth On or before 1937 1938 1939 1940 1941 1942 1943 – 1954 1955 1956 1957 1958 1959 On or after 1960

*Social Security Normal Retirement Age (SSNRA) 65 years 65 years, 2 months 65 years, 4 months 65 years, 6 months 65 years, 8 months 65 years, 10 months 66 years 66 years, 2 months 66 years, 4 months 66 years, 6 months 66 years, 8 months 66 years, 10 months 67 years 23

Disability When is my coverage effective? Your effective date of coverage is 7/1/2020. If you become eligible after this date, please see your plan administrator for your effective date.

Do I have to take a health exam You may receive coverage without answering any medical questions or providing evidence of to get coverage? insurability if you apply for coverage within 31 days after your eligibility date. If you apply more than 31 days after your eligibility date, your coverage will be subject to a 3/12 pre-existing condition exclusion.

Please see your plan administrator for your eligibility date.

What if I am out of work when the coverage goes into effect?

Insurance 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.

What is my maximum monthly benefit amount?

Your total monthly benefit (including all benefits provided under this plan) will not exceed 100% of your monthly earnings, unless the excess amount is payable as a Cost of Living Adjustment.

What else is included with this policy?

Worldwide emergency travel assistance is included with this long term disability plan. Emergency travel assistance is available to you, your spouse* and your dependent children when you travel to any foreign country, including Canada or Mexico. It is also available anywhere in the United States when you travel just 100 or more miles from home. * A spouse traveling on business for his or her employer is not covered by the program.

Does this plan include help with Yes. Our work-life balance employee assistance program (EAP) provides professional advice for a work-life balance? 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.

What is not covered?

Benefits would not be paid for disabilities caused by, contributed to by, or resulting from: • Intentionally self-inflicted injuries; • Active participation in a riot; • War, declared or undeclared, or any act of war; • Commission of a crime for which you have been convicted; • Loss of professional license, occupational license or certification; • Pre-existing conditions (see pre-existing condition section); or • Any occupational injury or sickness for Short Term Disability coverage.

The loss of a professional or occupational license does not, in itself, constitute disability.

Unum will not pay a benefit for any period of disability during which you are incarcerated.

Please refer to policy for a complete listing of policy exclusions.

What is considered a preexisting condition?

You have a pre-existing condition if: • You received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and • The disability begins in the first 12 months after your effective date of coverage.

Benefits under this provision are payable for no more than 90 days of benefit from the date of disability. After 90 days, benefits are subject to a 3/12 pre-existing condition exclusion. In no event will benefits be paid beyond the applicable benefit duration. This applies to the 7/1/2020 enrollment only and new hires. Late entrants will be subject to a 3/12 pre-ex.

24

Disability When does my coverage end?

Your coverage under the policy ends on the earliest of the following: • 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 except as provided under the covered layoff or leave of absence provision.

Please see your plan administrator for further information on these provisions.

Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

How can I apply for coverage?

To apply for coverage, complete your enrollment online by the enrollment deadline.

If you were hired after 7/1/2020, check with your plan administrator for your eligibility date, and complete your enrollment online within 31 days of that date.

You are considered in active employment, if on the day you apply for coverage, you are being paid regularly by your employer for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation.

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.

Worldwide emergency travel assistance services, provided by Assist America, Inc., are available with select Unum insurance offerings. Terms and availability of service are subject to change and prior notification requirements. Services are not valid after coverage terminates. Please contact your Unum representative for details.

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.

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-1776 (1-17) FOR EMPLOYEES

25

UNUM

Critical Illness

YOUR BENEFITS PACKAGE

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

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

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

Critical Illness Socorro Independent School District Critical Illness Plan Highlights Policy Number 474620 Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness.

Who is eligible for this coverage?

All employees in active employment in the United States working at least 30 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status).

What are the Critical Illness coverage amounts?

The following coverage amounts are available.

For you: Select one of the following Choice $10,000, $20,000 or $30,000 For your Spouse and Children: 50% of employee coverage amount

Can I be denied coverage?

Coverage is guarantee issue.

When is coverage effective?

Please see your Plan Administrator for your effective date of coverage.

Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

What critical illness conditions are covered?

Covered Conditions* Percentage of Coverage Amount Critical Illnesses Coronary Artery Disease (major) 50% Coronary Artery Disease (minor) 10% End Stage Renal (Kidney) Failure 100% Heart Attack (Myocardial Infarction) 100% Major Organ Failure Requiring Transplant 100% Stroke 100% Cancer Invasive Cancer (including all Breast Cancer) 100% Non-Invasive Cancer 25% Skin Cancer $500 Supplemental Critical Illnesses Benign Brain Tumor 100% Coma 100% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Infectious Disease 25% Occupational Human Immunodeficiency Virus (HIV) or Hepatitis 100% Permanent Paralysis 100% Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) 100% Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100% Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100% *Please refer to the policy for complete definitions of covered conditions.

Covered Condition Benefit The covered condition benefit is payable once per covered condition per insured.

Unum will pay a covered condition benefit for a different covered condition if: • the new covered condition is medically unrelated to the first covered condition; or • the dates of diagnosis are separated by more than 180 days.

27

Critical Illness Reoccurring Condition Benefit We will pay the reoccurring condition benefit for the diagnosis of the same covered condition if the covered condition benefit was previously paid and the new date of diagnosis is more than 180 days after the prior date of diagnosis. The benefit amount for any reoccurring condition benefit is 100% of the percentage of coverage amount for that condition.

The following Covered Conditions are eligible for a reoccurring condition benefit:

• • • • • Are wellness screenings covered?

Benign Brain Tumor Coma Coronary Artery Disease (Major) Coronary Artery Disease (Minor) End Stage Renal (Kidney) Failure

• • • • •

Heart Attack (Myocardial Infarction) Invasive Cancer (includes all Breast Cancer) Major Organ Failure Requiring Transplant Non-Invasive Cancer Stroke

Each insured is eligible to receive one Be Well Benefit per calendar year.

Be Well Benefit For you, your spouse and your children: $50 If the employee’s Critical Illness Coverage Amount is: $10,000 $20,000 $30,000

The Be Well Benefit Amount for you, your spouse and your children is: $50 $50 $50

Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also include imaging studies, immunizations and annual examinations by a Physician. See certificate for details.

How much does the coverage cost?

28

Option 1: $10,000 EE, $5,000 SP, $50 Be Well Benefit Age Employee Cost Spouse Cost Less than age 25 $3.61 $2.71 25-29 $4.51 $3.16 30-34 $5.61 $3.71 35-39 $7.31 $4.56 40-44 $9.61 $5.71 45-49 $12.81 $7.31 50-54 $16.51 $9.16 55-59 $22.31 $12.06 60-64 $31.21 $16.51 65-69 $45.11 $23.46 70-74 $69.41 $35.61 75-79 $101.11 $51.46 80-84 $145.71 $73.76 85 or over $233.51 $117.66 Option 3: $30,000 EE, $15,000 SP, $50 Be Well Benefit Age Employee Cost Spouse Cost Less than age 25 $7.21 $4.51 25-29 $9.91 $5.86 30-34 $13.21 $7.51 35-39 $18.31 $10.06 40-44 $25.21 $13.51 45-49 $34.81 $18.31 50-54 $45.91 $23.86 55-59 $63.31 $32.56 60-64 $90.01 $45.91 65-69 $131.71 $66.76 70-74 $204.61 $103.21 75-79 $299.71 $150.76 80-84 $433.51 $217.66 85 or over $696.91 $349.36

Option 2: $20,000 EE, $10,000 SP, $50 Be Well Benefit Age Employee Cost Spouse Cost Less than age 25 $5.41 $3.61 25-29 $7.21 $4.51 30-34 $9.41 $5.61 35-39 $12.81 $7.31 40-44 $17.41 $9.61 45-49 $23.81 $12.81 50-54 $31.21 $16.51 55-59 $42.81 $22.31 60-64 $60.61 $31.21 65-69 $88.41 $45.11 70-74 $137.01 $69.41 75-79 $200.41 $101.11 80-84 $289.61 $145.71 85 or over $465.21 $233.51

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 the Employee’s insurance age, which is their age immediately prior to and including the anniversary/effective date .

Critical Illness Do my critical illness insurance benefits decrease with age?

Critical Illness benefits do not decrease due to age.

Are there any exclusions or limitations?

We will not pay benefits for a claim that is caused by, contributed to by, or occurs as a result of any of the following: • committing or attempting to commit a felony; • being engaged in an illegal occupation or activity; • injuring oneself intentionally or attempting or committing suicide, whether sane or not; • active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, injury as an innocent bystander, or Injury for self-defense; • participating in war or any act of war, whether declared or undeclared; • combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations; • voluntary use of or treatment for voluntary use of any prescription or nonprescription drug, alcohol, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s Physician; • being intoxicated; and • a Date of Diagnosis that occurs while an Insured is legally incarcerated in a penal or correctional institution.

Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the coverage effective date.

Pre-existing Conditions We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following: • a pre-existing condition; or • complications arising from treatment or surgery for, or medications taken for, a pre-existing condition.

An insured has a pre-existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which: • medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period; • drugs or medications were taken, or prescribed to be taken during that period; or • symptoms existed.

The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective.

Is the coverage portable (can I keep it if I leave my employer)?

If your employment with your employer ends or you are no longer in an eligible group you can apply for ported coverage and pay the first premium within 31 days to continue coverage for yourself, your spouse and your children.

If your spouse’s coverage ends as a result of your death, divorce or annulment, your spouse may elect to continue spouse and children coverage, as long as premium is paid as required.

When does my coverage end?

If you choose to cancel coverage, it will end on the first of the month following the date you provide notification to your employer. Otherwise, coverage ends on the earliest of: • the date the policy is cancelled by your employer; • the date you no longer are in an eligible group; • the date your eligible group is no longer covered; • the date of your death • the last day of the period any required contributions are made; • the last day you are in active employment.

If you choose to cancel your Spouse’s coverage, it will end on the first of the month following the date you provide notification to your employer. Otherwise, your spouse’s coverage will end on the earliest of: • the date your coverage ends; • the date your spouse is no longer eligible for coverage; • the date your spouse no longer meets the definition of a spouse; • the date of your spouse’s death; or • the date of divorce or annulment.

Your children’s coverage will end on the earliest of: • the date your coverage ends; • the date your children are no longer eligible for coverage; or • the date your children no longer meet the definition of children.

The limited benefits provided are a supplement to major medical coverage and are not a substitute for major medical coverage or other minimal essential coverage as required by federal law. Lack of minimal essential coverage may result in an additional tax payment being due. 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 GCIP16-1 et al or contact your Unum representative. © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Underwritten by Unum Insurance Company, Portland, Maine

29

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

#1

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 30 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Socorro ISD Benefits Website: www.mybenefitshub.com/socorroisd

Basic Life and AD&D Socorro Independent School District Life and AD&D Insurance Plan Highlights Policy Number 474618

Who is eligible for this coverage?

All actively employed employees working at least 30 hours each week for your employer in the U.S.

What is the coverage amount?

Your employer is providing you with one of the following options: Option 1: If you are participating in the District’s medical plan: $30,000 of term life insurance and $60,000 of Accidental Death and Dismemberment insurance.

Or Option 2: If you are not participating in the District’s medical plan: $50,000 of term life insurance and $60,000 of Accidental Death and Dismemberment insurance.

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?*

Your coverage is effective on 7/1/2020.

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/AD&D insurance benefits decrease with age?

Coverage amounts will reduce according to the following schedule: Age: 70

Insurance amount reduces to: 50% of original amount

Coverage may not be increased after a reduction.

*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 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.EN1771 (6-18) FOR EMPLOYEES

31

Voluntary Life and AD&D Socorro Independent School District Voluntary Life and AD&D Insurance Plan Highlights Policy Number 474619

Who is eligible for this coverage?

All actively employed employees working at least 30 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.

What are the Life/AD&D 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 $5,000; not to exceed $250,000.

Child: up to 100% of employee coverage amount in increments of $5,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000.

Note: In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself.

Can I be denied coverage?

If you and your eligible dependents enroll before the enrollment deadline, you may apply for any amount of coverage up to $200,000 for yourself and any amount of coverage up to $50,000 for your spouse, without answering any medical questions.

If you want coverage over the amount you are guaranteed, you will need to provide answers to health questions. In addition, if you and your eligible dependents do not enroll during this enrollment period, you will have to wait for a future annual enrollment period to apply — and then you will need to answer health questions for the entire amount of coverage you apply for.

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.

Why buy now?

As long as you buy $10,000 of life coverage now, you can buy more coverage later - up to $200,000 - without answering any medical questions.

How do I apply?

To apply for coverage, complete your enrollment form by 7/1/2020.

If you were hired after 7/1/2020, complete your enrollment form within 31 days of your eligibility date determined by your employer.

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

When is coverage effective? Your coverage is effective 7/1/2020 or the date your application is approved by underwriting, if health questions were required.

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.

32

Voluntary Life and AD&D How much does the coverage cost?

Term Life / AD&D Employee Monthly Life/AD&D Spouse Monthly Life/AD&D rate per $10,000 rate per $5,000 <25 $0.65 $0.325 25-29 $0.65 $0.325 30-34 $0.80 $0.40 35-39 $0.88 $0.44 40-44 $0.95 $0.475 45-49 $1.33 $0.665 50-54 $2.00 $1.00 55-59 $3.43 $1.715 60-64 $5.15 $2.575 65-69 $9.73 $4.865 70-74 $15.65 $7.825 75+ $15.65 $7.825 Child Life/AD&D monthly rate is $0.50 per $5,000 and $1.00 for $10,000. One Life/AD&D premium covers all children.

Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.

Age band

Spouse rate is based on the employee’s insurance age, which is their age immediately prior to and including the anniversary/ effective date.

Do my life insurance Coverage amounts will reduce according to the following schedule: benefits decrease with age? Age: Insurance amount reduces to: 70 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.

33

Life and AD&D Are there any AD&D exclusions or limitations?

When does my coverage end?

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 self-inflicted 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 non-prescription 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.

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.

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

34

35

MUTUAL OF OMAHA 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 to paycheck.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 36 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Socorro ISD Benefits Website: www.mybenefitshub.com/socorroisd

Accident Voluntary Accident Insurance If you broke a leg, would it break your bank account too?

Don’t let an accident catch you off guard. Protect your family’s finances with Accident Insurance from United of Omaha Life Insurance Company.

An accident insurance policy supplements your medical coverage and provides a cash benefit for injuries you or an insured family member sustain from an accident. This benefit can be used to pay out-of-pocket medical expenses, help supplement your daily living expenses and cover unpaid time off work.

As an active employee of Socorro Independent School District, you may purchase this coverage for yourself and your family members, and premiums can be deducted from your paycheck. It’s a simple and affordable way for your family to receive added financial protection.

Coverage guidelines and benefits are outlined below.

This insurance offers financial protection by paying a cash benefit if you or an insured dependent are injured as a result of a covered accident. Unless otherwise stated, the benefit amount payable is the same for you and your insured dependent(s).

Two accident plans are available to you, Option 1 and Option 2. You have the flexibility to enroll for the plan that best meets your (and your family’s) supplemental insurance needs.

ELIGIBILITY - ALL ELIGIBLE EMPLOYEES Eligibility Requirement

You must be actively working a minimum of 30 hours per week to be eligible for coverage.

Dependent Eligibility Requirement

To be eligible for coverage, your dependents must be able to perform normal activities, and not be confined (at home, in a hospital, or in any other care facility), and any child(ren) must be under age 26. In order for your spouse and/or children to be eligible for coverage, you must elect coverage for yourself.

Premium Payment

The premiums for this insurance are paid in full by you.

PLAN INFORMATION

OPTION 1

OPTION 2

Coverage Type

24-hour (On and off-job)

24-hour (On and off-job)

Express Benefit

$100

$50

Portability

Included

Included

Initial Care & Emergency1 – Most treatment / service required within 72 hours of accident; Once per accident per insured person Emergency Room

$200

$100

Urgent Care Center

$125

$75

Initial Physician Office Visit

$100

$50

Ambulance

Up to $1,500

Up to $500

Up to $6,000 / Up to $3,000

Up to $3,000 / Up to $1,500

Dislocations (Surgical / Non-surgical) Up to $9,000 / Up to $4,500

Up to $3,000 / Up to $1,500

Lacerations

Up to $800

Up to $400

Burns

Up to $15,000

Up to $5,000

Dental

Up to $300

Up to $150

Specified Injuries

1,2

Fractures (Surgical / Non-surgical)

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Accident Hospital, Surgical & Diagnostic1,3

Admission

$1,500

$750

Daily Confinement (Up to 365 days per accident)

$300 per day

$100 per day

ICU Confinement (Up to 15 days per accident)

$600 per day

$300 per day

Rehab. Facility Confinement (Up to 30 days per accident)

$150 per day

$50 per day

Surgical

Up to $2,000

Up to $1,000

Diagnostic

Up to $300

Up to $100

Follow-Up Care1 – Treatment / service required within 365 days of accident; Medical device is once per accident per insured person Physician Follow-Up Office Visit

$100; Up to 6 per accident

$50; Up to 6 per accident

Therapy Services

$50; Up to 6 per accident

$25; Up to 6 per accident

Medical Device

$200

$50

Prosthetic Device(s)

$1,000; Up to 2 per accident

$500; Up to 2 per accident

Additional Benefits1 – Benefits are payable within 365 days of accident Transportation (Up to 3 trips per accident)

$450 per trip

$150 per trip

Lodging (Up to 30 nights per accident)

$150 per night

$100 per night

Childcare (Up to 30 days per accident)

$30 per day

$20 per day

Catastrophic Benefits1,4 – Benefits are payable within 365 days of accident; Once per accident per insured person Principal Sum (PS)

You: $50,000 Spouse: $25,000 Child(ren): $10,000

You: $10,000 Spouse: $5,000 Child(ren): $5,000

Common Carrier Accidental Death

300% of PS

300% of PS

Transportation of Remains

Up to $5,000

Up to $5,000

Dismemberment & Paralysis

Up to 100% of PS

Up to 100% of PS

Reasonable Modifications

Up to 10% of PS

Up to 10% of PS

Coma

25% of PS

50% of PS

SERVICES Hearing Discount Program

The Hearing Discount program provides you and your family discounted hearing products, including hearing aids and batteries. Call 1-888-534-1747 or visit www.amplifonusa.com/ mutualofomaha to learn more.

1. Additional limitations apply as described in the certificate.

2. Fractures and dislocations require treatment within 90 days of accident, burns and lacerations within 72 hours of an accident, and dental care within 30 days. If an insured person sustains both a fracture and dislocation as the result of the same accident, the maximum amount payable is up to 200% of the amount payable for the injury with the highest applicable benefit amount.

3. Daily confinement must begin with 90 days of accident and ICU confinement within 30 days. Surgical treatment timeframes vary. If applicable, diagnostic services must be received within 90 days of accident. Except for confinement benefits, most benefits are payable once per accident per insured person. If any surgery occurs concurrently with an open reduction for a fracture or dislocation of the same bone or joint as a result of the same accident, only the highest applicable benefit is payable.

4. The principal sum for you and your spouse reduces by 50% when you reach the age of 70.

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Accident How Accident Insurance Works

Frequently Asked Questions

(For Illustration Purposes Only)

Who is eligible for this insurance?

•You must be actively working (performing all normal duties of your job) at least 30 hours per week and be under age 80 •Your dependent(s) must be performing normal activities and not be confined (at home or in a hospital / care facility) and any child(ren) must be under age 26

Accident Coverage This insurance pays a benefit for each injury, treatment or service included in the policy that occurs as the result of a covered accident.

For example, Jeff’s son, Jake, was playing soccer during recess at school. He was tripped and falls hard, injures his shoulder, and is transported by ambulance to the ER due to concerns of head trauma. The ER doctor orders a CT scan to check for any facial or head injuries and a shoulder X-ray.

Jake was diagnosed with a concussion and a broken collarbone.

His arm was set in a sling, and he was released to his pediatrician for follow-up care. Jake visits his pediatrician at two weeks and one month after the accident to make sure he’s healing well.

In the meantime, Jeff starts receiving bills for the care Jake received. The ambulance bill alone was $556. He’s a pretty healthy kid, so a health insurance deductible of $1,500 had to be met before Jeff’s health insurance would begin covering Jake’s care, and after that, there’s a 20% copay.

Accident benefits pay in addition to other insurance, and can be used to help cover gaps in health insurance or other expenses if the unexpected happens.

BENEFITS

AMOUNT

Ambulance

$200

ER Visit

$150

CT Scan

$200

X-ray

$50

Concussion

$150

Broken Collarbone

$300

Follow-Up Visit 1

$75

Follow-Up Visit 2

$75

Total Benefit

Note: The benefits shown in this example are for a sample design and may vary from the benefits that are available to you.

$1,200

Voluntary Accident Premium Rates The amounts shown below are MONTHLY amounts (12 payments / deductions per year). You may elect insurance for you only, or for your family. You have a choice of plan options.

Premiums will be automatically deducted from your paychecks as authorized by you during the enrollment process.

COVERAGE TIER

OPTION 1

OPTION 2

Employee/Member

$14.00 ($0.46 per day) $6.00 ($0.20 per day)

Employee/Member + $22.00 ($0.72 per day) $9.00 ($0.30 per day) Spouse Employee/Member + $28.00 ($0.92 per day) $12.00 ($0.39 per day) Child(ren)

What is the “Express Benefit”?

This benefit is payable upon notification of an accident in which an insured person is injured. It can be paid in a short time frame with minimal information (compared to a typical claim).

Can I take this insurance with me if I change jobs / am no longer a member of this group?

In the event this insurance ends due to a change in your employment / membership status with the group, or for certain other reasons, you or your insured spouse have the right to continue this insurance under the Portability provision, subject to certain conditions.

When does this insurance end?

Insurance will end on the last day of the month in which an insured person no longer satisfies the applicable eligibility conditions, or when you reach the age of 80. Additional circumstances under which insurance will end are described in the certificate.

Are there any exclusions or limitations?

The benefits payable are based on the insurance in effect on the date of the covered accident, subject to the definitions, limitations, exclusions and other provisions of the policy. The exclusions and limitations are summarized in the outline of coverage and detailed in the certificate.

Please contact your benefits administrator for a copy of the outline of coverage or if you have questions prior to enrolling.

This information describes some of the features of the benefits plan.

Benefits may not be available in all states. Please refer to the certificate booklet for a full explanation of the plan's benefits, exclusions, limitations and reductions. Should there be any discrepancy between the certificate booklet and this summary, the certificate booklet will prevail. Availability of benefits is subject to final acceptance and approval of the group application by the underwriting company. Accident insurance is underwritten by United of Omaha Life Insurance Company, 3300 Mutual of Omaha Plaza, Omaha, NE 68175, 1-800-769-7159. United of Omaha Life Insurance Company is licensed nationwide, except in New York. Policy form number 7000GM-U-EZ 2010. This policy provides accident insurance only. It does not provide basic hospital, basic medical or major medical insurance. It is not a Medicare supplement policy. The insurance is designed to pay you a fixed dollar amount regardless of the amount any provider charges.

Employee/Member + $37.00 ($1.22 per day) $16.00 ($0.53 per day) Family Note: The amount(s) above may vary due to rounding and are subject to change based on the final terms of the policy.

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Deer Oaks

EAP (Employee Assistance Program)

About this Benefit An Employee Assistance Plan (EAP) is an employee benefit program offered to help employees manage personal and professional problems that might adversely impact their work performance, health, and well-being. Employee Assistance Plans generally include short-term counseling and referral services for employees and their household members. Your Employee Assistance Program benefit is provided to you by your employer.

38%

YOUR BENEFITS PACKAGE

of employees have missed life events because of bad worklife balance.

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 40 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Socorro ISD Benefits Website: www.mybenefitshub.com/socorroisd

Employee Assistance Program Discover Your EAP + Work-Life Benefit Employee Assistance Program The Deer Oaks Employee Assistance Program (EAP) is a free service provided for you, your dependents, and household members by your employer. This program offers a wide variety of counseling, referral, and consultation services, which are all designed to assist you and your family in resolving work and life issues in order to live happier, healthier, more balanced lives. From stress, addiction, and change management, to locating child care facilities, legal assistance, and financial challenges, our qualified professionals are here to help.

These services are completely confidential and can be easily accessed 24/7, offering you around-the-clock assistance for all of lifeâ&#x20AC;&#x2122;s challenges.

Program Access: You may access the EAP by calling the toll - free Helpline number, using our iConnectYou App, or instant messaging with a work-life consultant through our online instant messaging system.

Telephonic Assessments & Support: In-the-moment telephonic support and crisis intervention are available 24/7 along with intake and clinical assessments.

Short-term Counseling: Counseling sessions with a qualified counselor to assist with issues such as stress, anxiety, grief, marital/family challenges, relationship issues, addiction, etc. Counseling is available via structured telephonic sessions, video, and in-person at local provider offices.

Referrals & Community Resources: Our team provides referrals to local community resources, member health plans, support groups, legal resources, and child/elder care/daily living resources.

Advantage Legal Assist: Free 30 minute telephonic or inperson consultation with a plan attorney; 25% discount on hourly attorney fees if representation is required; unlimited online access to a wealth of educational legal resources, links, tools and forms; and interactive online Simple Will preparation.

Advantage Financial Assist: Unlimited telephonic consultation with an Accredited Financial Counselor qualified to advise on a range of financial issues such as bankruptcy prevention, debt reduction and financial planning; supporting educational materials available; unlimited online access to a wealth of educational financial resources, links, tools and forms (i.e. tax guides, financial calculators, etc.).

Identity Theft Assistance: Free telephonic consultation with an Accredited Financial Counselor; information on steps that should be taken upon discovery of identity theft; referral to full-service credit recovery agencies; free credit monitoring service.

Work-life Services: Our work-life consultants are available to assist you with a wide range of daily living resources such as locating pet sitters, event planners, home repair, tutors, travel planning, and moving services. Simply call the Helpline for resource and referral information.

Child & Elder Care Referrals: Our child and elder care specialists can help you with your search for licensed child and elder care facilities in your area. They will discuss your needs, provide guidance, resources, and qualified referral packets. Searchable databases and other resources are also available on the Deer Oaks member website.

Take the High Road Ride Reimbursement Program: Deer Oaks reimburses members for their cab, Lyft and Uber fares in the event that they are incapacitated due to impairment by a substance or extreme emotional condition. This service is available once per year per participant, with a maximum reimbursement of $45.00 (excludes tips).

Your receipt may be submitted up to 60 days from date of service.

Contact Us: Toll-Free: (888) 993-7650 Website: www.deeroakseap.com Email: eap@deeroaks.com

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