2022-23 Crosby ISD Benefit Guide by Higginbotham Public Sector

2022 - 2023 Plan Year

CROSBY ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023 WWW.MYBENEFITSHUB.COM/CROSBYISD

Table of Contents How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) Medical Health Savings Account (HSA) Telehealth Hospital Indemnity Dental Vision Disability Cancer Accident Critical Illness Life and AD&D Individual Life Legal and Identity Theft Emergency Medical Transportation Flexible Spending Account (FSA)

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YOUR BENEFITS

Benefit Contact Information CROSBY ISD BENEFITS

MEDICAL

HEALTH SAVINGS ACCOUNT (HSA)

Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/crosbyisd

Texas Schools Health Benefits Program (TSHBP) (888) 803-0081 All Plans: www.tshbp.org Pharmacy Benefits: SouthernScripts Group #50000 https://tshbp.info/DrugPham

GCEFCU (281) 487-9333 www.gcefcu.org

TELEHEALTH

HOSPITAL INDEMNITY

DENTAL

MDLIVE (888) 365-1663 www.mdlive.com/fbsbh

Cigna (800) 244-6224 www.cigna.com

VISION

DISABILITY

CANCER

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

Mutual of Omaha (800) 775-1000 www.mutualofomaha.com

MetLife/Administered by Bay Bridge (800) 845-7519 www.bbadmin.com

ACCIDENT

CRITICAL ILLNESS

LIFE AND AD&D

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

Cigna (800) 997-1654 www.cigna.com

Lincoln Financial Group (800) 423-2765 www.lincolnfinancial.com

INDIVIDUAL LIFE

LEGAL AND IDENTITY THEFT

EMERGENCY MEDICAL TRANSPORTATION

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

Legal Shield (800) 654-7757 www.legalshield.com

MASA (800) 423-3226 www.masamts.com

FLEXIBLE SPENDING ACCOUNT (FSA) Higginbotham (866) 419-3519 www.higginbotham.com

All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS CROSBY” to (800) 583-6908 and get access to everything you need to complete your

benefits enrollment: •

Benefit Resources

•

Online Enrollment

•

Interactive Tools

•

And more!

App Group #: FBSCROSBY

Text “FBS CROSBY” to (800) 583-6908 OR SCAN

How to Log In 1

www.mybenefitshub.com/crosbyisd

CLICK LOGIN

ENTER USERNAME & PASSWORD Your Username Is: Your email in THEbenefitsHUB. (Typically your work email) Your Password Is: Four (4) digits of your birth year followed by the last four (4) digits of your Social Security Number If you have previously logged in, you will use the password that you created, NOT the password format listed above.

Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New: NEW Third Party Administrator (TPA) - Crosby ISD has transitioned • New Hires will be able to make elections for both medical to Financial Benefit Services as its Benefit Consultant and TPA. and certain supplemental benefits to start September 1st There are new insurance carriers, new plan designs, and and will also complete their enrollment for the new benefits additional insurance options to choose from. All employees are that will start November 1st. required to log into the new online enrollment system to Short Plan Year - Crosby ISD has elected a short plan year for complete their enrollment. 2022-23. What this means is that supplemental benefits will run NEW - Starting September 1st, Crosby ISD has joined the Texas from November 1st through August 31st. Starting with the 2023Schools Health Benefits Program (TSHBP) for employee medical 24 plan year, all benefits will start on September 1st for insurance. There are 4 plan options to choose from; two directed simplicity. care plans and two traditional PPO plans. NEW District Paid Life - Starting November 1st, Crosby ISD will Flex and Dependent Care Administration - Crosby ISD will transition to Higginbotham for its Flex and Dependent Care administration. Those enrolling in Flex will receive a new debit card for November 1st. Employees are encouraged to use up current year funds prior to October 31st to ease the transition to Higginbotham.

provide a $10,000 Basic Life and Accidental Death and Dismemberment policy for all full time employees. Even if you decline the district benefits, employees need to log into the enrollment system to assign their beneficiary/ies to this policy.

Guarantee Issue - Many of the supplemental benefits that start November 1st will be offered to both current CISD employees NEW H.S.A. Administrator - Crosby ISD will be moving to Gulf and new hires on a guarantee issue basis meaning you can't be Coast Educators Federal Credit Union for H.S.A. administration denied coverage and will not be required to answer health starting November 1st. Employees who currently have a payroll questions. Some plans also provide benefits for pre-existing deducted H.S.A. who have a balance they wish to transfer to the conditions or will waive pre-existing condition exclusions. Please new account with GCEFCU may complete a transfer authorization review this benefit guide and the plan information available on form with GCEFCU after November 1st. the district's benefit website at www.mybenefitshub.com/ crosbyisd. One Open Enrollment Period •

Current employees of Crosby ISD will make a medical election for September 1st and then will make elections for their supplemental benefits that will start November 1st. The district will not have a separate enrollment for supplemental benefits after the school year has started.

Don’t Forget! • Login and complete your benefit enrollment from 07/26/2022 - 08/17/2022 • Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202. Call Center hours are Mon-Fri, 8 am to 6 pm. • Update your information: home address, phone numbers, email, and beneficiaries. • REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator. 6

Annual Benefit Enrollment

SUMMARY PAGES

Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

CHANGES IN STATUS (CIS): Marital Status

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

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

A change in number of dependents includes the following: birth, adoption and placement for Change in Number of adoption. You can add existing dependents not previously enrolled whenever a dependent Tax Dependents gains eligibility as a result of a valid change in status event. Change in Status of Change in employment status of the employee, or a spouse or dependent of the employee, Employment Affecting that affects the individual's eligibility under an employer's plan includes commencement or Coverage Eligibility termination of employment. Gain/Loss of Dependents' Eligibility Status

Judgment/Decree/ Order

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. 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.

Eligibility for Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Government Programs

Annual Benefit Enrollment

SUMMARY PAGES

Annual Enrollment 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.

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

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.

New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

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.

Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ crosbyisd. 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? For benefit summaries and claim forms, go to the Crosby ISD benefit website: www.mybenefitshub.com/crosbyisd. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. 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.

Annual Benefit Enrollment

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.

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.

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.

PLAN

MAXIMUM AGE

Medical

To age 26

Hospital Indemnity

To age 26

Dental

To age 26

Vision

To age 26

Life

To age 26

Cancer

To age 26

Critical Illness

To age 26

AD&D

To age 26

Individual Life

To age 24

Emergency Transportation

To age 26

Legal/ID Shield

To age 26

Telehealth

To age 26

Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents. Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility. FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance.

Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility. Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.

SUMMARY PAGES

Helpful Definitions Actively-at-Work

In-Network

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.

Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.

Annual Enrollment The period during which existing employees are given the opportunity to enroll in or change their current elections.

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

Calendar Year January 1st through December 31st

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

Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or preexisting condition exclusion provisions do apply, as applicable by carrier. 10

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

Plan Year September 1st through August 31st

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

SUMMARY PAGES

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

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

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source

Employee and/or employer

Account Owner

Individual

Employer

Underlying Insurance Requirement

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 Not permitted 65).

Year-to-year rollover of account balance?

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

No. Your employer’s plan contains a $500 rollover provision.

Does the account earn interest?

Yes

Portable?

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

Description

FLIP TO FOR HSA INFORMATION

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Medical Insurance Texas Schools Health Benefits Program

EMPLOYEE BENEFITS

ABOUT TSHBP The TSHBP is proud to offer a variety of plans and benefits to meet your school district’s needs. All plans are designed so members can easily navigate through their health medical needs.

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

Directed Care Highlights

Aetna Network Highlights

The TSHBP Directed Care Plans utilize a national network to provide physician and ancillary services access to all members. Enrolled school districts will access the HealthSmart practitioner and ancillary only network to gain access to over 478,000 providers in over 1,222,000 unique locations across the United States, Please note, hospitals are excluded from the PPO networks. All hospital and other medical facility-based services are accessed via an assigned Care Coordinator.

You want a network that is comprehensive, is easy to use and can help you save on costs. Look no further. You can now find support through our Aetna Signature Administrators® preferred provider organization network. Discover provider options and reduced costs.

TSHBP members will experience the lowest out-of-pocket costs for physician and ancillary medical services when utilizing network providers. HealthSmart Network Solutions’ Physician and Ancillary Only Primary PPO contains approximately 478,000 contracted providers in over 1,222,000 unique locations across the country. It is easy to look up providers in your area by looking up providers in your area by clicking on the link below. Your searches can be saved to your computer or sent to your email. https://tshbp.info/HSNetwork

Access the MyTSHBP Digital Wallet for easy access to all your benefit resources.

With our network, you now have access to over 1.2 million participating doctors, 8,700 hospitals, and strong, negotiated discounts. We know quality care is important. So we make sure our doctors successfully complete our credentialing requirements. Our credentialing process meets industry standards, as well as state and federal requirements. You’ll also have access to over 600 Institutes of Excellence™ facilities and Institutes of Quality® facilities. We measure these publicly recognized institutes by clinical performance, outcomes and efficiency. Then, we pass this guidance along to you—so you can choose the best facility. No one likes changing doctors every year. We make it easier, so you don’t have to. Our local network teams work with doctors and hospitals to promote effective member care and better customer satisfaction. As a result, the turnover in our network is remarkably low, year after year. Ready to search our network? Just visit http://aetna.com/asa

PPO Deductible Credits With the Aetna PPO plans, if you choose to utilize the services of a Care Coordinator for a procedure or admission to a facility, you will receive a $500 credit toward your deductible1. If you have already met your deductible, the $500 credit will apply to your out-of-pocket maximum! 1

On the HDHP plan, a member must meet a minimum of $1,400 of the deductible accumulation before receiving the credit to comply with HSA requirements. 12

Medical Insurance

EMPLOYEE BENEFITS

Texas Schools Health Benefits Program DIRECTED CARE PLANS

AETNA NETWORK PLANS

High Deductible

CoPay

Aetna HD

Aetna Signature

Directed Care Plan • Use CC for Hospital/ Surgical Services • Compatible with an HSA • Lowest HD Premium Plan • Out-of-Network Benefits In-Network

Directed Care Plan • Use CC for Hospital/ Surgical Services • Co-payments for Services • Reduce Out-of-Pocket • Out-of-Network Benefits In-Network

Traditional PPO Plan • Compatible with an HSA • Network for all physician and hospital services

Traditional PPO Plan • Lowest Deductible Plan • Brand Drug Deductible • Network for all physician and hospital services

In-Network

$3,000/$9,000

$0 Deductible

$3,000/$6,000

$2,000/$4,000

None - Plan Pays 100% after deductible $3,000/$9,000

None - Plan Pays 100% after out-of-pocket is met $3,500/$10,500

You pay 30% after deductible $7,000/$14,000

You pay 25% after deductible $7,500/$15,000

HealthSmart

Aetna

PCP Required

PCP Referral to Specialist

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

Yes - $0 copay

Yes - $0 copay You pay 30% after deductible You pay 30% after deductible $30 per consultation

Yes - $0 Copay

PLAN SUMMARY

Plan Features Individual/Family Deductible Coinsurance Ind/Fam Out of Pocket National Network

Doctor Visits Preventive Care Primary Care Specialist Virtual Health

$35 copay $35 copay $0 per consultation

$30 copay $70 copay $0 per consultation

Care Facilities Urgent Care Emergency Care Outpatient Surgery

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

$500 copay

Integrated with medical 30-Day Supply / 90-Day Supply

No deductible 30-Day Supply / 90-Day Supply

Deductible, then Plan pays 100%

$0 at selected pharmacies; others $10/$20 copay

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

$35 copay or 50% copay (max $100) $70 copay or 50% copay (max $200)

Limited - PAP Required

Plan year rate

$50 copay

$500 copay

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

$50 copay You pay $500 copay + 25% after deductible You pay 25% after deductible

Prescriptions Drug Deductible Days Supply Generics Preferred Brand Non-preferred Brand Specialty Employee Cost (District Contribution of $225) Employee Only

Integrated with medical 30-Day Supply / 90-Day Supply You pay 20% after deductible; $0 for certain generics You pay 25% after deductible You pay 50% after deductible Full Coverage - PAP Required

$500 brand deductible 30-Day Supply / 90-Day Supply

Plan year rate

$15/$45 copay You pay 25% after deductible You pay 50% after deductible Full Coverage - PAP Required

$150.00

$192.00

$229.00

$300.00

Employee/Spouse

$800.00

$942.00

$1,096.00

$1,157.00

Employee/Child

$476.00

$568.00

$626.00

$673.00

$1,118.00

$1,315.00

$1,355.00

$1,471.00

Employee/Family

Health Savings Account (HSA) GCEFCU

EMPLOYEE BENEFITS

ABOUT HSA A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). For full plan details, please visit your benefit website: www.mybenefitshub.com/crosbyisd

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 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.

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. 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.

Opening an HSA

HSA Eligibility You are eligible to open and contribute to an HSA if you are: • Enrolled in an HSA-eligible HDHP • Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan • Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account • Not eligible to be claimed as a dependent on someone else’s tax return • Not enrolled in Medicare or TRICARE • Not receiving Veterans Administration benefits 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.

Maximum Contributions Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2022 is based on the coverage option you elect: • Individual – $3,650 • Family (filing jointly) – $7,300

To get started with your new HSA, you will enroll with Crosby ISD. Afterwards, Gulf Coast Educators FCU will service your HSA, and mail your new benefit cards to the address listed in THEbenefitsHUB. You will have the option to make pre-tax deductions straight from your paycheck, or transfer funds as you are able.

Important HSA Information •

•

Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount. You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.

How to Use your HSA Participant Account Web Access: www.gcefcu.org Participants may call Gulf Coast Educators FCU and talk to a representative during regular business hours, Monday - Friday, 7 am to 7 pm CST, and on Saturday from 9 am to 12 pm CST. Participants may also log into their GCEFCU online banking account at any time to view their balance, account history, and make transfers to their HSA.

Telehealth

EMPLOYEE BENEFITS

MDLIVE 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/crosbyisd 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.

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/fbs • 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.

Behavioral Health With MDLIVE, you can visit with a doctor or counselor 24/7 from your home, office or on-the-go. You have a telehealth benefit giving you virtual care, anywhere. At a price you can afford. • Board-certified doctors • Available anytime, day or night • Consults by mobile app, video or phone • Prescriptions can be sent to your nearest pharmacy if medically necessary We treat over 50 routine medical conditions including: • Acne • Allergies • Cold/flu • Constipation • Cough • Diarrhea • Ear problems • Insect bites • Nausea/vomiting • Pink eye • Rash • Respiratory problems • Sore throats • And more www.mdlive.com/fbsbh 888-365-1663

Telehealth Employee and Family

$12.00 15

Hospital Indemnity

EMPLOYEE BENEFITS

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

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

SUMMARY OF BENEFITS Hospital Care coverage provides a benefit according to the schedule below when a Covered Person incurs a Hospital stay resulting from a Covered Injury or Covered Illness. See State Variations (marked by *) below.

Who Can Elect Coverage:

Employee’s Monthly Cost of Coverage Tier Plan 1 Plan 2 Employee Only $17.62 $32.50 Employee & Spouse $30.20 $56.30 Employee & Child(ren) $28.14 $52.86 Employee & Family $40.74 $76.68

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, Domestic Partner, or Civil Union Partner and Dependent Children who are United States citizens or permanent resident aliens and who are residing in the United States. You will be eligible for coverage on the first of the month following date of hire or Active Service. Your Spouse/Domestic Partner: Up to age 100, as long as you apply for and are approved for coverage yourself. Your Child(ren): Birth to age 26; 26+ if disabled, as long as you apply for and are approved for coverage yourself.

Available Coverage: The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred and are paid on a per day basis unless otherwise specified. Benefits are only payable when all policy terms and conditions are met. Please read all the information in this summary to understand the terms, conditions, state variations, exclusions and limitations applicable to these benefits. See your Certificate of Insurance for more information. Benefit Waiting Period:* None, unless otherwise stated. No benefits will be paid for a loss which occurs during the Benefit Waiting Period. Hospitalization Benefits Plan 1 Hospital Admission $1,500 No Elimination Period. Limited to 1 day, 1 benefit(s) every 365 days. Hospital Chronic Condition Admission $50 No Elimination Period. Limited to 1 day, 1 benefit(s) every 90 days. Hospital Stay $100 No Elimination Period. Limited to 30 days, 1 benefit(s) every 90 days. Hospital Intensive Care Unit (ICU) Stay $200 No Elimination Period. Limited to 30 days, 1 benefit(s) every 90 days. Hospital Observation Stay $500 per 2424 hour Elimination Period. Limited to 72 hours. hour period Newborn Nursery Care Admission Limited to 1 day, 1 benefit per newborn child. This benefit is payable $500 to the employee even if child coverage is not elected. Newborn Nursery Care Stay* Limited to 30 days, 1 benefit per newborn child. This benefit is $100 payable to the employee even if child coverage is not elected. 16

Plan 2 $3,000 $100 $200 $400 $500 per 24hour period $500

$100

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.

Dental Insurance

EMPLOYEE BENEFITS

Cigna 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 disease.

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

Dental Coverage Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Cigna.

DPPO Plan

Dental PPO High PPO Low Employee Only $27.19 $18.47 Employee and Spouse $54.30 $36.81 Employee and Child(ren) $56.36 $39.85 Employee and Family $92.09 $64.52

DHMO $12.54 $24.98 $27.05 $43.79

Two levels of benefits are available with the DPPO plan: in-network and out-of-network. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an out-ofnetwork provider.

Dental schedule of benefits Plan Deductible Individual Family Deductible applies to: Benefit Levels Type 1 – Diagnostic & Preventative Type 2 – Basic Services Type 3 – Major Services Type 4 – Orthodontic Services (Children and Adults) Maximum Benefit (per covered person): Types 1, 2 & 3 combined Type 4, while covered by the plan

Low Plan Contracted Dentist $50 $150 Type 2 & 3 100% 80% 25%

High Plan Annually on a Plan Year Basis Non Contracted Dentist Contracted Dentist Non Contracted Dentist $50 $50 $50 $150 $150 $150 Type 2 & 3 Type 2 & 3 Type 2 & 3 100% 80% 25% *Based on Maximum Allowable Charge

$1,000 Per Plan Year Not Covered

100% 80% 50%

50%

50% *90th Percentile of Allowed Charges

$1,500 Per Plan Year $1,500 Per Plan Year $1,000 Lifetime $1,000 Lifetime

DHMO Plan • • • • • •

You choose your primary-care dentist when you enroll. To find a participating dentist, visit https://hcpdirectory.cigna.com/web/ public/consumer/directory/search?consumerCode=HDC041 and select Find a Dentist. (You can also print your dental ID card from this site once your coverage begins.) This dental plan offers a detailed list of covered procedures, each with a dollar copayment (see the Summary of Benefits on Benefits Portal for details). You pay for services provided during your visit. Emergency care away from home is covered up to a set dollar limit. You can change your primary-care dentist at any time by calling the customer service number listed on your dental ID card. Covers most preventive and diagnostic care services at no charge. Also covers a wide variety of specialty services - lowering your out-of-pocket costs with no deductibles or maximums. 17

Vision Insurance

EMPLOYEE BENEFITS

Superior Vision 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/crosbyisd

How to Print your Vision ID Card: You can request your vision id card by contacting Superior Vision directly at 800-507-3800. You can also go to www.superiorvision.com and register/login to access your account by clicking on “Members” at the top of the page. You can also download the Superior Vision mobile app on your smart phone.

Employee Employee + Spouse Employee + Child(ren) Employee + Family Co-pays Exam1 $10 Eyewear2 $25

Benefits Exam

Gold Plan

Platinum Plan

Monthly Premiums

Monthly Premiums $7.17 $12.17 $12.17 $17.94

Services/Frequency Exam 12 Months Frame 24 Months Lenses 12 Months Contact Lenses 12 Months

In-Network Out-of-Network Covered In Full Up to $35 $150 retail Frame Up to $70 allowance Lenses (Clear, Standard, Glass or Plastic) Per Pair: Single Vision Covered In Full Up to $25 Bifocal Covered In Full Up to $40 Trifocal Covered In Full Up to $45 Charges Allowance at Progressive3 standard trifocal Up to $45 level Lenticular Covered In Full Up to $80 Scratch Resistant Covered In Full Up to $25 Coating Ultraviolet Coating Covered In Full Up to $20 Tints Covered In Full Up to $15 $150 retail Contact Lenses4 Up to $80 allowance Medically Necessary Covered In Full Up to $150 Contact Lenses $200 retail $200 retail Laser Vision Correction5 allowance allowance 18

Employee Employee + Spouse Employee + Child(ren) Employee + Family Co-pays Exam1 $5 Eyewear2 $10

Benefits Exam

$12.79 $21.79 $21.79 $32.03 Services/Frequency Exam 12 Months Frame 12 Months Lenses 12 Months Contact Lenses 12 Months

In-Network Out-of-Network Covered In Full Up to $35 $200 retail Frame Up to $70 allowance Lenses (Clear, Standard, Glass or Plastic) Per Pair: Single Vision Covered In Full Up to $25 Bifocal Covered In Full Up to $40 Trifocal Covered In Full Up to $45 Allowance at Progressive3 standard trifocal Up to $45 level Lenticular Covered In Full Up to $80 Scratch Resistant Covered In Full Up to $25 Coating Ultraviolet Coating Covered In Full Up to $20 Tints Covered In Full Up to $15 $225 retail Contact Lenses4 Up to $80 allowance Medically Necessary Covered In Full Up to $150 Contact Lenses $200 retail $200 retail Laser Vision Correction5 allowance allowance

Disability Insurance

EMPLOYEE BENEFITS

Mutual of Omaha ABOUT DISABILITY 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.

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

PREFERRED CHOICE VOLUNTARY SHORT-TERM DISABILITY INSURANCE Short Term Disability Elimination Period Rates Per $100 of Monthly Payroll

14 Days

30 Days

$0.90

$0.56

Class 1 60% $1,500 14 days 14 days 11 weeks

Class 2 60% $1,500 30 days 30 days 9 weeks

3/6

BENEFIT SUMMARY BENEFIT PERCENTAGE MAXIMUM BENEFIT ACCIDENT ELIMINATION PERIOD SICKNESS ELIMINATION PERIOD BENEFIT DURATION PRE-EXISTING CONDITION No pre-existing condition limitations for pregnancy ADDITIONAL STD BENEFITS DEFINITION OF WEEKLY EARNINGS Earnings Just Prior to Disability, Annual Salary

OPEN ENROLLMENT

A one-time open enrollment is available for a period of up to 90 days prior to the effective date of the policy, subject to the enrollment strategy requirements. During this time, the employee/member may elect insurance for the first time or request increased insurance up to the Guarantee Issue amount without providing health information.

ANNUAL OPEN ENROLLMENT

An open enrollment is available for a period of up to 30 days each Policy Year. The first annual enrollment period will occur after the effective date of the policy. During this time, the employee/member may elect insurance for the first time or request increased insurance up to the Guarantee Issue amount without providing health information.

PORTABILITY

Included, a continuation option is available

Disability Insurance

EMPLOYEE BENEFITS

Mutual of Omaha VOLUNTARY LONG-TERM DISABILITY INSURANCE Long Term Disability Age Bands

Rate Per $100 of Monthly Payroll

<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

$0.26 $0.26 $0.32 $0.41 $0.56 $0.77 $1.03 $1.38 $1.49 $1.65 $2.67 BENEFIT SUMMARY Class 1 60% $6,000 $6,000 90 days 180 days RBD to SSNRA 3/12 24 months - Lifetime 24 months - Lifetime $100

BENEFIT PERCENTAGE MAXIMUM BENEFIT GUARANTEE ISSUE ELIMINATION PERIOD ACCUMULATION PERIOD BENEFIT DURATION PRE-EXISTING CONDITION MENTAL DISORDERS DRUG & ALCOHOL MINIMUM BENEFIT ADDITIONAL LTD BENEFITS

DEFINITION OF MONTHLY EARNINGS

Earnings Just Prior to Disability, Annual Salary

RECURRENT DISABILITY

6 months

SURVIVOR BENEFIT

3 months

Cancer Insurance

EMPLOYEE BENEFITS

MetLife/Administered by Bay Bridge 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/crosbyisd

Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living, and household upkeep. In addition to these non-medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health.

Group Cancer - Monthly Rates Coverage Tier Employee Employee + Spouse Employee + Child(ren) Family

Benefit Hospital Confinement Surgical Radiation/Chemotherapy First Diagnosis Colony Stimulating Factors

Base Policy Low $14.92 $30.57 $21.51 $37.16 Variable Benefit Elections Low $100 per day up to $1,500 $200 per day $2,500 $500 per month

High $30.99 $63.11 $43.43 $75.56

High $300 per day up to $4,500 $2,500 per month $5,000 $1,500 per month

Wellness

$50 per year

$100 per year

ICU

$325 per day

Accident Insurance

EMPLOYEE BENEFITS

The Hartford 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/crosbyisd

ACCIDENT COVERAGE INFORMATION You have a choice of two accident plans, which allows you the flexibility to enroll for the coverage that best meets your needs. This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). PLAN INFORMATION Coverage Type BENEFITS EMERGENCY, HOSPITAL & TREATMENT CARE Accident Follow-Up Up to 3 visits per accident Acupuncture/Chiropractic Care/PT Up to 10 visits each per accident Ambulance – Air Once per accident Ambulance – Ground Once per accident Blood/Plasma/Platelets Once per accident Child Care Up to 30 days per accident while insured is confined Daily Hospital Confinement Up to 365 days per lifetime Daily ICU Confinement Up to 30 days per accident Diagnostic Exam Once per accident Emergency Dental Once per accident Emergency Room Once per accident Health Screening Benefit Once per year for each covered person Hospital Admission Once per accident Initial Physician Office Visit Once per accident Lodging Up to 30 nights per lifetime Medical Appliance Once per accident Rehabilitation Facility Up to 15 days per lifetime Transportation Up to 3 trips per accident Urgent Care Once per accident X-ray Once per accident SPECIFIED INJURY & SURGERY Abdominal/Thoracic Surgery Once per accident Arthroscopic Surgery Once per accident

LOW PLAN On and off-job (24 hour) LOW PLAN

HIGH PLAN On and off-job (24 hour) HIGH PLAN

$100 $75 $2,000 $750 $300 $35 $200 $400 $300 Up to $450 $300 $50 $1,500 $125 $150 $200 $300 $600 $150 $150

$150 $100 $2,500 $1,000 $400 $50 $400 $600 $400 Up to $600 $600 $50 $2,500 $150 $175 $300 $450 $800 $200 $200

$3,000 $500

$4,000 $750

Accident Insurance

EMPLOYEE BENEFITS

The Hartford BENEFITS SPECIFIED INJURY & SURGERY Cont’d. Burn Once per accident Burn – Skin Graft Once per accident for third degree burn(s) Concussion Up to 3 per year Dislocation Once per joint per lifetime Eye Injury Once per accident Fracture Once per bone per accident Hernia Repair Once per accident Joint Replacement Once per accident Knee Cartilage Once per accident Laceration Once per accident Ruptured Disc Once per accident Tendon/Ligament/Rotator Cuff Once per accident CATASTROPHIC Accidental Death Within 90 days; Spouse @ 50% and child @ 25% Common Carrier Death Within 90 days Coma Once per accident Dismemberment Once per accident Home Health Care Up to 30 days per accident Paralysis Once per accident Prosthesis Once per accident FEATURES Ability Assist® EAP2 – 24/7/365 access to help for financial, legal or emotional issues HealthChampionSM3 – Administrative & clinical support following serious illness or injury

LOW PLAN

HIGH PLAN

Up to $15,000 Up to $20,000 50% of burn benefit 50% of burn benefit $200 $250 Up to $8,000 Up to $12,000 Up to $750 Up to $1,000 Up to $10,000 Up to $12,000 $400 $600 $4,000 $6,000 Up to $2,000 Up to $3,000 Up to $1,000 Up to $1,500 $2,000 $3,000 $2,000 $3,000 $75,000 $150,000 Up to $15,000 Up to $75,000 $75 Up to $75,000 Up to $3,000

$100,000 $300,000 Up to $20,000 Up to $100,000 $100 Up to $100,000 Up to $4,000

Included Included

PREMIUMS The amounts shown are monthly amounts. COVERAGE TIER Employee Only Employee & Spouse Employee & Child(ren) Employee & Family

LOW PLAN $9.58 ($0.31 per day) $15.08 ($0.50 per day) $16.06 ($0.53 per day) $25.26 ($0.83 per day)

HIGH PLAN $14.04 ($0.46 per day) $22.10 ($0.73 per day) $23.34 ($0.77 per day) $36.78 ($1.21 per day)

Critical Illness Insurance

EMPLOYEE BENEFITS

Cigna ABOUT CRITICAL ILLNESS Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non-medical costs related to the illness, including transportation, child care, etc.

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

Age Bands <24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Benefit Waiting Period Pre-Existing Condition Limitation Employee Benefit Amount(s)

Critical Illness Employee Rate Per $10,000 $1.56 $2.40 $2.76 $4.80 $7.60 $11.80 $17.99 $23.14 $28.89 $36.47 $52.66 $62.87 $83.96 $113.22

Spouse Rate Per $10,000 $1.24 $1.83 $2.04 $3.74 $6.15 $10.54 $19.42 $28.85 $36.83 $44.54 $60.36 $90.66 $104.14 $140.81

SUMMARY OF BENEFITS None. Does not apply. Voluntary Benefits Amounts (options for employee selection): $10,000, $20,000, $30,000 $30,000 Guaranteed Issue

Spouse, Domestic Partner, or Civil Union Voluntary Benefits Amounts (options for spouse, domestic partner, or civil union partner Partner Benefit Amount(s) selection): (Spouse, domestic partner, or civil union $10,000, $20,000, $30,000 partner to age 100 is eligible for coverage if $30,000 Guaranteed Issue employee is enrolled)

Dependent Child Benefit Amount(s) Child only eligible if Employee is enrolled Birth to 26; 26+ if disabled

Age Based Reductions

Initial Critical Illness Benefit

Voluntary Benefits Amounts (eligible Dependent Children are automatically enrolled for no additional cost when employee enrolls): 50% of Employee Issued Amount None. Pays a lump sum benefit direct to the insured, unless otherwise assigned, upon the date of diagnosis made after the coverage effective date, for each of the Covered Conditions listed below. The amount payable per Covered Condition is the Initial Benefit Amount multiplied by the applicable percentage for the diagnosis of the Covered Condition shown below. Each Covered Condition will be payable one time per Covered Person, subject to the Maximum Lifetime Limit. A 180 separation period between the dates of diagnosis is required.

Critical Illness Insurance Cigna Recurrence Critical Illness Benefit Skin Cancer Benefit Maximum Lifetime Limit

EMPLOYEE BENEFITS

Benefits will be paid for the diagnosis of a subsequent and same Covered Condition that has already received a benefit payout under this policy after a 6 month separation period from the previous diagnosis, subject to the Maximum Lifetime Limit. Pays a flat dollar benefit. See below for Benefit Amount. The lesser of 5 times the elected Benefit Amount or $150,000 per Covered Person. Does not apply to Skin Cancer or Optional Benefits.

CRITICAL ILLNESS COVERAGE LIST OF COVERED CONDITIONS Option 1 Recurrence Cancer Conditions % of Initial Benefit Amount % of Initial Benefit Amount Invasive Cancer 100% 100% Carcinoma in Situ 25% 25% Benefit Amount Skin Cancer $250 Not Available 1x per lifetime Custom Recurrence Vascular Conditions % of Initial Benefit Amount % of Initial Benefit Amount Heart Attack 100% 100% Stroke 100% 100% Coronary Artery Disease 50% 50% Aortic & Cerebral Aneurysm 25% 25% Advanced Heart Failure 25% Not Available Custom Recurrence Nervous System Conditions % of Initial Benefit Amount % of Initial Benefit Amount Advanced Stage Alzheimer’s Disease 50% Not Available Amyotrophic Lateral Sclerosis (ALS) 100% Not Available Parkinson’s Disease 50% Not Available Multiple Sclerosis 25% Not Available Option 1 Recurrence Infectious Conditions % of Initial Benefit Amount % of Initial Benefit Amount Severe Sepsis 25% 25% Custom Recurrence Childhood Conditions % of Child Initial Benefit Amount* % of Child Initial Benefit Amount* Cerebral Palsy 100% Not Available Cystic Fibrosis 100% Not Available Muscular Dystrophy 100% Not Available *For Childhood Conditions please refer to the Dependent Child Benefit Amount(s) section above for details on how much coverage is available for covered children. Option 1 Recurrence Other Specified Conditions % of Initial Benefit Amount % of Initial Benefit Amount Benign Brain Tumor 100% 100% Blindness 100% Not Available Coma 25% 25% End-Stage Renal (Kidney) Disease 100% 100% Major Organ Failure 100% 100% Paralysis 100% 100% Advanced Obesity 25% 25% Crohn's Disease 25% Not Available Pulmonary Embolism 25% 25% 25

Life and AD&D Lincoln Financial Group

EMPLOYEE BENEFITS

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

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

Basic Life •

All Full Time employees will receive $10,000 Basic Life Insurance which includes a matching amount of Accidental Death & Dismemberment. This is a benefit paid for you by Crosby ISD.

Voluntary Group Life •

• • • •

Voluntary Group Life Insurance Guarantee Issue: $200,000 for employees (not to exceed 7 x annual earnings) and $50,000 for spouses (not to exceed employee election) and $10,000 for children. Employees and spouses are eligible for up to $500,000 in $10,000 increments. Evidence of insurability (EOI) is required for amounts over GI Employee must cover themselves to cover a spouse or dependent child. Rates are age-banded, this means costs increase as you age Death benefit reduces at age 70 to 50% of original amount. Spouse coverage reduces based on employee’s reduction

Accidental Death and Dismemberment AD&D is 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. • Can elect up to $500,000 in AD&D, no health questions asked. • If you elect coverage, you may also cover spouses and eligible dependent children. Spouse coverage up to $500,000 but may not exceed employee coverage. Children may be covered for an additional $10,000 • Death benefit reduces at age 70 to 50% of original amount. Spouse coverage reduces based on employee’s reduction

Voluntary Group Life - per $10,000 in coverage Age Bands Employee Spouse 0-24 $0.45 $0.45 25-29 $0.53 $0.53 30-34 $0.64 $0.64 35-39 $0.80 $0.80 40-44 $0.89 $0.89 45-49 $1.34 $1.34 50-54 $2.05 $2.05 55-59 $3.83 $3.83 60-64 $5.88 $5.88 65-69 $11.32 $11.32 70+ $18.35 $18.35 Voluntary Group Life - Child(ren) $10,000 in coverage 0-26 $2.00 Voluntary AD&D - per $1,000 in coverage Employee Spouse Child $0.028 $0.030 $0.035

Individual Life Insurance 5Star Life Insurance

EMPLOYEE BENEFITS

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

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

The 5Star Life Insurance Company’s Family Protection Plan Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy. CUSTOMIZABLE With several options to choose from, employees select the coverage that best meets the needs of their families. TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL). PORTABLE Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly. CONVENIENCE Easy payments through payroll deduction.

PROTECTION TO COUNT ON Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions. QUALITY OF LIFE Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following: • Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.

FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves. * Financially dependent children 14 days to 23 years old.

Legal and Identity Theft

EMPLOYEE BENEFITS

Legal Shield 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/crosbyisd

Identity Theft Is Growing Better Protect You and Your Family Fraud Legal and Identity Theft continues to grow more complex. And, it is becoming harder for ID Only Legal Only consumers and identity theft victims to manage the intricacies on their own. Fraudsters are taking advantage of consumers' increased Employee $12.95 digital dependence to steal personal and financial information Employee + Family $22.95 $21.95 doubling the amount of identity theft reports to the FTC in 2020.1

ID+Legal $34.90 $41.90

The LegalShield Membership Includes: • • • • • • •

Dedicated Law Firm Legal Advice/Consultation on unlimited personal issues Letters/Calls made on your behalf Contracts/Documents Reviewed up to 15 pages Residential Loan Document Assistance Lawyers prepare your Will/Living Will/Health Care Power of Attorney/Financial Power of Attorney Speeding Ticket Assistance

• • • • •

IRS Audit Assistance Trial Defense (if named defendant/respondent in a covered civil action suit) Uncontested Divorce, Separation, Adoption and/or Name Change Representation (available 90 days after enrollment) 25% Preferred Member Discount (bankruptcy, criminal charges, DUI, personal injury, etc.) 24/7 Emergency Access for covered situations

The IDShield Membership Includes: Privacy & Security Monitoring NEW! High risk account monitoring. Comprehensive identity protection service and financial account number monitoring that leaves nothing to chance by monitoring your name, SSN, date of birth, email address (up to 10), phone numbers (up to 10), driver’s license, passport numbers and medical ID numbers (up to 10). Additionally, we’ll give you peace of mind with credit score tracking, financial activity alerts and sex offender searches. With the family plan, Minor Identity Protection is included and provides monitoring for up to 10 children under the age of 18 for no additional cost. Social Media Monitoring Allows you to monitor multiple social media accounts and content feeds for privacy and reputational risks. Credit Monitoring Gain access to continuous credit monitoring through TransUnion that you can access immediately via the service portal dashboard

on myidshield.com or through the free IDShield mobile app. Credit activity will be reported promptly via an email alert and mobile push notification. Credit Inquiry Alerts NEW! Instant hard inquiry alerts. Receive alerts when a creditor requests your TransUnion credit file for the purposes of opening a new credit account or when a creditor requests a credit file for changes that would result in a new financial obligation. Consultation Your identity protection plan includes 24/7/365 live support for covered emergencies, unlimited consultation, identity alerts, data breach notifications and lost wallet protection. Full Service Restoration If your identity is stolen, our complete recovery services from our Licensed Private Investigators will ensure that it will be restored to its pre-theft status.

Emergency Medical Transport MASA

EMPLOYEE BENEFITS

ABOUT MEDICAL TRANSPORT 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/crosbyisd

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. After the group health plan pays its portion, MASA MTS works with providers to deliver our members’ $0 in out-of-pocket costs for emergency transport. Emergent Air Transportation 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 In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities. 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 facilities. Repatriation/Recuperation Suppose you or a family member 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 http://www.mybenefitshub.com/crosbyisd.

Emergency Transportation Employee and Family

$14.00

Flexible Spending Account (FSA) Higginbotham

EMPLOYEE BENEFITS

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 contains a $500 rollover provision).

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

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).

Higginbotham Benefits Debit Card The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).

Dependent Care FSA 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.

Things to Consider Regarding the Dependent Care FSA • • • •

Overnight camps are not eligible for reimbursement (only day camps can be considered). If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13. 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. The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.

Important FSA Rules • • • • 30

The maximum per plan year you can contribute to a Health Care FSA is $2,850. 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. You cannot change your election during the year unless you experience a Qualifying Life Event. You can continue to file claims incurred during the plan year for another 90 days after August 31st. Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.

Flexible Spending Account (FSA) Higginbotham

EMPLOYEE BENEFITS

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

Higginbotham Portal The Higginbotham Portal provides information and resources to help you manage your FSAs. • Access plan documents, letters and notices, forms, account balances, contributions and other plan information • Update your personal information • Utilize Section 125 tax calculators • Look up qualified expenses • Submit claims • Request a new or replacement Benefits Debit Card

Register on the Higginbotham Portal Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information. • Enter your Employee ID, which is your Social Security number with no dashes or spaces. • Follow the prompts to navigate the site. • If you have any questions or concerns, contact Higginbotham:  Phone – 866-419-3519  Email – flexclaims@higginbotham.net  Fax – 866-419-3516

2022 - 2023 Plan Year

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 Crosby ISD Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice. Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the Crosby 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.