2022-23 Splendora ISD Benefit Guide by Higginbotham Public Sector

SPLENDORA ISD BENEFIT GUIDE EFFECTIVE: 09/01/2022 8/31/2023 WWW.MYBENEFITSHUB.COM/SPLENDORAISD 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 12-13 Health Savings Account (HSA) 14 Flexible Spending Account (FSA) 15-16 Telehealth 17 Hospital Indemnity 18 Dental 19-20 Vision 21-22 Disability 23 Life and AD&D 24-25 Individual Life 26 Cancer 27 Critical Illness 28-29 Emergency Medical Transportation 30 HOW TO ENROLLPG. 4 SUMMARYPAGESPG. 6 BENEFITSYOURPG. 12 2

BENEFITS ADMINISTRATORS SPLENDORA ISD ADMINISTRATOR MEDICAL Financial Benefit Services (469) 385 4685 Brandon Campbell (281) 689 bcampbell@splendoraisd.org4004 Texas Schools Health Benefits Program (TSHBP) (888) 803 0081 All Plans: https://tshbp.info/DrugPhamGroupPharmacywww.tshbp.orgBenefits:SouthernScripts#50000 HEALTH SAVINGS ACCOUNT (HSA) FLEXIBLE SPENDING ACCOUNT (FSA) TELEHEALTH (817)EECU 882 www.eecu.org0800 https://flexservices.higginbotham.net(866)Higginbotham4193519 (888)MDLive365 www.consultmdlive.com1663 HOSPITAL INDEMNITY DENTAL VISION GroupAetna #802494 (800) 872 www.aetna.com3862 (800)MetLife638 www.metlife.com5433 Superior Vision Group #34986 (800) 507 www.superiorvision.com3800 DISABILITY VOLUNTARY LIFE AND AD&D CANCER www.oneamerica.com(800)GroupOneAmerica#006186205535318 Lincoln Financial Group Group #1053269 (800) 423 www.lincolnfinancial.com/2765 American Public Life Group #23457 (800) 256 www.ampublic.com8606 CRITICAL ILLNESS EMERGENCY MEDICAL TRANSPORT INDIVIDUAL LIFE Unum Group #474092 (866) 679 www.unum.com3054 (800)MASA423 3226 www.masamts.com 5Star (866) 863 9753 https://5starlifeinsurance.com/ Benefit Contact Information 3

Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS SPLENDORA” to (800) 583-6908 App Group #: FBSSPLENDORA Text “FBS SPLENDORA” 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/splendoraisd How to Log In 2 CLICK LOGIN 3 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. 5

Benefit Updates What’s New: Don’t Forget! • Login and complete your benefit enrollment from 05/02/2022 06/03/2022 • Enrollment assistance is available by calling Financial Benefit Services at (866) 914 5202. • Update your information: home address, phone numbers, email, and beneficiaries. • REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator. SUMMARY PAGESAnnual Benefit Enrollment New Carrier for Voluntary Term Life and Accidental Death and Dismemberment: Lincoln Financial Group • Guarantee Issue for all employees up to $250,000, spouses $50,000 and children $10,000 • AD&D Life All guarantee issue up to $500,000 New Administrator for Flex and Dependent Care: AllHigginbothamwhoenroll will receive new Higginbotham debit cards 6

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 Eligibility for Government Programs

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.

Section 125 Cafeteria Plan Guidelines Benefit

Marital Status

SUMMARY PAGESAnnual

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.

Gain/Loss

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.

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.

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

CHANGES IN (CIS):STATUS QUALIFYING EVENTS

Judgment/Decree/Order

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.

Change in Number of Tax Dependents

EligibilityDependents'ofStatus

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

Enrollment 7

New Hire Enrollment

SUMMARY PAGESAnnual Benefit Enrollment 8

Q&A Who do I contact with Questions?

Where can I find forms?

For benefit summaries and claim forms, go to the Splendora ISD benefit www.mybenefitshub.com/splendoraisdwebsite:.

• 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.

Howsection.can I find a Network Provider?

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?

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.

• 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.

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

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

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

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.

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

Dependent RequirementsEligibility

AGE Medical To age 26 Dental To age 26 Vision To age 26 Life To age 26 AD&D To age 26 Individual Life To age 24 HealthAccountSavings To age 26 Critical Illness To age 26 Disability To age 26 IndemnityHospital To age 26 Telehealth To age 26 TransportationEmergency To age 26 Cancer To age 26

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

Annual Benefit

Enrollment 9

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.

Employee RequirementsEligibility

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

Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent Disclaimer:eligibility. 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 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.

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. MAXIMUM

SUMMARY PAGES

PLAN

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:

Plan Year

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

In Network

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

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

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.

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

Pre Existing Conditions

SUMMARY PAGESHelpful Definitions 10

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.

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.

Actively at Work

Annual Enrollment

Guaranteed Coverage

September 1st through August 31st

FLIP TO FOR HSA INFORMATION PG. 14 FLIP TO FOR FSA INFORMATION PG. 15 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. However, your plan does allow for $500 to be rolled over. Does the account earn interest? Yes No Portable? Yes, portable year to year and between jobs. No SUMMARY PAGESHSA vs. FSA 11

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/sampleisd

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.

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

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.

ABOUT TSHBP

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! 1On 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. Access the MyTSHBP Digital Wallet for easy access to all your benefit resources.

Medical Insurance Texas Schools Health Benefits Program

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.

Directed Care Highlights

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.

EMPLOYEE BENEFITS

Aetna Network Highlights

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.

EMPLOYEE BENEFITS Medical Insurance Texas Schools Health Benefits Program PLAN SUMMARY DIRECTED CARE PLANS AETNA NETWORK PLANS High(Current)Deductible (Current)CoPay Aetna(New)HD Aetna(New)Signature Directed Care Plan • Use CC for Hospital/ Surgical Services • Compatible with an HSA • Lowest HD Premium Plan • Out of Network Benefits Directed Care Plan • Use CC for Hospital/ Surgical Services • Co payments for Services • Reduce Out of Pocket • Out of Network Benefits 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 Plan Features In Network In Network In Network In Network Individual/FamilyDeductible $3,000/$9,000 $0 Deductible $3,000/$6,000 $2,000/$4,000 Coinsurance None Plan Pays 100% after deductible None Plan Pays 100% after out of pocket is met You pay 30% deductibleafter You pay 25% deductibleafter Ind/Fam Out of Pocket $3,000/$9,000 $3,500/$10,500 $7,000/$14,000 $7,500/$15,000 National Network HealthSmart HealthSmart Aetna Aetna PCP Required No No No No PCP Referral to Specialist No No No No Doctor VisitsPreventive Care Yes $0 copay Yes $0 copay Yes $0 copay Yes $0 Copay Primary Care Deductible, then Plan pays 100% $35 copay You pay 30% deductibleafter $30 copay Specialist Deductible, then Plan pays 100% $35 copay You pay 30% deductibleafter $70 copay Virtual Health $30 per consultation $0 per consultation $30 per consultation $0 per consultation Care Facilities Urgent Care Deductible, then Plan pays 100% $50 copay You pay 30% deductibleafter $50 copay Emergency Care Deductible, then Plan pays 100% $500 copay You pay 30% deductibleafter You pay $500 copay + 25% after deductible Outpatient Surgery Deductible, then Plan pays 100% $500 copay You pay 30% deductibleafter You pay 25% deductibleafter PrescriptionsDrug Deductible Integrated with medical No deductible Integrated with medical $500 brand deductible Days Supply 30 Day Supply / 90 Day Supply 30 Day Supply / 90 Day Supply 30 Day Supply / 90 Day Supply 30 Day Supply / 90 Day Supply Generics Deductible, then Plan pays 100% $0 at selected pharmacies; others $10/$20 copay You pay 20% deductible;after $0 for certain generics $15/$45 copay Preferred Brand Deductible, then Plan pays 100% $35 copay or 50% copay (max $100) You pay 25% deductibleafter You pay 25% deductibleafter Non preferred Brand Deductible, then Plan pays 100% $70 copay or 50% copay (max $200) You pay 50% deductibleafter You pay 50% deductibleafter Specialty Limited PAP Required Limited PAP Required Full Coverage PAP Required Full Coverage PAP Required Employee Cost (District Contribution of Employee$300)Only $78.00 $121.00 $126.00 $173.00 Employee/Spouse $735.00 $878.00 $898.00 $937.00 Employee/Child $408.00 $501.00 $465.00 $503.00 Employee/Family $1,057.00 $1,256.00 $1,132.00 $1,219.00 13

• 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.

• Not enrolled in Medicare or TRICARE

HSA

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

• Enrolled in an HSA eligible HDHP (TSHBP HD, Aetna HD)

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

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.

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:

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

If you meet the eligibility requirements, you may open an HSA administered by EECU. 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.

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

Important HSA Information

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

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

• Individual $3,650

ABOUT

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

Opening an HSA

Health Savings Account (HSA) BENEFITS

A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used.

You 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.

EECU EMPLOYEE

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/splendoraisd

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.

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

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

• 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

• Not receiving Veterans Administration benefits

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.

• Family (filing jointly) $7,300

• 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.

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:

Things to Consider Regarding the Dependent Care FSA

Higginbotham EMPLOYEE BENEFITS

Dependent Care 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/splendoraisd

• Medical deductibles and coinsurance

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

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

• Prescription copays

• Dental and vision expenses

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.

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

Flexible Spending Account (FSA)

Higginbotham Benefits Debit Card

ABOUT FSA

• 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).

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).

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 16

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.

Higginbotham FSA Rules

Flexible Spending Account (FSA)

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

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

EMPLOYEE BENEFITS Important

• The IRS has amended the “use it or lose it rule” to allow you to carry over up to $570 in your Health Care FSA into the next plan year. The carry over rule does not apply to your Dependent Care FSA.

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. Portal Portal provides information and resources to help you manage your FSAs. and other

• You can continue to file claims incurred during the plan year for another 90 days after August 31st

Higginbotham

The Higginbotham

•

• Access plan documents, letters and notices, forms, account balances, contributions

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/splendoraisd 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. 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. 17

Employee and Spouse $52.29 $69.24

Important Note: All daily inpatient stay benefits begin on day two and count toward the plan year maximum.

2 Hospital Stay Admission Pays a lump sum benefit for the initial day of your stay in a hospital. Maximum 1 stay per plan year. $1,500 $2,000 Hospital Stay Daily Pays a daily benefit, beginning on day two of your stay in a non ICU room of a hospital. Maximum 30 days per plan year $150 $200 Hospital Stay (ICU) Daily Pays a daily benefit, beginning on day two of your stay in an ICU room of a hospital. Maximum 30 days per plan year $300 $400 Newborn routine care Provides a lump sum benefit after the birth of your newborn. This will not pay for an outpatient birth. $200 $200 Observation unit Provides a lump sum benefit for the initial day of your stay in an observation unit as the result of an illness or accidental injury. Maximum 1 day per plan year. $200 $200

PLANBenefit1PLAN

Substance abuse stay Daily Pays a daily benefit for each day you have a stay in a hospital or

PLAN 1 PLAN 2

Employee and Child(ren) $43.03 $56.82

EMPLOYEE BENEFITS

The Hospital Indemnity Plan provided through Aetna helps with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance, which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment you receive. These costs may include meals and transportation, childcare or time away from work due to a medical issue that requires hospitalization.

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/splendoraisd

Employee Only $26.55 $35.06

Employee and Family $67.29 $88.94

If you need to submit a claim you do so on the Aetna portal at myaetnasupplemental.com

Hospital Indemnity Aetna

Service

ABOUT HOSPITAL INDEMNITY

Hospital Indemnity Plan Monthly Premiums

substance abuse treatment facility for the treatment of substance abuse. Maximum 30 days per plan year. $150 $200 Mental Disorder stay Daily Pays a daily benefit for each day you have a stay in a hospital or mental disorder treatment facility for the treatment of mental disorders. Maximum 30 days per plan year. $150 $200 Rehabilitation unit stay Daily Pays a benefit each day of your stay in a rehabilitation unit immediately after your hospital stay due to an illness or accidental injury. Maximum 30 days per plan year. $75 $100

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/splendoraisd Dental Insurance MetLife EMPLOYEE BENEFITS DPPO PLANS How do I request a new ID Card? You can request your dental id card by contacting MetLife directly at 800 942 0854. You can also go to www.metlife.com and register/login to access your account. How do I find an in network Dentist? 1. Go to metlife.com 2. Select “Find a Dentist” 3. Select PDP Plus next to “Choose a network” DPPO HIGH DENTAL PLAN Coverage Type: In Network1 % of PDP Fee2 Out of Network1 % of R&C Fee4 Type A Preventive 100% 100% Type B Basic Restorative 80% 80% Type C Major Restorative 50% 50% Type D Orthodontia 50% 50% Deductible3 Individual $50 $50 Family $150 $150 Annual Maximum Benefit: Per Individual $1300 $1300 Orthodontia Lifetime Maximum Ortho applies to Adult and Child Up to dependent age limit $1000 per Person $1000 per Person 1. "In Network Benefits" refers to benefits provided under this plan for covered dental services that are provided by a participating dentist. "Out of Network Benefits" refers to benefits provided under this plan for covered dental services that are not provided by a participating dentist. 2. Negotiated fees refer 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. 3. Applies to Type B and C services only. 4. Out of network benefits are payable for services rendered by a dentist who is not a participating provider. The Reasonable and Customary charge is based on the lowest of: • the dentist’s actual charge (the 'Actual Charge'), • the dentist’s usual charge for the same or similar services (the 'Usual Charge') or • the usual charge of most dentists in the same geographic area for the same or similar services as determined by MetLife (the 'Customary Charge'). For your plan, the Customary Charge is based on the 90th percentile. Services must be necessary in terms of generally accepted dental standards. 19

EMPLOYEE BENEFITS Dental Insurance MetLife DPPO LOW DENTAL PLAN Coverage Type: In Network1 % of PDP Fee2 Out of Network1 % of R&C Fee2 Type A Preventive 100% 100% Type B Basic Restorative 70% 70% Type C Major Restorative 50% 50% Deductible3 Individual $50 $50 Family $150 $150 Annual Maximum Benefit: Per Individual $1050 $1050 1. "In Network Benefits" refers to benefits provided under this plan for covered dental services that are provided by a participating dentist. "Out of Network Benefits" refers to benefits provided under this plan for covered dental services that are not provided by a participating dentist. 2. Negotiated fees refer 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. 3. Applies to Type B and C services only. DHMO PLAN If you enroll in the DHMO plan, you must select a Primary Care Dentist (PCD) from the DHMO network directory to manage your care. Each eligible dependent may choose their own PCD. Dental services are unlimited, you pay fixed copays, there are no deductibles and there are no claim forms to file. There is no coverage for services provided without a referral from your PCD or if you seek care from out of network providers. How do I find an in network Dentist? 1. Go to metlife.com 2. Select “Dental HMO/Managed Care network” and enter your Zip code 3. Enter your plan name which is located on your Schedule of Benefits. This can be found at www.mybenefitshub.com/ splendoraisd Dental Plan Monthly Premiums HIGH LOW DHMO Employee Only $25.67 $13.34 $7.97 Employee and Spouse $55.20 $32.80 $20.92 Employee and Child(ren) $74.43 $40.29 $19.62 Employee and Family $104.41 $57.85 $35.18 20

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/splendoraisd Vision Insurance Superior Vision EMPLOYEE BENEFITS In network Out of network Exam (ophthalmologist) Covered in full Up to $42 retail Exam (optometrist) Covered in full Up to $37 retail Frames $100 retail allowance Up to $40 retail Contact lens fitting (standard2) Covered in full Not covered Contact lens fitting (specialty2) $50 retail allowance Not covered Lenses (standard) per pair Single vision Covered in full Up to $26 retail Bifocal Covered in full Up to $34 retail Trifocal Covered in full Up to $50 retail Progressives lens upgrade See description3 Up to $50 retail Factory scratch coat Covered in full Not covered Polycarbonate Covered in full Not covered Contact lenses4 $100 retail allowance Up to $180 retail Co pays apply to in network benefits; co pays for out of network visits are deducted from reimbursements 1. Materials co pay applies to lenses and frames only, not contact lenses 2. Standard contact lens fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty contact lens fitting applies to new contact wearers and/or a member who wear toric, gas permeable, or multi focal lenses. 3. Covered to provider’s in office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co pay. 4. Contact lenses are in lieu of eyeglass lenses and frames benefit Copays Services/frequency Monthly Premiums Exam $0 Exam 12 months Employee Only $8.19 Materials1 $0 Frame 12 months Employee and Spouse $19.66 Contact lens fitting (standard & specialty) Contact lens fitting 12 months Employee and Child(ren) $19.66$25 Lenses 12 months Employee and Family $19.66 Contact lenses 12 months 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. 21

Discount Features Look for providers in the provider directory who accept discounts, as some do not; please verify their services and discounts (range from 10% 30%) prior to service as they vary. Discounts on covered materials Frames: 20% off amount over allowance Lens options: 20% off retail Progressives: 20% off amount over retail lined trifocal lens, including lens options Specialty contact lens fit: 10% off retail, then apply allowance Discounts on non covered exam, services and materials Exams, frames, and prescription lenses: 30% off retail Lens options, contacts, miscellaneous options: 20% off retail Disposable contact lenses: 10% off retail Retinal imaging: $39 maximum out of pocket Maximum member out of pocket The following options have out of pocket maximums5 on standard (not premium, brand, or progressive) lenses. Single Vision Bifocal Trifocals& Ultraviolet coat $15 $15 Tints, solid or gradients $25 $25 Anti reflective coat $50 $50 High index 1.6 $55 20% off retail Photochromics $80 20% off retail 5. Discounts and maximums may vary by lens type. Please check with your provider. EMPLOYEE BENEFITS Vision Insurance Superior Vision Refractive Surgery Superior Vision has a nationwide network of independent refractive surgeons and partnerships with leading LASIK networks who offer members a discount. These discounts range from 10% 50%, and are the best possible discounts available to Superior Vision. 22

Partial Disability: You may be paid a partial disability benefit, if because of injury or sickness, you are unable to perform every material and substantial duty of your regular occupation on a full time basis, are performing at least one of the material and substantial duties of your regular occupation, or another occupation, on a full or part time basis, and are earning less than 80% of your pre disability earnings due to the same injury or sickness.

Total Disability: You are considered disabled if, because of injury or sickness, you cannot perform the material and substantial duties of your regular occupation, you are not working in any occupation and are under the regular attendance of a physician for that injury or sickness.

Educator Disability insurance is a hybrid that combines features of short term and long term disability into one plan. Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. The plan gives you flexibility to be able to choose an amount of coverage and waiting period that suits your needs. We offer Educator Disability insurance for you to purchase through Splendora ISD. If you need to file a claim, please contact OneAmerica at 855 517 6365 and provide group #00618620.

Period: This is a period of consecutive days of disability before benefits may become payable under the Eliminationcontract.

Eligibility: This benefit is available for employees who are actively at work on the effective date and working a minimum of 20 hours per Benefitweek.Amount: You may select a minimum monthly benefit of $200 up to a maximum monthly benefit of $8,000, in increments of $100, not to exceed 66.67% of your monthly pre disability Maximumearnings.

Pre Existing Condition Limitation: The pre existing period is 3/12.

Disability Elimination Period Monthly Premiums 0/7 $2.63 14/14 $2.21 30/30 $1.62 60/60 $1.31

Disability Insurance OneAmerica

BENEFITS

EMPLOYEE What is Educator Disability Insurance?

Period Options: Option 1 7/7, Option 2 14/14, Option 3 30/30, Option 4 60/60 First Day Hospital: If a Person is Totally Disabled and hospital confined for 24 hours or more with room and board charges during the Elimination Period due to an Injury or Sickness resulting in a covered Disability, benefits are payable from the first day of that confinement. Applies to plans with Elimination Periods of 30 days or less.

Certain disabilities are not covered if the cause of the disability is traceable to a condition existing prior to your effective date of coverage. A pre existing condition is any condition for which a person has received medical treatment or consultation, taken or were prescribed drugs or medicine, or received care or services, including diagnostic measures, within a time frame specified in the contract. You must also be treatment free for a time frame specified in some contracts following your individual effective date of coverage. A limited benefit will be paid if the Person’s Disability begins in the first 12 months following the Person’s Individual Effective Date of Insurance; and the Person’s Disability is caused by, contributed to by, or the result of a condition for which the Person received medical advice or treatment in the 3 months just prior to the Person’s Individual Effective Date of ReturnInsurancetoWork: You may be able to return to work for a specified time period without having your partial disability benefits reduced according to the contract. The Return to Work Benefit is offered up to a maximum of 12 months.

Benefit Duration: Accident: 3 years to age 70/ Sickness: Elimination65/5/70

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/splendoraisd

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/beaumontisd Life and AD&D Lincoln Financial Group EMPLOYEE BENEFITS Voluntary Life Insurance • Provides a cash benefit to your loved ones in the event of your death • Features group rates for Splendora ISD employees • Includes LifeKeys® services, which provide access to counseling, financial, and legal support services • Also includes TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home • To file a claim contact Lincoln Financial at (800) 423 2765Employee Guaranteed coverage amount during initial offering or approved special enrollment period $250,000 Newly hired employee guaranteed coverage amount $250,000 Continuing employee guaranteed coverage annual increase amount Up to $40,000 Maximum coverage amount 7 times your annual salary ($500,000 maximum in increments of $10,000) Minimum coverage amount $10,000 Spouse Guaranteed coverage amount during initial offering or approved special enrollment period $50,000 Newly hired employee guaranteed coverage amount $50,000 Continuing employee guaranteed coverage annual increase amount Up to $20,000 Maximum coverage amount 100% of the employee coverage amount ($500,000 maximum in increments of $5,000) Minimum coverage amount $5,000 Dependent Children Day 1 months to age 26 guaranteed coverage amount $10,000 Additional Plan Benefits Accelerated Death Benefit Included Premium Waiver Included Conversion Included Portability Included 24

Life and AD&D Lincoln Financial Group EMPLOYEE BENEFITS Voluntary Group Life Age (perEmployee$10,000) (perSpouse$5,000) 0 24 $0.50 $0.25 25 29 $0.60 $0.30 30 34 $0.80 $0.40 35 39 $1.00 $0.50 40 44 $1.50 $0.75 45 49 $2.50 $1.25 50 54 $4.10 $2.05 55 59 $6.80 $3.40 60 64 $8.40 $4.20 65 69 $13.60 $6.80 Age Per $5,000 Per $2,500 70 74 $11.25 $5.63 75 99 $17.50 $8.75 Voluntary Group Life Child(ren) (per $1,000 in coverage) 0 26 $0.15 Voluntary Group AD&D (per $1,000 in coverage) Employee/Spouse/Child $0.026 Voluntary AD&D Employee Only AD&D This coverage provides a cash benefit to the beneficiary/beneficiaries you name if you die in an accident, or to you if you suffer a covered loss in an accident, such as losing a limb or your eyesight Maximum coverage amount $500,000 maximum in $10,000 increments Minimum coverage amount $10,000 Your employee AD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire. Spouse AD&D Maximum coverage amount Up to $500,000 not to exceed 100% of employee’s benefit amount. Minimum coverage amount $5,000 The spouse AD&D coverage amount will reduce by 50% when you reach age 70. Benefits end when you retire. Dependent Child AD&D Maximum coverage amount $10,000 Benefit Exclusions Like any insurance, this term life insurance policy does have exclusions. A suicide exclusion may apply. A complete list of benefit exclusions is included in the policy. State variations apply. Note: You must be an active Splendora Independent School District employee to select coverage for a spouse and/or dependent children. To be eligible for coverage, a spouse or dependent child cannot be confined to a health care facility or unable to perform the typical activities of a healthy person of the same age and gender. 25

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.

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

Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years).$7.15 monthly for $10,000 coverage per child.

Insurance 5Star EMPLOYEE BENEFITS

Enhanced coverage options for employees. Easy and flexible enrollment for employers. The 5Star Life Insurance

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).

Find full details and rates at www.mybenefitshub.com/ Shouldsplendoraisd.youneed to file a claim, contact 5Star directly at (866) 863 9753.

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/splendoraisd

Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your CUSTOMIZABLEemployees.With

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.

• Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.

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.

Individual Life

*Quality of Life not available ages 66 70. Quality of Life benefits not available for children

several options to choose from, employees select the coverage that best meets the needs of their families.

Cancer Insurance 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. Should you need to file a claim contact APL at 800 256 8606 or online at www.ampublic.com. You can find additional claim forms and materials at www.mybenefitshub.com/splendoraisd.

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/splendoraisd

APL EMPLOYEE BENEFITS

Cancer Plan Monthly PLANPremiums1 PLAN 2 Employee Only $19.80 $32.70 Employee and Spouse $41.70 $68.56 Employee and Child(ren) $25.78 $41.30 Employee and Family $47.62 $77.18 Plan 1 Plan 2 Internal Cancer First Occurrence (Carcinoma in situ is not considered internal cancer) $2,500 $5,000 Cancer Screening Rider Benefits Diagnostic Testing 1 test per calendar year $50 per test $50 per test Follow Up Diagnostic Testing 1 test per calendar year $100 per test $100 per test Medical Imaging per calendar year $500 per test/ 1 per calendar year $500 per test/ 2 per calendar year Cancer Treatment Policy benefits Radiation and Chemotherapy, Immunotherapy Maximum Per 12 month period $10,000 $20,000 Hormone Therapy Max 12 treatments per calendar year $50 per treatment $50 per treatment Surgical Rider Benefits Surgical $30 unit dollar amount Max $3,000 per operation $60 unit dollar amount Max $6,000 per operation Anesthesia 25% of amount paid for covered surgery Bone Marrow Transplant Maximum per lifetime $6,000 $12,000 Stem Cell Transplant Maximum per lifetime $600 $1,200 Miscellaneous Care Rider Benefits Hair Piece (Wig) 1 per lifetime $150 $150 Blood, Plasma &Platelets $300 per day $300 per day Ambulance Ground /Air Maximum of 2 trips per Hospital Confinement for all modes of transportation combined $200/$2,000 per trip $200/$2,000 per trip Hospital Intensive Care Unit Rider Benefits Intensive Care Unit $600 per day $600 per day Pre Existing Condition Exclusion: Review the Plan Summary page that can be found at www.mybenefitshub.com/splendoraisd for full details 27

ABOUT CRITICAL ILLNESS

The following coverage amounts are available. For you: Select one of the following $10,000, $20,000 or $30,000 For your Spouse and Children: 50% of employee coverage amount Can I be denied coverage? Coverage is guarantee issue. When is coverage effective? Please see your Plan Administrator for your effective date of coverage. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. What critical illness conditions are covered?

Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. To file a claim call UNUM at 800 858 6843 or find claim form at www.mybenefitshub.com/ splendoraisd.

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/splendoraisd

Critical Illness Insurance

Unum EMPLOYEE BENEFITS

Who is eligible for this coverage? All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status). What are the Critical Illness coverage amounts?

Covered Conditions* Percentage of Coverage Amount CriticalCoronaryIllnessesArtery Disease (major) 50% Coronary Artery Disease (minor) 10% End Stage Renal (Kidney) Failure 100% Heart Attack (Myocardial Infarction) 100% Major Organ Failure Requiring Transplant 100% Stroke 100% CancerInvasive Cancer (including all Breast Cancer) 100% Non Invasive Cancer 25% Skin Cancer $500 Supplemental Critical Illnesses Benign Brain Tumor 100% Coma 100% Loss of Hearing 100% Loss of Sight 100% Loss of Speech 100% Infectious Disease 25% Occupational Human Immunodeficiency Virus (HIV) or Hepatitis 100% Permanent Paralysis 100% 28

•

Pre existing Conditions We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following: a pre existing condition; or complications arising from treatment or surgery for, or medications taken for, a pre existing condition.

The pre existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective.Critical

• drugs or medications were taken, or prescribed to be taken during that period; or • symptoms existed.

•

Illness Employee$10,000 Spouse$5,000 Employee$20,000 $10,000Spouse Employee$30,000 $15,000Spouse < 25 $3.84 $2.84 $5.84 $3.84 $7.84 $4.84 25 29 $4.74 $3.29 $7.64 $4.74 $10.54 $6.19 30 34 $5.94 $3.89 $10.04 $5.94 $14.14 $7.99 35 39 $7.94 $4.89 $14.04 $7.94 $20.14 $10.99 40 44 $10.34 $6.09 $18.84 $10.34 $27.34 $14.59 45 49 $13.54 $7.69 $25.24 $13.54 $36.94 $19.39 50 54 $16.94 $9.39 $32.04 $16.94 $47.14 $24.49 55 59 $22.74 $12.29 $43.64 $22.74 $64.54 $33.19 60 64 $31.54 $16.69 $61.24 $31.54 $90.94 $46.39 65 69 $45.44 $23.64 $89.04 $45.55 $132.64 $67.24 70 74 $70.64 $36.24 $139.44 $70.64 $208.24 $105.04 75 79 $104.04 $52.94 $206.24 $104.04 $308.44 $155.14 80 84 $151.54 $76.69 $301.24 $151.54 $450.94 $226.39 80+ $244.04 $122.94 $486.24 $244.04 $728.44 $365.14 29

covered?

Critical Illness Insurance Unum EMPLOYEE BENEFITS Progressive DiseasesWhat critical illness conditions are covered? (cont’d) Amyotrophic Lateral Sclerosis (ALS) 100% Dementia (including Alzheimer’s Disease) 100% Functional Loss 100% Multiple Sclerosis (MS) 100% Parkinson’s Disease 100% Additional Critical Illnesses for your Children Cerebral Palsy 100% Cleft Lip or Palate 100% Cystic Fibrosis 100% Down Syndrome 100% Spina Bifida 100% * Please refer to the policy for complete definitions of covered conditions.

Are wellness Screenings Each insured is eligible to receive one Be Well Benefit per calendar year. Be Well Benefit For you, your spouse and your children: $50 Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also include imaging studies, immunizations and annual examinations by a Physician. See certificate for details.

An insured has a pre existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which: medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period;

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.

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/splendoraisd

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 Shouldrecuperation.youneed assistance with a claim contact MASA at 800 643 9023. You can find full benefit details www.mybenefitshub.com/splendoraisdEmergencyMedicalTransportEmployeeandFamily$14.00

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.

Emergency Medical Transport MASA EMPLOYEE BENEFITS

Notes 31

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 Splendora 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.

WWW.MYBENEFITSHUB.COM/SPLENDORAISD 2022 - 2023 PlanYear

Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the Splendora 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.