2023-24 ESC 20 BC Benefit Guide (TRS) by Higginbotham Public Sector

2023 - 2024 Plan Year

ESC REGION 20 BENEFITS COOPERATIVE

BENEFIT GUIDE EFFECTIVE: 09/01/2023 - 8/31/2024 WWW.ESC20BC.NET

Table of Contents How to Enroll

4-5

Annual Benefit Enrollment

6-10

1. Section 125 Cafeteria Plan Guidelines

2. Annual Enrollment

3. Eligibility Requirements

4. Helpful Definitions

5. Health Savings Account (HSA) vs. Flexible Spending Account (FSA)

Medical - Region 20

12-17

Medical - Region 13

18-24

Health Savings Account (HSA)

25-26

Hospital Indemnity

Telehealth

Dental

39-30

Vision

Disability

Cancer Accident

PG. 4

HOW TO ENROLL

PG. 6

SUMMARY PAGES

PG. 12

YOUR BENEFITS

Critical Illness

36-37

Life and AD&D

38-39

Individual Life

Emergency Medical Transportation

Identity Theft

Flexible Spending Account (FSA)

33-34

FLIP TO...

43-44

Employee Assistance Program

FBS Benefits App Group # Index

Benefit Contact Information ESC REGION 20 BC BENEFITS

TRS ACTIVECARE MEDICAL

TRS HMO MEDICAL

Financial Benefit Services (800) 583-6908 www.esc20bc.net

BCBSTX (866) 355-5999 www.bcbstx.com/trsactivecare

Scott & White HMO (844) 633-5325 trs.swhp.org

HEALTH SAVINGS ACCOUNT (HSA)

HOSPITAL INDEMNITY

TELEHEALTH

EECU (817) 882-0800 www.eecu.org

CHUBB Claims Assistance: (888) 499-0425

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

DENTAL

VISION

DISABILTY

Cigna Group #3336975 (800) 244-6224 www.mycigna.com

Superior Vision by MetLife Group #28888 (800) 638-5433 www.metlife.com

The Hartford (866) 547-9124 www.thehartford.com

CANCER

ACCIDENT

CRITICAL ILLNESS

American Public Life Group #13309 (800) 256-8606 www.ampublic.com

CHUBB Claims Assistance: (888) 499-0425

LIFE AND AD&D

INDIVIDUAL LIFE

EMERGENCY MEDICAL TRANSPORT

CHUBB Claims Assistance: (888) 499-0425

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

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

IDENTITY THEFT

FLEXIBLE SPENDING ACCOUNT (FSA)

EMPLOYEE ASSISTANCE PROGRAM (EAP)

ID Watchdog (800) 774-3772 www.idwatchdog.com

Higginbotham (866) 419-3519 https://flexservices.higginbotham. net/ flexclaims@higginbotham.com

ComPsych (844) 266-0712 www.guidanceresources.com Web ID: CHUBB

All Your Benefits One App Employee benefits made easy through the FBS Benefits App! Text “FBS ESC20” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment:

Text “FBS ESC20” to (800) 583-6908

• Benefit Resources • Online Enrollment • Interactive Tools • And more!

App Group #:

Go to PAGE 46 to find your district’s group #

OR SCAN

How to Log In 1

www.esc20bc.net

SELECT YOUR SCHOOL FROM THE DROP DOWN LIST

CLICK LOGIN

ENTER USERNAME & PASSWORD Your Username Is: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number. If you have not logged in recently, your Password is: Last Name (Excluding punctuation) followed by the last four (4) digits of your Social Security Number. If you have logged in recently, your password may the password previously created, NOT the password format listed above.

Annual Benefit Enrollment

SUMMARY PAGES

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

CHANGES IN STATUS (CIS):

QUALIFYING EVENTS

Marital Status

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

Change in Number of Tax Dependents

A change in number of dependents includes the following: birth, adoption and placement for adoption. You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a result of a valid change in status event.

Change in Status of Employment Affecting Coverage Eligibility

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

Gain/Loss of Dependents’ Eligibility Status

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

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.

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

Annual Benefit Enrollment

SUMMARY PAGES

Annual Enrollment During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year. Changes are not permitted during the plan year (outside of annual enrollment) unless a Section 125 qualifying event occurs. •

•

Changes, additions or drops may be made only during the annual enrollment period without a qualifying event. Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.

Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.esc20bc.net. 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 ESC Region 20 BC benefit website: www.esc20bc.net. 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 • Employees must confirm on each benefit screen expect to receive those 3-4 weeks after your effective (medical, dental, vision, etc.) that each dependent date. For most dental and vision plans, you can login to be covered is selected in order to be included in to the carrier website and print a temporary ID card the coverage for that particular benefit. 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 All new hire enrollment elections must be completed in the online enrollment system within the first 30 days carrier’s customer service number to request another card. of benefit eligible employment. Failure to complete elections during this timeframe will result in the If the insurance carrier provides ID cards, but there are forfeiture of coverage. no changes to the plan, you typically will not receive a new ID card each year.

New Hire Enrollment

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.

Annual Benefit Enrollment

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 18.75 or more regularly scheduled hours each work week.

Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.

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

PLAN

MAXIMUM AGE

Accident

Through 25

Cancer

Through 25

Dental

Through 25

Dependent Flex

12 or younger or qualified individual unable to care for themselves & claimed as a dependent on your taxes

Healthcare FSA

Through 25 or IRS Tax Dependent

Health Savings Account

IRS Tax Dependent

Identity Theft

Through 25

Hospital Indemnity

Through 25

Individual Life

Through 22

Telehealth

Through 25

Vision

Through 25

Voluntary Life

Through 25

Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents. Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility. FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse’s FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance. Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility. Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee’s enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts. If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.

SUMMARY PAGES

Helpful Definitions Actively-at-Work

In-Network

You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2023 please notify your benefits administrator.

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

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

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

Calendar Year January 1st through December 31st

Out-of-Pocket Maximum The most an eligible or insured person can pay in co insurance 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).

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. 9

SUMMARY PAGES

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

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

Description

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source

Employee and/or employer

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)

Permissible Use Of Funds

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

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

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

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

Year-to-year rollover of account balance?

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

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

Does the account earn interest?

Yes

Portable?

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

FLIP TO

FOR HSA INFORMATION

PG. 25

FLIP TO

FOR FSA INFORMATION

PG. 43

Notes

Medical Insurance

EMPLOYEE BENEFITS

TRS - Region 20 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/sampleisd

The rates shown apply to the following districts: Alameda School for Art and Design Big Springs Charter School Brackett ISD BRAINATION (Charter) Charlotte ISD ESC Region 20 Jourdanton ISD Jubilee Academies Knippa ISD Legacy Traditional Schools - Texas Meadowland Charter School Somerset Academy Inc. Southwest Preparatory School

TRS Region 20 Medical Rates* TRS ActiveCare HD Employee Only $388.00 Employee & Spouse $1,048.00 Employee & Child(ren) $660.00 Employee & Family $1,320.00 TRS ActiveCare 2 Employee Only $1,013.00 Employee & Spouse $2,402.00 Employee & Child(ren) $1,507.00 Employee & Family $2,841.00 TRS ActiveCare Primary Employee Only $376.00 Employee & Spouse $1,016.00 Employee & Child(ren) $640.00 Employee & Family $1,279.00 TRS ActiveCare Primary+ Employee Only $442.00 Employee & Spouse $1,150.00 Employee & Child(ren) $752.00 Employee & Family $1,459.00 *Listed rates do not include employer contributions.

Remember the Alamo... and that TRS-ActiveCare has the largest network of doctors and hospitals in Texas!

TRS-ActiveCare Plan Highlights 2023-24 Learn the Terms. • Premium: The monthly amount you pay for health care coverage. • Deductible: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay its portion. • Copay: The set amount you pay for a covered service at the time you receive it. The amount can vary by the type of service. • Coinsurance: The portion you’re required to pay for services after you meet your deductible. It’s often a specified percentage of the costs; i.e. you pay 20% while the health care plan pays 80%. • Out-of-Pocket Maximum: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket 13 maximum, the plan pays 100% of allowable charges for covered services.

762383.0523

2023-24 TRS-ActiveCare Plan Highlights Sept. 1, 2023 – How to Calculate Your Monthly Premium

All TRS-ActiveCare participants have three plan options. E TRS-ActiveCare Primary

Total Monthly Premium Your District and State Contributions

• Lowest premium of all three plans • Copays for doctor visits before you meet your deductible • Statewide network • Primary Care Provider (PCP) referrals required to see specialists • Not compatible with a Health Savings Account (HSA) • No out-of-network coverage

Plan Summary

Your Premium

TRS-

• Lower deductible t • Copays for many s • Higher premium • Statewide network • PCP referrals requi • Not compatible wit • No out-of-network

Ask your Benefits Administrator for your district’s specific premiums.

Monthly Premiums

Wellness Benefits at No Extra Cost* Being healthy is easy with:

• One-on-one health coaches

Your Premium

Total Premi

Employee Only

$376

$442

Employee and Spouse

$1,016

$1,150

Employee and Children

$640

$752

Employee and Family

$1,279

$1,459

Plan Features

• $0 preventive care • 24/7 customer service

Total Premium

Type of Coverage Individual/Family Deductible Coinsurance

In-Network Coverage Only You pay 30% after deductible

Individual/Family Maximum Out of Pocket

$7,500/$15,000

Network

Statewide Network

• Weight loss programs

$2,500/$5,000

PCP Required

Yes

Primary Care

$30 copay

Specialist

$70 copay

Urgent Care

$50 copay

You

• Nutrition programs • OviaTM pregnancy support

Doctor Visits

• TRS Virtual Health • Mental health benefits • And much more! *Available for all plans. See the benefits guide for more details.

Immediate Care Emergency Care

You pay 30% after deductible

You

TRS Virtual Health-RediMD (TM)

$0 per medical consultation

TRS Virtual Health-Teladoc

$12 per medical consultation

New Rx Benefits!

Prescription Drugs Drug Deductible Generics (31-Day Supply/90-Day Supply)

• Express Scripts is your new pharmacy benefits manager! CVS pharmacies and most of your preferred pharmacies and medication are still included. • Certain specialty drugs are still $0 through SaveOnSP. 14

Integrated with medical

$200 deducti

$15/$45 copay; $0 copay for certain generics

Preferred

You pay 30% after deductible

You

Non-preferred

You pay 50% after deductible

You

Specialty (31-Day Max)

$0 if SaveOnSP eligible; You pay 30% after deductible

Insulin Out-of-Pocket Costs

$25 copay for 31-day supply; $75 for 61-90 day supply

You

$25 copay for 3

Aug. 31, 2024

Each includes a wide range of wellness benefits.

-ActiveCare Primary+

TRS-ActiveCare HD

than the HD and Primary plans services and drugs

• Compatible with a Health Savings Account (HSA) • Nationwide network with out-of-network coverage • No requirement for PCPs or referrals • Must meet your deductible before plan pays for non-preventive care

k ired to see specialists th a Health Savings Account (HSA) coverage

ium

Your Premium

Total Premium

Your Premium

This plan is closed and not accepting new enrollees. If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan.

TRS-ActiveCare 2 • Closed to new enrollees • Current enrollees can choose to stay in plan • Lower deductible • Copays for many services and drugs • Nationwide network with out-of-network coverage • No requirement for PCPs or referrals

Total Premium

Your Premium

$388

$1,013

$1,048

$2,402

$660

$1,507

$1,320

$2,841

n-Network Coverage Only

In-Network

Out-of-Network

$1,200/$2,400

$3,000/$6,000

$5,500/$11,000

$1,000/$3,000

$2,000/$6,000 You pay 40% after deductible $23,700/$47,400

In-Network

Out-of-Network

u pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible

$6,900/$13,800

$7,500/$15,000

$20,250/$40,500

$7,900/$15,800

Statewide Network

Nationwide Network

Yes

$15 copay

You pay 30% after deductible

You pay 50% after deductible

$30 copay

You pay 40% after deductible

$70 copay

You pay 30% after deductible

You pay 50% after deductible

$70 copay

You pay 40% after deductible

$50 copay

You pay 30% after deductible

You pay 50% after deductible

$50 copay

You pay 40% after deductible

You pay a $250 copay plus 20% after deductible

u pay 20% after deductible

You pay 30% after deductible

0 per medical consultation

$30 per medical consultation

$0 per medical consultation

$42 per medical consultation

$12 per medical consultation

Integrated with medical

$200 brand deductible

12 per medical consultation

ible per participant (brand drugs only) $15/$45 copay

You pay 20% after deductible; $0 coinsurance for certain generics

$20/$45 copay

u pay 25% after deductible

You pay 25% after deductible

u pay 50% after deductible

You pay 50% after deductible

You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max)

$0 if SaveOnSP eligible; u pay 30% after deductible

You pay 20% after deductible

31-day supply; $75 for 61-90 day supply

You pay 25% after deductible

You pay 50% after deductible ($100 min/$200 max)/ You pay 50% after deductible ($215 min/$430 max) $0 if SaveOnSP eligible; You pay 30% after deductible ($200 min/$900 max)/ No 90-day supply of specialty medications $25 copay for 31-day supply; $75 for 61-90 day supply

What’s New and What’s Changing This table shows you the changes between 2022-23 statewide premium price and this year’s 2023-24 regional price for your Education Service Center. 2022-23 Total Premium

TRS-ActiveCare Primary

TRS-ActiveCare HD

TRS-ActiveCare Primary+

TRS-ActiveCare 2 (closed to new enrollees)

New 2023-24 Total Premium

Change in Dollar Amount

Key Plan Changes

Employee Only

$346

$376

$30

Employee and Spouse

$976

$1,016

$40

• Individual maximum-out-of-pocket decreased by $650. Previous amount was $8,150 and is now $7,500.

Employee and Children

$622

$640

$18

Employee and Family

$1,168

$1,279

$111

• Family maximum-out-of-pocket decreased by $1,300. Previous amount was $16,300 and is now $15,000.

Employee Only

$357

$388

$31

Employee and Spouse

$1,005

$1,048

$43

Employee and Children

$641

$660

$19

Employee and Family

$1,202

$1,320

$118

• Individual maximum-out-of-pocket increased by $450 to match IRS guidelines. Previous amount was $7,050 and is now $7,500. • Family maximum-out-of-pocket increased by $900 to match IRS guidelines. Previous amount was $14,100 and is now $15,000. These changes apply only to in-network amounts.

Employee Only

$434

$442

Employee and Spouse

$1,062

$1,150

$88

Employee and Children

$699

$752

$53

Employee and Family

$1,336

$1,459

$123

Employee Only

$1,013

Employee and Spouse

$2,402

• No changes.

Employee and Children

$1,507

• This plan is still closed to new enrollees.

Employee and Family

$2,841

• Family deductible decreased by $1,200. Previous amount was $3,600 and is now $2,400. • Primary care provider copay decreased from $30 to $15.

At a Glance

Primary

Primary+

Premiums

Lowest

Lower

Higher

Deductible

Mid-range

High

Low

Copays

Yes

Network

Statewide network

Nationwide network

Statewide network

PCP Required?

Yes

HSA-eligible?

Yes

Effective: Sept. 1, 2023

Compare Prices for Common Medical Services

REMEMBER: Benefit

Call a Personal Health Guide (PHG) any time 24/7 to help you find the best price for a medical service. Reach them at 1-866-355-5999. TRS-ActiveCare Primary

TRS-ActiveCare Primary+

In-Network Only

Office/Indpendent Lab: You pay $0

TRS-ActiveCare HD In-Network

In-Network

Out-of-Network

Office/Indpendent Lab: You pay $0 You pay 30% after deductible

Diagnostic Labs*

Out-of-Network

TRS-ActiveCare 2

You pay 40% after deductible

You pay 50% after deductible

Outpatient: You pay 30% after deductible

Outpatient: You pay 20% after deductible

High-Tech Radiology

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible + $100 copay per procedure

You pay 40% after deductible + $100 copay per procedure

Outpatient Costs

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible ($150 facility copay per incident)

You pay 40% after deductible ($150 facility copay per incident)

Inpatient Hospital Costs

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible ($500 facility per day maximum)

You pay 20% after deductible ($150 facility copay per day)

You pay 40% after deductible ($500 facility per day maximum)

Freestanding Emergency Room

You pay $500 copay + 30% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 30% after deductible

You pay $500 copay + 50% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 40% after deductible

Facility: You pay 30% after deductible

Facility: You pay 20% after deductible

Facility: You pay 20% after deductible ($150 facility copay per day)

Professional Services: Professional Services: You pay $5,000 You pay $5,000 copay + 20% after copay + 30% after deductible deductible

Professional Services: You pay $5,000 copay + 20% after deductible

Bariatric Surgery

Outpatient: You pay 20% after deductible

Not Covered

Only covered if rendered at a BDC+ facility

Annual Vision Exam (one per plan year; performed by an ophthalmologist or optometrist)

You pay $70 copay

You pay 30% after deductible

You pay 50% after deductible

You pay $70 copay

You pay 40% after deductible

Annual Hearing Exam (one per plan year)

$30 PCP copay $70 specialist copay

You pay 30% after deductible

You pay 50% after deductible

$30 PCP copay $70 specialist copay

You pay 40% after deductible

*Pre-certification for genetic and specialty testing may apply. Contact a PHG at 1-866-355-5999 with questions.

www.trs.texas.gov Revised 05/30/23

Medical Insurance TRS - Region 13

The rates shown apply to the following districts: Dime Box ISD Dripping Springs ISD Flatonia ISD Harper ISD Johnson City ISD Katherine Anne Porter School Nixon Smiley CISD Prairie Lea ISD Schulenburg ISD Smithville ISD Texas Preparatory School Valere Public Schools, Inc. Wayside Schools

EMPLOYEE BENEFITS

TRS Region 13 Medical Rates* TRS ActiveCare HD Employee Only $408.00 Employee & Spouse $1,102.00 Employee & Child(ren) $694.00 Employee & Family $1,388.00 TRS ActiveCare 2 Employee Only $1,013.00 Employee & Spouse $2,402.00 Employee & Child(ren) $1,507.00 Employee & Family $2,841.00 TRS ActiveCare Primary Employee Only $395.00 Employee & Spouse $1,067.00 Employee & Child(ren) $672.00 Employee & Family $1,343.00 TRS ActiveCare Primary+ Employee Only $463.00 Employee & Spouse $1,204.00 Employee & Child(ren) $788.00 Employee & Family $1,528.00 West Texas HMO Employee Only $865.00 Employee & Spouse $2,103.16 Employee & Child(ren) $1,361.42 Employee & Family $2,233.34 Scott and White HMO Employee Only $515.37 Employee & Spouse $1,293.46 Employee & Child(ren) $828.11 Employee & Family $1,488.60 *Listed rates do not include employer contributions.

TRS-ActiveCare has more doctors and hospitals than the hill country has hills.

TRS-ActiveCare Plan Highlights 2023-24 Learn the Terms. • Premium: The monthly amount you pay for health care coverage. • Deductible: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay its portion. • Copay: The set amount you pay for a covered service at the time you receive it. The amount can vary by the type of service. • Coinsurance: The portion you’re required to pay for services after you meet your deductible. It’s often a specified percentage of the costs; i.e. you pay 20% while the health care plan pays 80%. • Out-of-Pocket Maximum: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket 19 maximum, the plan pays 100% of allowable charges for covered services.

762376.0523

2023-24 TRS-ActiveCare Plan Highlights Sept. 1, 2023 – How to Calculate Your Monthly Premium

All TRS-ActiveCare participants have three plan options. E TRS-ActiveCare Primary

Total Monthly Premium Your District and State Contributions

Plan Summary

Your Premium

TRS-

• Lower deductible t • Copays for many s • Higher premium • Statewide network • PCP referrals requi • Not compatible wit • No out-of-network

Ask your Benefits Administrator for your district’s specific premiums.

Monthly Premiums

Wellness Benefits at No Extra Cost* Being healthy is easy with:

• One-on-one health coaches

Your Premium

Total Premi

Employee Only

$395

$463

Employee and Spouse

$1,067

$1,204

Employee and Children

$672

$788

Employee and Family

$1,343

$1,528

Plan Features

• $0 preventive care • 24/7 customer service

Total Premium

Type of Coverage Individual/Family Deductible Coinsurance

In-Network Coverage Only You pay 30% after deductible

Individual/Family Maximum Out of Pocket

$7,500/$15,000

Network

Statewide Network

• Weight loss programs

$2,500/$5,000

PCP Required

Yes

Primary Care

$30 copay

Specialist

$70 copay

Urgent Care

$50 copay

You

• Nutrition programs • OviaTM pregnancy support

Doctor Visits

• TRS Virtual Health • Mental health benefits • And much more! *Available for all plans. See the benefits guide for more details.

Immediate Care Emergency Care

You pay 30% after deductible

You

TRS Virtual Health-RediMD (TM)

$0 per medical consultation

TRS Virtual Health-Teladoc

$12 per medical consultation

New Rx Benefits!

Prescription Drugs Drug Deductible Generics (31-Day Supply/90-Day Supply)

Integrated with medical

$200 deducti

$15/$45 copay; $0 copay for certain generics

Preferred

You pay 30% after deductible

You

Non-preferred

You pay 50% after deductible

You

Specialty (31-Day Max)

$0 if SaveOnSP eligible; You pay 30% after deductible

Insulin Out-of-Pocket Costs

$25 copay for 31-day supply; $75 for 61-90 day supply

You

$25 copay for 3

Aug. 31, 2024

Each includes a wide range of wellness benefits.

-ActiveCare Primary+

TRS-ActiveCare HD

than the HD and Primary plans services and drugs

k ired to see specialists th a Health Savings Account (HSA) coverage

ium

Your Premium

Total Premium

Your Premium

This plan is closed and not accepting new enrollees. If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan.

Total Premium

Your Premium

$408

$1,013

$1,102

$2,402

$694

$1,507

$1,388

$2,841

n-Network Coverage Only

In-Network

Out-of-Network

$1,200/$2,400

$3,000/$6,000

$5,500/$11,000

$1,000/$3,000

$2,000/$6,000 You pay 40% after deductible $23,700/$47,400

In-Network

Out-of-Network

u pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible

$6,900/$13,800

$7,500/$15,000

$20,250/$40,500

$7,900/$15,800

Statewide Network

Nationwide Network

Yes

$15 copay

You pay 30% after deductible

You pay 50% after deductible

$30 copay

You pay 40% after deductible

$70 copay

You pay 30% after deductible

You pay 50% after deductible

$70 copay

You pay 40% after deductible

$50 copay

You pay 30% after deductible

You pay 50% after deductible

$50 copay

You pay 40% after deductible

You pay a $250 copay plus 20% after deductible

u pay 20% after deductible

You pay 30% after deductible

0 per medical consultation

$30 per medical consultation

$0 per medical consultation

$42 per medical consultation

$12 per medical consultation

Integrated with medical

$200 brand deductible

12 per medical consultation

ible per participant (brand drugs only) $15/$45 copay

You pay 20% after deductible; $0 coinsurance for certain generics

$20/$45 copay

u pay 25% after deductible

You pay 25% after deductible

u pay 50% after deductible

You pay 50% after deductible

You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max)

$0 if SaveOnSP eligible; u pay 30% after deductible

You pay 20% after deductible

31-day supply; $75 for 61-90 day supply

You pay 25% after deductible

TRS-ActiveCare Primary

TRS-ActiveCare HD

TRS-ActiveCare Primary+

TRS-ActiveCare 2 (closed to new enrollees)

New 2023-24 Total Premium

Change in Dollar Amount

Key Plan Changes

Employee Only

$364

$395

$31

Employee and Spouse

$1,026

$1,067

$41

• Individual maximum-out-of-pocket decreased by $650. Previous amount was $8,150 and is now $7,500.

Employee and Children

$654

$672

$18

Employee and Family

$1,228

$1,343

$115

• Family maximum-out-of-pocket decreased by $1,300. Previous amount was $16,300 and is now $15,000.

Employee Only

$376

$408

$32

Employee and Spouse

$1,058

$1,102

$44

Employee and Children

$675

$694

$19

Employee and Family

$1,265

$1,388

$123

Employee Only

$457

$463

Employee and Spouse

$1,117

$1,204

$87

Employee and Children

$735

$788

$53

Employee and Family

$1,405

$1,528

$123

Employee Only

$1,013

Employee and Spouse

$2,402

• No changes.

Employee and Children

$1,507

• This plan is still closed to new enrollees.

Employee and Family

$2,841

• Family deductible decreased by $1,200. Previous amount was $3,600 and is now $2,400. • Primary care provider copay decreased from $30 to $15.

At a Glance

Primary

Primary+

Premiums

Lowest

Lower

Higher

Deductible

Mid-range

High

Low

Copays

Yes

Network

Statewide network

Nationwide network

Statewide network

PCP Required?

Yes

HSA-eligible?

Yes

Effective: Sept. 1, 2023

Compare Prices for Common Medical Services

REMEMBER: Benefit

Call a Personal Health Guide (PHG) any time 24/7 to help you find the best price for a medical service. Reach them at 1-866-355-5999. TRS-ActiveCare Primary

TRS-ActiveCare Primary+

In-Network Only

Office/Indpendent Lab: You pay $0

TRS-ActiveCare HD In-Network

In-Network

Out-of-Network

Office/Indpendent Lab: You pay $0 You pay 30% after deductible

Diagnostic Labs*

Out-of-Network

TRS-ActiveCare 2

You pay 40% after deductible

You pay 50% after deductible

Outpatient: You pay 30% after deductible

Outpatient: You pay 20% after deductible

High-Tech Radiology

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible + $100 copay per procedure

You pay 40% after deductible + $100 copay per procedure

Outpatient Costs

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible

You pay 20% after deductible ($150 facility copay per incident)

You pay 40% after deductible ($150 facility copay per incident)

Inpatient Hospital Costs

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 50% after deductible ($500 facility per day maximum)

You pay 20% after deductible ($150 facility copay per day)

You pay 40% after deductible ($500 facility per day maximum)

Freestanding Emergency Room

You pay $500 copay + 30% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 30% after deductible

You pay $500 copay + 50% after deductible

You pay $500 copay + 20% after deductible

You pay $500 copay + 40% after deductible

Facility: You pay 30% after deductible

Facility: You pay 20% after deductible

Facility: You pay 20% after deductible ($150 facility copay per day)

Professional Services: Professional Services: You pay $5,000 You pay $5,000 copay + 20% after copay + 30% after deductible deductible

Professional Services: You pay $5,000 copay + 20% after deductible

Bariatric Surgery

Outpatient: You pay 20% after deductible

Not Covered

Only covered if rendered at a BDC+ facility

Annual Vision Exam (one per plan year; performed by an ophthalmologist or optometrist)

You pay $70 copay

You pay 30% after deductible

You pay 50% after deductible

You pay $70 copay

You pay 40% after deductible

Annual Hearing Exam (one per plan year)

$30 PCP copay $70 specialist copay

You pay 30% after deductible

You pay 50% after deductible

$30 PCP copay $70 specialist copay

You pay 40% after deductible

*Pre-certification for genetic and specialty testing may apply. Contact a PHG at 1-866-355-5999 with questions.

www.trs.texas.gov Revised 05/30/23

2023-24 Health Maintenance Organization (HMO) Plans and Premiums for Select Regions of the State 2023-24 Health Maintenance Organization (HMO) Plans and Premiums for Select Regions of the State

REMEMBER: REMEMBER:

Remember that when you choose an HMO, you’re choosing a regional network. Remember that when you choose an HMO, you’re choosing a regional network.

TRS contracts with HMOs in certain regions to bring participants in those areas additional options. TRS contracts with HMOs in certain regions to bring participants in those areas additional options. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims. Central and North Texas Central and North Texas Baylor Scott & White Health Plan Baylor Scott & White Health Plan Brought to you by TRS-ActiveCare

Brought to you by TRS-ActiveCare You can choose this plan if you live in You can choose this plan if you live in one of these counties: Austin, Bastrop, one of theseBosque, counties: Austin, Bastrop, Bell, Blanco, Brazos, Burleson, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Collin, Coryell, Dallas, Burnet, Caldwell, Collin, Dallas, Denton, Ellis, Erath, Falls,Coryell, Freestone, Denton, Ellis, Erath,Hays, Falls,Hill, Freestone, Grimes, Hamilton, Hood, Houston, Grimes, Hamilton, Hays, Hood, Houston, Johnson, Lampasas, Lee,Hill, Leon, Limestone, Johnson, Lampasas, Leon, Limestone, Madison, McLennan, Lee, Milam, Mills, Madison,Robertson, McLennan,Rockwall, Milam, Mills, Navarro, Somervell, Navarro, Robertson, Rockwall, Somervell, Tarrant, Travis, Walker, Waller, Washington, Tarrant, Travis, Walker, Waller, Washington, Williamson Williamson

Total Monthly Premiums Total Monthly Premiums

Employee Only Employee Only Employee and Spouse Employee and Spouse Employee and Children Employee and Children Employee and Family Employee and Family

Total Premium Total Premium $553.45 $515.37 $1,390.74 $1,293.46 $889.98 $828.11 $1,600.72 $1,488.60

$ $ $ $ $ $ $ $

Your Premium Your Premium

Blue Essentials - South Blue Essentials - South Texas HMO Brought toTexas you by HMO TRS-ActiveCare

Brought to you by TRS-ActiveCare You can choose this plan if you live You canofchoose this plan Cameron, if you live in one these counties: in one ofStarr, theseWillacy counties: Cameron, Hildalgo, Hildalgo, Starr, Willacy

Total Premium Total Premium N/A N/A N/A N/A N/A N/A N/A N/A

$ $ $ $ $ $ $ $

Your Premium Your Premium

Blue Essentials - West Texas HMO BlueBrought Essentials - West Texas HMO to you by TRS-ActiveCare Brought to you by TRS-ActiveCare

You can choose this plan if you live in one You can choose this plan if you live in one of these counties: Andrews, Armstrong, Bailey, of theseBrewster, counties:Briscoe, Andrews, Armstrong, Bailey, Borden, Callahan, Carson, Castro, Borden, Brewster, Callahan,Collingsworth, Carson, Castro, Childress, Cochran,Briscoe, Coke, Coleman, Childress, Cochran, Collingsworth, Comanche, Concho,Coke, Cottle,Coleman, Crane, Crockett, Crosby, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Dallam, Dawson, Deaf Smith, Dickens,Garza, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Eastland, Ector, Floyd, Gaines, Garza, Glasscock, Gray,Fisher, Hale, Hall, Hansford, Hartley, Glasscock, Gray, Hale, Hall, Howard, Hansford,Hutchinson, Hartley, Haskell, Hemphill, Hockley, Haskell, Hemphill, Hockley,King, Howard, Irion, Jones, Kent, Kimble, Knox,Hutchinson, Lamb, Irion, Jones,Llano, Kent,Loving, Kimble,Lubbock, King, Knox, Lamb, Lipscomb, Lynn, Martin, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Mason, Motley, McCulloch, Menard, Midland, Mitchell, Moore, Nolan, Ochiltree, Oldham, Parmer, Moore, Motley,Randall, Nolan, Ochiltree, Oldham,Roberts, Parmer, Pecos, Potter, Reagan, Reeves, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Sherman,Taylor, Stephens, Stonewall, Swisher, Terry,Sterling, Throckmorton, TomSutton, Green, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, Yoakum Upton, Ward, Wheeler, Winkler, Yoakum Total Premium Total Premium N/A $865.00 N/A $2,103.16 N/A $1,361.42 N/A $2,233.34

$ $ $ $ $ $ $ $

Your Premium Your Premium

Plan Plan Features Features Type Type of of Coverage Coverage Individual/Family Individual/Family Deductible Deductible Coinsurance Coinsurance Individual/Family Individual/Family Maximum Maximum Out Out of of Pocket Pocket

In-Network In-Network Coverage Coverage Only Only $2,400/$4,800 $2,400/$4,800

N/A N/A N/A N/A

In-Network N/A Coverage Only N/A $950/$2,850

You You pay pay 25% 25% after after deductible deductible $8,150/$16,300 $8,150/$16,300

N/A N/A N/A N/A

You pay 25%N/A after deductible N/A $7,450/$14,900

$20 $20 copay copay $70 copay $70 copay

N/A N/A N/A N/A

$20N/A copay N/A $70 copay

Doctor Visits Primary Primary Care Care Specialist Specialist

Immediate Care $45 $40 copay

N/A

$50N/A copay

Emergency Care Emergency Care

Urgent Care

$500 copay after deductible

N/A

N/A deductible $500 copay before + 25% after deductible

Drug Deductible Drug Deductible Days Supply Days Supply Generics Generics Preferred Brand Preferred Brand Non-preferred Brand Non-preferred Brand Specialty Specialty

$200 (excl. generics) $200 (excl. generics) 30-day supply/90-day supply 30-day supply/90-day supply $14/$35 copay $14/$35 You pay 35% after deductible You pay 35% after deductible You pay 50% after deductible You pay 50% after deductible You pay 35% after deductible You pay 35% after deductible

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

N/A $150 N/A 30-Day Supply/90-Day Supply N/A $5/$12.50 copay; $0 for certain generics N/A You pay 30% after deductible N/A You pay 50% after deductible N/A You pay 15%/25% after deductible (preferred/non-preferred)

Prescription Drugs Prescription Drugs

www.trs.texas.gov www.trs.texas.gov Revised 05/30/23 Revised 24 05/30/23

Health Savings Account (HSA) EECU

EMPLOYEE BENEFITS

ABOUT HSA A Health Savings Account (HSA) is a personal savings account where the money can only be used for eligible medical expenses. Unlike a flexible spending account (FSA), the money rolls over year to year however only those funds that have been deposited in your account can be used. Contributions to a Health Savings Account can only be used if you are also enrolled in a High Deductible Health Care Plan (HDHP). For full plan details, please visit your benefit website: www.esc20bc.net

A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a taxexempt 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 • 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 by the HDHP.

Maximum Contributions

Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2023 is based on the coverage option you elect: • Individual – $3,850 • Family (filing jointly) – $7,750 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 HSA Bank. 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.

Health Savings Account (HSA) EECU

EMPLOYEE BENEFITS

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; locations & service hours: www.eecu.org/locations

Hospital Indemnity

EMPLOYEE BENEFITS

CHUBB

ABOUT HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. For full plan details, please visit your benefit website: www.esc20bc.net

It’s not easy to pay hospital bills, especially if you have a high deductible medical plan. Chubb Hospital Cash pays money directly to you if you are hospitalized so you can focus on your recovery. And since the cash goes directly to you, there are no restrictions on how you use your money. Choose from 1 of 2 plans: Hospitalization Benefits

Payable Benefit PLAN 1

PLAN 2

Hospital Admission Benefit This benefit is for admission to a hospital or hospital sub-acute intensive care unit.

• •

$1,000 Maximum Benefit Per Calendar Year: 5

• •

$3,000 Maximum Benefit Per Calendar Year: 5

Hospital Confinement Benefit This benefit is for confinement in hospital or hospital sub-acute intensive care unit.

• •

$100 Per Day Maximum Days Per Calendar Year: 30

• •

$200 Per Day Maximum Days Per Calendar Year: 30

• •

$200 Per Day Maximum Days Per Calendar Year: 30

• •

$400 Per Day Maximum Days Per Calendar Year: 30

• •

$500 Per Day Maximum Days per Confinement - Normal Delivery: 2 Maximum Days per Confinement - Caesarean Section: 2

• •

$500 Per Day Maximum Days per Confinement - Normal Delivery: 2 Maximum Days per Confinement - Caesarean Section: 2

• •

$50 Maximum Benefit Per Calendar Year: 1

• •

$50 Maximum Benefit Per Calendar Year: 1

• •

$500 Maximum Benefit Per Calendar Year: 2

• •

$500 Maximum Benefit Per Calendar Year: 2

Hospital Confinement ICU Benefit The benefit for confinement in a hospital intensive care unit.

Newborn Nursery This benefit is payable for an insured newborn baby receiving newborn nursery care and who is not confined for treatment of a physical illness, infirmity, disease or injury.

Health Screening Benefit Observation Unit This benefit is for treatment in a hospital observation unit for a period of less than 20 hours.

Employee Employee + Spouse Employee + Child(ren) Family

•

Monthly Premiums PLAN 1 $9.72 $21.57 $17.98 $29.84

•

PLAN 2 $19.85 $44.07 $36.73 $60.95 27

Telehealth

EMPLOYEE BENEFITS

MDLive

ABOUT TELEHEALTH Telehealth provides 24/7/365 access to board-certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available. For full plan details, please visit your benefit website: www.esc20bc.net 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! • Unlimited, confidential online consultations for a variety of counseling needs with no copay. • The MDLIVE app helps you stay connected with appointment reminders, important notifications and secure messaging. * Does not apply to those with employer-paid telehealth. Check with your benefits office for details.

Registration is Easy

Register with MDLIVE so you are ready to use this valuable service when and where you need it. • Online – www.mdlive.com/fbsbh • Phone – 888-365-1663 • Mobile – download the MDLIVE mobile app to your smartphone or mobile device • Select –“MDLIVE as a benefit” and “FBS” as your Employer/Organization when registering your account. Telehealth Employee Family

$8.00 $16.00

Dental Insurance

EMPLOYEE BENEFITS

Cigna

ABOUT DENTAL Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease. For full plan details, please visit your benefit website: www.esc20bc.net

DPPO Plan

Coverage is provided through Cigna, and a High Plan and a Low Plan are offered. Those two levels of benefits are available with the DPPO plan: in-network and out-ofnetwork. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an outof-network provider.

How to Find an In-network Dentist

To search for a dentist on Cigna.com, visit the site and click “Find a Doctor, Dentist or Facility.” Follow the prompts on screen and when asked to choose your plan, select “DPPO/ EPO > Dental Choice Cigna DPPO.” Or call 800-244-6224 to find an in-network dentist.

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.

Employee Employee + Spouse Employee + Child(ren) Family

DHMO – Dental Plan

Coverage is provided through Cigna Dental Care DHMO benefits After you enroll in a plan and receive your ID card, you can manage your plan information on your personal home page on myCigna.com • You have the freedom to select any participating general dentist as your primary care dentist. To select a dental provider from our network, simply visit Cigna.com. Once there, you can also check your benefits, email us and get a new or temporary ID card. If you prefer, contact us at 1-800-244-6224. With the Cigna Dental DHMO plan you pay your dentist directly, when applicable. • Your primary dentist will provide all of your routine dental care and you will pay any copayment or discounted charges at the time of service. • Visit Cigna.com to find a participating specialist. For additional information refer to your benefits at www.esc20bc.net and select your school district and then Dental.

Dental High DPPO $35.09 $86.44 $94.77 $132.11

Low MAC $17.58 $35.72 $41.07 $62.71

DHMO $11.74 $22.16 $25.00 $38.70

Dental Insurance

EMPLOYEE BENEFITS

Cigna

Cigna Dental Choice Plan Summary Please see plan documents for details and limitations High PPO Plan

Reimbursement Levels Calendar Year Deductible Individual Family Calendar Year Benefit Maximum Per Individual

PPO Low Plan

In-Network ‘Total Cigna DPPO’

Out-of-Network

In-Network ‘Total Cigna DPPO’

Out-of-Network

Based on Contracted Fees

Maximum Reimbursable Charge

Based on Contracted Fees

Maximum Allowable Charge

$50 $150

Year 1: $1,750 Year 2: $2,000 Year 3: $2,250

$1,000

You Pay

Benefit Highlights Class I: Diagnostic & Preventive Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain

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

20% after deductible

Class III: Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Repairs: bridges, crowns and inlays Denture Relines, Rebases and Adjustments

50% after deductible

50% No Deductible

No Coverage

Class IV: Orthodontia Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000

Vision Insurance

EMPLOYEE BENEFITS

Superior Vision by MetLife 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.esc20bc.net

Our vision plan provides quality care to help preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes and high cholesterol. You may seek care from any licensed optometrist, ophthalmologist or optician, but plan benefits are better if you use an in-network provider. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Superior Vision.

How to Find a Vision Provider

Visit www.metlife.com/vision or call (877) 235-5317 to find an in-network vision provider. Your network is the Superior Vision by MetLife network. Copays

Services/frequency Base

Monthly Premiums

Base

Buy-Up

Base

Buy-Up

Exam

$10

Exam

12 months

Materials

$25

Frame

12 months

Employee

$6.88

$10.97

Employee + Spouse

$13.66

$21.79

Contact Lens Fitting

$25

Lenses

12 months

Employee + Child(ren)

$13.38

$21.34

Contacts

12 months

Family

$20.36

$32.48

Base Plan

Buy-Up Plan

In-network

Out-of-network

In-network

Out-of-network

Lenses • Single Vision • Bifocals • Trifocals • Factory Scratch Coat • Ultraviolet coat

Covered in full Covered in full Covered in full $15/Covered in full $12/Covered in full

Up to $32 Up to $46 Up to $61 Not Covered Not Covered

Covered in full Covered in full Covered in full Covered in full Covered in full

Up to $32 Up to $46 Up to $61 Not Covered Not Covered

Frames

$125 retail allowance

Up to $68

$175 retail allowance

Up to $68

Contacts • Contact lenses

$120 retail allowance

Up to $100

$120 retail allowance

Up to $100

*Contact lenses are in lieu of eyeglass lenses and frames benefit.

How to Print your Vision ID Card:

You can request your vision id card by contacting Superior Vision directly at (855) MET-EYE1. You can also go to www.metlife.com/vision and register/login to access your account by clicking on “Members” at the top of the page.

Disability Insurance The Hartford

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.esc20bc.net

What is Disability Insurance?

Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. The plan gives you flexibility to be able to choose an amount of coverage and waiting period that suits your needs. For more information regarding Disability insurance, please review information in your benefits website at www.esc20bc.net and select your school district to review your plan options.

Cancer Insurance

EMPLOYEE BENEFITS

APL

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.esc20bc.net

Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living, and household upkeep. In addition to these non-medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health. Should you need to file a claim contact APL at 800256-8606 or online at www.ampublic.com. You can find additional claim forms and materials at www.esc20bc.net. SUMMARY OF BENEFITS Benefits Internal Cancer First Occurrence* Cancer Screening Rider Benefits Diagnostic Testing- 1 test per calendar year Follow Up-Diagnostic Testing- 1 test per calendar year Medical Imaging- per calendar year Cancer Treatment Policy Benefits Radiation and Chemotherapy, Immunotherapy Maximum Per 12-month period Hormone Therapy- Maximum of 12 treatments per calendar year Surgical Rider Benefits Surgical Anesthesia Bone Marrow Transplant-Maximum per lifetime Stem Cell Transplant- Maximum per lifetime Misc. Care Rider Benefits Hair Piece (Wig)- 1 per lifetime Blood, Plasma &Platelets

Plan 1 $2,500

Plan 2 $2,500

$50 per test

$100 per test

$500 per test/ 1 per calendar year

$10,000

$20,000

$50 per treatment

Plan 1 $30 unit dollar amount Max $3,000 per operation

Plan 2 $45 unit dollar amount Max $4,500 per operation $0.50 per mile per round trip $100 per day, up to 100 days per calendar year

25% of amount paid for covered surgery $6,000

$9,000

$600

$900

Plan 1 $150 $300 per day

Plan 2 $150 $300 per day 33

Cancer Insurance

EMPLOYEE BENEFITS

APL

SUMMARY OF BENEFITS (cont’d) Misc. Care Rider Benefits Plan 1 Ambulance- Ground /Air-Maximum of Ground: $200 per trip 2 trips per Hospital Confinement for all Air: $2000 per trip modes of transportation combined Heart Attack/Stroke First Occurrence Plan 1 Rider Benefits Lump Sum Benefit- Maximum per 1 $2500 covered person per lifetime Hospital Intensive Care Unit Rider Plan 1 Benefits Intensive Care Unit $600 per day *Carcinoma in situ is not considered internal cancer

Plan 2 Ground: $200 per trip Air: $2000 per trip Plan 2 $2500 Plan 2 $600 per day

Pre-Existing Condition Exclusion: Review the Benefit Summary page that can be found at www.esc20bc.net for full details.

Employee Employee + Spouse Employee + Child(ren) Family

Cancer Plan 1 $17.80 $32.70 $24.80 $32.70

Plan 2 $32.40 $57.80 $44.60 $57.80

The plan includes an annual Wellness Benefit. Download a claim form on your benefit website: www.esc20bc.net Should you need to file a cancer claim contact APL at 800-256-8606 or online at www.ampublic.com. You can find additional claim forms and informational materials at www.esc20bc.net under your school district in the Cancer section of the portal.

Accident Insurance

EMPLOYEE BENEFITS

APL

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.esc20bc.net

The Accident Plan provided through American Public Life (APL) is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or not-so-serious, injury. Accident coverage is low-cost protection available to you and your family without evidence of insurability. Should you need to file a claim contact APL at 800-256-8606 or online at www.ampublic.com. You can find additional claim forms and materials on your employee benefits portal. Benefit Description

Summary of Benefits

Accidental Death – per unit

$5,000

Medical Expense Accidental Injury Benefit – per unit

Actual charges up to $500

Daily Hospital Confinement Benefit

$75 per day

Air and Ground Ambulance Benefit

Actual charges up to $1,250

Accidental Dismemberment Benefit • Single finger or toe • Multiple fingers or toes • Single hand, arm, foot or leg • Multiple hands, arms, feet or legs

$500 $500 $2,500 $5,000

Accidental Loss of Sight Benefit – per unit • Loss of sight in one eye • Loss of sight in both eyes

$2,500 $5,000

Accident Employee Employee + Spouse Employee + Child(ren) Family

$10.80 $19.40 $21.20 $29.80

Critical Illness Insurance

EMPLOYEE BENEFITS

CHUBB

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.esc20bc.net Available Coverage Choices Employee $10,000; $20,000; $30,000; or $40,000 face amounts Spouse $10,000; $20,000; $30,000; or $40,000 face amounts Child Included in the employee rate No benefit will be paid for a date of diagnosis that occurs prior to the coverage effective date. Covered individuals must be treatment free from cancer for 12 months prior to diagnosis date and in complete remission. There is no pre-existing condition limitation. All amounts are Guaranteed Issue- no medical questions are required for coverage to be issued.

Critical Illness Benefits Covered Conditions ALS Alzheimer's Disease Benign Brain Tumor Breast Cancer Carcinoma In Situ Cancer (See below for skin cancer) Carcinoma In Situ Coma Coronary Artery Obstruction End Stage Renal Failure Heart Attack Loss of Sight, Speech, or Hearing Major Organ Failure Multiple Sclerosis Paralysis or Dismemberment Parkinson’s Disease Severe Burns Stroke Sudden Cardiac Arrest Transient Ischemic Attacks Skin Cancer Benefit - Payable once per insured per year 36

Payable Benefit as a Percentage of Face Amount 100% 100% 100% 100% 100% 25% 100% 25% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 10% $500

Critical Illness Insurance

EMPLOYEE BENEFITS

CHUBB

Covered Conditions Occupational Package Pays 100% of the face amount; Benefits payable for HIV or Hepatitis B, C, or D, MRSA, Rabies, Tetanus, or Tuberculosis contracted on the job. Childhood Conditions Pays 100% of the dependent child face amount; Provides benefits for childhood conditions (Autism Spectrum Disorder; Cerebral Palsy; Congenital Birth Defects; Heart, Lung, Cleft Lip, Palate, etc; Cystic Fibrosis; Down Syndrome; Gaucher Disease; Muscular Dystrophy; Type 1 Diabetes). Miscellaneous. Disease Rider + COVID-19 The Miscellaneous Disease Rider is payable once per covered condition. Covered Conditions include: Addison’s Disease, Cerebrospinal Meningitis, Diphtheria, Huntington’s Chorea, Legionnaire’s Disease, Malaria, Myasthenia Gravis, Meningitis, Necrotizing Fasciitis, Osteomyelitis, Polio, Rabies, Scleroderma, Systemic Lupus, Tetanus, Tuberculosis. COVID-19 means a disease resulting in a positive COVID-19 diagnostic screening and 5 consecutive days of hospital confinement. Recurrence Benefit Benefits are payable for a subsequent diagnosis of Benign Brain Tumor, Cancer, Coma, Coronary Artery Obstruction, Heart Attack, Major Organ Failure, Severe Burns, Stroke, or Sudden Cardiac Arrest. Additional Benefits Waiver of Premium Waives premium while the Insured is totally disabled. Wellness Benefit - Payable once per insured per year

Payable Benefit as a Percentage of Face Amount Included

Included

25%

100%

Included $50

Life and AD&D

EMPLOYEE BENEFITS

CHUBB

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.esc20bc.net

Educator Group Term Life Insurance

Life insurance is an important part of your employee benefits package. Chubb Term Life and Accidental Death and Dismemberment (AD&D) insurance provides the protection your family needs if something were to happen to you. Your family can receive cash benefits paid directly to them that they can use to help cover expenses like mortgage payments, credit card debt, childcare, college tuition and other household expenses.

Benefit Summary

Voluntary Term Life and AD&D Insurance is made available for purchase by you and your family. Employees must be actively at work for at least 18.75 hours per week.

Life Insurance/AD&D

For You • Life/AD&D: $10,000 to $500,000 in $10,000 increments For Your Spouse Life: $10,000 to $500,000 in $10,000 increments AD&D: 50% of the employee AD&D amount not to exceed $250,000

• •

For Your Dependent Children Life: $10,000 AD&D: 10% of the employee AD&D amount to a maximum of $50,000

• •

Reduction Schedule 50% at age 70 Guaranteed Issue Employee: $300,000 Spouse: $50,000 Child: $10,000 You and your eligible dependents may enroll in amounts up to $300,000 for employee and $50,000 for spouse without

• • •

answering health questions. Amounts over the guaranteed issue will require medical underwriting. If you buy at least $10,000 of coverage during initial enrollment, you may buy up to the guaranteed issue in subsequent re-enrollments without medical underwriting.

Additional Plan Benefits Accelerated Death Benefit for Chronic Illness Up to 50% of Death Benefit in payments of 4% per month. Accelerated Death Benefit for Terminal Illness 75% of Death Benefit Employee Assistance Program 6 visits Travel Assistance Services Included AD&D Covered Losses and Benefits The AD&D plan provides additional protection for you and your dependents in the event of an accidental bodily injury resulting in death or dismemberment. In addition to standard dismemberment coverage, the following benefit provisions are included: • Child Care Expense Benefit – 10% of AD&D Benefit up to $4,000 per year for 5 years • Child Education Expense Benefit – 10% of AD&D Benefit up to $4,000 for up to 5 years • Exposure and Disappearance Benefit • Repatriation Expense Benefit – 10% of AD&D Benefit up to $5,000 • Seatbelt Benefit – 10% of AD&D Benefit up to $25,000 • Air Bag Benefit – 10% of AD&D Benefit up to $5,000

Life and AD&D

EMPLOYEE BENEFITS

CHUBB

Definitions and Provisions

Term Life Exclusions*

Conversion When your group coverage ends, you may convert your coverage to an individual life policy without providing evidence of insurability.

AD&D Exclusions*

Portability You can elect portable coverage, at group rates, if you terminate employment, reduce hours or retire from the employer.

Monthly Costs for Voluntary Term Life/AD&D Insurance You have the option to purchase Supplemental Term life Insurance. Listed below are the monthly rates.

Voluntary Group Life Employee Spouse Monthly Age Band Monthly Life Rate Life Rate per per $10,000 $10,000 <25 $0.50 $0.50 25-29 $0.50 $0.50 30-34 $0.70 $0.70 35-39 $0.80 $0.80 40-44 $1.00 $1.00 45-49 $1.40 $1.40 50-54 $2.40 $2.40 55-59 $3.90 $3.90 60-64 $5.90 $5.90 65-69 $8.30 $8.30 70-74 $10.30 $10.30 75+ $14.70 $14.70 Child Life $10,000 $1.80 One premium covers all children

No benefits will be paid for losses that are caused by, contributed to, or result from: 1) suicide, while sane or insane, occurring within 12 months after a Covered Person’s initial effective date of coverage; and 2) suicide, while sane or insane, occurring within two years after the date any increases in or additional coverage applied for becomes effective for a Covered Person. No benefits will be paid for any loss caused or contributed to by: 1) attempted suicide; 2) intentionally self-inflicted harm; 3) travel if Insured is other than passenger; 4) war; 5) active participation in a riot, insurrection, or terrorist activity; 6) committing or attempting to commit a felony; 7) voluntary intake or use by any means of any drug, unless taken in accordance with instructions; 8) any poison, gas or fumes, unless a direct result of an occupational accident; 9) being intoxicated; 10) bungee jumping; 11) participation in an illegal occupation/activity; 12) rock or mountain climbing; and 13) aeronautics.

Voluntary AD&D - $10,000 in coverage

Employee Family

$0.25 $0.40

Individual Life Insurance 5Star

EMPLOYEE BENEFITS

ABOUT INDIVIDUAL LIFE Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire. For full plan details, please visit your benefit website: www.esc20bc.net

Enhanced coverage options for employees. Easy and flexible enrollment for employers. The 5Star Life Insurance Company’s Family Protection Plan offers both Individual and Group products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees. CUSTOMIZABLE With several options to choose from, employees select the coverage that best meets the needs of their families. TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL). PORTABLE Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly. CONVENIENCE Easy payments through payroll deduction. FAMILY PROTECTION Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves. * Financially dependent children 14 days to age 23. PROTECTION TO COUNT ON Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions. QUALITY OF LIFE Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following: • Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision. Find full details and rates at www.esc20bc.net Should you need to file a claim, contact 5Star directly at (866) 863-9753. * Quality of Life not available ages 66-70. Quality of Life benefits not available for children Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years).$7.15 monthly for $10,000 coverage per child.

Emergency Medical Transport MASA

EMPLOYEE BENEFITS

ABOUT MEDICAL TRANSPORT Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan. For full plan details, please visit your benefit website: www.esc20bc.net

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 benefit Emergency Transportation Emergent Plus Employee and Family

$14.00

Identity Theft

EMPLOYEE BENEFITS

ID Watchdog

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.esc20bc.net

Easy & Affordable Identity Protection

Your identity is important — it’s what makes you, you. You’ve spent a lifetime building your name and financial reputation. Let us help you better protect it. And we’ll even go one step further and help you better protect the identities of your family!

Features • •

Credit Lock- helps provide additional protection against unauthorized access to your credit More For Families- helps better protect your loved ones no matter the age. Resolution Specialist- manage the case for you until your identity is restored

Manage & Alert • Child Credit Lock*| 1Bureau • Credit Report Lock | 1Bureau* • Financial Accounts Monitoring • Social Network Alerts* • Registered Sex Offender Reporting* • Customizable Alert Options • Breach Alert Emails • Mobile App • National Provider ID Alerts

Call 866-513-1518 or download the app to additional services.

Support & Restore • Identity Theft Resolution Specialists (Resolution for Pre existing Conditions)* • 24/7/365 U.S.-based Customer Care Center • Up to $1M Identity Theft Insurance* • Lost Wallet Vault & Assistance • Deceased Family Member Fraud Remediation • Fraud Alert & Credit Freeze Assistance

IDENTITY THEFT PROTECTION

*Helps better protect children

•

ID watchdog Monitors: social media, transaction records, public records, and more.

How to file a claim:

The Powerful Features You Want — All at an Affordable Price Monitor & Detect • Credit Report & VantageScore • Credit Score | 1 Bureau Monthly • Credit Score Tracker | 1 Bureau Monthly • Credit Report Monitoring1 | 3 Bureau • Dark Web Monitoring* • High-Risk Transactions Monitoring* • Subprime Loan Monitoring* • Public Records Monitoring* • USPS Change of Address Monitoring • Identity Profile Report

Identity Theft Employee Family

$7.95 $14.95

Flexible Spending Account (FSA) Higginbotham

EMPLOYEE BENEFITS

ABOUT FSA A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $610 rollover or grace period provision). For full plan details, please visit your benefit website: www.esc20bc.net 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 $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 The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s). Dependent Care FSA The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full-time student. Things to Consider Regarding the Dependent Care FSA • Overnight camps are not eligible for reimbursement (only day camps can be considered). • If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13. • You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care. • The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes. 43

Flexible Spending Account (FSA) Higginbotham

EMPLOYEE BENEFITS

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 head of household and $2,500 when married filing separately. • You cannot change your election during the year unless you experience a Qualifying Life Event. • You can continue to file claims incurred during the plan year for another 90 days after August 31st. • Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses. Higginbotham Portal The Higginbotham Portal provides information and resources to help you manage your FSAs. • Access plan documents, letters and notices, forms, account balances, contributions and other plan information • Update your personal information • Utilize Section 125 tax calculators • Look up qualified expenses • Submit claims • Request a new or replacement Benefits Debit Card Register on the Higginbotham Portal Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information. • Enter your Employee ID, which is your Social Security number with no dashes or spaces. • Follow the prompts to navigate the site. • If you have any questions or concerns, contact Higginbotham: ◊ Phone – 866-419-3519 ◊ Email – flexclaims@higginbotham.net ◊ Fax – 866-419-3516 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 in order to use the mobile app.

Employee Assistance Program (EAP) ComPsych

EMPLOYEE BENEFITS

ABOUT EAP An Employee Assistance Program (EAP) is a program that assists you in resolving problems such as finding child or elder care, relationship challenges, financial or legal problems, etc. This program is provided by your employer at no cost to you. For full plan details, please visit your benefit website: www.esc20bc.net

Why I Need Employee Assistance

Balancing work and life is difficult sometimes. Your EAP option covers trouble areas such as: • Substance abuse • Stress management • Financial problems EAP Employee Assistance Program: This is an added value of your Basic Life Insurance plan with the district that offers no cost counseling up to 6 Sessions in- person per plan year. For full plan details, please visit your benefit website, www.esc20bc.net and select your school district.

ESC20BC Mobile App Login Group #’s Use your District’s group # to login to the FBS Benefits app. District

GROUP #

District

GROUP #

Alameda School for Art and Design

ESC20A

Knippa ISD

ESC20S

Big Springs Charter School

ESC20B

Leakey ISD

ESC20U

Brackett ISD

ESC20C

Legacy Traditional Schools - Texas

ESC20AD

BRAINATION (Charter)

ESC20D

Meadowland Charter School

ESC20AV

Charlotte ISD

ESC20F

Meridian World School

ESC20AW

Dime Box ISD

ESC20G

New Frontiers Public Schools

ESC20AX

Divide ISD

ESC20V

Nixon-Smiley CISD

ESC20AY

Doral ISD

ESC20AZ

Prairie Lea ISD

ESC20AA

Dripping Springs ISD

ESC20H

Prelude Preparatory

ESC20AK

Eleanor Kolitz Hebrew Language Academy

ESC20I

Promesa Public Schools

ESC20AB

ESC Region 20

ESC20J

San Antonio Preparatory

ESC20AC

Fayetteville ISD

ESC20L

Schulenburg ISD

ESC20AE

Flatonia ISD

ESC20M

Smithville ISD

ESC20AF

Harper ISD

ESC20N

Somerset Academy Inc.

ESC20AG

Johnson City ISD

ESC20O

Southwest Preparatory School

ESC20AH

Jourdanton ISD

ESC20P

Texas Preparatory School

ESC20AI

Jubilee Academies

ESC20Q

Utopia ISD

ESC20AJ

Katherine Anne Porter School

ESC20R

Wayside Schools

ESC20AL

Notes

2023 - 2024 Plan Year

Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the ESC Region 20 BC 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 ESC Region 20 BC 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.