2022-23 Carrollton-Farmers Branch ISD Benefit Guide by Higginbotham Public Sector

CARROLLTON-FARMERS BRANCH ISD BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.MYBENEFITSHUB.COM/CFBISD 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 Dental DPPO 19-20 Dental DHMO 21 Vision 22-23 Cancer 24-25 Accident 26-27 Identity Theft 28-29 Disability 30-31 Life and AD&D 32-33 Whole Life 34 Health Savings Account (HSA) 35 Hospital Indemnity 36-37 Emergency Medical Transportation 38 Telehealth 39 Flexible Spending Account (FSA) 40-41 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 12 2

CFB ISD BENEFITS MEDICAL TRS ACTIVECARE MEDICAL TRS HMO Financial Benefit Services (800) 583 www.mybenefitshub.com/cfbisd6908 (866)BCBSTX355 www.bcbstx.com/trsactivecare5999 Scott & White HMO (844) 633 www.trs.swhp.org5325 CFBISD BENEFITS ADMINISTRATOR DENTAL DPPO DENTAL DHMO (972) 968‐6120 benefithelp@cfbisd.edu GroupMetLife#233529 (800) 638 5433 www.metlife.com GroupCigna #3334580 (800) 244 www.mycigna.com6224 VISION CANCER ACCIDENT www.myUHCvision.com(800)UnitedHealthcare6383120 American Public Life (800) 256 www.ampublic.com8606 (800)Cigna244 www.mycigna.com6224 LIFE AND AD&D IDENTITY THEFT DISABILITY (800)Cigna244 www.mycigna.com6224 (800)Allstate789 www.allstateidentityprotection.com2720 (800)Cigna244 www.mycigna.com6224 WHOLE LIFE HEALTH SAVINGS ACCOUNT (HSA) HOSPITIAL INDEMNITY (866)UNUM679 www.unum.com6054 (800)HSABank357 www.hsabank.com6246 (800)Cigna244 www.mycigna.com6224 EMERGENCY MEDICAL TRANSPORT FLEXIBLE SPENDING ACCOUNT (FSA) (800)MASA423 www.masamts.com3226 National Benefit Services (855) 399 www.nbsbenefits.com3035 Benefit Contact Information 3

Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS CFB” to (800) 583-6908 App Group #: FBSCFB Text “FBS CFB” 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/cfbisd How to Log In 2 CLICK LOGIN 3 ENTER USERNAME & PASSWORD Your Username is: District Login Your Password is: District Password If you don't know your district login, need your password reset or need assistance logging in please call the CFBISD Help Desk at (972) 968 4357 or Helpdesk@cfbisd.eduemail. 5

Life You may increase your current election by two increments (or $20,000) without having to complete Evidence of Insurability (i.e., no medically related questions).

Vision moving from Superior Vision to United Healthcare and are receiving a 23% discounts in rates across all tiers!

• TRS ActiveCare Primary+ (requires Primary Care Physician*): This plan has lower deductibles and copays for many services and drugs. There is no out of network coverage. $12 Teladoc (change from $0) and $0 RediMD Virtual Health visits. New Specialty Drug program through PrudentRx. Out of pocket for insulin capped at $25 for 31‐day supply; $75 for 61 90 day supply.

Hospital Indemnity moving from Aflac to Cigna effective 9/1/2022. Admission benefits will remain the same under the new Hospital Indemnity plan but rates have been reduced across all tiers of coverage.

• TRS ActiveCare HD: This plan works with a Health Savings Account (HSA), has out of network coverage, and coinsurance rates instead of copays. You must meet the deductible before the plan will pay for non preventive services. Includes nationwide network and out of network coverage. $42 Teladoc Virtual Health (was $30) and $30 RediMD Virtual Health visits. The out of pocket in network amount increased by $50 for individual and $100 for family.

Health Savings Account (HSA) the IRS indexes maximum HSA contribution amounts and has increased the annual contribution amount for individual accounts from $3,600 to $3,650 and from $7,200 to $7,300 for family accounts. Both individual and family accounts can add $1,000 for catch up if the account holder is age 55 or Voluntaryolder.Term

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, even if you are not adding dependent coverage. If you have questions, please contact your Benefits Administrator. SUMMARY PAGESAnnual Benefit Enrollment Effective 9/1/2022, rates for ActiveCare Plans for 2022‐23 have decreased or remained the same! Blue Cross and Blue Shield of Texas (BCBSTX) will continue to offer the same plans. Refer to TRS Plan Highlights for full details.

PASSWORD RESET When you reset your password this year, make it something you will remember as passwords will not be reset moving forward. For password assistance, please contact the CFBISD Helpdesk.

• TRS ActiveCare 2: This plan is closed to new enrollees; those currently enrolled may remain. $12 Teladoc (change from $0) and $0 RediMD Virtual Health visits. Out of pocket for insulin capped at $25 for 31‐day supply; $75 for 61 90 day supply.

TRS ActiveCare Primary (requires Primary Care Physician*): This plan has the lowest premiums, $30 copays for primary care visits; $70 for specialist. There is no out of network coverage. $12 Teladoc (change from $0) and $0 RediMD Virtual Health visits. New Specialty Drug program through PrudentRx. Out of pocket for insulin capped at $25 for 31‐day supply; $75 for 61 90 day supply.

Accident moving from Lincoln Financial Group to Cigna. Under the new Cigna Accident plan, benefits have been improved and broadened with reduced rates!!

FSA Medical increased annual election to $2,850. A medical FSA allows you to set aside a portion of your earnings to pay for qualified expenses, most commonly for medical costs, such as doctors, dentists, and optometrist copays. Please utilize your current funds prior to 8/31/22, remember you can use your flex dollars at www.fsastore.com. A dependent care FSA works just like a medical FSA but the pre tax dollars you set aside are for the reimbursement of qualified day care expenses.

•

EligibilityDependents'ofStatus

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.

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.

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.

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/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. IN EVENTS

Judgment/Decree/Order

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

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.

Section 125 Cafeteria Plan Guidelines SUMMARY PAGESAnnual Benefit Enrollment CHANGES

Eligibility for Government Programs

Marital Status

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.

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

(CIS):STATUS QUALIFYING

For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/cfbisd

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.

When will I receive ID cards?

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.

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

For benefit summaries and claim forms, go to the Carrollton Farmers Branch ISD benefit website: www.mybenefitshub.com/cfbisd.

Annual Enrollment

Where can I find forms?

• Employees must review their personal information and verify all dependents are included, even if you do not wish to provide coverage for them. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.

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.

• 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. Hire Enrollment

Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section. How can I find a Network Provider?

SUMMARY PAGESAnnual Benefit Enrollment 8

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.

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.

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

New

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, except for the New York Life Voluntary Term Life product.

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

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. PLAN MAXIMUM AGE Medical To Age 26 Dental To Age 26 IndemnityHospital To Age 26 Dental To Age 26 Vision To Age 26 Cancer To Age 26 Whole Life w/ LTC To Age 26 Group Term Life w/AD&D To Age 26 Emergency TransportMedical To Age 26

Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.

Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse FSA/HSAeligibility.Limitations:

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.

Dependent RequirementsEligibility

SUMMARY PAGES

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.

Annual Benefit Enrollment

Employee RequirementsEligibility

Supplemental Benefits: Eligible employees must work 20 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.

After

Guaranteed

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

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

Actively at Work

Annual

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

Calendar Year

Plan Year 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 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).

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.

September

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.

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

SUMMARY PAGESHelpful Definitions 10

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 through the 2 1/2 month grace period provision. Does the account earn interest? Yes No Portable? Yes, portable year to year and between jobs. No FLIP TO FOR HSA INFORMATION PG. 35 FLIP TO FOR FSA INFORMATION PG. 40 11

Monthly Premium District Contribution Employee Cost TRS ActiveCare HD Employee Only $422.00 $350.00 $72.00 Employee & Spouse $1,187.00 $350.00 $837.00 Employee & Child(ren) $757.00 $350.00 $407.00 Employee & Family $1,419.00 $350.00 $1,069.00 TRS ActiveCare 2 Employee Only $1,013.00 $350.00 $663.00 Employee & Spouse $2,402.00 $350.00 $2,052.00 Employee & Child(ren) $1,507.00 $350.00 $1,157.00 Employee & Family $2,841.00 $350.00 $2,491.00 TRS ActiveCare Primary Employee Only $410.00 $350.00 $60.00 Employee & Spouse $1,157.00 $350.00 $807.00 Employee & Child(ren) $738.00 $350.00 $388.00 Employee & Family $1,384.00 $350.00 $1,034.00 TRS ActiveCare Primary+ Employee Only $515.00 $350.00 $165.00 Employee & Spouse $1,259.00 $350.00 $909.00 Employee & Child(ren) $829.00 $350.00 $479.00 Employee & Family $1,584.00 $350.00 $1,234.00 Central and North Texas Baylor Scott & White HMO Employee Only $543.35 $350.00 $193.35 Employee & Spouse $1,364.92 $350.00 $1,014.92 Employee & Child(ren) $873.57 $350.00 $523.57 Employee & Family $1,570.98 $350.00 $1,220.98 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/CFBISD Medical Insurance TRS EMPLOYEE BENEFITS 12

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/cfbisd Dental Insurance - DPPO MetLife EMPLOYEE BENEFITS Network: PDP Plus Plan Option 1 High Plan Plan Option 2 Low Plan In Network % of Negotiated Fee* Out of Network 90% of R&C Fee*** In Network % of Negotiated Fee* Out of Network 90% of R&C Fee*** Type A: (cleanings,Preventiveexams, X rays) 100% 100% 80% 80% Type B: Basic Restorative (fillings, extractions, X rays) 60% 60% 60% 60% Type C: Major Restorative (bridges, dentures, X rays) 60% 60% 60% 60% Type D: Orthodontia 50% 50% 50% 50% Deductible† FamilyIndividual $150$50 $150$50 $150$50 $150$50 Annual Maximum Benefit Per Person $1,500 $1,500 $1,500 $1,500 Orthodontia Lifetime Maximum Per Person*** $1,000 $1,000 $1,000 $1,000 Child(ren)’s eligibility for dental coverage is from birth up to age 26. Plan Type Plan Option 1: High Plan How Many/How Often Plan Option 2: Low Plan How Many/How Often Type A ProphylaxisPreventive(cleanings) Two per plan year Two per plan year Oral Examinations Two exams per plan year Two exams per plan year Topical Fluoride Applications One fluoride treatment per plan year for dependent children up to their 19th birthday X rays Full mouth X rays; one per 3 plan years. Bitewings X rays; two sets per plan year for adults and children. Space Maintainers Space maintainers for dependent children up to their 19th birthday. Once per tooth area, per lifetime Sealants One application of sealant material every 3 years for each non restored, non decayed 1st and 2nd molar of a dependent child up to their 14th birthday DentalPPOPPOHigh PPO Low Employee $42.84 $37.22 Employee + Spouse $94.64 $82.22 Employee + Child(ren) $85.74 $74.50 Family $142.44 $123.78 19

***R&C

***Ortho

†

Dental Insurance MetLife EMPLOYEE BENEFITS Plan Type Plan Option 1: High Plan How Many/How Often Plan Option 2: Low Plan How Many/How Often Type A ProphylaxisPreventive (cleanings) Two per plan year Two per plan year Oral Examinations Two exams per plan year Two exams per plan year Topical Fluoride Applications One fluoride treatment per plan year for dependent children up to their 19th birthday X rays Full mouth X rays; one per 3 plan years. Bitewings X rays; two sets per plan year for adults and children. Space Maintainers Space maintainers for dependent children up to their 19th birthday. Once per tooth area, per lifetime Sealants One application of sealant material every 3 years for each non restored, non decayed 1st and 2nd molar of a dependent child up to their 14th birthday Type B Basic Restorative Fillings 1 per 24 months 1 per 24 months Simple Extractions Oral EndodonticsSurgery Root canal treatment limited to once per tooth per lifetime General Anesthesia When dentally necessary in connection with oral surgery, extractions, or other covered dental services Periodontics Periodontal scaling and root planing once per quadrant, every 24 months Periodontal surgery once per quadrant, every 36 months Total number of periodontal maintenance treatments and prophylaxis cannot exceed two treatments in a calendar year Type C Major Restorative Crown, Denture and Bridge Repair/ Recementations Repairs 1 per 12 months Recementations 1 per 12 months Repairs 1 per 12 months Recementations 1 per 12 months Bridges and Dentures Dentures and bridgework replacement; one every 5 years. Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed Crowns, Inlays and Onlays Replacement once every 5 years Replacement once every 5 years Type D Orthodontia You, your spouse and your children, up to age 26, are covered while Dental insurance is in effect

*Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. fee refers to the Reasonable and Customary (R&C) charge, which is based on the lowest of (1) the dentist’s actual charge, (2) the dentist’s usual charge for the same or similar services, or (3) the charge of most dentists in the same geographic area for the same or similar services as determined by MetLife. Applies only to Type B & C Services. Plan Orthodontia excluded for adults. Available for dependent children up to age 19. Plan Orthodontia available for adults and children up to age 26. 50% up to the lifetime maximum.

***Standard

All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia Payments are on a repetitive basis 20% of the Orthodontia Lifetime Maximum will be considered at initial placement of the appliance and paid based on the plan benefit’s coinsurance level for Orthodontia as defined in the plan summary Orthodontic benefits end at cancellation of coverage Your children, up to age 19 are covered while Dental insurance is in effect

***Enhanced

• Online provider directory on www.myCigna.com Call the number located on your ID card to:

www.mybenefitshub.com/cfbisd Dental Insurance - DHMO Cigna EMPLOYEE BENEFITS 21

The American Dental Association may periodically change CDT Codes or definitions. Different codes may be used to describe these covered procedures. The language in italics is intended to clarify the members’ benefit. Call the dental office identified in your Welcome Kit. If you wish to change dental offices, a transfer can be arranged at no charge by calling Cigna Dental at the toll free number listed on your ID card or plan materials.

The Patient Charge Schedule can be found on your benefit website, www.mybenefitshub.com/cfbisd, and applies to Specialty Care when an appropriate referral is made to a Network Specialty Periodontist or Oral Surgeon. You should verify with the Network Specialty Dentist that your treatment plan has been authorized for payment by Cigna Dental. Prior authorization is not required for specialty referrals for Pediatric, Orthodontic and Endodontic services. You may select a Network Pediatric Dentist for your child under the age of 7 by calling Customer Service at 1.800.Cigna24 to get a list of Network Pediatric Dentists in your area. Coverage for treatment by a Pediatric Dentist ends on your child’s 7th birthday; however, exceptions for medical reasons may be considered on an individual basis. Your Network General Dentist will provide care upon your child’s 7th birthday.

EMERGENCY: If you have a dental emergency as defined in your group’s plan documents, contact your Network General Dentist as soon as possible. If you are out of your service area or unable to contact your Network Office, emergency care can be rendered by any dental office, dental clinic, or other comparable facility.

Cigna Dental considers infection control and/or sterilization to be incidental to and part of the charges for services provided and not separately chargeable. This Patient Charge Schedule is subject to annual change in accordance with the terms of the group agreement.

The administration of IV sedation, general anesthesia, and/or nitrous oxide is not covered except as specifically listed on this Patient Charge Schedule. The application of local anesthetic is covered as part of your dental treatment.

Multiple ways to locate a (*DHMO) Network General Dentist:

This Patient Charge Schedule applies only when covered dental services are performed by your Network Dentist, unless otherwise authorized by Cigna Dental as described in your plan documents. Not all Network Dentists perform all listed services, and it is suggested to check with your Network Dentist in advance of receiving services.

Definitive treatment (e.g., root canal) is not considered emergency care and should be performed or referred by your Network General Dentist. Consult your group’s plan documents for a complete definition of dental emergency, your emergency Dental DHMO $9.48 $20.10 $20.10 that helps defray of against the expense of routine care, dental treatment and details, please visit your benefit website:

Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/ certificate of coverage and/or group contract. All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated.

• Speak to a Customer Service Representative

Employee + Child(ren)

Family $27.48 ABOUT DENTAL Dental insurance is a coverage

Fordisease.fullplan

Important Highlights

• Online provider directory at www.Cigna.com

Employee

the costs

Procedures not listed on this Patient Charge Schedule are not covered and are the patient’s responsibility at the dentist’s usual fees. If more than one professionally accepted and appropriate method of treatment can be used to treat a dental condition, coverage will be limited to the less costly Covered Service. If you choose the more costly service, the fee listed on the Patient Charge Schedule will not apply. Discuss your options and increased financial obligations with your dentist.

dental care. It insures

Employee + Spouse

• Use the Dental Office Locator via Speech Recognition

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/cfbisd Vision Insurance UHC EMPLOYEE BENEFITS Vision Employee $7.90 Employee + Spouse $14.10 Employee + Child(ren) $14.16 Family $20.34 Plan Options In Network Out of Network Exam(s) Co pay $10 Not Applicable Material Co (Frames/Spectaclepay Lenses or Necessary Contact Lenses) $25 Not Applicable Service Frequency Exams/ Lenses/ Frames/Contacts 12/12/12/12 Eye Exam(s)Examination(Includes additional eye exam for ages 0 12 and pregnant or breastfeeding women) 100% Up to $40 SingleLensesVision 100% Up to $40 Lined Bifocal 100% Up to $60 Lined Trifocal 100% Up to $80 Lenticular 100% Up to $80 RetailFramesFrame Allowance Up to $150 Up to $45 Discount on Frame Overage at participating providers 30% Not Applicable Elective Contact Lenses Contact Lens Material Allowance Up to $150 Up to $125 Contact Lens Fitting and Evaluation Allowance Up to $60 $0 Necessary Contact Lenses 100% Up to $210 22

35%

Blue Light Protection Eyesafe Discount

LASIK

United

Member savings

UnitedHealthcare Vision has collaborated with Eyesafe® to provide members with a 20% discount off the retail price on blue light screen filters for their devices. Members can receive the discount by visiting www.myuhcvision.com and clicking on the Eyesafe® link. Children's and Maternity Eye Care Replacement Eyeglasses eyeglass frame/lenses due to prescription change (ages 0 12 and pregnant or breastfeeding women).

Additional

laser)

add value to your vision care program by offering access to discounted laser vision correction procedures through QualSight

Discounts

Vision Insurance UHC EMPLOYEE BENEFITS 23

UnitedHealthcare is proud to LASIK, the largest manager in the States. represent up to off the national average price of LASIK. are also provided on newer technologies such as Custom Bladeless (all LASIK. Visit www.myuhcvision.com for more information.

Members ages 0 12 and members pregnant or breastfeeding who have a prescription change of 0.5 diopter or more are eligible for a replacement frame and lenses. The replacement benefits are the same as the benefits for the initial frame and lenses. Not applicable for Exam Core or Exam with Discounted Material Plans.

Laser Discount

Lens Options Covered in full Lens Options PolycarbonatePhotochromicLenses for Children up to Age: 19 Tier 1 Progressive Standard Scratch Coating Tint UV Coating Not Applicable Non covered Lens Options Price Protection available for non covered lens options ranging from 20 60% off retail pricing at participating providers (except where not permitted by state law). Value Services

Vision

Cancer Low Low w/ICU High High w/ICU Employee $23.12 $24.84 $39.34 $41.08 Employee + Spouse $49.26 $52.88 $84.22 $87.84 Employee + Child(ren) $27.76 $31.50 $47.36 $51.10 Family $53.88 $59.52 $92.28 $97.92 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/cfbisd Cancer Insurance APL EMPLOYEE BENEFITS Cancer Benefit Highlights Cancer Screening Benefits Option 1 Base Plan Option 2 Base Plan Diagnostic Testing 1 test per Calendar Year $50 per test $75 per test Follow Up Diagnostic Testing 1 test per Calendar Year $100 per test $100 per test Medical Imaging 1 per Calendar Year $500 per test $500 per test Cancer Treatment Benefits Radiation Therapy, Chemotherapy, or Immunotherapy Maximum per 12 month period $15,000 $20,000 Hormone Therapy Maximum of 12 treatments per Calendar Year $50 per treatment $50 per treatment Surgical Benefits MaximumSurgical $30 Unit Dollar Amount $3,000 per operation $45 Unit Dollar Amount $4,500 per operation Anesthesia 25% of amount paid for covered surgery Bone Marrow Transplant Maximum per lifetime $6,000 $9,000 Stem Cell Transplant Maximum per lifetime $600 $900 SurgicalProsthesisImplantation 1 device per site, per lifetime Non Surgical (not hair piece) 1 device per site, per lifetime $1,000$100 $2,000$200 Patient Care Benefits Hospital Confinement Per day of Hospital Confinement (1 30 days) Per day for Eligible Dependent children Per day of Hospital Confinement (31+ days) Per day for Eligible Dependent children $200$100$200$100 $800$400$400$200 Outpatient Facility Per day surgery is performed $200 $400 Attending Physician Per day of Hospital Confinement $30 $40 Dread Disease Per day of Hospital Confinement (1 30 days) Per day of Hospital Confinement (31+ days) $100$100 $400$200 Extended Care Facility Up to the same number of Hospital Confinement Days $100 per day $200 per day Donor $100 per day $200 per day 24

Cancer Insurance APL EMPLOYEE BENEFITS Home Health Care Up to the same number of Hospital Confinement Days $100 per day $200 per day Hospice Care Up to maximum of 365 days per lifetime $100 per day $200 per day US Government, Charity Hospital or HMO Per day of Hospital Confinement (1 30 days) Per day of Hospital Confinement (31+ days) $100$100 $400$200 Miscellaneous Benefits Option 1 Option 2 Cancer Treatment Center Evaluation or Consultation 1 per lifetime N/A $750 Evaluation or Consultation Travel and Lodging 1 per lifetime N/A $350 Second and Third Surgical Opinion Second Surgical Opinion Third Surgical Opinion $300 per Diagnosis of Cancer $300 per Diagnosis of Cancer Drugs and Medicine OutpatientInpatient Maximum $150 per month $150 per Confinement $50 per Prescription $150 per Confinement $50 per Prescription Hair Piece (Wig) 1 per lifetime $150 $150 TravelTransportationbybus,plane or train Actual coach fare Or $.40 per mile Actual coach fare or $.75 per mile Travel by car Maximum of 12 trips per Calendar year for all modes of transportation combined $.40 per mile $.75 per mile Lodging up to a maximum of 100 days per Calendar Year $50 per day $100 per day Family Transportation Travel by bus, plane or train Actual coach fare or $.40 per mile Actual coach fare or $.75 per mile Travel by Maximumcarof 12 trips per Calendar year for all modes of transportation combined $.40 per mile $.75 per mile Family Lodging up to a maximum of 100 days per Calendar Year $50 per day $100 per day Blood, Plasma and Platelets $300 per day $300 per day Experimental Treatment Paid the same manner/under the same maximums as other benefit MaximumAirGroundAmbulanceof 2 trips per Hospital Confinement for all modes of transportation combined $200 per trip $2,000 per trip $200 per trip $2,000 per trip Inpatient Special Nursing Services Per day of Hospital Confinement $150 per day $150 per day Medical Equipment Maximum of 1 benefit per Calendar Year N/A $150 Physical, Occupational, Speech, Audio Therapy & Psychotherapy Maximum per Calendar Year $25 per $1,000visit $25 per $1,000visit Benefit Riders Option 1 Option 2 Internal Cancer First Occurrence Benefit Rider Lump Sum Benefit Maximum 1 per Covered Person per lifetime $5,000 $10,000 Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime $7,500 $15,000 Heart Attack/Stroke First Occurrence Benefit Rider Lump Sum Benefit Maximum 1 per Covered Person per lifetime $5,000 $10,000 Lump Sum for Eligible Dependent Children Maximum 1 per Covered Person per lifetime $7,500 $15,000 Optional Hospital Intensive Care Unit Rider Intensive Care Unit $600 per day $600 per day Step Down Unit Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit $300 per day $300 per day 25

ABOUT ACCIDENT Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you. For full plan details, please visit your benefit website: www.mybenefitshub.com/cfbisd Accident Insurance Cigna EMPLOYEE BENEFITS Who Can Elect Coverage: You: All active, Full time Employees of the Employer who are regularly working in the United States a minimum of 20 hours per week and regularly residing in the United States and who are United States citizens or permanent resident aliens and their Spouse and Dependent Children who are United States citizens or permanent resident aliens and who are residing in the United States. You will be eligible to elect coverage on the first of the month following date of hire or Active Service. Your Spouse*: 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: This Accidental Injury plan provides 24 hour 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 terms, conditions, state variations, exclusions and limitations applicable to these benefits. See your Certificate of Insurance for more information. Benefits Coverage Initial & Emergency Care Emergency Care Treatment $400 Physician Office Visit $400 Diagnostic Exam (x ray or lab) $200 Ground or Water Ambulance/Air Ambulance $400/$1,600 Hospitalization Benefits Hospital Admission $1,500 Hospital Stay $200 Intensive Care Unit Stay $400 Fractures and Dislocations Per covered surgically repaired fracture $300 $8,000 Per covered non surgically repaired fracture $150 $4,000 Chip Fracture (percent of fracture benefit) 25% Per covered surgically repaired dislocation $300 $6,000 Per covered non surgically repaired dislocation $150 $3,000 Follow Up Care Follow up Physician Office Visit $100 Follow up Physical Therapy Visit $100 Enhanced Accident Benefits Accident Employee $10.32 Employee + Spouse $15.36 Employee + Child(ren) $18.60 Family $25.36 26

Covered Person: An eligible person who is enrolled for coverage under this Policy.

Important Definitions and Policy Provisions:

Accident Insurance Cigna BENEFITS

When your coverage ends: Coverage ends on the earliest of the date you and your dependents are no longer eligible, the date the group policy is no longer in force, or the date for the last period for which required premiums are paid. For your dependent, coverage also ends when your coverage ends, when their premiums are not paid or when they are no longer eligible. (Under certain circumstances, your coverage may be continued. Be sure to read the provisions in your Certificate.)

30 Day Right to Examine Certificate: If a Covered Person is not satisfied with the Certificate for any reason, it may be returned to us within 30 days after receipt. We will return any premium that has been paid and the Certificate will be void as if it had never been issued.

Additional Accidental Injury benefits included See certificate for details, including limitations & exclusions. Virtual Care accepted for Initial Physician Office Visit and Follow Up Care.

Covered Injury: Any bodily harm that results directly and independently of all other causes from a Covered Accident.

Examples of benefits include (but are not limited to) payment for death from Automobile accident; total and permanent loss of speech or hearing in both ears. Actual benefit amount paid depends on the type of Covered Loss. The Spouse and Child benefit is 50% and 25% respective of the benefit shown.

Portability Feature: You, your spouse, and child(ren) can continue 100% of your coverage at the time your coverage ends. You must be under the age of 100 in order to continue your coverage. Rates may change and all coverage ends at age 100. Applies to United States Citizens and Permanent Resident Aliens residing in the United States.

A sudden, unforeseeable, external event that results, directly and independently of all other causes, in a Covered Injury or Covered Loss and occurs while the Covered Person is insured under this Policy; is not contributed to by disease, sickness, mental or bodily infirmity; and is not otherwise excluded under the terms of this Policy.

Covered Loss: A loss that is the result, directly and independently of other causes, from a Covered Accident suffered by the Covered Person within the applicable time period described in the Policy.

Accidental Death and Dismemberment Benefit

Coverage Type: Benefits are paid when a Covered Injury results, directly and independently of all other causes, from a Covered

When your coverage begins: Coverage begins on the later of the program's effective date, the date you become eligible, or the first of the month following the date your completed enrollment form is received unless otherwise agreed upon by Cigna. Your coverage will not begin unless you are actively at work on the effective date. Coverage for all Covered Persons will not begin on the effective date if hospital, facility or home confined, disabled or receiving disability benefits or unable to perform activities of daily living.

EMPLOYEE

Loss of Life: $50,000 $100,000 Dismemberment: $2,000 $30,000 Wellness Treatment, Health Screening Test & Preventive Care Benefit* Wellness Treatment, Health Screening Test and Preventive Care Benefit: * Examples include (but are not limited to) routine gynecological exams, general health exams, mammography, and certain blood tests. Benefit paid for all covered persons is 100% of the benefit shown. Also includes COVID 19 Immunization. Virtual Care accepted. $50

CoveredAccident.Accident:

Hospital: An institution that is licensed as a hospital pursuant to applicable law; primarily and continuously engaged in providing medical care and treatment to sick and injured persons; managed under the supervision of a staff of medical doctors; provides 24 hour nursing services by or under the supervision of a graduate registered Nurse (R.N.); and has medical, diagnostic and treatment facilities with major surgical facilities on its premises, or available to it on a prearranged basis, and charges for its services. The term Hospital does not include a clinic, facility, or unit of a hospital for: rehabilitation, convalescent, custodial, educational, or nursing care; the aged, treatment of drug or alcohol addiction.

IP address monitoring We look for malicious use of your IP addresses. IP addresses may contribute to a profile of an individual, which if compromised can lead to identity Socialtheft.

• Learn how to take action

Employee

• Track where you’ve been online

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/cfbisd Identity Theft Allstate EMPLOYEE BENEFITS

Allstate Digital FootprintSM The internet knows a lot about you, but it doesn’t have to. Now, you can see where your personal information lives online, so you can take action and help protect it.

Identity Health Status A unique tool, viewable within the Allstate Identity Protection portal and in your monthly status email, that communicates a snapshot of your overall identity health risk level. Our enhanced algorithm and deep analytics help us spot fraud trends quickly and alert you, to help you stay one step ahead. New enhancements provide personalized tips and information to help you understand and improve your identity health Dark web monitoring In depth monitoring goes beyond just looking out for your Social Security number. Bots and human intelligence scour closed hacker forums for compromised credentials and other personal information. Then we alert you if you have been compromised. Users can track:

• Spot possible threats

High risk transaction monitoring We send alerts for non credit based activity that could indicate fraud, such as a wire transfer or an electronic document signature that matches your Financialinformation.activity monitoring Alerts triggered from sources such as bank accounts, thresholds, credit and debit cards, 401(k)s, and other investment accounts help you take control of your Unemploymentfinances. fraud center with dedicated support Our unemployment fraud center ensures that victims have the tools and support they need for a quicker and easier resolution of their case, saving time and stress. Our dedicated specialists are available 24/7 to help you unravel unemployment fraud.

media monitoring

Comprehensive monitoring and alerts Our proprietary monitoring platform detect high risk activity to provide rapid alerts, so you can detect fraud at its earliest sign, enabling quick restoration for minimal damage and stress.

• Social Security number Email address Accident $9.96 Family $17.96

Lost wallet protection You can store critical information in your secure portal, which conveniently holds important information from credit cards, credentials, and documents. Should you lose your wallet, you’ll be able to easily access and replace the contents.

Alerts for emerging threats and scams We provide real time, personalized content about heightened security risks. Alerts leverage internal data to inform you about emerging threats, how they may affect users, and what steps you can take to better protect yourself.

Add your and your family’s social media accounts and get notified of suspicious activity that could indicate hacking or account takeover. You can even add YouTube accounts and we’ll monitor comments for cyberbullying, threats, and explicit content.

Stolen wallet emergency cash We’ll reimburse you up to $500 for cash you had in your wallet when it was lost or stolen, after providing a police report.

•

Identity Theft Allstate EMPLOYEE BENEFITS • Usernames and passwords • Credit card numbers • Debit card numbers • Driver’s license number • Medical ID number • IP address • Gamer credentials Up to $1 million identity theft expense coverage & stolen fund reimbursement If you fall victim to fraud, we will reimburse your out of pocket costs.† Get expense reimbursement for home title fraud and professional fraud.† We’ll also reimburse you for stolen funds up to $1 million.† Coverage includes funds stolen from: • Employee HSA, 401(k), 403(b), and other investment accounts that traditional banks may not cover • SBA loans • Unemployment benefits • Tax return refunds Solicitation reduction We aid you in opting in or out of the National Do Not Call Registry, credit offers, and junk mail. Credit monitoring and alerts We alert for transactions like new inquiries, accounts in collections, new accounts, and bankruptcy filings. We also provide credit monitoring from all three bureaus, which may make spotting and resolving fraud faster and easier. Data breach notifications We send alerts every time there’s a data breach affecting you directly so you can take action Creditimmediately.assistance Our in house experts will help you freeze your credit files with the major credit bureaus. You can even dispute credit report items from your portal. Sex offender notifications If a sex offender is registered in a nearby area, we’ll notify you and provide a photo and physical Mobiledescription.appAccess the entire Allstate Identity Protection portal on the go! Available for iOS and Android. Protect the entire family We have a generous definition of family, covering those who live in your household and those you take care of financially everyone that’s “under roof and wallet.” If they are dependent on you financially or live under your roof, they’re covered.*

Senior family coverage, including parents, in laws, and grandparents age 65+ We’ve expanded our family plan to cover your parents, in laws, and grandparents over the age of 65.*

Best in class customer care Should fraud or identity theft occur, in house experts are available 24/7 to fully restore compromised identities, even if the fraud or identity theft occurred prior to enrollment. Our expert team is highly trained and certified to handle and remediate every type of identity fraud case. When resolving complex cases of identity theft, our satisfaction score is an industry leading 100%. We fully manage participants’ restoration cases, helping them save time, money, and 24/7stress.U.S.based customer care center We believe customer care is an essential part of our team. Our support center is located directly in our corporate headquarters, and our customer care team is available 24/7.

Pre existing Condition Waiver The Insurance Company will waive the Pre Existing Condition Limitation for up to 4 weeks of Disability even if the Employee has a Pre Existing Condition. The Disability Benefits as shown in the Schedule of Benefits will continue beyond 4 weeks only if the Pre Existing Condition Limitation does not apply.

Disability: “Disability” or “Disabled” means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 80% or more of your indexed earnings. We will require proof of earnings and continued disability.

Covered Earnings: “Covered Earnings” means your wages or salary, not including bonuses, commissions, and other extra Whencompensation.BenefitsBegin: You must be continuously Disabled for your elected benefit waiting period before benefits will be payable for a covered Disability. 30/30 or less elimination plans have a waiver of the elimination period with a 24 hour hospitalization.

Gross Monthly Benefit Maximum Gross Monthly Benefit Benefit Waiting Period Maximum Benefit Period Select Monthly Benefit: $8,000 SelectAccident/SicknessfromSixOptions: Please refer to the “Maximum Benefit Period” Schedules below for more details 25%* 0 days/7 days 35%* 14 days/14 days 45%* 30 days/30 days 55%* 60 days/60 days 65%* 90 days/90 days *of your current monthly earnings 180 days/180 days 30

Eligibility: If you are an active employee who is a citizen or permanent resident alien of the United States, regularly working at least 20 hours per week in the United States, you are eligible on the first of the month following date of hire.

Pre existing Condition Limitation: Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures,) during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a pre existing condition unless the disability occurs after you have been insured under this plan for at least 12 months after your most recent effective date of insurance.

ABOUT DISABILITY

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

Disability Insurance BENEFITS

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.

Important Definitions and Policy Provisions:

New York Life EMPLOYEE

25%

Rehabilitation Requirement: To be eligible for Disability benefits under this plan, you may be required to participate in a rehabilitation plan at the sole discretion and expense of the insurance company or company administering benefits under this plan. If you fail to fully cooperate with the rehabilitation plan, no Disability benefits will be paid, and coverage will end. For details, see your Certificate of Insurance.

$3.12 $3.20 $4.05 $5.09 14/14 $2.01 $2.01 $2.08 $2.66 $3.19 $2.81 $2.81 $2.89 $3.72 $4.60 30/30 $1.80 $1.80 $1.84 $2.35 $2.82 $2.53 $2.53 $2.60 $3.33 $4.13 60/60 $1.02 $1.02 $1.06 $1.35 $1.62 $1.98 $1.98 $2.04 $2.63 $3.24 90/90 $0.78 $0.78 $0.08 $1.01 $1.22 $1.48 $1.48 $1.51 $1.97 $2.43 180/180 $0.62 $0.62 $0.64 $0.81 $0.99 $1.12 $1.12 $1.16 $1.49 $1.83 31

Benefit Reductions, Conditions, Limitations and Exclusions:

Maximum Benefit Period: Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit or until you no longer qualify for benefits, whichever occurs first. Should you remain Disabled, your benefits continue according to one of the following schedules, depending on your age at the time you become Disabled and the plan you select.

Effects of Other Income Benefits: This plan is structured to prevent your total benefits and post disability earnings from equaling or exceeding pre disability earnings. Therefore, we reduce this plan’s benefits by Other Income Benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Disability benefits may be reduced by amounts received through Social Security disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them.

Disability benefits will also be reduced by amounts received through other government programs, sick leave, employer’s sabbatical leave, employer’s assault leave plan, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no fault, and damages for wage loss. For details, see your outline of coverage, policy certificate, or your employer’s summary plan description. Note: Some of the Other Income Benefits, as defined in the group policy, will not be considered until after disability benefits are payable for 6 months.

Life EMPLOYEE BENEFITS

Termination of Disability Benefits: Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, or on the following events: (1) the date you earn from any occupation more than 80% of your Covered Earnings, or the date you fail to cooperate with us in a rehabilitation plan, or transitional work arrangement, or the administration of the claim.

When Coverage Takes Effect: Your coverage takes effect on the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit evidence of good health, your coverage takes effect on the date we agree, in writing, to cover you.

Earnings While Disabled: During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of pre disability Covered Earnings. After that, benefits will be reduced by 50% of earnings from

New

Disability per $100 in benefit Plan A: $100 in Coverage Plan B: $100 in Coverage 25% 35% 45% 55% 65% 35% 45% 55% 65% 0/7 $2.29 $2.29 $2.35 $3.00 $3.61 $3.12

Disability Insurance York

Limitedemployment.Benefit Period: Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months for outpatient treatment: Anxiety disorders, delusional (paranoid) or depressive disorders, eating disorders, mental illness, somatoform disorders (including psychosomatic illnesses), alcoholism, drug addiction or abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 24 month lifetime outpatient limit is exhausted.

Life and AD&D New York Life ABOUT LIFE AND AD&D Group term life is the most inexpensive way to purchase life insurance.

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/cfbisd

AD&D Benefit Details:

the same hand; or Loss

and Reattachment of one hand or

50%

Total paralysis of both lower limbs or both upper limbs

Term Life insurance can help protect your loved ones’ financial health if you are no longer there to support them. If you pass away or are seriously injured as a result of a covered accident or injury, you or your beneficiaries will receive a set amount to help pay for unexpected expenses, or help your loved ones pay for future expenses after you’re gone. Who Is Eligible For Coverage?

25%

EMPLOYEE BENEFITS

(both

• Your Spouse: Is eligible as long as you apply for and are approved for coverage yourself. Your Child(ren): Birth to 26, as long as you apply for and are approved for coverage yourself. You, your spouse, and children will receive equal amounts of Term Life and Accidental Death and Dismemberment insurance Guaranteed Issue means that you may be able to purchase coverage without medical exams or health questions. See “Guaranteed Issue” below for more information.

Available Coverage:

Employee Units of $10,000 Lesser of 7 times salary or $500,000 Lesser of 7 times salary or $200,000 Spouse Units of $5,000 $100,000 not to exceed 100% of the employees benefit $50,000

75%

For Comas You will receive 1% of the full benefit amount each month, for up to a maximum of 11 months if you or an insured family member are in a coma for 30 days or more as a result of a Covered Accident. If the covered person is still in a coma after 11 months, or dies, the full benefit amount will be paid.

You have the freedom to select an amount of life insurance coverage you need to help protect the well being of your family.

• You will be eligible for coverage the first of the month following date of hire.

• You: All active, Full time Employees of the Employer who are citizens or permanent resident aliens of the United States and regularly working a minimum of 20 hours per week in the United States, excluding temporary, leased or seasonal Employees.

Loss of one hand, one foot,

20% Voluntary Group Life and AD&D per $10,000 in coverage Age Employee Spouse 0 29 $0.50 $0.50 30 39 $0.60 $0.60 40 44 $0.90 $0.90 45 49 $1.20 $1.20 50 54 $1.90 $1.90 55 59 $3.40 $3.40 60 64 $4.30 $4.30 65 69 $7.70 $7.70 70+ $12.30 $12.30 Voluntary Group Life and AD&D: Child(ren) $10,000 in coverage 0 26 $1.10 Spouse rates based on Employee's age. 32

hands or feet; Loss

100%

Total paralysis of upper and lower limbs on one side of the body; sight in one eye, speech, or hearing in both ears; Severance foot

Total paralysis of one upper or one lower limb; Loss of all four fingers of of thumb and index finger of the same hand Loss of all toes of the same foot

Loss of life; Total paralysis of both upper and lower limbs; Loss of two more of sight in both eyes; or Loss of speech and hearing ears)

Maximum Guaranteed Issue AmountBenefit Amount

Children Units of $1,000 $10,000; under 6 Months old $1,000 All amounts

If, within 365 days of a Covered Accident, bodily injuries result in: We’ll pay this % of the Benefit Amount:

Continuation of Disability

For Wearing a Seatbelt & Protection by an Airbag You will receive an additional 10% benefit but not more than $25,000 if the covered person dies in a covered automobile accident and law enforcement certified to be wearing a seatbelt or approved child restraint. We will increase the benefit by an additional 5% but not more than $5,000 if the insured person was also positioned in a seat protected by a properly functioning and properly deployed Supplemental Restraint System (Airbag).

Life and AD&D New York Life EMPLOYEE BENEFITS

Extended Death Benefit with Waiver of Premium

If you become Disabled prior to age 60, and you remain Disabled continuously for a 9 month period and thereafter, you won’t need to pay premiums for your life insurance coverage, provided we/the Insurance Company determine(s) you are Disabled.

“Disabled” for this coverage means, because of injury or sickness, you are unable to perform the material duties of your regular occupation or are receiving disability benefits under a program sponsored by your employer, for the first 12 months after your Disability began. Thereafter, you must be unable to perform the material duties of any occupation that you are or may reasonably become qualified based on your education, training, or experience. If you qualify for this coverage and have insured your spouse or children, the insurance company will also waive their premium if applicable.

Term Life Features:

Waiver of Premium

Accelerated Death Benefit Terminal Illness if two unaffiliated doctors diagnose you or your spouse as terminally ill while the coverage is active, with a life expectancy of 12 months or less, the benefit for Terminal Illness provides up to: Employee: 75% of your Term Life Insurance coverage amount or $375,000, whichever is less. Spouse: 75% of your Term Life Insurance coverage amount or $75,000, whichever is less.

Portability If your employment is terminated, you can continue your life insurance on a direct bill basis. Coverage may also be continued for your spouse/children. Premiums will increase at this time. Coverage can be continued to age 99 unless the insurance company terminates portability for all insured persons. Refer to your certificate for details.

Important Definitions and Policy Provisions:

Conversion If group accident coverage ends (except due to nonpayment of premium), your employment is terminated, membership in an eligible class is terminated, or insurance coverage is reduced based on attained age, you can convert to an individual non term policy. To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends. Dependents may convert their coverage as well if applicable. Premiums may change at this time, and terms of coverage will be subject to change. You can also convert to an individual policy of up to $10,000 if you have been insured for at least 3 years and the policy is terminated or amended, provided coverage is not replaced and you are not covered under a different conversion policy issued by Life Insurance Company of North America. Refer to your certificate for Additionaldetails.

Additional AD&D Features:

For Exposure & Disappearance Benefits are payable if you or an insured family member suffer a covered loss due to unavoidable exposure to the elements as a result of a Covered Accident. If your or an insured family member's body is not found within one year of the disappearance, wrecking or sinking of the conveyance in which you or an insured family member were riding, on a trip otherwise covered, it will be presumed that you sustained loss of life as a result of a Covered ForAccident.Furthering Education If you die in a covered accident, we will pay an extra benefit for each insured child who enrolls in a school of higher learning within one year of your death. We will increase your benefit by 6% or $6,000, whichever is less, for each qualifying child, each year for 4 consecutive years as long as your child continues his/her education. If there is no qualifying child, we will pay an additional $1,000 to your beneficiary.

The extended death benefit continues your coverage without payment of premium, before you’re eligible to qualify for Waiver of Premium, if you are continuously Disabled for 9 months prior to age 60. “Disabled” means, because of injury or sickness, you are unable to perform all the material duties of your regular occupation, or you are receiving disability benefits under a program sponsored by your Employer. Regular Occupation means the occupation you routinely performed at the time your Disability began. We/the insurance company will consider the duties of your occupations as those that are normally performed in the general labor market in the national economy. If you qualify for this benefit and have insured your spouse or children, the insurance company will also extend their coverage if applicable.

Conversion To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage Guaranteedends.Issue for Term Life Insurance Coverage: If you are a new hire and you apply within 31 days after you are eligible to elect coverage for yourself, you are entitled to choose any coverage offered up to the Guaranteed Issue Amount, without providing proof of good health. If you apply for an amount of coverage greater than the Guaranteed Issue Amount, coverage in excess of the Guaranteed Issue Amount will not be issued until the insurance company approves acceptable proof of good health. If you apply for coverage for yourself more than 31 days from the date you become eligible to elect coverage under this plan, the Guaranteed Issue Amount will not apply, unless Guaranteed Issue has been approved by your employer for a specific period of time. Coverage will not be issued until the insurance company approves acceptable proof of good Thesehealth.are summarized definitions only. To be eligible for coverage, the covered illness or event must meet the definitions and other terms and conditions set forth in the group policy.

If your active service ends due to disability, at age 60 or over, your life insurance coverage will continue while you are disabled. Benefits will remain in force until the earliest of: the date you are no longer disabled, the date the policy terminates, the date you are Disabled for 12 consecutive months, or the day after the last period for which premiums are paid. You are considered disabled if, because of injury or sickness, you are unable to perform all the material duties of your Regular Occupation, or you are receiving disability benefits under your Employer’s plan.

When Your Coverage Begins and Ends Coverage becomes effective on the later of the program’s effective date, the date you become eligible, the date your enrollment elections are received if applicable, or the date you authorize any necessary payroll deductions if applicable. Your coverage will not begin unless you are actively at work on the effective date. Dependent coverage, if applicable, will not begin for any spouse or child who on the effective date is an inpatient in a facility or is home.

ABOUT WHOLE LIFE Whole 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. For full plan details, please visit your benefit website: www.mybenefitshub.com/cfbisd Whole Life Insurance UNUM EMPLOYEE BENEFITS Benefit Overview Unum’s Whole Life insurance offers protection beyond an individual’s working years, potentially for your lifetime. With a guaranteed death benefit that will never decrease, level premiums that will never increase, cash value accumulation, living benefits and other options, Whole Life goes beyond typical term life insurance. Purchase Option Type Volume Purchase Benefit Amount • Employee $5,000 $200,000 • Spouse $5,000 $50,000 • Child $5,000 $50,000 Guarantee Issue: • Employee  Ages: 15 50 $125,000  Ages: 51 80 $70,000 • Spouse*  Ages: 15 50 $25,000  Ages: 51 80 $10,000  *One qualifying health question must be answered for any level of coverage. • Child  $25,000 Waiver of Premium Included Long Term Care Rider Included This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Details may differ from state to state. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. 34

• HSA Bank Mobile App Download to check available balances, view HSA transaction details, save and store receipts, scan items in store to see if they’re qualified, and access customer service contact information.

• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account

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.

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

Access online at: http://www.hsabank.com

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.

Opening an HSA If you meet the eligibility requirements, you may open an HSA administered by HSABank. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.

Maximum

Important HSA Information

•

you

www.mybenefitshub.com/cfbisd

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.

HSA Eligibility

• Not enrolled in Medicare or TRICARE

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

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 under your HDHP. Contributions

How to Use your HSA

•

• myHealth PortfolioSM Track your healthcare expenses, manage receipts and claims from multiple providers, and view expenses by provider, description, and more.

You decide whether to use the money in your account to pay for qualified expenses or let it grow for future use. 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.

Health Savings Account (HSA)

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.

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

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 elect: Individual $3,650 Family (filing jointly) $7,300

HSA Bank EMPLOYEE BENEFITS

For

• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan

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

• Account preferences Designate a beneficiary, add an authorized signer, order additional debit cards, and keep important information up to date.

• Not receiving Veterans Administration benefits

•

ABOUT HSA

• 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.

•

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:

•

$100

• Your Spouse:* Up to age 100, as long as you apply for and are approved for coverage yourself.

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. $500 $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 Hospital IndemnityLow$1,500 High $2,750 Only $19.92 $30.22 and Spouse $34.60 $52.70 and Child(ren) $31.42 $47.66 Family $46.08 $70.14

• Your Child(ren): Birth to age 26; 26+ if disabled, as long as you apply for and are approved for coverage yourself.

Benefit Waiting Period:* None, unless otherwise stated. No benefits will be paid for a loss which occurs during the Benefit Waiting HospitalizationPeriod.

Employee

Benefits Plan 1 Plan 2 Hospital Admission No Elimination Period. Limited to 1 day, 1 benefit(s) every 90 days. $1,500 $2,750 Hospital Chronic Condition Admission No Elimination Period. Limited to 1 day, 1 benefit(s) every 90 days. $50 $50 Hospital Stay No Elimination Period. Limited to 30 days. $150 $150 Hospital Intensive Care Unit (ICU) Stay No Elimination Period. Limited to 30 days. $200 $200 Hospital Observation Stay 24 hour Elimination Period. Limited to 72 hours. $500 per 24 hour period

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/cfbisd Hospital Indemnity Cigna EMPLOYEE BENEFITS Who Can Elect Coverage?

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.

Employee

Employee and

• You: All active, Full time Employees of the Employer who are regularly working in the United States a minimum of 20 hours per week and regularly residing in the United States and who are United States citizens or permanent resident aliens and their Spouse and Dependent Children who are United States citizens or permanent resident aliens and who are residing in the United States. You will be eligible to elect coverage on the first of the month following date of hire or Active Service.

Hospital Chronic Condition 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).

Covered Person: An eligible person, as defined in the Schedule of Benefits, who is enrolled and for whom Evidence of Insurability, where required, has been accepted by Us, required premium has been paid when due, and coverage under this Policy remains in Eliminationforce.

Covered Injury: Any bodily harm that results in a covered loss.

Important Definitions: Covered Illness: A physical or mental disease or disorder including pregnancy and complications of pregnancy that results in a covered loss. A Covered Illness includes medically necessary quarantine in a Hospital in conjunction with medically necessary preventive treatment due to an identifiable exposure to a life threatening contagious and infectious Disease

Period: The continuous period of time that must be satisfied before a benefit shown in the Schedule of Benefits is payable. An Elimination Period may be satisfied during the Policy’s Benefit Waiting Period.

Portability Feature: You, your spouse, and child(ren) can continue 100% of your coverage at the time your coverage ends. You must be covered under the policy and be under the age of 100 in order to continue your coverage. Rates may change and all coverage ends at age 100. Applies to United States Citizens and Permanent Resident Aliens residing in the United States.

Hospital Indemnity Cigna BENEFITS

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.

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.

EMPLOYEE

Hospital: An institution that is licensed as a hospital pursuant to applicable law; primarily and continuously engaged in providing medical care and treatment to sick and injured persons; managed under the supervision of a staff of physicians; provides 24 hour nursing services by or under the supervision of a graduate registered Nurse (R.N.); and has medical, diagnostic and treatment facilities with major surgical facilities on its premises, or available to it on a prearranged basis. The term Hospital does not include a clinic or facility for: (1) rehabilitation, convalescent, custodial, educational, hospice, or skilled nursing care; (2) the aged, drug addiction or alcoholism; or (3) a facility primarily or solely providing psychiatric services to mentally ill patients. The term Hospital also does not include a unit of a Hospital for rehabilitation, convalescent, custodial, educational, hospice, or skilled nursing care.

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 Commonphysician.Exclusions and Limitations: Refer to your benefit website for a full list of exclusions and limitations.

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

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 conditions).

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.

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.

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 account.

Transport MASA EMPLOYEE BENEFITS

Emergency Medical

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

Emergent Ground Transportation

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

Emergent Air Transportation

ABOUT MEDICAL TRANSPORT

Non Emergency Inter Facility Transportation

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

Emergency Medical Transportation 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

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.

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

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

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/cfbisd Telehealth 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 Employee & Family $12.00 39

• 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.

•

Dependent Care FSA Guidelines

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.

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

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

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. (Your plan has a 75 day grace period provision through 11/14/2023). For full plan details, please visit your benefit website: www.mybenefitshub.com/cfbisd 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

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

Important FSA Rules

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

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

(FSA) NBS EMPLOYEE

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.

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

Flexible Spending Accounts Account Type Eligible Expenses Annual Contribution Limits Benefit Health Care FSA

Flexible Spending Account BENEFITS

copayments,

• You cannot change your election during the year unless you experience a Qualifying Life Event.

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.

Most are not covered by your plan (such as coinsurance, deductibles, and doctor prescribed over the counter medications)

income Dependent Care FSA Dependent care expenses

medical, dental and vision care expenses that

Over the Counter Item Rule Reminder (OTC)

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.

• 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.

health

eyeglasses

Notes 42

Notes 43

WWW.MYBENEFITSHUB.COM/CFBISD 2022 - 2023 PlanYear

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 Carrollton Farmers Branch 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

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 Carrollton Farmers Branch 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.