2023-24 WTXEBC Benefit Guide (TRS) by Higginbotham Public Sector

2023 - 2024 Plan Year

WTXEBC

BENEFIT GUIDE EFFECTIVE: 09/01/2023 - 8/31/2024 WWW.WTXEBC.COM

Table of Contents How to Enroll

4-5

Annual Benefit Enrollment

6-11

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)

13-18

Medical: Region 14

19-24

Medical: Region 15

25-30

Medical: Region 16

31-36

Medical: Region 17

37-42

Medical: Region 18

43-48

Medical: Region 19

49-53

Health Savings Account (HSA)

54-55

Hospital Cash

56-57 58

Dental

59-60

Vision

61-62

Disability

PG. 4

HOW TO ENROLL

PG. 6

SUMMARY PAGES

PG. 11

YOUR BENEFITS

Life and AD&D

64-65

Individual Life

Emergency Medical Transportation

Cancer

68-69

Accident

70-71

Critical Illness

72-73

Financial Wellness & ID Theft

Medical: Region 9

Telehealth

FLIP TO...

Flexible Spending Account (FSA)

75-76

FBS Benefits App Group # Index

Benefit Contact Information WTXEBC BENEFITS

MEDICAL - TRS ACTIVECARE

MEDICAL - TRS HMO

Financial Benefit Services (833) 453-1680 www.wtxebc.com HEALTH SAVINGS ACCOUNT (HSA)

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

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

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

CHUBB Claims Assistance: (888) 499-0425 www.combinedinsurance.com VISION

MD Live (888) 365-1663 www.consultmdlive.com DISABILITY Unum (866) 679-3054 www.unum.com

LIFE AND AD&D

Superior Vision Group #28790 (800) 507-3800 www.superiorvision.com INDIVIDUAL LIFE

Unum (866) 679-3054 www.unum.com CANCER

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

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

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

The Hartford CHUBB Claims Assistance: (888) 499-0425 (800) 547-5000 www.combinedinsurance.com www.thehartford.com FLEXIBLE SPENDING ACCOUNT (FSA)

DENTAL Lincoln Financial Group (800) 423-2765 https://www.lfg.com

FINANCIAL WELLNESS & IDENTITY THEFT Experian (866)-617-1894 www.experian.com

EMERGENCY TRANSPORTATION

NBS (855) 399-3035 www.nbsbenefits.com

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

Text “FBS WTX” to (800) 583-6908

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

App Group #:

Go to PAGE 77 to find your district’s group #

OR SCAN

How to Log In 1

www.wtxebc.com

CLICK LOGIN

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 six (6) or less 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.

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 6

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

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.wtxebc.com. 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 your benefit website: www.wtxebc.com. 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 eligibility 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 Benefit Office 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 20 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

Critical Illness

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

Individual Life

Issue through 23; Keep to 121

Healthcare FSA

Through 25 or IRS Tax Dependent

Health Savings Account

IRS Tax Dependent

Identity Theft

Through 25

Medical Supplement

Through 25

Telehealth

Through 25

Vision

Through 25

Life and AD&D

Through 25

Medical Transportation

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 Benefit Office 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 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).

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.

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 $610 rollover provision.

Does the account earn interest?

Yes

Portable?

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

FLIP TO

FOR HSA INFORMATION

PG. 54

FLIP TO

FOR FSA INFORMATION

PG. 75

Notes

Medical Insurance

EMPLOYEE BENEFITS

Carrier Name 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.wtxebc.com

When will I get my ID Card?

Everyone on ActiveCare plans should receive a new ID card by mid-September. If you do not have your ID card by Sept 1st you can access your ID card using Blue Access for Members (BAM). Member ID numbers do not change for ActiveCare participants. Therefore, you can use your existing ID card for appointments until your new one is received.

PG. 13

REGION 9

PG. 19

REGION 14

PG. 25

REGION 15

PG. 31

REGION 16

PG. 37

REGION 17

PG. 43

REGION 18

PG. 49

REGION 9

The falls in Region 9 might be small, but your TRS-ActiveCare network is the largest in the state.

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.

762372.0523

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

$462

$542

Employee and Spouse

$1,248

$1,410

Employee and Children

$786

$922

Employee and Family

$1,571

$1,789

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

$465

$1,013

$1,256

$2,402

$791

$1,507

$1,581

$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

$417

$462

$45

Employee and Spouse

$1,176

$1,248

$72

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

Employee and Children

$751

$786

$35

Employee and Family

$1,405

$1,571

$166

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

Employee Only

$422

$465

$43

Employee and Spouse

$1,187

$1,256

$69

Employee and Children

$757

$791

$34

Employee and Family

$1,419

$1,581

$162

• 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

$527

$542

$15

Employee and Spouse

$1,288

$1,410

$122

Employee and Children

$848

$922

$74

Employee and Family

$1,620

$1,789

$169

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

REMEMBER:

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. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.

Total Monthly Premiums

Central and North Texas Baylor Scott & White Health Plan

Blue Essentials - South Texas HMO

Brought to you by TRS-ActiveCare

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

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

Total Premium

Your Premium

Total Premium

Your Premium

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

Your Premium

Employee Only

N/A

$865.00

Employee and Spouse

N/A

$2,103.16

Employee and Children

N/A

$1,361.42

Employee and Family

N/A

$2,233.34

Plan Features Type of Coverage

N/A

In-Network Coverage Only

Individual/Family Deductible

N/A

$950/$2,850

Coinsurance

N/A

You pay 25% after deductible

Individual/Family Maximum Out of Pocket

N/A

$7,450/$14,900

Primary Care

N/A

$20 copay

Specialist

N/A

$70 copay

Doctor Visits

Immediate Care Urgent Care

N/A

$50 copay

N/A

$500 copay before deductible + 25% after deductible

Drug Deductible

N/A

$150

Days Supply

N/A

30-Day Supply/90-Day Supply

Emergency Care

Prescription Drugs

Generics

N/A

$5/$12.50 copay; $0 for certain generics

Preferred Brand

N/A

You pay 30% after deductible

Non-preferred Brand

N/A

You pay 50% after deductible

N/A

You pay 15%/25% after deductible (preferred/non-preferred)

Specialty

www.trs.texas.gov Revised 18 05/30/23

With TRS-ActiveCare, the Big Country is covered by the biggest 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 19 maximum, the plan pays 100% of allowable charges for covered services.

762377.0523

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

$393

$461

Employee and Spouse

$1,062

$1,199

Employee and Children

$669

$784

Employee and Family

$1,337

$1,522

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

$405

$1,013

$1,094

$2,402

$689

$1,507

$1,377

$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

$370

$393

$23

Employee and Spouse

$1,044

$1,062

$18

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

Employee and Children

$666

$669

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

Employee and Family

$1,249

$1,337

$88

Employee Only

$382

$405

$23

Employee and Spouse

$1,075

$1,094

$19

Employee and Children

$686

$689

Employee and Family

$1,285

$1,377

$92

Employee Only

$465

$461

($4)

Employee and Spouse

$1,136

$1,199

$63

Employee and Children

$748

$784

$36

Employee and Family

$1,429

$1,522

$93

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

REMEMBER:

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. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.

Total Monthly Premiums

Central and North Texas Baylor Scott & White Health Plan

Blue Essentials - South Texas HMO

Brought to you by TRS-ActiveCare

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

Total Premium

Your Premium

Total Premium

Your Premium

Employee Only

N/A

$865.00

Employee and Spouse

N/A

$2,103.16

Employee and Children

N/A

$1,361.42

Employee and Family

N/A

$2,233.34

Plan Features Type of Coverage

N/A

In-Network Coverage Only

Individual/Family Deductible

N/A

$950/$2,850

Coinsurance

N/A

You pay 25% after deductible

Individual/Family Maximum Out of Pocket

N/A

$7,450/$14,900

Primary Care

N/A

$20 copay

Specialist

N/A

$70 copay

Doctor Visits

Immediate Care Urgent Care

N/A

$50 copay

N/A

$500 copay before deductible + 25% after deductible

Drug Deductible

N/A

$150

Days Supply

N/A

30-Day Supply/90-Day Supply

Emergency Care

Prescription Drugs

Generics

N/A

$5/$12.50 copay; $0 for certain generics

Preferred Brand

N/A

You pay 30% after deductible

Non-preferred Brand

N/A

You pay 50% after deductible

N/A

You pay 15%/25% after deductible (preferred/non-preferred)

Specialty

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

TRS-ActiveCare’s network has more doctors and hospitals than you can round up.

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 25 maximum, the plan pays 100% of allowable charges for covered services.

762378.0523

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

$420

$493

Employee and Spouse

$1,134

$1,282

Employee and Children

$714

$839

Employee and Family

$1,428

$1,627

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

$434

$1,013

$1,172

$2,402

$738

$1,507

$1,476

$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

$378

$420

$42

Employee and Spouse

$1,064

$1,134

$70

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

Employee and Children

$679

$714

$35

Employee and Family

$1,274

$1,428

$154

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

Employee Only

$393

$434

$41

Employee and Spouse

$1,106

$1,172

$66

Employee and Children

$705

$738

$33

Employee and Family

$1,322

$1,476

$154

Employee Only

$474

$493

$19

Employee and Spouse

$1,159

$1,282

$123

Employee and Children

$763

$839

$76

Employee and Family

$1,457

$1,627

$170

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

REMEMBER:

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. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.

Total Monthly Premiums

Central and North Texas Baylor Scott & White Health Plan

Blue Essentials - South Texas HMO

Brought to you by TRS-ActiveCare

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

Total Premium

Your Premium

Total Premium

Your Premium

Employee Only

N/A

$865.00

Employee and Spouse

N/A

$2,103.16

Employee and Children

N/A

$1,361.42

Employee and Family

N/A

$2,233.34

Plan Features Type of Coverage

N/A

In-Network Coverage Only

Individual/Family Deductible

N/A

$950/$2,850

Coinsurance

N/A

You pay 25% after deductible

Individual/Family Maximum Out of Pocket

N/A

$7,450/$14,900

Primary Care

N/A

$20 copay

Specialist

N/A

$70 copay

Doctor Visits

Immediate Care Urgent Care

N/A

$50 copay

N/A

$500 copay before deductible + 25% after deductible

Drug Deductible

N/A

$150

Days Supply

N/A

30-Day Supply/90-Day Supply

Emergency Care

Prescription Drugs

Generics

N/A

$5/$12.50 copay; $0 for certain generics

Preferred Brand

N/A

You pay 30% after deductible

Non-preferred Brand

N/A

You pay 50% after deductible

N/A

You pay 15%/25% after deductible (preferred/non-preferred)

Specialty

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

Get your kicks on Route 66 and your reliable health care on TRS-ActiveCare plans.

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 31 maximum, the plan pays 100% of allowable charges for covered services.

762379.0523

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

$401

$471

Employee and Spouse

$1,083

$1,225

Employee and Children

$682

$801

Employee and Family

$1,364

$1,555

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

$414

$1,013

$1,118

$2,402

$704

$1,507

$1,408

$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

$380

$401

$21

Employee and Spouse

$1,072

$1,083

$11

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

Employee and Children

$684

$682

($2)

Employee and Family

$1,283

$1,364

$81

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

Employee Only

$394

$414

$20

Employee and Spouse

$1,107

$1,118

$11

Employee and Children

$706

$704

($2)

Employee and Family

$1,324

$1,408

$84

Employee Only

$478

$471

($7)

Employee and Spouse

$1,168

$1,225

$57

Employee and Children

$769

$801

$32

Employee and Family

$1,468

$1,555

$87

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

REMEMBER:

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. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.

Total Monthly Premiums

Central and North Texas Baylor Scott & White Health Plan

Blue Essentials - South Texas HMO

Brought to you by TRS-ActiveCare

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

Total Premium

Your Premium

Total Premium

Your Premium

Employee Only

N/A

$865.00

Employee and Spouse

N/A

$2,103.16

Employee and Children

N/A

$1,361.42

Employee and Family

N/A

$2,233.34

Plan Features Type of Coverage

N/A

In-Network Coverage Only

Individual/Family Deductible

N/A

$950/$2,850

Coinsurance

N/A

You pay 25% after deductible

Individual/Family Maximum Out of Pocket

N/A

$7,450/$14,900

Primary Care

N/A

$20 copay

Specialist

N/A

$70 copay

Doctor Visits

Immediate Care Urgent Care

N/A

$50 copay

N/A

$500 copay before deductible + 25% after deductible

Drug Deductible

N/A

$150

Days Supply

N/A

30-Day Supply/90-Day Supply

Emergency Care

Prescription Drugs

Generics

N/A

$5/$12.50 copay; $0 for certain generics

Preferred Brand

N/A

You pay 30% after deductible

Non-preferred Brand

N/A

You pay 50% after deductible

N/A

You pay 15%/25% after deductible (preferred/non-preferred)

Specialty

www.trs.texas.gov Revised 36 05/30/23

TRS-ActiveCare’s vast network of doctors and hospitals makes a west Texas dust storm look small.

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 37 maximum, the plan pays 100% of allowable charges for covered services.

762380.0523

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

$410

$482

Employee and Spouse

$1,107

$1,254

Employee and Children

$697

$820

Employee and Family

$1,394

$1,591

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

$424

$1,013

$1,145

$2,402

$721

$1,507

$1,442

$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

$368

$410

$42

Employee and Spouse

$1,038

$1,107

$69

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

Employee and Children

$662

$697

$35

Employee and Family

$1,242

$1,394

$152

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

Employee Only

$380

$424

$44

Employee and Spouse

$1,069

$1,145

$76

Employee and Children

$682

$721

$39

Employee and Family

$1,279

$1,442

$163

Employee Only

$462

$482

$20

Employee and Spouse

$1,130

$1,254

$124

Employee and Children

$744

$820

$76

Employee and Family

$1,421

$1,591

$170

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

REMEMBER:

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. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.

Total Monthly Premiums

Central and North Texas Baylor Scott & White Health Plan

Blue Essentials - South Texas HMO

Brought to you by TRS-ActiveCare

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

Total Premium

Your Premium

Total Premium

Your Premium

Employee Only

N/A

$865.00

Employee and Spouse

N/A

$2,103.16

Employee and Children

N/A

$1,361.42

Employee and Family

N/A

$2,233.34

Plan Features Type of Coverage

N/A

In-Network Coverage Only

Individual/Family Deductible

N/A

$950/$2,850

Coinsurance

N/A

You pay 25% after deductible

Individual/Family Maximum Out of Pocket

N/A

$7,450/$14,900

Primary Care

N/A

$20 copay

Specialist

N/A

$70 copay

Doctor Visits

Immediate Care Urgent Care

N/A

$50 copay

N/A

$500 copay before deductible + 25% after deductible

Drug Deductible

N/A

$150

Days Supply

N/A

30-Day Supply/90-Day Supply

Emergency Care

Prescription Drugs

Generics

N/A

$5/$12.50 copay; $0 for certain generics

Preferred Brand

N/A

You pay 30% after deductible

Non-preferred Brand

N/A

You pay 50% after deductible

N/A

You pay 15%/25% after deductible (preferred/non-preferred)

Specialty

www.trs.texas.gov Revised 42 05/30/23

TRS-ActiveCare plans are all hat AND all cattle with the most doctors and hospitals in the state.

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 43 maximum, the plan pays 100% of allowable charges for covered services.

762381.0523

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

$347

$407

Employee and Spouse

$937

$1,059

Employee and Children

$590

$692

Employee and Family

$1,180

$1,344

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 $357

Your Premium $

$964

$607

$ $

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

$1,013

$2,402

$1,507

$2,841

$1,214

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

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.

TRS-ActiveCare Primary

TRS-ActiveCare HD

TRS-ActiveCare Primary+

TRS-ActiveCare 2 (closed to new enrollees)

Change in Dollar Amount

2022-23 Total Premium

New 2023-24 Total Premium

Employee Only

$343

$347

Employee and Spouse

$967

$937

($30)

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

Employee and Children

$616

$590

($26) $23

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

Employee and Family

$1,157

$1,180

Employee Only

$354

$357

Employee and Spouse

$996

$964

($32)

Employee and Children

$635

$607

($28)

Employee and Family

$1,190

$1,214

$24

Key Plan Changes

Employee Only

$431

$407

($24)

Employee and Spouse

$1,053

$1,059

Employee and Children

$693

$692

($1)

Employee and Family

$1,324

$1,344

$20

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

REMEMBER:

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. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.

Total Monthly Premiums

Central and North Texas Baylor Scott & White Health Plan

Blue Essentials - South Texas HMO

Brought to you by TRS-ActiveCare

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

Total Premium

Your Premium

Total Premium

Your Premium

Employee Only

N/A

$865.00

Employee and Spouse

N/A

$2,103.16

Employee and Children

N/A

$1,361.42

Employee and Family

N/A

$2,233.34

Plan Features Type of Coverage

N/A

In-Network Coverage Only

Individual/Family Deductible

N/A

$950/$2,850

Coinsurance

N/A

You pay 25% after deductible

Individual/Family Maximum Out of Pocket

N/A

$7,450/$14,900

Primary Care

N/A

$20 copay

Specialist

N/A

$70 copay

Doctor Visits

Immediate Care Urgent Care

N/A

$50 copay

N/A

$500 copay before deductible + 25% after deductible

Drug Deductible

N/A

$150

Days Supply

N/A

30-Day Supply/90-Day Supply

Emergency Care

Prescription Drugs

Generics

N/A

$5/$12.50 copay; $0 for certain generics

Preferred Brand

N/A

You pay 30% after deductible

Non-preferred Brand

N/A

You pay 50% after deductible

N/A

You pay 15%/25% after deductible (preferred/non-preferred)

Specialty

www.trs.texas.gov Revised 48 05/30/23

TRS-ActiveCare has a network of doctors and hospitals that span all the way to the Rio Grande.

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 49 maximum, the plan pays 100% of allowable charges for covered services.

762382.0523

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

$388

$455

Employee and Spouse

$1,048

$1,183

Employee and Children

$660

$774

Employee and Family

$1,320

$1,502

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

$403

$1,013

$1,089

$2,402

$686

$1,507

$1,371

$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

$362

$388

$26

Employee and Spouse

$1,020

$1,048

$28

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

Employee and Children

$650

$660

$10

Employee and Family

$1,221

$1,320

$99

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

Employee Only

$376

$403

$27

Employee and Spouse

$1,058

$1,089

$31

Employee and Children

$675

$686

$11

Employee and Family

$1,265

$1,371

$106

Employee Only

$454

$455

Employee and Spouse

$1,110

$1,183

$73

Employee and Children

$731

$774

$43

Employee and Family

$1,396

$1,502

$106

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

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.wtxebc.com

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 (High Deductible Health Plan) • 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. 54

Health Savings Account (HSA) EECU

EMPLOYEE BENEFITS

Opening an HSA If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.

Important HSA Information •

Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount. • You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit. You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.

How to Use your HSA •

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

•

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

•

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

•

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

Hospital Cash

EMPLOYEE BENEFITS

CHUBB

ABOUT HOSPITAL CASH 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.wtxebc.com

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.

Hospital Cash Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

Plan 2

$20.36 $40.68 $29.68 $50.00

$33.06 $73.39 $53.82 $81.19

Payable Benefit

Hospitalization and Rehabilitation Benefits

Plan 1

First Hospitalization Benefit This benefit is payable for the first covered hospital confinement per certificate. Hospital Admission Benefit This benefit is for admission to a hospital or hospital sub-acute intensive care unit. Hospital Admission ICU Benefit This benefit is for admission to a hospital intensive care unit.

• •

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

• •

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

• •

Plan 1

• • • •

• •

•

$500 Maximum Benefit Per Certificate: 1 $1,500 Maximum Benefit Per Calendar Year: 3 $3,000 Maximum Benefit Per Calendar Year: 3 $100 Per Day Maximum Days Per Calendar Year: 30 $200 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 Maximum Days Per Calendar Year: 2

• • • • • • • • • • • • • • •

Plan 2 $1,000 Maximum Benefit Per Certificate: 1 $3,000 Maximum Benefit Per Calendar Year: 5 $6,000 Maximum Benefit Per Calendar Year: 5 $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 Maximum Days Per Calendar Year: 2

Hospital Cash

EMPLOYEE BENEFITS

CHUBB

Payable Benefit Hospitalization and Rehabilitation Benefits (Continued) Plan 1 • Rehabilitation Unit Admission Benefit This benefit is for admission to a rehabilitation unit as an inpatient. • Rehabilitation Unit Confinement Benefit This benefit is for confinement in a rehabilitation unit.

• • •

Family Care Benefit This benefit helps pay for childcare when an insured is confined in a hospital or rehabilitation unit.

•

Medical Travel Benefit This benefit helps pay for travel expenses when an insured must travel at least 50 miles from their residence to receive special treatment or confinement in a hospital. Waiver of Premium Hospital Confinement This benefit waives premium when the employee is confined for more than 30 continuous days.

•

Plan 2

$500 Maximum Benefit Per Calendar Year: 3 $200 Per Day Payable per day for days 2 through 11 Maximum Days Per Calendar Year: 10 Childcare Benefit Per Day: $200 Maximum Days per Calendar Year: 10

• •

Per Day – 50 or more miles: $100 Maximum Days Per Calendar Year: 4

•

Included

• • • • •

•

$500 Maximum Benefit Per Calendar Year: 5 $400 Per Day Payable per day for days 2 through 11 Maximum Days Per Calendar Year: 10 Childcare Benefit Per Day: $200 Maximum Days per Calendar Year: 10 Per Day – 50 or more miles: $100 Maximum Days Per Calendar Year: 4 Included

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.wtxebc.com 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

Registration is Easy

When to Use MDLIVE:

Telehealth Employee & Family

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.

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

$9.00

Dental Insurance

EMPLOYEE BENEFITS

Lincoln Financial Group 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.wtxebc.com

The Lincoln DentalConnect® PPO Plans: • Cover many preventive, basic, and major dental care services • Also cover orthodontic treatment for children • Feature group rates for WTXEBC employees • Let you choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist • Do not make you and your loved ones wait six months between routine cleanings

Dental MAC Plan Employee Only $20.10 Employee and Spouse $38.49 Employee and Child(ren) $48.83 Employee and Family $67.33

High Plan $34.87 $66.66 $84.88 $116.77

Benefit Highlights Some plans may not be offered at every district within WTXEBC. Check your district benefit website for details. MAC

Individual: $50 Family: $150 Waived for Preventive

Calendar (Annual) Deductible

High

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. Annual Maximum

$1,500

Lifetime Orthodontic Max

$1,000

Orthodontic Coverage is available for dependent children. Waiting Period

There are no benefit waiting periods for any service types

Visit LincolnFinancial.com/FindADentist You can search by: • Location • Dentist name or office name • Distance you are willing to travel • Specialty, language and more Your search will automatically provide up to 100 dentists that most closely match your criteria. If your search does not locate the dentist you prefer, you can nominate one—just click the Nominate a Dentist llink and complete the online form. 59

Dental Insurance

EMPLOYEE BENEFITS

Lincoln Financial Group

Plan Features Some plans may not be offered at every district within WTXEBC. Check your district benefit website for details. Preventive Services

MAC

High

90% No Deductible

100% No Deductible

MAC

High

50% After Deductible

80% After Deductible

MAC

High

50% After Deductible

Orthodontics

MAC

High

Orthodontic exams X-rays Extractions Study models Appliances

50%

Routine oral exams Bitewing X-rays Full-mouth or panoramic X-rays Other dental X-rays - including periapical films Routine cleanings Fluoride treatments Space maintainers for children Palliative treatment - including emergency relief of dental pain Sealants Basic Services

Problem focused exams Injections of antibiotics and other therapeutic medications Fillings Simple extractions General anesthesia and I.V. sedation Major Services

Consultations Prefabricated stainless steel and resin crowns Surgical extractions Oral surgery Biopsy and examination of oral tissue - including brush biopsy Prosthetic repair and recementation services Endodontics - including root canal treatment

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

Contracting Dentists

Non-Contracting Dentists

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

… you pay a deductible (if applicable), then the remaining balance between the maximum allowable change and the dentist’s billed charge. You are responsible for the difference between the maximum allowable charge and the dentist’s billed charge.

MAC Option *Out of network reimbursement on this plan is based on the in-network fee schedule. This can mean more cost is incurred to you as the employee if you select this plan and see a dentist that is out of network. To find a in network dentist please visit to www.LincolnFinancial.com. 60

Vision Insurance

EMPLOYEE BENEFITS

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.wtxebc.com

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. Copays Exam Materials1 Contact lens fitting (standard & specialty)

$10 $25 $0

Exam (ophthalmologist) Exam (optometrist) Frames Contact lens fitting (standard2) Contact lens fitting (specialty2) Lenses (standard) per pair Single vision Bifocal Trifocal Scratch Coat (factory) Progressives lens upgrade Contact lenses4

Services/Frequency Exam 12 months Frame 12 months Contact lens fitting 12 months Lenses 12 months Contact lenses 12 months

Monthly Premiums Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

In-network Covered in full Covered in full $125 retail allowance Covered in full $50 retail allowance

Out-of-network Up to $42 retail Up to $37 retail Up to $68 retail Not covered Not covered

Covered in full Covered in full Covered in full Covered in full See description3 $120 retail allowance

Up to $32 retail Up to $46 retail Up to $61 retail Not covered Up to $61 retail Up to $100 retail

$7.80 $15.46 $15.17 $22.95

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1. Materials co-pay applies to lenses and frames only, not contact lenses 2. See your benefits materials for definitions of standard and specialty contact lens fittings 3. Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay. 4. Contact lenses are in lieu of eyeglass lenses and frames benefit 61

Vision Insurance

EMPLOYEE BENEFITS

Superior Vision 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%-40%) 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

Discounts on non-covered exam, services and materials Exams, frames, and prescription lenses:

30% off retail

Lens options, contacts, prescription materials options:

20% off retail

Disposable contact lenses:

10% off retail

Maximum member out-of-pocket Single Vision

Bifocal & Trifocals

Ultraviolet coat

$15

Tints, solid or gradients

$25

Anti-reflective coat

$50

High index 1.6

$55

20% off retail

Photochromics

$80

20% off retail

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

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 5%-50%, and are the best possible discounts available to Superior Vision. Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Benefit Office if you have any questions.

Disability Insurance

EMPLOYEE BENEFITS

Unum

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.wtxebc.com

Who is eligible? You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. You are considered in active employment, if on the day you apply for coverage, you are being paid regularly by your employer for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation. How can I apply for coverage? To apply for coverage, complete your enrollment online by the enrollment deadline. If you were hired after 9/1/2023, check with your plan administrator for your eligibility date, and complete your enrollment online within 31 days of that date. What if I am out of work when insurance goes into effect? Insurance will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. What is my monthly benefit amount? You can elect to purchase a benefit of 30% 40% 50% 60% or 70% of your monthly earnings. 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. 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. Elimination Period Options: • Option 1: 7 days/7 days first day hospital • Option 2: 14 days/14 days first day hospital • Option 3: 30 days/30 days first day hospital • Option 4: 60 days/60 days • Option 5: 90 days/90 days During your elimination period, you will be considered disabled if you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury, you are under the regular care of a physician and you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient

means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. Your admission and discharge dates and time must be 23 or more consecutive hours apart. (Applies to Elimination Periods of 30 days or less.) What is considered a pre-existing condition? You have a pre-existing condition if: • You received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and • The disability begins in the first 12 months after your effective date of coverage. 4 week pre-ex benefit included for pre-existing conditions. Please refer to policy for detailed description of this provision. When does my coverage end? Your coverage under the policy ends on the earliest of the following: • The date the policy or plan is cancelled • The date you no longer are in an eligible group • The date your eligible group is no longer covered • The last day of the period for which you made any required contributions • The last day you are in active employment except as provided under the covered layoff or leave of absence provision. Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

Disability (per $100 in benefit) Elimination Period

30%

40%

50%

60%

70%

7/7

$1.68

$1.76

$2.03

$2.34

$2.84

14/14

$1.56

$1.65

$1.91

$2.20

$2.79

30/30

$1.30

$1.37

$1.59

$1.85

$2.24

60/60

$0.80

$0.84

$0.98

$1.21

$1.73

90/90

$0.71

$0.75

$0.88

$1.09

$1.53 63

Life and AD&D

EMPLOYEE BENEFITS

Unum

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.wtxebc.com

BASIC LIFE AND AD&D

Who is eligible? All actively employed employees working at least 15 hours each week for your employer in the U.S. and their eligible spouses and children to age 26. What are the Basic Life and AD&D coverage amounts? • Your employer is providing you with either $10,000, $20,000, $30,000, $40,000 or $50,000. Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 65: 65% of original amount 70: 50% of original amount Coverage may not be increased after a reduction. When is coverage effective? Please see your plan administrator for your effective date. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness or disorder, your dependent spouse and children: are confined in a hospital or similar institution; are confined at home under the care of a physician for a sickness or injury; or your spouse has a life-threatening condition. Exception: Infants are insured from live birth. Is this coverage portable (can I keep it when I leave my employer)? If you retire, reduce your hours, or leave your employer, you can continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life 64

expectancy — but they may be able to convert their term life policy to an individual life insurance policy.

VOLUNTARY LIFE AND AD&D

Who is eligible? All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children to age 26. What are the Voluntary Life and AD&D coverage amounts? • Employee: up to 7 times salary in increments of $10,000; not to exceed $500,000. • Spouse: up to 100% of employee amount in increments of $10,000; not to exceed $500,000. • Child: up to 100% of employee coverage amount in increments of $5,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and 14 days is $1,000 and 14 days to six months is $2,000. Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 65: 65% of original amount 70: 50% of original amount Coverage may not be increased after a reduction. Can I be denied coverage? Current employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to $200,000 for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions. If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or before the enrollment deadline and will be required to answer health questions for any amount of coverage.

Life and AD&D Unum

EMPLOYEE BENEFITS

New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.

When is coverage effective? Please see your plan administrator for your effective date. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

How much does coverage cost? Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date. Spouse rate is based on your Spouse’s insurance age, which is their age immediately prior to and including the anniversary/ effective date.

For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness or disorder, your dependent spouse and children: are confined in a hospital or similar institution; are confined at home under the care of a physician for a sickness or injury; or your spouse has a life-threatening condition. Exception: Infants are insured from live birth.

Age band <25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

Employee and Spouse Rate per $10,000 $0.54 $0.54 $0.72 $0.81 $0.99 $1.53 $2.88 $4.95 $7.92 $11.04 $18.54 $18.54 Child life monthly rate is $1.00 per $5,000.

What are the AD&D coverage amounts? • Employee: up to 10 times salary in increments of $10,000; not to exceed $500,000 • Spouse: up to 50% of employee amount in increments to a maximum of $250,000 • Child: up to 10% of employee coverage amount to a maximum of $50,000 Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. To purchase AD&D coverage for your dependents, you must buy coverage for yourself. What does AD&D insurance pay for? The full benefit amount is paid for loss of: • Life • both hands or both feet or sight of both eyes • one hand and one foot • one hand or one foot and the sight of one eye • speech and hearing Other losses may be covered as well. Please contact your plan administrator. How much does coverage cost? • Employee: $0.40 per $10,000 in coverage • Employee and Family: $0.70 per $10,000 in coverage

When does my coverage end? You and your dependents’ coverage under the Summary of Benefits ends on the earliest of: • the date the policy or plan is cancelled • the date you no longer are in an eligible group • the date your eligible group is no longer covered • the last day of the period for which you made any required contributions • the last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage. In addition, coverage for any one dependent will end on the earliest of: • the date your coverage under a plan ends • the date your dependent ceases to be an eligible dependent • for a spouse, the date of a divorce or annulment and • for dependent coverage, the date of your death Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan. Is this coverage portable (can I keep it when I leave my employer)? If you retire, reduce your hours, or leave your employer, you can continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy. Will my premiums be waived if I become disabled? If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends.

Individual Life Insurance

EMPLOYEE BENEFITS

5Star

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.wtxebc.com

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 monthly, 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.

ADDITIONAL DETAILS: 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. Find full details and rates at www.wtxebc.com Should you need to file a claim, contact 5Star directly at 866- 863-9753.

Emergency Transportation MASA

EMPLOYEE BENEFITS

ABOUT EMERGENCY TRANSPORTATION 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.wtxebc.com

A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. If a member has a high deductible health plan that is compatible with a health savings account, benefits will become available under the MASA membership for expenses incurred for medical care (as defined under Internal Revenue Code (“IRC”) section 213 (d)) once a member satisfies the applicable statutory minimum deductible under IRC section 223(c) for high-deductible health plan coverage that is compatible with a health savings account. Emergent Air Transportation In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities. Emergent Ground Transportation In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities. Non-Emergency Inter-Facility Transportation In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non-emergency air or ground transportation between medical facilities. Repatriation/Recuperation Suppose you or a family member is hospitalized more than 100-miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation. Should you need assistance with a claim contact MASA at 800-643-9023. You can find full benefit details at www.wtxebc.com Emergency Transportation Employee & Family $14.00

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.wtxebc.com

Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living and household upkeep. In addition to these non-medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance through American Public Life helps pay for these direct and indirect treatment costs so you can focus on your health. Summary of Benefits Cancer Treatment Policy Benefits Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12 month period Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment Surgical Rider Benefits Surgical Anesthesia Bone Marrow Transplant - Maximum per lifetime Stem Cell Transplant - Maximum per lifetime Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime Miscellaneous Care Rider Benefits Cancer Treatment Center Evaluation or Consultation - 1 per lifetime Evaluation or Consultation Travel and Lodging - 1 per lifetime Second / Third Surgical Opinion - per diagnosis of cancer Drugs and Medicine - Inpatient / Outpatient (maximum $150 per month) Hair Piece (Wig) - 1 per lifetime Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane, or train Travel by car Lodging - up to a maximum of 100 days per calendar year Family Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Family Lodging - up to a maximum of 100 days per calendar year 68

Low Level 3

High Level 4

$15,000

$20,000

$50 per treatment paid in same manner and under the same maximums as any other benefit Level 1 Level 4 $30 unit dollar amount $60 unit dollar amount Max $3,000 per operation Max $6,000 per operation 25% of amount paid for covered surgery $6,000 $12,000 $600 $1,200 $1,000 / $100

$3,000 / $300

Level 4 Level 4 $750 $750 $350 $350 $300 / $300 $300 / $300 $150 per confinement / $50 per prescription $150 $150 actual coach fare or $0.75 per mile $0.75 per mile $100 per day actual coach fare or $0.75 per mile $0.75 per mile $100 per day

Cancer Insurance

EMPLOYEE BENEFITS

APL

Miscellaneous Care Rider Benefits (cont’d) Blood, Plasma and Platelets Ambulance - Ground/Air - Maximum of 2 trips per Hospital Confinement for all modes of transportation combined Inpatient Special Nursing Services - per day of Hospital Confinement Outpatient Special Nursing Services - Up to same number of Hospital Confinement days Medical Equipment - Maximum of 1 benefit per calendar year Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year Waiver of Premium Internal Cancer First Occurrence Rider Benefits Lump Sum Benefit - Maximum 1 per Covered Person per lifetime Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime Heart Attack/Stroke First Occurrence Rider Benefits Lump Sum Benefit - Maximum 1 per Covered Person per lifetime Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime Hospital Intensive Care Unit Rider Benefits

Level 4

Level 4 $300 per day $200 / $2,000 per trip $150 per day $150 per day $150 $25 per visit / $1,000 Waive Premium

Level 2 $5,000

Level 4 $10,000

$7,500

$15,000

Level 1

Intensive Care Unit Step Down Unit - Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit

Level 1 $2,500 $3,750 $600 per day $300 per day

Should you need to file a claim contact APL at 800-256-8606 or online at www.ampublic.com. You can find additional claim forms and materials at www.wtxebc.com.

Cancer Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

Low $21.24 $38.10 $26.24 $39.94

High $34.30 $61.40 $42.30 $64.48

Accident Insurance

EMPLOYEE BENEFITS

The Hartford

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.wtxebc.com

With Accident insurance, you’ll receive payment(s) Accident associated with a covered injury and related services. LOW HIGH You can use the payment in any way you choose – Employee Only $6.44 $13.42 from expenses not covered by your major medical Employee and Spouse $10.14 $21.16 plan to day-to-day costs of living such as the mortgage or your utility bills. You have a choice of two accident Employee and Child(ren) $10.73 $22.32 plans, which allows you the flexibility to enroll for the Employee and Family $16.92 $35.19 coverage that best meets your needs. This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). BENEFITS EMERGENCY, HOSPITAL & TREATMENT CARE

LOW PLAN

HIGH PLAN

Accident Follow-Up

Up to 3 visits per accident

$150

$250

Accident Prevention Beneﬁt

Once per year for each covered person

$50

Chiropractic Care/PT

Up to 10 visits each per accident

Up to $50

Up to $100

Ambulance – Air

Once per accident

$2,500

$5,000

Ambulance – Ground

Once per accident

$2,500

$5,000

Blood/Plasma/Platelets

Once per accident

$200

$400

Daily Hospital Conﬁnement

Up to 365 days per lifetime

$200

$600

Daily ICU Conﬁnement

Up to 30 days per accident

$400

$800

Diagnostic Exam

Once per accident

$200

$400

Emergency Dental

Once per accident

Up to $300

Up to $600

Emergency Room

Once per accident

$150

$250

Hospital Admission

Once per accident

$1,000

$2,000

Initial Physician Ofﬁce Visit

Once per accident

$150

$250

Lodging

Up to 30 nights per lifetime

$125

$175

Medical Appliance

Once per accident

$100

$300

Rehabilitation Facility

Up to 15 days per lifetime

$150

$450

Transportation

Up to 3 trips per accident

$400

$800

Urgent Care

Once per accident

$150

$250

X-ray

Once per accident

$100

$200

Accident Insurance

EMPLOYEE BENEFITS

The Hartford

BENEFITS (cont’d) SPECIFIED INJURY & SURGERY

LOW PLAN

HIGH PLAN

$2,000

$4,000

$250

$750

Abdominal/Thoracic Surgery

Once per accident

Arthroscopic Surgery

Once per accident

Burn

Once per accident

Burn – Skin Graft

Once per accident for third degree burn(s)

50% of burn beneﬁt

Concussion

Up to 3 per year

$150

$250

Dislocation

Once per joint per lifetime

Up to $4,000

Up to $12,000

Eye Injury

Once per accident

Up to $500

Up to $1,000

Fracture

Once per bone per accident

Up to $8,000

Up to $12,000

Hernia Repair

Once per accident

$200

$600

Joint Replacement

Once per accident

$2,000

$6,000

Knee Cartilage

Once per accident

Up to $1,000

Up to $3,000

Laceration

Once per accident

Up to $500

Up to $1,500

Ruptured Disc

Once per accident

$1,000

$3,000

Tendon/Ligament/Rotator Cuff

Once per accident

Up to $1,500

Up to $3,000

LOW PLAN

HIGH PLAN

Up to $10,000 Up to $20,000

CATASTROPHIC Accidental Death

Within 90 days; Spouse @ 50% and child @ 25%

$50,000

$100,000

Common Carrier Death

Within 90 days

$75,000

$300,000

Coma

Once per accident

$10,000

$20,000

Dismemberment

Once per accident

Up to $50,000

Up to $100,000

Paralysis

Once per accident

Up to $50,000

Up to $100,000

Prosthesis

Once per accident

Up to $2,000

Up to $4,000

LOW PLAN

HIGH PLAN

FEATURES

25% increase of noncatastrophic benefits

Organized Amateur Sports Injury Enhancement Benefit Ability Assist® EAP2 – 24/7/365 access to help for financial, legal or emotional issues

Included

HealthChampionSM3 – Administrative & clinical support following serious illness or injury

Included

WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full-time employee who works at least 20 hours per week on a regularly scheduled basis. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26. CAN I INSURE MY DOMESTIC OR CIVIL UNION PARTNER? Yes. Any reference to “spouse” in this document includes your domestic partner, civil union partner or equivalent, as recognized and allowed by applicable law. AM I GUARANTEED COVERAGE? This insurance is guaranteed issue coverage – it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured. Premiums will be automatically paid through payroll deduction, as authorized by you during the enrollment process. This ensures you don’t have to worry about writing a check or missing a payment. WHEN CAN I ENROLL? You may enroll during any scheduled enrollment period or within 31 days of the date you have a change in family status.

WHEN DOES THIS INSURANCE BEGIN? Insurance will become effective in accordance with the terms of the certificate (usually the first day of the month following the date you elect coverage). You must be actively at work with your employer on the day your coverage takes effect. Your spouse and child(ren) must be performing normal activities and not be confined (at home or in a hospital/care facility), unless already insured with the prior carrier. WHEN DOES THIS INSURANCE END? This insurance will end when you or your dependents no longer satisfy the applicable eligibility conditions, premium is unpaid, you are no longer actively working, you leave your employer, or the coverage is no longer offered. CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP? Yes, you can take this coverage with you. Coverage may be continued for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances. The specific terms and qualifying events for portability are described in the certificate.

Critical Illness Insurance CHUBB

EMPLOYEE BENEFITS

ABOUT CRITICAL ILLNESS Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non-medical costs related to the illness, including transportation, child care, etc. For full plan details, please visit your benefit website: www.wtxebc.com Heart attacks and strokes happen every day and often unexpectedly. They don’t give you time to prepare and can take a serious toll on both your physical and financial well-being. Chubb Critical Illness pays cash benefits directly to you that you can use to help with your bills, your mortgage, your rent, your childcare— you name it—so you can focus on recovery. 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. 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 Covered Conditions

Payable Benefit as a % of Face Amount

ALS

100%

Alzheimer's Disease Benign Brain Tumor 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 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.

100% 100% 100% 25% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 10%

50%

Critical Illness Insurance

EMPLOYEE BENEFITS

CHUBB

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.

Included

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).

Included

Recurrence Benefit - Benefits are payable for a subsequent diagnosis of Aneurysm - Cerebral or Aortic, Benign Brain Tumor, Coma, Coronary Artery Obstruction, Heart Attack, Major Organ Failure, Severe Burns, Stroke, or Sudden Cardiac Arrest.

100%

Diabetes Diagnosis Benefit - Pays a benefit once for Covered Person’s Diabetes diagnosis.

$500

Wellness Benefit - Payable once per insured per year

$50

Critical Illness Age Band

18-25

26-30

31-35

36-40

41-45

46-50

51-55

56-60

61-65

66-70

71-75

76+

Face Amount: Employee: $10,000; Spouse: $10,000; Child: $10,000 Employee Only

$0.74

$0.93

$0.96

$1.28

$1.65

$2.26

$2.84

$4.91

$7.65

$12.17

$15.42

$23.46

Employee and Spouse

$1.49

$1.86

$1.92

$2.56

$3.30

$4.51

$5.68

$9.82

$15.30 $24.34

$30.83

$46.91

Employee and Child(ren)

$0.74

$0.93

$0.96

$1.28

$1.65

$2.26

$2.84

$4.91

$7.65

$12.17

$15.42

$23.46

Employee and Family

$1.49

$1.86

$1.92

$2.56

$3.30

$4.51

$5.68

$9.82

$15.30 $24.34

$30.83

$46.91

Face Amount: Employee: $20,000; Spouse: $20,000; Child: $20,000 Employee Only

$1.49

$1.86

$1.92

$2.56

$3.30

$4.51

$5.68

$9.82

$15.30 $24.34

$30.83

$46.91

Employee and Spouse

$2.98

$3.71

$3.84

$5.12

$6.59

$9.02

$11.36 $19.65 $30.59 $48.67

$61.66

$93.82

Employee and Child(ren)

$1.49

$1.86

$1.92

$2.56

$3.30

$4.51

$5.68

$15.30 $24.34

$30.83

$46.91

Employee and Family

$2.98

$3.71

$3.84

$5.12

$6.59

$9.02

$11.36 $19.65 $30.59 $48.67

$61.66

$93.82

$46.25

$70.37

$9.82

Face Amount: Employee: $30,000; Spouse: $30,000; Child: $30,000 Employee Only

$2.23

$2.78

$2.88

$3.84

$4.94

$6.77

Employee and Spouse

$4.46

$5.57

$5.76

$7.68

$9.89

$13.54 $17.04 $29.47 $45.89 $73.01

$8.52

$92.50 $140.74

Employee and Child(ren)

$2.23

$2.78

$2.88

$3.84

$4.94

$6.77

$46.25

Employee and Family

$4.46

$5.57

$5.76

$7.68

$9.89

$13.54 $17.04 $29.47 $45.89 $73.01

$8.52

$14.74 $22.94 $36.50 $14.74 $22.94 $36.50

$70.37

$92.50 $140.74

Face Amount: Employee: $40,000; Spouse: $40,000; Child: $40,000 Employee

$2.98

$3.71

$3.84

$5.12

$6.59

Employee and Spouse

$5.95

$7.42

$7.68

$10.24 $13.18 $18.05 $22.72 $39.30 $61.18 $97.34 $123.33 $187.65

Employee and Child(ren)

$2.98

$3.71

$3.84

$5.12

Employee and Family

$5.95

$7.42

$7.68

$10.24 $13.18 $18.05 $22.72 $39.30 $61.18 $97.34 $123.33 $187.65

$6.59

$9.02 $9.02

$11.36 $19.65 $30.59 $48.67 $11.36 $19.65 $30.59 $48.67

$61.66 $61.66

$93.82 $93.82

Financial Wellness & ID Theft Experian

EMPLOYEE BENEFITS

ABOUT FINANCIAL WELLNESS & ID THEFT Experian Elite benefits plan features Digital Financial Managerproviding you tools to help manage your finances and credit profile in a single experience. 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.wtxebc.com

With features like Digital Financial Management, you will have tools to help manage your finances and credit profile in a single experience. 360° view of financial accounts Link your financial accounts to generate unique insights that can help improve your financial health and build good credit habits. Stay on top of your daily spending with recommended budgets powered by AI and machine learning of past transactional behavior. Exclusive credit insights Combine the power of financial transaction and credit data to unlock 50+ unique insights and recommendations to help achieve financial goals. Inisights are displayed in your personalized feed and categories include account activity, spending and budgeting, VantageScore®* improvements, financial updates, and more. Industry leading monitoring & alerts Consistent monitoring of your Experian® credit report and VantageScore* can help you better understand your current credit profile and personal finances. Financial Alerts will notify you, via push notifications and emails, when certain financial events are detected.

Elite Plan Monthly Premium Employee Only $7.50 Employee and Family $14.00

Flexible Spending Account (FSA) NBS

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.wtxebc.com

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 ∗ 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

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. 75

Flexible Spending Account (FSA) NBS

EMPLOYEE BENEFITS

Dependent Care FSA Guidelines • •

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.

• •

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 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 $610 in your Health Care FSA into the next plan year. The carry-over rule does not apply to your Dependent Care FSA.

• • • •

Over-the-Counter Item Rule Reminder (OTC)

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. Flexible Spending Accounts Annual Contribution Limits

Benefit

Health Care FSA

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

$3,050

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

Dependent Care FSA

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

Reduces your taxable income

Account Type

Eligible Expenses

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

GROUP #

District

GROUP #

Abernathy ISD

WTXA

Farwell ISD

WTXAK

Adrian ISD

WTXB

Floydada ISD

WTXAL

Amherst ISD

WTXC

Follett ISD

WTXAM

Anthony ISD

WTXD

Forsan ISD

WTXAO

Anton ISD

WTXE

Fort Elliott CISD

WTXAP

Archer City ISD

WTXF

Fort Stockton ISD

WTXAQ

Balmorhea ISD

WTXG

Friona ISD

WTXAR

Benjamin ISD

WTXI

WTXAS

Big Spring ISD

FBSBSISD

Garden City - Glasscock County ISD

Blackwell CISD

WTXJ

Grady ISD

WTXAT

Blanket ISD

WTXK

Grandfalls-Royalty ISD

WTXBD

Booker ISD

WTXL

Grandview - Hopkins ISD

WTXAU

Borger ISD

WTXM

Greenwood ISD

WTXBF

Bovina ISD

WTXN

Groom ISD

WTXAV

Brookesmith ISD

WTXP

Gruver ISD

WTXAW

Bryson ISD

WTXQ

Guthrie CSD

WTXAX

Canadian ISD

WTXR

Hale Center ISD

WTXAY

Channing ISD

WTXS

Happy ISD

WTXAZ

Cherokee ISD

WTXT

Harrold ISD

WTXAZZ4

Childress ISD

WTXU

Hart ISD

WTXHA

City View ISD

WTXV

Hartley ISD

WTXAAA

Clarendon CISD

WTXW

Hedley ISD

WTXABB

Coahoma ISD

WTXX

Henrietta ISD

WTXACC

Cotton Center ISD

WTXY

Hereford ISD

WTXBE

Crane ISD

WTXBA

Highland Park ISD

WTXADD

Crosbyton Consolidated ISD

WTXZ

Holliday ISD

WTXAEE

Crowell ISD

WTXAA

Idalou ISD

WTXAFF

Culberson County - Allamoore ISD

Iraan-Sheffield ISD

WTXAGG3

WTXAB

Jacksboro ISD

WTXAGG

Dalhart ISD

WTXAC

Jayton ISD

WTXAHH

Darrouzett ISD

WTXAD

Jim Ned CISD

WTXAII

Dimmitt ISD

WTXAE

Kelton ISD

WTXAJJ

Dumas ISD

WTXAF

Klondike ISD

WTXAKK

Eden CISD

WTXAG

Kress ISD

WTXALL

El Paso Education Initiative Inc

WTXAH

Lazbuddie ISD

WTXAMM

El Paso Leadership Academy

WTXAI

Lefors ISD

WTXANN

Electra ISD

WTXAJ

Lockney ISD

WTXAOO 77

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

GROUP #

District

GROUP #

Loop ISD

WTXAPP

RISE Academy

WTXAYY1

Lorenzo ISD

WTXAQQ

River Road ISD

WTXAZZ1

May ISD

WTXARR

Robert Lee ISD

WTXAAA2

McLean ISD

WTXASS

Roosevelt ISD

WTXABB2

Meadow ISD

WTXATT

Ropes ISD

WTXACC2

Memphis ISD

WTXAUU

Saint Jo ISD

WTXADD2

Menard ISD

WTXAVV

Sands CISD

WTXAEE2

Miami ISD

WTXAWW

Sanford-Fritch ISD

WTXAFF2

Midland Academy Charter School

WTXAXX

Santa Anna ISD

WTXAGG2

Monahans-Wickett-Pyote ISD

WTXAYY

Seagraves ISD

WTXAHH2

Montague ISD

WTXAZZ

Shamrock ISD

WTXAII2

Morton ISD

WTXAAA1

Sierra Blanca ISD

WTXAJJ2

Munday CISD

WTXABB1

Smyer ISD

WTXAHH3

Nazareth ISD

WTXACC1

Southland ISD

WTXAKK2

New Home ISD

WTXADD1

Spring Creek ISD

WTXALL2

Newcastle ISD

WTXAEE1

Springlake-Earth ISD

WTXAFF3

Nocona ISD

WTXAFF1

Sudan ISD

WTXAMM2

Northside ISD

WTXAGG1

Sunray ISD

WTXANN2

O'Donnell ISD

WTXAHH1

Sweetwater ISD

WTXAOO2

Olfen ISD

WTXAII1

Texline ISD

WTXAQQ2

Olton ISD

WTXAJJ1

Throckmorton ISD

WTXARR2

Paducah ISD

WTXAKK1

Tulia ISD

WTXASS2

Paint Rock ISD

WTXALL1

Turkey-Quitaque ISD

WTXATT2

Panhandle ISD

WTXAMM1

Valentine ISD

WTXAUU2

Panther Creek CISD

WTXANN1

Vega ISD

WTXAVV2

Patton Springs ISD

WTXAOO1

Water Valley ISD

WTXAWW2

Petersburg ISD

WTXAPP1

Wellington ISD

WTXAXX2

Petrolia ISD

WTXAQQ1

Wheeler ISD

WTXAZZ2

Plains ISD

WTXARR1

White Deer ISD

WTXAAA3

Post ISD

WTXASS1

Whitharral ISD

WTXABB3

Prairie Valley ISD

WTXATT1

Wildorado ISD

WTXAZZ3

Pringle-Morse CISD

WTXAUU1

Wilson ISD

WTXACC3

Windthorst ISD

WTXADD3

Zephyr ISD

WTXAEE3

PSPartners

WTXBA

Quanah ISD

WTXAVV1

Ralls ISD

WTXAWW1

Rankin ISD

WTXAXX1

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 WTXEBC 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 WTXEBC 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.