2021-22 Galveston ISD Benefit Guide by Higginbotham Public Sector

GALVESTON ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2021 - 8/31/2022 WWW.MYBENEFITSHUB.COM/GALVESTONISD 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) Texas Schools Health Benefits (TSHB) Program TRS Medical APL Hospital Indemnity EECU Health Savings Account (HSA) MDLive Telehealth Lincoln Financial Group Dental Humana Vision The Hartford Disability MetLife Cancer The Hartford Accident UNUM Critical Illness UNUM Life and AD&D 5Star Individual Term Life NBS Flexible Spending Account (FSA) LegalEASE Legal Services Identity Guard Identity Theft

4 4-5 6-11 6 7 8 9 10 11 12-17 18-21 22-25 26-27 28-29 30-35 36-39 40-43 44-49 50-53 54-57 58-63 64-67 68-71 72-73 74-76

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

The Hartford (800) 549-6514 www.thehartford.com

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

TEXAS SCHOOLS HEALTH BENEFITS (TSHB) PROGRAM

CANCER

FLEXIBLE SPENDING ACCOUNT

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

MetLife (800) 438-6388 www.metlife.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 Claims (800) 635-5597 www.unum.com

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

TELEHEALTH

ACCIDENT

IDENTITY THEFT

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

The Hartford (866) 547-4205 www.thehartford.com

Aura/ID Guard (800) 452-2541 www.identityguard.com

DENTAL

LIFE AND AD&D

LEGAL SERVICES

Lincoln Financial Group 800-423-2765 www.lfg.com/

UNUM 866-679-3054 www.unum.com

LegalEASE (888) 416-4313 www.legaleaseplan.com/gisd

VISION

COBRA

Humana (877) 877-1051 www.humana.com/vision-insurance

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

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

and get access to everything you need to complete your benefits

Text “FBS GISD”

to (800) 583-6908

enrollment: •

Enrollment Resources

•

Online Support

•

Interactive Tools

•

And more!

App Group #: FBSGISD

OR SCAN

How to Log In

1 BENEFIT INFO

2 3

www.mybenefitshub.com/galvestonisd

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

SUMMARY PAGES

Benefit Updates - What’s New •

NEW! TPA—FINANCIAL BENEFIT SERVICES

•

GISD ALTERNATIVE MEDICAL PLANS New Medical Plan Options! Galveston ISD has joined the Texas Schools Health Benefits Program (TSHBP) and will be offering alternate plans as medical options in addition to the TRS medical plans. Two plan options are available: a High Deductible HSA Compatible plan and a CoPay plan. On both plans, there is In and Out-of-Network Coverage and the plan does not require a primary care provider or referral to a specialist. Telehealth is provided at no cost for the CoPay plan and consults are $30 for the High Deductible plan. On both plans, once your deductible is met all other eligible medical expenses are covered at 100%. There is no coinsurance requirement. Preventative services are always covered at 100%. Specialty drugs are not covered after the first 90 days unless at a facility setting (at the hospital, outpatient facility) or if they are less than $670 (see plan summary for program options). All hospital and other medical facility-based services are scheduled via the assistance of your assigned Care Coordinator.

•

NEW! SUPPLEMENTAL OPTIONS New Insurance Carriers, Plans, and Enhanced Plan Options!  Dental - High plan - Adult ortho now available in addition to children, New Low plan option. No waiting periods for services on either plan.  Vision - Frame replacement every 12 months  Cancer Plan - New benefit - Guarantee Issue meaning no one is denied coverage  Term Life - Guarantee issue for all employees this year  Individual Life - Guarantee issue for all employees this year!

•

NEW! TRS-ACTIVECARE CHANGES Rate increased for all plans. For ACHD plan: deductible, outof-pocket maximum, and coinsurance increased.

•

NEW! HSA CONTRIBUTION LIMITS The new 2021 HSA annual maximums are $3,600 for an Individual and $7,200 for the Family.

Important Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202 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).

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/galvestonisd. 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

ISD benefit website: www.mybenefitshub.com/galvestonisd.

included in the dependent profile. Additionally, you must

Click on the benefit plan you need information on (i.e.,

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

•

For benefit summaries and claim forms, go to the Galveston

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.

Dental) and you can find provider search links under the Quick

Links 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 TSHBP

To age 26

Telehealth

MDLIVE

To age 26

Dental

Lincoln Financial Group

To age 26

Vision

Humana

To age 26

Cancer

MetLife

To age 26

Critical Illness

UNUM

To age 26

Accident

The Hartford

To age 25

Life and AD&D

UNUM

To age 26

Identity Theft

Aura/Identity Guard

To age 26

Individual Life

5STAR Life Insurance Company

To age 24

Legal Services

LegalEASE

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 please notify your benefits administrator.

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

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.

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

Calendar Year

orders to take drugs, or received medical care or services

January 1st through December 31st

(including diagnostic and/or consultation services).

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.

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. However, Galveston ISD has 75 day grace period provision.

Does the account earn interest?

Yes

Portable?

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

FLIP TO FOR HSA INFORMATION

PG. 26

FLIP TO FOR FSA INFORMATION

PG. 68 11

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

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

Galveston 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

$360

$679

$1,000 $1,310

CoPay Plan

$401

$775

$1,125

$1,485

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

TRS | BCBSTX

TRS-ActiveCare

YOUR BENEFITS PACKAGE

About this Benefit Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. More than 70% of adults across the United States are already being diagnosed with a chronic disease.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 18 details on covered expenses, limitations and exclusions are included in the summary plan description located on the McKinney ISD Benefits Website: www.mybenefitshub.com/mckinneyisd

Medical Rate Comparison Medical Monthly Premium

District Contribution

Employee Cost

TSHBP High Deductible Plan Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

$360.00

$300.00

$60.00

$1,000.00

$300.00

$700.00

$679.00

$300.00

$379.00

$1,310.00

$300.00

$1,010.00

$401.00

$300.00

$101.00

$1,125.00

$300.00

$825.00

$775.00

$300.00

$475.00

$1,485.00

$300.00

$1,185.00

$429.00

$300.00

$129.00

$1,209.00

$300.00

$909.00

$772.00

$300.00

$472.00

$1,445.00

$300.00

$1,145.00

TSHBP CoPay Plan Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

TRS ActiveCare HD Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

TRS ActiveCare 2 Employee Only

$1,013.00

$300.00

$713.00

Employee & Spouse

$2,402.00

$300.00

$2,102.00

Employee & Child(ren)

$1,507.00

$300.00

$1,207.00

Employee & Family

$2,841.00

$300.00

$2,541.00

TRS ActiveCare Primary Employee Only Employee & Spouse Employee & Child(ren)

Employee & Family

$417.00

$300.00

$117.00

$1,176.00

$300.00

$876.00

$751.00

$300.00

$451.00

$1,405.00

$300.00

$1,105.00

TRS ActiveCare Primary+ Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

$542.00

$300.00

$242.00

$1,334.00

$300.00

$1,034.00

$879.00

$300.00

$579.00

$1,675.00

$300.00

$1,375.00

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

TRS-ActiveCare Primary+

TRS-ActiveCare HD

• Lower deductible than the HD and

• Compatible with a health savings

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

Plan summary

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

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

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 Your Premium Total Premium Your Premium $417 $ $542 $ $1,176 $ $1,334 $ $751 $ $879 $ $1,405 $ $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

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. 20

• • • • •

$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 21

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

MedChoice™ Group Limited Benefit Hospital Indemnity Insurance Galveston 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

Hospital Admission Benefit

$1,500 per day; maximum of 1 day

$2,500 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 30 days

Rehabilitation Benefit

$200 per day; maximum of 5 days

Included

Additional Rider Portability Rider

HSA Compatible Monthly Premiums* Individual Ages 18 +

Individual & Spouse

Individual & Child(ren)

Individual & Family

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

$15.98

$22.40

$37.04

$46.60

$20.54

$25.40

$38.44

$49.84

* 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. 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.

APSB-22507(TX)-0321 Galveston ISD

Page 1 of 3

MedChoice™ Group Limited Benefit Hospital Indemnity Insurance 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.

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. 24 APSB-22507(TX)-0321 Galveston ISD

Page 2 of 3

MedChoice™ Group Limited Benefit Hospital Indemnity Insurance 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 | Galveston ISD

APSB-22507(TX)-0321 Galveston 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 26 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Galveston ISD Benefits Website: www.mybenefitshub.com/galvestonisd

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.

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

Telehealth Welcome to MDLIVE!

Your virtual doctor is here. Join for free today!

With MDLIVE, you can visit with a doctor or counselor 24/7 from your home, office or on-the-go.

You have a telehealth benefit giving you virtual care, anywhere. At a price you can afford. •

• • •

Board-certified doctors Available anytime, day or night Consults by mobile app, video or phone Prescriptions can be sent to your nearest pharmacy if medically necessary

We treat over 50 routine medical conditions including: • Acne • Allergies • Cold/flu • Constipation • Cough • Diarrhea • Ear problems • Insect bites • Nausea/vomiting • Pink eye • Rash • Respiratory problems • Sore throats • And more

Download the app. Join for Free. Visit a Doctor.

consultmdlive.com 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 substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will 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 services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit https://www.MDLIVE.com/terms-of-use/. 29

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

Dental PPO– High Full-Time Employees of Galveston ISD

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 • Features group coverage for Galveston ISD 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 $1,250 $1,250 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): $0 - $600 • Rollover Amount: $300 per calendar year • Rollover Amount with Preferred Provider: $450 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 Space maintainers for children Sealants Problem focused exams Biopsy and examination of oral tissue (including brush biopsy) FDA approved oral cancer screening Basic Services 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 Periodontal maintenance procedures Periodontal surgery Harmful habit appliances Occlusal adjustments Major Services Prosthetic repair and recementation services Endodontics (including root canal treatment) Bridges Full and partial dentures Denture reline and rebase services Crowns, inlays, onlays and related services Implants & implant 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

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.

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

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 Rate Here’s how little you pay with group rates. As a Galveston ISD employee, you can take advantage of this dental coverage for less than $1.07 a day. Plus, you can add loved ones to the plan for just a little more. Your estimated cost is itemized below.

Coverage

Monthly Rate

Employee only

$32.18

Employee & spouse

$60.76

Employee & child/children

$65.28

Employee & family

$96.60

Dental– Low PPO Full-Time Employees of Galveston ISD

Benefits At-A-Glance Dental Insurance Low Option The Lincoln DentalConnect® PPO Plan: • Covers many preventive, basic, and major dental care services • Features group coverage for Galveston ISD 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 $750 $750 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): $1-$300 • Rollover Amount: $150 per calendar year • Rollover Amount with Preferred Provider: $200 per calendar year • Maximum Rollover Account Balance: $750 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

100% No Deductible

Contracting Dentists

Non-Contracting Dentists

70% After Deductible

Contracting Dentists

Non-Contracting Dentists

50% After Deductible

Dental– Low PPO Orthodontics

Contracting Dentists

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

With the Lincoln Dental Mobile App • • • • •

Lincoln DentalConnect® Online Health Center • • • •

Covered Family Members

Non-Contracting Dentists

•

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

Dental Rate

Coverage

Here’s how little you pay with group rates. As a Galveston ISD employee, you can take advantage of this dental coverage for less than $0.58 a day. Plus, you can add loved ones to the plan for just a little more. Your estimated cost is itemized below.

Employee only

$17.52

Employee & spouse

$33.28

Employee & child/children

$39.98

Employee & family

$60.12

Monthly Rate

Dental– DHMO Now Available to Full-Time Employees of Galveston ISD: Dental insurance with affordable group rates

Simplify your dental care and save. Trips to the dentist are a little less scary when you know how much you’ll pay ahead of time. And easier, too, with no claim forms or deductibles.

The Lincoln DentalConnect® DHMO Plan: •

• • • •

Covers most preventive and diagnostic care services at no charge Also covers a wide variety of specialty services - lowering your out-of-pocket costs with no deductibles or maximums Features group rates for Galveston ISD employees Lets you choose a participating dentist from a regional network Saves you time and hassle with no waiting periods and no claim forms

Here’s how this important coverage works. •

• • • •

You choose your primary-care dentist when you enroll. To find a participating dentist, visit http://ldc.lfg.com, select Find a Dentist, and choose the Texas LDC Plan 5 network. (You can also print your dental ID card from this site once your coverage begins.) This dental plan offers a detailed list of covered procedures, each with a dollar copayment (see the Summary of Benefits for details). You pay for services provided during your visit. Emergency care away from home is covered up to a set dollar limit. You can change your primary-care dentist at any time by calling the customer service number listed on your dental ID card. A complete Summary of Benefits is included on the next few pages.

Here’s how little you pay with group rates. As a Galveston ISD employee, you can take advantage of this dental insurance plan for less than $0.42 a day. Plus, you can add loved ones to the plan for just a little more.

Coverage Employee only Employee & spouse Employee & child/children Employee & family

Monthly Premium $12.60 $24.60 $26.60 $38.44

No money is due at enrollment. Your premium simply comes out of your paycheck.

Lincoln DentalConnect® DHMO (policy series TX-EOC 08 2010) is underwritten in Texas by National Pacific Dental, Inc., Houston, TX. National Pacific Dental is not a Lincoln Financial Group® company. Coverage is subject to actual contract language. Each independent company is solely responsible for its own obligations.

HUMANA

Vision

YOUR BENEFITS PACKAGE

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

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

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

Vision Humana Vision 160

Galveston ISD

VISION CARE IF YOU USE AN IN-NETWORK PROVIDER IF YOU USE AN OUT-OF-NETWORK SERVICES (MEMBER COST) PROVIDER (REIMBURSEMENT) Exam with dilation as necessary $10 Up to $30 Retinal Imaging1 Up to $39 Not covered CONTACT LENS EXAM OPTIONS2 Standard contact lens fit and follow-up $0 Up to $30 Premium contact lens fit and follow-up 10% off retail less $55 allowance Up to $30 FRAME3 $160 allowance; 20% off balance over $160 $80 allowance STANDARD PLASTIC LENSES4 Single Vision $10 Up to $25 Bifocal $10 Up to $40 Trifocal $10 Up to $60 Lenticular $10 Up to $100 COVERED LENS OPTIONS4 UV Coating $15 Not covered Tint (Solid and Gradient) $15 Not covered Standard scratch-resistance $15 Not covered Standard polycarbonate - adults $40 Not covered Standard polycarbonate - children <19 $0 Not covered Standard anti-reflective coating $10 Not covered Premium anti-reflective coating Premium anti-reflective coatings as follows: Premium anti-reflective coatings as follows: • Tier 1 $22 Up to $25 • Tier 2 $33 Up to $25 • Tier 3 80% of charge less $35 allowance Up to $25 Standard progressive (add-on to bifocal) $10 Up to $40 Premium progressive Premium progressives as follows: Premium progressives as follows: • Tier 1 $45 Up to $40 • Tier 2 $55 Up to $40 • Tier 3 $70 Up to $40 • Tier 4 $25 copay, 80% of charge less $120 allowance Up to $40 Photochromatic / plastic transitions $75 Not covered Polarized 80% of charge Not covered CONTACT LENSES5 (applies to materials only) Conventional $160 allowance,15% off balance over $160 $128 allowance Disposable $160 allowance $128 allowance Medically Necessary $0 $210 allowance FREQUENCY Exam Once every 12 months Once every 12 months Frame Once every 12 months Once every 12 months Lenses Once every 12 months Once every 12 months Contacts Lenses Once every 12 months Once every 12 months DIABETIC EYE CARE: care and testing for diabetic members Examination - Up to (2) services per year $0 Up to $77 Retinal Imaging - Up to (2) services per year $0 Up to $50 Extended Ophthalmoscopy - Up to (2) services per year $0 Up to $15 Gonioscopy - Up to (2) services per year $0 Up to $15 Scanning Laser - Up to (2) services per year $0 Up to $33 OPTIONAL BENEFITS 12-month Frame Benefit Benefit replaces the 24-month frequency of the base plan. Polycarbonate Lenses for Children <19 Provides for standard polycarbonate lens with $0 copay. Not available in AK, CT, ID, & OH. 1 Member costs may exceed $39 with certain providers. Members may contact their participating provider to determine what costs or discounts are available. 2 Standard contact lens exam fit and follow up costs and premium contact lens exam discounts up to 10% may vary by participating provider. Members may contact their participating provider to determine what costs or discounts are available. 3 Discounts may be available on all frames except when prohibited by the manufacturer. 4 Lens option costs may vary by provider. Members may contact their participating provider to determine if listed costs are available. 5 Plan covers contact lenses or frames, but not both.

Monthly rates* (12 deductions per year)

Employee Employee + spouse Employee + child(ren) Family

$8.92 $17.86 $18.46 $28.12

Vision • Any conflict involving armed forces of any international authority. 4. Any expense arising from the completion of forms. 5. Your failure to keep an appointment. 6. Any hospital, surgical or treatment facility, or for services of an anesthesiologist or anesthetist. 7. Prescription drugs or pre-medications, whether dispensed or prescribed. 8. Any service not specifically listed in the Schedule of Benefits. 9. Any service that we determine: • Is not a visual necessity; • Does not offer a favorable prognosis; • Does not have uniform professional endorsement; or • Is deemed to be experimental or investigational in nature. 10. Orthoptic or vision training. 11. Subnormal vision aids and associated testing. 12. Aniseikonic lenses. 13. Any service we consider cosmetic. 14. Any expense incurred before your effective date or after the date your coverage under this policy terminates. 15. Services provided by someone who ordinarily lives in your home or who is a family member. 16. Charges exceeding the reimbursement limit for the service. 17. Treatment resulting from any intentionally self-inflicted injury or bodily illness. 18. Plano lenses. 19. Medical or surgical treatment of eye, eyes, or supporting structures. 20. Replacement of lenses or frames furnished under this plan which Routine eye exams can lead to early detection of vision are lost or broken, unless otherwise available under the plan. problems and other diseases such as diabetes, 21. Any examination or material required by an Employer as a condition hypertension, multiple sclerosis, high blood pressure, of employment. osteoporosis, and rheumatoid arthritis.1 22. Non-prescription sunglasses. 1 Thompson Media Inc. 23. Two pair of glasses in lieu of bifocals. 24. Services or materials provided by any other group benefit plans providing vision care. 25. Certain name brands when manufacturer imposes no discount. Check out Humana.com 26. Corrective vision treatment of an experimental nature. Call 1-866-995-9316 seven days a week: 27. Solutions and/or cleaning products for glasses or contact lenses. 8 a.m. to 6 p.m. Eastern Time 28. Pathological treatment. 29. Non-prescription items. Monday through Saturday and 11 a.m. to 8 p.m. Sunday. 30. Costs associated with securing materials. 31. Pre- and Post-operative services. Limitations and Exclusions: 32. Orthokeratology. In addition to the limitations and exclusions listed in your "Vision Benefits" section, this policy does not provide benefits for the following: 33. Routine maintenance of materials. 34. Refitting or change in lens design after initial fitting, unless 1. Any expenses incurred while you qualify for any worker's specifically allowed elsewhere in the certificate. compensation or occupational disease act or law, whether or not you 35. Artistically painted lenses. applied for coverage. Humana Vision products insured by Humana Insurance Company, 2. Services: • That are free or that you would not be required to pay for if you did Humana Health Benefit Plan of Louisiana, The Dental Concern, Inc. or Humana Insurance Company of New York. not have this insurance, unless charges are received from and This is not a complete disclosure of the plan qualifications and reimbursable to the U.S. government or any of its agencies as limitations. Specific limitations and exclusions as contained in the required by law; Regulatory and Technical Information Guide will be provided by the • Furnished by, or payable under, any plan or law through any agent. Please review this information before applying for coverage. government or any political subdivision (this does not include NOTICE: Your actual expenses for covered services may exceed the Medicare or Medicaid); or stated cost or reimbursement amount because actual provider charges • Furnished by any U.S. government-owned or operated hospital/ institution/agency for any service connected with sickness or bodily may not be used to determine insurer and member payment obligations. injury. 3. Any loss caused or contributed by: • War or any act of war, whether declared or not; • Any act of international armed conflict; or

ADDITIONAL PLAN DISCOUNTS • Member may receive a 20% discount on items not covered by the plan at network Providers. Members may contact their participating provider to determine what costs or discounts are available. Discount does not apply to EyeMed Provider's professional services, or contact lenses. Plan discounts cannot be combined with any other discounts or promotional offers. Services or materials provided by any other group benefit plan providing vision care may not be covered. Certain brand name Vision Materials may not be eligible for a discount if the manufacturer imposes a nodiscount practice. Frame, Lens, & Lens Option discounts apply only when purchasing a complete pair of eyeglasses. If purchased separately, members receive 20% off the retail price. • Members may also receive 15% off retail price or 5% off promotional price for LASIK or PRK from the US Laser Network, owned and operated by LCA Vision. Since LASIK or PRK vision correction is an elective procedure, performed by specialty trained providers, this discount may not always be available from a provider in your immediate location.

Vision health impacts overall health

Questions?

Vision Important! At Humana, it is important you are treated fairly. Humana Inc. and its subsidiaries do not discriminate or exclude people because of their race, color, national origin, age, disability, sex, sexual orientation, gender, gender identity, ancestry, marital status, or religion. Discrimination is against the law. Humana and its subsidiaries comply with applicable Federal Civil Rights laws. If you believe that you have been discriminated against by Humana or its subsidiaries, there are ways to get help. • You may file a complaint, also known as a grievance: Discrimination Grievances, P.O. Box 14618, Lexington, KY 40512-4618 If you need help filing a grievance, call 1-877-320-1235 or if you use a TTY, call 711. • You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through their Complaint Portal, available at https://ocrportal.hhs.gov/ocr/ portal/ lobby.jsf, or at U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at https:// www.hhs.gov/ocr/office/file/index.html. • California residents: You may also call California Department of Insurance toll-free hotline number: 1-800-927-HELP (4357), to file a grievance Auxiliary aids and services, free of charge, are available to you. 1-877-320-1235 (TTY: 711)

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

Long Term Disability BENEFIT HIGHLIGHTS FOR: Galveston Independent School District

EDUCATOR DISABILITY INSURANCE OVERVIEW What is Educator Disability Income Insurance? Educator Disability insurance combines the features of a short-term and long-term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need. You have the opportunity to purchase Disability Insurance through your employer. This highlight sheet is an overview of your Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail. Why do I need Disability Insurance Coverage? More than half of all personal bankruptcies and mortgage foreclosures are a consequence of disability1 1

Facts from LIMRA, 2016 Disability Insurance Awareness Month

The average worker faces a 1 in 3 chance of suffering a job loss lasting 90 days or more due to a disability2 2

Facts from LIMRA, 2016 Disability Insurance Awareness Month

Only 50% of American adults indicate they have enough savings to cover three months of living expenses in the event they’re not earning any income3 3

Federal Reserve, Report on the Economic Well-Being of U.S. Households in 2018

ELIGIBILITY AND ENROLLMENT Eligibility You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis. Enrollment You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period. Effective Date Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect. Actively at Work You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break (s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.

FEATURES OF THE PLAN Benefit Amount You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $8,000 that cannot exceed 66 2/3% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer. Elimination Period You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Disability

benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin. For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization. Maximum Benefit Duration Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the age at which disability occurs, the maximum duration may vary. Please see the applicable schedule below based on the Premium benefit option. Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from sickness or injury. Age Disabled Prior to 63 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and older

Maximum Benefit Duration To Normal Retirement Age or 48 months if greater To Normal Retirement Age or 42 months if greater 36 months 30 months 27 months 24 months 21 months 18 months

Mental Illness, Alcoholism and Substance Abuse: Duration You can receive benefit payments for Long-Term Disabilities resulting from mental illness, alcoholism and substance abuse for a total of 24 months for all disability periods during your lifetime. Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24 month lifetime limit. Partial Disability Partial Disability is covered provided you have at least a 20% loss of earnings and duties of your job. Other Important Benefits Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or child under age 26, equal to three times your last monthly gross benefit. The Hartford's Ability Assist service is included as a part of your group Long Term Disability(LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services. Travel Assistance Program – Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre-trip information, emergency medical assistance and emergency personal services. Identity Theft Protection – An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the 41

Long Term Disability case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims. Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full-time employment.

• • • •

PROVISIONS OF THE PLAN

conflict The commission of, or attempt to commit a felony An intentionally self-inflicted injury Any case where Your being engaged in an illegal occupation was a contributing cause to your disability You must be under the regular care of a physician to receive benefits

Definition of Disability Termination Provisions Disability is defined as The Hartford’s contract with your employer. Typically, disability means that you cannot perform one or more of the Your coverage under the plan will end if: The group plan ends or is discontinued essential duties of your occupation due to injury, sickness, pregnancy or • • You voluntarily stop your coverage other medical conditions covered by the insurance, and as a result, • You are no longer eligible for coverage your current monthly earnings are 80% or less of your pre-disability • You do not make the required premium payment earnings. • Your active employment stops, except as stated in the One you have been disabled for 24 months, you must be prevented continuation provision in the policy from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 66 2/3% or less of your preThe Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, disability earnings.

including underwriting company Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. All benefits are subject to the terms and conditions Pre-Existing Condition Limitation of the policy. Policies underwritten by the underwriting company listed above Your policy limits the benefits you can receive for a disability caused by detail exclusions, limitations, reduction of benefits and terms under which the a pre-existing condition. In general, if you were diagnosed or received policies may be continued in force or discontinued. This Benefit Highlights Sheet care for a disabling condition within the 3 consecutive months just prior explains the general purpose of the insurance described, but in no way changes to the effective date of this policy, your benefit payment will be limited, or affects the policy as actually issued. In the event of a discrepancy between this Benefit Highlights Sheet and the policy, the terms of the policy apply. unless: You have been insured under this policy for 12 months before Complete details are in the Certificate of Insurance issued to each insured your disability begins. individual and the Master Policy as issued to the policyholder. Benefits are If your disability is a result of a pre-existing condition, we will pay subject to state availability. © 2020 The Hartford.

benefits for a maximum of 90 Days.

Continuity of Coverage If you were insured under your district’s prior plan and not receiving benefits the day before this policy is effective, there will not be a loss in coverage and you will get credit for your prior carrier’s coverage. Recurrent Disability What happens if I Recover but become Disabled again? Periods of Recovery during the Elimination Period will not interrupt the Elimination Period, if the number of days You return to work as an Active Employee are less than one-half (1/2) the number of days of Your Elimination Period. Any day within such period of Recovery, will not count toward the Elimination Period. Benefit Integration Your benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as: • Social Security Disability Insurance • State Teacher Retirement Disability Plans • Workers’ Compensation • Other employer-based disability insurance coverage you may have • Unemployment benefits • Retirement benefits that your employer fully or partially pays for (such as a pension plan) Your plan includes a minimum benefit the greater of 10% of your elected benefit or $100. General Exclusions You cannot receive Disability benefit payments for disabilities that are caused or contributed to by: • War or act of war (declared or not) • Military service for any country engaged in war or other armed 42

Long Term Disability Galveston Independent School District Premium Option – Monthly Premium Cost (based on 12 payments per year) Accident / Sickness Elimination Period in Days Annual Monthly Monthly Earnings Earnings Benefit

0/7

14/14

30/30

60/60

90/90

180/180

Accident / Sickness Elimination Period in Days Annual Monthly Monthly Earnings Earnings Benefit

0/7

14/14

30/30

60/60

90/90

180/180

$3,600

$300

$200

$5.44

$5.20

$4.28

$2.92

$2.54

$1.96

$75,600 $6,300

$4,200 $114.24 $109.20 $89.88

$61.32

$53.76

$41.16

$5,400

$450

$300

$8.16

$7.80

$6.42

$4.38

$3.84

$2.94

$77,400 $6,450

$4,300 $116.96 $111.80 $92.02

$62.78

$55.04

$42.14

$7,200

$600

$400

$10.88

$10.40

$8.56

$5.84

$5.12

$3.92

$79,200 $6,600

$4,400 $119.68 $114.40 $94.16

$64.24

$56.32

$43.12

$9,000

$750

$500

$13.60

$13.00

$10.70

$7.30

$6.40

$4.90

$81,000 $6,750

$4,500 $122.40 $117.00 $96.30

$65.70

$57.60

$44.10

$10,800

$900

$600

$16.32

$15.60

$12.84

$8.76

$7.68

$5.88

$82,800 $6,900

$4,600 $125.12 $119.60 $98.44

$67.16

$58.88

$45.08

$12,600 $1,050

$700

$19.04

$18.20

$14.98

$10.22

$8.96

$6.86

$84,600 $7,050

$4,700 $127.84 $122.20 $100.58 $68.62

$60.16

$46.06

$14,400 $1,200

$800

$21.76

$20.80

$17.12

$11.68

$10.24

$7.84

$86,400 $7,200

$4,800 $130.56 $124.80 $102.72 $70.08

$61.44

$47.04

$16,200 $1,350

$900

$24.48

$23.40

$19.26

$13.14

$11.52

$8.82

$88,200 $7,350

$4,900 $133.28 $127.40 $104.86 $71.54

$62.72

$48.02

$18,000 $1,500

$1,000

$27.20

$26.00

$21.40

$14.60

$12.80

$9.80

$90,000 $7,500

$5,000 $136.00 $130.00 $107.00 $73.00

$64.00

$49.00

$19,800 $1,650

$1,100

$29.92

$28.60

$23.54

$16.06

$14.08

$10.78

$91,800 $7,650

$5,100 $138.72 $132.60 $109.14 $74.46

$65.28

$49.98

$21,600 $1,800

$1,200

$32.64

$31.20

$25.68

$17.52

$15.36

$11.76

$93,600 $7,800

$5,200 $141.44 $135.20 $111.28 $75.92

$66.56

$50.96

$23,400 $1,950

$1,300

$35.36

$33.80

$27.82

$18.98

$16.64

$12.74

$95,400 $7,950

$5,300 $144.16 $137.80 $113.42 $77.38

$67.84

$51.94

$25,200 $2,100

$1,400

$38.08

$36.40

$29.96

$20.44

$17.92

$13.72

$97,200 $8,100

$5,400 $146.88 $140.40 $115.56 $78.84

$69.12

$52.92

$27,000 $2,250

$1,500

$40.80

$39.00

$32.10

$21.90

$19.20

$14.70

$99,000 $8,250

$5,500 $149.60 $143.00 $117.70 $80.30

$70.40

$53.90

$28,800 $2,400

$1,600

$43.52

$41.60

$34.24

$23.36

$20.48

$15.68

$100,800 $8,400

$5,600 $152.32 $145.60 $119.84 $81.76

$71.68

$54.88

$30,600 $2,550

$1,700

$46.24

$44.20

$36.38

$24.82

$21.76

$16.66

$102,600 $8,550

$5,700 $155.04 $148.20 $121.98 $83.22

$72.96

$55.86

$32,400 $2,700

$1,800

$48.96

$46.80

$38.52

$26.28

$23.04

$17.64

$104,400 $8,700

$5,800 $157.76 $150.80 $124.12 $84.68

$74.24

$56.84

$34,200 $2,850

$1,900

$51.68

$49.40

$40.66

$27.74

$24.32

$18.62

$106,200 $8,850

$5,900 $160.48 $153.40 $126.26 $86.14

$75.52

$57.82

$36,000 $3,000

$2,000

$54.40

$52.00

$42.80

$29.20

$25.60

$19.60

$108,000 $9,000

$6,000 $163.20 $156.00 $128.40 $87.60

$76.80

$58.80

$37,800 $3,150

$2,100

$57.12

$54.60

$44.94

$30.66

$26.88

$20.58

$109,800 $9,150

$6,100 $165.92 $158.60 $130.54 $89.06

$78.08

$59.78

$39,600 $3,300

$2,200

$59.84

$57.20

$47.08

$32.12

$28.16

$21.56

$111,600 $9,300

$6,200 $168.64 $161.20 $132.68 $90.52

$79.36

$60.76

$41,400 $3,450

$2,300

$62.56

$59.80

$49.22

$33.58

$29.44

$22.54

$113,400 $9,450

$6,300 $171.36 $163.80 $134.82 $91.98

$80.64

$61.74

$43,200 $3,600

$2,400

$65.28

$62.40

$51.36

$35.04

$30.72

$23.52

$115,200 $9,600

$6,400 $174.08 $166.40 $136.96 $93.44

$81.92

$62.72

$45,000 $3,750

$2,500

$68.00

$65.00

$53.50

$36.50

$32.00

$24.50

$117,000 $9,750

$6,500 $176.80 $169.00 $139.10 $94.90

$83.20

$63.70

$46,800 $3,900

$2,600

$70.72

$67.60

$55.64

$37.96

$33.28

$25.48

$118,800 $9,900

$6,600 $179.52 $171.60 $141.24 $96.36

$84.48

$64.68

$48,600 $4,050

$2,700

$73.44

$70.20

$57.78

$39.42

$34.56

$26.46

$120,600 $10,050 $6,700 $182.24 $174.20 $143.38 $97.82

$85.76

$65.66

$50,400 $4,200

$2,800

$76.16

$72.80

$59.92

$40.88

$35.84

$27.44

$122,400 $10,200 $6,800 $184.96 $176.80 $145.52 $99.28

$87.04

$66.64

$52,200 $4,350

$2,900

$78.88

$75.40

$62.06

$42.34

$37.12

$28.42

$124,200 $10,350 $6,900 $187.68 $179.40 $147.66 $100.74 $88.32

$67.62

$54,000 $4,500

$3,000

$81.60

$78.00

$64.20

$43.80

$38.40

$29.40

$126,000 $10,500 $7,000 $190.40 $182.00 $149.80 $102.20 $89.60

$68.60

$55,800 $4,650

$3,100

$84.32

$80.60

$66.34

$45.26

$39.68

$30.38

$127,800 $10,650 $7,100 $193.12 $184.60 $151.94 $103.66 $90.88

$69.58

$57,600 $4,800

$3,200

$87.04

$83.20

$68.48

$46.72

$40.96

$31.36

$129,600 $10,800 $7,200 $195.84 $187.20 $154.08 $105.12 $92.16

$70.56

$59,400 $4,950

$3,300

$89.76

$85.80

$70.62

$48.18

$42.24

$32.34

$131,400 $10,950 $7,300 $198.56 $189.80 $156.22 $106.58 $93.44

$71.54

$61,200 $5,100

$3,400

$92.48

$88.40

$72.76

$49.64

$43.52

$33.32

$133,200 $11,100 $7,400 $201.28 $192.40 $158.36 $108.04 $94.72

$72.52

$63,000 $5,250

$3,500

$95.20

$91.00

$74.90

$51.10

$44.80

$34.30

$135,000 $11,250 $7,500 $204.00 $195.00 $160.50 $109.50 $96.00

$73.50

$64,800 $5,400

$3,600

$97.92

$93.60

$77.04

$52.56

$46.08

$35.28

$136,800 $11,400 $7,600 $206.72 $197.60 $162.64 $110.96 $97.28

$74.48

$66,600 $5,550

$3,700 $100.64 $96.20

$79.18

$54.02

$47.36

$36.26

$138,600 $11,550 $7,700 $209.44 $200.20 $164.78 $112.42 $98.56

$75.46

$68,400 $5,700

$3,800 $103.36 $98.80

$81.32

$55.48

$48.64

$37.24

$140,400 $11,700 $7,800 $212.16 $202.80 $166.92 $113.88 $99.84

$76.44

$70,200 $5,850

$3,900 $106.08 $101.40 $83.46

$56.94

$49.92

$38.22

$142,200 $11,850 $7,900 $214.88 $205.40 $169.06 $115.34 $101.12 $77.42

$72,000 $6,000

$4,000 $108.80 $104.00 $85.60

$58.40

$51.20

$39.20

$144,000 $12,000 $8,000 $217.60 $208.00 $171.20 $116.80 $102.40 $78.40

$73,800 $6,150

$4,100 $111.52 $106.60 $87.74

$59.86

$52.48

$40.18

METLIFE

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

Cancer GOOSE CREEK ISD GROUP CANCER MONTHLY RATES Effective Date - 09/01/2021 State - TX VariableSitus Benefit Elections Benefit Low High Hospital Confinement $100 per day $100 per day Surgical Up to $3,000 Up to $4,500 Radiation/Chemotherapy $200 per day $500 per day First Diagnosis $5,000 $10,000 Colony Stimulating Factors $0 $0 Miscellaneous Diagnostic $5,000 $5,000 Services Self-Administered Drugs $1,000 per month $1,000 per month Wellness $50 per year $50 per year Combined Premiums Base Plan + Intensive Care Rider (ICR- $325 per day) Coverage Tier Low + $325 ICR High + $325 ICR Employee $18.94 $30.53 Employee + Spouse $39.11 $62.73 Employee + Child(ren) $25.40 $40.10 Family $45.56 $72.29 Residents of most states will be covered by the situs state plan. Residents of certain states will be covered by a state specific certificate of insurance due to these states having extraterritorial laws. Underwritten by: Metropolitan Life Insurance Company Administered by: Bay Bridge Administrators P.O. Box 161690 - Austin, Texas 78716 - (800) 845-7519

GROUP CANCER AND SPECIFIED DISEASE EXPENSE INSURANCE GROUP POLICY FORM NO: GP18-BB-SD GROUP CERTIFICATE FORM NO: GCERT18-BB-SD/CAN THE CERTIFICATE OF INSURANCE PROVIDES LIMITED BENEFITS – BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES. YOU SHOULD HAVE MEDICAL COVERAGE IN FORCE WHEN YOU ENROLL FOR THIS INSURANCE. THE CERTIFICATE IS NOT A MEDICARE SUPPLEMENT CONTRACT. IF YOU ARE ELIGIBLE FOR MEDICARE, REVIEW THE GUIDE TO HEALTH INSURANCE FOR PEOPLE WITH MEDICARE AVAILABLE FROM METLIFE. RECEIPT OF GROUP CANCER AND SPECIFIED DISEASE EXPENSE INSURANCE BENEFITS MAY AFFECT ELIGIBILITY FOR MEDICAID AND OTHER GOVERNMENTAL BENEFITS AND ENTITLEMENTS. ACCORDINGLY, PERSONS WHO WISH TO MAINTAIN ELIGIBILITY FOR SUCH BENEFITS SHOULD NOT PURCHASE THE COVERAGE MADE AVAILABLE UNDER THE GROUP POLICY.

OUTLINE OF COVERAGE 1. READ YOUR CERTIFICATE CAREFULLY! This outline of coverage provides a very brief description of the important features of the coverage. This is not the insurance contract and only the actual provisions of the Group Policy and Certificate under which you have coverage will control. The Certificate sets forth in detail the rights and obligations of both you and Metropolitan Life Insurance Company (“MetLife”). 2. CANCER AND SPECIFIED DISEASE INSURANCE COVERAGE. Policies of this category are designed to provide to persons insured, restricted coverage, paying benefits only when certain losses occur as a result of diagnosis of cancer or a specified disease. 3. BENEFITS. The benefits listed in the attached Benefits Summary are primarily payable for certain losses as a result of a diagnosis of cancer or a specified disease covered under the policy. Benefits are payable based on a positive diagnosis of cancer or specified disease made after the covered person’s effective date of insurance. Please be aware that the Group Policy and Certificate contain specific conditions, definitions, maximums, limitations, exclusions and proof requirements for the benefits described below.

Throughout this outline, “you” and “your” refer to the employee who becomes insured for cancer and specified disease expense insurance. The term “covered person” refers to a person for whom insurance is in effect under the Group Policy. 4. EXCLUSIONS AND LIMITATIONS. Exceptions and Other Limitations. The Group Policy and Certificate pay benefits only for diagnoses, treatment and services resulting from cancer or specified diseases, as defined in the policy. It does not cover: • any other disease or sickness; • injuries; • unless otherwise defined in the certificate, any disease, condition, or incapacity that has been caused, complicated, worsened, or affected by: • specified disease or specified disease treatment; or • cancer or cancer treatment; • care and treatment received outside the United States or its territories; • care and treatment performed by You, Your Spouse or any member of Your immediate family including Your and/or Your Spouse’s parents, children (natural, step or adopted); siblings; grandparents; or grandchildren; or • treatment not prescribed by a physician; or experimental treatment by any program that does not qualify as new and experimental treatment as defined in the policy. Pre-Existing Condition Limitation. During the first 12 months that coverage under the certificate is in effect for a covered person no benefits will be payable for a loss due to a Pre-Existing Condition. Pre-Existing Condition - means a disease or physical condition, for which a covered person has received medical advice, treatment, care, services, or for which diagnostic test(s) have been recommended during the 12 months immediately preceding the effective date of insurance for each covered person. 5. TERMINATION DATES. Your insurance under the Group Policy and Certificate will automatically terminate on the earliest of the following dates: • the date that the policy terminates; • the date of termination of any section or part of the policy with respect to insurance under such section or part; • the premium due date that coincides with or next follows the date that you cease to be a member of an eligible class; or • any premium due date, if premium remains unpaid by the end of the grace period. The Certificate also sets forth termination provisions for dependents. 6. PORTABILITY. If your insurance ends, you may keep it in force under certain circumstances as described in the Certificate. 7. ADMINISTRATION OF INSURANCE. Some services in connection with this insurance may be performed by our third-party administrator(s). This service arrangement in no way alters Metropolitan Life Insurance Company's obligation to you. Services will not be performed by our third-party administrator(s) if prohibited by mutual agreement with a group customer. 8. PREMIUMS. Premium rates are based on your age on the effective date of coverage and are shown in the enclosed materials. Premium rates are subject to change as stated in the policy.

Cancer- Low Plan BENEFITS SUMMARY Low Plan The term “Incurred Expense” refers to charges that are solely your responsibility, or expenses that are a combination of insurance reimbursement and your responsibility such as deductibles or co-payments. The fee negotiated between your major medical insurer and medical providers, as reflected on an explanation of benefits from such insurer, would be considered the Incurred Expense. BENEFIT Positive Diagnosis Test Second and Third Surgical Opinions Non-Local Transportation

Adult Companion Lodging and Transportation

Ambulance Donor Benefit Bone Marrow and Stem Cell Transplant

Bone Marrow and Peripheral Stem Cell Transplant Anesthesia

Ambulatory Surgical Center Drugs and Medicine Outpatient Anti-Nausea Drugs Miscellaneous Diagnostic Services Self-Administered Drugs Blood, Plasma, and Platelets Physician's Attendance Private Duty Nursing Services National Cancer Institute Designated Comprehensive Cancer Treatment Center Evaluation/Consultation Benefit

BENEFIT AMOUNT The provider’s actual billed charge, up to $300 per covered person per calendar year The Incurred Expense for the opinion a) The actual billed charges for round trip coach fare on a common carrier; or b) 50 cents per mile for round-trip personal vehicle transportation for round trips over 60 miles a) For lodging: The actual billed charges up to $75 per day for a single room in a motel, hotel, or other accommodations, to a maximum stay of 60 days. b) For transportation: • the actual billed charges for a round trip coach fare on a common carrier; or • a personal vehicle allowance of 50 cents per mile for up to 700 miles per hospital stay The Incurred Expenses for the ambulance service a) Two times the hospital confinement benefit shown on the Certificate schedule for each day both the covered person and the donor are hospitalized for the transplant b) For transportation: • actual billed charges for round trip coach fare on a common carrier to the city where the transplant is performed; or • personal vehicle allowance of 50 cents per mile up to 700 miles per hospital stay; and (c) actual billed charges for lodging and meals for the donor to remain near hospital up to $50 per day The Incurred Expense up to a combined lifetime maximum per covered person of $15,000 a) For anesthesia for skin cancer that is not invasive melanoma: $100 per covered person. b) For anesthesia for all other surgery: 25% of the amount paid by us for the surgery $250 per covered person $25 per day per covered person for each day of confinement for a calendar year maximum per covered person of $600 The actual billed charges, up to $250 per covered person per calendar year The Incurred Expense up to a lifetime maximum of $5,000 per covered person The Incurred Expense up to $1,000 per calendar month per covered person The Incurred Expense up to $200 per covered person per day $35 per covered person per day $100 per covered person per day a) For the evaluation: The actual billed charges, up to a lifetime maximum per covered person up to $750 b) For transportation and lodging: The actual billed charges, up to a lifetime maximum per covered person up to $350

Cancer BENEFIT Breast Prosthesis Artificial Limb or Prosthesis Physical Therapy or Speech Therapy Extended Benefits Extended Care Facility At Home Nursing

New and Experimental Treatment Hospice Care Government or Charity Hospital or Outpatient Clinic Hairpiece Rental or Purchase of Durable Goods Waiver of Premium Surgery

First Diagnosis Benefit Radiation/Chemotherapy/Immunotherapy

Hospital Confinement

The Incurred Expense up to $200 per day per covered person The daily benefit amount $100 per day per covered person

Wellness Benefit

For dependent children under the age of 21 the benefit is two (2) times the daily hospital confinement benefit $50 per calendar year per covered person.

BENEFITS PROVIDED BY RIDER RIDER INTENSIVE CARE UNIT (ICU) BENEFIT RIDER Included

BENEFIT ICU daily benefit amount (used to determine benefits payable): $325 per covered person per day of confinement. Confinement for treatment of Cancer or Specified Disease pays 2 times the ICU daily benefit amount per day of confinement. Payable for up to 45 days of confinement per period of confinement.

Cancer- Low Plan BENEFITS SUMMARY High Plan The term “Incurred Expense” refers to charges that are solely your responsibility, or expenses that are a combination of insurance reimbursement and your responsibility such as deductibles or co-payments. The fee negotiated between your major medical insurer and medical providers, as reflected on an explanation of benefits from such insurer, would be considered the Incurred Expense. BENEFIT Positive Diagnosis Test Second and Third Surgical Opinions Non-Local Transportation

Adult Companion Lodging and Transportation

Ambulance Donor Benefit Bone Marrow and Stem Cell Transplant

Bone Marrow and Peripheral Stem Cell Transplant Anesthesia

Cancer BENEFIT Breast Prosthesis Artificial Limb or Prosthesis Physical Therapy or Speech Therapy Extended Benefits Extended Care Facility At Home Nursing

New and Experimental Treatment Hospice Care Government or Charity Hospital or Outpatient Clinic Hairpiece Rental or Purchase of Durable Goods Waiver of Premium Surgery

First Diagnosis Benefit Radiation/Chemotherapy/Immunotherapy Hospital Confinement

Wellness Benefit

BENEFITS PROVIDED BY RIDER RIDER INTENSIVE CARE UNIT (ICU) BENEFIT RIDER Included

BENEFIT AMOUNT The Incurred Expenses The actual billed charges, up to $1,500 lifetime maximum per covered person per amputated limb $35 per covered person per day Three times the hospital confinement benefit shown on the Certificate schedule $50 per covered person per day, not to exceed the number of days that the hospital confinement benefit was paid $100 per day per covered person, not to exceed the number of days that the hospital confinement benefit was paid The actual billed charges, up to $7,500 per covered person per calendar year $50 per covered person per day $200 per covered person per day The actual billed charges up to the lifetime maximum of $150 per covered person The Incurred Expenses up to $1,500 per covered person per calendar year Included Up to $4,500 per covered person for surgery based on the following: For inpatient surgery: The lesser of: • the amount listed on the surgical schedule shown in the Certificate for the applicable surgery; and • the surgeon’s actual billed charges for the surgery. For outpatient surgery: 150% of the surgery benefit payable for inpatient surgery. However, we will not pay an amount which exceeds the surgeon’s actual billed charges for the surgery. $10,000 per covered person The Incurred Expense up to $500 per day per covered person The daily benefit amount $100 per day per covered person For dependent children under the age of 21 the benefit is two (2) times the daily hospital confinement benefit $75 per calendar year per covered person. BENEFIT ICU daily benefit amount (used to determine benefits payable): $325 per covered person per day of confinement. Confinement for treatment of Cancer or Specified Disease pays 2 times the ICU daily benefit amount per day of confinement. Payable for up to 45 days of confinement per period of confinement.

GOC18-BB-SD/CAN 49

THE HARTFORD 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 50 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Galveston ISD Benefits Website: www.mybenefitshub.com/galvestonisd

Accident GROUP VOLUNTARY ACCIDENT INSURANCE BENEFIT HIGHLIGHTS Galveston Independent School District With Accident insurance, you’ll receive payment(s) associated with a covered injury and related services. You can use the payment in any way you choose – from expenses not covered by your major medical plan to day-to-day costs of living such as the mortgage or your utility bills To learn more about Accident insurance, visit thehartford.com/employeebenefits

More than 3.5 million children ages 14 and younger get hurt annually playing sports or participating in recreational activities.1

COVERAGE INFORMATION You have a choice of two accident plans, which allows you the flexibility to enroll for the coverage that best meets your needs. This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). PLAN INFORMATION LOW PLAN HIGH PLAN Coverage Type On and off-job (24 hour) On and off-job (24 hour) BENEFITS EMERGENCY, HOSPITAL & TREATMENT CARE LOW PLAN HIGH PLAN Accident Follow-Up

Up to 3 visits per accident

$75

$100

Acupuncture/Chiropractic Care

Up to 10 visits each per accident

$25

$50

Ambulance – Air

Once per accident

$1,500

$2,000

Ambulance – Ground

Once per accident

$500

$750

Blood/Plasma/Platelets

$200

$300

$25

$35

Daily Hospital Confinement

Once per accident Up to 30 days per accident while insured is confined Up to 365 days per lifetime

$200

$400

Daily ICU Confinement

Up to 30 days per accident

$400

$600

Diagnostic Exam

Once per accident

$200

$300

Emergency Dental

Once per accident

Up to $300

Up to $450

Emergency Room

Once per accident

$150

$200

Health Screening Benefit

Once per year for each covered person

Hospital Admission

Once per accident

Initial Physician Office Visit Lodging

Child Care

$50

$1,000

$1,500

Once per accident

$75

$100

Up to 30 nights per lifetime

$125

$150

Medical Appliance

Once per accident

$100

$200

Physical Therapy

Up to 10 visits each per accident

$50

$75

Rehabilitation Facility

Up to 15 days per lifetime

$150

$300

Transportation

Up to 3 trips per accident

$400

$600

Urgent Care

Once per accident

$100

$150

X-ray

Once per accident

$100

$150

SPECIFIED INJURY & SURGERY Abdominal/Thoracic Surgery Arthroscopic Surgery Burn Burn – Skin Graft Concussion

Once per accident Once per accident Once per accident Once per accident for third degree burn(s) Up to 3 per year

LOW PLAN $2,000 $250 Up to $10,000 50% of burn benefit $150

HIGH PLAN $3,000 $500 Up to $15,000 50% of burn benefit $200 51

Accident Dislocation Eye Injury Fracture Hernia Repair Joint Replacement Knee Cartilage Laceration Ruptured Disc Tendon/Ligament/Rotator Cuff CATASTROPHIC Accidental Death

Once per joint per lifetime Once per accident Once per bone per accident Once per accident Once per accident Once per accident Once per accident Once per accident Once per accident Within 90 days; Spouse @ 50% and child @ 25% Within 90 days Once per accident Once per accident Up to 30 days per accident Once per accident Once per accident

Common Carrier Death Coma Dismemberment Home Health Care Paralysis Prosthesis FEATURES Ability Assist® EAP2 – 24/7/365 access to help for financial, legal or emotional issues HealthChampionSM3 – Administrative & clinical support following serious illness or injury

Up to $4,000 Up to $500 Up to $8,000 $200 $2,000 Up to $1,000 Up to $500 $1,000 Up to $1,500 LOW PLAN

Up to $8,000 Up to $750 Up to $10,000 $400 $4,000 Up to $2,000 Up to $1,000 $2,000 Up to $2,000 HIGH PLAN

$50,000

$75,000

1.5 times death benefit $10,000 Up to $50,000 $50 Up to $50,000 Up to $2,000 LOW PLAN

1.5 times death benefit $15,000 Up to $75,000 $75 Up to $75,000 Up to $3,000 HIGH PLAN

Included

PREMIUMS The amounts shown are MONTHLY amounts (12 payments/deductions per year):4 COVERAGE TIER PLAN 2

PLAN 3

Employee Only

$5.56 ($0.18 per day)

$8.76 ($0.29 per day)

Employee & Spouse

$8.72 ($0.29 per day)

$13.78 ($0.45 per day)

Employee & Child(ren)

$9.20 ($0.30 per day)

$14.64 ($0.48 per day)

Employee & Family

$14.50 ($0.48 per day)

$23.02 ($0.76 per day)

ASKED & ANSWERED WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full-time employee who works at least 20 hours per week on a regularly scheduled basis. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26. AM I GUARANTEED COVERAGE? This insurance is guaranteed issue coverage – it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured. HOW MUCH DOES IT COST AND HOW DO I PAY FOR THIS INSURANCE? Premiums are provided above. You have a choice of plan options. You may elect insurance for you only, or for you and your dependent(s), by choosing the applicable coverage tier. Premiums will be automatically paid through payroll deduction, 52

as authorized by you during the enrollment process. This ensures you don’t have to worry about writing a check or missing a payment. WHEN CAN I ENROLL? You may enroll during any scheduled enrollment period, within 31 days of the date you have a change in family status, or within 31 days of the completion of any eligibility waiting period established by your employer. WHEN DOES THIS INSURANCE BEGIN? Insurance will become effective in accordance with the terms of the certificate (usually the first day of the month following the date you elect coverage). You must be actively at work with your employer on the day your coverage takes effect. Your spouse and child(ren) must be performing normal activities and not be confined (at home or in a hospital/care facility).

Accident WHEN DOES THIS INSURANCE END? This insurance will end when you or your dependents no longer satisfy the applicable eligibility conditions, premium is unpaid, you are no longer actively working, you leave your employer, or the coverage is no longer offered.

Suicide or attempted suicide, whether sane or insane, or intentionally self-inflicted injury • War or act of war, whether declared or undeclared, or a nuclear, chemical, biological, or radiological event • A covered person's participation in a felony, riot or insurrection CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO • A covered person's service in the armed forces or units LONGER A MEMBER OF THIS GROUP? auxiliary to it Yes, you can take this coverage with you. Coverage may be • A covered person's taking drugs, unless as prescribed by or continued for you and your dependent(s) under a group administered by a physician, or being intoxicated as defined portability policy. Your spouse may also continue insurance in by the jurisdiction in which the cause of loss was incurred certain circumstances. The specific terms and qualifying events • A covered person’s sickness or bacterial infection for portability are described in the • A covered person’s participation in bungee jumping or hang certificate. gliding • A covered person’s participation or competition in semi1“Sports Injury Statistics.” Stanford Children’s Health, n.d. Web. 30 June 2017. http:// professional or professional sports www.stanfordchildrens.org/en/topic/default?id=sports-injury-statistics-90-P02787 2AbilityAssist® services are offered through The Hartford by ComPsych®. ComPsych is not • Cosmetic surgery or any other elective procedure that is not affiliated with The Hartford and is not a provider of insurance services. The Hartford is not medically necessary responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue any of these services at any time. Ability Assist is a • While a covered person is on any aircraft: as a pilot, registered trademark of The Hartford. Services may not be available in all states. Visit crewmember or student pilot; as a flight instructor or https://www.thehartford.com/employee-benefits/value-added-services for more examiner; if it is owned, operated or leased by or on behalf information. 3HealthChampion℠ services are provided through The Hartford by ComPsych®. ComPsych is of the policyholder, or any employer or organization whose not affiliated with The Hartford and is not a provider of insurance services. The Hartford eligible persons are covered under the policy; or being used doesn’t provide basic hospital, basic medical, or major medical insurance. HealthChampion specialists are only available during business hours. Inquiries outside of this timeframe can for tests, experimental purposes, stunt flying,racing or either request a call-back the next day or schedule an appointment. endurance tests The Hartford is not responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue any of these services at any time. Health • Operating, learning to operate, serving as a crew member of Champion is a service mark of ComPsych. Services may not be available in all states. Visit or jumping or falling from any aircraft https://www.thehartford.com/employee-benefits/value-added-services for more • Riding in or driving any motor-driven vehicle in a race, stunt information. 4Rates and/or benefits may be changed. show or speed test All exclusions may not be applicable, or may be adjusted, as Prepare. Protect. Prevail. With The Hartford.® The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including required by state regulations in the situs state of a group. issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. 5962g NS 08/16 © 2016 The Hartford Financial Services Group, Inc. All rights reserved. This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details including the provisions, terms, conditions, limitations and exclusions are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder. The Hartford compensates both internal and external producers, as well as others, for the sale and service of our products. For additional information regarding Hartford’s compensation practices, please review our website http://thehartford.com/group-benefits-producercompensation. Accident Form Series includes GBD-2000, GBD-2300, or state equivalent

LIMITATIONS & EXCLUSIONS This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this insurance coverage. A copy of the certificate can be obtained from your employer. GROUP ACCIDENT INSURANCE LIMITATIONS AND EXCLUSIONS The benefits payable are based on the insurance in effect on the date of the covered accident, subject to the definitions, limitations, exclusions and other provisions of the policy. You and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates. This insurance does not provide benefits for any loss that results from or is caused by:

•

NOTICES THIS IS A LIMITED ACCIDENT ONLY BENEFIT POLICY IMPORTANT NOTICE – THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS. This limited benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage. For New York Residents: This policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. IMPORTANT NOTICE — THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS 5962g NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Accident Form Series includes GBD-2000, GBD-2300, or state equivalent. Prepare. Protect. Prevail. With The Hartford. ® The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder.

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

Critical Illness Galveston Independent 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 18.75 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% 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 $1.10 $1.10 25-29 $1.40 $1.40 30-34 $1.80 $1.80 35-39 $2.60 $2.60 40-44 $3.50 $3.50 45-49 $5.00 $5.00 50-54 $6.90 $6.90 55-59 $9.00 $9.00 60-64 $13.20 $13.20 65-69 $20.80 $20.80 70-74 $38.40 $38.40 75-79 $65.50 $65.50 80-84 $112.50 $112.50 85 or over $206.10 $206.10 Option 2: $20,000 EE, $20,000 SP Age Employee Cost Spouse Cost Less than age 25 $2.20 $2.20 25-29 $2.80 $2.80 30-34 $3.60 $3.60 35-39 $5.20 $5.20 40-44 $7.00 $7.00 45-49 $10.00 $10.00 50-54 $13.80 $13.80 55-59 $18.00 $18.00 60-64 $26.40 $26.40 65-69 $41.60 $41.60 70-74 $76.80 $76.80 75-79 $131.00 $131.00 80-84 $225.00 $225.00 85 or over $412.20 $412.20

• Heart Attack (Myocardial Infarction) • Major Organ Failure Requiring Transplant • Stroke

Option 3: $30,000 EE, $30,000 SP Age Employee Cost Spouse Cost Less than age 25 $3.30 $3.30 25-29 $4.20 $4.20 30-34 $5.40 $5.40 35-39 $7.80 $7.80 40-44 $10.50 $10.50 45-49 $15.00 $15.00 50-54 $20.70 $20.70 55-59 $27.00 $27.00 60-64 $39.60 $39.60 65-69 $62.40 $62.40 70-74 $115.20 $115.20 75-79 $196.50 $196.50 80-84 $337.50 $337.50 85 or over $618.30 $618.30

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 your Spouse’s insurance age, which is their age immediately prior to and including the anniversary date/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 57

UNUM

Life and AD&D

YOUR BENEFITS PACKAGE

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

Motor vehicle crashes are the

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

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

Basic Life and AD&D Galveston Independent School District Life and AD&D Insurance Plan Highlights Who is eligible for this coverage?

All actively employed employees working at least 18.75 hours each week for your employer in the U.S.

What is the coverage amount? Your employer is providing you with $10,000 of term life insurance. You will also receive $10,000 of Accidental Death and Dismemberment insurance. Is it portable (can I keep it if I leave my employer)?

If you retire, reduce your hours or leave your employer, you can take this coverage with you according to the terms outlined in the contract*.

Life Planning Financial & Legal Resources

This personalized financial counseling service provides expert, objective financial counseling to survivors and terminally ill employees at no cost to you. This service is also extended to you upon the death or terminal illness of your covered spouse. The financial consultants are master level consultants. They will help develop strategies needed to protect resources, preserve current lifestyles and build future security. At no time will the consultants offer or sell any product or service.

When is coverage effective? 1.

Your coverage is effective on 9/1/2021.

Accelerated Benefit

If you become terminally ill and are not expected to live beyond a certain time period as stated in your certificate booklet, you may request up to 75% of your life insurance amount up to $500,000 without fees or present value adjustments. A doctor must certify your condition in order to qualify for this benefit. Upon your death, the remaining benefit will be paid to your designated beneficiary(ies).

Waiver of Premium

If you become disabled (as defined by your plan) and are no longer able to work, your premium payments will be waived during the period of disability after a 6 month waiting period.

Retained Asset Account

Benefits of $10,000 or more are paid through the Unum Retained Asset Account. This interest bearing account will be established in the beneficiary’s name. He or she can then write a draft for the full amount or for $250 or more, as needed.

Additional AD&D Benefits

Education Benefit: If you or your insured spouse die within 365 days of an accident, an additional benefit is paid to your dependent child(ren). Your child(ren) must be a full-time student beyond grade 12. (Not available in Illinois or New York) Seat Belt/Air Bag Benefit: If you or your insured dependent(s) die in a car accident and are wearing a properly fastened seat belt and/or are in a seat with an air bag, an amount will be paid in addition to the AD&D benefit.

What does my AD&D insurance The full benefit amount is paid for loss of: pay for? • Life • Both hands or both feet or sight of both eyes • One hand and one foot • One hand and the sight of one eye • Speech and hearing Do my life insurance benefits decrease withage?

Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 70 50% of original amount Coverage may not be increased after a reduction.

Does this plan include help with Yes. Our work-life balance employee assistance program (EAP) provides professional advice for a work-life balance? wide range of personal and work-related issues. The service is available to you and your family members 24 hours a day, 365 days a year. It provides resources to help you find solutions to everyday issues — such as financing a car or selecting child care — as well as more serious problems, such as alcohol or drug addiction, divorce or relationship problems. There is no additional charge for using the program, and you do not have to have filed a disability claim or be receiving benefits to use the program. 59

Basic Life and AD&D Termination of coverage

Your coverage and your dependents’ coverage under the policy ends on the earliest of: • The date the policy or plan is cancelled • The date you no longer are in an eligible group • The date your eligible group is no longer covered • The last day of the period for which you made any required contributions • The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverage In addition, coverage for any one dependent will end on the earliest of: • The date your coverage under a plan ends • The date your dependent ceases to be an eligible dependent • For a spouse, the date of a divorce or annulment • For dependents, the date of your death Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.

Please refer to the policy for Exclusions and Limitations 1.Delayed Effective Date: If your spouse or child has a serious injury, sickness, or disorder, or is confined, their coverage may not take effect. Payment of premium does not guarantee coverage. Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan. *Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability. The Work-life balance employee assistance program and Life Planning Financial & Legal Resources services, are provided by HealthAdvocate, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et. al. or contact your Unum representative. Unum complies with state civil union and domestic partner laws when applicable. Underwritten by Unum Life Insurance Company of America, Portland, Maine © 2020 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. CE-540701 (11-20) FOR EMPLOYEES

Voluntary Life and AD&D Galveston Independent School District Life and AD&D Insurance Plan Highlights Who is eligible for this coverage?

All actively employed employees working at least 18.75 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.

What are the Life coverage amounts?

What are the AD&D coverage amounts?

Employee: up to 10 times salary in increments of $10,000; not to exceed $500,000. Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $250,000. Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $250. Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself.

Can I be denied coverage?

If you and your eligible dependents enroll before the enrollment deadline, you may apply for any amount of coverage up to guarantee issue for yourself and any amount of coverage up to the guarantee issue for your spouse, without answering any medical questions. Guarantee issue amounts are as follows:

Guarantee Issue Amounts

Employee: $250,000 Spouse: $50,000 Child: $10,000 If you want coverage over the amount you are guaranteed, you will need to provide answers to health questions. In addition, if you and your eligible dependents do not enroll during this enrollment period, you will have to wait for a future annual enrollment period to apply — and then you will need to answer health questions for the entire amount of coverage you apply for. New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.

Why buy now?

As long as you buy $10,000 of life coverage now, you can buy more coverage later - up to $250,000 - without answering any medical questions.

How do I apply?

To apply for coverage, complete your enrollment form 9/1/2021. If you were hired after 9/1/2021, complete your enrollment form within 31 days of your eligibility date determined by your employer. If you apply for coverage after your effective date or if you choose coverage over the guaranteed issue amount, you will need to complete a medical questionnaire, which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.

When is coverage effective?

Your coverage is effective 9/1/2021 or the date your application is approved by underwriting, if health questions were required. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness, or disorder, your dependent spouse and children: are confined in a hospital or similar institution; or are confined at home under the care of a physician for a sickness or injury. Exception: Infants are insured from live birth. 61

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

Term Life Age band Employee rate per $10,000 Spouse rate per $5,000 <25 $0.30 $0.15 25-29 $0.40 $0.20 30-34 $0.50 $0.25 35-39 $0.70 $0.35 40-44 $1.10 $0.55 45-49 $1.80 $0.90 50-54 $2.80 $1.40 55-59 $4.70 $2.35 60-64 $5.90 $2.95 65-69 $10.30 $5.15 70-74 $16.50 $8.25 75+ $25.40 $12.70 Child life monthly rate is $0.20 per $2,000. One life premium covers all children. AD&D rate chart– you must purchase life coverage to purchase AD&D coverage Employee Spouse Child

AD&D cost Per $10,000 Per $5,000 Per $2,000

Monthly Cost $0.15 $0.075 $0.03

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 your insurance age, which is your age immediately prior to and including the anniversary date/effective date. Do my life insurance benefits decrease with age?

Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 70 50% of original amount Coverage may not be increased after a reduction.

Is the coverage portable (can I If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your keep it if I leave my employer)? spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy. Are there any life insurance exclusions or limitations?

Life insurance benefits will not be paid for deaths caused by suicide within the first 24 months after the date your coverage becomes effective. If you increase or add coverage, these enhancements will not be paid for deaths caused by suicide within the first 24 months after you make these changes.

Will my premiums be waived if If you become disabled (as defined by your plan) and are no longer able to work, your life premium I’m disabled? payments will be waived until your disability period ends. What does my AD&D insurance The full benefit amount is paid for loss of: pay for? • life; • both hands or both feet or sight of both eyes; • one hand and one foot; • one hand or one foot and the sight of one eye; • speech and hearing. Other losses may be covered as well. Please contact your plan administrator.

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

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

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative. © 2017 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Underwritten by Unum Life Insurance Company of America, Portland, Maine

EN-1773 (8-17) FOR EMPLOYEES

5STAR

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, limitations and and exclusions exclusions are 64 details expenses, limitations are included included in in the the summary summary plan plan description description located located on on the the Angleton ISD Galveston ISD Benefits Benefits Website: Website: www.mybenefitshub.com/angletonisd www.mybenefitshub.com/galvestonisd

Term Life with Terminal Illness and Quality of Life Rider 5Star Life Insurance Company Individual and Group Term Life Insurance with Terminal Illness coverage to age 121 including Quality of Life Benefit Enhanced coverage options for employees. Easy and flexibile enrollment for employers. The 5Star Life Insurance Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees.

CUSTOMIZABLE With several options to choose from, select the coverage that best meets the needs of your family. TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL). PORTABLE Coverage continues with no loss of benefits or increase in cost if you terminate employment after the first premium is paid. We simply bill you directly.

Nearly

85%

of people said they thought most people need life insurance.

Yet only

59%

said that they have coverage themselves.

And

33%

wish their spouse or partner had more life insurance.*

FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves. • Financially dependent children 14 days to 23 years old. CONVENIENCE Easy payment through payroll deduction. PROTECTION YOU CAN COUNT ON Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions. QUALITY OF LIFE Benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following: • Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision. Underwritten by 5Star Life Insurance Company (a Lincoln, Nebraska company); Administered by NTT Data at 777 Research Drive, Lincoln, NE 68521 FPPi product available in all states and some U.S. Territories except: CA, DE, FL, NY, ND. SD. Quality of Life rider not available in CA. FPPg product available in all states and some U.S. Territories except: CA, DE, FL, NY, ND. SD, VI FPPi/gQOLFlyerR1119 FPPduoQOL_MKT_FLYER_1119

FPPi Rate Sheet MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT

18-25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46

$10,000 $9.90 $9.91 $9.98 $10.08 $10.23 $10.43 $10.64 $10.87 $11.11 $11.40 $11.72 $12.08 $12.46 $12.88 $13.33 $13.83 $14.38 $14.98 $15.60 $16.26 $16.93 $17.67

$20,000 $13.28 $13.34 $13.46 $13.66 $13.95 $14.35 $14.76 $15.23 $15.72 $16.30 $16.93 $17.65 $18.44 $19.25 $20.17 $21.15 $22.25 $23.46 $24.70 $26.02 $27.37 $28.83

$30,000 $16.68 $16.75 $16.96 $17.26 $17.68 $18.28 $18.90 $19.61 $20.33 $21.20 $22.16 $23.23 $24.40 $25.63 $27.00 $28.48 $30.13 $31.96 $33.81 $35.78 $37.80 $40.00

Employee Coverage Amounts $40,000 $50,000 $75,000 $20.07 $23.46 $31.94 $20.16 $23.59 $32.13 $20.44 $23.92 $32.62 $20.84 $24.42 $33.37 $21.40 $25.13 $34.44 $22.20 $26.12 $35.94 $23.04 $27.16 $37.50 $23.97 $28.34 $39.25 $24.93 $29.55 $41.06 $26.10 $31.00 $43.26 $27.37 $32.59 $45.63 $28.80 $34.37 $48.31 $30.36 $36.34 $51.25 $32.00 $38.38 $54.32 $33.83 $40.67 $57.76 $35.80 $43.13 $61.44 $38.00 $45.87 $65.57 $40.44 $48.92 $70.12 $42.90 $52.00 $74.75 $45.53 $55.30 $79.69 $48.23 $58.67 $84.75 $51.17 $62.33 $90.26

47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64

$18.43 $19.19 $20.02 $20.93 $21.94 $23.11 $24.42 $25.88 $27.44 $29.19 $30.99 $32.84 $34.74 $36.71 $38.77 $40.93 $43.22 $45.72

$30.35 $31.88 $33.55 $35.36 $37.39 $39.74 $42.33 $45.27 $48.37 $51.87 $55.49 $59.19 $62.97 $66.94 $71.05 $75.37 $79.95 $84.93

$42.28 $44.58 $47.08 $49.81 $52.83 $56.35 $60.26 $64.65 $69.31 $74.56 $79.98 $85.53 $91.21 $97.15 $103.33 $109.80 $116.68 $124.16

$54.20 $57.27 $60.60 $64.24 $68.26 $72.96 $78.17 $84.03 $90.23 $97.23 $104.46 $111.86 $119.43 $127.36 $135.60 $144.23 $153.40 $163.37

$66.13 $69.96 $74.13 $78.67 $83.71 $89.59 $96.09 $103.42 $111.17 $119.92 $128.96 $138.21 $147.67 $157.59 $167.88 $178.67 $190.13 $202.59

$95.94 $101.69 $107.94 $114.75 $122.32 $131.13 $140.87 $151.88 $163.50 $176.63 $190.19 $204.06 $218.25 $233.13 $248.57 $264.75 $281.94 $300.62

$125.75 $133.42 $141.75 $150.84 $160.91 $172.66 $185.67 $200.33 $215.83 $233.33 $251.41 $269.91 $288.83 $308.66 $329.25 $350.83 $373.75 $398.67

$155.56 $165.15 $175.57 $186.92 $199.52 $214.21 $230.46 $248.80 $268.17 $290.04 $312.64 $335.77 $359.42 $384.21 $409.94 $436.92 $465.56 $496.71

$185.38 $196.88 $209.38 $223.01 $238.13 $255.75 $275.26 $297.25 $320.51 $346.76 $373.88 $401.63 $430.01 $459.75 $490.63 $523.00 $557.38 $594.76

$48.50

$90.50

$132.51

$174.50

$216.50

$321.50

$426.50

$531.50

$636.51

Age on Eff. Date

$100,000 $40.42 $40.66 $41.34 $42.34 $43.75 $45.75 $47.84 $50.17 $52.58 $55.50 $58.67 $62.25 $66.16 $70.25 $74.83 $79.75 $85.25 $91.34 $97.50 $104.08 $110.83 $118.17

$125,000 $48.89 $49.21 $50.04 $51.29 $53.07 $55.56 $58.16 $61.09 $64.11 $67.75 $71.71 $76.18 $81.09 $86.19 $91.92 $98.06 $104.94 $112.54 $120.25 $128.48 $136.92 $146.09

$150,000 $57.38 $57.75 $58.76 $60.26 $62.38 $65.38 $68.50 $72.01 $75.63 $80.00 $84.76 $90.13 $96.00 $102.13 $109.00 $116.38 $124.63 $133.76 $143.01 $152.88 $163.00 $174.00

FPPi Rate Sheet MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT Age on Eff. Date 66* 67* 68* 69* 70*

$10,000 $49.13 $52.62 $56.58 $61.09 $66.18

$20,000 $91.75 $98.73 $106.67 $115.68 $125.85

$30,000 $134.38 $144.85 $156.75 $170.28 $185.53

Employee Coverage Amounts $40,000 $50,000 $75,000 $177.00 $219.63 $326.19 $190.97 $237.08 $352.38 $206.83 $256.92 $382.13 $224.87 $279.46 $415.94 $245.20 $304.88 $454.06

$100,000 $432.75 $467.67 $507.33 $552.42 $603.25

$125,000 $539.31 $582.96 $632.54 $688.90 $752.44

$150,000 $645.88 $698.25 $757.75 $825.38 $901.63

*Quality of Life not available ages 66 - 70. Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years). $7.15 monthly for $10,000 coverage per child.

FPPiDBQOLMonthlyRates

9/18 67

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. However, your plan includes a 75 day 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… FOR HSA VS. FSA COMPARISON

PG. 11

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

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.

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

LEGALEASE

YOUR BENEFITS PACKAGE

Legal Services

About this Benefit Finding the right type of attorney when a need arises can be one of the more stressful tasks when dealing with a legal matter. The right help is essential. There are many types of attorneys depending upon what type of issue someone may be facing. We help with this first step. We use our experience and relationships with our network providers to match you to the right type of attorney you need in the right location, with availability to set up a consultation with you. We see this step as a way to save you time, so you can get back to your busy schedule of work, kids or whatever may be just as important.

$1,500 Is the average cost of a basic will and estate planning package. The average yearly premium paid by Texas Legal Members is only $300.

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 Galveston ISD Benefits Website: www.mybenefitshub.com/galvestonisd

Legal Services Be fully prepared and confident with Legal Benefits Plan proudly offered to the employees of Galveston ISD

Protect your family’s future with LegalEASE. LegalEASE offers valuable benefits to shield your family and savings from unexpected personal legal issues. What you get with a LegalEASE plan: • An attorney with expertise specific to your personal legal matter • Access to a national network of attorneys with exceptional experience that are matched to meet your needs • In- and out-of-network coverage • Concierge help navigating common individual or family legal issues Enroll in the LegalEASE Benefits Plan. To learn more: Call: 1(800) 248-9000 Visit: www.legaleaseplan.com/gisd

A legal benefits plan can ease the biggest stresses - finding and paying for legal expertise when you need it most.

ESTATE PLANNING & WILLS Will or Codicil, Living Will, Health Care Power of Attorney, Living Trust Document, Probate of Small Estate FINANCIAL & CONSUMER Debt Collection: Pre-litigation Defense & Trial Defense, Bankruptcy (Chapter 7 or 13), Tax Audits, Student Loan Refinancing/Collection Defense, Document Preparation, Consumer Dispute, Small Claims Court, Financial Advisor, Mail Order or Internet Purchase Dispute, Bank Fee Dispute, Cell Phone Contract Dispute, Warranty Dispute, Healthcare Coverage Disputes and Records, Identity Theft Defense

FAMILY Separation, Divorce, Post-Divorce Proceedings, Prenuptial Agreement, Name Change, Guardianship/Conservatorship, Adoptions, Juvenile Court Proceedings GENERAL Civil Litigation Defense, Incompetency Defense, Initial Law Office Consultation, Review of Simple Documents, Discounted Contingency Fees, Mediation, Misdemeanor Defense Limitations apply. Please visit https://www.legaleaseplan.com/gisd for specific plan benefits.

LegalEASE offers a legal benefits plan that provides support and protection from unexpected personal legal issues.

Plan Details: $16.15 per month, via payroll deduction

Who’s covered: • • •

Employee Spouse Dependent Children: Up to age 26

For more information, visit: https://www.legaleaseplan.com/gisd To learn more, call: 1(800) 248-9000, and reference “Galveston ISD”

The value of a LegalEASE Benefits Plan. Being a member saves costly legal fees and provides coverage for: HOME & RESIDENTIAL Purchase of Primary Residence, Sale of Primary Residence, Refinancing of Primary Residence, Vacation or Investment Home Sale/Purchase/Refinancing, Tenant Dispute, Tenant Security Deposit Dispute, Landlord Dispute with Tenant, Security Deposit Dispute with Tenant, Construction Defect Dispute, Neighbor Dispute, Noise Reduction Dispute, Foreclosure AUTO & TRAFFIC Traffic Ticket, Serious Traffic Matters (Resulting in Suspension or Revocation of License), Administrative Proceeding (Regarding Suspension or Revocation of License), First-time Vehicle Buyer, Vehicle Repair and Lemon Law Litigation, DUI/DWI Defense

Limitations and exclusions apply. This benefit summary is intended only to highlight benefits and should not be relied upon to fully determine coverage. More complete descriptions of benefits and the terms under which they are provided are received upon enrolling in the plan. Group legal plans are administered by Legal Access Plans, L.L.C. or LegalEASE Home Office: 5151 San Felipe, Suite 2300, Houston, TX. This legal plan may not be regulated as insurance in some states, but is available in all states. Underwritten by Virginia Surety Company in all states except where underwriting is not required but the product is available. Please contact LegalEASE for complete details. ©2021 LegalEASE All rights reserved. VSC_INS_Enroll_1PG_GalvestonISD_202106

AURA/IDENTITY GUARD

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

Identity Theft An identity is stolen every two seconds.1 The Premier Plan For a low monthly payment, the Premier Plan provides coverage Cybercrime has become the number one threat facing our world to keep you and your family safe. today.2 With the amount of our personal information online, it’s become easier for your identity to be stolen. The need to protect IDENTITY SECURE FEATURES yourself and your family is more important than ever. • Near Real-Time Alerts • Human-sourced intelligence • Auto-On Monitoring • Compromised credentials Are you at risk? • Credit and debit card • Stolen fund reimbursement Our daily online activity makes us vulnerable to data breaches monitoring • 401(k) and HSA and identity theft. No one is immune to cybercrime. It impacts • Bank account transaction reimbursement every person regardless of age, gender, income level, and monitoring • $1M Identity Theft Insurance location.3 Aura™ Identity Guard® is designed to keep your entire • 401(k) investment account • Security Freeze Assistance household safe from the effects of cybercrime, not only shielding monitoring • Threat Alerts your personal data from getting into the wrong hands, but also • Student loan activity alerts • Risk Management Score protecting you and your children online. • High Risk Transaction • Social Insight Report Monitoring • Lost Wallet Protection • Bank Account Opening & • 3 Bureau Credit Monitoring Takeover Monitoring • 3 Bureau Annual Credit Aura Identity Guard combines superior IBM® Watson™ • Address Monitoring Report technology with around- the-clock, outstanding service to save • Criminal Record Monitoring • Monthly Credit Score you time and stress. • Fictitious Identity Monitoring • Credit Score Tracker • Home Title Monitoring • Cyberbullying and Social Monitor • Sex Offender Monitoring Media Monitoring We scan billions of online sources and suggest ways to reduce • Dark Web Monitoring your exposure to cybertheft

The Solution

Alert Within seconds, we alert you to possible threats from activities, so you can act quickly

DEVICE SECURE FEATURES • Safe Browsing Software

Recover Our team of dedicated experts can help you recover lost information and assist you in the case of identity theft

Why wait another minute when you’re at risk right now? Aura Identity Guard can keep you and your family protected. You’ll feel confident that your personal information is in good hands.

Insure Your $1 million insurance policy covers you from any losses or stolen funds6

THE COST OF IDENTITY THEFT

Contact Aura Identity Guard Employee Benefits 1-800-524-1125 EBSales@auracompany.com

Out-of-pocket fraud costs doubled from 2016 to 2018 to $1.7 Billion.4

More than 1 million children in the U.S. were victims of identity theft in 2017, costing families $540 million in out-of-pocket expenses.5 1 IBM Security. “2019 Cost of a Data Breach Report.” July 2019. 2 Ernst & Young. “EY CEO Imperative Study 2019,” July 2019. 3 Identity Theft Resource Center. “2019 End-of-Year Data Breach Report.” January 2020. 4 Poneman Institute. “2016 Cost of Data Breach Study,” June 2016. 5 Javelin Strategy & Research. “2018 Child Identity Fraud Study,” April 2018. 6 Identity Theft Insurance underwritten by insurance company subsidiaries or affiliates of American International Group‚ Inc. The description herein is a summary and intended for informational purposes only and does not include all terms‚ conditions and exclusions of the policies described. Please refer to the actual policies for terms‚ conditions‚ and exclusions of coverage. Coverage may not be available in all jurisdictions. 75

Identity Theft AURA™ IDENTITY GUARD® ULTIMATE PLAN

Identity and privacy protection to keep you and your family safe from online harm

• • • • •

Sex offender monitoring Dark web monitoring Human-sourced intelligence Lost Wallet protection Risk management score

Safeguarding you, your family, and your finances with identity protection, financial tracking, and online security.

POWERFUL FINANCIAL TOOLS • 1-Bureau credit monitoring • Monthly credit score Have you wondered: • Credit score tracker • What can I do to protect my data from getting into the • Security freeze assistance wrong hands? • Near real-time alerts • How do I know if my information has been comprised? Can I • Student loan activity alerts protect my children from identity theft? • Can I protect myself and my family on social media? What do BEST-IN-CLASS CUSTOMER CARE I do if my personal information has been stolen? • U.S.-based customer care • End-to-end remediation • Online identity dashboard Aura Identity Guard protects you and your • Mobile App

family against cybercrime.

COMPREHENSIVE IDENTITY PROTECTION • $1M in insurance protection1 of financial losses and legal fees • 24/7 expert guidance, if a threat is detected • Protect your loved ones for one low price with our family plan FASTEST SPEED AND LARGEST BREADTH OF ALERTS1 • Around-the-clock scan of billions of online resources • Reduce exposure to cybertheft • Be alerted within seconds of possible cyberthreats POWERFUL FINANCIAL TOOLS • Keep an eye on your spending and get alerted to suspicious transactions • Access to your credit report and real-time alerts to changes that impact your credit • Complete protection and monitoring of online accounts and passwords

Features that are included in all Aura Identity Guard Plans: PROACTIVE DEVICE & PRIVACY PROTECTION • Safe browsing: Anti-ransomware & anti-malware COMPREHENSIVE IDENTITY PROTECTION • $1 Million insurance with stolen funds reimbursement1 • 401(k) & HSA reimbursement • Compromised credentials • Auto-on monitoring • High-risk transaction monitoring • Bank account transaction monitoring • Address monitoring • Criminal record monitoring • Fictitious identity monitoring • Home title monitoring 76

Additional features in Aura Identity Guard’s Ultimate Plan: PROACTIVE DEVICE & PRIVACY PROTECTION • Device/cookie tracking protection • E-mail solicitation/junk mail prevention • Data broker list monitoring/removal • Social insight report COMPREHENSIVE IDENTITY PROTECTION • Credit card monitoring • Debit card monitoring POWERFUL FINANCIAL TOOLS • Up to 3-Bureau Credit monitoring • Up to 3-Bureau annual credit

Customer Service Concierge customercare@identityguard.com 855-443-7748 1Identity Theft Insurance underwritten by insurance company subsidiaries or affiliates of American International Group‚ Inc. The description herein is a summary and intended for informational purposes only and does not include all terms‚ conditions and exclusions of the policies described. Please refer to the actual policies for terms‚ conditions‚ and exclusions of coverage. Coverage may not be available in all jurisdictions. 0221_EE_PREMIER

NOTES