2021-22 McKinney ISD Benefit Guide by Higginbotham Public Sector

MCKINNEY ISD

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

Table of Contents

Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) TRS-ActiveCare Scott & White HMO EECU Health Savings Account (HSA) Delta Dental Avesis Vision NBS Flexible Spending Account (FSA) UNUM Life and AD&D UNUM Disability UNUM Hospital Indemnity & Accident UNUM Critical Illness

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

FLIP TO... PG. 4

HOW TO ENROLL

PG. 6

SUMMARY PAGES

PG. 12

YOUR BENEFITS

11 12-16 17 18-19 20-21 22-27 28-33 34-37 38-43 44-45 46-49

Benefit Contact Information MCKINNEY ISD BENEFITS

MCKINNEY ISD BENEFITS ADMINISTRATOR

FLEXIBLE SPENDING ACCOUNT (FSA)

Financial Benefit Services (469) 385-4685 www.mybenefitshub.com/mckinneyisd

Amanda Wallace (469) 302‐4029 benefits@mckinneyisd.net

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

TRS ACTIVECARE MEDICAL

TRS HMO MEDICAL

HOSPITAL INDEMNITY

BCBSTX (866) 355-5999 www.bcbstx.com/trsactivecare

Scott & White HMO (844) 633-5325 www.trs.swhp.org

Unum Group #R0747188 (866) 679-3054 www.unum.com

DENTAL

VISION

CRITICAL ILLNESS

Delta Dental Group #44-4370 (800) 521-2651 www.deltadental.com

Avesis Group #10771-1205 High Plan #10771-1205-01 Low Plan #10771-1205 (800) 522-0258 www.avesis.com

Unum Group #473073 (866) 679-3054 www.unum.com

LIFE AND AD&D

DISABILITY

ACCIDENT

Unum Group #148506 (866) 679-3054 www.unum.com

Unum Group #125328 (866) 679-3054 www.unum.com

Unum Group #R0747188 (866) 679-3054 www.unum.com

HEALTH SAVINGS ACCOUNT EECU (800) 333-9934 www.eecu.org

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

and get access to everything you need to complete your benefits

Text

“FBS MCKINNEY” to (800) 583-6908

enrollment: •

Enrollment Resources

•

Online Support

•

Interactive Tools

•

And more!

App Group #: FBSMCKINNEY

OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/mckinneyisd

CLICK LOGIN

ENTER USERNAME & PASSWORD Your login credentials will be the same as your McKinney ISD login. Username: Employee ID Password: district password

ONLINE SUPPORT

If you do not know your username and password please contact the Help Desk at 469-3024048 or Email support@mckinneyisd.net

Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New: TRS-ACTIVECARE - KEY PLAN CHANGES AC Primary This plan still has the lowest monthly costs and copays. Your Primary Care Provider copay is $30 and TRS Virtual Health is $0. AC Primary+ This plan still has copays and the lowest deductibles, maximum out-of- pockets, and coinsurance rates. Your Primary Care Provider copay is $30 and TRS Virtual Health is $0. AC HD In-network deductible rose by $200 for individuals and$400 for families. In-network coinsurance rates rose from 20% to 30% and Out-of- network rates rose from 40% to 50%. In- network maximum out-of-pocket rose by $100 for individuals and $200 for families. AC 2 Remains closed to new enrollees. Central and North Texas Scott & White Care Plan • EO and EC - $9/ month premium decrease! • Deductible increasing to $1,150 Individual/$3,450 Family. • Rx Deductible increasing to $200 (excludes generics). Generic copays increase to $10/$25.

Important

NEW HEALTH SAVINGS ACCOUNT BENEFIT (HSA) This is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year, however; only those funds that have been deposited in your account can be used. You must be enrolled in TRS Active Care HD to elect an H.S.A. IRS 2021 Contributions: $3600 Single/Family $7200. 55+ Catch Up $1000 Annually LIFE INSURANCE McKinney ISD offers all full-time eligible employees a $5,000 Basic Life/AD&D insurance coverage at no cost to you. A beneficiary must be added to avoid funds being assigned to your estate. DENTAL Your Dental deductible resets annually on 9/1. FLEXIBLE SPENDING ACCOUNT (FSA) Only new enrollees will receive FSA debit cards. VISION Your vision plan is based on date of service and provides the following in-network benefits: • Eye Exam once every 12 months • Frames once every 12 months • Lenses or Contact Lenses once every 12 months

• Login and complete your benefit enrollment from 7/12/2021—8/13/2021. • Enrollment assistance is available by calling Financial Benefit Services at (800) 583-6908 to speak to a representative. Hours are Monday-Friday, 8am-7pm CST. Bilingual assistance is available. • Update your profile information: home address, phone numbers, email. • Update dependent social security numbers and student status for college aged children.

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. Elections made during annual enrollment will become effective on the plan effective date or upon required underwriting approval and will remain in effect during the entire plan year.

CHANGES IN STATUS (CIS):

Changes in benefit elections can occur only if you experience a qualifying event. You must submit a Benefits Change Form and proof of a qualifying event to your Benefit Office with 31 days of your qualifying event 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 to review, change or continue benefit elections each year.

Where can I find forms?

Changes are not permitted during the plan year (outside of

For benefit summaries and claim forms, go to your school

annual enrollment) unless a Section 125 qualifying event occurs.

district’s benefit website: www.mybenefitshub.com/mckinneyisd. Click on the benefit

•

Changes, additions or drops may be made only during the

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

annual enrollment period without a qualifying event.

the forms you need under the Benefits and Forms section.

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

How can I find a Network Provider? For benefit summaries and claim forms, go to your school

included in the dependent profile. Additionally, you must

district’s benefit website:

notify your employer of any discrepancy in personal and/or

www.mybenefitshub.com/mckinneyisd. Click on the benefit

benefit information.

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

•

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

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

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

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

Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department at 469 302-4029 or email benefits@mckinneyisd.net. You can call Financial Benefit Services at 800.583.6908 for assistance. 8

card each year.

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

BCBSTX

To 26

Dental

Delta Dental

To 26

Vision

Avesis

To 26

FSA

NBS

To 26

Life and

UNUM

To 26

Accident

UNUM

Unmarried to 26

Hospital Indemnity

UNUM

Unmarried to 26

Critical Illness

UNUM

Unmarried to 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

order 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

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

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

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source Account Owner Underlying Insurance Requirement

Employee and/or employer Individual

Employee and/or employer Employer

High deductible health plan

None

Description

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

$1,400 single (2021) $2,800 family (2021) $3,600 single (2021) $7,200 family (2021) Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty. Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65).

Year-to-year rollover of account balance?

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

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

Does the account earn interest?

Yes

Portable?

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

Minimum Deductible Maximum Contribution

Permissible Use Of Funds

FLIP TO FOR HSA INFORMATION

PG. 18

N/A $2,750 Reimbursement for qualified medical expenses (as defined in Sec. 213(d) of IRC). Not permitted

FLIP TO FOR FSA INFORMATION

PG. 28 11

BCBSTX

Medical

YOUR BENEFITS PACKAGE

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 12 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

2021-2022 TRS-ActiveCare Plans Employee Premium The 21-22 MISD Monthly Contribution is $306 per month for active members in TRS.

21-22 Active Employee Monthly Premium

21-22 Active Employee "Per Paycheck" Premium

21-22 Sub/Temp Employee Monthly Premium

$111.00 $870.00 $445.00 $1099.00

$55.50 $435.50 $222.50 $549.50

$417.00 $1,176.00 $751.00 $1,405.00

$123.00 $903.00 $466.00 $1,139.00

$61.50 $451.50 $233.00 $569.50

$429.00 $1,209.00 $772.00 $1,445.00

$236.00 $1,028.00 $573.00 $1,369.00

$118.00 $514.00 $286.50 $684.50

$542.00 $1,334.00 $879.00 $1,675.00

Medical Plan TRS-Activecare Primary Employee Only Employee/Spouse Employee/Child(ren) Employee/Family TRS-Activecare HD Employee Only Employee/Spouse Employee/Child(ren) Employee/Family TRS-Activecare Primary + Employee Only Employee/Spouse Employee/Child(ren) Employee/Family Scott and White Plan (HMO) Employee Only Employee/Spouse Employee/Child(ren) Employee/Family Active Care 2 Employee Only Employee/Spouse Employee/Child(ren) Employee/Family

$236.48 $1,056.70 $566.16 $1,262.42 $707.00 $2,096.00 $1,201.00 $2,535.00

$118.24 $528.35 $283.08 $631.21 Grandfathered plan / No new enrollees for 21-22 $353.50 $1,048.00 $600.50 $1,267.50

$542.48 $1,362.70 $872.16 $1,568.42 $1,013.00 $2,402.00 $1,507.00 $2,841.00

*Note: The IRS allows changes, other than at open enrollment, if the change is necessary because of a Family Status Change. Any changes to your benefits must be made within 31 days of the Family Status Change. Verification of Status Change will be required. District Monthly Contribution applies to all employees greater than 50% (greater than half-time) all plan year. For all active Employees using payroll deductions. All Medical Insurance premiums will default to Pre-Tax status unless a Post- Tax Request Form is returned to the Benefits Office.

2021-22 TRS-ActiveCare Plan Highlights Sept. 1, 2021 – Aug. 31, 2022 How to Calculate Your Monthly Premium

All TRS-ActiveCare participants have three plan options. Each includes a wide range of wellness benefits. TRS-ActiveCare Primary

Total Monthly Premium Your District and State Contributions

• Lowest premium of the 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

Your Premium

TRS-ActiveCare Primary+ • Lower deductible than the HD and 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

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

TRS-ActiveCare HD • Compatible with a health savings account (HSA) • Nationwide network with out-of-network coverage • No requirement for PCPs or referrals • Must meet your deductible before plan pays for non-preventive care

TRS-ActiveCare 2 • 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

Ask your Benefits Administrator for your district’s premiums.

Monthly Premiums

Total Premium Employee Only

Wellness Benefits at No Extra Cost

Your Premium

$417

Employee and Spouse

$1,176

Employee and Children

$751

$1,405

Employee and Family

111 870 455 1,099

Total Premium

Your Premium

$542

$1,334

$879

$1,675

236 1,028 573 1,369

Total Premium

Your Premium

$429

$1,209

$772

$1,445

123 903 466 1,139

Total Premium

Your Premium

$1,013

$2,402

$1,507

$2,841

707 2096 1,201 2,535

Being healthy is easy with: • $0 preventive care • 24/7 customer service • One-on-one health coaches • Weight loss programs

Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out-of-Pocket Network Primary Care Provider (PCP) Required

In-Network

Out-of-Network

In-Network Coverage Only

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 40% after deductible $23,700/$47,400

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible

$8,150/$16,300

$6,900/$13,800

$7,000/$14,000

$20,250/$40,500

$7,900/$15,800

Statewide Network

Nationwide Network

Yes

$30 copay

You pay 30% after deductible

You pay 50% after deductible

$30 copay

You pay 30% after deductible

You pay 50% after deductible

$70 copay

• Nutrition programs • Ovia® pregnancy support

Doctor Visits

• TRS Virtual Health

Primary Care Specialist

• Mental health support

TRS Virtual Health

$70 copay

$0 per consultation

$50 copay

You pay 40% after deductible You pay 40% after deductible $0 per consultation

$30 per consultation

• And much more! Available for all plans. See your Benefits Booklet for more details.

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. 14

Immediate Care Urgent Care

You pay 30% after deductible

You pay 50% after deductible

$50 copay

You pay 40% after deductible

Emergency Care

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay a $250 copay plus 20% after deductible

TRS Virtual Health

$0 per consultation

$30 per consultation

$0 per consultation

Prescription Drugs Drug Deductible

Integrated with medical

$200 brand deductible

Integrated with medical

$200 brand deductible

$15/$45 copay; $0 for certain generics

$15/$45 copay

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

$20/$45 copay

Preferred Brand

You pay 30% after deductible

You pay 25% after deductible

Non-preferred Brand

You pay 50% after deductible

You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max)

Specialty

You pay 30% after deductible

You pay 20% after deductible

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

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)

2021-22 TRS-ActiveCare Plan Highlights Sept. 1, 2021 – Aug. 31, 2022 How to Calculate Your Monthly Premium

All TRS-ActiveCare participants have three plan options. Each includes a wide range of wellness benefits. TRS-ActiveCare Primary

Total Monthly Premium Your District and State Contributions

Plan summary

Your Premium

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

Ask your Benefits Administrator for your district’s premiums.

Monthly Premiums

Total Premium Employee Only

Wellness Benefits at No Extra Cost

Your Premium

$417

Employee and Spouse

$1,176

Employee and Children

$751

$1,405

Employee and Family

111 870 455 1,099

Total Premium

Your Premium

$542

$1,334

$879

$1,675

236 1,028 573 1,369

Total Premium

Your Premium

$429

$1,209

$772

$1,445

123 903 466 1,139

Total Premium

Your Premium

$1,013

$2,402

$1,507

$2,841

707 2096 1,201 2,535

Being healthy is easy with: • $0 preventive care • 24/7 customer service • One-on-one health coaches • Weight loss programs

Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out-of-Pocket Network Primary Care Provider (PCP) Required

In-Network

Out-of-Network

In-Network Coverage Only

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 40% after deductible $23,700/$47,400

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible

$8,150/$16,300

$6,900/$13,800

$7,000/$14,000

$20,250/$40,500

$7,900/$15,800

Statewide Network

Nationwide Network

Yes

$30 copay

You pay 30% after deductible

You pay 50% after deductible

$30 copay

You pay 30% after deductible

You pay 50% after deductible

$70 copay

• Nutrition programs • Ovia® pregnancy support

Doctor Visits

• TRS Virtual Health

Primary Care Specialist

• Mental health support

TRS Virtual Health

$70 copay

$0 per consultation

$50 copay

You pay 40% after deductible You pay 40% after deductible $0 per consultation

$30 per consultation

• And much more! Available for all plans. See your Benefits Booklet for more details.

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.

Immediate Care Urgent Care

You pay 30% after deductible

You pay 50% after deductible

$50 copay

You pay 40% after deductible

Emergency Care

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay a $250 copay plus 20% after deductible

TRS Virtual Health

$0 per consultation

$30 per consultation

$0 per consultation

Prescription Drugs Drug Deductible

Integrated with medical

$200 brand deductible

Integrated with medical

$200 brand deductible

$15/$45 copay; $0 for certain generics

$15/$45 copay

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

$20/$45 copay

Preferred Brand

You pay 30% after deductible

You pay 25% after deductible

Non-preferred Brand

You pay 50% after deductible

You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max)

Specialty

You pay 30% after deductible

You pay 20% after deductible

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

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) 15

Compare Prices for Common Medical Services

REMEMBER: Benefit

Log into Blue Access for MembersSM at www.bcbstx.com/trsactivecare to use the cost estimator tool. This will help you find the best prices. TRS-ActiveCare Primary

TRS-ActiveCare Primary+

In-Network Only

Office/Indpendent Lab: You pay $0

Outpatient: You pay 30% after deductible

Outpatient Costs

In-Network

Out-of-Network

TRS-ActiveCare 2 In-Network

You pay 30% after deductible

You pay 40% after deductible

Outpatient: You pay 20% after deductible

You pay 20% after deductible

You pay 30% You pay 50% after deductible after deductible

You pay 20% after deductible + $100 per procedure copay

You pay 40% after deductible + $100 per procedure copay

You pay 20% after deductible

You pay 30% You pay 50% after deductible after deductible

You pay 20% after deductible ($150 facility copay per incident)

You pay 40% after deductible ($150 facility copay per incident)

You pay 20% after deductible ($150 facility copay per day)

You pay 40% after deductible ($500 facility per day maximum)

You pay $500 copay + 20% after deductible

You pay $500 copay + 40% after deductible

Inpatient Hospital Costs

You pay 30% after deductible

You pay 20% after deductible

You pay 50% after deductible You pay 30% ($500 facility after deductible per day maximum)

Freestanding Emergency Room

You pay $500 copay + 30% after deductible

You pay $500 copay + 20% after deductible

You pay 30% You pay 50% after deductible after deductible + $500 copay + $500 copay

Facility – You pay 30% after deductible

Facility – You pay 20% after deductible

Facility – You pay 20% after deductible ($150 facility copay per day)

Professional Services – You pay $5,000 copay + 30% after deductible

Professional Services – You pay $5,000 copay + 20% after deductible

Bariatric Surgery

Out-of-Network

Office/Indpendent Lab: You pay $0 You pay 30% You pay 50% after deductible after deductible

Diagnostic Labs*

High-Tech Radiology

TRS-ActiveCare HD

Not Covered

Only covered if rendered at a BDC+ facility.

Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist)

You pay $70 copay

You pay 30% You pay 50% after deductible after deductible

You pay $70 copay

You pay 40% after deductible

Annual Hearing Exam (one per plan year)

$30 PCP copay $70 specialist copay

You pay 30% You pay 50% after deductible after deductible

$30 PCP copay $70 specialist copay

You pay 40% after deductible

Only covered if rendered at a BDC+ facility.

*Pre-certification for genetic and specialty testing may apply. Contact your Personal Health Guide at 1-866-355-5999 with questions.

trs.texas.gov 16

Revised 06/02/21

Benefits Summary

Fully Covered Healthcare Services

Home Health Services

Preventive Services

No Charge

Home Health Care Visit

Standard Lab and X-Ray

No Charge

Worldwide Emergency Care

Disease Management and Complex Case Management

No Charge

Ambulance and Helicopter

Well Child Care Annual Exams

No Charge

Immunizations (age appropriate)

No Charge

Nurse Advice Line

Telehealth (MyBSWHealth and MDLIVE)

Annual out-of-pocket maximum (including medical and

prescription co-pays and co-insurance)

Lifetime Paid Benefit Maximum

Annual Benefit Maximum

Ask an SWHP Pharmacy representative how to save money on your prescriptions.

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

None

$20 Copay

First Primary Care Visit for Illness - $0 Copay2

$20 copay

Specialty Care

$70 copay

Other Outpatient Services

20% after deductible3

Diagnostic/Radiology Procedures

20% after deductible

Expecting the Best® Maternity Program6

Available at BSW Pharmacies, in-network retail pharmacies and mail order

ACA Preventive*

$0 copay

Preferred Generic

$10 copay

$25 copay

Preferred Brand

30% after Rx deductible

Non-Preferred

50% after Rx deductible

trs.swhp.org BSWH: 855.388.3090 OptumRx: 855.205.9182

Specialty Medications (up to a 30-day supply)

Tier 1 Tier 2 Tier 3

No Charge

15% after Rx deductible 15% after Rx deductible 25% after Rx deductible

Diagnostic & Therapeutic Services

20% after deductible

Physical and Speech Therapy Manipulative Therapy4

20% of charges after deductible

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

Wellness Wondr HealthTM 6

No Charge

Well-Being Assessment6

No Charge

20% of charges after deductible

Digital Health Coaching6

No Charge

Equipment and Supplies Preferred Diabetic Supplies and Equipment - Rx only

(Up to a 90-day supply)

(Up to a 30-day supply)

Mail Order

Maternity Care

Inpatient Delivery

Maintenance Quantity Retail Quantity

Online Refills

Inpatient Services

Prenatal Care

$200

Does not apply to preferred generic drugs

$7,450 Individual/ $14,900 Family

After-Hours Primary Care Clinics

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

Unlimited

Rx Deductible per Individual $1,150 Individual/ $3,450 Family

$0 Copay 2

Allergy Serum & Injections

$50 copay

Prescription Drugs

$0 copay go to trs.swhp.org

Primary Care Dependents1 (under age 19)

Eye Exam (one annually)

$500 copay after deductible

Urgent Care Facility

1-877-505-7947

Outpatient Services Primary Care1

$40 copay and 20% of charges after deductible

Emergency Room5

Plan Provisions Annual Deductible

$70 copay

$10/$25 copay; no deductible

Including all services billed with office visit Does not apply to wellness or preventive visits

Includes other services, treatments, or procedures received at time of office visit

35 visits per year maximum

Non-Preferred Diabetic Supplies and Equipment - Rx only Durable Medical Equipment/ Prosthetics

GR_TRS_SB-2021-22

30% after Rx deductible

Copay waived if admitted within 24 hours

6See member guide for additional information

20% after deductible

*See list of ACA preventive drugs on the Pharmacy Benefits page at trs.swhp.org.

EECU

HSA (Health Savings Account)

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

YOUR BENEFITS PACKAGE

The interest earned in an HSA is tax free.

Money withdrawn for medical spending never falls under taxable income.

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

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.

DELTA DENTAL

Dental

YOUR BENEFITS PACKAGE

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

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

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

Dental Plan Benefit Highlights for: MCKINNEY INDEPENDENT SCHOOL DISTRICT Group No: 04370 Eligibility

Primary enrollee, spouse and eligible dependent children to age 26

Deductibles

$50 per person / $150 per family each plan year

Deductibles waived for Diagnostic & Preventive (D & P) and Orthodontics?

Yes

Maximums D & P counts toward maximum?

Waiting Period(s)

Benefits and Covered Services*

$1,500 per person each plan year Yes Basic Benefits Major Benefits None None

Prosthodontics None

Orthodontics None

Delta Dental DPO dentists**

Non-Delta Dental DPO dentists**

100%

80%

50%

$1,500 Lifetime

Diagnostic & Preventive Services (D&P) Exams, cleanings, x-rays and sealants Basic Services Fillings Endodontics (root canals) Covered Under Basic Services Periodontics (gum treatment) Covered Under Basic Services Oral Surgery Covered Under Basic Services Major Services Crowns, inlays, onlays and cast restorations Prosthodontics Bridges and dentures Orthodontic Benefits Dependent children Orthodontic Maximums

* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s submitted fees. ** Reimbursement is based on DPO contracted fees for DPO dentists, Premier contracted fees for Premier dentists and program allowance for non-Delta Dental dentists.

Delta Dental Insurance Company 1130 Sanctuary Parkway, Suite 600 Alpharetta, GA 30009 Customer Service 800-521-2651 Claims Address P.O. Box 1809 Alpharetta, GA 30023-1809

deltadentalins.com This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company’s benefits representative. Revised 6/4/2019

McKinney ISD 09/01/2020 Monthly Rates Contract Type

Non-Retention (Non-Participating)

Contract Term

09/01/2020 to 08/31/2022

Guaranteed Rate Effective Dates

From

09/01/2020

08/31/2022

Enrollee only

$44.44

Enrollee + 1 Dependent

$78.64

Enrollee + 2 or more Dependents $101.44

AVESIS

Vision

YOUR BENEFITS PACKAGE

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 22 details on covered expenses,Frisco limitations and exclusions included in the summary plan description located on the ISD Benefits Website:are www.mybenefitshub.com/friscoisd McKinney ISD Benefits Website: www.mybenefitshub.com/mckinneyisd

Vision– High Plan McKinney Independent School District - High Option Vision Care Services

Vision Examination (Includes Refraction) Contact Lens Fit and Follow-up Standard Contact Lens Fitting Custom Contact Lens Fitting Materials*

In-Network Member Cost

Out-of-Network Reimbursement

Covered in full after $10 copay

Up to $35

Up to $50 member out-of-pocket maximum Up to $75 member out-of-pocket maximum $ 20 copay

N/A N/A

(Materials copay applies to frame or spectacle lenses, if applicable.)

Frame Allowance (Up to 20% discount above frame allowance.) Standard Spectacle Lenses Single Vision

$150 allowance

Up to $45

Monthly Rates Employee Only $8.90 Employee + Spouse $15.80 Employee + Children $18.34 Employee + Family $23.26 Effective Date: 09/01/2021 Group Number: 10771-1205 Plan Number: 150150DY1L7

Reliable & Dependable Avēsis is a national leader in providing exceptional vision care benefits for millions of commercial members throughout the country. The Avēsis Vision care products give our members an easy-touse wellness benefit that provides excellent value and protection.

Covered in full after $20 copay

Up to $25

Bifocal

Covered in full after $20 copay

Up to $40

Trifocal

Covered in full after $20 copay

Up to $50

Lenticular

Covered in full after $20 copay

Up to $80

Covered in full

Up to $10

Covered in full

Up to $5

Here’s How It Works

Covered in full Covered in full

Up to $6 Up to $4

Covered in full

Up to $24

Covered in full Covered in full

Up to $40 Up to $48

$140 allowance + 20% discount

Up to $48

$70/$80

N/A

$75

N/A

$40

N/A

When you need to see an eye care professional, simply visit www.avesis.com or contact Avēsis’ Customer Service Monday through Friday, 7:00 AM to 8:00 PM (EST) at 800-828-9341 to receive a listing of providers in your area. 1. Select a provider 2. Make an appointment 3. Visit provider for service 4. Pay any copays or additional expenses

Preferred Pricing Options Level 7 Option Package Polycarbonate (Single Vision/Multi-Focal) Standard Scratch-Resistant Coating Ultra-Violet Screening Solid or Gradient Tint Standard Anti-Reflective Coating Level 1 Progressives Level 2 Progressives All Other Progressives Transitions® (Single Vision/ Multi-Focal) Polarized PGX/PBX

Other Lens Options Up to 20% discount Contact Lenses† (in lieu of frame and spectacle lenses)

N/A

Elective

$150 allowance

Up to $128

Medically Necessary

Covered in full

Up to $250

Refractive Laser Surgery

Onetime/lifetime $150 allowance Provider discount up to 25%

Onetime/lifetime $150 allowance

Frequency Eye Examination Lenses or Contact Lenses Frame

Once every 12 months Once every 12 months Once every 12 months

* Discounts are not insured benefits. † Prior authorization is required for medically necessary contacts. *At participating Walmart/Sam's locations, retail pricing for your plan is $82 . At participating Costco locations, retail pricing is $84.99 .

How can we help you? Avēsis website: www.avesis.com Customer Service: 800-828-9341 7:00 AM - 8:00 PM EST LASIK Provider: 877-712-2010 Underwritten by: Fidelity Security Life Insurance Company, Kansas City, MO

Vision– High Plan Using Out-of-Network Providers Members who elect to use an out-of-network provider must pay the provider in full at the time of service and submit a claim to Avēsis for reimbursement. Reimbursement levels are in accordance with the out-of-network reimbursement schedule previously listed. Outof-network benefits are subject to the same eligibility, availability, frequency of benefits, and limitation and exclusion provisions of the plan, and are in lieu of services provided by a participating Avēsis provider. Out-of-network claim forms can be obtained by contacting Avēsis’ Customer Service Center or your group administrator, or by visiting www.avesis.com.

Limitations and Exclusions Some provisions, benefits, exclusions, or limitations listed herein may vary depending on your state of residence. Limitations: This plan is designed to cover eye examinations and corrective eyewear. It is also designed to cover visual needs rather than cosmetic options. Should the member select options that are not covered under the plan, as shown in the schedule of benefits, the member will pay a discounted fee to the participating Avēsis provider. Benefits are payable only for services received while the group and individual member’s coverage is in force. Exclusions: There are no benefits under the plan for professional services or materials connected with and arising from: 1. 2. 3. 4. 5. 6. 7. 8.

Orthoptics or vision training; Subnormal vision aids and any supplemental testing, aniseikonic lenses; Plano (non-prescription) lenses, sunglasses; Two pair of glasses in lieu of bifocal lenses; Any medical or surgical treatment of eye or supporting structures; Replacement of lost or broken lenses, contact lenses or frames, except when the member is normally eligible for services; Any eye examination or corrective eyewear required by an employer as a condition of employment and safety eyewear; Services or materials provided as a result of Workers’ Compensation Law, or similar legislation, required by any governmental agency whether Federal, State, or subdivision thereof. 9. Services or materials provided by any other group benefit plan providing vision care. Refractive Surgery Vision Benefit Exclusions: Benefits are not payable for any of the following: 1. 2.

Routine vision examinations or corrective vision materials, including corrective eyeglasses, fittings, lenses, frames, or contact lenses; or Medical or surgical procedures, services, or treatments: a. not specifically covered under this Rider; b. provided free of charge in the absence of insurance c. payable under any Workers’ Compensation law or similar statutory authority d. payable under governmental plan or program, whether Federal, state, or subdivisions thereof.

Termination Provisions Coverage will end on the earliest of: the date the policy ends, the date the employee’s employment ends, or the date the employee is no longer eligible.

Notes and Disclaimers The contact lens allowance may be used all at once or throughout the plan year as needed or may be applied toward contact lenses only. Refractive Laser Surgery is considered an elective procedure, and may involve potential risks to patients. Avēsis is not responsible for the outcome of any refractive surgery. Discounts on materials are not available at Walmart locations. Members may not use their contact lens allowance toward fitting fees at Walmart and are responsible for any out-of-pocket fees associated with fittings there. Discounts on materials are not available at Costco locations. ID cards are not required for services. Underwritten by: Fidelity Security Life Insurance Company, Kansas City, MO Policy #: VC-16, Form M-9059

Vision– Low Plan McKinney Independent School District - High Option Vision Care Services

Vision Examination (Includes Refraction) Contact Lens Fit and Follow-up Standard Contact Lens Fitting Custom Contact Lens Fitting Materials*

In-Network Member Cost

Out-of-Network Reimbursement

Covered in full after $10 copay

Up to $35

out-of-pocket maximum: Up to $50 Up to $75 $ 20 copay

N/A

(Materials copay applies to frame or spectacle lenses, if applicable.)

Frame Allowance (Up to 20% discount above frame allowance.) Standard Spectacle Lenses Single Vision

$150 allowance

Up to $45

Monthly Rates Employee Only $5.90 Employee + Spouse $10.30 Employee + Children $12.14 Employee + Family $15.05 Effective Date: 09/01/2021 Group Number: 10771-1205 Plan Number: 150150DY1

Covered in full after $20 copay

Up to $25

Bifocal

Covered in full after $20 copay

Up to $40

Trifocal

Covered in full after $20 copay

Up to $50

Lenticular

Covered in full after $20 copay

Up to $80

$40/$44 (Covered in full up to age 19)

N/A (Up to $10 for ages up to 19)

$17

N/A

Here’s How It Works

$15 $17

N/A N/A

$45

N/A

$75 $110

Up to $40 Up to $40

$50 allowance + 20% discount

Up to $40

$70/$80

N/A

$75

N/A

$40

N/A

Other Lens Options Up to 20% discount Contact Lenses† (in lieu of frame and spectacle lenses)

N/A

Elective

$150 allowance

Up to $128

Medically Necessary

Covered in full

Up to $250

Refractive Laser Surgery

Onetime/lifetime $150 allowance Provider discount up to 25%

Onetime/lifetime $150 allowance

Frequency Eye Examination Lenses or Contact Lenses Frame

Once every 12 months Once every 12 months Once every 12 months

Termination Provisions Coverage will end on the earliest of: the date the policy ends, the date the employee’s employment ends, or the date the employee is no longer eligible.

Vision– Mobile App MEMBERSHIP HAS ITS ADVANTAGES

NEED ASSISTANCE?

member technology

Our Customer Care Center can be reached at 800-828-9341, 7:00 a.m. to 8:00 p.m. EST, Monday through Friday. *Note: Dental coverage is available in select states.

Using and managing your healthcare benefits should fill you with a sense of wellbeing. Avēsis makes it easy, with our www.avesis.com member portal and mobile app. The first step is signing up. Visit www.avesis.com, and click Avēsis is a wholly owned subsidiary of The Guardian Life Insurance Company of America, Members. The only thing you’ll need is information you already New York, NY. #2018-53265 (exp 1/20) REV 1/18 012 know, like your name and date of birth. Once you’re registered, you’ll have secure access to everything you need for clear vision and a healthy smile!* PRINT ID CARDS Didn’t get one in the mail yet? Need an extra? Lost your card? Print a replacement easily right from our portal. But remember: you never need to show your ID to receive dental or vision benefits. VIEW BENEFIT SUMMARIES See the full range of benefits—from eye exams to LASIK for vision, cleanings to major services for dental—of your plan for you and all non-adult members covered under your plan. SEE CLAIMS STATUS If you’ve submitted a claim for an out-of-network service, you can see its progress here. You can also check to see whether Avēsis has paid your dentist or vision care provider. CHECK ELIGIBILITY Wonder when you can get that pair of frames you’ve been longing for or when you qualify for your next teeth cleaning? See when you had service last and when you’ll be eligible again! SEARCH FOR PROVIDERS Find your most convenient vision or dental care provider from among the tens of thousands who participate with us. Search by mile radius, provider name, city and state, and more. NOMINATE PROVIDERS Don’t see your eye doctor or dentist on our list? Nominate one using a handy form on our website. Give us as much information as you can, and we’ll do the rest! LEARN MORE Good oral and ocular health begin with you. Learn more about sight and bite through our FAQs, glossaries, and vital vision and dental facts. AVĒSIS E-SSENTIALS: FOR BENEFITS ON THE GO† Do everything on your smartphone that you can do from our web portal, plus call providers and Customer Care with the touch of a button. Get yours for Android or iPhone at Google Play or the App Store. It’s free! †Vision, only; dental coming soon!

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.

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

FLIP TO…

PG. 11

FOR HSA VS. FSA COMPARISON

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 28 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

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 Annual taxable income $24,000 $24,000 cases, the taxpayer identification number of the service 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 Taxable income after FSA $21,000 $24,000 want and how much contributions should go toward each Income taxes -$6,300 -$7,200 benefit. It is very important that you make these choices carefully based on what you expect to spend on each covered After-tax income $14,700 $16,800 benefit or expense during the plan year. $0 -$3,000 Generally, you cannot change the elections you have made after After-tax health and welfare expenses Take-home pay $14,700 $13,800 the beginning of the plan year. However, there are certain limited situations when you can change your elections if you You saved $900 $0 have a "change in status". Please refer to your Summary Plan 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).

FSA (Flexible Spending Account) FLEXIBLE BENEFITS PLAN McKinney Independent School District Employer ID NBS142168

PLAN HIGHLIGHTS Login at: my.nbsbenefits.com

WHAT TYPE OF BENEFITS ARE AVAILABLE Under our Plan, you can choose the following benefits. Each benefit allows you to save taxes at the same time because the amount you elect is set aside on a pre-tax basis.

Health Flexible Spending Account: The Health Flexible Spending Account (FSA) enables you to pay Congratulations! McKinney Independent School District has for expenses allowed under Section 105 and 213(d) of the established a "Flexible Benefits Plan" to help you pay for your out Internal Revenue Code which are not covered by our insured -of-pocket medical expenses. One of the most important features medical plan. The most that you can contribute to your Health of the Plan is that the benefits being offered are paid for with a FSA each Plan Year is $2,700. Please note: If you contribute to portion of your pay before Federal income or Social Security this benefit you cannot elect a Health Savings Account (HSA) taxes are withheld. This means that you will pay less tax and have Benefit. more money to spend and save. However, if you receive a reimbursement for an expense under the Plan, you cannot claim Health Savings Account: A Health Savings Account allows participants insured by a a Federal income tax credit or deduction on your return. Qualified High Deductible Insurance Plan to save for deductibles and other expenses not covered under the Plan. If you participate DETERMINING CONTRIBUTIONS in this benefit you cannot participate in the Health Flexible Before each Plan Year begins, you will select the benefits you Spending Account benefit. want and how much of the contributions should go toward each benefit. It is very important that you make these choices carefully Dependent Care Flexible Spending Account: The Dependent Care Flexible Spending Account (DCAP) enables based on what you expect to spend on each covered benefit or you to pay for out-of-pocket, work-related dependent day-care expense during the Plan Year. cost. Please see the Summary Plan Description for the definition Generally, you cannot change the elections you have made after of eligible dependent. The law places limits on the amount of the beginning of the Plan Year. However, there are certain money that can be paid to you in a calendar year. Generally, your limited situations when you can change your elections if you have reimbursement may not exceed the lesser of: (a) $5,000 (if you a “change in status”. Please refer to your Summary Plan are married filing a joint return or you are head of a household) Description for a change in status listing. or $2,500 (if you are married filing separate returns; (b) your taxable compensation; (c) your spouse’s actual or deemed earned income. Also, in order to have the reimbursements made GENERAL PLAN INFORMATION to you and be excluded from your income, you must provide a Plan Year End:………………………………………………...……...August 31st statement from the service provider including the name, address, Run-out Period:…………………………………..……………………...…90 Days and in most cases, the taxpayer identification number of the Maximum Medical Limit…………..…...……..Current IRS limit $2,750 service provider, as well as the amount of such expense and …See Code Section 125(i)(2) or current enrollment information Maximum Dependent Care Limit:……..……………………..……..$5,000 proof that the expense has been incurred. Health FSA Carryover…..….Up to $500 following the Plan run-out For the Dependent Care Flexible Spending Account, you must Amounts exceeding $500 will be forfeited submit claims no later than 90 days after the end of the Plan Year. However, if you terminated employment during the Plan Deadlines to Use Funds Year, you must submit your Dependent Care Flexible Spending Health FSA……………….…...…,November 29 following Plan Year End Account claims within 90 days after your termination of DCAP………………………..…...…November 29 following Plan Year End employment. Any claims submitted after that time will not be FSA Mid-year termination….… 90 days following termination date considered. DCAP Mid-year termination….90 days following termination date Premium Expense Plan: A Premium Expense portion of the Plan allows you to use pre-tax WHEN AM I ELIGIBLE TO PARTICIPATE dollars to pay for specific premiums under various insurance If you work 20 hours or more each week for the company, you programs that we offer you. will be eligible to join the Plan when you have met the eligibility Please note: Policies other than company sponsored policies (i.e. requirements for our group medical plan. spouse's or dependents' individual policies etc.) may not be paid through the Flexible Benefits Plan. Furthermore, qualified longYou will enter the Plan on the same day that you join our group term care insurance plans may not be paid through the Flexible medical plan. Benefits Plan. 32

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 considered “incurred” when the service is performed, not necessarily when it is paid for. You can get a claim form at www.NBSbenefits.com. Claim forms must be submitted no later than 90 days after the end of the Plan Year for the Health Flexible Spending Account and the Dependent Care Flexible Spending Account. Any contributions remaining at the end of the Plan Year will be forfeited.

NBS Flexcard – FSA Pre-paid MasterCard Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement. Terminated Employees have 90 Days after their date of termination to submit receipts for services prior to their termination date.

WHO ARE HIGHLY COMPENSATED & KEY EMPLOYEES Under the Internal Revenue Code, "highly compensated employees" and "key employees" generally are Participants who are officers, shareholders or highly paid. If you are within these categories, the amount of contributions and benefits for you may be limited so that the Plan as a whole does not unfairly favor those who are highly paid, their spouses or their dependents. Please refer to your Summary Plan Description for more information. You will be notified of these limitations if you are affected.

Updated: 6/22/2020

NBS Welfare Benefit Service Center 8523 S. Redwood Road West Jordan, UT 84088 801-532-4000 or 1-800- 274-0503 Fax: 1-800-478-1528

McKinney Independent School District Flexible Benefits Plan Plan Contact Person: Amanda Wallace 1 Duvall Street McKinney, TX 75069 (469) 302-4069 33

UNUM

Life and AD&D

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.

YOUR BENEFITS PACKAGE

Experts recommend at least

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 34 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

Life and AD&D Who is eligible for this coverage? All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.

administrator. You may also be required to take certain medical tests at Unum’s expense.

How do I apply? Please see your plan administrator.

What are the coverage amounts? Employee: up to 5 times salary in increments of $10,000; not to exceed $500,000.

When is coverage effective?

Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $500,000.

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.

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 $1,000.

What are the AD&D coverage amounts? Employee: up to 5 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 $500,000.

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 $1,000. Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself.

Can I be denied coverage? Current Employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to the plan max for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions. If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or before the enrollment deadline and will be required to answer health questions for any amount of coverage. 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

Please see your plan administrator for your effective date.

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; are receiving chemotherapy, radiation therapy or dialysis treatment; are confined at home under the care of a physician for a sickness or injury; or your spouse is unable to perform two or more activities of daily living (ADLs) because of a physical or mental incapacity resulting from an injury or a sickness; is cognitively impaired; is receiving or is entitled to receive any disability income from any source due to any sickness or injury; or has a life threatening condition. Exception: Infants are insured from live birth.

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

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

Will my premiums be waived if I’m disabled? If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends.

Life and AD&D How much does the coverage cost? Term Life Employee rate Spouse rate Age band per $1,000 per $1,000 <25 0.019 0.019 25-29 0.019 0.019 30-34 0.028 0.028 35-39 0.048 0.048 40-44 0.057 0.057 45-49 0.085 0.085 50-54 0.143 0.143 55-59 0.247 0.247 60-64 0.323 0.323 65-69 0.599 0.599 70-74 0.960 0.960 75+ 0.960 0.960 Child life monthly rate is $0.26 per $1,000. One life premium covers all children. AD&D Rate Chart (You must purchase life coverage to purchase AD&D coverage) AD&D cost Monthly Cost Employee Per $1,000 $0.02 Spouse Per $1,000 $0.02 Child Per $1,000 $0.02

Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following schedule: Age: 70 75

Insurance amount reduces to: 65% of original amount 50% of original amount

Coverage may not be increased after a reduction.

What does my AD&D insurance pay for? The full benefit amount is paid for loss of: • life; • both hands or both feet or sight of both eyes; • one hand and one foot; • one hand or one foot and the sight of one eye; • speech and hearing.

• • • • •

•

edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM); suicide, self-destruction while sane, intentionally selfinflicted injury while sane or self-inflicted injury while insane; war, declared or undeclared, or any act of war; active participation in a riot; committing or attempting to commit a crime under state or federal law; the voluntary use of any prescription or 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.

Other losses may be covered as well. Please contact your plan administrator.

Are there any AD&D exclusions or limitations? Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from: • disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest 36

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

UNUM

YOUR BENEFITS PACKAGE

Disability

About this Benefit Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.

Just over 1 in 4 of today's 20 year -olds will become disabled before they retire.

34.6 months is the duration of the average disability claim.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 38 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

Long Term Disability Policy # 125328 Please read carefully the following description of your Unum Educator Select Income Protection Plan insurance.

Your Plan Eligibility You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period.

Guarantee Issue Current Employees: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may enroll on or before the enrollment deadline. After the initial enrollment period, you can apply only during an annual enrollment period. New Hires: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may apply for coverage within 60 days after your eligibility date. If you do not apply within 60 days after your eligibility date, you can apply only during an annual enrollment period. Benefits are subject to the pre-existing condition exclusion referenced later in this document.

Please see your Plan Administrator for your eligibility date

Benefit Amount You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $8,000. Please see your Plan Administrator for the definition of monthly earnings. The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment. However, if you are participating in Unum’s Rehabilitation and Return to Work Assistance program, the total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 110% of your monthly earnings (unless the excess amount is payable as a Cost of Living Adjustment).

Elimination Period The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits. You may choose an Elimination Period (injury/sickness) of 14/14, 30/30, 60/60, 90/90 or 180/180 days. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)

Benefit Duration Your duration of benefits is based on your age when the disability occurs.

Plan: ADEA II: Your duration of benefits is based on the following table:

Age at Disability Less than age 60 Age 60 through 64 Age 65 through 69 Age 70 and over

Maximum Duration of Benefits To age 65, but not less than 5 years 5 years To age 70, but not less than 1 year 1 year

Federal Income Taxation The taxability of benefits depends on how premium was taxed during the plan year in which you become disabled. If you paid 100% of the premium for the plan year with post-tax dollars, your benefits will not be taxed. If premium for the plan year is paid with pre-tax dollars, your benefits will be taxed. If premium for the plan year is paid partially with post-tax dollars and partially with pre-tax dollars, or if you and your Employer share in the cost, then a portion of your benefits will be taxed.

Additional Benefits Work/Life Balance Employee Assistance Program: Work-life balance is a comprehensive resource providing access to professional assistance for a wide range of personal and work-related issues. The service is available to you and your family members twenty- four hours a day, 365 days a year, and provides resources to help employees 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.

Services include: toll-free phone access to master’s-level consultants, up to three face-to-face sessions to help with more serious issues; and online resources. There is no additional charge for utilizing the program. Participation is confidential and strictly voluntary, and employees do not have to have filed a disability claim or be receiving benefits to use the program. However, if you become disabled and are receiving benefits, Unum's On Claim Support can provide additional resources including: coaching on how to communicate effectively with medical personnel, conducting consumer research for medical equipment and supplies, assessing emotional needs and locating counseling resources. Return to Work/Work Incentive Benefit: Unum supports efforts that enable a disabled employee to remain on the job or return to work as soon as possible. If you are disabled but working part time with monthly disability earnings of 20% or more of your indexed monthly earnings, during the first 12 months, the monthly benefit will not be reduced by any earnings until the gross disability payment plus your disability earnings, exceeds 100% of your indexed monthly earnings. The monthly benefit will then be reduced by that amount. Rehabilitation and Return to Work Assistance: Unum has a vocational Rehabilitation and Return to Work Assistance program available to assist you in returning to work. We will make the final determination of your eligibility for participation in the program, and will provide you with a written Rehabilitation and Return to Work Assistance plan developed specifically for you. This program may include, but is not limited to the following benefits: • coordination with your Employer to assist your return to work; • adaptive equipment or job accommodations to allow you to work; • vocational evaluation to determine how your disability may impact your employment options; • job placement services; • resume preparation; • job seeking skills training; or 39

Disability •

education and retraining expenses for a new occupation.

If you are participating in a Rehabilitation and Return to Work Assistance program, we will also pay an additional disability benefit of 10% of your gross disability payment to a maximum of $1,000 per month. In addition, we will make monthly payments to you for 3 months following the date your disability ends, if we determine you are no longer disabled while: • you are participating in a Rehabilitation and Return to Work Assistance program; and • you are not able to find employment. (This benefit is not allowed in New Jersey.) Worksite Modification: If a worksite modification will enable you to remain at work or return to work, a designated Unum professional will assist in identifying what’s needed. A written agreement must be signed by you, your employer and Unum, and we will reimburse your employer for the greater of $1,000 or the equivalent of two months of your disability benefit.

•

attending an accredited post-secondary school beyond the 12th grade level on a full-time basis.

Medical Treatment Benefit: A Medical Treatment Benefit will be paid when you receive treatment by a doctor as a result of a sickness or injury, provided no other benefits are payable under the plan as a result of the condition for which the treatment was rendered. The Medical Treatment Benefit will be the doctor's actual charge for services rendered, up to a maximum benefit of $50 for sickness or $100 for injury. In addition, the charges must be for medically necessary care and treatment and in keeping with the extent of the sickness or injury. No benefit will be paid unless you are personally seen and treated by a doctor and the treatment is not for routine medical examinations or dental work. Note: No more than one Medical Treatment Benefit will be paid for the same or related condition(s) unless the treatment dates are separated by at least 14 consecutive days. In addition, no more than one benefit will be paid for treatment during any 24 hour period and the benefit will not be paid more than 4 times per calendar year.

Waiver of Premium: After you have received disability payments under the plan for 90 consecutive days, from that point forward you will not be required to pay premiums as long as you are receiving disability benefits.

Worldwide Emergency Travel Assistance Services : Whether your travel is for business or pleasure, our worldwide emergency travel assistance program is there to help you when an unexpected emergency occurs. With one phone call anytime of the day or night, you, your spouse and dependent children can get immediate assistance anywhere in the Survivor Benefit: Unum will pay your eligible survivor a lump sum world3. Emergency travel assistance is available to you when you travel benefit equal to 3 months of your gross disability payment. to any foreign country, including neighboring Canada or Mexico. It is This benefit will be paid if, on the date of your death, your disability had also available anywhere in the United States for those traveling more continued for 180 or more consecutive days, and you were receiving or than 100 miles from home. Your spouse and dependent children do not were entitled to receive payments under the plan. If you have no have to be traveling with you to be eligible. However, spouses traveling eligible survivors, payment will be made to your estate, unless there is on business for their employer are not covered by this program. none. In that case, no payment will be made. However, we will first apply the survivor benefit to any overpayment which may exist on your claim. Pre-Existing Condition Exclusion : Benefits will not be paid for disabilities You may receive your survivor benefit prior to your death if you are caused by, contributed to by, or resulting from a pre-existing condition. receiving monthly payments and your physician certifies in writing that You have a pre-existing condition if: you have been diagnosed as terminally ill and your life expectancy has • you received medical treatment, consultation, care or services been reduced to less than 12 months. This benefit is only payable once including diagnostic measures, or took prescribed drugs or and if you elect to receive this benefit, no survivor benefit will be medicines in the 3 months just prior to your effective date of payable to your eligible survivor upon your death. (Note this coverage; and “Accelerated Survivor Benefit” is not available in Connecticut.) • the disability begins in the first 12 months after your effective date of coverage. Dependent Care Expense Benefit: If you are disabled and participating in Unum’s Rehabilitation and Return to Work Assistance program, Unum Continuity of Coverage: If you are actively at work at the time you will pay a Dependent Care Expense Benefit when you are disabled and convert to Unum’s plan and become disabled due to a pre-existing you provide satisfactory proof that you: condition, benefits may be payable if you were: • are incurring expenses to provide care for a child under the age of • in active employment and insured under the plan on its effective 15; date; and • and/or start incurring expenses to provide care for a child age 15 • insured by the prior plan at the time of change. or older or a family member who needs personal care assistance. To receive a payment, you must satisfy the pre-existing condition under The payment will be $350 per month per dependent, to a maximum of the Unum policy or the prior carrier’s policy. If you satisfy Unum’s pre$1,000 per month for all dependent care expenses combined. existing condition provision, payments will be determined by the Unum policy. Education Benefit: If you are disabled and receiving monthly disability benefits, you may receive an additional monthly Education Benefit of If you only satisfy the pre-existing condition provision for the prior $200 for each child who is an eligible student. Benefits will be payable carrier’s policy, the claim will be administered according to the Unum in between terms provided the eligible student is enrolled for the next policy. However, scheduled term. • the payments will be the lesser of the benefit payable under the terms of the prior plan or the benefit under the Unum plan; Eligible student means your unmarried dependent child(ren) who are: • the elimination period will be the shorter of the elimination period • less than 25 years of age; and under the prior plan or the elimination period under the Unum

Other Important Provisions

Disability •

plan; and benefits will end on the earlier of the end of the maximum period of payment under the Unum plan or the date benefits would have ended under the prior plan.

Definition of Disability: You are disabled when Unum determines that: • you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; • you have a 20% or more loss in indexed monthly earnings due to the same sickness or injury; and • during the elimination period you are unable to perform any of the material and substantial duties of your regular occupation. After benefits have been paid for 24 months, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. You must be under the regular care of a physician in order to be considered disabled. Gainful Occupation: Gainful occupation means an occupation that is or can be expected to provide you with an income within 12 months of your return to work, that exceeds 80% of your indexed monthly earnings if you are working or 60% of your indexed monthly earnings if you are not working. Benefit Integration: Your disability benefit will be reduced by deductible sources of income and any earnings you have while disabled. Your gross disability payment will be reduced immediately by such items as disability income or other amounts you receive or are entitled to receive from workers compensation or similar occupational benefit laws, sabbatical or assault leave plans and the amount of earnings you receive from an extended sick leave plan as described in Louisiana Revised Statutes or any other act or law with similar intent. After you have received monthly disability payments for 12 months, your gross disability payment will be reduced by such items as additional deductible sources of income you receive or are entitled to receive under: state compulsory benefit laws; automobile liability insurance; legal judgments and settlements; certain retirement plans; salary continuation or sick leave plans; other group or association disability programs or insurance; and amounts you or your family receive or are entitled to receive from Social Security or similar governmental programs. Regardless of deductible sources of income, an employee who qualifies for disability benefits is guaranteed to receive a minimum benefit amount of 25% of the gross disability payment.

Mental Illness/Self-Reported Symptoms: The lifetime cumulative maximum benefit period for all disabilities due to mental illness and disabilities based primarily on self-reported symptoms is 24 months. Only 24 months of benefits will be paid for any combination of such disabilities even if the disabilities are not continuous and/or are not related. Payments would continue beyond 24 months only if you are confined to a hospital or institution as a result of the disability. Instances When Benefits Would Not Be Paid: Benefits will not be paid for disabilities caused by, contributed to by, or resulting from: • intentionally self-inflicted injuries; • active participation in a riot; • commission of a crime for which you have been convicted;

• •

loss of professional license, occupational license or certification; pre-existing conditions (see definition).

Unum will not cover a disability due to war, declared or undeclared, or any act of war. Unum will not pay a benefit for any period of disability during which you are incarcerated. Termination of Coverage: Your coverage under the policy ends on the earliest of the following: • The date the policy or plan is cancelled; • The date you no longer are in an eligible group; • The date your eligible group is no longer covered; • The last day of the period for which you made any required contributions; • The later of the last day you are in active employment except as provided under the covered layoff or leave of absence provision; or if applicable, the last day of your contract with your Employer but not beyond the end of your Employer’s current school contract year. Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

Next Steps How to Apply/ Effective Date of Coverage: Current Employees: To apply for coverage, complete your enrollment form by the enrollment deadline. Please see your Plan Adminsitrator for your effective date. New Hires: To apply for coverage, complete your enrollment form within 60 days of your eligibility date. Please see your Plan Administrator for your effective date. If you do not enroll during the initial enrollment period, you may apply only during an annual enrollment. Delayed Effective Date of Coverage: If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will not take effect until you return to active employment. Please contact your Plan Administrator after you return to active employment for when your coverage will begin. Questions: If you should have any questions about your coverage or how to enroll, please contact your Plan Administrator.

This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Some provisions may vary or not be available in all states. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. For complete details of coverage, please refer to policy form number C.FP-1, et al. 1,2 Work-life balance employee assistance program and On-Claim Support services are provided by Ceridian Corporation. Worldwide emergency travel assistance services are provided by Assist America, Inc. Services are available with selected Unum insurance offerings. Exclusions, limitations and prior notice requirements may apply, and service features, terms and eligibility criteria are subject to change. The services are not valid after termination of coverage and may be withdrawn at any time. Please contact your Unum representative for full details. 3 All Worldwide emergency travel assistance must be arranged by Assist America, which pays for all services it provides. Medical expenses such as prescriptions or physician, lab or medical facility fees are paid by the employee or the employee’s health insurance. Underwritten by: Unum Life Insurance Company of America 2211 Congress Street, Portland, Maine 04122, www.unum.com ©2007 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Long Term Disability MCKINNEY INDEPENDENT SCHOOL DISTRICT Costs Effective as of September 1, 2018 Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year) Product: Educator Select Income Protection Plan

Plan A

ADEA II Duration of Benefits Elimination Period (Days) Maximum Monthly Benefit 14 / 14* 30 / 30* 60 / 60 90 / 90 180 / 180

Injury / Sickness (Days) Annual Earnings

Monthly Earnings

$7.86 $11.79 $15.72 $19.65 $23.58 $27.51 $31.44 $35.37 $39.30 $43.23 $47.16 $51.09 $55.02 $58.95 $62.88 $66.81 $70.74 $74.67 $78.60 $82.53 $86.46 $90.39 $94.32 $98.25 $102.18 $106.11 $110.04 $113.97 $117.90 $121.83 $125.76 $129.69 $133.62 $137.55 $141.48 $145.41 $149.34 $153.27 $157.20 $161.13 $165.06 $168.99 $172.92 42

$6.42 $9.63 $12.84 $16.05 $19.26 $22.47 $25.68 $28.89 $32.10 $35.31 $38.52 $41.73 $44.94 $48.15 $51.36 $54.57 $57.78 $60.99 $64.20 $67.41 $70.62 $73.83 $77.04 $80.25 $83.46 $86.67 $89.88 $93.09 $96.30 $99.51 $102.72 $105.93 $109.14 $112.35 $115.56 $118.77 $121.98 $125.19 $128.40 $131.61 $134.82 $138.03 $141.24

$4.30 $6.45 $8.60 $10.75 $12.90 $15.05 $17.20 $19.35 $21.50 $23.65 $25.80 $27.95 $30.10 $32.25 $34.40 $36.55 $38.70 $40.85 $43.00 $45.15 $47.30 $49.45 $51.60 $53.75 $55.90 $58.05 $60.20 $62.35 $64.50 $66.65 $68.80 $70.95 $73.10 $75.25 $77.40 $79.55 $81.70 $83.85 $86.00 $88.15 $90.30 $92.45 $94.60

$3.68 $5.52 $7.36 $9.20 $11.04 $12.88 $14.72 $16.56 $18.40 $20.24 $22.08 $23.92 $25.76 $27.60 $29.44 $31.28 $33.12 $34.96 $36.80 $38.64 $40.48 $42.32 $44.16 $46.00 $47.84 $49.68 $51.52 $53.36 $55.20 $57.04 $58.88 $60.72 $62.56 $64.40 $66.24 $68.08 $69.92 $71.76 $73.60 $75.44 $77.28 $79.12 $80.96

$2.76 $4.14 $5.52 $6.90 $8.28 $9.66 $11.04 $12.42 $13.80 $15.18 $16.56 $17.94 $19.32 $20.70 $22.08 $23.46 $24.84 $26.22 $27.60 $28.98 $30.36 $31.74 $33.12 $34.50 $35.88 $37.26 $38.64 $40.02 $41.40 $42.78 $44.16 $45.54 $46.92 $48.30 $49.68 $51.06 $52.44 $53.82 $55.20 $56.58 $57.96 $59.34 $60.72

Plan A

Injury / Sickness (Days) Annual Earnings

136, 138, 140,400 142, 144,

Monthly Earnings

Maximum Monthly Benefit 14 / 14*

7600 7700 7800 7900 8000

$176.85 $180.78 $184.71 $188.64 $192.57 $196.50 $200.43 $204.36 $208.29 $212.22 $216.15 $220.08 $224.01 $227.94 $231.87 $235.80 $239.73 $243.66 $247.59 $251.52 $255.45 $259.38 $263.31 $267.24 $271.17 $275.10 $279.03 $282.96 $286.89 $290.82 $294.75 $298.68 $302.61 $306.54 $310.47 $314.40

ADEA II Duration of Benefits Elimination Period (Days) 30 / 30* 60 / 60 90 / 90 180 / 180 $144.45 $147.66 $150.87 $154.08 $157.29 $160.50 $163.71 $166.92 $170.13 $173.34 $176.55 $179.76 $182.97 $186.18 $189.39 $192.60 $195.81 $199.02 $202.23 $205.44 $208.65 $211.86 $215.07 $218.28 $221.49 $224.70 $227.91 $231.12 $234.33 $237.54 $240.75 $243.96 $247.17 $250.38 $253.59 $256.80

$96.75 $98.90 $101.05 $103.20 $105.35 $107.50 $109.65 $111.80 $113.95 $116.10 $118.25 $120.40 $122.55 $124.70 $126.85 $129.00 $131.15 $133.30 $135.45 $137.60 $139.75 $141.90 $144.05 $146.20 $148.35 $150.50 $152.65 $154.80 $156.95 $159.10 $161.25 $163.40 $165.55 $167.70 $169.85 $172.00

$82.80 $84.64 $86.48 $88.32 $90.16 $92.00 $93.84 $95.68 $97.52 $99.36 $101.20 $103.04 $104.88 $106.72 $108.56 $110.40 $112.24 $114.08 $115.92 $117.76 $119.60 $121.44 $123.28 $125.12 $126.96 $128.80 $130.64 $132.48 $134.32 $136.16 $138.00 $139.84 $141.68 $143.52 $145.36 $147.20

$62.10 $63.48 $64.86 $66.24 $67.62 $69.00 $70.38 $71.76 $73.14 $74.52 $75.90 $77.28 $78.66 $80.04 $81.42 $82.80 $84.18 $85.56 $86.94 $88.32 $89.70 $91.08 $92.46 $93.84 $95.22 $96.60 $97.98 $99.36 $100.74 $102.12 $103.50 $104.88 $106.26 $107.64 $109.02 $110.40

REF #: 5223078 *If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Find your Annual/Monthly Earnings above to determine your Maximum Monthly Benefit. If your Annual/Monthly Earnings are not shown, use the next lower Annual/Monthly Earnings and corresponding Maximum Monthly Benefit. Or, you may refer to the Plan Highlights to calculate your Maximum Monthly Benefit based on your earnings. 43

UNUM YOUR BENEFITS PACKAGE

Group Accident & 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 44 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

Group Accident & Group Hospital Indemnity Benefit Overview Group Accident Insurance Group Accident insurance is designed to help covered employees meet the out-of-pocket expenses and extra bills that can follow an accidental injury, whether minor or catastrophic. Indemnity lump sum benefits are paid directly to the employee based on the amount of coverage listed in the schedule of benefits. The accident base plan is guaranteed issue, so no health questions are required. Plan Type Covered Conditions Wellness Benefit Premium

On/Off Job See Schedule of Benefits Included - $50 per insured per calendar year Paid by the Employee

Monthly Premium (includes Wellness) Employee and Spouse Employee and Child $26.30 $28.50

Employee $16.04

Employee, Spouse and Child $38.76

Spouse issue ages are 17 through 64 years. Dependent Children issue ages are newborn up to their 26th birthday or to the maximum coverage age defined in the policy.

Group Hospital Indemnity Group Hospital Indemnity insurance is designed to help provide financial protection for covered individuals by paying a benefit due to a hospitalization and in some cases, for treatment received for an accident or sickness, even if that treatment occurs outside the hospital. Employee can use the benefit to meet the out-of-pocket expenses and extra bills that can occur. Indemnity lump sum benefits are paid directly to the employee based on the amount of coverage listed, regardless of the actual cost of treatment. Hospital Admission Wellness Portability Pre-Existing Condition Period Premium

Age Band 17 - 49 50 - 59 60 - 64 65 +

Employee $12.52 $14.26 $19.04 $27.42

$1,000 per insured per calendar year Included - $50 per insured per calendar year Included 12/12 Exclusion Paid by the Employee

Monthly Premium (includes Wellness) Employee and Spouse Employee and Child $24.99 $17.82 $29.14 $19.56 $39.19 $24.34 $56.79 $32.72

Employee, Spouse and Child $30.29 $34.44 $44.49 $62.09

Note: Family Coverage Options assume Employee and Spouse are in the same Age Band. If Employee and Spouse are in different Age Bands, the final Monthly Premium amounts will be different. Spouse issue ages are 17 through 64 years. Dependent Children issue ages are newborn up to their 26th birthday or to the maximum coverage age defined in the policy. *Spouse rate is determined using the Employee’s date of birth at the time of enrollment. Note: You are not required to have medical coverage in order to enroll in this plan

This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Details may differ from state to state. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. 45

UNUM

Critical Illness

YOUR BENEFITS PACKAGE

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 46 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

Critical Illness Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. Who is eligible for this coverage?

All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status).

What are the Critical The following coverage amounts are available. Illness coverage amounts? For you: $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. 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 Cancer Invasive Cancer (including all Breast Cancer) 100% Non-Invasive Cancer 25% Skin Cancer $500 Supplemental Critical Illnesses Benign Brain Tumor 100% Coma 100% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Infectious Disease 25% Occupational Human Immunodeficiency Virus (HIV) or Hepatitis 100% Permanent Paralysis 100% Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) 100% Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100% Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100% *Please refer to the policy for complete definitions of covered conditions. Covered Condition Benefit The covered condition benefit is payable once per covered condition per insured. Unum will pay a covered condition benefit for a different covered condition if: • the new covered condition is medically unrelated to the first covered condition; or • the dates of diagnosis are separated by more than 180 days. 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. 47

Critical Illness What critical illness conditions are covered?

The following Covered Conditions are eligible for a reoccurring condition benefit: Benign Brain Tumor Heart Attack (Myocardial Infarction) Coma Invasive Cancer (includes all Breast Cancer) Coronary Artery Disease (Major) Major Organ Failure Requiring Transplant Coronary Artery Disease (Minor) Non-Invasive Cancer End Stage Renal (Kidney) Failure Stroke

Are wellness Each insured is eligible to receive one Be Well Benefit per calendar year. screenings covered? Be Well Benefit If the employee’s Critical Illness Coverage Amount is:

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

$10,000

$50

$20,000

$75

$30,000

$100

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

How much does the coverage cost?

Age

Option 1 $10,000 EE, $10,000 SP $50 Be Well Benefit Employee Cost Spouse Cost

Option 2 $20,000 EE, $20,000 SP $75 Be Well Benefit Employee Cost Spouse Cost

Option 3 $30,000 EE, $30,000 SP $100 Be Well Benefit Employee Cost Spouse Cost

Less than age 25

$3.52

$7.05

$10.57

25-29

$4.42

$8.85

$13.27

30-34

$5.62

$11.25

$16.87

35-39

$7.42

$14.85

$22.27

40-44

$9.72

$19.45

$29.17

45-49

$12.72

$25.45

$38.17

50-54

$16.02

$32.05

$48.07

55-59

$21.52

$43.05

$64.57

60-64

$29.72

$59.45

$89.17

65-69

$42.82

$85.65

$128.47

70-74

$66.72

$133.45

$200.17

75-79

$98.42

$196.85

$295.27

80-84

$143.62

$287.25

$430.87

85 or over

$231.42

$462.85

$694.27

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/ effective date. Do my critical illness insurance benefits Critical Illness benefits do not decrease due to age. decrease with age? Is the coverage If your employment with your employer ends or you are no longer in an eligible group you can apply for ported coverage and portable (can I keep pay the first premium within 31 days to continue coverage for yourself, your spouse and your children. it if I leave my employer)? 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. 48

Critical Illness 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 non- prescription 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 12 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. 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.

NOTES