2023-24 Andrews ISD Benefit Guide by Higginbotham Public Sector

ANDREWS ISD BENEFIT GUIDE EFFECTIVE: 09/01/2023 - 8/31/2024 WWW.MYBENEFITSHUB.COM/ANDREWSISD 2023 - 2024 Plan Year 1

How to Enroll 4-5 Annual Benefit Enrollment 6-10 1. Section 125 Cafeteria Plan Guidelines 6 2. Annual Enrollment 7 3. Eligibility Requirements 8 4. Helpful Definitions 9 5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 10 Dental Vision Cancer Accident Identity Theft Disability Life and AD&D Flexible Spending Accounts (FSA/DCFSA) Hospital Indemnity Critical Illness Emergency Medical Transportation Telehealth FLIP TO... SUMMARY PAGES PG. 6 YOUR BENEFITS

HOW TO ENROLL PG. 4 2

Table of Contents

PG. 11

Benefit Contact Information

ANDREWS ISD BENEFITS DENTAL VISION

Financial Benefit Services (800) 583-6908

www.mybenefitshub.com/andrewsisd

Lincoln Financial Group Group #00001D039766

(800) 423-2765

www.lfg.com

Superior Vision Group #38524 (800) 507-3800

www.superiorvision.com

CANCER ACCIDENT IDENTITY THEFT

American Public Life (800) 256-8606

www.ampublic.com

Mutual of Omaha Group #GPS3466429

(800) 775-8805

www.mutualofomaha.com

IDWatchdog (800) 774-3772

www.IDWatchdog.com

DISABILITY LIFE AND AD&D HOSPITAL INDEMNITY

OneAmerica

Group #618739

(855) 517-6365

www.oneamerica.com

CRITICAL ILLNESS

The Hartford Group #VCI-888093

(866) 547-4205

www.TheHartford.com

FLEXIBLE SPENDING ACCOUNTS (FSA AND DCFSA)

Higginbotham

(866) 419-3519

http://www.higginbotham.net/

Lincoln Financial Group Group #400254877

(800) 423-2765

www.lfg.com

The Hartford Group #VHI-888093

(866) 547-4205

www.TheHartford.com

EMERGENCY TRANSPORTATION TELEHEALTH

MASA

(800) 423-3226

www.masamts.com

MDLive

(888) 365-1663

https://members.mdlive.com/fbs/ landing_home

Employee benefits made easy through the FBS Benefits App! All Your BenefitsOne App OR SCAN Text “FBS ANDREWS” to (800) 583-6908 App Group #: FBSANDREWS Text “FBS ANDREWS” 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

How to Log In

1 www.mybenefitshub.com/andrewsisd

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.

Annual Benefit Enrollment

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

CHANGES IN STATUS (CIS): QUALIFYING EVENTS

Marital Status

Change in Number of Tax Dependents

Change in Status of Employment Affecting Coverage Eligibility

Gain/Loss of Dependents’ Eligibility Status

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

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

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

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 Government Programs

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

SUMMARY PAGES

Annual Benefit Enrollment

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 31 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 benefit questions, you can contact your Benefit Office 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/ andrewsisd. 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 Andrews ISD benefit website: www.mybenefitshub.com/andrewsisd. 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.

SUMMARY PAGES

Annual Benefit Enrollment

Employee Eligibility Requirements

Supplemental Benefits: Eligible employees must work 30 or more regularly scheduled hours each work week.

Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2023 benefits become effective on September 1, 2023, you must be actively-at-work on September 1, 2023 to be eligible for your new benefits.

Dependent Eligibility Requirements

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.

Vision To age 26

Life w/AD&D To age 26

Cancer To age 26

Critical Illness To age 26

AD&D To age 25

FSA and Dependent Care IRS Dependent

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 Benefit Office to request a continuation of coverage.

SUMMARY PAGES

PLAN MAXIMUM AGE

Dental To age 26

Helpful Definitions

Actively-at-Work

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 9/1/2023 please notify your benefits administrator.

Annual Enrollment

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

Annual Deductible

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

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.

In-Network

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

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

Description

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

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.

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

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

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

Employees may use funds any way they wish. If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.

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

Year-to-year rollover of account balance? Yes, will roll over to use for subsequent year’s health coverage.

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

No. Access to some funds may be extended if your employer’s plan contains a 2 1/2 –month grace period or $610 rollover provision.

FLIP TO FOR FSA INFORMATION PG. 15 SUMMARY PAGES HSA vs. FSA

Contribution Source Employee and/or employer Employee and/or employer Account Owner Individual Employer Underlying Insurance Requirement High deductible health plan None Minimum Deductible $1,500 single (2023) $3,000 family (2023) N/A Maximum Contribution $3,850 single (2023) $7,750 family (2023) 55+ catch up +$1,000 $3,050 (2023)

Employer Eligibility A qualified high deductible health plan. All employers

Permissible Use Of Funds

Not permitted

the account earn interest? Yes No Portable? Yes,

year-to-year and between

No 10

Does

portable

jobs.

Dental Insurance

Lincoln Financial Group EMPLOYEE BENEFITS

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/andrewsisd

(Annual) Deductible

Deductibles are combined for basic and major Contracting Dentists’ services. Deductibles are combined for basic and major NonContracting Dentists’ services.

are combined for preventive, basic, and major services.

Orthodontic Coverage is available for dependent children.

Period There are no benefit waiting periods for any service types

Bitewing X-rays

Full-mouth or panoramic X-rays

Other dental X-rays (including periapical films)

maintainers for children

Dental High Low Employee Only $31.74 $25.53 Employee and Spouse $62.66 $50.24 Employee and Child(ren) $83.58 $70.83 Employee and Family $124.60 $104.42 The Lincoln Dental Connect® PPO Plan HIGH LOW Contracting Dentists Non-Contracting Dentists Contracting Dentists Non-Contracting Dentists Calendar

Individual: $50 Family: $150 Waived for: Preventive Individual: $50 Family: $150 Waived for: Preventive

Annual

$1,500 $1,500 $1,500 $1,500 Annual

Lifetime Orthodontic Max $1,500 $1,500 $1,500 $1,500

Maximum

Maximums

Waiting

Preventive Services Contracting Dentists Non-Contracting Contracting Dentists Non-Contracting Routine

oral exams

Routine

Fluoride treatments Space

Sealants Problem focused exams 100% No Deductible 100% No Deductible 90% No Deductible 90% No Deductible 11

cleanings

Dental Insurance Lincoln Financial Group EMPLOYEE BENEFITS

Palliative treatment (including emergency relief of dental pain)

Injections of antibiotics and other therapeutic medications Fillings

Prefabricated stainless steel and resin crowns

Simple extractions

Biopsy and examination of oral tissue - including brush biopsy

General anesthesia and I.V. sedation(High Plan Only)

Oral surgery (High Plan Only)

Full and partial dentures

Denture reline and rebase services

Crowns, inlays, onlays, and related services

Implant

Contracting Dentists/Non-Contracting Dentists: Visit www.LincolnFinancial.com/FindADentist to find a contracting dentist near you. This plan lets you choose any dentist you wish. However, your out-of-pocket costs are likely to be lower when you choose a contracting dentist. For example, if you need a crown…

Contracting Dentists: you pay a deductible (if applicable), then 50% of the remaining discounted fee for PPO members. This is known as a PPO contracted fee.

Non-Contracting Dentists: you pay a deductible (if applicable), then 90% of the usual and customary fee, which is the maximum expense covered by the plan. You are responsible for the different between the usual and customary allowance and the dentist’s billed charge.

USUAL AND CUSTOMARY (U&C): the maximum expense covered by the Policy. U&C allowances are based on dental charge information collected by nationally recognized industry databases. U&C allowances are reviewed and updated periodically. If Covered Expenses are Incurred outside the United States, the U&C allowance will be the amount that would be allowed for that procedure if it had been performed at the Company’s Group Insurance Service Office in Omaha, Nebraska. U&C allowances may be higher or lower than the fees charged by a Dentist. U&C is not an indication of the appropriateness of the Dentist’s fee. Instead, U&C is a variable plan provision used to determine the extent of coverage provided by the Policy.

Basic Services Contracting Dentists Non-Contracting Contracting Dentists Non-Contracting

Consultations

80% After Deductible 80% After Deductible 50% After Deductible 50% After Deductible Major Services Contracting Dentists Non-Contracting Contracting Dentists Non-Contracting Surgical Extractions Bridges

sedation(Low

Oral

50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible Orthodontics Contracting Dentists Non-Contracting Contracting Dentists Non-Contracting Orthodontic exams X-rays Extractions Study models Appliances 50% 50% 50% 50% 12

& implant related services (High Plan Only) General anesthesia and I.V.

Plan Only)

surgery (Low Plan Only)

Vision Insurance Superior Vision EMPLOYEE BENEFITS

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/andrewsisd

Benefits

Co-pays apply to in-network benefits; co-pays for out-ofnetwork 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

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

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.

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.

through Superior National network In-Network Out-of-Network Exam (ophthalmologist) Covered in full Up to $42 retail Exam (optometrist) Covered in full Up to $37 retail Frames $150 retail allowance Up to $60 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 Contact lenses4 $150 retail allowance Up to $100 retail Vision Copays Services/Frequency Employee Only $8.05 Exam $10 Exam 12 months Employee and Spouse $16.09 Materials1 $25 Frame 12 months Employee and Child(ren) $19.02 Contact lens fitting $25 Contact lens fitting 12 months Employee and Family $29.12 Lenses 12 months

Cancer Insurance American Public Life

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/andrewsisd

GC14 Limited Benefit Group Specified Disease Cancer Indemnity 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.

Summary of Benefits

Cancer Low High Employee Only $18.36 $27.70 Employee and Spouse $35.66 $56.20 Employee and Child(ren) $25.26 $35.22 Employee and Family $39.80 $63.81 Cancer Treatment Policy Benefits Low Plan Level 1 High Plan Level 3 Radiation Therapy, Chemotherapy, ImmunotherapyMaximum per 12-month period $10,000 $15,000 Hormone Therapy - Maximum of 12 treatments per calendar year $50 per treatment $50 per treatment Experimental Treatment paid in same manner and under the same maximums as any other benefit Cancer Screening Rider Benefits Level 1 Level 1 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 test per calendar year $500 per test/1 test per calendar year Surgical Rider Benefits Level 1 Level 4 Surgical $30 unit dollar amount Max $3,000 per operation $45 unit dollar amount Max $4,500 per operation Anesthesia 25% of amount paid for covered surgery Bone Marrow Transplant - Maximum per lifetime $6,000 $9,000 Stem Cell Transplant - Maximum per lifetime $600 $900 Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime $1,000 / $100 $2,000 / $200

EMPLOYEE

BENEFITS

(800) 256-8606

www.ampublic.com

Patient Care Rider Benefits Level 1 Level 1 Hospital Confinement: Per day of Hospital Confinement (1-30 days) Per day for Eligible Dependent Children (1-30 days) Per day of Hospital Confinement (31+ days) Per day for Eligible Dependent Children (31+days) $100 $200 $100 $200 $100 $200 $100 $200 Outpatient Facility - Per day surgery is performed $200 $200 Attending Physician - Per day of Hospital Confinement $30 $30 Dread Disease - Per day of Hospital Confinement (1-30 days / 31+ day) $100 / $100 $100 / $100 Extended Care Facility - Up to the same number of Hospital Confinement Days $100 per day $100 per day Donor $100 per day $100 per day Home Health Care - Up to the same number of Hospital Confinement Days $100 per day $100 per day Hospice Care - Up to maximum of 365 days per lifetime $100 / $100 $100 / $100 US Government, Charity Hospital or HMO - Per day of Hospital Confinement (1-30 days/ 31+ days) $100 / $100 $100 / 100 Miscellaneous Care Rider Benefits Level 1 Level 1 Cancer Treatment Center Evaluation or Consultation - 1 per lifetime Not included $750 Evaluation or Consultation Travel and Lodging - 1 per lifetime Not Included $350 Second / Third Surgical Opinion - per diagnosis of cancer $300 / $300 $300 / $300 Drugs and Medicine - Inpatient / Outpatient (maximum $150 per month) $150 per confinement $50 per prescription $150 per confinement $50 per prescription Hair Piece (Wig) - 1 per lifetime $150 $150 Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane, or train Travel by car Lodging - up to a maximum of 100 days per calendar year actual coach fare or $0.40 per mile $0.40 per mile $50 per day actual coach fare or $0.75 per mile $0.75 per mile $100 per day Family Transportation

transportation combined Travel by bus, plane or train Travel by car Family Lodging - up to a maximum of 100 days per calendar year actual coach fare or $0.40 per mile $0.40 per mile $50 per day actual coach fare or $0.75 per mile $0.75 per mile $100 per day Blood, Plasma and Platelets $300 per day $300 per day Ambulance - Ground/Air - Maximum of 2 trips per Hospital Confinement for all modes of transportation

$200 / $2,000

$200 / $2,000 per trip Inpatient Special Nursing Services

per day

Hospital Confinement $150 per day $150 per day Outpatient Special Nursing Services - Up to same number of Hospital Confinement days $150 per day $150 per day Medical Equipment - Maximum of 1 benefit per calendar year Not included $150 Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year $25 per visit / $1,000 $25 per visit / $1,000 Waiver of Premium Waive Premium Waive Premium Internal Cancer First Occurrence Rider Benefits Level 1 Level 2 Lump Sum Benefit - Maximum 1 per Covered Person per lifetime $2,500 $5,000 Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime $3,750 $7,500 Hospital Intensive Care Unit Rider Benefits Intensive Care Unit $600 per day $600 per day Step Down Unit - Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit $300 per day $300 per day

Should you need to file a claim contact APL at

or online at

- Maximum 12 trips per calendar year for all modes of

combined

per trip

EMPLOYEE BENEFITS 15

Cancer Insurance American Public Life

Accident Insurance Mutual of Omaha EMPLOYEE BENEFITS

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/andrewsisd

ELIGIBILITY - ALL ELIGIBLE EMPLOYEES ENROLLED IN THE HIGH PLAN

Eligibility Requirement

Dependent Eligibility Requirement

You must be actively working a minimum of 30 hours per week to be eligible for coverage.

To be eligible for coverage, your dependents must be able to perform normal activities, and not be confined (at home, in a hospital, or in any other care facility), and any child(ren) must be under age 26. In order for your spouse and/or children to be eligible for coverage, you must elect coverage for yourself.

Accident High Plan Low Plan Employee Only $15.08 $6.37 Employee and Spouse $23.55 $9.91 Employee and Child(ren) $29.91 $13.04 Employee and Family $39.82 $17.23

Premium Payment The premiums for this insurance are paid in full by you. PLAN INFORMATION HIGH PLAN LOW PLAN Coverage Type 24-hour (On and off-job) 24-hour (On and off-job) Express Benefit $100 $50 Annual Benefit Maximum (ABM) Not Included Not Included Portability Included Included BENEFITS HIGH PLAN LOW PLAN Initial Care & Emergency1 – Most treatment / service required within 72 hours of accident; Once per accident per insured person Emergency Room Urgent Care Center Initial Physician Office Visit Ambulance $200 $125 $100 Up to $1,500 $100 $75 $50 Up to $500 Specified Injuries1,2 Fractures (Surgical / Non-surgical) Dislocations (Surgical / Non-surgical) Lacerations Burns Dental Up to $6,000/Up to $3,000 Up to $9,000/Up to $4,500 Up to $800 Up to $15,000 Up to $300 Up to $3,000/Up to $1,500 Up to $3,000/Up to $1,500 Up to $400 Up to $5,000 Up to $150 Hospital, Surgical & Diagnostic1,3 Admission Daily Confinement (Up to 365 days per accident) ICU Confinement (Up to 15 days per accident) Rehab. Facility Confinement (Up to 30 days per accident) Surgical Diagnostic $1,500 $300 per day $600 per day $150 per day Up to $2,000 Up to $300 $750 $100 per day $300 per day $50 per day Up to $1,000 Up to $100

Accident Insurance Mutual of Omaha EMPLOYEE BENEFITS

BENEFITS

Follow-Up Care1 – Treatment / service required within 365 days of accident; Medical device is once per accident per insured person

Physician Follow-Up Office Visit

Therapy Services

Medical Device

Prosthetic Device(s)

$100; Up to 2 per accident

$50; Up to 6 per accident

$200

$1,000; Up to 2 per accident

Additional Benefits1 – Benefits are payable within 365 days of accident

Transportation (Up to 3 trips per accident)

Lodging (Up to 30 nights per accident)

Childcare (Up to 30 days per accident)

$450 Per trip

$150 Per night

$30 Per day

$50; Up to 2 per accident

$25; Up to 6 per accident

$50

$500; Up to 2 per accident

$150 Per trip

$100 Per night

$20 Per day

Catastrophic Benefits1,4 – Benefits are payable within 365 days of accident; Once per accident per insured person

Principal Sum (PS)

Common Carrier Accidental Death

Transportation of Remains

Dismemberment & Paralysis

Reasonable Modifications

Coma

SERVICES

Hearing Discount Program

1Additional limitations apply as described in the certificate.

You: $50,000

Spouse: $25,000 Child(ren): $10,000

300% of PS

Up to $5,000

Up to 100% of PS

Up to 10% of PS

25% of PS

You: $10,000

Spouse: $5,000 Child(ren): $5,000

300% of PS

Up to $5,000

Up to 100% of PS

Up to 10% of PS

50% of PS

The Hearing Discount program provides you and your family discounted hearing products, including hearing aids and batteries. Call (888) 534-1747 or visit www.amplifonusa.com/mutualofomaha to learn more.

2Fractures and dislocations require treatment within 90 days of accident, burns and lacerations within 72 hours of an accident, and dental care within 30 days. If an insured person sustains both a fracture and dislocation as the result of the same accident, the maximum amount payable is up to 200% of the amount payable for the injury with the highest applicable benefit amount.

3Daily confinement must begin with 90 days of accident and ICU confinement within 30 days. Surgical treatment timeframes vary. If applicable, diagnostic services must be received within 90 days of accident. Except for confinement benefits, most benefits are payable once per accident per insured person. If any surgery occurs concurrently with an open reduction for a fracture or dislocation of the same bone or joint as a result of the same accident, only the highest applicable benefit is payable.

4The principal sum for you and your spouse reduces by 50% when you reach the age of 70.

Who is eligible for this insurance? You must be actively working (performing all normal duties of your job) at least 30 hours per week and be under age 80. Your dependent(s) must be performing normal activities and not be confined (at home or in a hospital / care facility) and any child(ren) must be under age 26.

What is the “Express Benefit”? This benefit is payable upon notification of an accident in which an insured person is injured. It can be paid in a short time frame with minimal information (compared to a typical claim).

Can I take this insurance with me if I change jobs / am no longer a member of this group? In the event this insurance ends due to a change in your employment / membership status with the group, or for certain other reasons, you or your insured spouse have the right to continue this insurance under the Portability provision, subject to certain conditions.

When does this insurance end? Insurance will end on the last day of the month in which an insured person no longer satisfies the applicable eligibility conditions, or when you reach the age of 80. Additional circumstances under which insurance will end are described in the certificate.

Are there any exclusions or limitations? The benefits payable are based on the insurance in effect on the date of the covered accident, subject to the definitions, limitations, exclusions and other provisions of the policy. The exclusions and limitations are summarized in the outline of coverage and detailed in the certificate. Please contact your benefits administrator for a copy of the outline of coverage or if you have questions prior to enrolling.

HIGH PLAN LOW PLAN

Identity Theft IDWatchdog

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/andrewsisd

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

Easy & Affordable Identity Protection ID Watchdog helps warn you when your personal information is stolen and helps you better protect yourself and your family from identity fraud—when stolen information is used for illicit gain. You’ll have greater peace of mind knowing you don’t have to face the complexities of identity theft alone.

More for Families. Our family plan helps you better protect the identities of your loved ones of all ages. We offer more features that help protect minors than any other provider.

Conditions

• Online Resolution Tracker

• Lost Wallet Vault & Assistance

• Deceased Family Member Fraud Remediation

• Credit Freeze Assistance

IDWatchdog is here for you 24/7/365. Reach our in-house customer care team at (866) 513-1518.

Identity Theft 1B Platinum Employee $7.95 $11.95 Employee and Family $14.95 $22.95 Control & Manage • Financial Accounts & Social Account Monitoring

Registered Sex Offender • Reporting

Customizable Alert Options • Equifax Blocked Inquiry Alerts

National Provider ID Alerts Monitor & Detect

Dark Web Monitoring1 • Data Breach Notifications

High-Risk Transactions Monitoring² • Subprime Loan Monitoring2 • Public Records Monitoring

USPS Change of Address Monitoring

Identity Profile Report

Credit Score Tracker Support & Restore

Fully Managed Resolution Services including Pre-Existing

•

Plan-Specific Features 1B Platinum Credit Report Monitoring³ 1 Bureau 3 Bureau Credit Report(s)⁴ & VantageScore Credit Score(s) 1 Bureau Monthly 1 Bureau Daily & 3 Bureau Annually Credit Report Lock⁵ 1 Bureau Multi-Bureau Identity Theft Insurance⁶ Up to $1 Million Up to $1 Million 401K/HSA Stolen Funds Reimbursement⁶ -  Subprime Loan Block² within the monitored lending network -  Social Account Takeover Alerts -  Integrated Fraud Alerts7 - 

EMPLOYEE BENEFITS 18

Disability Insurance

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/andrewsisd

Your premiums and benefits may vary. Actual premiums and benefit amounts will be calculated by OneAmerica and may change upon reaching certain ages, according to contract terms, and are subject to change. Volumes and benefit amounts shown may be subject to reductions due to age.

Enroll timely for guaranteed issue coverage. You may be eligible for coverage without having to answer any health questions if you enroll during the initial enrollment period when benefits are first offered by OneAmerica®, or if you enroll as a newly hired employee within 31 days after any applicable waiting period.

Enrolling later requires approval. If you decline coverage now, you will lose your only chance to apply for group insurance coverage without having to first undergo medical underwriting. If you decide to enroll later, you will need to submit a Statement of Insurability form for review. OneAmerica will then decide to approve or deny your coverage based on your health history. You may not be approved for any type of coverage at a later date if you have any current or future medical conditions.

What you need to know about your Educator Disability Benefits

Eligible Employees: This benefit is available for employees who are actively at work on the effective date and working a minimum of 30 hours per week.

Flexible Choices: Since everyone’s needs are different, these plans offer flexibility for you to choose a benefit option that fits your income replacement needs and budget. You are able to enroll and/or change plans during each scheduled enrollment.

Guaranteed Issue: If you enroll timely, you may be eligible for coverage without having to answer any health questions. If you decline insurance coverage now and decide to enroll later, you may need to provide Evidence of Insurability.

Timely Enrollment: Enrolling timely means you have enrolled during the initial enrollment period when benefits were first offered by AUL, or as a newly hired employee within 31 days following completion of any applicable waiting period.

Portability: Should your coverage terminate, you may be eligible to take this disability insurance with you without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible.

Waiver of Premium: If approved, this benefit waives your Disability insurance premium in case you become disabled and are unable to collect a paycheck.

Disability - per $100 in benefit Elimination Period 30% 40% 50% 60% 0/7 $3.02 $3.02 $3.02 $3.55 14/14 $2.54 $2.54 $2.54 $2.99 30/30 $2.04 $2.04 $2.04 $2.40 60/60 $1.37 $1.37 $1.37 $1.61 90/90 $1.19 $1.19 $1.19 $1.37 180/180 $0.91 $0.91 $0.91 $1.07

EMPLOYEE BENEFITS 19

OneAmerica

Disability Insurance OneAmerica EMPLOYEE BENEFITS

Pre-Existing Condition

Limitations:

An offset is an amount that reduces your benefit amount by amounts you receive from other sources for your disability and will be specified in the contract. The pre-existing period is 3/12. 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 timeframe specified in the contract. You must also be treatment-free for a timeframe 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 Insurance.

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.

About Your Benefits: Educator Disability benefits are illustrated and paid on a monthly basis.

What you need to know about your Educator Disability Benefits

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

Maximum Benefit Duration: This is the length of time that you may be paid benefits if continuously disabled as outlined in the contract.

Educator Disability Options

You may select a benefit percentage of 30%, 40%, 50% or 60% of your earnings, up to a maximum monthly benefit of $7,500.

Elimination Period Maximum Benefit Duration Age When Total Disability Begins Maximum Duration Option 1: 7 days / 7 days Less than age 60 Greater of Social Security Full Retirement Age or to age 65 Option 2: 14 days / 14 days 60 5 years Option 3: 30 days / 30 days 61 4 years Option 4: 60 days /60 days 62 3.5 years Option 5: 90 days / 90 days 63 3 years Option 6: 180 days/180 days 64 2.5 years 65 2 years 66 21 months 67 18 months 68 15 months 69 and over 12 months

Disability OneAmerica

Educator Disability - Definitions

What is disability insurance? 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. This type of disability plan is called an educator disability plan and includes both long and short term coverage into one convenient plan.

Pre-Existing Condition Limitations - Please note that all plans will include pre-existing condition limitations that could impact you if you are a first-time enrollee in your employer’s disability plan. This includes during your initial new hire enrollment. Please review your plan details to find more information about preexisting condition limitations.

How do I choose which plan to enroll in during my open enrollment?

1. First choose your elimination period. The elimination period, sometimes referred to as the waiting period, is how long you are disabled and unable to work before your benefit will begin. This will be displayed as 2 numbers such as 0/7, 14/14, 30/30, 60/60, 90/90, etc.

The first number indicates the number of days you must be disabled due to Injury and the second number indicates the number of days you must be disabled due to Sickness

When choosing your elimination period, ask yourself, “How long can I go without a paycheck?” Based on the answer to this question, choose your elimination period accordingly.

Important Note- some plans will waive the elimination period if you choose 30/30 or less and you are confined as an inpatient to the hospital for a specific time period. Please review your plan details to see if this feature is available to you.

2. Next choose your benefit amount. This is the maximum amount of money you would receive from the carrier on a monthly basis once your disability claim is approved by the carrier.

When choosing your monthly benefit, ask yourself, “How much money do I need to be able to pay my monthly expenses?” Based on the answer to this question, choose your monthly benefit accordingly.

Choose your Benefit Amount from the drop down box. Choose your desired elimination period.

EMPLOYEE BENEFITS

Life and AD&D Lincoln Financial Group

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/andrewsisd

$10,000

Spouse rates based on Employee’s age.

Voluntary Group Life - per $10,000 in coverage Age Employee 18-24 $0.65 25-29 $0.65 30-34 $0.75 35-39 $1.05 40-44 $1.65 45-49 $2.35 50-54 $4.15 55-59 $6.35 60-64 $6.55 65-69 $11.95 70-74 $25.25 75-79 $75.35 80-99 $162.55 Voluntary Group Life - Child(ren) $10,000 in coverage 0-26 $2.00 AD&D - per

in coverage

$0.25

EMPLOYEE BENEFITS

Life and AD&D Lincoln Financial Group

Basic Life Coverage

Provided to eligible employees.

A cash benefit of $50,000 to your loved ones in the event of your death, plus a matching cash benefit if you die in an accident.

Guaranteed coverage amount for Self $200,000

Maximum coverage amount 5 times your annual salary ($500,000 maximum in increments of $10,000)

AD&D coverage amount Equal to the life insurance amount chosen

Guaranteed coverage amount for Spouse $50,000

Maximum coverage amount for Spouse 50% of the employee coverage amount ($250,000 maximum in increments of $5,000)

AD&D coverage amount

Equal to the life insurance amount chosen

Guaranteed coverage amount for dependent children 6 months - 26 years $10,000

Guaranteed coverage amount for dependent children 14 days - 6 months $250

Guaranteed Life and AD&D Insurance Coverage Amount: Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $200,000 without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability.

If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense. You can increase this amount by up to $20,000 during the next limited open enrollment period.

Maximum Life Insurance Coverage Amount: You can choose a coverage amount up to 5 times your annual salary ($500,000 maximum) with evidence of insurability. See the Evidence of Insurability page for details. The maximum coverage amount for employees 70 and older who are electing coverage for the first time is $50,000. Your coverage amount will reduce by 35% when you reach age 65; an additional 25% of the original amount when you reach age 70; an additional 15% of the original amount when you reach age 75; and an additional 15% of the original amount when you reach age 80.

Guaranteed Life and AD&D Insurance Coverage Amount: Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to 50% of your coverage amount ($50,000 maximum) for your spouse without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability. If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense. You can increase this amount by up to $10,000 during the next limited open enrollment period.

Maximum Spouse Life Insurance Coverage Amount: You can choose a coverage amount up to 50% of your coverage amount ($250,000 maximum) for your spouse with evidence of insurability. Coverage amounts are reduced by 35% when an employee reaches age 65

Dependent Children Coverage: You can secure term life insurance for your dependent children when you choose coverage for yourself.

Guaranteed Life Insurance Coverage Options: $10,000

EMPLOYEE

BENEFITS

Flexible Spending Account (FSA) Higginbotham

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 (unless your plan contains a $610 rollover or grace period provision).

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

Health Care FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. You may contribute up to $3,050 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 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). 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).

The Dependent Care FSA helps pay for expenses associated with caring for elderly or child dependents so you or your spouse can work or attend school full-time. You can use the account to pay for daycare or babysitting 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 the 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

• The maximum per plan year you can contribute to a Health Care FSA is $3,050. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or as 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.

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

EMPLOYEE

BENEFITS

Flexible Spending Account (FSA)

Higginbotham

care expenses.

BENEFITS

• The IRS has amended the “use it or lose it rule” to allow you to carry over up to $610 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.

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

Higginbotham Flex Mobile App

Easily access your Health Care FSA on your smartphone or tablet with the Higginbotham mobile app. Search for Higginbotham in your mobile device’s app store and download it as you would any other app.

View Accounts – Includes detailed account and balance information

Card Activity – Account information

SnapClaim – File a claim and upload receipt photos directly from your smartphone Manage Subscriptions – Set up email notifications to keep up-to-date on all account and Health Care FSA debit card activity

Log in using the same username and password you use to log in to the Higginbotham Portal. Note: You must register on the Higginbotham Portal to use the mobile app.

FSAstore.Com

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

EMPLOYEE

Hospital Indemnity The Hartford

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/andrewsisd

Ability Assist® EAP4 – 24/7/365 access to help for financial, legal, or emotional issues

HealthChampionSM5 – Administrative & clinical support following serious illness or injury Included

Hospital Indemnity LOW HIGH Employee Only $14.16 $28.30 Employee and Spouse $25.24 $50.48 Employee and Child(ren) $25.58 $51.16 Employee and Family $38.56 $77.12 LOW HIGH Coverage Type On and off-job (24 hour) On and off-job (24 hour) Covered Events Illness and injury Illness and injury HSA Compatible Yes Yes BENEFITS LOW HIGH HOSPITAL CARE2 First Day Hospital Confinement Up to 1 day per year $1,000 $2,000 Daily Hospital Confinement (Day 2+) Up to 30 days per year $100 $200 VALUE ADDED SERVICES LOW HIGH

Included Included

Included

EMPLOYEE BENEFITS 26

Hospital Indemnity

IS THIS COVERAGE HSA COMPATIBLE? If you (or any dependent(s)) currently participate in a Health Saving Account (HSA) or if you plan to do so in the future, you should be aware that the IRS limits the types of supplemental insurance you may have in addition to a HSA, while still maintaining the tax-exempt status of the HSA. This plan design was designed to be compatible with Health Savings Accounts (HSAs). However, if you have or plan to open an HSA, please consult your tax and legal advisors to determine which supplemental benefits may be purchased by employees with an HSA.

WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full-time employee who works at least 30 hours per week on a regularly scheduled basis.

Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26.

CAN I INSURE MY DOMESTIC OR CIVIL UNION PARTNER? Yes. Any reference to “spouse” includes your domestic partner, civil union partner or equivalent, as recognized and allowed by applicable law.

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

HOW DO I PAY FOR THIS INSURANCE? Premiums will be automatically paid through payroll deduction, as authorized by you during the enrollment process. This ensures you don’t have to worry about writing a check or missing a payment.

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

WHEN DOES THIS INSURANCE BEGIN? The initial effective date of this coverage is September 1, 2019. Subject to any eligibility waiting period established by your employer, if you enroll for coverage prior to this date, insurance will become effective on this date. If you enroll for coverage after this date, insurance will become effective in accordance with the terms of the certificate (usually the first day of the month following the date you elect coverage).

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

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

CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP? Yes, you can take this coverage with you. Coverage may be continued for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances. This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this insurance coverage. A copy of the certificate can be obtained from your employer.

Hartford EMPLOYEE BENEFITS 27

The

Critical Illness Insurance The Hartford

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/andrewsisd

Facing a serious illness can be devastating both emotionally and financially. Major medical insurance may pick up most of the tab but can still leave out-of-pocket expenses that add up quickly. Critical Illness insurance can provide a lump-sum benefit upon diagnosis that can be used however you choose - from expenses related to treatment, to deductibles or day-to-day costs of living such as the mortgage or your utility bills.

Critical Illness $10,000 Plan Employee Only Employee & Spouse Employee & Children Employee & Family Under 25 $3.62 $5.88 $7.34 $10.20 25-29 $4.40 $7.04 $7.82 $11.02 30-34 $4.90 $7.80 $7.80 $11.20 35-39 $6.14 $9.68 $8.76 $12.74 40-44 $8.48 $13.28 $10.84 $16.02 45-49 $12.96 $20.22 $15.26 $22.90 50-54 $17.86 $27.87 $20.08 $30.42 55-59 $24.22 $37.72 $26.42 $40.30 60-64 $33.94 $52.80 $36.12 $55.32 65-69 $46.26 $71.56 $48.42 $74.10 70-74 $61.18 $94.44 $63.34 $96.98 75-79 $79.64 $122.48 $81.82 $125.02 $30,000 Plan Employee Only Employee & Spouse Employee & Children Employee & Family Under 25 $8.96 $13.90 $18.42 $24.92 25-29 $11.14 $17.12 $19.72 $27.12 30-34 $12.58 $19.28 $19.60 $27.48 35-39 $16.30 $24.86 $22.44 $32.02 40-44 $23.18 $35.34 $28.52 $41.58 45-49 $36.48 $55.88 $41.64 $61.92 50-54 $51.16 $78.60 $56.12 $84.44 55-59 $70.22 $108.30 $75.12 $114.04 60-64 $99.40 $153.52 $104.22 $159.14 65-69 $136.32 $209.80 $141.14 $215.42 70-74 $181.08 $278.46 $185.90 $284.08 75-79 $236.46 $362.58 $241.28 $368.20

EMPLOYEE BENEFITS 28

Critical Illness Insurance The Hartford

COVERAGE INFORMATION: Benefit amounts for covered illnesses are based on the coverage amount in effect for you or an insured dependent at the time of diagnosis.

a benefit for a subsequent diagnosis of conditions marked with an asterisk (*)

access to help for financial, legal or emotional issues

Administrative and clinical support following serious illness or injury

WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full-time employee who works at least 30 hours per week on a regularly scheduled basis and are less than age 80. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26.

WHEN DOES THIS INSURANCE END? This insurance will end when you or your dependent(s) no longer satisfy the applicable eligibility conditions, or when you reach the age of 80, premium is unpaid, you are no longer actively working, you leave your employer, or the coverage is no longer offered.

CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP? Yes, you can take this coverage

with you.

Coverage may be continued for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances.

GROUP CRITICAL ILLNESS INSURANCE LIMITATIONS AND EXCLUSIONS

The benefits payable are based on the insurance in effect on the date of the diagnosis of a covered illness, subject to the definitions, limitations, exclusions and other provisions of the policy.

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

Exclusions. This insurance does not provide benefits for any loss that results from or is caused by:

• Suicide, attempted suicide, or intentionally self-inflicted injury, whether sane or insane

• War or act of war, declared or undeclared

• A covered person’s participation in a felony, riot or insurrection

• A covered person’s engaging in any illegal occupation

• A covered person’s service in the armed forces or units auxiliary to them

General Limitations. Benefits under the policy are not payable for any covered illness:

• Diagnosed prior to the effective date of insurance for a covered person (except for newborn children)

• Diagnosed during an applicable benefit separation period

• For which a covered person has already received a benefit payment under the policy, unless the covered illness is included in a recurrence provision

• For which a covered person has already received a benefit payment under the recurrence provision In addition, benefits are not payable for any critical illness not included as a covered illness in your certificate.

COVERAGE AMOUNTS Employee Coverage Amount $10,000 or $30,000 Spouse Coverage Amount Greater of $5,000 or 50% of your coverage amount Child(ren) Coverage Amount 50% of your coverage amount COVERED ILLNESSES BENEFIT AMOUNTS CANCER CONDITIONS Benign Brain Tumor*; Invasive Cancer* 100% of coverage amount Non-invasive Cancer 25% of coverage amount VASCULAR CONDITIONS Heart Attack*; Heart Transplant*; Stroke* 100% of coverage amount Aneurysm; Angioplasty/Stent; Coronary Artery Bypass Graft 25% of coverage amount OTHER SPECIFIED CONDITIONS Coma*; End Stage Renal Failure; Loss

Transplant*; Paralysis 100% of coverage amount Bone Marrow Transplant 25% of coverage amount NEUROLOGICAL CONDITIONS Advanced Multiple Sclerosis; Advanced Parkinson’s;

100% of coverage amount CHILD CONDITIONS Cerebral Palsy; Congenital Heart Disease; Cystic Fibrosis; Muscular Dystrophy; Spina Bifida 100% of coverage amount ADDITIONAL BENEFITS BENEFIT AMOUNTS Recurrence – Pays

100% of original benefit amount Health Screening Benefit $50 once per year per covered person FEATURES DETAILS Coverage Maximum – Primary Insured & Spouse/Partner 500% of coverage amount Coverage Maximum – Child(ren) 300% of coverage amount Ability Assist® EAP2

HealthChampionSM2

of Hearing; Loss of Speech; Loss of Vision; Major Organ

Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s);

– 24/7/365

–

EMPLOYEE BENEFITS

Emergency Medical Transport MASA

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/andrewsisd

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.

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: www.mybenefitshub.com/andrewsisd

Plan Features Emergent Plus Membership Platinum Membership Emergency Air Transportation x x Emergent Ground Transportation x x Non-Emergency InterFacility Transportation x x Repatriation/ Recuperation x x Escort Transportation x Visitor Transportation x Return Transportation x Mortal Remains Transportation x Minor Return x Organ Retrieval/Organ Recipient Transportation x Vehicle Return x Pet Return x Worldwide Coverage x Emergency Medical Transportation Emergent Plus Platinum Employee & Family $14.00 $39.00

EMPLOYEE BENEFITS

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/andrewsisd

Telehealth

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

Do not use telemedicine for serious or life-threatening emergencies.

Registration is Easy

• Fever

• Urinary tract infections

• 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.

Telehealth

Employee and Family

$10.00

Telehealth MDLive EMPLOYEE BENEFITS

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 Andrews 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 Andrews 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.

2023 - 2024 Plan Year WWW.MYBENEFITSHUB.COM/ANDREWSISD