2021-22 Calallen ISD Benefit Guide by Higginbotham Public Sector

CALALLEN ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2021 - 8/31/2022 WWW.MYBENEFITSHUB.COM/CALALLENISD 1

Table of Contents Benefit Contact Sheet 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. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) TRS Medical Texas Schools Health Benefits (TSHB) Program APL Hospital Indemnity EECU Health Savings Account (HSA) Lincoln Financial Group Dental EyeMed Vision Lincoln Financial Group Disability APL Cancer UNUM Critical Illness UNUM Accident Lincoln Financial Group Life and AD&D Texas Life Individual Term Life ID Watchdog Identity Theft MDLive Telehealth NBS Flexible Spending Account (FSA) MASA MTS Emergency Medical Transportation 2

3 4-5 6-11 6 7 8 9 10 11

12-13 14-19 20-23 24-25 26-31 32-35 36-39 40-45 46-51 52-55 56-59 60-61 62-65 66-67 68-71 72-75

FLIP TO... PG. 4

HOW TO ENROLL

PG. 6

SUMMARY PAGES

PG. 12

YOUR BENEFITS

Benefit Contact Information TRS ACTIVECARE MEDICAL

DISABILITY

INDIVIDUAL LIFE

Blue Cross Blue Shield (866) 355-5999 www.bcbstx.com/trsactivecare

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

Texas Life Insurance Company (800) 283-9233 www.TexasLife.com

TEXAS SCHOOLS HEALTH BENEFITS (TSHB) PROGRAM

CANCER

FLEXIBLE SPENDING ACCOUNT

90 Degree Benefits (888) 803-0081 www.tshbp.org

APL 800-256-8606 www.ampublic.com

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

HOSPITAL INDEMNITY

CRITICAL ILLNESS

HEALTH SAVINGS ACCOUNT

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

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

EECU (817) 882-0800 www.eecu.org

TELEHEALTH

ACCIDENT

IDENTITY THEFT

MDLIVE (866) 365-1663 www.consultmdlive.com

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

ID Watchdog (800) 970-5182 www.idwatchdog.com

DENTAL

LIFE AND AD&D

COBRA

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

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

VISION

EMERGENCY MEDICAL TRANSPORT

EyeMed (844) 225-3107 www.eyemed.com

MASA MTS (800) 423-3226 https://www.masamts.com/

MOBILE APP DOWNLOAD Enrollment made simple through the new FBS Benefits App! Text “FBS CALALLEN” to (800) 583-6908

and get access to everything you need to complete your benefits

“FBS CALALLEN” to (800) 583-6908

enrollment: •

Enrollment Resources

•

Online Support

•

Interactive Tools

•

And more!

App Group #: FBSCALALLEN

Text

OR SCAN

How to Log In

1 BENEFIT INFO

2 3

www.mybenefitshub.com/calallenisd

CLICK LOGIN

ENTER USERNAME & PASSWORD

INTERACTIVE TOOLS 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. If you have six (6) or less 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.

ONLINE SUPPORT

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

Annual Benefit Enrollment Benefit Updates - What’s New BASIC LIFE WITH LIFE KEYS The $25K basic life insurance (employer-paid) also offers a Life Keys plan that includes preparation of a basic will, assistance with funeral planning, bereavement counseling and much more. DISABILITY WITH EMPLOYEE ASSISTANCE PROGRAM Short-term disability with Fast Track Claims benefit and does not require a physician's statement. Long-term Disability includes an additional 10% progressive earnings benefit paid if you lose two or more activities of daily living or suffer a loss of cognitive impairment. Employee Assistance Program includes 5 face to face visits per issue per person per year.

HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you if you have an inpatient hospitalization. This plan supplements your health insurance by helping you pay for costs not paid by your health insurance. CRITICAL ILLNESS Critical illness insurance can be used for medical or other expenses. It provides a lump sum benefit of up to $10K, $20K or $30K paid directly to the insured upon diagnosis of a covered condition or event, such as certain types of cancer, heart attack or stroke. Spouse and dependent coverage is available at 100% of the employee's amount. Children are automatically covered.

Important Enrollment assistance is available by calling Financial Benefit Services at (469) 385-4685 to speak to a representative. Spanish speaking representatives are also available. Annual Open Enrollment Benefit elections will become effective 9/1/2021 (elections requiring evidence of insurability, such as life Insurance, may have a later effective date, if approved). After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 30 days of event). 6

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):

Enrollment Changes - When a Life Event Occurs Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

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

SUMMARY PAGES

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

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your benefit

Changes are not permitted during the plan year (outside of

website: www.mybenefitshub.com/calallenisd. Click the

annual enrollment) unless a Section 125 qualifying event occurs.

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

•

Changes, additions or drops may be made only during the

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

benefit website: www.mybenefitshub.com/calallenisd. Click

included in the dependent profile. Additionally, you must

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

notify your employer of any discrepancy in personal and/or

you can find provider search links under the Quick Links

benefit information.

•

For benefit summaries and claim forms, go to the Calallen ISD

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.

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

New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

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

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

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more

Dependent Eligibility: You can cover eligible dependent

regularly scheduled hours each work week.

children under a benefit that offers dependent coverage,

Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if

provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.

your 2021 benefits become effective on September 1, 2021, you must be actively-at-work on September 1, 2021 to be eligible for

your new benefits. PLAN

CARRIER

MAXIMUM AGE

Medical

TRS-BCBS or TSHB

To age 26

Telehealth

MDLIVE

To age 26

Dental

Lincoln Financial Group

To age 26

Vision

EyeMed

To age 26

Cancer

American Public Life

To age 26

Critical Illness

UNUM

To age 26

Accident

UNUM

To age 26

Life and AD&D

Lincoln Financial Group

To age 26

Identity Theft

ID Watchdog

To age 26

Individual Life

Texas Life

To age 26

Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents. Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility. FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance. Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility. Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.

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

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 9/1/2021 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).

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 tax-free.

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source Account Owner Underlying Insurance Requirement

Employee and/or employer Individual

Employee and/or employer Employer

High deductible health plan

None

Description

Minimum Deductible Maximum Contribution

$1,400 single (2021) $2,800 family (2021) $3,600 single (2021) $7,200 family (2021)

N/A $2,750

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. 68 11

2021-22 TRS-ActiveCare Plan Highlights Sept. 1, 2021 — Aug. 31, 2022 All TRS-ActiveCare participants have three plan options. Each includes a wide range of wellness benefits. TRS-ActiveCare 2 TRS-ActiveCare Primary • Lowest premium of the • • •

Plan summary

• •

Monthly Premiums Employee Only Employee and Spouse Employee and Children Employee and Family

plans Copays for doctor visits before you meet deductible Statewide network PCP referrals required to see specialists Not compatible with a health savings account (HSA) No out-of-network coverage

Total Premium $417 $1,176 $751 $1,405

Your Premium $ $ $ $

(This plan is closed and not accepting new enrollees. If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan.)

TRS-ActiveCare Primary+

TRS-ActiveCare HD

• Lower deductible than the HD and

• Compatible with a health savings

• • • • • •

Primary plans Copays for many services and drugs Higher premium than the other plans Statewide network PCP referrals required to see specialists Not compatible with a health savings account (HSA) No out-of-network coverage

Total Premium $542 $1,334 $879 $1,675

account (HSA) • Nationwide network with out-ofnetwork coverage • No requirement for PCPs or referrals • Must meet your deductible before plan pays for non-preventive care

• Closed to new enrollees • Current enrollees can choose to

stay in this plan

• Lower deductible • Copays for many drugs and

services

• Nationwide network with out-of-

network coverage

• No requirement for PCPs or

referrals

Your Premium $ $ $ $

Total Premium $429 $1,209 $772 $1,445

Your Premium $ $ $ $

Total Premium $1,013 $2,402 $1,507 $2,841

Your Premium $ $ $ $

Plan Features Type of Coverage Individual/Family Deductible

In-Network Coverage Only

In-Network

Out-of-Network

In-Network

Out-of-Network

$2,500/$5,000

$1,200/$3,600

$3,000/$6,000

$5,500/$11,000

$1,000/$3,000

$2,000/$6,000

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 20% after deductible

$8,150/$16,300

$6,900/$13,800

Statewide Network

You pay 50% after deductible $20,250/ $7,000/$14,000 $40,500 Nationwide Network

You pay 40% after deductible $23,700/ $7,900/$15,800 $47,400 Nationwide Network

Yes

Primary Care

$30 copay

Specialist

$70 copay

$0 per consultation

$50 copay

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

$0 per consultation

$30 per consultation

Drug Deductible Generics (30-Day Supply/ 90-Day Supply)

Integrated with medical $15/$45 copay; $0 for certain generics

$200 brand deductible

Integrated with medical You pay 20% after deductible; $0 for certain generics

Preferred Brand

You pay 30% after deductible

You pay 25% after deductible

Non-preferred Brand

You pay 50% after deductible

Specialty

You pay 30% after deductible

You pay 20% after deductible

Coinsurance Individual/Family Maximum Out-of-Pocket Network Primary Care Provider (PCP) Required

Doctor Visits

TRS Virtual Health

You pay 30% You pay 50% after deductible after deductible You pay 30% You pay 50% after deductible after deductible $30 per consultation

You pay 40% after deductible You pay 40% $70 copay after deductible $0 per consultation $30 copay

Immediate Care Urgent Care Emergency Care TRS Virtual Health

You pay 30% after deductible

You pay 50% after deductible

You pay 40% after deductible You pay a $250 copay plus 20% after deductible $0 per consultation $50 copay

Prescription Drugs $15/$45 copay

How to Calculate Your Monthly Premium

Wellness Benefits at No Extra Cost

Total Monthly Premium

Being healthy is easy with:

Your District and State Contributions

Your Premium Ask your Benefits Administrator for your district’s premiums.

Things to Know • •

TRS’s Texas-sized purchasing power creates broad networks without county boundaries. Specialty drug insurance means you’re covered, no matter what life throws at you.

• • • • •

$0 preventive care 24/7 customer service One-on-one health coaches Weight loss programs Nutrition programs

$200 brand deductible $20/$45 copay You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max) You pay 50% after deductible ($100 min/$200 max)/ You pay 50% after deductible ($215 min/$430 max) You pay 20% after deductible ($200 min/$900 max)

• • • •

Ovia® pregnancy support TRS Virtual Health Mental health support And much more!

Available for all plans. See your Benefits Booklet for more details.

2021-22 Health Maintenance Organizations: Premiums for Regional Plans Remember: When you choose an HMO, you’re choosing a regional network. TRS also contracts with HMOs in certain regions of the state to bring participants in those areas another option.

Central and North Texas Scott and White Care Plan

Blue Essentials — South Texas HMOSM

Brought to you by TRS-ActiveCare

You can choose this plan if you live in one of these counties: Austin, Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Collin, Coryell, Dallas, Denton, Ellis, Erath, Falls, Freestone, Grimes, Hamilton, Hays, Hill, Hood, Houston, Johnson, Lampasas, Lee, Leon, Limestone, Madison, McLennan, Milam, Mills, Navarro, Robertson, Rockwall, Somervell, Tarrant, Travis, Walker, Waller, Washington, Williamson

Total Monthly Premiums Employee Only Employee and Spouse Employee and Children Employee and Family

Total Premium

Your Premium

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

Total Premium

Your Premium

Blue Essentials — West Texas HMOSM Brought to you by TRS-ActiveCare You can choose this plan if you live in one of these counties: Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Callahan, Carson, Castro, Childress, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, Yoakum

Total Premium

Your Premium

$542.48

$524.00

$596.54

$1,362.70

$1,264.28

$1,443.66

$872.16

$819.60

$936.18

$1,568.42

$1,345.58

$1,532.74

Plan Features Type of Coverage Individual/Family Deductible

In-Network Coverage Only

$1,150/$3,450

$500/$1,000

$950/$2,850

You pay 20% after deductible

You pay 25% after deductible

$7,450/$14,900

$4,500/$9,000

$7,450/$14,900

Primary Care

$20 copay

$25 copay

$20 copay

Specialist

$70 copay

$60 copay

$70 copay

$50 copay

$75 copay

$50 copay

$500 copay after deductible

You pay 20% after deductible

$500 copay before deductible and 25% after deductible

$200 (excl. generics)

$100

$150

30-day supply/90-day supply

$10/$25 copay

$10/$30 copay

$5/$12.50 copay; $0 for certain generics

Preferred Brand

You pay 30% after deductible

$40/$120 copay

You pay 30% after deductible

Non-preferred Brand

You pay 50% after deductible

$65/$195 copay

You pay 50% after deductible

You pay 15%/25% after deductible (preferred/non-preferred)

You pay 20% after deductible

You pay 15%/25% after deductible (preferred/non-preferred)

Coinsurance Individual/Family Maximum Outof-Pocket

Doctor Visits

Immediate Care Urgent Care Emergency Care

Prescription Drugs Drug Deductible Day Supply Generics

Specialty

trs.texas.gov 13

TSHBP

Alternative Medical Plan

YOUR BENEFITS PACKAGE

About this Benefit The TSHBP is proud to offer a variety of plans and benefits to meet school district needs. Plans for 2020-21 include our High Deductible Health Plan (HDHP) and our CoPay Plan (CPP). Both plans are designed so members can easily navigate through their health medical needs.

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 Calallen ISD Benefits Website: www.mybenefitshub.com/calallenisd

Texas Schools Health Benefits Plan About Texas Schools Health Benefits Program (TSHBP) The Texas Schools Health Benefits Program is a regionally rated program developed for Texas school districts. Our purpose is to support the school children of Texas. We do this by providing health benefit solutions to our dedicated teachers, administrators, and support staff so they can concentrate on what they do best – teaching and supporting our kids. It is our desire to increase member health and well-being and provide tools necessary to identify and manage the health of each and every member. TSHBP plans are available for school district employees who are employed by participating districts and are active, contributing TRS members.

Both TSHBP Plans Include •

A Nationwide Network for Physician and Ancillary Services. Both In and Out of Network physician and Ancillary Services are covered

•

No primary care provider required or referral to a specialist. A member can use any provider in the network or out of the network

•

A Care Coordinator service (personal concierge) to support members with all their medical needs and specifically assist them with all facility care

•

Specialty drugs over $670 (30 day supply) are not covered, but the plan offers Patient Assistance and Co-Pay assistance

•

A patient advocate to help members with any balance bill and to pay the bill on the members behalf if necessary

•

ACA Preventative Services are paid at 100% and all copays and deductibles are waived

TSHBP High Deductible Highlights •

Significantly lower premium rates compared to the TRS-

TSHBP Co-Pay Highlights •

ActiveCare HD plan •

Lower out-of-pocket maximums since a member-only have

A unique plan that members pay only copayments for service. All copayments apply to the deductible

•

to meet their deductible (no coinsurance)

Lower out-of-pocket maximums since a member-only have to meet their deductible (no coinsurance)

•

TSHBP HD - $3,000

•

TSHBP CoPay - $3,500

•

In comparison with TRSAC HD - $7,000

•

In comparison with TRSAC Primary - $8,150

•

Telehealth at a $30 Consultation Fee

•

Telehealth at $0 Copay

•

All eligible prescriptions are paid at 100% after the

•

$0 copay for generic drugs at CVS, HEB, Wal-Mart, Sam’s,

deductible

and Costco ($10 copay at other network pharmacies)

Texas Schools Health Benefits Plan—HD Plan Plan Plan Summary TSHBP HD Plan Plan Features

HOW DOES TSHBP COMPARE TO TRS? Our unique embedded deductible health plans offer members lower out-of pocket maximums, bringing substantial savings without sacrificing care or quality.

Network Plan Deductible Feature Individual/Family Deductible Individual/Family Maximum Out-of- Pocket Health Savings Account (HSA) Eligible Required - Primary Care Provider (PCP) Required - PCP Referral to Specialist Prescription Drug Benefits

In-Network Coverage

Out-of-Network Coverage

HealthSmart - National Deductible, then Plan pays 100% $3,000/$9,000

N/A Deductible, then Plan pays 100% $3,500/$9,500

$3,000/$9,000

$3,500/$9,500

Yes

Yes - Deductible, then Plan pays 100%

Yes - $0 copay $30 per consultation Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% In-Network Only In-Network Only In-Network Only

Deductible, then Plan pays 100%

In-Network Only

Deductible, then Plan pays 100%

In-Network Only

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100%* Deductible, then Plan pays 100%* Deductible, then Plan pays 100%* Deductible, then Plan pays 100%* In-Network Only

Doctor Visits Preventive Care Virtual Health - Teladoc Primary Care Specialist

Office Services

WHAT ARE CARE COORDINATORS? The Care Coordinators act as a personal concierge for all TSHBP plans and members, and their job is to support the member as their healthcare advocate. Watch the below video to learn more.

Allergy Injections Allergy Serum Chiropractic Services Office Surgery MRI’s, Cat Scans, and Pet Scans Urgent Care Facility

Care Facilities Urgent Care Facility Freestanding Emergency Room Hospital Emergency Room Ambulance Services Outpatient Surgery Hospital Services Surgeon Fees

Maternity and Newborn Services Maternity Charges (prenatal and postnatal care) Routine Newborn Care

Rehabilitation/Therapy

https://tshbp.info/CCVideo

Occupational/Speech/Physical Cardiac Rehabilitation Chemotherapy, Radiation, Dialysis Home Health Care Skilled Nursing

Care Coordinator* The Care Coordinator program must be used to access facility services or no benefits will be available under the Plan. These services include routine colonoscopy and related services; hospital providers for MRIs, Cat Scans, and Pet Scans; hospital providers for outpatient Lab/Radiology Services; Inpatient Hospital Admissions; Outpatient Hospital/Ambulatory Surgical Facility Services; Maternity and Newborn Services; Rehabilitation/Therapy Services; Extended Care Services; and Other Services including durable medical equipment/supplies, orthotics/ prosthetics, facilities for diabetic self-management training, and sleep disorder services. To review the complete plan document and services that require access through the Care Coordinator program, please call 888-803-0081.

Texas Schools Health Benefits Plan—CoPay Plan Plan Summary TSHBP CoPay Plan Plan Features

HOW DOES TSHBP COMPARE TO TRS? Our unique embedded deductible health plans offer members lower out-of pocket maximums, bringing substantial savings without sacrificing care or quality.

In-Network Coverage

Out-of-Network Coverage

HealthSmart - National Copayments, then Plan pays 100% $3,500/$10,500

N/A Copayments, then Plan pays 100% $4,000/$11,000

$3,500/$10,500

$4,000/$11,000

Yes - Copayments, then Plan pays 100%

Yes - $0 copay $0 per consultation $35 copay $35 copay

Yes - $0 copay $0 per consultation $40 copay $40 copay

$5 copay $35 copay $35 copay $110 copay $275 copay $50 copay

$10 copay $40 copay $40 copay $125 copay $325 copay $75 copay

$50 copay $500 copay $500 copay $220 copay $500 copay $500 copay $100 copay

$75 copay $500 copay $500 copay $220 copay In-Network Only In-Network Only In-Network Only

$500 copay

In-Network Only

$250 copay

In-Network Only

$55 copay $110 copay $110 copay $55 copay $500 copay

$65 copay* $125 copay* $125 copay* $75 copay* In-Network Only

Doctor Visits Preventive Care Virtual Health - Teladoc Primary Care Specialist

Office Services

Allergy Injections Allergy Serum Chiropractic Services Office Surgery MRI’s, Cat Scans, and Pet Scans Urgent Care Facility

Care Facilities Urgent Care Facility Freestanding Emergency Room Hospital Emergency Room Ambulance Services Outpatient Surgery Hospital Services Surgeon Fees

Maternity and Newborn Services Maternity Charges (prenatal and postnatal care) Routine Newborn Care

Rehabilitation/Therapy

https://tshbp.info/CCVideo

Occupational/Speech/Physical Cardiac Rehabilitation Chemotherapy, Radiation, Dialysis Home Health Care Skilled Nursing

Calallen ISD Medical Rates 2021-22 The rates below are not inclusive of your district’s medical contribuƟon. Please visit your benefit website for more informaƟon regarding your district’s medical contribuƟon amounts.

TRS‐Ac veCare HD

$429

$772

$1,209

$1,445

TRS‐Ac veCare Primary +

$542

$879

$1,334

$1,675

TRS‐Ac veCare Primary

$417

$751

$1,176

$1,405

TSHBP

HD Plan

$349

$679

$993

$1,297

CoPay Plan

$390

$751

$1,099

$1,464

Maximum Out‐of‐Pocket Costs (In-Network) For 2021‐22 Cost for Families

Cost for Individuals $3,000 $3,500

TSHBP CoPay Plan

$9,000 $10,500

$7,000

TRS‐Ac veCare HD

$14,000

$6,900

TRS‐ActiveCare Primary +

$13,800

$8,150

TSHBP HD Plan

TRS‐Ac veCare Primary

$16,300

Texas Schools Health Benefits Cost Examples TRS

PEG IS HAVING A BABY

Deductible

TSHBP

Primary Primary+

Co Pay

$3,000

$2,500

$1,200

$3,000

$3,500

Specialist Coinsurance/Copayment

30%

$70

$35

Hospital Coinsurance/Copayment

30%

20%

$500

Other Coinsurance/Copayment

30%

20%

$250

Total Example Cost

$12,800

Deductibles

$3,000

$2,500

$1,200

$3,000

Copayments

$70

$1,285

Coinsurance

$2,940

$3,000

$2,300

$60

$6,000

$5,630

$3,630

$3,000

$1,285

Limits or Exclusions Total Cost

Compared to TRS-AC HD (savings)

$3,000

Compared to TRS-AC Primary (savings)

$2,345

Compared to TRS-AC Primary + (savings)

$4,345

TOM’S KNEE REPLACEMENT Deductible

TRS HD

TSHBP

Primary Primary+

Co Pay

$3,000

$2,500

$1,200

$3,000

$3,500

Specialist Coinsurance/Copayment

30%

$70

$35

Hospital Coinsurance/Copayment

30%

20%

$500

Other Coinsurance/Copayment

30%

20%

$250

Total Example Cost

$38,000

Deductibles

$3,000

$2,500

$1,200

$3,000

Copayments

$70

$1,385

Coinsurance

$10,500

$10,650

$7,360

$60

$7,000*

$8,150*

$6,900*

$3,000

$1,385

Limits or Exclusions Total Cost

Compared to TRS-AC HD (savings)

$4,000

Compared to TRS-AC Primary (savings)

$6,785

Compared to TRS-AC Primary + (savings)

$5,535

*Out-of-pocket limit

APL 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 20 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Calallen ISD Benefits Website: www.mybenefitshub.com/calallenisd

MedChoice™ Group Limited Benefit Hospital Indemnity Insurance Calallen ISD HSA Compatible THE INSURANCE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM.

Summary of Benefits

Plan 1

Plan 2

Plan 3

Hospital Admission Benefit

$1,500 per day; maximum of 1 day

$2,000 per day; maximum of 1 day

$3,000 per day; maximum of 1 day

Hospital Confinement Benefit

$200 per day; maximum of 30 days

Intensive Care Unit Benefit

$200 per day; maximum of 15 days

Rehabilitation Benefit

$200 per day; maximum of 5 days

Surgery in a Hospital, Hospital Outpatient Facility or Freestanding Outpatient Surgery Center

$250 per day; maximum of 1 day

Surgery in a Physician’s Office

$125 per day; maximum of 1 day

Emergency Room

$100 per day; maximum of 1 day

Urgent Care

$50 per day; maximum of 1 day

Physician’s Office

$50 per day; maximum of 5 days

Physical, Speech or Occupational Therapy Facility

$15 per day; maximum of 1 day

Included

Accident Surgery Benefit

Outpatient Accident Treatment Benefit

Additional Rider Portability Rider

HSA Compatible Monthly Premiums* Individual Ages 18 +

Individual & Spouse

Individual & Child(ren)

Individual & Family

Plan 1

Plan 2

Plan 3

Plan 1

Plan 2

Plan 3

Plan 1

Plan 2

Plan 3

Plan 1

Plan 2

Plan 3

$16.76

$20.14

$26.26

$38.46

$41.64

$54.26

$22.28

$23.52

$30.40

$40.92

$45.44

$58.88

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

Benefits

Benefits are per day, up to the maximum number of days per calendar year, per covered person. Benefit amounts may vary based upon place of service. Benefits will only be paid for a covered loss incurred while covered under the certificate. A covered person is a person who is eligible for coverage under the certificate and for whom the coverage is in force. An eligible dependent means your lawful spouse; your natural, adopted or stepchild who is under the age of 26; and/or any child under the age of 26 who is under your charge, care and control, and who has been placed in your home for adoption, or for whom you are a party in a suit in which adoption of the child is sought; or any child under the age of 26 for whom you must provide medical support under an order issued under Chapter 154 of the Texas Family Code, or enforceable by a court in Texas; or grandchildren under the age of 26 if those grandchildren are your dependents for federal income tax purposes at the time application for coverage of the grandchild is made. Hospital Admission Benefit - Pays a benefit when a covered person is admitted and confined as an inpatient in a hospital due to an injury or covered sickness. APL will not pay this benefit for outpatient treatment, emergency room treatment or a stay less than 18 hours in an observation unit. This benefit is only payable once per period of confinement. A hospital is not an institution, or part thereof, used as a place for rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a long-term nursing unit or geriatrics ward or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients. APSB-22507(TX)-0321 Calallen ISD

Page 1 of 3

MedChoice™ Group Limited Benefit Hospital Indemnity Insurance Hospital Confinement Benefit - Pays a per day benefit when a covered person is confined as an inpatient to a hospital due to an injury or covered sickness. Intensive Care Unit Benefit - Pays a per day benefit when a covered person is confined in an ICU due to an injury or covered sickness. Benefits will be paid beginning the first day of ICU confinement when the ICU confinement begins after the covered person’s effective date. Rehabilitation Benefit - Pays a per day benefit when a covered person is receiving rehabilitation care services while confined in a rehabilitation unit or skilled nursing facility immediately after a covered period of confinement due to an injury or covered sickness. This benefit is not payable in addition to any other confinement benefit provided under the policy on the same day. If more than one confinement occurs on the same day, the higher benefit will be paid. Accident Surgery Benefit - Pays the applicable per day benefit when a surgical procedure is performed on a covered person in a hospital, hospital outpatient facility, a freestanding outpatient surgery center or a physician’s office due to an injury. Outpatient Accident Treatment Benefit - Pays the applicable per day benefit when a covered person receives treatment in an emergency room, urgent care facility, physician’s office or physical/speech/occupational therapy facility due to an injury.

Exclusions

No benefits are payable for any loss resulting from or caused, whether directly or indirectly by: hernia, adenoids, tonsils, varicose veins, appendix, disorder of the reproduction organs within six months after the certificate effective date unless due to an emergency; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war; (if coverage is suspended for any covered person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request.); dental treatment or routine vision services unless due to injury and if performed within 12 months of the date of the covered accident or due to congenital defect or birth anomaly of a covered newborn child; an intentionally self-inflicted injury or sickness; committing, or attempting to commit, an illegal act that is defined as a felony (felony is as defined by the law of the jurisdiction in which the act takes place); an injury or sickness incurred while engaging in an illegal occupation; cosmetic care, except when the hospital confinement is due to medically necessary reconstructive plastic surgery (medically necessary reconstructive plastic surgery is defined as: surgery to restore a normal bodily function, surgery to improve functional impairment by anatomic alteration made necessary as a result of a congenital birth defect or birth anomaly, breast reconstruction following mastectomy); being intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions (intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss was incurred); experimental treatment, drugs or surgery, except in connection with an approved cancer clinical trial; immunizations; artificial insemination, in vitro fertilization, test tube fertilization, sterilization, tubal ligation or vasectomy, and reversal thereof; participation in any sport for pay or profit; serious mental illness without demonstrable organic disease; alcoholism or drug addiction treatment; services for which payment is not legally required, except for: Medicaid; treatment of non-service connected disabilities in Veterans Administration hospitals and care rendered to armed services retirees and dependents in military medical facilities of the United States Government; voluntary abortion except, with respect to you or your covered eligible dependent spouse: where you or your dependent spouse’s life would be endangered if the fetus were carried to term or where medical complications have arisen from abortion; pregnancy of an eligible dependent child; participating in a riot, insurrection, rebellion, civil commotion, civil disobedience or unlawful assembly (this does not include a loss which occurs while acting in a lawful manner within the scope of authority); participation in a contest of speed in power driven vehicles, parachuting or hang gliding; air travel except as a fare-paying passenger on a commercial airline on a regularly scheduled route or as a passenger for transportation only and not as a pilot or crew member; sex changes; a diagnosis or treatment received outside the United States, or its territories, that cannot be confirmed by a physician licensed and practicing in the United States. The covered person, at his or her own expense, is responsible for obtaining such confirmation.

Termination of Certificate

Your insurance coverage under the certificate, including any attached riders, will end on the earliest of these dates: the date the policy terminates; the date the renewal premium became due once the grace period has ended if the premium remains unpaid; the date you no longer qualify as an insured; or the date of your death.

Termination of Coverage

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

Extension of Coverage

Coverage under the certificate will continue for a covered person who is totally disabled on the date coverage ends due to termination of the policy. This continuation of coverage will end the earliest of 90 days; the duration of the total disability or the date the covered person’s coverage is replaced with coverage by the succeeding carrier that provides a level of benefits that is at least substantially equal to the level of benefits provided under this policy. Benefits payable during this extension of coverage is subject to the regular benefit limits of this policy. Premiums will continue to be due during this extension of coverage. For the purpose of this provision only, totally disabled means the complete inability of the covered person to perform all of the substantial and material duties and functions of the individual’s occupation and any other gainful occupation in which the covered person earns substantially the same compensation earned before the disability.

COBRA Continuation of Coverage

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

22 APSB-22507(TX)-0321 Calallen ISD

Page 2 of 3

MedChoice™ Group Limited Benefit Hospital Indemnity Insurance Additional Riders

All riders are part of the policy/certificate to which it is attached and are subject to all the provisions of the policy/certificate that are not in conflict with the provisions of the rider. Portability Rider When your coverage under the Group Limited Benefit Hospital Indemnity Policy terminates for reasons other than non-payment of premium, he/she may elect to continue coverage. APL must receive a completed Portability Election form and payment of the first premium for the portability coverage no later than 30 days after such termination of coverage. The benefits, terms and conditions of the portability coverage will be the same as those under the Group Limited Benefit Hospital Indemnity Policy immediately prior to the date the portability option was elected. No changes may be made to benefit amounts, terms, or conditions after portability has been elected. Portability coverage may include any eligible dependents who were covered under the policy at the time of termination. No eligible dependents may be added to the portability coverage except as provided in the newborn and adopted children provision. Eligible dependents may be removed at any time. Premiums will be adjusted accordingly. Portability coverage will be effective on the day after coverage ends under the Policy. Under the portability coverage, you will no longer be required to be actively at work with the policyholder. Once portability has been elected, no further portability options are available for any person covered under the ported coverage. All future premiums due will be billed directly to you. You are responsible for payment of all premiums for the portability coverage. APL will notify you of the amount of premium due, the frequency of premium payments and the premium due dates. APL will not change the premium rate more than once in any period of six consecutive months and will give you 60 days advance written or electronic notice of any change in rates. Termination of Portability Rider Prior to Portability: Prior to portability being elected, the rider will terminate on the earliest of: the end of the grace period if the premium remains unpaid; the end of the certificate period in which we receive a request from the policyholder to terminate the rider or the end of the certificate period in which APL terminates the rider. Termination of Portability Coverage: Insurance under the portability privilege will end on the earliest of: the date the master policy terminates; the end of the grace period if the premium for the portability coverage remains unpaid; the end of the certificate period in which we receive a written request from you to terminate the portability coverage; the date of your death; with respect to eligible dependents, the date the covered person no longer qualifies as an eligible dependent. Once insurance under this portability provision is cancelled, it cannot be reinstated.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 Underwritten by American Public Life Insurance Company. All Riders are subject to all the Provisions, Conditions, Limitations and Exclusions of the Policy to which it is attached, which are not in conflict with those of the Rider. For complete benefits and other provisions, please refer to the policy/certificate/rider. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GHI17 Series | TX | Group Limited Benefit Hospital Indemnity Insurance Policy | (03/21) | FBS | Calallen ISD

APSB-22507(TX)-0321 Calallen ISD

Page 3 of 3

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

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 2021 Annual HSA Contribution Limits your HSA questions or transactions. You can also chat with Individual: $3,600 us online at eecu.org or use our secure email. Member Family: $7,200 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 account statements show all • Health Savings accountholder your account activity for that period. You can receive free • Age 55 or older (regardless of when in the year an online statements or printed statements. 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.

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

Dental PPO– High Full-Time Employees of Calallen Independent School District

Benefits At-A-Glance Dental Insurance 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 Calallen Independent School District employees • Allows you to choose any dentist you wish, though you can lower your outof-pocket costs by selecting a contracting dentist • Does not make you and your loved ones wait six months between routine cleanings

Contracting Dentists Non-Contracting Dentists Individual: $50 Individual: $50 Calendar (Annual) Deductible 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 Non-Contracting Dentists’ services. Annual Maximum $1,500 $1,500 MaxRewards® lets you and your covered family members roll a portion of unused dental benefits from one year into the next. So you have extra benefit dollars available when you need them most. • Eligible Range (claim threshold): $700 • Rollover Amount: $350 per calendar year • Rollover Amount with Preferred Provider: $500 per calendar year • Maximum Rollover Account Balance: $1,250 Lifetime Orthodontic Max $1,000 $1,000 Orthodontic Coverage is available for dependent children and adults. Waiting Period There are no benefit waiting periods for any service types 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. Contracting Dentists Non-Contracting Dentists

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 Basic Services Space maintainers for children Problem focused exams Consultations Palliative treatment (including emergency relief of dental pain) Injections of antibiotics and other therapeutic medications Fillings Prefabricated stainless steel and resin crowns Simple extractions Oral surgery Biopsy and examination of oral tissue (including brush biopsy) Periodontal maintenance procedures Occlusal adjustments Major Services Surgical extractions General anesthesia and I.V. sedation Prosthetic repair and recementation services Endodontics (including root canal treatment) Non-surgical periodontal therapy Periodontal surgery Bridges Full and partial dentures Denture reline and rebase services Crowns, inlays, onlays and related services

100% No Deductible

Contracting Dentists

Non-Contracting Dentists

80% After Deductible

Contracting Dentists

Non-Contracting Dentists

50% After Deductible

Dental– High PPO Orthodontics Orthodontic exams X-rays Extractions Study models Appliances

This plan lets you choose any dentist you wish. However, your out-ofpocket costs are likely to be lower when you choose a contracting dentist. For example, if you need a crown…

• • • • •

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.

Non-Contracting Dentists

50%

… you pay a deductible (if applicable), …you pay a deductible (if applicable), then 50% of the usual and customary fee, then 50% of the remaining which is the maximum expense covered discounted fee for PPO members. by the plan. You are responsible for the This is known as a PPO contracted difference between the usual and fee. 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

Contracting Dentists

•

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. • This plan includes continuation of coverage for employees with dental coverage from a previous employer. The member is required to complete the Continuity of Coverage form located on www.lfg.com. The form must be provided to us prior to the effective date to be eligible for continuation of coverage. A complete list of benefit exclusions is included in the summary plan description. Questions? Call 800-423-2765 and mention Group ID: LIFESCHDAL.

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 Benefit Exclusions maximum benefit amounts. Like any coverage, this dental coverage does have some exclusions. Lincoln DentalConnect® health center Web content is provided by • The plan does not cover services started before coverage begins or after it ends. Benefits are limited to appropriate and necessary go2dental.com, Santa Clara, CA. Go2dental.com is not a Lincoln Financial Group® company. Coverage is subject to actual summary plan procedures listed in the summary plan description. Benefits are not payable for duplication of services. Covered expenses will not description language. Each independent company is solely responsible for its own obligations. exceed the summary plan description’s usual and customary The Lincoln National Life Insurance Company (Fort Wayne, IN), does allowances. • Plan benefits are not payable for a condition that is covered under 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 Workers’ Compensation or a similar law; that occurs during the York (Syracuse NY). Both are Lincoln Financial Group Companies. course of employment or military service or involvement in an ©2020 Lincoln National Corporation LCN-2012491-013118 R 1.0 – illegal occupation, felony, or riot; or that results from a selfGroup ID: 1001048 inflicted injury.

Dental– Low PPO Full-Time Associates, Mid-Management and Executives of Life School of Dallas

Benefits At-A-Glance Dental Insurance Low 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 Calallen Independent School District employees • Allows you to choose any dentist you wish, though you can lower your outof-pocket costs by selecting a contracting dentist • Does not make you and your loved ones wait six months between routine cleanings

Contracting Dentists Non-Contracting Dentists Individual: $50 Individual: $50 Calendar (Annual) Deductible 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 Non-Contracting Dentists’ services. Annual Maximum $1,000 $1,000 MaxRewards® lets you and your covered family members roll a portion of unused dental benefits from one year into the next. So you have extra benefit dollars available when you need them most. • Eligible Range (claim threshold): $700 • Rollover Amount: $350 per calendar year • Rollover Amount with Preferred Provider: $500 per calendar year • Maximum Rollover Account Balance: $1,250 Lifetime Orthodontic Max $850 $850 Orthodontic Coverage is available for dependent children and adults. Waiting Period There are no benefit waiting periods for any service types 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. Contracting Dentists Non-Contracting Dentists

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 Space maintainers for children Basic Services Sealants Problem focused exams Consultations Palliative treatment (including emergency relief of dental pain) 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 Prosthetic repair and recementation services Periodontal maintenance procedures Major Services Endodontics (including root canal treatment) Non-surgical periodontal therapy Periodontal surgery Bridges Full and partial dentures Denture reline and rebase services Crowns, inlays, onlays and related services Occlusal adjustments

80% No Deductible

Contracting Dentists

Non-Contracting Dentists

65% After Deductible

Contracting Dentists

Non-Contracting Dentists

50% After Deductible

Dental– Low PPO Orthodontics

Orthodontic exams X-rays Extractions Study models Appliances

This plan lets you choose any dentist you wish. However, your out-ofpocket costs are likely to be lower when you choose a contracting dentist. For example, if you need a crown…

• • • • •

Lincoln DentalConnect® Online Health Center • • • •

Covered Family Members When you choose coverage for yourself, you can also provide coverage for: • Your spouse. • Dependent children, up to age 26.

Non-Contracting Dentists

50%

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

With the Lincoln Dental Mobile App

Contracting Dentists

•

EYEMED YOUR BENEFITS PACKAGE

Vision

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

Vision Calallen ISD SUMMARY OF BENEFITS VISION CARE SERVICES EXAM SERVICES Exam Retinal Imaging CONTACT LENS FIT AND FOLLOW-UP Fit & Follow-up - Standard follow-up visits Fit & Follow-up - Premium FRAME Frame STANDARD PLASTIC LENSES Single Vision Bifocal Trifocal Lenticular Progressive - Standard Progressive - Premium Tier 1 - 4 LENS OPTIONS Anti Reflective Coating - Standard Anti Reflective Coating - Premium Tier 1 - 3 Photochromic - Non-Glass Polycarbonate - Standard Scratch Coating - Standard Plastic Tint - Solid and Gradient UV Treatment All Other Lens Options CONTACT LENSES Contacts - Conventional Contacts - Disposable Contacts - Medically Necessary OTHER Hearing Care from Amplifon Network call 1.877.203.0675 Lasik or PRK from U.S. Laser Network call 1.800.988.4221 FREQUENCY Exam Frame Lenses Contacts Lenses

IN-NETWORK MEMBER COST

OUT-OF-NETWORK MEMBER REIMBURSEMENT

$10 copay Up to $39

Up to $40 Not covered

Up to $40; contact lens fit and two

Not covered

10% off retail price

Not covered

$0 copay; 20% off balance over $130 allowance

Up to $91

$25 copay $25 copay $25 copay $25 copay $80 copay $110 - 200 copay

Up to $30 Up to $50 Up to $70 Up to $70 Up to $50 Up to $50

$45 copay $57 - 85 copay $75 $40 $15 $15 $15 20% off retail price

Up to $23 Up to $23 Not covered Not covered Not covered Not covered Not covered Not covered

$0 copay; 15% off balance over $130 allowance $0 copay; 100% of balance over $130 allowance $0 copay; paid-in-full

Up to $91 Up to $91 Up to $210

Discounts on hearing exam and aids;

Not covered

15% off retail or 5% off promo price;

Not covered

ALLOWED FREQUENCY –ADULTS Once every plan year Once every plan year Once every plan year Once every plan year

ALLOWED FREQUENCY –KIDS Once every plan year Once every plan year Once every plan year Once every plan year

40% OFF additional complete pair of pre-

Find an eye doctor (Insight Network) • eyemed.com • EyeMed Members App • For LASIK, call 1.800.988.4221

Heads up You may have additional benefits. Log into eyemed.com/member to see all plans included with your benefits.

scription eyeglasses

20% OFF non-covered items, including non- prescription sunglasses

EyeMed reserves the right to make changes to the products available on each tier. All providers are not required to carry all brands on all tiers. For current listing of brands by tier, call 866939-3633. No benefits will be paid for services or materials connected with or charges arising from: medical or surgical treatment, services or supplies for the treatment of the eye, eyes or supporting structures; Refraction, when not provided as part of a Comprehensive Eye Examination; services provided as a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; any Vision Examination or any corrective Vision Materials required by a Policyholder as a condition of employment; safety eyewear; solutions, cleaning products or frame cases; non-prescription sunglasses; plano (non-prescription) lenses; plano (non- prescription) contact lenses; two pair of glasses in lieu of bifocals; electronic vision devices; services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order; or lost or broken lenses, frames, glasses, or contact lenses that are replaced before the next Benefit Frequency when Vision Materials would next become available. Fees charged by a Provider for services other than a covered benefit and any local, state or Federal taxes must be paid in full by the Insured Person to the Provider. Such fees, taxes or materials are not covered under the Policy. Allowances provide no remaining balance for future use within the same Benefit Frequency. Some provisions, benefits, exclusions or limitations listed herein may vary by state. Plan discounts cannot be combined with any other discounts or promotional offers. In certain states members may be required to pay the full retail rate and not the negotiated discount rate with certain participating providers. Please see online provider locator to determine which participating providers have agreed to the discounted rate.

Vision Ready to live your best EyeMed Life? There’s so much more to your vision benefits than copays and coverage. Get ready to see the good stuff for your self. Your network is the place to start See who you want. when you want. You have thousands of providers to choose from -independent eye doctors, your favorite retail stores, even online options. Keep your eyes open for extra discounts Members already save an average 71% off retail using their EyeMed benefits.1 but our long list of special offers takes benefits even further. Remember, you're never alone We're always here to help you use your benefits like a pro. Stay in-the-know with text alerts or healthy vision resources from the experts. If it can make benefits easier for you. we do it. 1 Based on weighted average of sample transactions; EyeMed Insight network/$!0 exom copay/$10 materials copay/$120 frame or contact lens allowance.

Create a member account at eyemed.com Everything is right there in one spot. Check claims and benefits. see special offers and find an eye doctor-search for one with the hours. location and brands you want. For maximum mobility. try the EyeMed Members App (Google Play or App Store).

PDF-2004-M-377 34

LINCOLN FINANCIAL GROUP 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 36 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Calallen ISD Benefits Website: www.mybenefitshub.com/calallenisd

Long Term Disability Full-Time Employees of Calallen Independent School District

Voluntary Long-term Disability Insurance The Lincoln Long-term Disability Insurance Premier Plan: • Provides a cash benefit after you are out of work for 90 days or more due to injury, illness, or surgery • Features group rates for Calallen ISD employees • Includes EmployeeConnectSM services, which give you and your family confidential access to counselors as well as personal, legal, and financial assistance

Benefits At-A-Glance Long-term Disability Monthly benefit amount

60% of your monthly salary, limited to $5,000 per month

Elimination period

90 days

Coverage period for your occupation

24 months

Maximum coverage period

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

Elimination Period

• This is the number of days you must be disabled before you can collect disability benefits. • The 90-day elimination period can be met through either total disability (out of work entirely) or partial disability (working with a reduced schedule or performing different types of duties).

Coverage Period for Your Occupation

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

Maximum Coverage Period

• This is the total amount of time you can collect disability benefits (also known as the benefit duration). • Benefits are limited to 24 months for mental illness; 24 months for substance abuse.

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

Additional Plan Benefits Progressive Income Benefit

Included

Family Care Expense Benefit

Included

Family Income Benefit

Included

Portability

Included

Open Enrollment

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

Benefit Exclusions & Reductions Like any insurance, this short-term disability insurance policy does have some exclusions. You will not receive benefits if: • Your disability is the result of a self-inflicted injury or act of war • You are not under the regular care of a doctor when you request disability benefits Your benefits may be reduced if you are eligible to receive benefits from: • A state disability plan or similar compulsory benefit act or law • A retirement plan • Social Security • Any form of employment • Workers’ Compensation A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan. This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. Refer to your certificate for your maximum benefit amounts. Should there be a difference between this summary and the contract, the contract will govern. EmployeeConnectSM services are provided by ComPsych® Corporation, Chicago, IL. ComPsych® and GuidanceResources® are registered trademarks of ComPsych® Corporation. ComPsych® is not a Lincoln Financial Group® company. Coverage is subject to actual contract language. Each independent company is solely responsible for its own obligations. Insurance products (policy series GL3001) are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply.

Short Term Disability—Option 1 Full-Time Employees of Calallen Independent School District

Voluntary Short-term Disability Insurance Option 1 The Lincoln Long-term Disability Insurance Premier Plan: • Provides a cash benefit when you are out of work for up to 11 weeks due to injury, illness, surgery, or recovery from childbirth • Provides a partial cash benefit if you can only do part of your job or work part time • Features group rates for Calallen ISD employees • Offers a fast, no-hassle claims process

Short-term Disability

Sickness elimination period

60% of your weekly salary, limited to $1,000 per week 14 days

Accident elimination period

14 days

First day hospitalization

0 days

Maximum coverage period

11 weeks

Sickness Elimination Period

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

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

First Day Hospitalization

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

Pre-existing Condition

• If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months, unless you received no treatment of the condition for 12 consecutive months after your effective date.

Benefits Integration

• Your short-term disability benefits can coordinate with income from other sources, such as continued income or sick pay from your employer, during your disability. • This allows you to receive up to 100% of your pre-disability income. 38

5% Rehabilitation Assistance

Included

Premium Waiver

Included

Family Income Benefit

Included

Portability

Included

Open Enrollment

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

Benefit Exclusions & Reductions

Benefits At-A-Glance Weekly benefit amount

Additional Plan Benefits

Like any insurance, this short-term disability insurance policy does have some exclusions. You will not receive benefits if: • Your disability is the result of a self-inflicted injury or act of war • You are not under the regular care of a doctor when you request disability benefits Your benefits may be reduced if you are eligible to receive benefits from: • A state disability plan or similar compulsory benefit act or law • A retirement plan • Social Security • Any form of employment • Workers’ Compensation A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan. This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. Refer to your certificate for your maximum benefit amounts. Should there be a difference between this summary and the contract, the contract will govern. Insurance products (policy series GL1101) are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply. ©2020 Lincoln National Corporation LCN-2016735-020518 R 1.0 – Group ID: 1001048 Voluntary Short-term Disability Insurance At-A-Glance | Option One STD-ENRO-BRC001-TX ©2020 Lincoln National Corporation LCN-2016714-020518 R 1.0 – Group ID: 1001048 Voluntary Long-term Disability Insurance At-A-Glance| Premier Plan LTD-ENRO-BRC001-TX

Voluntary Short-term Disability Premium Here’s how little you pay with group rates. Your estimated monthly premium is determined by multiplying your weekly salary amount (up to $1,667) by the premium rate of 0.04614. If your weekly salary exceeds $1,667, multiply $1,667 by 0.04614. $ X =$

weekly salary 0.04614

premium rate monthly premium

Short Term Disability—Option 2 Full-Time Employees of Calallen Independent School District

Voluntary Short-term Disability Insurance Option 2 The Lincoln Long-term Disability Insurance Premier Plan: • Provides a cash benefit when you are out of work for up to 11 weeks due to injury, illness, surgery, or recovery from childbirth • Provides a partial cash benefit if you can only do part of your job or work part time • Features group rates for Calallen ISD employees • Offers a fast, no-hassle claims process

5% Rehabilitation Assistance

Included

Premium Waiver

Included

Family Income Benefit

Included

Portability

Included

Open Enrollment

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

Benefit Exclusions & Reductions

Benefits At-A-Glance Short-term Disability

Sickness elimination period

60% of your weekly salary, limited to $1,000 per week 30 days

Accident elimination period

30 days

First day hospitalization

0 days

Maximum coverage period

11 weeks

Weekly benefit amount

Additional Plan Benefits

Sickness Elimination Period

• You must be out of work for 30 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 31.

Accident Elimination Period • You must be out of work for 30 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 31.

First Day Hospitalization

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

Pre-existing Condition

Benefits Integration

APL

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

GC14

Limited Benefit Group Specified Disease Cancer Indemnity Insurance

Calallen ISD

THE INSURANCE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM.

Summary of Benefits

Plan 1

Plan 2

Cancer Treatment Policy Benefits

Level 1

Level 4

Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12-month period

$10,000

$20,000

Hormone Therapy - Maximum of 12 treatments per calendar year

$50 per treatment

Experimental Treatment

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

Cancer Screening Rider Benefits

Level 1

Level 2

Diagnostic Testing - 1 test per calendar year

$50 per test

Follow-Up Diagnostic Testing - 1 test per calendar year

$100 per test

Medical Imaging - per calendar year

$500 per test / 1 per calendar year

$500 per test / 2 per calendar year

Surgical Rider Benefits

Level 1

Level 3

Surgical

$30 unit dollar amount Max $3,000 per operation

$45 unit dollar amount Max $4,500 per operation

Anesthesia

25% of amount paid for covered surgery

Bone Marrow Transplant - Maximum per lifetime

$6,000

$9,000

Stem Cell Transplant - Maximum per lifetime

$600

$900

Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime

$1,000 / $100

$2,000 / $200

Patient Care Rider Benefits

Level 1

Hospital Confinement Per day of Hospital Confinement (1-30 days) Per day for Eligible Dependent Children (1-30 days) Per day of Hospital Confinement (31+ days) Per day for Eligible Dependent Children (31+ days)

$100 $200 $100 $200

Outpatient Facility - Per day surgery is performed

$200

Attending Physician - Per day of Hospital Confinement

$30

Dread Disease - Per day of Hospital Confinement (1-30 days / 31+ days)

$100 / $100

Extended Care Facility - Up to the same number of Hospital Confinement Days

$100 per day

Donor

$100 per day

Home Health Care - Up to the same number of Hospital Confinement Days

$100 per day

Hospice Care - Up to maximum of 365 days per lifetime

$100 per day

US Government, Charity Hospital or HMO Per day of Hospital Confinement (1-30 days / 31+ days)

$100 / $100

Miscellaneous Care Rider Benefits

Level 1

Level 2

Cancer Treatment Center Evaluation or Consultation - 1 per lifetime

Not Included

$750

Evaluation or Consultation Travel and Lodging - 1 per lifetime

Not Included

$350

Second / Third Surgical Opinion - per diagnosis of cancer

$300 / $300

Drugs and Medicine - Inpatient / Outpatient (maximum $150 per month)

$150 per confinement $50 per prescription

Hair Piece (Wig) - 1 per lifetime

$150

actual coach fare or $0.40 per mile $0.40 per mile $50 per day

actual coach fare or $0.75 per mile $0.75 per mile $50 per day

actual coach fare or $0.40 per mile $0.40 per mile $50 per day

actual coach fare or $0.75 per mile $0.75 per mile $50 per day

Blood, Plasma and Platelets

$300 per day

Ambulance - Ground/Air - Maximum of 2 trips per Hospital Confinement for all modes of transportation combined

$200 / $2,000 per trip

Inpatient Special Nursing Services - per day of Hospital Confinement

$150 per day

Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Lodging - up to a maximum of 100 days per calendar year Family Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Family Lodging - up to a maximum of 100 days per calendar year

APSB-22339(TX)-0320 FBS Calallen ISD

Page 1 of 4

GC 14 Limited Benefit Group Specified Disease Cancer Indemnity Insurance Miscellaneous Care Rider Benefits Con’t.

Level 1

Level 2

Outpatient Special Nursing Services - Up to same number of Hospital Confinement days

$150 per day

Medical Equipment - Maximum of 1 benefit per calendar year

Not Included

$150

Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year

$25 per visit / $1,000

Waiver of Premium

Waive Premium

Internal Cancer First Occurrence Rider Benefits

Level 1

Level 2

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

$2,500

$5,000

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

$3,750

$7,500

Heart Attack/Stroke First Occurrence Rider Benefits

Level 1

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

$2,500

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

$3,750

Intensive Care Unit

$600 per day

Step Down Unit - Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit

$300 per day

Hospital Intensive Care Unit Rider Benefits

Total Monthly Premiums by Plan** Issue Ages 18 +

Individual

Individual & Spouse

1 Parent Family

2 Parent Family

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

$17.56

$31.68

$37.24

$66.84

$22.72

$39.80

$42.32

$74.94

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

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

Cancer Treatment Benefits Eligibility

You and your eligible dependents are eligible to be insured under this certificate if you and your eligible dependents meet our underwriting rules and you are actively at work with the policyholder and qualify for coverage as defined in the master application. A covered person is a person who is eligible for coverage under the certificate and for whom the coverage is in force. An eligible dependent means your lawful spouse; your natural, adopted or stepchild who is under the age of 26; and/or any child under the age of 26 who is under your charge, care and control, and who has been placed in your home for adoption, or for whom you are a party in a suit in which adoption of the child is sought; or any child under the age of 26 for whom you must provide medical support under an order issued under Chapter 154 of the Texas Family Code, or enforceable by a court in Texas; or grandchildren under the age of 26 if those grandchildren are your dependents for federal income tax purposes at the time application for coverage of the grandchild is made.

Limitations and Exclusions

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

Only Loss for Cancer

The policy pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The policy also covers other conditions or diseases directly caused by cancer or the treatment of cancer. The policy does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer 42 of cancer. or the treatment APSB-22339(TX)-0320 FBS Calallen ISD

Pre-Existing Condition Exclusion

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

Termination of Certificate

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

Termination of Coverage

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

Cancer Screening Benefits Limitations and Exclusions

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

Page 2 of 4

GC 14 Limited Benefit Group Specified Disease Cancer Indemnity Insurance Surgical Benefits

Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition.

Patient Care Benefits Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition.

Only Loss for Cancer or Dread Disease

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 rider also covers other conditions or diseases directly caused by cancer or the treatment of cancer. This rider does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer except for conditions specifically provided in the dread disease benefit. A hospital is not an institution, or part thereof, used as: a place of rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a long-term nursing unit or geriatrics ward, or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients.

Miscellaneous Benefits Waiver of Premium

When the certificate is in force and you become disabled, we will waive all premiums due including premiums for any riders attached to the certificate. Disability must be due to cancer and occur while receiving treatment for such cancer. You must remain disabled for 60 continuous days before this benefit will begin. The waiver of premium will begin on the next premium due date following the 60 consecutive days of disability. This benefit will continue for as long as you remain disabled until the earliest of either of the following: the date you are no longer disabled; the date coverage ends according to the termination provisions in the certificate; or the date coverage ends according to the termination provisions in this rider. Proof of disability must be provided for each new period of disability before a new waiver of premium benefit is payable.

Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition.

Termination of Cancer Screening, Surgical, Patient Care & Miscellaneous Benefit Riders

The above listed rider(s) will terminate and coverage will end for all covered persons on the earliest of: the end of the grace period if the premium for the rider remains unpaid; the date the policy or certificate

to which the rider is attached terminates; the end of the certificate month in which APL receives a request from the policyholder to terminate the rider; or the date of your death. Coverage on an eligible dependent terminates under the rider when such person ceases to meet the definition of eligible dependent.

Internal Cancer First Occurrence Benefits

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

Limitations and Exclusions

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

Pre-Existing Condition Exclusion

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

Termination

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

Heart Attack/Stroke First Occurrence Benefits

Pays a lump sum benefit amount when a covered person receives a first diagnosis of heart attack or stroke. Only one benefit per covered person per lifetime is payable under this benefit and the lump sum benefit amount will reduce by 50% at age 70.

Limitations and Exclusions

We will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war (if coverage is suspended for any covered person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request); participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; or participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).

Pre-Existing Condition Exclusion

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

Termination

APSB-22339(TX)-0320 FBS Calallen ISD

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GC 14 Limited Benefit Group Specified Disease Cancer Indemnity Insurance benefit amount for heart attack or stroke has been paid for all covered persons under this rider. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent, as defined in the policy.

Hospital Intensive Care Unit Benefits

Pays a daily benefit amount, up to the maximum number of days for any combination of confinement, for each day charges are incurred for room and board in an intensive care unit (ICU) or step-down unit due to an accident or sickness. Benefits will be paid beginning on the first day a covered person is confined in an ICU or step-down unit due to an accident or sickness that begins after the effective date of this rider. This benefit will reduce by 50% at age 70.

Limitations and Exclusions

For a newborn child born within the 10-month period following the effective date, no benefits under this rider will be provided for confinements that begin within the first 30 days following the birth of such child. No benefits under this rider will be provided during the first two years following the effective date for confinements caused by any heart condition when any heart condition was diagnosed or treated prior to the end of the 30-day period following the covered person’s effective date. The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date. We will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war (if coverage is suspended for any covered person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request); participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).

Termination

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

Optionally Renewable

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

submit the first premium due within 31 days from the date APL notified the policyholder of your termination of coverage. All future premiums will be billed directly to you. Portability coverage will be effective on the day after coverage ends under the policy and any applicable exclusion periods or incontestability periods not yet met under the current policy, will only apply for the period of time that remains. The benefits, terms and conditions of the ported coverage will be the same as those under the policy immediately prior to the date the portability option was elected, except as stated in this paragraph. Once ported coverage is in effect, the termination of ported coverage section, as shown in the portability rider, prevails all other termination provisions of the policy, certificate and any attached riders. Your coverage levels cannot be increased or decreased. Ported coverage may include any eligible dependent(s) who were covered under the policy at the time of termination. No eligible dependent may be added to the ported coverage except as provided in the newborn and adopted child provision set out in your certificate. An eligible dependent may be removed at any time. Premiums will be adjusted accordingly. Termination of the policy will not terminate ported coverage. The benefits, terms and conditions of the ported coverage will be the same as if the group policy had remained in full force and effect, with no further obligation of the policyholder. Any premium collected beyond the termination date will be refunded promptly. This will not prejudice any claim that originated prior to the date termination took effect.

Continuity of Coverage

Continuity of Coverage will be provided if all of the following conditions are met: you were insured by the policyholder’s prior group insurance carrier under a plan of similar coverage, you had coverage on the termination date of the policyholder’s prior coverage, you elected coverage under this policy and the termination date of the policyholder’s prior coverage and the effective date of this policy are simultaneous. The same continuity of coverage will be provided to your eligible dependents if they were insured by the policyholder’s prior group insurance carrier. Continuity of coverage will be administered as follows: if you were not subject to or had already satisfied the pre-existing condition limitation under the prior group carrier, there will be no pre-existing condition limitation applied under this policy. If you were not eligible for benefits under the prior group carrier’s plan of similar coverage due to a preexisting condition limitation, you are not eligible for benefits under this policy until such time as you have satisfied the pre-existing condition exclusion period described in this policy. Credit will be given for any portion of time satisfied with your employer’s prior group carrier provided you replaced that coverage with us on the effective date. ou will not be required to meet the eligibility requirements including actively at work or meet the benefit eligibility criteria as defined in the master application. Any changes to your coverage after the effective date of this policy will be subject to the eligibility provisions of this policy. We may request proof of coverage to determine if each person to be insured is eligible for continuity of coverage.

Portability Rider

When the portability rider is in effect and coverage is not continued under COBRA, you have the option to port your coverage when the policy terminated for a reason other than non-payment of premium or cancelation or termination of the policy by APL. Evidence of insurability will not be required. You must make an election to port coverage and

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the policy and riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC14 Series | TX | Limited Benefit Group Specified Disease Cancer Indemnity Insurance | (03/20) | FBS 44

APSB-22339(TX)-0320 FBS Calallen ISD

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UNUM 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 46 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Calallen ISD Benefits Website: www.mybenefitshub.com/calallenisd

Accident Accident Insurance can pay you money for covered accidental injuries and their treatment.

How does it work? Accident Insurance can pay a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more serious events

Why is this coverage so valuable? • • • • •

It can help you with out-of-pocket costs that your medical plan doesn’t cover, like co-pays and deductibles. You’re guaranteed base coverage, without answering health questions. The cost is conveniently deducted from your paycheck. You can keep your coverage if you change jobs or retire. You’ll be billed directly.

Who can get coverage? You Your spouse

Your children

If you’re actively at work* Can get coverage as long as you have purchased coverage for yourself. Dependent children from birth until their 26th birthday, regardless of marital or student status.

*Employees must be legally authorized to work in the United States and actively working at a U.S. location to receive coverage. Spouses and dependent children must reside in the United States to receive coverage.

How much does it cost? Your monthly premium

Option 1

Option 2

You You and your spouse You and your children Family

$5.81 $10.03 $13.87 $18.09

$10.04 $17.29 $23.71 $30.96

Active employment: You are considered in active employment if, on the day you apply for coverage, you are being paid regularly for the required minimum 20 hours each week and you are performing the material and substantial duties of your regular occupation. 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. New employees have a 0 day waiting period to be eligible for coverage. Please contact your plan administrator to confirm your eligibility date. If enrolling, and eligible for Medicare (age 65+; or disabled) the Guide to Health Insurance for People with Medicare is available at www.medicare.gov/Pubs/pdf/02110-Medicare- Medigapguide.pdf

Accident Insurance - Schedule of Benefits Accidental Death and Dismemberment AD&D Employee Spouse Children Common Carrier

Option 1

Option 2

$25,000.00 $50,000.00 $12,500.00 $25,000.00 $6,250.00 $12,500.00

Benefit can pay if the insured individual is injured as a fare-paying passenger on a common carrier (examples include mass transit trains, buses and planes)

Employee Spouse Children Dismemberment Both Feet Both Hands One Foot One Hand Thumb and Index Finger of the same hand Coma Coma Loss of Use Hearing Sight of one Eye Sight of both Eyes Speech Paralysis Uniplegia Hemi/Paraplegia Triplegia Quadriplegia Hospitalization Admission Admission – Hospital ICU Daily Stay (amount) Daily Stay – Hospital ICU(amount) Short Stay Injury Burns 2nd Degree Burns - At least 5%, but less than 20% of skin surface 2nd Degree Burns - 20% or greater of skin surface 3rd Degree Burns - Less than 5% of skin surface 3rd Degree Burns - At least 5%, but less than 20% of skin surface 3rd Degree Burns - 20% or greater of skin surface Concussion Concussion Connective Tissue Damage One Connective Tissue (tendon, ligament, rotator cuff, muscle) Two or more Connective Tissues (tendon, ligament, rotator cuff, muscle)

$25,000.00 $50,000.00 $12,500.00 $25,000.00 $6,250.00 $12,500.00 $25,000.00 $25,000.00 $12,500.00 $12,500.00 $6,250.00

$50,000.00 $50,000.00 $25,000.00 $25,000.00 $12,500.00

$5,000.00

$10,000.00

$12,500.00 $12,500.00 $25,000.00 $12,500.00

$25,000.00 $25,000.00 $50,000.00 $25,000.00

$6,250.00 $12,500.00 $18,750.00 $25,000.00

$12,500.00 $25,000.00 $37,500.00 $50,000.00

$300.00 $300.00 $100.00 $200.00 None

$500.00 $500.00 $200.00 $400.00 None

$375.00

$500.00

$750.00

$1,000.00

$1,500.00

$2,000.00

$3,750.00

$5,000.00

$7,500.00

$10,000.00

$200.00

$90.00

$150.00

$150.00 47

Accident Injury Option 1 Dislocations Knee joint (other than patella) $1,300.00 Ankle bone or bones of the $1,300.00 foot (other than toes) Hip joint $2,625 Collarbone (sternoclavicular) $650.00 Elbow joint $400.00 Hand (other than Fingers) $400.00 Lower Jaw $400.00 Shoulder $400.00 Wrist joint $400.00 Collarbone (acromioclavicular and $250.00 separation) Finger or Toe (Digit) $125.00 Kneecap (patella) $400.00 Incomplete Dislocation - Payable as a % of 25% the applicable Dislocations benefit Eye Injury Eye Injury $200.00 Fractures Skull (except bones of Face or Nose), $3,500.00 Depressed Hip or Thigh (femur) $2,625.00 Skull (except bones of Face or Nose), Non$1,750.00 depressed Vertebrae, body of (other than Vertebral $1,050.00 Processes) Leg (mid to upper tibia or fibula) $1,050.00 Pelvis $1,050.00 Bones of the Face or Nose (other than Lower $525.00 Jaw, Mandible or Upper Jaw, Maxilla) Upper Arm between Elbow and Shoulder $525.00 (humerus) Upper Jaw, Maxilla (other than alveolar $525.00 process) Ankle (lower tibia or fibula) $350.00 Collarbone (clavicle, sternum) or Shoulder $350.00 Blade (scapula) Foot or Heel (other than Toes) $350.00 Forearm (olecranon, radius, or ulna), Hand, $350.00 or Wrist (other than Fingers) Kneecap (patella) $350.00 Lower Jaw, Mandible (other than alveolar $350.00 process) Vertebral Processes $350.00 Rib $350.00 Tailbone (coccyx), Sacrum $350.00 Finger or Toe (Digit) $175.00 Chip Fracture - Payable as a % of the 25% applicable Fractures benefit Same bone maximum incurred per accident 1 Fracture 1 Fracture Maximum payable multiplier for multiple 2 Times bones 2 Times

Option 2

$1,650.00 $1,650.00 $3,375 $825.00 $500.00 $500.00 $500.00 $500.00 $500.00 $325.00 $150.00 $500.00 25% $200.00 $4,500.00 $3,375.00 $2,250.00 $1,350.00 $1,350.00 $1,350.00 $675.00 $675.00 $675.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $225.00

25% 1 Fracture 2 Times

Injury Option 1 Internal Injuries Internal Injuries $200.00 Lacerations No Repair $35.00 Repair Less than 2 inches $100.00 Repair At least 2 inches but less than 6 $200.00 inches Repair 6 inches or greater $400.00 Loss of a Digit One Digit (other than a Thumb $500.00 or Big Toe) One Digit (a Thumb or Big Toe) $750.00 Two or more Digits $1,000.00 Knee Cartilage Knee Cartilage (Meniscus) Injury $100.00 Ruptured or Herniated Disc One Disc $120.00 Two or more Discs $200.00 Recovery Acquired Brain Injury $25.00 At-Home Care $50.00 Physician Follow-Up Visits $25.00 Physician Follow-Up Maximum Visits 2 Visits Prescription Drug $25.00 Prescription Benefit Incidence per covered 1 Per accident Insured Rehabilitation or Subacute Rehabilitation Unit $50.00 Telehealth Service $25.00 Telemedicine Medical Service $25.00 Therapy Services (chiro, speech, PT, occ) $25.00 Therapy Services Maximum Days 15 Days Surgery Dislocations Dislocation, Surgical Repair - Payable as a % 100% of the applicable Injury benefit Anesthesia Epidural or Regional Anesthesia $40.00 General Anesthesia $100.00 Connective Tissue Exploratory without Repair $50.00 Repair for One Connective Tissue $400.00 Repair for Two or more Connective Tissues $600.00 Eye Surgery Eye Surgery, Requiring Anesthesia $100.00 Fractures Fractures, Surgical Repair - Payable as a % of the applicable Injury 100% benefit Surgical Repair same bone maximum 1 Fracture incurred per accident Surgical Repair same bone maximum 2 Times payable multiplier for multiple bones

Option 2

$200.00 $50.00 $150.00 $300.00 $600.00 $750.00 $1,125.00 $1,500.00 $150.00 $150.00 $250.00 $25.00 $75.00 $50.00 2 Visits $25.00 1 Per Insured $50.00 $25.00 $25.00 $50.00 15 Days

100% $60.00 $150.00 $75.00 $600.00 $900.00 $200.00

100%

1 Fracture 2 Times

Accident Surgury General Surgery Abdominal, Thoracic, or Cranial Exploratory Incidence per covered accident Hernia Surgery Hernia Surgery Knee Cartilage Knee Cartilage (Meniscus) Exploratory without Repair Knee Cartilage (Meniscus) with Repair Outpatient Surgical Facility Outpatient Surgical Facility Ruptured or Herniated Disc Surgery Exploratory without Repair One Disc Two or more Discs Treatment Ambulance Air Ground Durable Medical Equipment Tier 1 (arm sling, cane, medical ring cushion) Tier 2 (bedside commode, cold therapy system, crutches) Tier 3 (back brace, body jacket, continuous passive movement, electric scooter) Emergency Dental Repair Dental Crown Dental Extraction Filling or Chip Repair Imaging Tier 1: X-rays or Ultrasound Tier 2: Bone Scan, CAT, CT, EEG, MR, MRA, or MRI Medical Imaging Incidence allowance covered accident per Tier Lodging Lodging (per night) Prosthetic Device One Device or Limb Two or more Devices or Limbs Skin Grafts For Burns - Payable as a % of the applicable Burn benefit Not Burns - Less than 20% of skin surface Not Burns - 20% or greater of skin surface Treatment Emergency Room Treatment Injections to Prevent or Limit Infection (tetanus, rabies, antivenom, immune globulin) Pain Management Injections (epidural, cortisone, steroid) Transfusions Transportation (per trip) Treatment in a Physician’s Office or Urgent Care Facility (initial)

Option 1

Option 2

$500.00 $50.00 1 Per Insured

$1,000.00 $100.00 1 Per Insured

$50.00

$100.00

$50.00

$100.00

$250.00

$500.00

$100.00

$200.00

$75.00 $400.00 $600.00

$100.00 $525.00 $800.00

$500.00 $100.00

$600.00 $200.00

$25.00

$35.00

$50.00

$75.00

$100.00

$150.00

$150.00 $50.00 $40.00

$300.00 $100.00 $75.00

$50.00 $50.00 1 Per Insured Per Tier

$50.00 $100.00 1 Per Insured Per Tier

$50.00

$100.00

$250.00 $500.00

$500.00 $1,000.00

50%

$125.00 $250.00

$75.00

$150.00

$50.00

$25.00

$50.00

$200.00 $50.00

$300.00 $75.00

$25.00

$50.00

Accident Accident Insurance See Schedule of Benefits for a complete listing of what is covered. Effective date of coverage Coverage becomes effective on the first day of the month in which payroll deductions begin. Exclusions and limitations We will not pay benefits for a claim that is caused by, contributed to by, or occurs as the result 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; • a Covered Loss that occurs while an Insured is legally incarcerated in a penal or correctional institution; • elective procedures, cosmetic surgery, or reconstructive surgery unless it is a result of trauma, infection, or other diseases; • any Sickness, bodily infirmity, or other abnormal physical condition or Mental or Nervous Disorders, including diagnosis, treatment, or surgery for it; • Infection. This exclusion does not apply when the infection is due directly to a cut or wound sustained in a Covered Accident; • experimental or investigational procedures; • operating any motorized vehicle while intoxicated; • operating, learning to operate, serving as a crew member of any aircraft or hot air balloon, including those which are not motor-driven, unless flying as a fare paying passenger; • jumping, parachuting, or falling from any aircraft or hot air balloon, including those which are not motor-driven; • travel or flight in any aircraft or hot air balloon, including those which are not motor- driven, if it is being used for testing or experimental purposes, used by or for any military authority, or used for travel beyond the earth’s atmosphere;#practicing for or participating in any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received; • riding or driving an air, land or water vehicle in a race, speed or endurance contest; and • engaging in hang-gliding, bungee jumping, sail gliding, parasailing, parakiting, or BASE jumping. The Accidental Death and Dismemberment Benefits are also subject to the following Exclusions. We will not pay benefits for a claim that is caused by, contributed to by, or resulting from any of the following: 50

being intoxicated; and voluntary use of or treatment for voluntary use of any prescription or non-prescription drug, intoxicant, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s Physician Additionally, no benefits will be paid for a Covered Loss that occurs prior to the Coverage Effective Date. Termination of employee coverage If you choose to cancel your coverage your coverage ends on the first of the month following the date you provide notification to your employer. Otherwise, your coverage ends on the earliest of the: • the date this policy is canceled by Unum or your employer; • the date you are no longer 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 premium contributions are made; • the last day you are in active employment. • However, as long as premium is paid as required, coverage will continue • in accordance with the Continuation of your Coverage during Absences provision; or • if you elect to continue coverage for you, your Spouse, and Children under Portability of Accident Insurance. We will provide coverage for a Payable Claim that occurs while you are covered under this certificate Accident Insurance THIS IS A LIMITED BENEFITS POLICY 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 GAP16-1 et al. or contact your Unum representative. Unum complies with state civil union and domestic partner laws when applicable. Underwritten by: Unum Insurance Company, Portland, Maine Unum complies with state civil union and domestic partner laws when applicable. © 2020 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. • •

UNUM YOUR BENEFITS PACKAGE

Critical Illness

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

Critical Illness Calallen Independent School District Critical Illness Plan Highlights 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 20 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 $10,000, $20,000 or $30,000 For your Spouse: 100% of employee coverage amount For your Children: 100% 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.

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:

• • • • •

Benign Brain Tumor Coma Coronary Artery Disease (Major) Coronary Artery Disease (Minor) End Stage Renal (Kidney) Failure Option 1: How much does the coverage cost? $10,000 EE, $10,000 SP Age Employee Cost Spouse Cost Less than age 25 $2.10 $2.10 25-29 $3.10 $3.10 30-34 $4.30 $4.30 35-39 $6.20 $6.20 40-44 $8.60 $8.60 45-49 $11.70 $11.70 50-54 $15.30 $15.30 55-59 $21.20 $21.20 60-64 $30.00 $30.00 65-69 $44.10 $44.10 70-74 $69.20 $69.20 75-79 $102.40 $102.40 80-84 $149.30 $149.30 85 or over $241.10 $241.10 Option 2: $20,000 EE, $20,000 SP Age Employee Cost Spouse Cost Less than age 25 $4.20 $4.20 25-29 $6.20 $6.20 30-34 $8.60 $8.60 35-39 $12.40 $12.40 40-44 $17.20 $17.20 45-49 $23.40 $23.40 50-54 $30.60 $30.60 55-59 $42.40 $42.40 60-64 $60.00 $60.00 65-69 $88.20 $88.20 70-74 $138.40 $138.40 75-79 $204.80 $204.80 80-84 $298.60 $298.60 85 or over $482.20 $482.20

• • • • •

Heart Attack (Myocardial Infarction) Invasive Cancer (includes all Breast Cancer) Major Organ Failure Requiring Transplant Non-Invasive Cancer Stroke Option 3: $30,000 EE, $30,000 SP Age Employee Cost Spouse Cost Less than age 25 $6.30 $6.30 25-29 $9.30 $9.30 30-34 $12.90 $12.90 35-39 $18.60 $18.60 40-44 $25.80 $25.80 45-49 $35.10 $35.10 50-54 $45.90 $45.90 55-59 $63.60 $63.60 60-64 $90.00 $90.00 65-69 $132.30 $132.30 70-74 $207.60 $207.60 75-79 $307.20 $307.20 80-84 $447.90 $447.90 85 or over $723.30 $723.30

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 you have been insured for at least 12 months and 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, MaineAE-1226 FOR EMPLOYEES

LINCOLN FINANCIAL GROUP

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

Basic Life and AD&D Calallen Independent School District provides this valuable benefit at no cost to you. Full-Time Employees

Term Life and AD&D Insurance Safeguard the most important people in your life. Think about what your loved ones may face after you’re gone. Term life insurance can help them in so many ways, like covering everyday expenses, paying off debt, and protecting savings. AD&D provides even more coverage if you die or suffer a covered loss in an accident.

AT A GLANCE: A cash benefit of $25,000 to your loved ones in the event of your death, plus a matching cash benefit if you die in an accident • A cash benefit to you if you suffer a covered loss in an accident, suchas losing a limb or your eyesight • LifeKeys® services, which provide access to counseling, financial, and legalsupport • TravelConnect® services, which give you and your family access to emergency medical assistance when you're on a trip 100+ miles from home • EmployeeConnectSM services, which give you and your family confidential access to counselors as well as personal, legal, and financial assistance You also have the option to increase your cash benefit by securing additional coverage at affordable group rates. See the enclosed life insurance information for details.

ADDITIONAL DETAILS Conversion: You can convert your group term life coverage to an individual life insurance policy without providing evidence of insurability if you lose coverage due to leaving your job or for another reason outlined in the plan contract. AD&D benefits cannot be converted. Benefit Reduction: Coverage amounts begin to reduce at age 70 and benefits terminate at retirement. See the plan certificate for details. For complete benefit descriptions, limitations, and exclusions, refer to the certificate of coverage. This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. Refer to your certificate for your maximum benefit amounts. Should there be a difference between this summary and the contract, the contract will govern. LifeKeys® services are provided by ComPsych® Corporation, Chicago, IL. ComPsych®, EstateGuidance® and GuidanceResources® are registered trademarks of ComPsych® Corporation. TravelConnect® services are provided by On Call International, Salem, NH. ComPsych® and On Call International are not Lincoln Financial Group® companies. Coverage is subject to actual contract language. Each independent company is solely responsible for its own obligations. Insurance products (policy series GL1101) are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. Limitations and exclusions apply. Benefits Overview | The Lincoln National Life Insurance Company GP-ERPD-FLI001-TX - ©2020 Lincoln National Corporation - LCN-1821793-061517-Q1.0

Life and AD&D Full-Time Employees of Calallen Independent School District

Voluntary Term Life and AD&D Insurance

What your benefits cover

Employee Coverage Guaranteed Life and AD&D Insurance Coverage Amount • Initial Open Enrollment: When you are first offered this The Lincoln Term Life and AD&D Insurance Plan: coverage, you can choose a coverage amount up to • Provides a cash benefit to your loved ones in the event of $250,000 without providing evidence of insurability. your death • Annual Limited Enrollment: If you are a continuing • Provides an additional cash benefit to your loved ones if employee, you can increase your coverage amount by you die — or to you if you lose a limb or your eyesight — in $10,000 or $20,000 without providing evidence of a covered accident insurability . If you submitted evidence of insurability in the • Features group rates for Calallen ISD employees past and were declined for medical reasons, you may be • Includes LifeKeys® services, which provide access to required to submit evidence of insurability. counseling, financial, and legal support services • If you decline this coverage now and wish to enroll later, • Also includes TravelConnect® services, which give you and evidence of insurability may be required and may be at your family access to emergency medical assistance when your own expense. you’re on a trip 100+ miles from home • You can increase this amount by up to $20,000 during the next limited open enrollment period. Benefits At-A-Glance Maximum Life Insurance Coverage Amount Employee • You can choose a coverage amount up to 7 times your Guaranteed coverage amount annual salary ($500,000 maximum) with evidence of during initial offering or approved $250,000 insurability. See the Evidence of Insurability page for special enrollment period details. Newly hired employee guaranteed $250,000 • Your coverage amount will reduce by 50% when you reach coverage amount age 70 Continuing employee guaranteed Choice of $10,000 or $20,000 Spouse Coverage - You can secure term life and AD&D coverage annual increase amount insurance for your spouse if you select coverage for yourself. Maximum coverage amount 7 times your annual salary Guaranteed Life and AD&D Insurance Coverage Amount ($500,000 maximum in increments of $10,000) • Initial Open Enrollment: When you are first offered this Minimum coverage amount $10,000 coverage, you can choose a coverage amount up to 50% of AD&D coverage amount Equal to the life insurance amount your coverage amount ($50,000 maximum) for your chosen spouse without providing evidence of insurability. Spouse • Annual Limited Enrollment: If you are a continuing Guaranteed coverage amount employee, you can increase the coverage amount for your during initial offering or approved $50,000 spouse by $5,000 or $10,000 without providing evidence of special enrollment period insurability. If you submitted evidence of insurability in the Newly hired employee guaranteed $50,000 past and were declined for medical reasons, you may be coverage amount required to submit evidence of insurability. Continuing employee guaranteed Choice of $5,000 or $10,000 • If you decline this coverage now and wish to enroll later, coverage annual increase amount 50% of the employee coverage evidence of insurability may be required and may be at Maximum coverage amount amount ($250,000 maximum in your own expense. increments of $5,000) • You can increase this amount by up to $10,000 during the Minimum coverage amount $5,000 next limited open enrollment period. AD&D coverage amount Equal to the life insurance amount Maximum Life Insurance Coverage Amount chosen • You can choose a coverage amount up to 50% of your Dependent Children coverage amount ($250,000 maximum) for your spouse Day 1 to age 26 guaranteed $10,000 with evidence of insurability coverage amount Additional Plan Benefits Accelerated Death Benefit Premium Waiver Conversion Portability Seat Belt & Airbag Common Carrier 58

Included Included Included Included Included with AD&D Included with AD&D

Dependent Children Coverage - You can secure term life insurance for your dependent children when you choose coverage for yourself. Guaranteed Life Insurance Coverage Options: $10,000

Life and AD&D Benefit Exclusions Like any insurance, this term life and AD&D insurance policy does have exclusions. For life insurance, a suicide exclusion may apply. For AD&D, benefits will not be paid if death results from suicide, or death/ dismemberment occurs while:

• • • • • • •

Inflicting or attempting to inflict injury to one’s self Participating in a riot or as a result of war or act of war Serving as a member of the military, including the Reserves and National Guard Committing or attempting to commit a felony Deliberately inhaling gas (such as carbon monoxide) or using drugs other than those prescribed by a physician and administered as prescribed Flying in a non-commercial airplane or aircraft, such as a balloon or glider

Driving while intoxicated (with a blood alcohol level of .08 grams or more per 100 milliliters of blood) In addition, the AD&D insurance policy does not cover sickness or disease, including the medical and surgical treatment of a disease. A complete list of benefit exclusions is included in the policy. State variations apply.

This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. Refer to your certificate for your maximum benefit amounts. Should there be a difference between this summary and the contract, the contract will govern. LifeKeys® services are provided by ComPsych® Corporation, Chicago, IL. TravelConnect® travel assistance services are provided by On Call International, Salem NH. On Call International must coordinate and provide all arrangements in order for eligible services to be covered. ComPsych® and On Call International are not Lincoln Financial Group companies and Lincoln Financial Group does not administer these Services. Each independent company is solely responsible for its own obligations. Coverage is subject to contract language that contains specific terms, conditions, and limitations. Insurance products (policy series GL1101) are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply. ©2019 Lincoln National Corporation LCN-2016746-020518 R 1.0 – Group ID: 1001048

Monthly Voluntary Life and AD&D Insurance Premium Here’s how little you pay with group rates. Employee |Monthly Premiums for Select Life and AD&D Insurance Coverage Amounts Employee Age Range 0 -24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 Employee Age Range 70 -74 Employee Age Range 75 -79 Employee Age Range 80 -99

Spouse |Monthly Premiums for Select Life and AD&D Insurance Coverage Amounts

Employee Age Range $3.00 $6.00 $9.00 $15.00 $30.00 0 -24 $3.50 $7.00 $10.50 $17.50 $35.00 25-29 $4.50 $9.00 $13.50 $22.50 $45.00 30-34 $5.45 $10.90 $16.35 $27.25 $54.50 35-39 $5.95 $11.90 $17.85 $29.75 $59.50 40-44 $8.40 $16.80 $25.20 $42.00 $84.00 45-49 $12.40 $24.80 $37.20 $62.00 $124.00 50-54 $22.35 $44.70 $67.05 $111.75 $223.50 55-59 $33.80 $67.60 $101.40 $169.00 $338.00 60-64 $64.05 $128.10 $192.15 $320.25 $640.50 65-69 Employee $25,000 $50,000 $75,000 $125,000 $250,000 Age Range $51.65 $103.30 $154.95 $258.25 $516.50 70 -74 Employee $25,000 $50,000 $75,000 $125,000 $250,000 Age Range $51.65 $103.30 $154.95 $258.25 $516.50 75 -79 Employee $25,000 $50,000 $75,000 $125,000 $250,000 Age Range $51.65 $103.30 $154.95 $258.25 $516.50 80 -99

$10,000 $50,000 $100,000 $150,000 $250,000 $500,000

$5,000

$25,000 $50,000 $75,000 $125,000 $250,000

$0.60 $0.70 $0.90 $1.09 $1.19 $1.68 $2.48 $4.47 $6.76 $12.81

$0.30 $0.35 $0.45 $0.55 $0.60 $0.84 $1.24 $2.24 $3.38 $6.41

$1.50 $1.75 $2.25 $2.73 $2.98 $4.20 $6.20 $11.18 $16.90 $32.03

$2,500

$12,500 $25,000 $37,500 $62,500 $125,000

$5.17

$25.83

$2,500

$12,500 $25,000 $37,500 $62,500 $125,000

$5.17

$25.83

$2,500

$12,500 $25,000 $37,500 $62,500 $125,000

$5.17

$25.83

$5,000 $10.33 $5,000 $10.33 $5,000 $10.33

Dependent Children Monthly Premium for Life Insurance Coverage Coverage Amount $10,000

Monthly Premium $2.00

$3.00 $3.50 $4.50 $5.45 $5.95 $8.40 $12.40 $22.35 $33.80 $64.05

$51.65

$4.50 $5.25 $6.75 $8.18 $8.93 $12.60 $18.60 $33.53 $50.70 $96.08

$77.48

$7.50 $15.00 $8.75 $17.50 $11.25 $22.50 $13.63 $27.25 $14.88 $29.75 $21.00 $42.00 $31.00 $62.00 $55.88 $111.75 $84.50 $169.00 $160.13 $320.25

$129.13 $258.25

Group Rates for Your Dependent Children One affordable monthly premium covers all of your eligible dependent children. Note: You must be an active Calallen Independent School District employee to select coverage for a spouse and/or dependent children. To be eligible for coverage, a spouse or dependent child cannot be confined to a health care facility or unable to perform the typical activities of a healthy person of the same age and gender. Please see prior page for product information.

TEXAS LIFE

Individual Life

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

YOUR BENEFITS PACKAGE

Experts recommend at least

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

This This is is aa general general overview overview of of your your plan plan benefits. benefits. If If the the terms terms of of this this outline outline differ differ from from your your policy, policy, the the policy policy will will govern. govern. Additional Additional plan plan details on on covered covered expenses, expenses, limitations limitations and and exclusions exclusions are are included included in in the the summary summary plan plan description description located located on on the the 60 details Angleton Calallen ISD ISD Benefits Benefits Website: Website: www.mybenefitshub.com/angletonisd www.mybenefitshub.com/calallenisd

Individual Life Life Insurance Highlights For the Employee

You may apply for this permanent coverage, not only for yourself, but also for your spouse, children and grandchildren.5

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 cost more and decline in death benefit.

3 Quick Questions

The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has the following features: •

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

•

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

•

Accelerated Death Benefit Due to Terminal Illness Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months, you will have the option to receive 92% 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.) (Form ICC07-ULABR-07 or Form Series ULABR-07)

You can qualify by answering just 3 questions – no exams or needles. DURING THE LAST SIX MONTHS, HAS THE PROPOSED INSURED: 1. Been actively at work on a full time basis, performing usual duties? 2. Been absent from work due to illness or medical treatment for a period of more than 5 consecutive working days? 3. Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation, dialysis treatment, or treatment for alcohol or drug abuse? PureLife-plus is a Flexible Premium Adjustable Life Insurance to Age 121. As with most life insurance products, Texas Life contracts and riders contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative or see the Purelife-plus brochure for costs and complete details. Contract Form ICC18PRFNG-NI-18 or Form Series PRFNG-NI-18. 1 Voluntary Whole and Universal Life Products, Eastbridge Consulting Group, December 2018 2 Chronic Illness Rider available for an additional cost for employees only. Conditions apply. Form ICC15-ULABR-CI-15 or Form Series ULABR-CI-15. 3 Six Activities of Daily Living include: bathing, continence, dressing, eating, toileting, and transferring. Severe Cognitive Impairment means a deterioration or loss in intellectual capacity that: (1) places the Insured in jeopardy of harming him/herself or others and, therefore, the Insured requires Substantial Supervision by another individual; and (2) is measured by clinical evidence and standardized tests which reliably measure impairment in: (a) short or long-term memory; (b) orientation to people, places or time; and (c) deductive or abstract reasoning. 21M066-C 2009 (exp0523)

Additional Features • Minimal Cash Value. Designed to provide a high death benefit at a reasonable premium, purelife-plus provides peace of mind for you and your beneficiaries while freeing investment dollars to be directed toward such tax-favored retirement plans as 403(b), 457 and 401(k). •

Long Guarantees. Enjoy the assurance of a contract 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).4

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

Identity Theft IDENTITY THEFT PROTECTION Better protect what matters most. You’ve spent a lifetime building your name and financial reputation. Now more than ever, it is important to better protect your identity—and your family’s identities—as fraudsters take advantage of the pandemic to trick victims into giving up personal and financial information. US victims of identity fraud lost $16.9

Billion in 2019.1

Easy & Affordable Identity Protection With ID Watchdog®, you have an easy and affordable way to help better protect and monitor the identities of you and your family. You’ll be alerted to potentially suspicious activity and enjoy the peace of mind that comes with the support of dedicated identity resolution specialists. WHY CHOOSE ID WATCHDOG Greater Protection & Control We've got you covered with alerts on identity-related vulnerabilities and lock features for added control over your credit report(s).

More for Families Our family plan helps you better protect your loved ones, with each adult getting their own personalized account. And, we offer more features that help protect minors than any other provider.

Fully Managed Identity Restoration If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored.

ID Watchdog Is Here for You Our US-based customer care team is available 24/7/365 at 866.513.1518. Take a step to help better protect your identity today. 1

2020 Identity Fraud Study, Javelin Research, April 2020

The Powerful Features You Want at an Affordable Price FEATURES INCLUDED IN BOTH ID WATCHDOG PLANS CONTROL & MANAGE • Blocked Inquiry Alerts • Child Credit Lock | 1 Bureau* • Financial Accounts Monitoring • Social Account Monitoring* • Registered Sex Offender Reporting* • Customizable Alert Options • National Provider ID Alerts • Integrated Fraud Alerts1 With a fraud alert, potential lenders are encouraged to take extra steps to verify your identity before extending credit.

MONITOR & DETECT • Child Credit Monitoring | 1 Bureau* • Dark Web Monitoring2 * • High-Risk Transactions Monitoring3 * • Subprime Loan Monitoring3 * • Public Records Monitoring* • USPS Change of Address Monitoring • Identity Profile Report

SUPPORT & RESTORE • Identity Theft Resolution Specialists (Resolution for Pre-existing Conditions)* • Online Resolution Tracker • Lost Wallet Vault & Assistance • Deceased Family Member Fraud Remediation • Credit Freeze Assistance • Breach Alert Emails • Mobile App

*Helps better protect children | 1 Bureau = Equifax® | Multi-Bureau = Equifax, TransUnion® | 3 Bureau = Equifax, Experian®, TransUnion 63

Identity Theft What You Need to Know The credit scores provided are based on the VantageScore 3.0 model. For three-bureau VantageScore credit scores, data from Equifax, Experian, and TransUnion are used respectively. Any one-bureau VantageScore uses Equifax data. Third parties use many different types of credit scores and are likely to use a different type of credit score to assess your creditworthiness. PLAN OPTIONS

ESSENTIALS

PLATINUM PLUS

1 Bureau

3 Bureau

Credit Report(s)5 & VantageScore Credit Score(s)

1 Bureau Monthly

1 Bureau Daily & 3 Bureau Annually

Credit Score Tracker

1 Bureau Monthly

1 Bureau Daily

1 Bureau

Multi-Bureau

Up to $1M

✓

Social Account Takeover Alerts*

✓

Personal VPN & Safe Browsing*

✓

Password Manager

✓

Employee

$5.90/month

$7.50/month

Employee + Family

$10.90/month

$13.50/month

Credit Report Monitoring

Credit Report Lock6 Identity Theft Insurance

401K/HSA Stolen Funds Reimbursement7 3

Subprime Loan Block * within the monitored lending network

Enroll in this valuable benefit today.

(1) The Integrated Fraud Alert feature is made available to consumers by Equifax Information Services LLC and fulfilled on its behalf by Identity Rehab Corporation. (2) Dark Web Monitoring scans thousands of internet sites where consumers’ personal information is suspected of being bought and sold, and is constantly adding new sites to those it searches. However, the internet addresses of these suspected internet trading sites are not published and frequently change, so there is no guarantee that ID Watchdog is able to locate and search every possible internet site where consumers’ personal information is at risk of being traded. (3) The monitored network does not cover all businesses or transactions. (4) Monitoring from TransUnion® and Experian® will take several days to begin after you create your online account (5) Under certain circumstances, access to your Equifax Credit Report may not be available as certain consumer credit files maintained by Equifax contain credit histories, multiple trade accounts, and/or an extraordinary number of inquiries of a nature that prevents or delays the delivery of your Equifax Credit Report. If a remedy for the failure is not available, the product subscription will be cancelled and a full refund will be made. (6) Locking your Equifax or TransUnion credit report will prevent access to it by certain third parties. Locking your Equifax or TransUnion credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax or TransUnion credit report include: companies like ID Watchdog and TransUnion Interactive, Inc. which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state, and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make pre-approved offers of credit or insurance to you. To opt out of pre-approved offers, visit www.optoutprescreen.com. (7) The Identity Theft Insurance is underwritten and administered by American Bankers Insurance Company of Florida, an Assurant company. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions. Review the Summary of Benefits (www.idwatchdog.com/ terms/insurance). © 2021 ID Watchdog. Other product and company names are property of their respective owners. EE91924CG0221

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

Telehealth Welcome to MDLIVE! Your anytime, anywhere doctor’s office. Avoid waiting rooms and the inconvenience of going to the doctor’s office. Visit a doctor by phone, secure video, or MDLIVE App. Pediatricians are available 24/7, and family members are also eligible. • U.S. board-certified doctors with an average of 15 years of experience. • Consultations are convenient, private and secure. • Prescriptions can be sent to your nearest pharmacy, if medically necessary.

Need a doctor? No long wait. No big bill. Always open. With MDLIVE, you can visit with a doctor 24/7 from your home, office or on-the-go.

We treat over 50 routine medical conditions including: • • • • • • •

Acne Allergies Cold / Flu Constipation Cough Diarrhea Ear Problems

• • • • • •

Fever Headache Insect Bites Nausea / Vomiting Pink Eye Rash

• • • • •

Respiratory Problems Sore Throats Urinary Problems / UTI Vaginitis And More

Welcome to MDLIVE Behavioral Health! Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or MDLIVE App. • Talk to a licensed counselor or psychiatrist from your home, office, or on the go! • Affordable, confidential online therapy for a variety of counseling needs. • The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging.

Confidential, convenient online therapy. With MDLIVE, you can visit with a counselor or psychiatrist 24/7 from your home, office or on-the-go. We can help you address:

• • • • •

Addictions Bipolar Disorders Child and Adolescent Issues Depression Eating Disorders

• • • • • •

Introducing the MDLIVE App Sick in bed? Sick at work? Got a smartphone? Doctor visits are easier than ever with the MDLIVE App. • 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

• • • • •

Relationship and Marriage Issues Stress Trauma and PTSD Women’s Issues And more

2 Visits $0

Your Monthly Premium is $9.00 Join for free. Visit a doctor. consultmdlive.com 888-365-1663

Grief and Loss Life Changes Men’s Issues Panic Disorders Parenting Issues Postpartum Depression

Refer to fee schedule for additional visit copays. Your doctor will send prescriptions (if medically necessary) to your nearest pharmacy. www.consultmdlive.com (888) 365-1663

mdlive.com/getapp No smartphone? No worries! • Activate your account online or over the phone at: consultmdlive.com • 1-888-365-1663

Copyright © 2019 MDLIVE Inc. All Rights Reserved. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not replace the primary care physician, is not an insurance product and may not be able to substitute for traditional in person care in every case or for every condition. MDLIVE does not prescribe DEA controlled MDLIVE, INC. CONFIDENTIALITY NOTICE: This e-mail and any attachments are for the exclusive and confidential use of the intended recipient. If you are not the intended recipient, substances and may not prescribe non-therapeutic drugs and certain other drugs which may please do not read, distribute or take action in reliance on this message. If you have received be harmful because of their potential for abuse. MDLIVE does not guarantee patients will this message in error, please notify us immediately by return e-mail and promptly delete this receive a prescription. Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of message and its attachments from your computer system. We do not waive attorney-client, services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may work product, doctor-patient, therapist-client or intellectual property privileges by the not be used without written permission. For complete terms of use visit https:// transmission of this message. www.MDLIVE.com/terms-of-use/.

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, co-payments, orthodontics, glasses and contacts.

FLIP TO…

PG. 11

FOR HSA VS. FSA COMPARISON

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 68 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Calallen ISD Benefits Website: www.mybenefitshub.com/calallenisd

FSA (Flexible Spending Account) How do I receive reimbursements? During the course of the plan year, you may submit requests for reimbursement of expenses you have incurred. Expenses are Congratulations! considered "incurred" when the service is performed, not Your employer has established a "flexible benefits plan" to help necessarily when it is paid for. You can get submit a claim online you pay for your out-of-pocket health and daycare expenses. at: my.nbsbeneits.com One of the most important features of the plan is that the Please note: Policies other than company sponsored policies (i.e. benefits being offered are paid for with a portion of your pay spouse’s or dependents’ individual policies) may not be paid before federal income or social security taxes are withheld. This through the flexible beneits plan. Furthermore, qualified longmeans that you will pay less tax and have more money to spend term care insurance plans may not be paid through the flexible and save. However, if you receive a reimbursement for an benefits plan. expense under the plan, you cannot claim a federal income tax NBS Benefits Card credit or deduction on your return. Your employer may Health Flexible spending account: sponsor the use of the The health flexible spending account (FSA) enables you to pay NBS Benefits Card, for expenses allowed under Section 105 and 213(d) of the making access to your Internal Revenue Code which are not covered by our insured flex dollars easier than medical plan. ever. You may use the The most that you can contribute to your Health FSA each plan card to pay merchants year is set by the IRS. This amount can be adjusted for increases or service providers in cost-of-living in accordance with Code Section 125(i)(2). that accept credit cards such as hospitals and pharmacies, so there is no need to pay cash up front then wait for Premium expense plan: reimbursement. A premium expense portion of the plan allows you to use preOrthodontic expenses that are paid fully up-front at the time of tax dollars to pay for specific premiums under various insurance initial service are reimbursable in full after the initial service has programs we offer you. been performed and payment has been made. Ongoing orthodontia payments are reimbursable only as they are paid. Dependent care Flexible spending account: The dependent care flexible spending account (DCFSA) enables Account Information you to pay for out-of-pocket, work-related dependent daycare Participants may call NBS and talk to a representative during our costs. Please see the Summary Plan Description for the regular business hours, Monday-Friday, 7 a.m. to 7 p.m. Central definition of an eligible dependent. The law places limits on the Time. Participants can also obtain account information using the amount of money that can be paid to you in a calendar year. Automated Voice Response Unit, 24 hours a day, 7 days a week Generally, your reimbursement may not exceed the lesser of: at (385) 988-6423 or toll free at (800) 274-0503. For immediate (a) $5,000 (if you are married filing a joint return or you are access to your account information at any time, log on to our head of a household) or $2,500 (if you are married filing website at my.nbsbenefits.com or download the NBS Mobile separate returns); (b) your taxable compensation; (c) your App. spouse's actual or deemed earned income. Also, in order to have the reimbursements made to you and be What can I save with an FSA? excluded from your income, you must provide a statement from FSA No FSA the service provider including the name, address and, in most cases, the taxpayer identification number of the service Annual taxable income $24,000 $24,000 provider as well as the amount of such expense and proof that Health FSA $1,500 $0 the expense has been incurred. Dependent care FSA $1,500 $0 Determining contributions Total pre-tax contributions -$3,000 $0 Before each plan year begins, you will select the benefits you want and how much contributions should go toward each Taxable income after FSA $21,000 $24,000 benefit. It is very important that you make these choices Income taxes -$6,300 -$7,200 carefully based on what you expect to spend on each covered benefit or expense during the plan year. After-tax income $14,700 $16,800 Generally, you cannot change the elections you have made after After-tax health and welfare expenses $0 -$3,000 the beginning of the plan year. However, there are certain limited situations when you can change your elections if you Take-home pay $14,700 $13,800 have a "change in status". Please refer to your Summary Plan You saved $900 $0 Description for a change in status listing. 69

Plan Highlights Flexible Spending Plans

FSA (Flexible Spending Account) NBS Mobile App When you're on the go, save time and hassle with the NBS Mobile App. Submit claims, check your balances, view transactions, and submit documentation using your device's camera.

Easy and convenient •

•

Designed to work just as other iOS and Android apps which makes it easy to learn and use. Shares user authentication with the NBS portal. Registered users can download the app and log in immediately to gain access to their benefit accounts, with no need to register their phone or your account.

It's secure •

No sensitive account information is ever stored on your mobile device and secure encryption is used to protect all transmissions.

Mobile app features The NBS mobile app supports a wide variety of features, empowering you to proactively manage your account. • View account balances • View claims • View reimbursement history • Submit claims • Submit documentation using your device's camera • Pay providers • Setup a variety of SMS alerts • Edit your personal information • View contribution details • View plan information • View calendar deadlines • Contact a service representative • View Benefits Card information

FSA (Flexible Spending Account) Sample Expenses Medical expenses • • • • • • • • • • •

Acupuncture Addiction programs Adoption (medical expenses for baby birth) Alternative healer fees Ambulance Body scans Breast pumps Care for mentally handicapped Chiropractor Copayments Crutches

Dental expenses • • • • • • • •

Artificial teeth Copayments Deductible Dental work Dentures Orthodontia expenses Preventative care at dentist office Bridges, crowns, etc.

Vision expenses • • • • • • • •

Braille - books & magazines Contact lenses Contact lens solutions Eye exams Eye glasses Laser surgery Office fees Guide dog and upkeep/other animal aid

Diabetes (insulin, glucose monitor) Eye patches Fertility treatment First aid (i.e. bandages, gauze) Hearing aids & batteries Hypnosis (for treatment of illness) Incontinence products (i.e. Depends, Serene) Joint support bandages and hosiery Lab fees Monitoring device (blood pressure, cholesterol)

• • • • • • • • • •

Physical exams Pregnancy tests Prescription drugs Psychiatrist/psychologist (for mental illness) Physical therapy Speech therapy Vaccinations Vaporizers or humidifiers Weight loss program fees (if prescribed by physician) Wheelchair

• • • • • • • • • •

Items that generally do not qualify for reimbursement • • • • • • • • • • • •

• • •

Personal hygiene (deodorant, soap, body powder, sanitary products) Addiction products Allergy relief (oral meds, nasal spray) Antacids and heartburn relief Anti-itch and hydrocortisone creams Athlete's foot treatment Arthritis pain relieving creams Cold medicines (i.e. syrups, drops, tablets) Cosmetic surgery Cosmetics (i.e. makeup, lipstick, cotton swabs, cotton balls, baby oil) Counseling (i.e. marriage/family) Dental care - routine (i.e. toothpaste, toothbrushes, dental floss, anti-bacterial mouthwashes, fluoride rinses, teeth whitening/ bleaching) Exercise equipment Fever & pain reducers (i.e. Aspirin, Tylenol) Hair care (i.e. hair color, shampoo, conditioner, brushes, hair loss

• • • • • • • •

products) Health club or fitness program fees Homeopathic supplement or herbs Household or domestic help Laser hair removal Laxatives Massage therapy Motion sickness medication Nutritional and dietary supplements (i.e. bars, milkshakes, power drinks, Pedialyte) Skin care (i.e. sun block, moisturizing lotion, lip balm) Sleep aids (i.e. oral meds, snoring strips) Smoking cessation relief (i.e. patches, gum) Stomach & digestive relief (i.e. Pepto- Bismol, Imodium) Tooth and mouth pain relief (Orajel, Anbesol) Vitamins Wart removal medication Weight reduction aids (i.e. Slimfast, appetite suppressant

These expenses may be eligible if they are prescribed by a physician (if medically necessary for a specific condition).

8523 South Redwood Road, West Jordan, Utah 84088 (800) 274-0503 service@nbsbenefits.com www.nbsbenefits.com

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 72 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Friendswood Calallen ISD Benefits Website: www.mybenefitshub.com/calallenisd www.mybenefitshub.com/friendswoodisd

Medical Transport - Emergent Plan Enroll in the Emergent Plus plan today and protect you and your family against the financial burden of massive out-of-pocket ambulance costs, all at an affordable group rate.

EMERGENT PLUS MEMBERSHIP BENEFITS A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. After the group health plan pays its portion, MASA MTS works with providers to deliver our members $0 in out-ofpocket costs for emergency transport. Emergent Air Transportation In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities. Emergent Ground Transportation In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.

DID YOU KNOW? 25 MILLION PEOPLE are sent to the emergency room through ground or air ambulance every year. Insurance companies may not cover all air and ground ambulance expenses which can result in excessive bills.

$5,000

$60,000

Non-Emergency Inter-Facility Transportation In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non-emergency air or ground transportation between medical facilities. Repatriation/Recuperation Suppose you or a family member is hospitalized more than 100-miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation.

$11 /MONTH Contact Your MASA MTS Representative, Financial Benefit Services to learn more about membership plan options. contactus@fbsbenefits.com 800-583-6908

The information provided in this product sheet is for informational purposes only. The benefits listed, and the descriptions thereof, do not represent the full terms and conditions applicable for usage and may only be offered in some memberships. Premiums vary depending on the benefits selected. Commercial Air and Worldwide coverage are not available in all territories. For a complete list of benefits, premiums, and full terms and conditions please refer to the applicable member service agreement for your territory. MASA MTS products and services are not available where prohibited. For Florida residents, Medical Air Services Association of Florida, Inc. is doing business as MASA MTS and is a prepaid limited health service organization licensed under Chapter 636, Florida Statutes, license number: 65-0265219 operating in Florida at 1250 S. Pine Island Road, Suite 500, Plantation, FL 33324. MASA Global, MASA MTS and MASA TRS are registered trade names of Medical Air Services Association, Inc., an Oklahoma corporation. VER: EPPSLAVS1.050521 SOURCE: Welch, Shari. “Emergency Department Usage Trend Data Can Help Physicians Prepare for Patients.” ACEP Now http://bit.ly/3qBvNrc

Medical Transport - Platinium Plan A Platinum Membership provides the ultimate peace of mind at an affordable rate when it comes to protecting you and your family from massive out-of-pocket ambulance charges. PLATINUM MEMBERSHIP BENEFITS A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. After the group health plan pays its portion, MASA MTS works with providers to deliver our members’ $0 in out- of-pocket costs for emergency transport. Emergent Air Transportation In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities. Emergent Ground Transportation In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities. Non-Emergency Inter-Facility Transportation In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non-emergency air or ground transportation between medical facilities. Repatriation/Recuperation Suppose you or a family member is hospitalized more than 100-miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation.

Escort Transportation If you or a family member requires medical transportation, you may elect to have a family member or friend accompany you during the medical

transport. This benefit is limited to space availability within the vehicle, giving due priority to medical personnel and equipment. Visitor Transportation If you or a family member is hospitalized more than 100-miles away from home for more than 7-days (consecutively), you may elect to have a family member or friend transported (by commercial airline) to be present while you recover. Return Transportation In the event a Member is hospitalized more than 100miles away from home for more than 24-hours, Member has access to return transportation, upon their release, to the commercial airport nearest their home. Mortal Remains Transportation If you or a family member dies more than 100-miles from home, MASA shall pay (on behalf of the Member’s estate) the airway bill associated with the return of the Member’s mortal remains.

Minor Return Suppose you require the use of one or more of the transportation benefits and, as a result of your need, a minor child (who is in your custody) is left unattended. Even if this occurs, the minor child will be covered for return transportation (by commercial airline) to the commercial airport nearest the child’s home. Organ Retrieval/Organ Transportation In the event of an organ transplant procedure, MASA will arrange for the transportation of you or the transplant organ to the transplant site. Vehicle Return Suppose you use one or more of the member transportation benefits. As a result of using the benefit, you may elect to have MASA transport your ground vehicle to your home or rental return location. Pet Return If you use one or more of the member transportation benefits while with your pet, you may elect to have MASA MTS transport your pet home.

Medical Transport - Platinium Plan Worldwide Coverage Contingent on a 10-day prior notice to MASA MTS of your travel plans, you have coverage for worldwide non- emergent air transportation, repatriation/ recuperation, return transportation, escort transportation, visitor transportation, and mortal remains transportation. Coverage is limited to 90 days or less of travel.

$39 /MONTH Contact Your MASA MTS Representative, Financial Benefit Services to learn more about membership plan options. contactus@fbsbenefits.com 800-583-6908

The information provided in this product sheet is for informational purposes only. The benefits listed, and the descriptions thereof, do not represent the full terms and conditions applicable for usage and may only be offered in some memberships. Premiums vary depending on the benefits selected. Commercial Air and Worldwide coverage are not available in all territories. For a complete list of benefits, premiums, and full terms and conditions please refer to the applicable member service agreement for your territory. MASA MTS products and services are not available where prohibited. For Florida residents, Medical Air Services Association of Florida, Inc. is doing business as MASA MTS and is a prepaid limited health service organization licensed under Chapter 636, Florida Statutes, license number: 65-0265219 operating in Florida at 1250 S. Pine Island Road, Suite 500, Plantation, FL 33324. MASA Global, MASA MTS and MASA TRS are registered trade names of Medical Air Services Association, Inc., an Oklahoma corporation. VER: PMPSLAVS1.050521 SOURCE: Welch, Shari. “Emergency Department Usage Trend Data Can Help Physicians Prepare for Patients.” ACEP Now http:// bit.ly/3qBvNrc