2022-23 Crowley ISD Benefit Guide by Higginbotham Public Sector

CROWLEY ISD BENEFIT GUIDE EFFECTIVE: 09/01/2022 - 8/31/2023

2022 - 2023 PlanYear 1

WWW.MYBENEFITSHUB.COM/CROWLEYISD

SUMMARY PAGES PG. 6 YOUR BENEFITS PG. 12

FLIP

How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Annual Enrollment 6 2. Section 125 Cafeteria Plan Guidelines 7 3. Helpful Definitions 8 4. Eligibility Requirements 9 5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) 10 Medical 12-18 Health Savings Account (HSA) 19 Telehealth 20 Hospital Indemnity 21-22 Dental 23-24 Vision 25 Disability 26-27 Life and AD&D 28-29 Accident 30-31 Critical Illness 32-33 Flexible Spending Account (FSA) 34-35 Identity Theft 36

ENROLL

Table of Contents

TO...

HOW TO

PG. 4

Benefit Contact Information

CROWLEY ISD BENEFITS TRS ACTIVECARE MEDICAL TRS HMO MEDICAL Financial Benefit Services

(800) 583-6908

www.mybenefitshub.com/crowleyisd

BCBSTX (866) 355-5999

www.bcbstx.com/trsactivecare

Scott & White HMO

(844) 633-5325

www.trs.swhp.org

HEALTH SAVINGS ACCOUNT (HSA) TELEHEALTH HOSPITAL INDEMNITY

EECU

(817) 882-0800

www.eecu.org

MDLIVE (888) 365-1663

www.mdlive.com/fbsbh

Cigna

(800) 244-6224

www.cigna.com

DENTAL VISION DISABILITY

Cigna

(800) 244-6224

www.cigna.com

MetLife

(800) 638-5433

www.metlife.com

New York Life (800) 362-4462

(866) 562-8421 (Español)

www.newyorklife.com

LIFE AND AD&D ACCIDENT CRITICAL ILLNESS

New York Life

(800) 225-5695

www.newyorklife.com

FLEXIBLE SPENDING ACCOUNT (FSA)

Higginbotham

(866) 419-3519

https://flexservices.higginbotham.net/

Cigna

(800) 244-6224

www.cigna.com

Cigna (800) 244-6224

www.cigna.com

Employee benefits made easy through the FBS Benefits App!

Your BenefitsOne App OR SCAN Text “FBS CROWLEYISD” to App Group #: FBSCROWLEYISD Text “FBS CROWLEYISD” 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

All

How to Log In

1 www.mybenefitshub.com/crowleyisd

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.

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 30 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

Q&A

Who do I contact with Questions?

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

Where can I find forms?

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

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 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.

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

Eligibility for Government Programs

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.

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

SUMMARY PAGES

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 9/1/2022 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

Annual Benefit Enrollment

Employee Eligibility Requirements

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.

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.

Dental To age 26

Vision To age 26

Life To age 26

Cancer To age 26

Critical Illness To age 26

Accident To age 26

Telehealth To age 26

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

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

FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance.

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

Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending

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

PLAN MAXIMUM AGE

Hospital Indemnity

Medical To age 26

To age 26

SUMMARY PAGES

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

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, tax-free. This also allows employees to pay for qualifying dependent care taxfree. Employer

Permissible Use Of Funds

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

Year-to-year rollover of account balance?

Does the account earn interest?

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.

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).

Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65). Not permitted

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

No. Access to some funds may be extended if your employer’s plan contains a 2 1/2-month grace period or $500 rollover provision.

No Portable? Yes, portable year-to-year and between jobs.

SUMMARY PAGES HSA vs. FSA

Flexible

Description

Eligibility

All employers Contribution Source Employee and/or employer Employee and/or employer Account Owner Individual Employer Underlying Insurance Requirement High deductible health plan None Minimum Deductible $1,400 single (2022) $2,800 family (2022) N/A Maximum Contribution $3,650 single (2022) $7,300 family (2022) $2,850 (2022)

A qualified high deductible health plan.

TO FOR HSA INFORMATION PG.

FLIP TO FOR FSA INFORMATION PG.

Yes

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Notes 11

Medical Insurance

ABOUT MEDICAL

Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.

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

TRS EMPLOYEE

Monthly Premium District Contribution Employee Cost TRS ActiveCare HD Employee Only $429.00 $225.00 $204.00 Employee & Spouse $1,209.00 $225.00 $984.00 Employee & Child(ren) $772.00 $225.00 $547.00 Employee & Family $1,445.00 $225.00 $1,220.00 TRS ActiveCare 2 Employee Only $1,013.00 $225.00 $788.00 Employee & Spouse $2,402.00 $225.00 $2,177.00 Employee & Child(ren) $1,507.00 $225.00 $1,282.00 Employee & Family $2,841.00 $225.00 $2,616.00 TRS ActiveCare Primary Employee Only $417.00 $225.00 $192.00 Employee & Spouse $1,176.00 $225.00 $951.00 Employee & Child(ren) $751.00 $225.00 $526.00 Employee & Family $1,405.00 $225.00 $1,180.00 TRS ActiveCare Primary+ Employee Only $525.00 $225.00 $300.00 Employee & Spouse $1,284.00 $225.00 $1,059.00 Employee & Child(ren) $845.00 $225.00 $620.00 Employee & Family $1,614.00 $225.00 $1,389.00 Central and North Texas Baylor Scott & White HMO Employee Only $569.24 $225.00 $344.24 Employee & Spouse $1,431.08 $225.00 $1,206.08 Employee & Child(ren) $915.65 $225.00 $690.65 Employee & Family $1,647.24 $225.00 $1,422.24 12

BENEFITS

Health Savings Account (HSA)

ABOUT HSA

A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP).

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

A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs; it is 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. 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.

HSA Eligibility

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

• Enrolled in an HSA-eligible HDHP.

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

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

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

• Not enrolled in Medicare or TRICARE

• Not receiving Veterans Administration benefits

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

Maximum Contributions

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

• Individual – $3,650

• Family (filing jointly) – $7,300

EMPLOYEE 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.

Opening an HSA

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.

Important HSA Information

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

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

• 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.

How to Use your HSA

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

• 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.

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

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

EECU

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/crowleyisd

Alongside your medical coverage is access to quality telehealth services through MDLIVE. Connect anytime day or night with a board-certified doctor via your mobile device or computer. While MDLIVE does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:

• Have a non-emergency issue and are considering a convenience care clinic, urgent care clinic or emergency room for treatment

• Are on a business trip, vacation or away from home

• Are unable to see your primary care physician

When to Use MDLIVE:

At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as:

• Sore throat

• Headache

• Stomachache

• Cold

• Flu

• Allergies

• Fever

• Urinary tract infections

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

MDLIVE Behavioral Health:

Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or MDLIVE App.

• Talk to a licensed counselor or psychiatrist from your home, office, or on the go!

• Affordable, confidential online therapy for a variety of counseling needs.

• The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging.

Registration is Easy

• Register with MDLIVE so you are ready to use this valuable service when and where you need it.

• Online – www.mdlive.com/fbsbh

• Phone – 888-365-1663

• Mobile – download the MDLIVE mobile app to your smartphone or mobile device

 Select –“MDLIVE as a benefit” and “FBS” as your Employer/Organization when registering your account.

Telehealth MDLive EMPLOYEE

BENEFITS

Telehealth Employee & Family $10.00

Hospital Indemnity Cigna EMPLOYEE BENEFITS

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/crowleyisd

Even with the best primary health insurance plan, out-of-pocket costs from a hospital stay can add up. Cigna’s Hospital Care plan pays a scheduled benefit if you or an insured dependent (spouse or child) are confined in a hospital for a covered illness or injury. The benefits are paid to you, and can help offset expenses that primary health insurance doesn’t cover (like deductibles, co-insurance amounts or copays), or benefits can be used for any non-medical expenses (like housing costs, groceries, car expenses, etc.).

Plan Highlights

• No Pre-existing Limitations!

• HSA Compatible

Claims

Call 800-754-3207 or email SuppHealthClaims@cigna.com to file a claim. Group number on page 3 of this guide.

Available Coverage

The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred and are paid on a per day basis unless otherwise specified. Benefits are only payable when all policy terms and conditions are met. Please read all the information in the plan summary document on the benefit website to understand limitations and conditions.

Hospitalization Benefits

Hospital Admission

No elimination period. Limited to 1 day, 1 benefit(s) every 180 days.

Hospital Chronic Condition Admission

No elimination period. Limited to 1 day, 1 benefit(s) every 90 days. $50 $50

Hospital Stay

No elimination period. Limited to 30 days, 1 benefit(s) every 90 days. $100 per day $200 per day

Hospital Intensive Care Unit (ICU) Stay

No elimination period. Limited to 30 days, , 1 benefit(s) every 90 days.

Hospital Observation Stay

24 hour elimination period. Limited to 72 hours.

Newborn Nursery Care Admission

Limited to 1 day, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected.

Newborn Nursery Care Stay*

Limited to 30 days, 1 benefit per newborn child. This benefit is payable to the employee even if child coverage is not elected.

$200 $400

$500 per 24- hour period

$500 $500

$100 per day $100 per day

Hospital Indemnity Low High Employee $13.97 $26.28 Employee + Spouse $27.79 $49.97 Employee + Child(ren) $23.31 $41.58 Family $36.13 $65.27

Plan 1 Plan 2

$1,000 $2,000

Hospital Indemnity Cigna EMPLOYEE BENEFITS

Additional Information:

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

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

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

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

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

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

Dental Insurance Cigna 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/crowleyisd

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

How to Find a Dentist

Visit https://hcpdirectory.cigna.com/ or call 800-244-6224 to find an innetwork dentist. Your network will be Total Cigna DPPO.

How to Request a New ID Card

You can request your dental id card by contacting Cigna directly at 800-244-6224. You can also go to www.mycigna.com and register/login to access your account. In addition, you can download the “MyCigna” app on your smartphone and access your id card right there on your phone.

Dental DPPO DHMO Employee $34.75 $14.30 Employee + 1 Dependent $60.16 $27.16 Employee + Family $98.64 $40.75 Cigna Dental Choice Plan In-Network Out-of-Network Network Options Total Cigna DPPO Network See Non-Network Reimbursement Reimbursement Levels Based on Contracted Fees Maximum Reimbursable Charge Policy Year Benefits Maximum Applies to: Class I, II & III expenses Year 1: $750, Year 2: $900 Year 3: $1,050,Year 4 & Beyond: $1,200 Year 1: $750, Year 2: $900 Year 3: $1,050,Year 4 & Beyond: $1,200 Policy Year Deductible Individual Family $30 $60 $30 $60 Benefit Highlights Plan Pays You Pay Plan Pays You Pay Class I: Diagnostic & Preventive Oral Evaluations, Prophylaxis: routine cleanings, X-rays: routine, Xrays: non-routine, Fluoride Application, Sealants: per tooth, Space Maintainers: non-orthodontic Emergency Care to Relieve Pain 100% No Deductible No Charge 100% No Deductible No Charge Class II: Basic Restorative Restorative: fillings, Endodontics: minor and major, Periodontics: minor and major, Oral Surgery: minor and major, Anesthesia: general and IV sedation, Repairs: dentures 80% After Deductible 20% After Deductible 80% After Deductible 20% After Deductible Class III: Major Restorative Inlays and Onlays Prosthesis

and Dentures, Repairs:

Rebases and Adjustments 50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000 50% No Deductible 50% No Deductible 50% No Deductible 50% No Deductible Class IX: Implants 50% After Deductible 50% After Deductible 50% After Deductible 50% After Deductible 23

Over Implant, Crowns: prefabricated stainless steel / resin, Crowns: permanent cast and porcelain, Bridges

bridges, crowns and inlays, Denture Relines,

Dental Insurance Cigna EMPLOYEE BENEFITS

Benefit Plan Provisions:

In-Network Reimbursement

Non-Network Reimbursement

DHMO PLAN

For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule.

For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge. The MRC is calculated at the 90th percentile of all provider submitted amounts in the geographic area. The dentist may balance bill up to their usual fees.

If you enroll in the DHMO plan, you must select a Primary Care Dentist (PCD) from the DHMO network directory to manage your care. Each eligible dependent may choose their own PCD. The Patient Charge Schedule applies only when covered dental services are performed by your network dentist. Not all Network Dentist perform all listed services and it is suggested to check with your Network Dentist in advance of receiving services. Dental services are unlimited; you pay fixed co-pays, there are no deductibles and there are no claim forms to file. There is no coverage for services provided without a referral from your PCD or if you seek care from out-of-network providers. Please refer to the patient charge schedule details located on your benefit website, www.mybenefitshub.com/crowleyisd

How do I find an In-network Dentist?

Visit: https://hcpdirectory.cigna.com/ or call 800-244-6224 to find an in-network dentist. Your network will be Cigna Dental Care DHMO.

Vision Insurance MetLife 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/crowleyisd

Contact Lenses (instead of eyeglasses)

• Once every 12 months

• Contact lens fitting (standard): Covered in full after $25 copay.

Disability Insurance New York Life EMPLOYEE BENEFITS

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/crowleyisd

Employee

Unites of $100, minimum amount of $200

Important Definitions and Policy Provisions:

Disability– “Disability” or “Disabled” means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 60% or more of your indexed earnings. We will require proof of earnings and continued disability.

Covered Earnings–“Covered Earnings” means your wages or salary, not including bonuses, commissions, and other extra compensation.

When Benefits Begin- You must be continuously Disabled for your elected benefit waiting period before benefits will be payable for a covered Disability.

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

Maximum Benefit Period Schedule Age at Disability Prior to age 61 62 63 64 65 66 67 68 69+ Duration of Payments (Accident and Sickness) To age 65 or the date the 42nd monthly benefit is payable, if later. 42 36 30 24 21 18 15 12 26

Eligibility: All active Full-time Employees of the Employer who are citizens or permanent resident aliens of the United States and working a minimum of 40 hours per week in the United States.

Options Maximum Gross Monthly Benefit Benefit Waiting Period Maximum Benefit Period

When Coverage Takes Effect- Your coverage takes effect on the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit evidence of good health, your coverage takes effect on the date we agree, in writing, to cover you. Select from Four Options: Accident/Sickness 14 days/14 days 30 days/30 days 60 days/60 days 90 days/90 days 150 days/150 days

Please refer to the “Maximum Benefit Period” Schedules below for more details

Disability Insurance

Benefit Reductions, Conditions, Limitations and Exclusions: Effects of Other Income Benefits- This plan is structured to prevent your total benefits and post-disability earnings from equaling or exceeding pre-disability earnings. Therefore, we reduce this plan’s benefits by Other Income Benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Disability benefits will be reduced by amounts received through Social Security disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will also be reduced by amounts received through other government programs, employer’s sabbatical leave, employer’s assault leave plan, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no-fault, and damages for wage loss. For details, see your outline of coverage, policy certificate, or your employer’s summary plan description. Note: Some of the Other Income Benefits, as defined in the group policy, will not be considered until after disability benefits are payable for 6 months.

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

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

Pre-existing Condition Waiver-The Insurance Company will waive the Pre-Existing Condition Limitation for the first eight weeks of Disability even if the Employee has a Pre-Existing Condition. The Disability Benefits as shown in the Schedule of Benefits will continue beyond 8 weeks only if the PreExisting Condition Limitation does not apply.

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

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

Rehabilitation Requirement- To be eligible for Disability benefits under this plan, you may be required to participate in a rehabilitation plan at the sole discretion and expense of the insurance company or company administering benefits under this plan. If you fail to fully cooperate with the rehabilitation plan, no Disability benefits will be paid, and coverage will end. For details, see your Certificate of Insurance. Exclusions- This plan does not pay benefits for a Disability which results, directly or indirectly, from any of the following: • Suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane. ─ war or any act of war, whether or not declared. ─ active participation in a riot; • commission of a felony; • the revocation, restriction or non-renewal of an Employee’s license, permit or certification necessary to perform the duties of his or her occupation unless due solely to Injury or Sickness otherwise covered by the Policy. ─ any cosmetic surgery or surgical procedure that is not Medically Necessary. ─ an Injury or Sickness for which the Employee is entitled to benefits from Workers’

Compensation or occupational disease law ─ an Injury or Sickness that is work related. In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution.

New York Life EMPLOYEE BENEFITS

Disability - per $100 in benefit Elimination Period Plan 1 14/14 $3.08 30/30 $2.47 60/60 $2.09 90/90 $1.77 180/180 $1.33 27

Life and AD&D

New York Life

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/crowleyisd

Summary of Benefits

EMPLOYEE BENEFITS

Eligibility: All active, Full-time Employees of the Employer regularly working a minimum of 40 hours per week in the United States, who are citizens or permanent resident aliens of the United States.

• Employee: You will be eligible for coverage the first of the month coincident with or following date of hire.

• Spouse: As long as you apply for and are approved for coverage yourself.

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

Available Coverage: You, your spouse, and children will receive equal amounts of Term Life and Accidental Death and Dismemberment insurance.

You, your spouse and dependent children will receive the same amount of Voluntary Accidental Death and Dismemberment insurance under Policy OK 971523, underwritten by Life Insurance Company of North America.

Guaranteed Issue means that you may be able to purchase coverage without medical exams or health questions. See “Guaranteed Issue” below for more information.

AD&D Benefit Details:

If, within 365 days of a Covered Accident, bodily injuries result in:

of life; Quadriplegia; Loss of two or more hands or feet; Loss of sight in both eyes; or Loss of speech and hearing (both ears)

of one hand, one foot, sight in one eye, speech, or hearing in both ears; or Severance and Reattachment of one hand or foot

Benefit Amount Maximum Guaranteed Issue Amount Employee Units of $10,000 $500,000 $200,000 Spouse Units of $5,000 $100,000 not to exceed 50% of the employees benefit $25,000 Children Units of $1,000 $10,000; under 6 months old $500 All amounts

We’ll

Amount: Loss

100% Paraplegia 75% Hemiplegia;

50% Uniplegia;

25% Loss

toes

foot 20% Voluntary Group

and AD&D

Age Employee Spouse 25-29 $0.70 $0.70 30-34 $0.90 $0.90 35-39 $1.10 $1.10 40-44 $1.40 $1.40 45-49 $2.00 $2.00 50-54 $3.10 $3.10 55-59 $5.30 $5.30 60-64 $7.30 $7.30 65-69 $13.10 $13.10 70-74 $23.30 $23.30 Voluntary Group Life: Child(ren) ($10,000 in coverage) 0-26 $1.10 Spouse rates based on Employee's age. 28

pay this % of the Benefit

Loss

Loss of all four fingers of the same hand; or Loss of thumb and index finger of the same hand

of all

of the same

Life

(per $10,000 in coverage)

Life and AD&D New York Life EMPLOYEE BENEFITS

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

Conversion – If group accident coverage ends (except due to nonpayment of premium), your employment is terminated, membership in an eligible class is terminated, or insurance coverage is reduced based on attained age, you can convert to an individual non-term policy. To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends. Dependents may convert their coverage as well if applicable. Premiums may change at this time, and terms of coverage will be subject to change. You can also convert to an individual policy of up to $10,000 if you have been insured for at least 5 years and the policy is terminated or amended, provided coverage is not replaced and you are not covered under a different conversion policy issued by Life Insurance Company of North America. Refer to your certificate for details.

Accelerated Death Benefit – Terminal Illness – if two unaffiliated doctors diagnose you or your spouse as terminally ill while the coverage is active, with a life expectancy of 12 months or less, the benefit for Terminal Illness provides up to:

• Employee: 75% of your Term Life Insurance coverage amount or $375,000, whichever is less.

• Spouse: 75% of your Term Life Insurance coverage amount or $75,000, whichever is less.

Portability – If your employment is terminated, you can continue your life insurance on a direct-bill basis. Coverage may also be continued for your spouse/children. Premiums will increase at this time. Coverage can be continued to age 70, unless the insurance company terminates portability for all insured persons. Refer to your certificate for details.

Conversion – To convert, you must apply for the conversion policy and pay the first premium payment within 31 days after your group coverage ends.

Term Life Benefit Reductions, Exclusions and Limitations

Benefit Reduction Schedule - If you are still employed, your benefits will reduce to 50% at age 70. Spouse reductions are based on employee age.

Exclusions - Voluntary life insurance will not be paid if you commit suicide, while sane or insane, within the first two years of coverage. Limitations - The Accelerated Death Benefit is payable only once. Using this benefit reduces the life insurance death benefit. The amount payable under the Accelerated Death Benefit may be reduced by the amount of other benefits already paid to the insured under the policy. See your certificate for details. After premiums have been waived for 12 months, they will be waived for future periods of 12 months if you remain Disabled. This benefit will remain active until age 65 subject to proof of continuing disability each year.

Guaranteed Issue for Term Life Insurance Coverage: If you are a new hire and you apply within 31 days after you are eligible to elect coverage for yourself, you are entitled to choose any coverage offered up to the Guaranteed Issue Amount, without providing proof of good health. If you apply for an amount of coverage greater than the Guaranteed Issue Amount, coverage in excess of the Guaranteed Issue Amount will not be issued until the insurance company approves acceptable proof of good health. If you apply for coverage for yourself more than 31 days from the date you become eligible to elect coverage under this plan, the Guaranteed Issue Amount will not apply, unless Guaranteed Issue has been approved by your employer for a specific period of time. Coverage will not be issued until the insurance company approves acceptable proof of good health.

These are summarized definitions only. To be eligible for coverage, the covered illness or event must meet the definitions and other terms and conditions set forth in the group policy.

Accident Insurance Cigna 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/crowleyisd

Employee + Child(ren) $19.62

Accidental Injury coverage provides a fixed cash benefit according to the schedule below when a Covered Person suffers certain Injuries or undergoes a broad range of medical treatments or care resulting from a Covered Accident.

Who Can Elect Coverage:

You: All active, full-time Employees of the Employer who are regularly working in the United States a minimum of 40 hours per week and regularly residing in the United States and who are United States citizens or permanent resident aliens and their Spouse, and Dependent Children who are United States citizens or permanent resident aliens and who are residing in the United States. You will be eligible to elect coverage on the first of the month coinciding with or next following your date of hire or Active Service.

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

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

Available Coverage: This Accidental Injury plan provides 24 hour coverage. The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred and are paid on a per day basis unless otherwise specified. Benefits are only payable when all policy terms and conditions are met. Please read all the information in this summary to understand terms, conditions, state variations, exclusions and limitations applicable to these benefits. See your Certificate of Insurance for more information.

Benefit Percentage Amount (unless otherwise indicated)

•

100% of benefits shown

• Spouse: 100% of benefits shown

• Children: 100% of benefits shown

Per covered non-surgically-repaired fracture $200-$5,250

Chip Fracture (percent of fracture benefit) 25%

Per covered surgically-repaired dislocation

Small Lacerations (Less than or equal to 6 inches long and requires 2 or more sutures) $150

Large Lacerations (more than 6 inches long and requires 2 or more sutures) $800

Coma (lasting 7 days with no response) $15,000

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

Employee:

Initial & Emergency Care Plan Emergency Care Treatment $300 Physician Office Visit (includes urgent care) $300 Diagnostic Exam (x-ray or lab) $60 Ground or Water Ambulance/Air Ambulance $600/$2,000 Hospitalization

Hospital Admission $1,500 Hospital

$400 Intensive Care

$600

Plan

Benefits Plan

Stay

Unit Stay

Fractures and Dislocations

Per covered surgically-repaired fracture $400-$10,500

$400-$7,000

Plan

Office

Per covered non-surgically-repaired dislocation $200-$3,500 Follow-Up Care

Follow-up Physician (or medical professional)

Visit $100

Follow-up Physical Therapy Visit $75 Enhanced Accident Benefits Plan

Concussion $200

Accident

Employee $9.06 Employee + Spouse $16.22

Family

$26.78

Accident Insurance Cigna

Wellness Treatment, Health Screening Test & Preventive Care Benefit Plan

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

$50

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

Important Definitions and Policy Provisions:

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

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

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

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

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

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

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

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

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

EMPLOYEE

BENEFITS

Critical Illness Insurance Cigna EMPLOYEE BENEFITS

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/crowleyisd

Who Can Elect Coverage:

You: All active, Employees of the Employer who are regularly working a minimum of 40 hours per week who are United States citizens or permanent resident aliens regularly working in the United States. You will be eligible to elect coverage on the first of the month after 30 days from date of hire or Active Service.

Your Spouse: Up to age 100, as long as you apply for and are approved for coverage yourself. Your Child(ren): Birth to age 26; 26+ if disabled, as long as you apply for and are approved for coverage yourself.

Available Coverage:

The benefit amounts shown will be paid regardless of the actual expenses incurred. The benefit descriptions are a summary only. There are terms, conditions, state variations, exclusions and limitations applicable to these benefits. Please read all of the information in this Summary and your Certificate of Insurance for more information. All Covered Critical Illness Conditions must be due to disease or sickness.

Benefit Amount Guaranteed Issue Amount Employee $10,000, $15,000, $20,000, $25,000 $30,000 Up to $30,000 Spouse $10,000, $15,000, $20,000 Up to $20,000 Children 25% of employee amount, include Childhood Conditions All guaranteed issue Covered Conditions Initial Benefit Amount % Recurrence % of Initial Benefit Amount Cancer Conditions Skin cancer $250 1x per lifetime Invasive Cancer 100% 100% Carcinoma in Situ 25% 25% Vascular Conditions Heart Attack 100% 100% Stroke 100% 100% Coronary Artery Disease 25% 25% Nervous System Conditions Advanced Alzheimer's Disease 100% Not Available Amyotrophic Lateral Sclerosis (ALS) 100% Not Available Parkinson's Disease 100% Not Available Multiple Sclerosis 100% Not Available Childhood Conditions* Cerebral Palsy 100% Not Available Cystic Fibrosis 100% 100% Muscular Dystrophy 100% 100% Poliomyelitis 100% Not Available 32

Critical Illness Insurance Cigna

*For Childhood Conditions please refer to the beginning of the Available Coverage section above for details on how much coverage is available for covered children.

Health Screening Test Benefit Benefit Amount

Examples includes (but are not limited to) mammography, and certain blood tests. The benefit amount shown will be paid regardless of the actual expenses incurred and is paid on a per day basis. Virtual Care accepted.

Benefits

Initial Critical Illness Benefit

Benefit for a diagnosis made after the effective date of coverage for each Covered Condition shown above. The amount payable per Covered Condition is the Initial Benefit Amount multiplied by the applicable percentage shown. Each Covered Condition will be payable one time per Covered Person, subject to the Maximum Lifetime Limit. A 90 days separation period between the dates of diagnosis is required.*

Recurrence Benefit

Maximum Lifetime Limit

Skin Cancer Benefit

Guaranteed Issue:

Benefit for the diagnosis of a subsequent and same Covered Condition for which an Initial Critical Illness Benefit has been paid, payable after a 6 month separation period from diagnosis of a previous Covered Condition, subject to the Maximum Lifetime Limit.

The maximum benefit payable per Covered Person is the lesser of 5 times the elected Benefit Amount or $150,000.

Pays benefit stated above

If you are a new hire you are not required to provide proof of good health if you enroll during your employer's eligibility waiting period and you choose an amount of coverage up to and including the Guaranteed Issue Amount. If you apply for an amount of coverage greater than the Guaranteed Issue Amount, coverage in excess of the Guaranteed Issue Amount will not be issued until the insurance company approves acceptable proof of good health. Guaranteed Issue coverage may be available at other specified periods of time. Your employer will notify you when these periods of time are available. Your Spouse must be age 18 or older to apply if evidence of insurability is required.

EMPLOYEE

Critical Illness Age Band Employee Spouse $10,000 $15,000 $20,000 $25,000 $30,000 $10,000 $15,000 $20,000 <25 $3.09 $4.64 $6.18 $7.73 $9.27 $2.99 $4.49 $5.98 25 to 29 $3.50 $5.25 $7.00 $8.75 $10.50 $3.17 $4.76 $6.34 30 to 34 $4.63 $6.95 $9.26 $11.58 $13.89 $4.05 $6.08 $8.10 35 to 39 $6.56 $9.84 $13.12 $16.40 $19.68 $5.63 $8.45 $11.26 40 to 44 $7.87 $11.81 $15.74 $19.68 $23.61 $6.77 $10.16 $13.54 45 to 49 $11.13 $16.70 $22.26 $27.83 $33.39 $10.37 $15.56 $20.74 50 to 54 $14.58 $21.87 $29.16 $36.45 $43.74 $15.87 $23.81 $31.74 55 to 59 $19.61 $29.42 $39.22 $49.03 $58.83 $23.48 $35.22 $46.96 60 to 64 $24.73 $37.10 $49.46 $61.83 $74.19 $30.68 $46.02 $61.36 65 to 69 $30.54 $45.81 $61.08 $76.35 $91.62 $36.63 $54.95 $73.26 70 to 74 $43.56 $65.34 $87.12 $108.90 $130.68 $49.71 $74.57 $99.42 75 to 79 $57.92 $86.88 $115.84 $144.80 $173.76 $68.09 $102.14 $136.18 80 to 84 $74.18 $111.27 $148.36 $185.45 $222.54 $86.39 $129.59 $172.78 85 to 89 $102.00 $153.00 $204.00 $255.00 $306.00 $124.23 $186.35 $248.46 90 to 94 $102.00 $153.00 $204.00 $255.00 $306.00 $124.23 $186.35 $248.46 95+ $102.00 $153.00 $204.00 $255.00 $306.00 $124.23 $186.35 $248.46

BENEFITS

$50, 1 per year

Other Specified Conditions Benign Brain Tumor 100% 100% Blindness 100% Not Available Coma 100% 25% End-Stage Renal (Kidney) Disease 100% 100% Major Organ Failure 100% 100% Paralysis 100% 100% Loss of Hearing 100% Not Available Loss of Speech 100% Not Available Systemic Lupus 25% 25% Systemic Sclerosis 25% 25%

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 $500 rollover or grace period provision).

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

Health Care FSA

The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $2,850 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include:

• Dental and vision expenses

• Medical deductibles and coinsurance

• Prescription copays Hearing aids and batteries

You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).

Higginbotham Benefits Debit Card

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

Dependent Care FSA

The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or babysitter 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 mid-year, you may only request reimbursement for the part of the year when the child is under age 13.

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

• 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 $2,850. The maximum per plan year you can contribute to a Dependent Care FSA is $5,000 when filing jointly or head of household and $2,500 when married filing separately.

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

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

• 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.

EMPLOYEE

BENEFITS

Flexible Spending Account (FSA)

Higginbotham

Higginbotham Portal

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

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

• Update your personal information

• Utilize Section 125 tax calculators

• Look up qualified expenses

• Submit claims

• Request a new or replacement Benefits Debit Card

1. Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.

2. Enter your Employee ID, which is your Social Security number with no dashes or spaces.

3. 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 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.

Flexible Spending Accounts

Health Care FSA

Dependent Care FSA

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

Dependent care expenses (such as day care, after-school programs or elder care programs) so you and your spouse can work or attend school full-time

$2,850

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

$5,000 single $2,500 if married and filing separate tax returns

Reduces your taxable income

EMPLOYEE

BENEFITS

Account Type Eligible Expenses Annual Contribution Limits Benefit

Identity Theft Identity Guard EMPLOYEE BENEFITS

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/crowleyisd

THE ULTIMATE PLAN

Safeguarding you, your family, and your finances with identity protection, financial tracking, and online security.

Have you wondered:

• How do I know if my information has been comprised?

• What do I do if my personal information has been stolen?

• Can I protect myself and my family on social media?

• Can I protect my children from identity theft?

Aura Identity Guard protects you and your family against cybercrime.

COMPREHENSIVE IDENTITY PROTECTION

• $1M in insurance protection1 from financial losses and legal fees

• 24/7 expert guidance, if a threat is detected

• Protect your loved ones for one low price with our family plan

FASTEST SPEED AND LARGEST BREADTH OF ALERTS

• Around-the-clock scan of billions of online resources

• Reduce exposure to cybertheft

• Be alerted within seconds of possible cyberthreats

POWERFUL FINANCIAL TOOLS

• Keep an eye on your spending and get alerted to suspicious transactions

• Access to your credit report and real-time alerts to changes that impact your credit

• Complete protection and monitoring of online accounts and passwords

COMPREHENSIVE IDENTITY PROTECTION $1 Million insurance with stolen funds reimbursement ✓ 401(k) & HSA reimbursement ✓ Address monitoring ✓ Auto-on monitoring ✓ Compromised credentials scan ✓ Court records monitoring ✓ Criminal record monitoring ✓ Cyberbullying monitoring ✓ Dark web monitoring ✓ Data broker list monitoring/removal ✓ Device/cookie tracking protection ✓ Fictitious identity monitoring ✓ Home title monitoring ✓ Human-sourced intelligence ✓ Medical ID monitoring ✓ Social media monitoring ✓ Social security and ID authentication monitoring ✓ FINANCIAL FRAUD PROTECTION Bank account transaction monitoring ✓ Credit card monitoring ✓ Debit card monitoring ✓ Financial accounts monitoring ✓ High-risk transaction monitoring ✓ Lost wallet protection ✓ Online accounts monitoring ✓ POWERFUL FINANCIAL TOOLS Annual credit report Up to 3-Bureau Credit bureau monitoring Up to 3-Bureau Credit report lock 1-Bureau Credit score tracker ✓ Monthly credit score ✓ Near real-time alerts ✓ Security freeze assistance ✓ Student loan activity alerts ✓ CUSTOMER CARE End-to-end remediation ✓ Mobile App ✓ Online identity dashboard ✓ U.S.-based customer care ✓ Features that are included in the Aura Identity Guard Ultimate Plan: PROACTIVE DEVICE & PRIVACY PROTECTION Anti-adware ✓ Anti-virus ✓ E-mail solicitation/junk mail prevention ✓ Robo-call/robo-text protection ✓ Safe browsing extension ✓ Safe browsing: anti-ransomware & anti-malware ✓ VPN / WiFi security ✓ Identity Theft Employee $10.85 Employee + Family $19.85 Customer Service Concierge customercare@identityguard.com or (855) 443-7748 36

Notes 37

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 Crowley 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 Crowley 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.

2022 - 2023

PlanYear WWW.MYBENEFITSHUB.COM/CROWLEYISD