2021-22 Texarkana ISD Benefit Guide

TEXARKANA ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2021 - 8/31/2022 WWW.MYBENEFITSHUB.COM/TEXARKANAISD 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) Texas Schools Health Benefits (TSHB) Program TRS-ActiveCare The Hartford Hospital Indemnity MDLIVE Telehealth Cigna Dental Superior Vision Unum Disability APL Cancer Unum Life and AD&D Unum Employee Assistance Program (EAP) HSA Bank Healthcare Savings Account (HSA) NBS Flexible Spending Account (FSA) 2

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 12-17 18-21 22-25 26-27 28-33 34-35 36-39 40-43 44-51 52-53 54-55 56-59

Benefit Contact Information TEXARKANA ISD BENEFITS

DENTAL

LIFE AND AD&D

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

Group #3334658 Cigna (800) 244-6224 www.mycigna.com

Group#422284 Unum (800) 583-6908 www.unum.com

TEXARKANA ISD BENEFITS OFFICE

VISION

FLEXIBLE SPENDING ACCOUNT

Shelley McGee (903) 794-3651 ext. 1009 shelley.mcgee@txkisd.net

Group #328882 Superior Vision (800) 507-3800 www.superiorvision.com

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

MEDICAL: TRS & TSHB

DISABILITY

HOSPITAL INDEMNITY

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

Short Term Group# 000010253169 Long Term Group# 000010253172 Lincoln Financial Group (877) 275-5462 www.lfg.com

Group# 681609 The Hartford (800) 523-2233 www.thehartford.com

TELEHEALTH

EAP

CANCER

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

Unum 800-854-1446 www.unum.com/lifebalance

Group#13311 American Public Life (800) 256-8606 www.ampublic.com

COBRA (MEDICAL)

COBRA (DENTAL & VISION)

HEALTHCARE SAVINGS ACCOUNT

BSwift (833) 682-8972

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

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

Texas Schools Health Benefits Program (800) 583-6908

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

and get access to everything you need to complete your benefits

Text

“FBS TXRK” to (800) 583-6908

enrollment: •

Enrollment Resources

•

Online Support

•

Interactive Tools

•

And more!

App Group #: FBSTXRK

OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/ texarkanaisd

CLICK LOGIN

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

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

ONLINE SUPPORT

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

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

5

Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New: NEW HSA CARRIER EECU

HOSPITAL INDEMNITY

A Health Savings Account (HSA) 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. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP).

This is an affordable supplemental plan that pays you should you be inpatient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance.

Hospital Indemnity insurance provides a cash benefit for every day, week or month you are hospitalized.

Most policies have additional features that help with out of pocket costs related to medical care. Benefits are paid to you directly and it works in addition to your health insurance coverage. This benefit may also be available to your spouse and dependent children.

SHORT TERM DISABILITY What would happen if you lost your ability to earn your paycheck? How long would you be able to continue paying off your bills and buy groceries before you ran out of money? If you’re like 69% of Americans who don’t have as much as $1,000 set aside in their savings account, disability insurance may be the perfect plan for you. Disability Insurance is a safety net that keeps you from having to answer these questions. Short‐term disability replaces a portion of your income and typically provides a benefit for up to 3‐12 months. This policy provides a benefit if you are disabled as a result of a covered illness or injury. Think of it as paycheck protection.

Important Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202 to speak to a representative. Spanish speaking representatives are also available.

Annual Open Enrollment Benefit elections will become effective 9/1/2021 (elections requiring evidence of insurability, such as life Insurance, may have a later effective date, if approved). After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 30 days of event).

6

SUMMARY PAGES

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

Enrollment is automatic unless you decline this benefit.

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

CHANGES IN STATUS (CIS):

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

QUALIFYING EVENTS

Marital Status

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

Change in Number of Tax Dependents

A change in number of dependents includes the following: birth, adoption and placement for adoption.

You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

Change in Status of Employment Affecting Coverage Eligibility

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

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

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

Eligibility for Government Programs

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

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SUMMARY PAGES

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

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your school

Changes are not permitted during the plan year (outside of

district’s benefit website:

annual enrollment) unless a Section 125 qualifying event occurs.

www.mybenefitshub.com/texarkanaisd. Click on the benefit plan you need information on (i.e., Dental) and you can find

•

Changes, additions or drops may be made only during the

the forms you need under the Benefits and Forms section.

annual enrollment period without a qualifying event.

How can I find a Network Provider?

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

district’s benefit website:

included in the dependent profile. Additionally, you must

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

notify your employer of any discrepancy in personal and/or

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

benefit information.

•

For benefit summaries and claim forms, go to your school

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.

provider search links under the Quick Links section.

When will I receive ID cards?

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

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

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

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

Q&A Who do I contact with Questions?

For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 866-914-5202 for assistance.

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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

Blue Cross Blue Shield

26

Dental

Cigna

26

Vision

Superior Vision

26

Cancer

APL

26

Voluntary Life

UNUM

26

Hospital Indemnity

The Hartford

26

Telehealth

MDLIVE

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.

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Helpful Definitions

SUMMARY PAGES

Actively at Work

In-Network

You are performing your regular occupation for the employer

Doctors, hospitals, optometrists, dentists and other providers

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

who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2021 please notify your benefits administrator.

Annual Enrollment The period during which existing employees are given the

opportunity to enroll in or change their current elections.

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

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

Plan Year September 1st through August 31st

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

Calendar Year January 1st through December 31st

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

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

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

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

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(including diagnostic and/or consultation services).

SUMMARY PAGES

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

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

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source

Employee and/or employer

Employee and/or employer

Account Owner

Individual

Employer

Underlying Insurance Requirement

High deductible health plan

None

Minimum Deductible

$1,400 single (2021) $2,800 family (2021)

N/A

Maximum Contribution

$3,600 single (2021) $7,200 family (2021)

$2,750

Permissible Use Of Funds

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

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

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

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

Not permitted

Year-to-year rollover of account balance?

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

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

Does the account earn interest?

Yes

No

Portable?

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

No

Description

FLIP TO FOR HSA INFORMATION

PG. 54

FLIP TO FOR FSA INFORMATION

PG. 56 11

TSHBP

Alternative Medical Plan

YOUR BENEFITS PACKAGE

About this Benefit The TSHBP is proud to offer a variety of plans and benefits to meet school district needs. Plans for 2021-22 include our High Deductible Health Plan (HDHP) and our CoPay Plan (CPP). Both plans are designed so members can easily navigate through their health medical needs.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 12 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Arlington ISD Benefits Website: www.myaisdbenefits.net

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

TSHBP plans are available for school district employees who are employed by participating districts and are active, contributing TRS members.

Both TSHBP Plans Include •

A Nationwide Network for Physician and Ancillary Services.

Both In and Out of Network physician and Ancillary Services are covered

•

No primary care provider required or referral to a specialist.

A member can use any provider in the network or out of the network

•

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

•

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

•

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

•

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

TSHBP High Deductible Highlights •

Significantly lower premium rates compared to the TRS-

TSHBP Co-Pay Highlights •

ActiveCare HD plan •

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

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

•

to meet their deductible (no coinsurance)

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

•

TSHBP HD - $3,000

•

TSHBP CoPay - $3,500

•

In comparison with TRSAC HD - $7,000

•

In comparison with TRSAC Primary - $8,150

•

Telehealth at a $30 Consultation Fee

•

Telehealth at $0 Copay

•

All eligible prescriptions are paid at 100% after the

•

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

deductible

and Costco ($10 copay at other network pharmacies)

13

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

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

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

In-Network Coverage

Out-of-Network Coverage

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

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

$3,000/$9,000

$3,500/$9,500

Yes

Yes

No

No

No

No

Yes - Deductible, then Plan pays 100%

Yes - Deductible, then Plan pays 100%

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

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

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

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

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

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

Deductible, then Plan pays 100%

In-Network Only

Deductible, then Plan pays 100%

In-Network Only

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

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

Doctor Visits Preventive Care Virtual Health - Teladoc Primary Care Specialist

Office Services

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

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

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

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

Rehabilitation/Therapy

https://tshbp.info/CCVideo

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

Care Coordinator* The Care Coordinator program must be used to access facility services or no benefits will be available under the Plan.

These services include routine colonoscopy and related services; hospital providers for MRIs, Cat Scans, and Pet Scans; hospital providers for outpatient Lab/Radiology Services; Inpatient Hospital Admissions; Outpatient Hospital/Ambulatory Surgical Facility Services; Maternity and Newborn Services; Rehabilitation/Therapy Services; Extended Care Services; and Other Services including durable medical equipment/supplies, orthotics/ prosthetics, facilities for diabetic self-management training, and sleep disorder services. To review the complete plan document and services that require access through the Care Coordinator program, please call 888-803-0081.

14

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

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

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

In-Network Coverage

Out-of-Network Coverage

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

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

$3,500/$10,500

$4,000/$11,000

No

No

No

No

No

No

Yes - Copayments, then Plan pays 100%

Yes - Copayments, then Plan pays 100%

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

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

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

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

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

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

$500 copay

In-Network Only

$250 copay

In-Network Only

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

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

Doctor Visits Preventive Care Virtual Health - Teladoc Primary Care Specialist

Office Services

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

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

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

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

Rehabilitation/Therapy

https://tshbp.info/CCVideo

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

Care Coordinator* The Care Coordinator program must be used to access facility services or no benefits will be available under the Plan.

These services include routine colonoscopy and related services; hospital providers for MRIs, Cat Scans, and Pet Scans; hospital providers for outpatient Lab/Radiology Services; Inpatient Hospital Admissions; Outpatient Hospital/Ambulatory Surgical Facility Services; Maternity and Newborn Services; Rehabilitation/Therapy Services; Extended Care Services; and Other Services including durable medical equipment/supplies, orthotics/ prosthetics, facilities for diabetic self-management training, and sleep disorder services. To review the complete plan document and services that require access through the Care Coordinator program, please call 888-803-0081.

15

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

EO

EC

ES

EF

TRS‐Ac veCare HD

$429

$772

$1,209

$1,445

TRS‐Ac veCare Primary +

$542

$879

$1,334

$1,675

TRS‐Ac veCare Primary

$417

$751

$1,176

$1,405

TSHBP

EO

EC

ES

EF

HD Plan

$347

$665

$985

$1,298

CoPay Plan

$391

$755

$1,115

$1,467

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

Cost for Individuals $3,000 $3,500

TSHBP CoPay Plan

$9,000 $10,500

$7,000

TRS‐Ac veCare HD

$14,000

$6,900

TRS‐ActiveCare Primary +

$13,800

$8,150

16

TSHBP HD Plan

TRS‐Ac veCare Primary

$16,300

Texas Schools Health Benefits Cost Examples TRS

PEG IS HAVING A BABY

HD

Deductible

TSHBP

Primary Primary+

HD

Co Pay

$3,000

$2,500

$1,200

$3,000

$3,500

Specialist Coinsurance/Copayment

30%

$70

$70

0%

$35

Hospital Coinsurance/Copayment

30%

30%

20%

0%

$500

Other Coinsurance/Copayment

30%

30%

20%

0%

$250

Total Example Cost

$12,800

$12,800

$12,800

$12,800

$12,800

Deductibles

$3,000

$2,500

$1,200

$3,000

$0

Copayments

$0

$70

$70

$0

$1,285

Coinsurance

$2,940

$3,000

$2,300

$0

$0

$60

$60

$60

$0

$0

$6,000

$5,630

$3,630

$3,000

$1,285

Limits or Exclusions Total Cost

Compared to TRS-AC HD (savings)

$3,000

Compared to TRS-AC Primary (savings)

$2,345

Compared to TRS-AC Primary + (savings)

$4,345

TOM’S KNEE REPLACEMENT Deductible

TRS HD

TSHBP

Primary Primary+

HD

Co Pay

$3,000

$2,500

$1,200

$3,000

$3,500

Specialist Coinsurance/Copayment

30%

$70

$70

0%

$35

Hospital Coinsurance/Copayment

30%

30%

20%

0%

$500

Other Coinsurance/Copayment

30%

30%

20%

0%

$250

Total Example Cost

$38,000

$38,000

$38,000

$38,000

$38,000

Deductibles

$3,000

$2,500

$1,200

$3,000

$0

Copayments

$0

$70

$70

$0

$1,385

Coinsurance

$10,500

$10,650

$7,360

$0

$0

$60

$60

$60

$0

$0

$7,000*

$8,150*

$6,900*

$3,000

$1,385

Limits or Exclusions Total Cost

Compared to TRS-AC HD (savings)

$4,000

Compared to TRS-AC Primary (savings)

$6,785

Compared to TRS-AC Primary + (savings)

$5,535

*Out-of-pocket limit

17

BCBS

Medical

About this Benefit

YOUR BENEFITS PACKAGE

DID YOU KNOW?

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 in-patient or out-patient basis.

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

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

Medical

TRS ActiveCare Plan 2021-2022 Health Insurance Rates Medical—Employees (10 or more hours per week are eligible) TRS-ActiveCare Primary Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

Employee Pays

Employer Pays

Monthly Total

$417.00

$242

$175.00

$1,176.00

$242

$934.00

$751.00

$242

$509.00

$1,405.00

$242

$1,163.00

$429.00

$242.00

$187.00

$1,209.00

$242.00

$967.00

$772.00

$242.00

$530.00

$1,445.00

$242.00

$1,203.00

$542.00

$242.00

$300.00

$1,334.00

$242.00

$1,092.00

$879.00

$242.00

$637.00

$1,675.00

$242.00

$1,433.00

TRS-ActiveCare HD Employee Only Employee and Spouse Employee and Child(ren) Employee and Family TRS-ActiveCare Primary+ Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

ActiveCare 2 (current participants only) Employee Only

$1,013.00

$242.00

$771.00

Employee and Spouse

$2,402.00

$242.00

$2,160.00

Employee and Child(ren)

$1,507.00

$242.00

$1,265.00

Employee and Family

$2,841.00

$242.00

$2,599.00

19

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

TRS-ActiveCare 2 TRS-ActiveCare Primary • Lowest premium of the •

Plan summary

• • • •

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

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

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

Your Premium $ $ $ $

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

TRS-ActiveCare Primary+

TRS-ActiveCare HD

• Lower deductible than the HD and

• Compatible with a health savings

• • • • • •

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

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

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

• Closed to new enrollees • Current enrollees can choose to

stay in this plan

• Lower deductible • Copays for many drugs and

services

• Nationwide network with out-of-

network coverage

• No requirement for PCPs or

referrals

Your Premium $ $ $ $

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

Your Premium $ $ $ $

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

Your Premium $ $ $ $

Plan Features Type of Coverage Individual/Family Deductible

In-Network Coverage Only

In-Network Coverage Only

In-Network

Out-of-Network

In-Network

Out-of-Network

$2,500/$5,000

$1,200/$3,600

$3,000/$6,000

$5,500/$11,000

$1,000/$3,000

$2,000/$6,000

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 20% after deductible

$8,150/$16,300

$6,900/$13,800

Statewide Network

Statewide Network

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

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

Yes

Yes

No

No

Primary Care

$30 copay

$30 copay

Specialist

$70 copay

$70 copay

$0 per consultation

$0 per consultation

$50 copay

$50 copay

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

$0 per consultation

$0 per consultation

$30 per consultation

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

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

$200 brand deductible

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

Preferred Brand

You pay 30% after deductible

You pay 25% after deductible

You pay 25% after deductible

Non-preferred Brand

You pay 50% after deductible

You pay 50% after deductible

You pay 50% after deductible

Specialty

You pay 30% after deductible

You pay 20% after deductible

You pay 20% after deductible

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

Doctor Visits

TRS Virtual Health

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

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

Immediate Care Urgent Care Emergency Care TRS Virtual Health

You pay 30% after deductible

You pay 50% after deductible

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

Prescription Drugs $15/$45 copay

How to Calculate Your Monthly Premium

Wellness Benefits at No Extra Cost

Total Monthly Premium

Being healthy is easy with:

Your District and State Contributions

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

Things to Know • •

TRS’s Texas-sized purchasing power creates broad networks without county boundaries.

Specialty drug insurance means you’re covered, no matter what life throws at you.

20

• • • • •

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

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

• • • •

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

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

2021-22 Health Maintenance Organizations: Premiums for Regional Plans Remember: When you choose an HMO, you’re choosing a regional network.

TRS also contracts with HMOs in certain regions of the state to bring participants in those areas another option.

Central and North Texas Scott and White Care Plan

Blue Essentials — South Texas HMOSM

Brought to you by TRS-ActiveCare

Brought to you by TRS-ActiveCare

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

Total Monthly Premiums Employee Only

Total Premium

Your Premium

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

Total Premium

Your Premium

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

Total Premium

Your Premium

$542.48

$

$524.00

$

$596.54

$

Employee and Spouse

$1,362.70

$

$1,264.28

$

$1,443.66

$

Employee and Children

$872.16

$

$819.60

$

$936.18

$

$1,568.42

$

$1,345.58

$

$1,532.74

$

Employee and Family

Plan Features Type of Coverage

In-Network Coverage Only

In-Network Coverage Only

$1,150/$3,450

$500/$1,000

$950/$2,850

You pay 20% after deductible

You pay 20% after deductible

You pay 25% after deductible

$7,450/$14,900

$4,500/$9,000

$7,450/$14,900

Primary Care

$20 copay

$25 copay

$20 copay

Specialist

$70 copay

$60 copay

$70 copay

$50 copay

$75 copay

$50 copay

$500 copay after deductible

You pay 20% after deductible

$500 copay before deductible and 25% after deductible

$200 (excl. generics)

$100

$150

30-day supply/90-day supply

30-day supply/90-day supply

30-day supply/90-day supply

Individual/Family Deductible Coinsurance Individual/Family Maximum Outof-Pocket

In-Network Coverage Only

Doctor Visits

Immediate Care Urgent Care Emergency Care

Prescription Drugs Drug Deductible Day Supply Generics

$10/$25 copay

$10/$30 copay

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

Preferred Brand

You pay 30% after deductible

$40/$120 copay

You pay 30% after deductible

Non-preferred Brand

You pay 50% after deductible

$65/$195 copay

You pay 50% after deductible

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

You pay 20% after deductible

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

Specialty

trs.texas.gov 21

THE HARTFORD YOUR BENEFITS PACKAGE

Hospital Indemnity

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

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

$9,600

$10,400

$10,700

2008

2012

2018

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

Hospital Indemnity Plan GROUP VOLUNTARY HOSPITAL INDEMNITY INSURANCE BENEFIT HIGHLIGHTS Hospital indemnity (HI) insurance pays a cash benefit if you or an insured dependent (spouse or child) are confined in a hospital for a covered illness or injury. Even with the best primary health insurance plan, out-of-pocket costs from a hospital stay can add up.

The benefits are paid in lump sum amounts to you, and can help offset expenses that primary health insurance doesn’t cover (like deductibles, co-insurance amounts or co- pays), or benefits can be used for any non-medical expenses (like housing costs, groceries, car expenses, etc.).

To learn more about Hospital Indemnity insurance, visit thehartford.com/employeebenefits

A 4-day stay in the hospital could cost around $10,000.1

Coverage Information You have a choice of two hospital indemnity plans, which allows you the flexibility to enroll for the coverage that best meets your needs. Benefit amounts are based on the plan in effect for you or an insured dependent at the time the covered event occurs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s).

PLAN INFORMATION

OPTION 1

OPTION 2

Coverage Type

On and off-job (24 hour)

On and off-job (24 hour)

Covered Events

Illness and injury

Illness and injury

HSA Compatible

Yes

Yes

OPTION 1

OPTION 2

$1,000

$2,000

BENEFITS HOSPITAL CARE

First Day Hospital Confinement

Up to 1 day per year

Daily Hospital Confinement (Day 2+)

Up to 30 days per year

$100

$200

Daily ICU Confinement (Day 1+)

Up to 30 days per year

$200

$400

VALUE ADDED SERVICES Ability Assist® EAP4 – 24/7/365 access to help for financial, legal or emotional issues HealthChampionSM5 – Administrative & clinical support following serious illness or injury

PLAN 1

PLAN 3

Included

Included

Included

Included

ASKED & ANSWERED

PREMIUMS The amounts shown are monthly amounts (12 payments/deductions per year).3

IS THIS COVERAGE HSA COMPATIBLE? PLAN 1 PLAN 3 If you (or any dependent(s)) currently participate Employee Only $14.44 ($0.47 per day) $28.88 ($0.95 per day) in a Health Saving Account (HSA) or if you plan to Employee & Spouse $26.09 ($0.86 per day) $52.19 ($1.72 per day) do so in the future, you should be aware that the Employee & Child(ren) $26.59 ($0.87 per day) $53.17 ($1.75 per day) IRS limits the types of supplemental insurance Employee & Family $40.25 ($1.32 per day) $80.51 ($2.65 per day) you may have in addition to a HSA, while still maintaining the tax-exempt status of the HSA. Both HSA compatible and non-HSA compatible plans are available to you, as indicated in the Plan Information section. If you have or plan to open an HSA, please consult your tax and legal advisors to determine which supplemental benefits may be purchased by employees with an HSA. WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full-time employee who works at least 20 hours per week on a regularly scheduled basis. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26.

AM I GUARANTEED COVERAGE? This insurance is guaranteed issue coverage – it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured.

23

Hospital Indemnity HOW MUCH DOES IT COST AND HOW DO I PAY FOR THIS INSURANCE? Premiums are provided above. You have a choice of plan options. You may elect insurance for you only, or for you and your dependent(s), by choosing the applicable coverage tier.

Premiums will be automatically paid through payroll deduction, as authorized by you during the enrollment process.

This ensures you don’t have to worry about writing a check or missing a payment.

WHEN CAN I ENROLL? You may enroll during any scheduled enrollment period, or within 31 days of the date you have a change in family status.

WHEN DOES THIS INSURANCE BEGIN? Insurance will become effective in accordance with the terms of the certificate (usually the first day of the month following the date you elect coverage).

You must be actively at work with your employer on the day your coverage takes effect. Your spouse and child(ren) must be performing normal activities and not be confined (at home or in a hospital/care facility).

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

CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP? Yes, you can take this coverage with you. Coverage may be continued for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances. The specific terms and qualifying events for portability are described in the certificate.

1“Hospital Adjusted Expenses per Inpatient Day.” Kaiser Family Foundation. 2015. Web. 2 Mar. 2017.

2For Hospital Care benefits, when an insured is eligible for more than one benefit in a single day, only the highest benefit will be paid.

3Rates and/or benefits may be changed.

4HealthChampionSM and Ability Assist® services are provided through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford is not responsible and assumes no liability for the goods and services provided by ComPsych.

Prepare. Protect. Prevail. With The Hartford. ® The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. 5962h NS 08/16 © 2016 The Hartford Financial Services Group, Inc. All rights reserved.

This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder. Hospital does not include: convalescent homes, or convalescent, rest or nursing facilities; facilities affording primarily custodial, educational or rehabilitory care; or facilities primarily for care of the aged/elderly, persons with substance abuse issues/disorders or mental/nervous disorders. Confinement means the assignment to a bed in a medical facility for a period of at least 20 consecutive hours. Required hours may vary by state. The Hartford compensates both internal and external producers, as well as others, for the sale and service of our products. For additional information regarding Hartford’s compensation practices, please review our website http://thehartford.com/group-benefits-producer-compensation. Hospital Income Plan Form Series includes GBD-2800, GBD-2900, or state equivalent.

LIMITATIONS & EXCLUSIONS This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this

insurance coverage. A copy of the certificate can be obtained from your employer.

GROUP HOSPITAL INDEMNITY INSURANCE LIMITATIONS AND EXCLUSIONS The benefits payable are based on the insurance in effect on the date of the covered event, subject to the definitions, limitations, exclusions and other provisions of the policy.

You and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates.

Other Hospital Indemnity Policy Limitation (Over-insurance Limitation): If an employee is insured under any other hospital indemnity policy underwritten by The Hartford, any claim for benefit is only payable under the one policy elected by the employee (or beneficiary or estate, in the event of death). We will return the amount of premium paid for any other policy that is declined by the employee retroactive to the later of: • the last date any benefit was paid for any covered person under the other policy • the effective date of insurance for the employee under the other policy

24

Hospital Indemnity Exclusions. This insurance does not provide benefits for any loss that results from or is caused by: • Voluntary intoxication (as defined by the law of the jurisdiction in which the illness or injury occurred) or while under the influence of any narcotic, drug or controlled substance, unless administered by or taken according to the instruction of a physician or medical professional • Voluntary intoxication through use of poison, gas or fumes, whether by ingestion, injection, inhalation or absorption • Voluntary commission of or attempt to commit a felony, voluntary participation in illegal activities (except for misdemeanor violations), voluntary participation in a riot, or voluntary engagement in an illegal occupation • Incarceration or imprisonment following conviction for a crime • Travel in or descent from any vehicle or device for aviation or aerial navigation, except as a fare-paying passenger in a commercial aircraft (other than a charter airline) on a regularly scheduled passenger flight or while traveling on business of the policyholder • Ride in or on any motor vehicle or aircraft engaged in acrobatic tricks/stunts (for motor vehicles), acrobatic/stunt flying (for aircraft), endurance tests, off-road activities (for motor vehicles), or racing • Participation in any organized sport in a professional or semi-professional capacity • Participation in abseiling, base jumping, Bossaball, bouldering, bungee jumping, cave diving, cliff jumping, free climbing, freediving, freerunning, hang gliding, ice climbing, Jai Alai, jet powered flight, kite surfing, kiteboarding, luging, missed climbing, mountain biking, mountain boarding, mountain climbing, mountaineering, parachuting, paragliding, parakiting, paramotoring, parasailing, Parkour, proximity flying, rock climbing, sail gliding, sandboarding, scuba diving, sepak takraw, slacklining, ski jumping, skydiving, sky surfing, speed flying, speed riding, train surfing, tricking, wingsuit flying, or other similar extreme sports or high risk activities • Travel or activity outside the United States or Canada • Active duty service or training in the military (naval force, air force or National Guard/Reserves or equivalent) for service/training extending beyond 31 days of any state, country or international organization, unless specifically allowed by a provision of the certificate • Involvement in any declared or undeclared war or act of war (not including acts of terrorism), while serving in the military or an auxiliary unit attached to the military, or working in an area of war whether voluntarily or as required by an employer This insurance also does not provide benefits, unless required by law, for: • Elective abortion or complications thereof • Artificial insemination, in vitro fertilization, test tube fertilization • Sterilization, tubal ligation or vasectomy, and reversal thereof • Aroma therapeutic, herbal therapeutic, or homeopathic services • Any mental and nervous disorder, unless specifically allowed by a provision of the certificate • Substance abuse, unless specifically allowed by a provision of the certificate • Medical mishap or negligence on the part of any physician, medical professional, or therapist, including malpractice; • Treatment, supplies or services provided by, through or, behalf of any government agency or program; unless payment is required by a covered person • Custodial care, unless specifically allowed by a benefit provision in the certificate or any rider attached to the policy (if applicable) • Elective or cosmetic surgery or procedures, except for reconstructive surgery: • Incidental to or following surgery for disease, infection or trauma of the involved body part • Due to congenital anomaly or disease of a dependent child which has resulted in a functional defect • Dental care or treatment, except for: • Treatment due to an Injury to sound natural teeth within 12 months of an accident • Treatment necessary due to congenital disease or anomaly NOTICES THE POLICY IS A HOSPITAL CONFINEMENT INDEMNITY POLICY. THE POLICY PROVIDES LIMITED BENEFITS. This limited health benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage.

The Policy may provide payment of several benefits as a result of claims from a single hospitalization or covered incident. Payment of one benefit under the Policy does not constitute acceptance of liability for all claims made under the Policy nor does it prohibit Us from further investigation of subsequent claims.

Please note: For residents of CA, GA, NJ and NY, since this is a limited benefit health product, persons without comprehensive health benefits from an individual or group health insurance policy or an HMO, or an employer plan providing essential health benefits are not eligible for this insurance. For residents of CT, ID, ME, NH, and WV, a person covered by any Title XIX program (Medicaid or any similar name) is not eligible for this insurance.

5962h NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Hospital Income Plan Form Series includes GBD-2800, GBD-2900, or state equivalent.

Prepare. Protect. Prevail. With The Hartford. ® The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder.

TEXARKANA INDEPENDENT SCHOOL DISTRICT HOSPITAL INDEMNITY BHS_PUBLICATION DATE: 4/16/2019

25

MDLIVE

Telehealth

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

YOUR BENEFITS PACKAGE

75%

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

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

Telehealth Need a doctor?

Download the MDLIVE Mobile App

No long wait. No big bill. Always open.

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

Quality care now goes where you do.

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

Welcome to MDLIVE! Your anytime, anywhere doctor’s office.

Welcome to MDLIVE!

We treat over 50 routine medical conditions including:

Your virtual doctor is here. Join for free today!

Your anytime, anywhere doctor’s office.

Avoid waiting rooms and the inconvenience of going to the Avoid waiting rooms and the inconvenience of going to the doctor’s office. Visit a doctor or counselor by phone, secure video doctor’s office. Visit a doctor by phone, secure video, or MDLIVE or MDLIVE app. Pediatricians are available 24/7, and family App. Pediatricians are available 24/7, and family members are also members are also eligible. eligible.

• U.S. board-certified doctors with an average of 15 years of • U.S. board certified doctors and licensed counselors with an experience. average of 15 years of experience.

• Consultations are convenient, private and secure.

• Consultations are convenient, private and secure • Prescriptions can be sent to your nearest pharmacy, if • Prescriptions can be sent to your nearest pharmacy, if medically necessary. medically necessary.

• • • • • • •

Acne Allergies Cold / Flu Constipation Cough Diarrhea Ear Problems

• • • • • •

Fever Headache Insect Bites Nausea / Vomiting Pink Eye Rash

Your Monthly Premium is

•

• • • •

Respiratory Problems Sore Throats Urinary Problems / UTI Vaginitis And More

The MDLIVE mobile app makes connecting with doctors and behavioral health counselors fast, easy and convenient.

No smartphone? No worries!

Register your account using a computer or phone.

Download the app.

Join for free. Visit a doctor. consultmdlive.com 888-365-1663

$10 Join for free. Visit a doctor. consulmdlive.com 888-365-1663

Copyright © 2019 MDLIVE Inc. All Rights Reserved. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not replace the primary care physician, is not an insurance product and may not be able to substitute for traditional in person care in every case or for every condition. MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will receive a prescription. Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit https://www.MDLIVE.com/terms-of-use/.

27

CIGNA

Dental

YOUR BENEFITS PACKAGE

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

Good dental care may improve your overall health.

Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 28 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 Texarkana ISD Benefits Website: www.mybenefitshub.com/texarkanaisd

Dental PPO - High Plan Network Options

Cigna Dental Choice Plan In-Network: Total Cigna DPPO Network

Out-of-Network: See Non-Network Reimbursement

Reimbursement Levels Policy Year Benefits Maximum

Based on Contracted Fees

Maximum Reimbursable Charge

Applies to: Class I, II, & III expenses

$1,000

$1,000

$50 $150

$50 $150

Monthly Premium

EE Only

$28.53

EE + Spouse

$65.29

EE + Children

$70.97

EE + Family

$103.88

Policy Year Deductible Individual Family

Benefit Highlights Class I: Diagnostic & Preventive Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain

Class II: Basic Restorative Restorative: fillings Endodontics: minor and major Periodontics: minor and major Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: Bridges, Crowns and Inlays Repairs: Dentures Denture Relines, Rebases and Adjustments

Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures

Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000

Plan Pays

You Pay

100% No Deductible

No Charge

Plan Pays

You Pay

100% *Any amount over No Deductible the maximum reimbursable charge

80% After Deductible

20% After Deductible

80% After Deductible

*20% After Deductible

50% After Deductible

50% After Deductible

50% After Deductible

*50% After Deductible

50% 50% 50% No Deductible No Deductible No Deductible

Cigna Dental Benefit Summary Texarkana ISD #3334658 - High Insured by: Cigna Health and Life Insurance Company This material is for informational purposes only and is designed to highlight some of the benefits available under this plan. Consult the plan documents to determine specific terms of coverage relating to your plan. Terms include covered procedures, applicable waiting periods, exclusions and limitations.

*50% No Deductible

Benefit Plan Provisions:

In-Network Reimbursement *Non-Network Reimbursement

Cross Accumulation Policy Year Benefits Maximum

Policy Year Deductible Pretreatment Review Alternate Benefit Provision

For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule.

For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge. The MRC is calculated at the 90th percentile of all provider charges in the geographic area. The dentist may balance bill up to their usual fees.

All deductibles, plan maximums, and service specific maximums cross accumulate between in and out of network. Benefit frequency limitations are based on the date of service and cross accumulate between in and out of network.

The plan will only pay for covered charges up to the yearly Benefits Maximum, when applicable.

Benefit-specific Maximums may also apply.

This is the amount you must pay before the plan begins to pay for covered charges, when applicable. Benefit-specific deductibles may also apply.

Pretreatment review is available on a voluntary basis when dental work in excess of $200 is proposed.

When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses.

29

Dental PPO - High Plan

Oral Health Integration Program (OHIP)

Timely Filing Benefit Limitations: Missing Tooth Limitation Oral Evaluations X-rays (routine) X-rays (non-routine) Diagnostic Casts Cleanings Fluoride Application Sealants (per tooth) Space Maintainers

Inlays, Crowns, Bridges, Dentures and Partials Denture and Bridge Repairs Denture Adjustments, Rebases and Relines Prosthesis Over Implant

Cigna Dental Oral Health Integration Program offers enhanced dental coverage for customers with the following medical conditions: diabetes, heart disease, stroke, maternity, head and neck cancer radiation, organ transplants and chronic kidney disease. There’s no additional charge for the program, those who qualify get reimbursed 100% of coinsurance for certain related dental procedures. Eligible customers can also receive guidance on behavioral issues related to oral health and discounts on prescription and non-prescription dental products. Reimbursements under this program are not subject to the plan deductible, but will be applied to and are subject to the plan annual maximum. Discounts on certain prescription and non-prescription dental products are available through Cigna Home Delivery Pharmacy only, and you are required to pay the entire discounted charge. For more information including how to enroll in this program and a complete list of program terms and eligible medical conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24.

Out of network claims submitted to Cigna after 365 days from date of service will be denied.

For teeth missing prior to coverage with Cigna, the amount payable is 50% of the amount otherwise payable until covered for 24 months; thereafter, considered a Class III expense.

2 per policy year Bitewings: 2 per policy year Complete series of radiographic images and panoramic radiographic images: Limited to a combined total of 1 per 36 months Payable only in conjunction with orthodontic workup 2 per policy year, including periodontal maintenance procedures following active therapy 1 per policy year for children under age 19 Limited to posterior tooth. 1 treatment per tooth every 36 months for children under age 14 Limited to non-orthodontic treatment for children under age 19 Replacement every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth-colored material on molar crowns or bridges.

Reviewed if more than once Covered if more than 6 months after installation 1 every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth colored material on molar crowns or bridges.

Benefit Exclusions: Covered Expenses will not include, and no payment will be made for the following: Procedures and services not listed under Benefit Highlights; Diagnostic: cone beam imaging; Preventive Services: instruction for plaque control, oral hygiene and diet; Restorative: Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and/or third molars; Periodontic: bite registrations; splinting; Prosthodontic: precision or semi-precision attachments; Implants: implants or implant related services; Procedures, appliances or restorations, except full dentures, whose main purpose is to: change vertical dimension; diagnose or treat conditions or dysfunction of the temporomandibular joint (TMJ); stabilize periodontally involved teeth; or restore occlusion; Athletic mouth guards; Replacement of a lost or stolen appliance; Services performed primarily for cosmetic reasons; Personalization; Services that are deemed to be medical in nature; Services and supplies received from a hospital; Drugs: prescription drugs Charges in excess of the Maximum Reimbursable Charge.

Contracted providers are not obligated to provide discounts on non-covered services and may charge their usual fees.

This document provides a summary only. It is not a contract. If there are any differences between this summary and the official plan documents, the terms of the official plan documents will prevail.

Cigna Dental PPO plans are insured and/or administered by Cigna Health and Life Insurance Company (CHLIC) or Connecticut General Life Insurance Company (CGLIC), with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO network.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. Policy forms (for insured dental plans) in OK: HP-POL99 (CHLIC), GM6000 ELI288 et al (CGLIC); OR: HP-POL68; TN: HP-POL69/HC-CER2V1 et al (CHLIC). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. © 2017 Cigna / version 06192017 30

Dental PPO - Low Plan Network Options

Cigna Dental Choice Plan In-Network: Total Cigna DPPO Network

Out-of-Network: See Non-Network Reimbursement

Reimbursement Levels Policy Year Benefits Maximum

Based on Contracted Fees

Maximum Reimbursable Charge

Applies to: Class I, II, & III expenses

$500

$500

$50 $150

$50 $150

Monthly Premium

EE Only

$25.10

EE + Spouse

$57.46

EE + Children

$62.47

EE + Family

$91.40

Policy Year Deductible Individual Family

Benefit Highlights Class I: Diagnostic & Preventive Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain

Class II: Basic Restorative Restorative: fillings Endodontics: minor and major Periodontics: minor and major Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: Bridges, Crowns and Inlays Repairs: Dentures Denture Relines, Rebases and Adjustments

Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures

Plan Pays

You Pay

100% No Deductible

No Charge

Plan Pays

You Pay

100% *Any amount over No Deductible the maximum reimbursable charge

80% After Deductible

20% After Deductible

80% After Deductible

*20% After Deductible

50% After Deductible

50% After Deductible

50% After Deductible

*50% After Deductible

Cigna Dental Benefit Summary Texarkana ISD #3334658 - Low Insured by: Cigna Health and Life Insurance Company This material is for informational purposes only and is designed to highlight some of the benefits available under this plan. Consult the plan documents to determine specific terms of coverage relating to your plan. Terms include covered procedures, applicable waiting periods, exclusions and limitations.

Benefit Plan Provisions: In-Network Reimbursement *Non-Network Reimbursement

Cross Accumulation Policy Year Benefits Maximum Policy Year Deductible Pretreatment Review Alternate Benefit Provision

For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule.

For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge. The MRC is calculated at the 90th percentile of all provider charges in the geographic area. The dentist may balance bill up to their usual fees.

All deductibles, plan maximums, and service specific maximums cross accumulate between in and out of network. Benefit frequency limitations are based on the date of service and cross accumulate between in and out of network.

The plan will only pay for covered charges up to the yearly Benefits Maximum, when applicable. Benefit-specific Maximums may also apply.

This is the amount you must pay before the plan begins to pay for covered charges, when applicable. Benefit-specific deductibles may also apply.

Pretreatment review is available on a voluntary basis when dental work in excess of $200 is proposed.

When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses.

31

Dental PPO - Low Plan

Oral Health Integration Program (OHIP)

Timely Filing Benefit Limitations: Missing Tooth Limitation Oral Evaluations X-rays (routine) X-rays (non-routine) Cleanings Fluoride Application Sealants (per tooth) Space Maintainers Inlays, Crowns, Bridges, Dentures and Partials

Denture and Bridge Repairs Denture Adjustments, Rebases and Relines Prosthesis Over Implant

Cigna Dental Oral Health Integration Program offers enhanced dental coverage for customers with the following medical conditions: diabetes, heart disease, stroke, maternity, head and neck cancer radiation, organ transplants and chronic kidney disease. There’s no additional charge for the program, those who qualify get reimbursed 100% of coinsurance for certain related dental procedures. Eligible customers can also receive guidance on behavioral issues related to oral health and discounts on prescription and non-prescription dental products. Reimbursements under this program are not subject to the plan deductible, but will be applied to and are subject to the plan annual maximum. Discounts on certain prescription and non-prescription dental products are available through Cigna Home Delivery Pharmacy only, and you are required to pay the entire discounted charge. For more information including how to enroll in this program and a complete list of program terms and eligible medical conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24.

Out of network claims submitted to Cigna after 365 days from date of service will be denied.

For teeth missing prior to coverage with Cigna, the amount payable is 50% of the amount otherwise payable until covered for 24 months; thereafter, considered a Class III expense.

2 per policy year Bitewings: 2 per policy year Complete series of radiographic images and panoramic radiographic images: Limited to a combined total of 1 per 36 months 2 per policy year, including periodontal maintenance procedures following active therapy 1 per policy year for children under age 19 Limited to posterior tooth. 1 treatment per tooth every 36 months for children under age 14 Limited to non-orthodontic treatment for children under age 19 Replacement every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth-colored material on molar crowns or bridges.

Reviewed if more than once Covered if more than 6 months after installation 1 every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth colored material on molar crowns or bridges.

Benefit Exclusions: Covered Expenses will not include, and no payment will be made for the following: Procedures and services not included in the list of covered dental expenses; Diagnostic: cone beam imaging; Preventive Services: instruction for plaque control, oral hygiene and diet; Restorative: veneers of porcelain, ceramic, resin, or acrylic materials on crowns or pontics on or replacing the upper and or lower first, second and/ or third molars; Periodontics: bite registrations; splinting; Prosthodontics: precision or semi-precision attachments; initial placement of a complete or partial denture per plan guidelines; Implants: implants or implant related services; Orthodontics: orthodontic treatment; Procedures, appliances or restorations, except full dentures, whose main purpose is to: change vertical dimension; diagnose or treat conditions or dysfunction of the temporomandibular joint (TMJ); stabilize periodontally involved teeth; or restore occlusion; Athletic mouth guards; services performed primarily for cosmetic reasons; personalization; replacement of an appliance per benefit guidelines; Services that are deemed to be medical in nature; services and supplies received from a hospital; Drugs: prescription drugs Charges in excess of the Maximum Reimbursable Charge.

This document provides a summary only. It is not a contract. If there are any differences between this summary and the official plan documents, the terms of the official plan documents will prevail.

Cigna Dental PPO plans are insured and/or administered by Cigna Health and Life Insurance Company (CHLIC) or Connecticut General Life Insurance Company (CGLIC), with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO network.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. Policy forms (for insured dental plans) in OK: HP-POL99 (CHLIC), GM6000 ELI288 et al (CGLIC); OR: HP-POL68; TN: HP-POL69/ HC-CER2V1 et al (CHLIC). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. © 2017 Cigna / version 06192017

32

33

SUPERIOR VISION

Vision

YOUR BENEFITS PACKAGE

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 34 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 Texarkana ISD Benefits Website: www.mybenefitshub.com/texarkanaisd

Vision Presenting the Superior Vision Plan Provided through Texarkana ISD

Outline of Benefits Comprehensive Exam Ophthalmologist (MD) Comprehensive Exam Optometrist (OD)

In-Network

Out-ofNetwork

Covered in full Covered in full

Up to $42 Up to $37

Covered in full Covered in full Covered in full Covered in full

Up to $32 Up to $46 Up to $61 Up to $84

Covered in full Up to $120 Covered in full Up to $50 Up to $100

Up to $210 Up to $100 Not Covered Not Covered Up to $48

Standard Lenses: Single Vision Bifocal Trifocal Lenticular

Contact Lenses:* Medically Necessary Cosmetic-Elective** Standard Contact Lens Fitting Exam Fee*** Specialty Contact Lens Fitting Exam Fee*** Frames-Standard**

*Contact lenses are in lieu of eyeglass lenses and frames benefit. **The insured is responsible for paying any charges in excess of this allowance. ***Standard contact lens fitting fee applies to an existing contact lens user who wears disposable, daily wear, or extended wear lenses only. The specialty contact lens fitting fee applies to new contact lens wearers and/or a member who wears toric, gas permeable, or multi-focal lenses. For the specialty fit, the member is responsible for any charges over $50.

Note: This is only a summary of the benefit plan. You may review and/or obtain a copy of the certificate of coverage by contacting your Human Resources/Employee Benefits office.

Monthly Rates

Employee Only

$7.68

Employee + Spouse

$15.18

Employee + Child(ren)

$14.88

Employee + Family

$22.62

Co-Payment Exam

$10

Materials

$25

Contact Lens Fitting Exam Fee

$25

In-network co-pay: Paid to the in-network provider.

Materials co-pay: Applies to lenses and/or frames, not contact lenses.

Plan Frequency Comprehensive Exam

12 months

Lenses

12 months

Frames

24 months

Contact Lenses

12 months

Discount SVP8-20

Discounts on Additional Purchases

These discounts apply to upgrades on the covered frame and lenses only.

For discounts on additional pairs, please refer to the Discounts on Additional Purchases.

Prescription eyeglass lenses 30% off retail Add-on charges to basic lenses 20% off retail Contact lenses (except disposables) 20% off retail Disposable contact lenses 10% off retail All other prescription materials 20% off retail Eyeglass frames 30% off retail Everyday “frames and lens” package pricing 20% off retail Discounts are provided by Superior Vision contracted providers identified in the provider directory with a “DP”.

Frames:

20% off the difference between the covered frame allowance and the retail price of the selected frame.

Note: Discounts do not apply when prohibited by the manufacturer.

Add-ons to the covered pair of lenses Lens Options and Upgrades Scratch Coat (Factory) Ultraviolet Coat Standard Anti-Reflective Coat* High Index 1.6* Polycarbonate Standard Photochromic Plastic Tints solid or gradient Glass Coloring Power over 4.00 Sphere, 2.00D Cylinder & 5.00D Prism Cosmetic Finishing, Beveling, Edging & Mounting All other Lens Options/Upgrades

Member pays 20% off retail up to $13 (Single Vision & Standard Lined Multifocal Lenses) $15 (Single Vision & Standard Lined Multifocal Lenses) $50 (Single Vision & Standard Lined Multifocal Lenses) $55 (Single Vision Lenses Only) $40 (Single Vision Lenses Only) $80 (Single Vision Lenses Only) $25 (Any Type Lenses) $35 (Any Type Lenses) Member pays 20% discount off retail

Refractive Surgery Discounts & Cosmetic Eyelid Surgery Discounts are available: Superior Vision Services has a nationwide network of refractive surgeons who specialize in the popular elective procedures of radial keratotomy (RK), photo-refractive keratotomy (PRK) and LASIK. These providers offer Superior Vision Plan members a 20% discount off their usual and customary surgical fees for these procedures. Ophthalmic plastic surgeons are also contracted to provide the procedure of blephoraplasty (cosmetic eyelid surgery) to Superior Vision Plan members on the same discount basis.

View your benefits and provider listings at ww.superiorvision.com.

20% discount off retail

20% discount off retail

* Higher end or brand name lens upgrades are at an additional expense to the member. You may apply the maximum out of pocket expense toward the upgraded lens retail cost and the member is responsible for the difference less 20%.

Progressive Power Lens Benefit (no-line): The member pays the difference between the provider’s price for Standard Trifocal lenses and the price of the progressive power lenses selected, less 20%.

Contact lenses can be purchased on-line and delivered directly to your door. Visit www.svcontacts.com for more information.

For assistance with using your plan, please contact Customer Service at (800) 507-3800.

Superior Vision Services, Inc •. P.O. Box 967 Rancho Cordova, CA 95741, 800-5073800 • www.superiorvision.com The Superior Vision Plan is underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America, a/k/a The Guardian or Guardian Life 0708-215/TX

35

LINCOLN FINANCIAL GROUP YOUR BENEFITS PACKAGE

Disability

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

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

34.6 months is the duration of the average disability claim.

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

Long Term Disability Texarkana Independent School District provides this valuable benefit at no cost to you.

Full-Time Employees

Long Term Disability Insurance

ADDITIONAL DETAILS Coverage Period for Your Occupation: 36 months. After this initial period, you may be eligible to continue receiving benefits if your disability prohibits you from performing any employment for which you are reasonably suited through your training, education, and experience.

In this case, your benefits may be extended through the end of your maximum coverage period (benefit duration).

Keep getting a check when you’re hurt or sick.

You always have bills to pay, even when you can’t get to work due to injury, illness, or surgery. Long-term disability Pre-existing Condition: If you have a medical condition that insurance helps you make ends meet during this difficult begins before your coverage takes effect, and you receive time. treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for AT A GLANCE: benefits for that condition until you have been covered by • A cash benefit of 60% of your monthly salary (up to the plan for 12 months. $5,000) starting 180 days after you are out of work and continuing up to age 65 if the disability occurs at For complete benefit descriptions, limitations, and age 59 or before, 5 years if the disability occurs at age exclusions, refer to the certificate of coverage.

60 to 64, up to age 70 if the disability occurs at age 65 This is not intended as a complete description of the insurance coverage to 69, and 1 year if the disability occurs at age 70 or offered. Controlling provisions are provided in the policy, and this summary after does not modify those provisions or the insurance in any way. This is not a SM • EmployeeConnect services, which give you and your binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. Refer to your certificate for your family confidential access to counselors as well as maximum benefit amounts. Should there be a difference between this summary and the contract, the contract will govern. personal, legal, and financial assistance. Program EmployeeConnectSM services are provided by ComPsych® Corporation, Services include: Chicago, IL. ComPsych® is a registered trademark of ComPsych® Corporation.

• Unlimited, 24/7 access to information and ComPsych® is not a Lincoln Financial Group® company. Coverage is subject to actual contract language. Each independent company is solely responsible for its referrals own obligations. Insurance products (policy series GL3001) are issued by The • In-person help for short-term issues; up to four Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit sessions with a counselor per person, per issue, business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply. Lincoln Financial per year.

Group is the marketing name for Lincoln National Corporation and its affiliates.

• One free consultation with a network attorney Affiliates are separately responsible for their own financial and contractual obligations. Limitations and exclusions apply. (with subsequent meetings at a reduced fee) Benefits Overview | The Lincoln National Life Insurance Company • Online tools, tutorials, videos and much more GP-ERPD-FLI001-TX - ©2019 Lincoln National Corporation - LCN-1821793061517-Q1.0

37

Short Term Disability - Option One Full-Time Employees of Texarkana Independent School District

Benefit Exclusions & Reductions

Benefits At-A-Glance

Like any insurance, this short-term disability insurance policy does have some exclusions. You will not receive benefits if: • Your disability is the result of a self-inflicted injury or act of war • You are not under the regular care of a doctor when you request disability benefits

Voluntary Short Term Disability Insurance

Option One The Lincoln Short-term Disability Insurance Plan: • Provides a cash benefit when you are out of work for up to 24 weeks due to injury, illness, surgery, or recovery from childbirth • Provides a partial cash benefit if you can only do part of your job or work part time • Features group rates for Texarkana ISD employees • Offers a fast, no-hassle claims process Short-term Disability Weekly benefit amount

Sickness elimination period Accident elimination period Maximum coverage period

66.67% of your weekly salary, limited to $1,500 per week 14 days 14 days 24 weeks

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

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

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

Benefits Integration • Your short-term disability benefits can coordinate with income from other sources, such as continued income or sick pay from your employer, during your disability.

• This allows you to receive up to 100% of your pre-disability income.

Additional Plan Benefits 5% Rehabilitation Assistance Premium Waiver

Included Included

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

38

Your benefits may be reduced if you are eligible to receive benefits from: • A state disability plan or similar compulsory benefit act or law • A retirement plan • Social Security • Any form of employment • Workers’ Compensation A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.

This is not intended as a complete description of the insurance coverage offered.

Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. Refer to your certificate for your maximum benefit amounts.

Should there be a difference between this summary and the contract, the contract will govern.

Insurance products (policy series GL1101) are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply. ©2019 Lincoln National Corporation LCN-2016735-020518 R 1.0 – Group ID: TEXARISD Voluntary Short-term Disability Insurance At-A-Glance | Option One STD-ENRO-BRC001-TX

Voluntary Short Term Disability Premium Here’s how little you pay with group rates.

Your estimated monthly premium is determined by multiplying your weekly salary amount (up to $2,250) by the premium rate of 0.04400. If your weekly salary exceeds $2,250, multiply $2,250 by 0.04400.

$ X

weekly salary 0.04400 premium rate

=$ monthly premium

Short Term Disability - Option Two Full-Time Employees of Texarkana Independent School District

Open Enrollment

Benefits At-A-Glance

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

Voluntary Short Term Disability Insurance

Option Two The Lincoln Short-term Disability Insurance Plan: • Provides a cash benefit when you are out of work for up to 24 weeks due to injury, illness, surgery, or recovery from childbirth • Provides a partial cash benefit if you can only do part of your job or work part time • Features group rates for Texarkana ISD employees • Offers a fast, no-hassle claims process Short-term Disability Weekly benefit amount

Sickness elimination period Accident elimination period Maximum coverage period

66.67% of your weekly salary, limited to $1,500 per week 30 days 30 days 24 weeks

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

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

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

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

Benefits Integration • Your short-term disability benefits can coordinate with income from other sources, such as continued income or sick pay from your employer, during your disability.

• This allows you to receive up to 100% of your pre-disability income.

Additional Plan Benefits 5% Rehabilitation Assistance Premium Waiver

Included Included

Benefit Exclusions & Reductions Like any insurance, this short-term disability insurance policy does have some exclusions. You will not receive benefits if: • Your disability is the result of a self-inflicted injury or act of war • You are not under the regular care of a doctor when you request disability benefits Your benefits may be reduced if you are eligible to receive benefits from: • A state disability plan or similar compulsory benefit act or law • A retirement plan • Social Security • Any form of employment • Workers’ Compensation A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.

This is not intended as a complete description of the insurance coverage offered.

Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. Refer to your certificate for your maximum benefit amounts.

Should there be a difference between this summary and the contract, the contract will govern.

Insurance products (policy series GL1101) are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply. ©2019 Lincoln National Corporation LCN-2016735-020518 R 1.0 – Group ID: TEXARISD Voluntary Short-term Disability Insurance At-A-Glance | Option One STD-ENRO-BRC001-TX

Voluntary Short Term Disability Premium Here’s how little you pay with group rates.

Your estimated monthly premium is determined by multiplying your weekly salary amount (up to $2,250) by the premium rate of 0.04400. If your weekly salary exceeds $2,250, multiply $2,250 by 0.04400.

$ X

weekly salary 0.03507 premium rate

=$ monthly premium 39

APL

Cancer

About this Benefit Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.

YOUR BENEFITS PACKAGE

Breast Cancer is the most commonly diagnosed cancer in women.

If caught early, prostate cancer is one of the most treatable malignancies.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 40 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Texarkana ISD Benefits Website: www.mybenefitshub.com/texarkanaisd

GC3 Limited Benefit Group Cancer Indemnity Insurance Texarkana ISD

THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

SUMMARY OF BENEFITS Benefits

Level 1 Plan

Level 2 Plan

Radiation Therapy/Chemotherapy/ Immunotherapy Benefit

$500 per calendar month of treatment

$1,500 per calendar month of treatment

Hormone Therapy Benefit

$50 per treatment, up to 12 per calendar year

$50 per treatment, up to 12 per calendar year

Surgical Schedule Benefit

$1,600 max per operation; $15 per surgical unit

$4,800 max per operation; $45 per surgical unit

Anesthesia Benefit

25% of the amount paid for covered surgery

25% of the amount paid for covered surgery

Hospital Confinement Benefit

$100 per day 1-90 days; $100 per day, 91+ days in lieu of other benefits

$300 per day 1-90 days; $300 per day, 91+ days in lieu of other benefits

US Government/Charity Hospital/HMO

$100 per day in lieu of most other benefits

$300 per day in lieu of most other benefits

Outpatient Hospital or Ambulatory Surgical Center Benefit

$200 per day of surgery

$600 per day of surgery

Drugs & Medicine Benefit - Inpatient

$150 per confinement

$150 per confinement

Drugs & Medicine Benefit - Outpatient

$50 per prescription, up to $50 per cal month

$50 per prescription, up to $150 per cal month

Transportation & Outpatient Lodging Benefit

$0.50 per mile per round trip $100 per day, up to 100 days per calendar year

$0.50 per mile per round trip $100 per day, up to 100 days per calendar year

Family Member Transportation & Lodging Benefit

$0.50 per mile per round trip $100 per day, up to 100 days per calendar year

$0.50 per mile per round trip $100 per day, up to 100 days per calendar year

Blood, Plasma & Platelets Benefit

$150 per day, up to $7,500 per calendar year

$250 per day, up to $12,500 per calendar year

Bone Marrow/Stem Cell Transplant

Autologous - $500 per calendar year Non-Autologous - $1,500 per calendar year

Autologous - $1,500 per calendar year Non-Autologous - $4,500 per calendar year

Experimental Treatment Benefit

Pays as any non-experimental benefit

Pays as any non-experimental benefit

Attending Physician Benefit

$30 per day of confinement

$50 per day of confinement

Surgical Prosthesis Benefit

$1,000 per device (includes surgical fee); max 1 device per site, 2 lifetime max

$3,000 per device (includes surgical fee); max 1 device per site, 2 lifetime max

Hair Prosthesis Benefit

$50 per hair prosthetic, 2 lifetime max

$50 per hair prosthetic, 2 lifetime max

Dread Disease Benefit

$100 per day, 1-90 days of hospital confinement

$300 per day, 1-90 days of hospital confinement

Hospice Care Benefit

$50 per day, $9,000 lifetime max

$100 per day, $18,000 lifetime max

Inpatient Special Nursing Services

$150 per day of confinement

$150 per day of confinement

Ambulance Ground Benefit

$200 per ground trip

$200 per ground trip

Ambulance Air Benefit

$2,000 per air trip; up to 2 trips per hospital confinement (any combination of ground/air)

$2,000 per air trip; up to 2 trips per hospital confinement (any combination of ground/air)

Extended Care Benefit

$100 per day

$300 per day

Home Health Care Benefit

$100 per day

$300 per day

Second & Third Surgical Opinions

$300 per diagnosis; additional $300 if third opinion required

$300 per diagnosis; additional $300 if third opinion required

Waiver of Premium

Premium waived after 90 days of primary insured continuous total disability due to cancer

Premium waived after 90 days of primary insured continuous total disability due to cancer

Physical/Speech Therapy Benefit

$25 per visit, up to 4 visits per calendar month, $1,000 lifetime max

$25 per visit, up to 4 visits per calendar month, $1,000 lifetime max

Diagnostic Testing Benefit Rider

$50; 1 person, per calendar year

$50; 1 person, per calendar year

Critical Illness Rider: Heart Attack/Stroke

$2,500 lump sum benefit

$2,500 lump sum benefit

$600 up to a max of 30 days per confinement

$600 up to a max of 30 days per confinement

Riders

Optional Benefit Rider Intensive Care Unit Rider

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APSB-22356(TX) MGM/FBS Texarkana ISD

GC3 Limited Benefit Group Cancer Indemnity Insurance Monthly Premium

Level 1

Level 1 + ICU Rider

Level 2

Level 2 + ICU Rider

Individual

$12.50

$15.50

$27.10

$30.10

One-Parent Family

$17.30

$21.50

$37.10

$41.30

Two-Parent Family

$22.10

$28.40

$47.20

$53.50

*Premium and amount of benefits provided vary dependent upon the level selected at time of application.

Eligibility

Diagnostic Testing Benefit Rider

If You are working either under contract to or as a Full-Time Employee for the Policyholder, or You are a member in or employed by the association, You are eligible for insurance provided You qualify for coverage as defined in the Master Application. You must apply for insurance within thirty (30) days of the Policy Effective Date or the date that You become eligible for coverage. If You do not apply within thirty (30) days of the Policy Effective Date or the date You become eligible for coverage, You may be subject to additional underwriting by Us.

Critical Illness Rider

This policy/certificate will be issued only to those persons who meet American Public Life Insurance Company’s insurability requirements. The policy/certificate and the Internal Cancer coverage under the Critical Illness Rider will not be issued to anyone who has been diagnosed or treated for Cancer in the previous ten years. The Heart Attack or Stroke coverage under the Critical Illness Rider will not be issued to anyone who has been diagnosed or treated for any heart or stroke related conditions. The Hospital Intensive Care Unit Rider will not cover heart conditions for a period of two years following the Effective Date of coverage for anyone who has been diagnosed or treated for any heart related condition prior to the 30th day following the Covered Person’s Effective Date of coverage.

Base Policy

All diagnosis of cancer must be positively diagnosed by a legally licensed doctor of medicine certified by the American Board of Pathology or American Board of Osteopathic Pathology. This policy/certificate pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. This policy/certificate also covers other conditions or diseases directly caused by cancer or the treatment of cancer.

No benefits are payable for any covered person for any loss incurred during the first year of this policy/certificate as a result of a Pre-Existing Condition. A PreExisting Condition is a specified disease for which, within 12 months prior to the covered person’s effective date of coverage, medical advice, consultation or treatment, including prescribed medications, was recommended by or received from a member of the medical profession, or for which symptoms manifested in such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment. Pre-Existing Conditions specifically named or described as excluded in any part of this contract are never covered.

This policy/certificate contains a 30-day waiting period during which no benefits will be paid under this policy/certificate. If any covered person has a specified disease diagnosed before the end of the 30-day period immediately following the covered person’s effective date, coverage for that person will apply only to loss that is incurred after one year from the effective date of such person’s coverage. If any covered person is diagnosed as having a specified disease during the 30-day period immediately following the effective date, you may elect to void the policy/certificate from the beginning and receive a full refund of premium. All benefits payable only up to the maximum amount listed in the schedule of benefits in the policy/certificate.

A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex-members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward.

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APSB-22356(TX) MGM/FBS Texarkana ISD

We will pay the indemnity amount for one generally medically recognized internal cancer screening test per covered person per calendar year.

Screening test include, but limited to: mammogram; breast ultrasound; breast thermography; breast cancer blood test (CA15-3); colon cancer blood test (CEA); prostate-specific antigen blood test (PSA); flexible sigmoidoscopy; colonoscopy; virtual colonoscopy; ovarian cancer blood test (CA-125); pap smear (lab test required); chest x-ray; hemocult stool specimen; serum protein electrophoresis (blood test for myeloma); thin prep pap test. Screening tests payable under this benefit will only be paid under this benefit. Benefits will only be paid for tests performed after the 30-day period following the covered person’s effective date of coverage.

Benefits will only be paid for a covered critical illness as shown on the policy/ certificate schedule page in the policy. No benefits will be provided for any loss caused by or resulting from: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; or alcoholism or drug addiction; or any act of war, declared or undeclared , or any act related to war; or military service for any country at war; or a pre-existing condition; or a covered critical illness when the date of diagnosis occurs during the waiting period; or participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; or participation in, or attempting to participate in a felony, riot or insurrection (a felony is as defined by the law of the jurisdiction in which the activity takes place). Internal cancer does not include: other conditions that may be considered pre-cancerous or having malignant potential such as: acquired immune deficiency syndrome (AIDS); or actinic keratosis; or myelodysplastic and non-malignant myeloproliferative disorders; or aplastic anemia; or atypia; or non-malignant monoclonal gamopathy; or Leukoplakia; or Hyperplasia; or Carcinold; or Polycythemia; or carcinoma in situ or any skin cancer other than invasive malignant melanoma into the dermis or deeper. For a pre-existing condition no benefits are payable.

Hospital Intensive Care Unit Rider

No benefits will be provided during the first two years of this rider for hospital intensive care unit confinement caused by any heart condition when any heart condition was diagnosed or treated prior to the 30th day following the covered person’s effective date of this rider. The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date. No benefits will be provided if the loss results from: attempted suicide, whether sane or insane; or intentional self-injury; or alcoholism or drug addiction; or any act of war, declared or undeclared, or any act related to war; or military service for a country at war. No benefits will be paid for confinements in units such as surgical recovery rooms, progressive care, burn units, intermediate care, private monitored rooms, observation units, telemetry units or psychiatric units not involving intensive medical care; or other facilities which do not meet the standards for intensive care unit as defined in the rider. For a newborn child born within the tenmonth period following the effective date of this rider, no benefits will be provided for hospital intensive care unit confinement that begins within the first 30 days following the birth of such child.

GC3 Limited Benefit Group Cancer Indemnity Insurance Conditionally Renewable

This policy/certificate is conditionally renewable. This means that We have the right to terminate your policy/certificate on any premium due date after the first Policyholder’s Anniversary Date. We must give the Policyholder at least 60 days written notice prior to cancellation. We cannot cancel Your coverage because of a change in Your age or health.

We can change Your premiums if We change premiums for all similar Certificates issued to the Policyholder. We must give the Policyholder at least 60 days written notice before We change Your premiums.

Continuation Rider Continuation

Coverage is continued when the Insured (You) cease employment with the employer through whom You originally became insured under the Policy.

You will have the option to continue this Certificate (including any Riders, if applicable) by paying the premiums directly to Us at Our home office.

Premiums must be paid within thirty-one (31) days after employment with your employer terminates. Premium rates required under this Continuation provision will be the same rates as those charged under the Employer’s Policy as if You had continued employment. We will bill You for these premiums after You notify Us to continue this coverage. Coverage will continue until the earlier of: (1) the Policy under which You originally became insured ends; or (2) You stop paying premiums under this option (subject to the terms of the Grace Period).

Termination of Coverage

Your Insurance coverage will end on the earliest of these dates: (a) the date You no longer qualify as an Insured; (b) the last day of the period for which a premium has been paid, subject to the Grace Period; (c) the date the Policy terminates (See Conversion provision); (d) the date You retire; (e) the date You cease employment, or terminate Your contract with the employer through whom You originally became insured under the Policy (See Conversion provision); or (f) the date We receive Your written request for termination. Termination of Dependent(s) Insurance coverage on Your Dependent(s) will end on the earliest of these dates: (a) the date the coverage under the Certificate terminates; (b) the date the Dependent no longer meets the definition of Dependent, as defined in the Policy/Certificate (See Conversion provision); (c) the date We receive Your written request for termination.

Termination of Rider Coverage

This rider terminates: (a) when Your coverage terminates under the Policy/ Certificate to which this Rider is attached; or, (b) when any premium for this rider is not paid before the end of the Grace Period; or, (c) when You give Us a written request to do so. Coverage on a Dependent terminates under this rider when such person ceases to meet the definition of Dependent, as defined in the Policy.

Conversion

If the Employer’s Policy is terminated, this Certificate will terminate. Upon termination of the Employer’s Policy, the employee (You) will be entitled to convert to an individual policy of insurance issued by Us without evidence of insurability provided the required premiums have been paid on your behalf and You notified Us in writing within thirty-one (31) days of the Employer’s Policy termination. Premiums for the individual policy of insurance will be figured from the premium rate table in effect on the date of conversion.

Subject to the terms of this provision, a covered child who ceases to be eligible may convert to an individual policy of insurance and a covered spouse who ceases to be eligible for coverage because of divorce or annulment may convert to an individual policy.

Terms of this provision include: (1) Application for the individual policy and payment of the first premium must be made within 60 days after coverage ceases under the Policy/Certificate. Premiums will be figured from the premium rate table in effect on the date of conversion. (2) The individual policy will be issued without proof of insurability. It will provide benefits that most nearly approximates those of the Policy/Certificate.

(3) The individual policy will take effect the day after coverage ceases under the Policy/Certificate. However, no benefits will be payable under the individual policy for any loss for which benefits are payable under the Policy/Certificate. (4) The Pre-Existing Condition Limitation and Time Limit on Certain Defenses provisions for the individual policy will be figured from the Covered Person’s Effective Date of coverage under the Policy/ Certificate. (5) Any benefit maximums will be figured from the Effective Date of the Policy/Certificate.

This rider is subject to all the provisions of the Policy and Certificate to which it is attached that are not in conflict with this rider.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606

Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For complete benefits, limitations, exclusions and other provisions, please refer to the policy and riders.

This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC-3 Series | Texas | Limited Benefit Group Cancer Indemnity Insurance Policy | (11/14) | Texarkana ISD

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APSB-22356(TX) MGM/FBS Texarkana ISD

UNUM

Life and AD&D

YOUR BENEFITS PACKAGE

About this Benefit Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family.

Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

Motor vehicle crashes are the

#1

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 44 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Texarkana ISD Benefits Website: www.mybenefitshub.com/texarkanaisd

Life and AD&D (30+ Hours per Week) Texarkana Independent School District Flex Life and AD&D Insurance Plan Highlights

Who is eligible for this coverage?

All Full-Time actively at work employees working at least 30 hours each week.

Who pays for the coverage?

Base Plan is paid by the District. Buy–Up Plan is paid by Employee.

Dependent Coverage is paid by Employee.

What are the Employee Life/AD&D coverage amounts?

Employer Funded Base Life/AD&D Benefit: 1 x annual salary (rounded to the next higher $1,000) to an overall maximum of $160,000.

Employee Funded Buy-Up Life/AD&D Plan: Additional Life/AD&D coverage can be purchased equal to the lesser of 7 x annual salary (in increments of $10,000) to an overall Life/AD&D maximum of $750,000.

Overall combined Base and Buy-Up maximum is $910,000.

Spouse Life/AD&D: $5,000 increments up to a maximum of $250,000 can be purchased. This amount is not to exceed the lesser of 50% of the employee Life amount or $10,000.

What are the Spouse and Child Life/AD&D coverage amounts?

Child: $500 death benefit for the ages between live birth and 14 days $10,000 death benefit for 14 days + Child Age Limit: 26 Note: The amount of Life Insurance for a dependent will not be more than 50% of the employee additional Life amount. The employee must be covered for additional Life insurance in order to insure dependents for Life insurance.

Current employees: If you and your Spouse are enrolled in the buy-up plan and wish to increase your life insurance coverage, you may apply for an increase of up to 2 benefit levels (benefit level for Employee is $10,000 and benefit level for Spouse is $5,000) without answering medical questions. Any life insurance coverage requested over the 2-benefit level increase will be subject to answers to health questions.

Can I be denied coverage?

New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you elect to purchase additional life coverage during your initial eligibility period, you may apply for any amount of coverage (within you and your spouse plan maximums) up to $200,000 for yourself and up to $50,000 for your spouse, without answering any medical questions. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.

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.

When is coverage effective?

For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, a sickness, or disorder your dependent spouse and children: are confined in a hospital or similar institution; are confined at home under the care of a physician for a sickness or injury; or your spouse has a life-threatening condition. Exception: Infants are insured from live birth.

Coverage amounts will reduce according to the following schedule:

Do my life insurance benefits decrease with age?

Age: 70 75

Insurance amount reduces to: 67% of original amount 50% of original amount

Coverage may not be increased after a reduction.

45

Life and AD&D (30+ Hours per Week) If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your spouse and

Is the coverage portable your dependent children at the group rate. Portability is not available for people who have a medical condition (can I keep it if I leave that could shorten their life expectancy — but they may be able to convert their term life policy to an individual my employer)? 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 insurance premiums will be waived for insured employees who become totally disabled from any occupation prior to age 60, and who remain disabled during the elimination period of 9 months. Life insurance premium waiver terminates at age 70.

What does my AD&D insurance pay for?

The full benefit amount is paid for loss of: • life; • both hands or both feet or sight of both eyes; • one hand and one foot; • one hand or one foot and the sight of one eye; • speech and hearing.

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

Are there any AD&D exclusions or limitations?

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

Does this plan include help with work-life balance?

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

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 When does my coverage 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: end?

• 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.

46

Life and AD&D (30+ Hours per Week) Additional Term Life/AD&D

How much does the coverage cost?

Age Band

Employee Rate per $10,000

Spouse Rate per $5,000

<25

$0.40

$0.20

25-29

$0.40

$0.20

30-34

$0.50

$0.25

35-39

$0.80

$0.40

40-44

$1.00

$0.50

45-49

$1.50

$0.75

50-54

$2.30

$1.15

55-59

$4.20

$2.10

60-64

$5.80

$2.90

65-69

$10.50

$5.25

70-74

$17.00

$8.50

75+

$17.00

$8.50

Child Life/AD&D monthly rate is $1.50 per $10,000. One life premium covers all children.

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

The work-life balance employee assistance program, provided by Ceridian Corporation, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance.

Services are not valid after coverage terminates. Please contact your Unum representative for details.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative. © 2016 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Underwritten by Unum Life Insurance Company of America, Portland, Maine EN-1773 (1-16) FOR EMPLOYEES 47

Life and AD&D (20-30 Hours per Week) Texarkana Independent School District Flex Life and AD&D Insurance Plan Highlights

Who is eligible for this coverage?

All Part-Time or Full-Time actively at work employees working a minimum of 20 hours per week but less than 30 hours each week.

What are the Employee Life/AD&D coverage amounts?

Employee: up to 7 x annual salary (in increments of $10,000); not to exceed a Life/AD&D maximum of $750,000.

What are the Spouse and Child Life/AD&D coverage amounts?

Spouse Life/AD&D: $5,000 increments up to a maximum of $250,000 can be purchased. This amount is not to exceed the lesser of 50% of the employee Life amount or $10,000.

Child: $500 death benefit for the ages between live birth and 14 days $10,000 death benefit for 14 days + Child Age Limit: 26 Note: The amount of Life Insurance for a dependent will not be more than 50% of the employee additional Life amount.

The employee must be covered for additional Life insurance in order to insure dependents for Life insurance.

Current employees: If you and your Spouse are enrolled in the plan and wish to increase your life insurance coverage, you may apply for an increase of up to 2 benefit levels (benefit level for Employee is $10,000 and benefit level for Spouse is $5,000) without answering medical questions. Any life insurance coverage requested over the 2-benefit level increase will be subject to answers to health questions.

Can I be denied coverage?

New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you elect to purchase additional life coverage during your initial eligibility period, you may apply for any amount of coverage (within you and your spouse plan maximums) up to $200,000 for yourself and up to $50,000 for your spouse, without answering any medical questions. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.

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.

When is coverage effective?

For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, a sickness, or disorder your dependent spouse and children: are confined in a hospital or similar institution; are confined at home under the care of a physician for a sickness or injury; or your spouse has a life-threatening condition. Exception: Infants are insured from live birth.

Coverage amounts will reduce according to the following schedule:

Do my life insurance benefits decrease with age?

Age: 70 75

Insurance amount reduces to: 67% of original amount 50% of original amount

Coverage may not be increased after a reduction.

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

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

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

48

Life and AD&D (20-30 Hours per Week) 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 insurance premiums will be waived for insured employees who become totally disabled from any occupation prior to age 60, and who remain disabled during the elimination period of 9 months. Life insurance premium waiver terminates at age 70.

What does my AD&D insurance pay for?

The full benefit amount is paid for loss of: • life; • both hands or both feet or sight of both eyes; • one hand and one foot; • one hand or one foot and the sight of one eye; • speech and hearing.

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

Are there any AD&D exclusions or limitations?

Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from: • disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM); • suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane; • war, declared or undeclared, or any act of war; • active participation in a riot; • committing or attempting to commit a crime under state or federal law; • the voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor.

This exclusion does not apply to you or your dependent if the chemical substance is ethanol; • intoxication – “being intoxicated” means you or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.

Does this plan include help with work-life balance?

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

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.

When does my coverage end?

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.

49

Life and AD&D (20-30 Hours per Week) Additional Term Life/AD&D

How much does the coverage cost?

Age Band

Employee Rate per $10,000

Spouse Rate per $5,000

<25

$0.40

$0.20

25-29

$0.40

$0.20

30-34

$0.50

$0.25

35-39

$0.80

$0.40

40-44

$1.00

$0.50

45-49

$1.50

$0.75

50-54

$2.30

$1.15

55-59

$4.20

$2.10

60-64

$5.80

$2.90

65-69

$10.50

$5.25

70-74

$17.00

$8.50

75+

$17.00

$8.50

Child Life/AD&D monthly rate is $1.50 per $10,000. One life premium covers all children.

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

The work-life balance employee assistance program, provided by Ceridian Corporation, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance.

Services are not valid after coverage terminates. Please contact your Unum representative for details.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative. © 2016 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.

Underwritten by Unum Life Insurance Company of America, Portland, Maine EN-1773 (1-16) FOR EMPLOYEES 50

51

UNUM

EAP (Employee Assistance Program)

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

38%

YOUR BENEFITS PACKAGE

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 52 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Texarkana ISD Benefits Website: www.mybenefitshub.com/texarkanaisd

Employee Assistance Program (EAP) Help your workforce work through life’s challenges, before they impact your business We’ve all experienced some type of personal problem, concern or emotional crisis at one time or another. Unum’s EAP+Work/ Life program gives employees access to counselors* and services for help with personal, family and work issues. Because when employees get the help they need, they can give their best at work.

Employee assistance program Unum’s employee assistance program (EAP) is designed to help your employees lead happier and more productive lives at home and at work. When they have issues, they can work with Licensed Professional Counselors to define the problem and obtain appropriate assistance.

Through the EAP, employees can get help with personal, family and work issues such as: • Stress, depression, anxiety • Relationship issues, divorce • Job stress, work conflicts • Family and parenting problems • Anger, grief and loss • Addiction, eating disorders, mental illness The Licensed Professional Counselor will either address concerns during a few initial sessions or refer the employee to other appropriate counselors or community resources for long-term help.

Employees can now get help with medical and dental bills • •

Our EAP program comes with Medical Bill SaverTM, which can help lower employees’ out-of-pocket costs on medical and dental bills.

We work with medical and dental providers to negotiate and lower bills over $400 where possible.

Work/Life balance services Employees can also reach out to our Work/Life Specialists for help with balancing the demands of home, family and the workplace. Our specialists can answer questions, as well as put employees in touch with outside resources.

Work/Life Specialists can help find: CHILDCARE SERVICES • • •

• • •

Community resources Nanny agencies Pre-schools

ELDERCARE SERVICES • • •

Assisted living facilities • Nursing homes • Independent living options •

Adult day-care services Geriatric care managers Services for adults with disabilities

FINANCIAL SERVICES • • •

Debt management solutions Budgeting assistance Credit report assistance

LEGAL SERVICES • • •

Personal/family and elder law Real estate Identity theft

ADDITIONAL KEY FEATURES • • • •

• For more information about Unum’s Employee Assistance Program, please contact your Unum representative.

Childcare centers Babysitter tips Family-run child care homes

Medical Bill Saver™ service that can help negotiate out-ofpocket medical and dental expenses over $400.

24/7 access to master’s level staff clinicians for information, assessment, short-term problem resolution and referrals.

Up to 3 face-to-face counseling sessions. Sessions are conducted by a network of qualified EAP consultants.

In lieu of face to face sessions, we offer HIPAA compliant video counseling sessions for those in rural communities, those with transportation concerns, or those that may prefer the use of technology to receive the service.

We provide access to a national network of over 60,000 licensed EAP affiliates. All EAP providers have a master’s degree or higher with state licensure.

unum.com Services may not be available in New York. * The consultants must abide by federal regulations regarding duty to warn of harm to self or others. In these instances, the consultant may be mandated to report a situation to the appropriate authority.

The Work-life Balance Employee Assistance Program, provided by HealthAdvocate, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance.

Services are not valid after coverage terminates. Please contact your Unum representative for details.

Insurance products are underwritten by the subsidiaries of Unum Group. © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. MK-3692 (4-18)

53

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 54 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 Texarkana ISD Benefits Website: www.mybenefitshub.com/texarkanaisd

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 statements show all your • Health Savings accountholder account activity for that period. You can receive free online • Age 55 or older (regardless of when in the year an statements or pay $2 per printed statement. accountholder turns 55) * Contributions, investment earnings, and distributions are tax free for federal tax purposes if • Not enrolled in Medicare (if an accountholder enrolls in used to pay for qualified medical expenses, and may or may not be subject to state taxation.

Medicare mid-year, catch-up contributions should be A list of Eligible Medical Expenses can be found in IRS Publication 502, http://www.irs.gov/ pub/irs-pdf/p502.pdf. As described in IRS publication 969, http://www.irs.gov/pub/irs-pdf/ prorated) p969.pdf, certain over-the-counter medications (when prescribed by a doctor) are Authorized Signers who are 55 or older must have their own considered eligible medical expenses for HSA purposes. If an individual is 65 or older, there is no penalty to withdraw HSA funds. However, income taxes will apply if the distribution is not HSA in order to make the catch-up contribution used for qualified medical expenses. For more information consult a tax adviser or your state department of revenue. All contributions and distributions are your responsibility and must be within IRS regulatory limits. ** Call 817-882-0800 or stop-by an EECU branch to order standard checks at no charge (excludes shipping and handling) or order custom checks - prices vary.

55

NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

About this Benefit A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a pre-established amount of money per plan year in a Healthcare Flexible Spending Account (FSA). Funds allocated to a healthcare FSA must be used during the plan year or are forfeited unless your plan contains a $500 rollover or grace period provision.

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

FLIP TO…

PG. 11

FOR HSA VS. FSA COMPARISON

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 56 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Texarkana ISD Benefits Website: www.mybenefitshub.com/texarkanaisd

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

57

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

58

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).

59

WWW.MYBENEFITSHUB.COM/TEXARKANAISD 60