2022-23 Burleson ISD Benefit Guide by Higginbotham Public Sector

BURLESON ISD BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.MYBENEFITSHUB.COM/BURLESONISD 2022 - 2023 PlanYear 1

Table of Contents FLIP TO... How to Enroll 4 5 Annual Benefit Enrollment 6-11 1. Benefit Updates 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Annual Enrollment 8 4. Eligibility Requirements 9 5. Helpful Definitions 10 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 11 Medical 12-18 Basic Life and AD&D 19 Employee Assistance Program (EAP) 20 Health Savings Account (HSA) 21 Flexible Spending Account (FSA) 22-23 Hospital Indemnity 24-25 Telehealth + Behavioral Health 26 Dental 27-28 Vision 29 Disability 30-31 Cancer 32-33 Identity Theft 34 Voluntary Life and AD&D 35-36 Individual Life 37 Emergency Medical Transportation 38 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 12 2

BURLESON ISD BENEFITS MEDICAL TRS ACTIVECARE MEDICAL TRS HMO Financial Benefit Services (800) 583 www.mybenefitshub.com/burlesonisd6908 (866)BCBSTX355 www.bcbstx.com/trsactivecare5999 Scott & White HMO (844) 633 www.trs.swhp.org5325 BURLESON ISD BENEFITS OFFICE EMPLOYEE ASSISTANCE PROGRAM (EAP) HEALTH SAVINGS ACCOUNT (HSA) (817) 245 www.burlesonisd.net1046 (800)Unum854 1446 www.unum.com/lifebalance (800)EECU 333 9934 www.eecu.org FLEXIBLE SPENDING ACCOUNT (FSA) HOSPTIAL INDEMNITY TELEHEALTH National Benefit Services (800) 274 www.nbsbenefits.com0503 GroupCigna #HC961014 (800) 754 www.mycigna.com3207 (888)MDLIVE365 www.mdlive.com/fbsbh1663 DENTAL VISION DISABILITY GroupCigna #3335459 (800) 244 www.mycigna.com6224 Superior Vision Group #323990 (800) 507 www.superiorvision.com3800 The Claims:(800)GroupHartford#3953205475000(866)547 www.thehartford.com9124 CANCER IDENTITY THEFT BASIC & VOL. LIFE AND AD&D American Public Life Group #10103 (800) 256 www.ampublic.com8606 ID www.idwatchdog.com(800)Watchdog7743772 GroupUnum #147822 (866) 679 www.unum.com3054 INDIVIDUAL LIFE EMERGENCY MEDICAL TRANSPORT 5Star Life Insurance (866) 863 www.5starlifeinsurance.com9753 GroupMASA #MKBUISD (800) 423 www.masamts.com3226 Benefit Contact Information 3

Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS BURLESON” to (800) 583-6908 App Group #: FBSBURLESON Text “FBS BURLESON” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment: • Benefit Resources • Online Enrollment • Interactive Tools • And more! 4

1 www.mybenefitshub.com/burlesonisd How to Log In 2 CLICK LOGIN 3 ENTER USERNAME & PASSWORD TheUsername:firstsix (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. If you have six (6) or less characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. 5

Benefit Updates - What’s New: Don’t Forget! • Login and complete your benefit enrollment from 07/18/2022 08/18/2022 • Enrollment assistance is available by calling Financial Benefit Services at (866) 914 5202. • Update your information: home address, phone numbers, email, and beneficiaries. • REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator. SUMMARY PAGESAnnual Benefit Enrollment • New MDLIVE Behavioral Benefits! • TRS ActiveCare Medical Changes to Regional Rates • New TRS No Cost Digital Mental Health Program • All $9 MASA Plan enrollees will be migrated into the $14 MASA Plan • All GF Texas Life coverage will need to set up bank draft with carrier effective 09/01/22. New Benefits & Services at a Glance MDLIVE Behavioral Health Benefits Now Available! Your district is now offering behavioral health benefits with MDLIVE 24/7. The plan includes a confidential, convenient online therapy at a $0 cost for unlimited sessions with either a counselor or a psychiatrist. In addition, the plan includes non emergency medical care visits online. You do not have to be enrolled in a medical plan; the cost is $12.00 for the entire family. If you are currently enrolled in this plan, you will automatically be migrated to the enhanced benefit effective 9/1. MASA Emergent Plan Migrating to the Emergent Plus IfPlan.you currently enrolled in the $9 MASA plan, you will automatically be migrated into the $14 Emergent Plus Plan effective 09/01/22. This enhanced plan offers non medical emergency transportation and repatriation. For more details go GFwww.mybenefitshub.com/burlesonisdtoTexasLifeIndividualLifeplanwillno longer offer payroll deduction after 9/1/22. Please watch for email communications from your BISD Benefits Office around the middle of August for more details on how to set up your bank draft with Texas Life. TRS NO COST DIGITAL MENTAL HEALTH PROGRAM Learn to Live offers digital cognitive behavioral therapy tools to help participants learn new skills and break old patterns. To check our Learn to Live, 1)participants:Loginto Blue Access for Members 2) Click Wellness 3) Choose Digital Mental Health If participants have questions or need help registering for Learn to Live, they should call a Personal Health Guide at (866) 355 5999. 6

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.

Change in Status of Employment Affecting Coverage Eligibility

Change in Number of Tax Dependents

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 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.

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

Eligibility for Government Programs

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

Section 125 Cafeteria Plan Guidelines SUMMARY PAGESAnnual Benefit Enrollment CHANGES

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

Judgment/Decree/Order

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.

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.

Marital Status

(CIS):STATUS QUALIFYING

Gain/Loss

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 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. IN EVENTS

EligibilityDependents'ofStatus

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.

For benefit summaries and claim forms, go to the Burleson ISD benefit www.mybenefitshub.com/burlesonisdwebsite:. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards?

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

Where can I find forms?

• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.

For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ burlesonisd. Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms

SUMMARY PAGESAnnual Benefit Enrollment 8

Howsection.can I find a Network Provider?

• 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.

Annual Enrollment

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

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

Q&A Who do I contact with Questions?

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.

New Hire Enrollment

• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.

During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs.

Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, 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.

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 Disclaimer:eligibility.

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your Benefit Administrator to request a continuation of coverage. PLAN MAXIMUM AGE Medical To 26 Hospital Indemnity To 26 Dental To 26 Vision To 26 Voluntary Life Unmarried To 26 Cancer To 26 Telehealth Unmarried to 26 Medical FSA To 26 Dependent Care FSA 12 or younger or qualified individual unable to care for themselves & claimed as a dependent on your taxes HealthAccountSavings Tax Dependent Identity Theft Unmarried to 26 Individual Life Issue to thru24/covered100 TransportationEmergency To 26 Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.

SUMMARY PAGES

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.

Annual

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 Potentialguidance.Dependent

Employee RequirementsEligibility

Supplemental Benefits: Eligible employees must work 30 or more regularly scheduled hours each work week. 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 your 2022 benefits become effective on September 1, 2022, you must be actively at work on September 1, 2022 to be eligible for your new benefits.

Dependent RequirementsEligibility

Benefit Enrollment 9

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 FSA/HSAeligibility.Limitations:

Actively at Work

September

Guaranteed

SUMMARY PAGESHelpful Definitions 10

You are performing your regular occupation for the employer on a full time basis, either at one of the employer’s usual 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 9/1/2022 please notify your benefits administrator. Enrollment

After

Plan Year 1st through August 31st Pre Existing Conditions

The most an eligible or insured person can pay in co insurance for covered expenses.

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.

Annual

January 1st through December 31st Co-insurance 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. Coverage

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.

Calendar Year

In Network Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider. Out of Pocket Maximum

Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).

SUMMARY PAGESHSA vs. FSA Health Savings Account (HSA) (IRC Sec. 223) Flexible Spending Account (FSA) (IRC Sec. 125) Description 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 RequirementInsurance High deductible health plan None Minimum Deductible $1,400 single (2022) $2,800 family (2022) N/A Maximum Contribution $3,650 single (2022) $7,300 family (2022) $2,850 (2022) Permissible Use Of Funds Employees may use funds any way they wish. 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 FLIP TO FOR HSA INFORMATION PG. 21 FLIP TO FOR FSA INFORMATION PG. 22 11

Monthly Premium District Contribution Employee Cost TRS ActiveCare HD Employee Only $429.00 $250.00 $179.00 Employee & Spouse $1,209.00 $250.00 $959.00 Employee & Child(ren) $772.00 $250.00 $522.00 Employee & Family $1,445.00 $250.00 $1,195.00 TRS ActiveCare 2 Employee Only $1,013.00 $250.00 $763.00 Employee & Spouse $2,402.00 $250.00 $2,152.00 Employee & Child(ren) $1,507.00 $250.00 $1,257.00 Employee & Family $2,841.00 $250.00 $2,591.00 TRS ActiveCare Primary Employee Only $417.00 $250.00 $167.00 Employee & Spouse $1,176.00 $250.00 $926.00 Employee & Child(ren) $751.00 $250.00 $501.00 Employee & Family $1,405.00 $250.00 $1,155.00 TRS ActiveCare Primary+ Employee Only $525.00 $250.00 $275.00 Employee & Spouse $1,284.00 $250.00 $1,034.00 Employee & Child(ren) $845.00 $250.00 $595.00 Employee & Family $1,614.00 $250.00 $1,364.00 Scott and White HMO Employee Only $569.24 $250.00 $319.24 Employee & Spouse $1,431.08 $250.00 $1,181.08 Employee & Child(ren) $915.65 $250.00 $665.65 Employee & Family $1,647.24 $250.00 $1,397.24 ABOUT MEDICAL Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. For full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd Medical Insurance TRS EMPLOYEE BENEFITS 12

Basic Life and AD&D UNUM ABOUT LIFE AND AD&D 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. For full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd EMPLOYEE BENEFITS Who is eligible for this coverage? All actively employed employees working at least 30 hours each week for your employer in the U.S. What is the coverage amount? Your employer is providing you with $10,000 of term life insurance. You will also receive $10,000 of Accidental Death and Dismemberment insurance. Is it portable (can I keep it if I leave my employer)? If you retire, reduce your hours or leave your employer, you can continue coverage at the group rate. What does my AD&D insurance pay for? The full benefit amount is paid for loss of: • Life • Both hands or both feet or sight of both eyes • One hand and one foot • One hand and the sight of one eye • Speech and hearing Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 65 65% of original amount 70 50% of original amount Coverage may not be increased after a reduction. 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. 19

ABOUT EAP An Employee Assistance Program (EAP) is a program that assists you in resolving problems such as finding child or elder care, relationship challenges, financial or legal problems, etc. This program is provided by your employer at no cost to you. For full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd Employee Assistance Program (EAP) UNUM EMPLOYEE BENEFITS Help, when you need it most With your Employee Assistance Program and Work/Life Balance services, confidential assistance is as close as your phone or computer. Employee Assistance Program (EAP) Your EAP is designed to help you lead a happier and more productive life at home and at work. Call for confidential access to a Licensed Professional Counselor* who can help Ayou.Licensed Professional Counselor can help you with: • Stress, depression, anxiety • Relationship issues, divorce • Job stress, work conflicts • Family and parenting problems • Anger, grief and loss • And more Work/Life Balance You can also reach out to a specialist for help with balancing work and life issues. Just call and one of our Work/Life Specialists can answer your questions and help you find resources in your community. • Ask our Work/Life Specialists about: • Child care • Elder care • Legal questions • Identity theft • Financial services, debt management, credit report issues • Even reducing your medical/dental bills! • And more Always by your side • Expert support 24/7 • Convenient website • Short term help • Referrals for additional care • Monthly webinars • Medical Bill SaverTM helps you save on medical bills Who is covered? Unum’s EAP services are available to all eligible employees, their spouses or domestic partners, dependent children, parents and parents in law. Employee Assistance Program Work/Life Balance Toll free 24/7 access: 1 800 854 1446 (multi lingual) www.unum.com/lifebalance Help is easy to access: Online/phone support: Unlimited, confidential, 24/7. In person: You can get up to 3 visits available at no additional cost to you with a Licensed Professional Counselor. Your counselor may refer you to resources in your community for ongoing *support.Thecounselors 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. 20

• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.

You are eligible to open and contribute to an HSA if you are:

• Not enrolled in Medicare or TRICARE

There is no “use it or lose it” rule you do not lose your money if you do not spend it in the calendar year and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.

• Not eligible to be claimed as a dependent on someone else’s tax return

• Individual $3,650

• Lost/Stolen Debit Card: Call the 24/7 debit card hotline at (800) 333 9934.

Health Savings Account (HSA)

• Call/Text: (817) 882 0800 EECU’s dedicated member service representatives are available to assist you with any questions. Their hours of operation are Monday through Friday from 8:00 a.m. to 7:00 p.m. CT, Saturday 9:00 a.m. to 1:00 p.m. CT and closed on Sunday.

A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs it is also a tax exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.

Qualified Expenses

• Family (filing jointly) $7,300 If you are 55 or older, you may make a yearly catch up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch up contribution for the entire plan year.

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.

• You will receive a debit card to manage your Health Savings Account. Keep in mind, available funds are limited to the balance in your HSA.

• Enrolled in an HSA eligible High Deductible Health Plan (HDHP)

You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered by the HDHP.

• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.

• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction.

Maximum Contributions

EECU EMPLOYEE BENEFITS

HSA Eligibility

Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). full plan details, please visit your benefit website:

• Online/Mobile: Sign in for 24/7 account access to check your balance, pay bills and more.

A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax free and spends tax free if used to pay for qualified medical expenses.

For

Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2022 is based on the coverage option you elect:

ABOUT HSA

www.mybenefitshub.com/burlesonisd

You can use your HSA for a wide range of qualified expenses, such as doctor’s visits, prescription drugs, lab work, medical equipment, contacts lenses, dental work, physical therapy the list goes on! Refer to IRS Publication 502 for comprehensive guidelines.

• If you enroll in an HSA and FSA, the FSA becomes a Limited Purpose FSA and may only be used for Dental and Vision, not medical expenses.

How To Use Your HSA

• Stop by a local EECU financial center for in person assistance; find locations & service hours at www.eecu.org/locations

Important HSA Information

The maximum per plan year you can contribute to a Health Care FSA is $2,850.00. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately.

ABOUT FSA A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (BISD offers a 75 day grace period provision). For full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd Flexible Spending Account (FSA) NBS EMPLOYEE BENEFITS Health Care FSA The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $2,850 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include: • Dental and vision expenses • Medical deductibles and coinsurance • Prescription copays • Hearing aids and batteries You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA). How the Health Care FSAs Work You can access the funds in your Health Care FSA two different ways: • Use your NBS Debit Card to pay for qualified expenses, doctor visits and prescription copays. • Pay out of pocket and submit your receipts for reimbursement:  Fax 844 438 1496  Email service@nbsbenefits.com  Online my.nbsbenefits.com  Call for Account Balance: 855 399 3035  Mail: PO Box 6980 West Jordan, UT 84084 Contact NBS • Hours of Operation: 6:00 AM 6:00 PM MST, Mon Fri • Phone: (800) 274 0503 • Email: service@nbsbenefits.com • Mail: PO Box 6980 West Jordan, UT 84084

The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.

• You cannot change your election during the year unless

•

• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self care.

• Overnight camps are not eligible for reimbursement (only day camps can be considered).

•

• If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.

Important FSA Rules

The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full time student. Dependent Care FSA Guidelines

Dependent Care FSA

• You can continue to file claims incurred during the plan year for another 30 days (up until date).

NBS BENEFITS you experience a Qualifying Life Event.

Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor prescribed over the counter medications)

• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.

Annual Contribution Limits Benefit Health Care FSA

Dependent Care FSA Dependent care expenses (such as day care, after school programs or elder care programs) so you and your spouse can work or attend school full time $5,000 single $2,500 if married and filing separate tax returns Reduces your incometaxable

FSAstore.com FSAstore.com offers thousands of FSA eligible products and services to purchase using your FSA Debit Card or any major credit card. Competitive pricing and free shipping on orders over $50 can save you up to 40% using your FSA pretax dollars. Shop directly at FSAstore.com or have your physician submit prescriptions (when required). The FSAstore.com Services Channel allows you to search a database of more than 300,000 health care providers for nearby eligible services, such as acupuncture and chiropractic care. The FSAstore.com Learning Center focuses on answering common questions and keeping you informed about changes to your FSA benefits.

Health care reform legislation requires that certain over the counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription.

Over the Counter Item Rule Reminder (OTC)

EMPLOYEE

Flexible Spending Accounts

Account Type Eligible Expenses

Flexible Spending Account (FSA)

• The IRS has amended the “use it or lose it rule” to allow you to carry over up to $500 in your Health Care FSA into the next plan year. The carry over rule does not apply to your Dependent Care FSA.

$2,850 Saves on eligible expenses not covered by insurance, reduces your taxable income

Plan 1 Plan 2 Hospital

Hospitalization Benefits Admission No Elimination

ABOUT HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. For full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd Hospital Indemnity Cigna EMPLOYEE BENEFITS SUMMARY OF BENEFITS Hospital Indemnity coverage provides a benefit according to the schedule below when a Covered Person incurs a Hospital stay resulting from a Covered Injury or Covered Illness Who Can Elect Coverage: You: All active, full time Employees of the Employer who are regularly working in the United States a minimum of 30 hours per week and regularly residing in the United States and who are United States citizens or permanent resident aliens and their Spouse, Domestic Partner, or Civil Union Partner and Dependent Children who are United States citizens or permanent resident aliens and who are residing in the United States. You will be eligible for coverage the first of the month coincident with or following date of hire. Your Spouse/Domestic Partner: Up to age 100, if you apply for and are approved for coverage yourself. Your Child(ren): Birth to age 26; 26+ if disabled if you apply for and are approved for coverage yourself. Available Coverage: The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred and are paid on a per day basis unless otherwise specified. Benefits are only payable when all policy terms and conditions are met. Please read all the information in this summary to understand the terms, conditions, state variations, exclusions, and limitations applicable to these benefits. See your Certificate of Insurance for more information. Benefit Waiting Period: None Pre Existing Conditions: None How do I submit a claim? • Complete the claim form found on your benefit website. • Options for filing the Claim Form:  Call 800.754.3207 to speak with one of our dedicated customer service representatives.  Email your scanned documents to: SuppHealthClaims@Cigna.com

Period. Limited to 1 day, 1 benefit(s) every 365 days. $1,500 $2,500 Hospital Chronic Condition Admission No Elimination Period. Limited to 1 day, 1 benefit(s) every 90 days. $50 $100 Hospital Stay No Elimination Period. Limited to 30 days. $100 $200 Hospital Intensive Care Unit (ICU) Stay No Elimination Period. Limited to 30 days. $150 $250 Hospital Observation Stay (per 24 hour 24period)hour Elimination Period. Limited to 72 hours. $100 $200 Newborn Nursery Care Admission Limited to 1 day, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected. $250 $500 Newborn Nursery Care Stay* Limited to 30 days, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected. $100 $200 Hospital Indemnity MonthlyPlanPremiums1 Plan 2 Employee $18.31 $36.63 Employee + Spouse $37.39 $74.78 Employee + Child(ren) $26.24 $52.47 Family $41.82 $83.63 24

Hospital Stay: Must be admitted as an Inpatient and confined to the Hospital, due to a Covered Injury or Covered Illness, at the direction and under the care of a physician. If also eligible for the ICU Stay Benefit, only 1 benefit will be paid for the same Covered Injury or Covered Illness, whichever is greater. Hospital stays within 90 days for the same or a related Covered Injury or Covered Illness is considered one Hospital Stay.

EMPLOYEE BENEFITS Benefit Amounts Payable: Benefits for all Covered Persons are payable at 100% of the Benefit Amounts shown, unless otherwise stated. Late applicants, if allowed under this plan, may be required to provide medical evidence of insurability.

Admission: Must be admitted as an Inpatient due to a covered chronic condition and treatment for a covered chronic condition must be provided by a specialist in that field of medicine. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re admission for the same Covered Injury or Covered Illness (including chronic conditions).

Benefit Specific Conditions, Exclusions & Limitations (Hospital Indemnity):

Newborn Nursery Care Admission and Newborn Nursery Care Stay: Must be admitted as an Inpatient and confined in a Hospital immediately following birth at the direction and under the care of a physician.

THIS POLICY PAYS LIMITED BENEFITS ONLY. Please refer to the benefit site www.mybenefitshub.com/burlesonisd under the Hospital Indemnity Section for limitations and exclusions.

Hospital Indemnity Cigna

Intensive Care Unit (ICU) Stay: Must be admitted as an Inpatient and confined in an ICU of a Hospital, due to a Covered Injury or Covered Illness, at the direction and under the care of a physician. If also eligible for the Hospital Stay Benefit, only 1 benefit will be paid for the same Covered Injury or Covered Illness, whichever is greater. ICU stays within 90 days for the same or a related Covered Injury or Covered Illness is considered one ICU stay.

Hospital Admission: Must be admitted as an Inpatient due to a Covered Injury or Covered Illness. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re admission for the same Covered Injury or Covered Illness (including chronic Hospitalconditions).ChronicCondition

Hospital Observation Stay: Must be receiving treatment for a Covered Injury or Covered Illness in a Hospital, including an observation room, or ambulatory surgical center, for more than 24 hours on a non inpatient basis and a charge must be incurred. This benefit is not payable if a benefit is payable under the Hospital Stay Benefit or Hospital Intensive Care Unit Stay Benefit.

ABOUT TELEHEALTH Telehealth provides 24/7/365 access to board certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non emergency care when your primary care physician is not available. For full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd Telehealth + Behavioral Health MDLIVE EMPLOYEE BENEFITS Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost effective option when you need care and: • Have a non emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment • Are on a business trip, vacation or away from home • Are unable to see your primary care physician When to Use MDLIVE: At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as: • Sore throat • Headache • Stomachache • Cold • Flu • Allergies • Fever • Urinary tract infections Do not use telemedicine for serious or life threatening emergencies. MDLIVE Behavioral Health: Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or MDLIVE App. • Talk to a licensed counselor or psychiatrist from your home, office, or on the go! • Affordable, confidential online therapy for a variety of counseling needs. • The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging. Registration is Easy Register with MDLIVE so you are ready to use this valuable service when and where you need it. • Online www.mdlive.com/fbsbh • Phone 888 365 1663 • Mobile download the MDLIVE mobile app to your smartphone or mobile device • Select “MDLIVE as a benefit” and “FBS” as your Employer/Organization when registering your account. Telehealth Monthly Premiums Employee & Family $12.00 26

ABOUT DENTAL Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and Fordisease.fullplan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd Dental Insurance Cigna EMPLOYEE BENEFITS DENTAL HIGH PLAN Network Options In Network: Total Cigna DPPO Network Out of Network: See Non Network Reimbursement Reimbursement Levels Based on Contracted Fees Maximum Reimbursable Charge Policy Year Benefits Maximum Applies to: Class II & III expenses $1,500 $1,500 Policy Year Deductible FamilyIndividual $150$50 $150$50 Benefit Highlights Plan Pays You Pay Plan Pays You Pay 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 Deductible100%No No Charge Deductible100%No No Charge Class II: Basic Restorative Restorative: fillings, Endodontics: minor and major, Periodontics: minor and major, Oral Surgery: minor and major, Anesthesia: general and IV sedation, X rays: non routine, Sealants: per tooth DeductibleAfter80% DeductibleAfter20% DeductibleAfter80% DeductibleAfter20% Class III: Major Restorative Inlays and Onlays, Prosthesis Over Implant, Crowns: prefabricated stainless steel / resin, Crowns: permanent cast and porcelain, Bridges and Dentures, Repairs: bridges, crowns and inlays, Repairs: dentures, Denture Relines, Rebases and Adjustments, Space Maintainers: non orthodontic DeductibleAfter50% DeductibleAfter50% DeductibleAfter50% DeductibleAfter50% Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,500 Deductible50%No Deductible50%No Deductible50%No Deductible50%No Benefit Plan Provisions In Network Reimbursement: For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse thedentist according to a Fee Schedule or Discount Schedule. Non Network Reimbursement: For services provided by a non network dentist, Cigna Dental will reimburse according to theMaximum Reimbursable Charge. The MRC is calculated at the 90th percentile of all provider submitted amounts in the geographic area. The dentist may balance bill up to their usual fees. Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. pretaxfromcontributionsPremiumaredeductedyourpaycheckonabasis.Coverageis provided through Cigna Dental. How to Find a Dentist Visit hcpdirectory.cigna.com/https:// or call 800 244 6224 to find an in network dentist. Your network will be Total Cigna DPPO. How to Request a New ID Card You can request your dental id card by contacting Cigna directly at 800 244 6224. You can also go www.mycigna.comto and register/login to access your account. In addition, you can download the “MyCigna” app on your smartphone and access your id card right there on your phone. 27

DENTAL LOW PLAN Network Options In Network: Total Cigna DPPO Network Out of Network: See Non Network Reimbursement Reimbursement Levels Based on Contracted Fees Maximum Allowable Charge Policy Year Benefits Maximum Applies to: Class II & III expenses $1,000 $1,000 Policy Year Deductible FamilyIndividual $150$50 $150$50 Benefit Highlights Plan Pays You Pay Plan Pays You Pay Class I: Diagnostic & Preventive Oral Evaluations, Prophylaxis: routine cleanings, X rays: routine, Fluoride Application, Emergency Care to Relieve Pain 80% No Deductible 20% No Deductible 80% No Deductible 20% No Deductible Class II: Basic Restorative Restorative: fillings, Endodontics minor or major, Periodontics: minor and major, Oral Surgery: minor and major, Anesthesia: general and IV sedation, X rays: non routine, Sealants: per tooth 60% After Deductible 40% After Deductible 60% After Deductible 40% After Deductible Class III: Major Restorative Inlays and Onlays, Prosthesis Over Implant, Crowns: prefabricated stainless steel / resin, Crowns: permanent cast and porcelain, Bridges and Dentures, Repairs: bridges, crowns and inlays, Repairs: dentures, Denture Relines, Rebases and Adjustments, Space Maintainers: non orthodontic 40% After Deductible 60% After Deductible 40% After Deductible 60% After Deductible Benefit Plan Provisions In Network Reimbursement: For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse thedentist according to a Fee Schedule or Discount Schedule. Non Network Reimbursement: For services provided by a non network dentist, Cigna Dental will reimburse according to theMaximum Reimbursable Charge. The MRC is calculated at the 90th percentile of all providersubmitted amounts in the geographic area. The dentist may balance bill up to their usual fees. Late Entrant Limitation Provision: Payment will be reduced by 50% for Class III services for 12 months for eligible members that are allowed to enroll in this plan outside of the designated open enrollment period. This provision does not apply to new hires. DHMO PLAN If you enroll in the DHMO plan, you must select a Primary Care Dentist (PCD) from the DHMO network directory to manage your care. Each eligible dependent may choose their own PCD. The Patient Charge Schedule applies only when covered dental services are performed by your network dentist. Not all Network Dentist perform all listed services and it is suggested to check with your Network Dentist in advance of receiving services. Dental services are unlimited; you pay fixed co pays, there are no deductibles and there are no claim forms to file. There is no coverage for services provided without a referral from your PCD or if you seek care from out of network providers. Please refer to your benefit website for full details. How do I find an In network Dentist? Visit: https://hcpdirectory.cigna.com/ or call 800 244 6224 to find an in network dentist. Your network will be Cigna Dental Care DHMO. Dental Monthly Premiums High Plan Low Plan DHMO Employee $41.47 $23.73 $10.17 Employee + Spouse $92.23 $51.36 $16.51 Employee + Child(ren) $102.38 $54.47 $22.83 Family $142.22 $82.39 $27.19 Dental Insurance Cigna EMPLOYEE BENEFITS Please refer to www.mybenefitshub.com/burlesonisd for additional plan features, claims information, and limitations. 28

ABOUT VISION Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses. For full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd Vision Insurance Superior Vision EMPLOYEE BENEFITS Copays Services/frequency Vision Monthly Premiums Exam $10 Exam 12 months Employee $10.30 Materials $10 Frame 12 months Employee + Spouse $17.58 Lenses 12 months Employee + Child(ren) $18.62 Contact lenses 12 months Family $27.30 Based on date of service Benefits: Superior Select Southwest network In network Out of network Exam Covered in full Up to $35 retail Frames $150 retail allowance Up to $70 retail Lenses (standard) per pair Single Vision Covered in full Up to $25 retail Bifocal Covered in full Up to $40 retail Trifocal Covered in full Up to $45 retail Progressive See description Up to $45 retail Lenticular Covered in full Up to $80 retail Contact Lenses $175 retail allowance Up to $80 retail Medically Necessary Contact Lenses Covered in full Up to $150 retail Lasik Vision Correction $200 allowance How to Print your Vision ID Card: You can request your vision id card by contacting Superior Vision directly at 800 507 3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone. Need to search an in network provider? Call 800 507 3800 or Visit https://superiorvision.com/locator/ to locate a provider. Need Help? Call 800 507 3800 Customer Service, log in online at www.SuperiorVision.com, or create an account on the app. Discount Features Non Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy. The national LASIK network of laser vision correction providers, featuring LasikPlus, offers members special program pricing on ser29

Schedule

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. full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd

ABOUT DISABILITY

Disability

caused

The Hartford EMPLOYEE BENEFITS Disability Insurance protects one your valuable assets, your paycheck. This insurance will replace a portion of your income if you become physically unable to work due to sickness or injury for an extended period of time. You must be under the regular care of a physician to receive benefits. A Premium Option: Disabilities resulting from sickness or injury as noted in the chart below for Plan A.

Schedule

sickness: Age Disabled Benefits Payable Prior to Age 60 Benefits continue to age 65 Age 60 64 60 months Age 65 68 To age 70 Age 69 and older 12 months Age Disabled Benefits Payable Prior to Age 60 Benefits continue to age 65 Age 60 64 60 months Age 65 68 To age 70 Age 69 and older 12 months Age Disabled Benefits Payable Prior to Age 61 60 months Age 61 54 months Age 62 48 months Age 63 42 months Age 64 36 months Age 65 30 months Age 66 27 months Age 67 24 months Age 68 21 months Age 69 and over 18 months 30

Insurance

• Plan B Select Option: Disabilities resulting from injury or sickness as noted in the chart below for Plan B. A Premium Option: For the Premium benefit option the table below applies to disabilities resulting from sickness or injury: Plan B Select Option: For the Select benefit option see the tables below for the applicable benefit duration based on whether your disability is a result of injury or sickness. for disability caused by injury: for disability by

Benefit Highlights Benefit Duration • Plan

For

Plan

Disability Insurance The Hartford EMPLOYEE BENEFITS Guarantee Issue Pre ex applies: 3/12 Waiver of Elimination (Waiting) Period: Requires 24 hour hospital confinement and only available for 0/7, 14/14 and 30/30 elimination periods Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full time employment. Survivor Benefit If you die while receiving disability benefits, a benefit will be paid to your spouse, or in equal shares to your surviving children under the age of 25, equal to three times the last monthly gross benefit. The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services. Includes emotional work life counseling, financial information and resources, Legal Support and Heath benefits services. Call 1 800 964 3577 or visit www.guidanceresources.com Web ID HLF902 Company Name Field ABILI Travel Assistance Program Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre trip information, emergency medical assistance and emergency personal services. Identity Theft Protection An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims. How to file a Claim: Call The Hartford at 1 866 547 9124. Online at: HTTPS:// ABILITYADVANTAGE.THEHARTFORD.COM Reductions of Benefits can Disabilityoccur.Monthly Premiums per $200 in benefit Elimination Period Plan A Plan B 0/7 $9.02 $8.04 14/14 $7.20 $6.36 30/30 $5.94 $5.32 60/60 $4.06 $3.62 90/90 $3.52 $3.14 180/180 $2.72 $2.42 31

Family Member Transportation & Lodging Benefit $0.50

Experimental Treatment Benefit Pays

$200 per day of surgery $600 per day of surgery $150 per confinement $150 per confinement $50 per prescription, up to $50 per cal month $50 per prescription, up to $150 per cal month & $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 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 $150 per day, up to $7,500 per calendar year $250 per day, up to $12,500 per calendar year $500 per calendar year Autologous $1,500 per calendar year $1,500 per calendar year

benefit Attending Physician Benefit $30

Drugs & Medicine Benefit Inpatient

Outpatient Lodging Benefit

Non Autologous $4,500 per calendar year as any non experimental benefit Pays as any non experimental per day of confinement $50 per day of confinement 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

Non

ABOUT CANCER 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. For full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd Cancer Insurance American Public Life EMPLOYEE BENEFITS Cancer Monthly Premiums Low w/ICU Option 2 w/ICU Individual $14.50 $17.80 $30.60 $33.90 One Parent $20.30 $24.80 $42.10 $46.60 Two Parent $25.90 $32.80 $53.50 $60.40 Benefits Level 1 Base Plan Level 2 Base 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

Drugs & Medicine Benefit Outpatient

Transportation

Surgical Prosthesis Benefit $1,000

Bone Marrow/Stem Cell Transplant Autologous

Blood, Plasma & Platelets Benefit

Autologous

Cancer Insurance American Public Life EMPLOYEE BENEFITS Benefits Level 1 Base Plan Level 2 Base Plan 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 DiagnosticRiders Testing Benefit Rider $50; 1 person, per calendar year $50; 1 person, per calendar year Critical Illness Rider: Cancer $2,500 lump sum benefit $2,500 lump sum benefit Optional Benefit Rider Intensive Care Unit Rider Up to $600 max of 30 days per ICU $100confinement;ambulance per ICU admission Up to $600 max of 30 days per ICU $100confinement;ambulance per ICU admission This plan includes a Wellness Benefit. Refer to your benefit website for details and forms. Should you need to file a cancer claim contact APL at 800 256 8606 or online at www.ampublic.com. You can find additional claim forms and materials at www.mybenefitshub.com/burlesonisd under the Cancer section of the portal. 33

ABOUT IDENTITY THEFT PROTECTION Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered. For full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd Identity Theft ID Watchdog EMPLOYEE BENEFITS ID Watchdog is everywhere you can’t be monitoring credit reports, social media, transaction records, public records and more to help you better protect your identity. And don’t worry, we’re always here for you. In fact, our U.S. based customer care team is available 24/7/365 at 866.513.1518. UNIQUE FEATURES INCLUDED IN ALL ID WATCHDOG PLANS Monitor & Detect • Dark Web Monitoring* • High Risk Transactions Monitoring* • Subprime Loan Monitoring* • Public Records Monitorin* • USPS Change of Address Monitoring • Identity Profile Report Manage & Alert • Child Credit Lock | 1 Bureau* • Financial Accounts Monitoring • Social Network Alerts* • Registered Sex Offender Reporting* • Customizable Alert Options • Breach Alert Emails • Mobile App Support & Restore • Identity Theft Resolution Specialists (Resolution for Pre existing Conditions)* • 24/7/365 U.S. based Customer Care Center • Lost Wallet Vault & Assistance • Deceased Family Member Fraud Remediation • Fraud Alert & Credit Freeze Assistance *Helps better protect children 1 Bureau = Equifax® Multi Bureau = Equifax, TransUnion® 3 Bureau = Equifax, Experian®, TransUnion WHAT YOU NEED TO KNOW Plan Options ID WATCHDOG® 1B ID WATCHDOG® PLATINUM Credit Report(s)& VantageScore Credit Score(s) 1 Bureau Monthly 1 Bureau Daily & 3 Bureau Annually Credit Score Tracker 1 Bureau Monthly 1 Bureau Daily Credit Report Monitoring 1 Bureau 3 Bureau Credit Report Lock 1 Bureau Multi Bureau Identity Theft Insurance Up to $1M Up to $1M 401K/HSA Stolen Funds Reimbursement Up to $500k MONTHLY PREMIUMS Employee $7 95 $11.95 Employee and Family $14.95 $22.95 34

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

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

Who is eligible for this coverage?

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

Voluntary Life and AD&D UNUM ABOUT LIFE AND AD&D 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.

For full plan details, please visit

Employee: up to 7 times salary in increments of $10,000; not to exceed $500,000.

Child: the death benefit for a child between the ages of six months to age 26 is $10,000.

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. your benefit

website: www.mybenefitshub.com/burlesonisd EMPLOYEE BENEFITS

When is effective?coverage

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

Do my life insurance benefits decrease with age?

Child: the death benefit for a child between the ages of six months to age 26 is $10,000.

Coverage amounts will reduce according to the following schedule:

Age: Insurance amount reduces to: 70 65% of original amount 75 45% of original amount 80 30% of original amount 85 20% of original amount 90 15% of original amount Coverage may not be increased after a reduction.

What are the AD&D coverage amounts?

What are the coverage amounts?

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

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.

Are there any life insuranceexclusions or limitations?

Employee: up to 7 times salary in increments of $10,000; not to exceed $500,000.

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

For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness or disorder, your dependent spouse and children: are confined in a hospital or similar institution; are unable to perform two or more activities of daily living (ADLs) because of a physical or mental incapacity resulting from an injury or a sickness; are cognitively impaired; or have a life threatening condition. Exception: Infants are insured from live birth.

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.

Voluntary Life and AD&D UNUM EMPLOYEE BENEFITS 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. Are there any life insuranceexclusions 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. Voluntary Group Life Monthly Premiums Age Employee per $10,000 Spouse per $5,000 <24 $0.42 $0.21 25 29 $0.42 $0.21 30 34 $0.48 $0.24 35 39 $0.57 $0.29 40 44 $0.89 $0.45 45 49 $1.51 $0.76 50 54 $2.51 $1.25 55 59 $3.91 $1.96 60 64 $6.12 $3.06 65 69 $10.97 $5.49 70 74 $19.65 $5.49 75+ $32.40 $5.49 Spouse rates based on Employee's age. AD&D Monthly Premiums Employee (per $10,000) $0.25 Spouse (per $5,000) $0.13 Child (per $10,000) $0.25 Voluntary Group Life: Child(ren) Monthly Premiums $10,000 in coverage 0 26 $0.78 36

ABOUT INDIVIDUAL LIFE

Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire.

EMPLOYEE

• Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.

Individual Life Insurance

For full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd

Find

Should you need to file a claim, contact 5Star directly at (866) 863 9753.

TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL).

PORTABLE Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly. CONVENIENCE Easy payments through payroll deduction.

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

PROTECTION TO COUNT ON Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two year contestability period and/or under investigation. This coverage has no war or terrorism exclusions. full details and rates at www.mybenefitshub.com/burlesonisd.

5Star Life Insurance BENEFITS Family Protection Plan with 5Star Life Insurance offers individual insurance coverage to age 121. The plan includes a Terminal Illness Acceleration of Benefit and a Qualify of Life Benefit.

QUALITY OF LIFE Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following:

FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.

* Financially dependent children 14 days to 23 years old.

Emergent Ground Transportation

Non Emergency Inter Facility Transportation

Air Transportation

A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for high deductible health plan coverage that is compatible with a health savings Emergentaccount.

Emergency Medical Transport BENEFITS

For full plan details, please visit your benefit website: www.mybenefitshub.com/burlesonisd

In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non emergency air or ground transportation between medical facili-

Emergency Medical Transportation Monthly Premiums Emergent Plus Platinum Employee & Family $14.00 $39.00 Plan FeaturesEmergentMembershipPlus MembershipPlatinum Emergency TransportationAir x x Emergent TransportationGround x x Non Emergency Inter Facility Transportation x x RecuperationRepatriation/ x x Escort Transportation x Visitor Transportation x Return Transportation x Mortal TransportationRemains x Minor Return x Organ RecipientRetrieval/OrganTransportation x Vehicle Return x Pet Return x Worldwide Coverage x 38

Should you need assistance with a claim contact MASA at 800 643 9023. You can find full benefit details at: www.mybenefitshub.com/burlesonisd.

In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.

Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out of pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.

In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities.

SupposeRepatriation/Recuperationties.youorafamilymember is hospitalized more than 100 miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation.

MASA EMPLOYEE

ABOUT MEDICAL TRANSPORT

Notes 39

WWW.MYBENEFITSHUB.COM/BURLESONISD 2022 - 2022 PlanYear

Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Burleson ISD Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice.

Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the Burleson ISD Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.