2023-24 Life School of Dallas Benefit Guide

LIFE SCHOOL OF DALLAS BENEFIT GUIDE

EFFECTIVE: 09/01/2023 - 8/31/2024

WWW.MYBENEFITSHUB.COM/LIFESCHOOLOFDALLAS

Benefit Contact Information

BENEFIT ADMINISTRATOR LIFE SCHOOL OF DALLAS BENEFITS

Financial Benefit Services

(800) 583-6908

www.mybenefitshub.com/

lifeschoolofdallas

HOSPITAL INDEMNITY PLAN

Cigna Group #HC110473

(800) 754-3207

www.mycigna.com

Mayda Falcon Central Office

(469)850-5433

Mayda.Falcon@lifeschools.net

HEALTH SAVINGS ACCOUNT

EECU

(817) 882-0800

www.eecu.org

MEDICAL

Blue Cross Blue Shield of Texas

(972) 766-6900

(800) 512-2227

www.bcbstx.com

FLEXIBLE SPENDING ACCOUNT

National Benefit Services (800) 274-0503

www.nbsbenefits.com

DENTAL VISION DISABILITY

Lincoln Financial Group

(800) 423-2765

Dental Low Plan: 0001D040928

Dental High Plan: 0001D040929

Dental HMO: 0001D040930

https://www.lfg.com/

ACCIDENT

VOYA Financial Group #0070618-3

(800) 955-7736

www.voya.com

INDIVIDUAL LIFE

5 Star Life Insurance Company

(866) 863-9753

www.5starlifeinsurance.com

Superior Vision Group #037494

(800) 507-3800

Superior National Network

www.superiorvision.com

CRITICAL ILLNESS

The Hartford Group #: 884986

(800) 583-6908

File a claim: (866) 278-2655

www.thehartford.com

UNUM (866) 679-3054

STD Group #419941

LTD Group #419942

www.unum.com

LIFE AND AD&D

OneAmerica Financial Partners, Inc.

Group #00617146

(800) 537-6442

www.oneamerica.com

EMERGENCY MEDICAL TRANSPORT IDENTITY THEFT PROTECTION

MASA Group # MKLIFE

(800) 423-3226

www.masamts.com

EMPLOYEE ASSISTANCE PROGRAM (EAP) 403(B) RETIREMENT PLANNING

ComPsych Guidance Resources Program

Group #ONEAMERICA3

(855) 387-9727

https://www.guidanceresources.com/

NBS Retirement Service Center

(800) 274-0503 ext 2,5

nbsbenefits.com/403b

Aura Identity Guard (855) 443-7748

www.identityguard.com

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www.mybenefitshub.com/lifeschoolofdallas

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ENTER

USERNAME & PASSWORD

Username:

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 less than six (6) characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.

Default Password: Last Name* (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.

Password Reset Date: 04/13/2023

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 Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

CHANGES IN STATUS (CIS): QUALIFYING EVENTS

Marital Status

Change in Number of Tax Dependents

Change in Status of Employment Affecting Coverage Eligibility

Gain/Loss of Dependents’ Eligibility Status

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

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

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

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

If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual’s plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.

Eligibility for Government Programs

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

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 eligibility 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 Office or you can call Financial Benefit Services at (866) 914-5202 for assistance.

Where can I find forms?

For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/ lifeschoolofdallas. 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 Life School of Dallas benefit website: www.mybenefitshub. com/lifeschoolofdallas. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.

When will I receive ID cards?

If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card.

If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

Annual Benefit Enrollment

Employee Eligibility Requirements

Supplemental Benefits: Eligible employees must work 32 or more regularly scheduled hours each work week.

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

Dependent Eligibility Requirements

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

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

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

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

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

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

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

Helpful Definitions

Actively-at-Work

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

Annual Enrollment

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

Annual Deductible

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

Calendar Year

January 1st through December 31st

Co-insurance

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

Guaranteed Coverage

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

In-Network

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

Out-of-Pocket Maximum

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

Plan Year

September 1st through August 31st

Pre-Existing Conditions

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

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

Permissible Use Of Funds

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

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

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

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

Not permitted

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?

Hospital Indemnity Cigna

ABOUT HOSPITAL INDEMNITY

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

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

Summary of Benefits

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

Benefit Waiting Period:* None, unless otherwise stated. No benefits will be paid for a loss which occurs during the Benefit Waiting Period.

Limited to 30 days.

Observation Stay

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.

How do I submit a claim?

Complete the claim form with the link provided below: https://www.cigna.com/static/www-cigna-com/docs/individuals-families/member-resources/hospital-care-claim-form.pdf

Options for filing the Claim Form:

• Call (800) 754-3207 to speak with one of our dedicated customer service representatives.

• Email your scanned documents to: SuppHealthClaims@Cigna.com

Hospital Indemnity Cigna

Benefit Amounts Payable: Benefits for all Covered Persons are payable at 100% of the Benefit Amounts shown, unless otherwise stated. Late applicants, if allowed under this plan, may be required to provide medical evidence of insurability.

NOTE: The following are some of the important policy provisions, terms and conditions that apply to benefits described in the policy. This is not a complete list. See your Certificate of Insurance for more information.

Benefit-Specific Conditions, Exclusions & Limitations (Hospital Care):

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.

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/lifeschoolofdallas

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 (Offered only under the TSHBP HD or AETNA HD plans)

• 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 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.

Health Savings Account (HSA)

Opening an HSA

EMPLOYEE BENEFITS

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.

Flexible Spending Account (FSA)

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/lifeschoolofdallas

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).

How the Health Care FSAs Work

You can access the funds in your Health Care FSA two different ways:

• Use your NBS Debit Card to pay for qualified expenses, doctor visits and prescription copays.

• Pay out-of-pocket and submit your receipts for reimbursement:

◊ Fax – (844) 438-1496

◊ Email – service@nbsbenefits.com

◊ Online – my.nbsbenefits.com

◊ Call for Account Balance: (855) 399-3035

◊ Lost or Stolen Debit Cards Replacement Fee $5.00 (taken from account balance)

◊ Mail: PO Box 6980 West Jordan, UT 84084

Contact NBS

• Hours of Operation: 6:00 AM – 6:00 PM MST, Mon-Fri

• Phone: (800) 274-0503

• Email: service@nbsbenefits.com

• Mail: PO Box 6980 West Jordan, UT 84084

Dependent Care FSA

This account 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.

Flexible Spending Account (FSA)

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 30 days (up until date).

• Your Health Care or Limited Purpose 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 (OTC) Item Rule

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.

Dependent Care FSA

FSAstore.Com

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-thecounter 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

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

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

Reduces your taxable income

Check out the FSAstore at: https://fsastore.com. It offers thousands of FSA-eligible products and services to purchase using your FSA Debit Card or any major credit card. Competitive pricing and free shipping on orders over $50 can save you up to 40% using your FSA pretax dollars.

Dental Insurance

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/lifeschoolofdallas

Dental PPO High Option

Rates shown include the Disrict Contribution

Benefits At-A-Glance - Group# 0001D040929

• Plan cover many preventive, basic, and major dental care services. (See Below)

• Both plans allow you to choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist.

• Does not make you and your dependents wait six months between routine cleanings.

Plan Year Deductible

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

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

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

Plan Year Maximum $2,000 $2,000

Plan Year Maximums are combined for preventive, basic, and major services.

Waiting Period There are no benefit waiting periods for any service types

Lifetime Orthodontic Max $1,000 $1,000

Orthodontic Coverage is available for dependent children. Age 19

Basic Services

• Palliative treatment (including emergency relief of dental pain) Injections of antibiotics and other therapeutic medications Fillings

• Simple extractions Surgical extractions Oral surgery

• Biopsy and examination of oral tissue (including brush biopsy) General anesthesia and I.V. sedation

• Prosthetic repair and recementation services Endodontics (including root canal treatment) Periodontal maintenance procedures

• Non-surgical periodontal therapy Periodontal surgery

• Denture reline and rebase services

• Occlusal guard

Dental Insurance Lincoln Financial EMPLOYEE BENEFITS

Dental PPO Low Option

Benefits At-A-Glance - Group# 0001D040928

You can request your dental ID card by contacting Lincoln Financial Dental directly at (800) 423-2765 and mention Group ID: LIFESCHDAL

Contracting Dentists Non-Contracting Dentists

Individual: $100 Family: $300

Individual: $100 Family: $300

Plan Year Deductible

Waived for: Preventive

Waived for: Preventive

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

Plan Year Maximum $750 $750

Plan Year Maximums are combined for preventive, basic, and major services.

Waiting Period There are no benefit waiting periods for any service types

Basic Services

• Palliative treatment (including emergency relief of dental pain) Injections of antibiotics and other therapeutic medications Fillings

• Biopsy and examination of oral tissue (including brush biopsy) Prosthetic repair and recementation services

• Denture reline and rebase services

You can also go to www.lfg.com and register/login to access your account and Downloand the Lincoln Dental Mobile App.

• Find a network dentist near you in minutes

• Have an ID card on your phone

• Customize the app to get details of your plan

DHMO Plan

Benefits At-A-Glance - Group #0001D040930

• Find out how much your plan covers for checkups and other services

• Keep track of your claims

Trips to the dentist are a little less scary when you know how much you’ll pay ahead of time. And easier, too, with no claim forms or deductibles.

Here’s how this important coverage works.

• You choose your primary-care dentist when you enroll. To find a participating dentist, visit http://ldc.lfg.com and select Find a Dentist. (You can also print your dental ID card from this site once your coverage begins.)

• This dental plan offers a detailed list of covered procedures, each with a dollar copayment (see the Summary of Benefits for details). You pay for services provided during your visit.

• Emergency care away from home is covered up to a set dollar limit.

• You can change your primary-care dentist at any time by calling the customer service number listed on your dental ID card.

Vision Insurance Superior Vision

ABOUT VISION

Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses.

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

How to Print your Vision ID Card:

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

Vision Insurance Superior Vision EMPLOYEE BENEFITS

Discount Features

Look for providers in the provider directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-30%) prior to service as they vary.

Discounts on covered materials

Frames: 20% off amount over allowance

Lens options: 20% off retail

Progressives: 20% off amount over retail lined trifocal lens, including lens options

Speciality contact lens fit: 10% off retail, then apply allowance

Discounts on non-covered exam, services and materials

Exams, frames, and prescription lenses: 30% off retail

Lens options, contacts, miscellaneous options: 20% off retail

Disposable contact lenses: 10% off retail

Retinal imaging: $39 maximum out-of-pocket

Maximum member out-of-pocket

The following options have out-of-pocket maximums5 on standard (not premium, brand, or progressive) lenses.

High index 1.6

5. Discounts and maximums may vary by lens type. Please check with your provider.

Refractive Surgery

Superior Vision has a nationwide network of independent refractive surgeons and partnerships with leading LASIK networks who offer members a discount. These discounts range from 10%-50%, and are the best possible discounts available to Superior Vision.

Long Term Disability Insurance

ABOUT DISABILITY

Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.

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

Who is eligible?

You are eligible for Long Term Disability (LTD) coverage if you are an active employee in the United States working a minimum of 32 hours per week. This benefit is employer paid.

What is my monthly benefit amount?

Your employer is providing a benefit of 60% of your monthly earnings to a maximum of $9,500.

How long do I have to wait to receive benefits?

The elimination period is the length of time you must be continuously disabled before you can receive benefits.

You could begin receiving LTD benefits if, after 90 days of disability, you are still disabled (as described in the definition of disability).

If you return to work while satisfying the elimination period and are no longer disabled, you may satisfy the elimination period within the accumulation period – you don’t have to be continuously disabled through the elimination period, if you are satisfying the elimination period under this provision. If you don’t satisfy the elimination period within the accumulation period, a new period of disability will begin.

Accumulation Period is the period of time from the date the disability begins during which you must satisfy the elimination period. The accumulation period is two times your elimination period.

During your elimination period, you will be considered disabled if you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury, and you are under the regular care of a physician. You are not required to have a 20% or

more earnings loss to be considered disabled during the elimination period due to the same sickness or injury.

How long will my benefits last?

The duration of your benefit payments is based on your age when your disability occurs. Your LTD benefits are payable for the period during which you continue to meet the definition of disability. If your disability occurs before age 62, benefits could be payable up to the Social Security Normal Retirement Age. If your disability occurs at or after age 62, your benefits would be paid according to the benefit duration schedule.

What is my maximum monthly benefit amount?

Your total monthly benefit (including all benefits provided under this plan) will not exceed 100% of your monthly earnings, unless the excess amount is payable as a Cost of Living Adjustment.

Can my benefit be reduced?

Your disability benefit may be reduced by deductible sources of income and any earnings you have while disabled. Deductible sources of income may include such items as disability income or other amounts you receive or are entitled to receive under: workers’ compensation or similar occupational benefit laws; state compulsory benefit laws; automobile liability and no fault insurance; legal judgments and settlements; certain retirement plans; other group or association disability programs or insurance; and amounts you or your family receive or are entitled to receive from Social Security or similar governmental programs.

When would I be considered disabled?

During the first 24 months, you are disabled when Unum determines that:

Long Term Disability Insurance Unum EMPLOYEE BENEFITS

• You are unable to perform the material and substantial duties of your regular occupation* due to sickness or injury and are not working; or

• You have a 20% or more loss of indexed monthly earnings while working.

• After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury:

• You are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.

Can I receive rehabilitation and return-to-work services?

If you are deemed eligible and are participating in the program, Unum will pay an additional benefit of 10% of your gross disability payment to a maximum of $1,000 per month.

What other services are available?

If you are disabled, participating in the rehabilitation and return-to-work assistance program, and have dependent care expenses, you may also receive the dependent care expense benefit — $350 per dependent per month, to a monthly maximum of $1,000 for all eligible dependents combined.

Short Term Disability Insurance Unum 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/lifeschoolofdallas

Rates shown are calculated by using your annual salary. Please refer to the plan summary for a more detailed explanation.

Who is eligible?

You are eligible for Short Term Disability coverage if you are an active employee in the United States working a minimum of 32 hours per week.

What is my weekly benefit amount?

You can elect to purchase a benefit of 60% of your weekly earnings to a maximum of $500 per week.

How long do I have to wait to receive benefits?

The elimination period is the length of time you must be continuously disabled before you can receive benefits. If your disability is the result of a covered injury or sickness, you could begin receiving benefits after 7 days.

When would I be considered disabled?

• You are disabled when Unum determines that, due to sickness or injury:

• You are limited from performing the material and substantial duties of your regular occupation

• You have a 20% or more loss in weekly earnings due to the same sickness or injury.

• You must be under the regular care of a physician to be considered disabled.

*Unless the policy specifies otherwise, as part of the disability claims evaluation process, Unum will evaluate your occupation based on how it is normally performed in the national economy, not how work is performed for a specific employer, at a specific location, or in a specific region.

How long will my benefits last?

If you continue to meet the definition of disability, you may receive benefits for 12 weeks.

Accident Insurance Voya 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/lifeschoolofdallas

What is Accident Insurance?

Accident Insurance pays you benefits for specific injuries and events resulting from a covered accident that occurs, on or after your coverage effective date. The benefit amount depends on the type of injury and care received. You have the option to elect Accident Insurance to meet your needs. Accident Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

Other features of Accident Insurance include:

• Guaranteed issue: No medical questions or tests are required for coverage.

• Flexible: You can use the benefit payments for any purpose you like.

• Payroll deductions: Premiums are paid through convenient payroll deductions.

• Portable: If you leave your current employer, you can take your coverage with you.

How can Accident Insurance help?

• Medical expenses, such as deductibles and copays

• Home healthcare costs

• Lost income due to lost time at work

• Everyday expenses like utilities and groceries

How to File a Claim:

• www.voya.com

• Click contact and services

• Select Claims and then “start a claim”

• Complete the questionnaire so that a custom claim form package can be generated for you. Download your claim forms.

• Fill out each form by the appropriate party.

• Father additional supporting documents.

• Submit your completed and signed forms and supporting documents.

◊ Upload at voya.com

◊ Click on the contact and services

◊ Select “Upload a form”

• Mail and or Fax information provided on the top of your claim form package.

If you have any questions about the claim process, call (888) 238-4840.

Critical Illness Insurance The

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/lifeschoolofdallas

Critical Illness insurance can provide a lump-sum benefit upon diagnosis that can be used however you choose - from expenses related to treatment, to deductibles or day-to-day costs of living such as the mortgage or your utility bills.

COVERAGE INFORMATION

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

BENEFIT & FEATURES

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

– 24/7/365 access to help for financial, legal or emotional issues

Critical Illness Insurance The Hartford

Life and AD&D OneAmerica

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/lifeschoolofdallas

What you need to know about your Basic Life and AD&D Benefits

Guaranteed Issue: Employee: $20,000

Accidental Death and Dismemberment (AD&D): Additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. Additional AD&D benefits include seat belt, air bag, repatriation, child higher education, child care, paralysis/loss of use, severe burns, disappearance, and exposure.

Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.

Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule.

Basic Employee Life and AD&D Coverage

Your Life and AD&D insurance coverage amount is $20,000. This is an employer paid benefit to full time employees. Coverage is provided at no cost to you.

What you need to know about your Voluntary Term Life Benefits and AD&D Benefits

Flexible Options:

Employee: $10,000 to $500,000, in $10,000 increments.

Spouse: $10,000 to $500,000, in $5,000 increments, not to exceed 100% of the employee’s amount.

Guaranteed Issue:

Employee: $200,000

Spouse: $50,000

Child: $10,000

Dependent Life Coverage: Optional dependent life coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren).

Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.

Guaranteed Increase In Benefit: You may be eligible to increase your coverage annually until you reach your maximum amount without providing evidence of insurability.

Accidental Death and Dismemberment (AD&D): You must select Life coverage in order to select any AD&D coverage. Additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract.

Individual Life Insurance

ABOUT INDIVIDUAL LIFE

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

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

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 23 years old.

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.txescbenefits.com

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.

Individual Life Insurance

Emergency Medical Transport

ABOUT MEDICAL TRANSPORT

Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It can include emergency transportation via ground ambulance, air ambulance and helicopter, depending on the plan.

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

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 nonemergency 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 www.mybenefitshub.com/lifeschoolofdallas

Only $14.00 per month to cover you and your family!

Identity Theft Aura 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/lifeschoolofdallas

AURA™ IDENTITY GUARD® ULTIMATE PLAN

Identity and privacy protection to keep you and your family safe from online harm

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

Aura Identity Guard protects you and your family against cybercrime.

COMPREHENSIVE IDENTITY PROTECTION

• $1M in insurance protection1 of 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

Features that are included in all Aura Identity Guard

Plans:

PROACTIVE DEVICE & PRIVACY PROTECTION

• Safe browsing: Anti-ransomware & anti-malware

COMPREHENSIVE IDENTITY PROTECTION

• $1 Million insurance with stolen funds reimbursement 1

• 401(k) & HSA reimbursement

• Compromised credentials

• Auto-on monitoring

• High-risk transaction monitoring

• Bank account transaction monitoring

• Address monitoring

• Criminal record monitoring

• Fictitious identity monitoring

• Home title monitoring

• Sex offender monitoring

• Dark web monitoring

• Human-sourced intelligence

• Lost Wallet protection

• Risk management score

POWERFUL FINANCIAL TOOLS

• 1-Bureau credit monitoring

• Monthly credit score

• Credit score tracker

• Security freeze assistance

• Near real-time alerts

• Student loan activity alerts

BEST-IN-CLASS CUSTOMER CARE

• U.S.-based customer care

• End-to-end remediation

• Online identity dashboard

• Mobile App

Additional features in Aura Identity Guard’s Ultimate Plan:

PROACTIVE DEVICE & PRIVACY PROTECTION

• Device/cookie tracking protection

• E-mail solicitation/junk mail prevention

• Data broker list monitoring/removal

• Social insight report

COMPREHENSIVE IDENTITY PROTECTION

• Credit card monitoring

• Debit card monitoring

POWERFUL FINANCIAL TOOLS

• Up to 3-Bureau Credit monitoring

• Up to 3-Bureau annual credit

Customer Service Concierge

customercare@identityguard.com

(855) 443-7748

Identity Theft Monthly Rates

Employee $10.60

Employee and Family $19.50

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.mybenefitshub.com/lifeschoolofdallas

Personal issues, planning for life events or simply managing daily life can affect your work, health, and family. Your Guidance Resources program provides support, resources, and information for personal and work-life issues. The program is companysponsored, confidential, and provided at no charge to you and your dependents. This explains how Guidance Resources can help you and your family deal with everyday challenges.

Confidential Counseling

3 Session Plan

This no-cost counseling service helps you address stress, relationship and other personal issues you and your family may face. It is staffed by GuidanceConsultantsSM—highly trained master’s and doctoral level clinicians who will listen to your concerns and quickly refer you to in-person counseling (up to 3 sessions per year) and other resources for:

› Stress, anxiety and depression

› Relationship/marital conflicts

› Problems with children

› Job pressures

› Grief and loss

› Substance abuse

Financial Information and Resources

Discover your best options.

Speak by phone with our Certified Public Accountants and Certified Financial Planners on a wide range of financial issues including:

› Getting out of debt

› Credit card or loan problems

› Tax questions

Legal Support and Resources

Expert info when you need it.

› Retirement planning

› Estate planning

› Saving for college

Talk to our attorneys by phone. If you require representation, we’ll refer you to a qualified attorney in your area for a free 30-minute consultation with a 25% reduction in customary legal fees thereafter. Call about:

› Divorce and family law transactions

› Debt and bankruptcy

› Real estate

› Civil and criminal actions

› Contracts

Work-Life Solutions

Delegate your “to-do” list.

Our Work-Life specialists will do the research for you, providing qualified referrals and customized resources for:

› Child and elder care

› Moving and relocation

› Making major purchases

GuidanceResources® Online

Knowledge at your fingertips.

› College planning

› Pet care

› Home repair

GuidanceResources Online is your one stop for expert information on the issues that matter most to you… relationships, work, school, children, wellness, legal, financial, free time and more.

› Timely articles, HelpSheetsSM, tutorials, streaming videos and self-assessments

› “Ask the Expert” personal responses to your questions

› Child care, elder care, attorney and financial planner searches

Free Online Will Preparation

Get peace of mind.

EstateGuidance® lets you quickly and easily write a will on your computer. Just go to www.guidanceresources.com and click on the EstateGuidance link. Follow the prompts to create and download your will at no cost. Online support and instructions for executing and filing your will are included. You can:

› Name an executor to manage your estate

› Choose a guardian for your children

› Specify your wishes for your property

› Provide funeral and burial instructions

Call Your ComPsych Guidance Resources program anytime for confidential assistance. Call: (855) 387-9727 TDD: (800) 697-0353

Go online: guidanceresources.com

Your company Web ID: ONEAMERICA3

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 Life School of Dallas 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 Life School of Dallas Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.

WWW.MYBENEFITSHUB.COM/LIFESCHOOLOFDALLAS