2023 EOAC Benefit Guide

Benefit Contact Information

ECONOMIC OPPORTUNITIES

ADVANCEMENT CORPORATION

FBS A Higginbotham Partner (866) 914 5202 www.mybenefitshub.com/eoac

HOSPITIAL INDEMNITY

The Hartford (866) 547 4205 www.thehartford.com/employeebenefits

VISION

Blue Cross Blue Shield (855) 556 8796 www.eyemedvisioncare.com/bcbstxvis

LONG TERM DISABILITY

Blue Cross Blue Shield Group #VF026025 (800) 769 9187 www.bcbstx.com

CRITICAL ILLNESS

Chubb (800) 252 4670 www.chubb.com/us en/claims.html

BENEFITS ACCOUNT MANAGER MEDICAL

Higginbotham

Natalie BeShears (254) 741 6770 nabeshears@higginbotham.net

TELEHEALTH

TELADOC (800) 945 4355 www.teledoc.com

LIFE AND AD&D

Blue Cross Blue Shield (800) 769 9187 www.bcbstx.com

ACCIDENT

Cigna Group #AI962406 (800) 244 6224 www.mycigna.com

EMERGENCY MEDICAL

TRANSPORT

MASA (800) 423 3226 www.masamts.com

BCBSTX PPO Group #250624 HMO Group #250625 (800) 521 2227 www.bcbstx.com

DENTAL

Blue Cross Blue Shield (800) 521 2227 www.bcbstx.com

SHORT TERM DISABILITY

Blue Cross Blue Shield Group #VF026025 (800) 769 9187 www.bcbstx.com

CANCER

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

IDENTITY THEFT

Experian (866) 617 1894 www.experian.com

Annual Benefit Enrollment

Section 125 Cafeteria Plan Guidelines

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

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 30 days of your qualifying event and meet with your HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

CHANGES IN STATUS (CIS):

Marital Status

Change in Number of Tax Dependents

Change in Status of Employment Affecting Coverage Eligibility

Gain/Loss of Dependents' Eligibility Status

Judgment/Decree/ Order

Eligibility for Government Programs

QUALIFYING EVENTS

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

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

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

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

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

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

Annual Benefit Enrollment

Annual Enrollment

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

• Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.

• Employees must review their personal information and verify that dependents they wish to provide coverage for are included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or benefit information.

• Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.

New Hire Enrollment

All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit eligible employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

Q&A

Who do I contact with Questions?

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

Where can I find forms?

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

Click the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms section.

How can I find a Network Provider?

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

When will I receive ID cards?

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

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

Annual Benefit Enrollment

Employee Eligibility Requirements

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

Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2022 benefits become effective on December 1, 2022, you must be actively at work on December 1, 2022 to be eligible for your new benefits.

Dependent Eligibility Requirements

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

PLAN MAXIMUM AGE

Medical To age 26

Dental To age 26 Vision To age 26 Life and AD&D To age 26 Cancer To age 26

Critical Illness To age 26 Hospital Indemnity To age 26

Accident To age 26

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

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

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

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

Annual Benefit Enrollment

Actively-at-Work

You are performing your regular occupation for the employer on a full time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel If you will not be actively at work beginning 12/1/2022 please notify your benefits administrator.

Annual Enrollment

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

Annual Deductible

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

Calendar Year

January 1st through December 31st

Co insurance

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

Guaranteed Coverage

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

In-Network

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

Out-of-Pocket Maximum

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

Plan Year

December 1st through November 30th

Pre Existing Conditions

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

Medical Insurance Blue Cross Blue Shield EMPLOYEE BENEFITS

ABOUT MEDICAL

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

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

The medical plan options through vendor protect you and your family from major financial hardship in the event of illness or injury.

Health Maintenance Organization (HMO)

With an HMO, you must seek care from in network providers in the vendor HMO network. The selection of a primary care physician and a referral is required. It is best to confirm that your doctor and all specialists are in network before seeking care.

Preferred Provider Organization (PPO)

A PPO allows you the freedom to see any provider when you need care. When you use in network providers, you receive benefits at a discounted network cost. You may pay more for services if you use out of network providers. In network office visits, urgent care and prescription drugs are covered with a copay. Most other in network services are covered at the coinsurance level.

Monthly Medical Rates

500

Total Mo. Premium Employer Contribution

Cost

Employee Only $724.87 $480.00 $244.87

Employee and Spouse $1,401.15 $480.00 $921.15

Employee and Child(ren) $1,344.61 $480.00 $864.61

Employee and Family $2,080.33 $480.00 $1,600.33

HMO 2500

Total Mo. Premium Employer Contribution Employee Cost

Employee Only $767.01 $480.00 $287.01

Employee and Spouse $1,482.60 $480.00 $1,002.60

Employee and Child(ren) $1,422.79 $480.00 $942.79

Employee and Family $2,201.28 $480.00 $1,721.28

HMO 1500

Total Mo. Premium Employer Contribution Employee Cost

Employee Only $789.84 $480.00 $309.84

Employee and Spouse $1,526.75 $480.00 $1,046.75

Employee and Child(ren) $1,465.15 $480.00 $985.15

Employee and Family $2,266.83 $480.00 $1,786.83

PPO

Total Mo. Premium Employer Contribution Employee Cost

Employee Only $795.50 $480.00 $315.50

Employee and Spouse $1,537.71 $480.00 $1,057.71

Employee and Child(ren) $1,475.65 $480.00 $995.65

Employee and Family $2,283.08 $480.00 $1,803.08

Hospital Indemnity The

ABOUT HOSPITAL INDEMNITY

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

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

Coverage Information

You have a choice of two hospital indemnity plans, which allows you the flexibility to enroll for the coverage that best meets your needs. Benefit amounts are based on the plan in effect for you or an insured dependent at the time the covered event occurs. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s).

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Is this coverage HSA compatible?

EMPLOYEE BENEFITS

If you (or any dependent(s)) currently participate in a Health Saving Account (HSA) or if you plan to do so in the future, you should be aware that the IRS limits the types of supplemental insurance you may have in addition to a HSA, while still maintaining the tax exempt status of the HSA.

This plan design was designed to be compatible with Health Savings Accounts (HSAs). However, if you have or plan to open an HSA, please consult your tax and legal advisors to determine which supplemental benefits may be purchased by employees with an HSA.

Who is eligible?

You are eligible for this insurance if you are an active full time employee who works at least 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.

Am I guaranteed coverage?

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

How much does it cost and how do I pay for it?

Premiums are provided above. You have a choice of plan options. You may elect insurance for you only, or for you and your dependent(s), by choosing the applicable coverage tier.

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.

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 an eligible member of this group?

Yes, you can take this coverage with you. Your spouse/partner may also continue insurance in certain circumstances.

2 For Hospital Care benefits, when an insured is eligible for more than one benefit in a single day, only the highest benefit will be paid.

3 Rates and/or benefits may be changed.

4 AbilityAssist® services are offered through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford is not responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue any of these services at any time. Ability Assist is a registered trademark of The Hartford. Services may not be available in all states.

5 HealthChampion℠ services are provided through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford doesn’t provide basic hospital, basic medical, or major medical insurance. HealthChampion specialists are only available during business hours. Inquiries outside of this timeframe can either request a call back the next day or schedule an appointment. The Hartford is not responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue any of these services at any time. Health Champion is a service mark of ComPsych. Services may not be available in all states. Visit https://www.thehartford.com/employee benefits/value added services for more information.

Telehealth Teledoc

ABOUT TELEHEALTH

Telehealth provides 24/7/365 access to board certified doctors via telephone or video consultations that can diagnose, recommend treatment and prescribe medication. Telehealth makes care more convenient and accessible for non emergency care when your primary care physician is not available.

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

BENEFITS

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

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

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

• Are unable to see your primary care physician

When to Use myStrength:

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

• Bronchitis

• Flu

• Rashes

• Sinus infections

• Sore throats

• And more!

Do not use telemedicine for serious or life threatening emergencies.

myStrength Behavioral Health:

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

• Talk to a licensed therapist of your choice from your home, office, or on the go! Affordable, confidential online therapy for a variety of counseling needs.

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

Registration is Easy

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

• Go inline to www.teladoc.com

• Download the app at www.mystrength.com/join

• Register by Phone at (800) 945 4355

ABOUT DENTAL

is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and

full plan details, please visit your benefit website:

Dental Insurance Blue Cross Blue Shield

EMPLOYEE BENEFITS

Contracting Provider/Non Contracting Provider: Contact your dental carrier at (800) 521 2227 to find a contracting dentist near you. This plan lets you choose any dentist you wish. However, your out of pocket costs are likely to be lower when you choose a contracting dentist.

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

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

**Non Network Provider: For services provided by a non network dentist, your provider will reimburse according to the Maximum Allowable Charge. The dentist may balance bill up to their usual fees.

Monthly Dental Rates*

Employee $21.79

Employee and Spouse $44.55

Employee and Child(ren) $47.21

Employee and Family $69.96

* Rates for both Dental plans are identical, please services/network coverage details for differences in coverage(s).

Vision Insurance Blue Cross Blue Shield

ABOUT VISION

BENEFITS

Vision insurance provides coverage for routine eye

and can help with covering some of the costs for

or contact

For full plan details, please visit your

Frequency

Monthly Vision Rates

Examination

Lenses

Care Services

Exam with dilation

Any available frame at

Standard Lenses

Single

Lens Options

Tint (solid and

resistant

Ultraviolet coating

coating

Photochromic/transitions

Contact Lenses (in

Conventional

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Vision Insurance Blue Cross Blue Shield

Other

Laser vision correction

Additional pairs benefit

Amplifon hearing discount

Additional discounts

Progressive Price

Standard progressive

Premium Progressives

2

Anti Refective Coating Price

Standard

Follows:

retail price or 5% off promotional price

off purchase of complete pair of eyeglasses and a

off conventional contact lenses once the funded benefit has been used

off hearing exams and low price guarantee on discounted hearing aids

off non covered items with limitations

Cost In Network

80% of charge less $120

Cost In Network

reflective

Other

Cost In

EMPLOYEE BENEFITS

Exclusions

• Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; aniseikonic lenses

• Medical and/or surgical treatment of the eye, eyes or supporting

• Any eye or vision examination, or any corrective eyewear required by a Policyholder as a condition of employment; safety eyewear

• Services provided as a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof Plano (non prescription) lenses and/or contact lenses

• Non prescription sunglasses

• Two pair of glasses in lieu of bifocals

• Services rendered after the date an insured person ceases to be covered under the policy, except when vision materials ordered before coverage ended are delivered, and the services rendered to the insured person are within 31 days from the date of such order

• Services or materials provided by any other group benefit plan providing vision care

• Lost or broken lenses, frames, glasses or contact lenses will not be replaced except in the next benefit frequency when vision materials would next become available

1. Member Reimbursement Out of Network will be the lesser of the listed amount or the member’s actual cost from the out of network provider. In certain states, members may be required to pay the full retail rate.

2. Blue Cross Blue Shield of Texas 9ision &are reserves the right to make changes to the products on each tier and the member out of pocket costs. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels.

3. Premium progressives and premium anti reflective designations are subject to annual review by (ye0edȇs Medical Director and are subject to change based on market conditions. Fixed pricing is reflective of brands at the listed product level. All providers are not required to carry all brands at all levels. Not available in all states. Some provisions, benefits, exclusions or limitations listed herein may vary.

Life and AD&D Blue Cross Blue Shield

ABOUT LIFE AND AD&D

Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well being of your family.

Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

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

Basic Life and AD&D

EMPLOYEE BENEFITS

Basic Life and AD&D Coverage $50,000 coverage provided to full time benefits eligible employees by EOAC.

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

Voluntary Term Life/AD&D Benefits

Employee Guaranteed Issue $100,000

AD&D coverage amount Equal to the life insurance amount chosen Spouse Guaranteed Issue $50,000 employees under age 65; $10,000 employees 65 and over Spouse Maximum Coverage $250,000 maximum in increments of $5,000 not to exceed 100% employee coverage amount

AD&D coverage amount Equal to the life insurance amount chosen Guaranteed coverage amount for dependent Children.

• Birth 14 days: $500

• 15 days 6 months: $500

• 6 months 26 years: up to $10,000 in $1,000 increments

Age Reduction Schedule Life and AD&D benefits reduce by 35% of the original amount at age 70 and further reduce by 50% of the original amount at age 75. Accelerated Death Benefit (ADB) Upon the employee's request, this benefit pays a lump sum up to 75% of the employee's life insurance, if diagnosed with a terminal illness and has a life expectancy of 24 months or less. Minimum: $7,500. Maximum $500,000. The amount of group term life insurance otherwise payable upon the employee's death will be reduced by the ADB.

Guaranteed Life and AD&D Insurance Coverage Amount: Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to your employer’s guaranteed issued requirements without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability. If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.

Maximum Life Insurance Coverage Amount: You can choose a coverage amount up to 5 times your annual salary ($250,000 maximum) with evidence of insurability. See the Evidence of Insurability page for details.

Life and AD&D Blue Cross Blue Shield

AD&D Schedule of Loss* Principal Sum

Loss of life 100%

Loss of both hands or both feet 100%

Loss of one hand and one foot 100%

Loss of speech and hearing 100%

Loss of sight of both eyes 100%

Loss of one hand and sight of one eye 100%

Loss of one foot and sight of one eye 100%

Quadriplegia 100%

Paraplegia 75%

Hemiplegia 50%

Loss of sight of one eye 50%

Loss of one hand or one foot 50%

Loss of speech or hearing 50%

Loss of thumb and index finger of same hand 25%

Uniplegia 25%

AD&D Product Features Included:

Seatbelt and Airbag Benefits

Day Care Benefit Public Conveyance Benefit

EMPLOYEE BENEFITS

Monthly Voluntary Group Life Rates

Spouse

based on Employee's age.

Disability Blue Cross Blue Shield EMPLOYEE BENEFITS

ABOUT DISABILITY

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

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

Group Short term Disability Insurance (STD)

Today, most Americans would not be able to make payments on their homes or keep their family financially stable without their current salary. STD reduces the burden during these unstable times. It is a convenient, economical way of securing an income while out of work from an unexpected injury or illness. Group STD is a guaranteed issue coverage, which requires no health questionnaires to complete.

Eligibility Provided to all full time benefits eligible employees by EOAC

Employer Paid STD Benefit 60% of basic weekly earnings

Weekly Maximum Benefit $1,000

Benefits Begin After 7th day for accident; 7th day for sickness Maximum Benefit Period 13 Weeks or until LTD begins, whichever is earlier

Total Disability Total Disability means that due to Injury or Sickness the employee is unable to perform all of the material and substantial duties of the employee’s regular occupation, and the employee’s disability earnings, if any, are less than the percentage (20%) of the employee’s pre disability weekly earnings.

Partial Disability Partial Disability means that during the elimination period the employee is able to perform some, but not all, of the material and substantial duties of the employee’s regular occupation. After the elimination period, partial disability means that due to injury or sickness the employee is able to perform some but not all of the material and substantial duties of the employee’s regular occupation, and the employee’s disability earnings, if any are at least the minimum percentage (20%), but less than the maximum percentage of the employee’s pre disability weekly earnings (80%).

Exclusions We do not pay benefits for any loss or disability caused by, resulting from, arising out of or substantially contributed to, directly by any one or more of the following:

• Loss of professional license, occupational license or certification

• Commission of, participation in, or an attempt to commit an assault or felony

Intentionally self inflicted injuries

Attempted suicide, regardless of mental capacity

Cosmetic surgery except when required due to illness or injury

Occupational

Participation in a

or undeclared, or any

of

Voluntary Group Long term Disability Insurance (LTD)

Disability Blue Cross Blue Shield

Elimination Period 90 days

Maximum Period Payable Social Security Normal Retirement Age (SSNRA)

Social Security Offset Method Primary and Family Integration Own Occupation Period 24 months

Partial Disability Earnings Test During Own Occ Period Earnings Test After Own Occ Period 80% 60%

Work Incentive Benefit

Rehabilitation Incentive Income (RII)

BENEFITS

Survivor Benefit

Day Care Expense Benefit

Proportionate 12 months. Partially disabled employees are eligible for a Work Incentive Benefit. The Work Incentive Benefit allows the partially disabled employee to receive their monthly benefit if their benefit plus their earnings do not exceed 100% of indexed pre disability income. If their benefit plus their earnings exceeds 100% of indexed pre disability income, their benefit is reduced by the excess. After 12 months, the employee’s Work Incentive Benefit is calculated by multiplying their monthly benefit by their loss of salary ratio. “Partially Disabled” means that an employee is working in a partial or part time capacity after becoming disabled and meets the earnings test shown above.

Proportionate 12 months. RII is offered to employees who agree to take part in a rehabilitation plan, structured to return them to gainful employment in another occupation because they can not return to their regular occupation. During the first 12 months, RII is equal to the monthly benefit. If disability earnings during this period exceed 100% of indexed pre disability earnings, the monthly benefit is reduced by the excess. After 12 months, RII is equal to the monthly benefit reduced by multiplying the monthly benefit by the adjusted loss of salary ratio.

If the employee passes away after being disabled and receiving long term disability benefits for 6 consecutive months, We will pay the employee’s beneficiary a lump sum benefit equal to three months of disability benefits.

While receiving RII, and participating in an approved rehabilitation plan, the claimant may be reimbursed for eligible day care expenses.

Mental Disorder Limitation 24 months

Substance Abuse Limitation 24 months

Special Conditions Limitation 24 months

Pre Existing Condition Limitation

12/24 A pre existing condition means a sickness or injury for which an employee received treatment within 12 months prior to the effective date. Any disability contributed to or caused by a pre existing condition within the first 24 months of the effective date will not be covered.

Additional Features Disability Resource Services In addition to the resource services available on line at GuidanceResources.com, Disability Resource Services provides a 24 hour telephonic support for all LTD insureds for behavioral health issues. A staff of master degree clinicians are available to provide each caller with assessment, counseling and referral advice for face to face counseling. Face to face counseling Up to three face to face counseling sessions per year to address appropriate behavioral health issues. Available for groups with 10 or more employees.

Monthly Long Term Disability Rates (per $100 in benefit) Age Rate Under 20 $0.208

$0.236

$0.427

$0.725

$0.934

$1.282

$1.495

$1.810

$1.972

$1.237

$1.938

$1.399

$1.412

Accident Insurance Cigna

ABOUT ACCIDENT

Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you.

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

Who Can Elect Coverage?

You: All active, Full time Employees of the Employer who are regularly working in the United States a minimum of 30 hours per week and regularly residing in the United States who are United States citizens or permanent resident aliens and their Spouse and Dependent Children who are United States citizens or permanent resident aliens and are residing in the United States. You will be eligible for coverage the first of the month following date of hire.

Employee

Employee

Employee and

Accident

BENEFITS

$19.40

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

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

& Emergency Care

Diagnostic Exam (x ray or lab)

urgent care)

Ground or Water Ambulance/Air Ambulance

Hospitalization Benefits

Hospital Admission

Stay

Intensive Care Unit Stay

Fractures and Dislocations

Per covered surgically repaired fracture

Per covered non surgically repaired fracture

Chip Fracture (percent of fracture benefit)

Per covered surgically repaired dislocation

Per covered non surgically repaired dislocation

Follow Up Care

Follow up Physician (or medical professional) Office Visit

Follow up Physical Therapy Visit

Enhanced Accident Benefits Examples

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

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

Concussion

Coma (lasting 7 days with no response)

Accident Insurance

Cigna

BENEFITS

Accidental Death and Dismemberment Benefit Plan 1 Plan 2

Examples of benefits include (but are not limited to) payment for death from Automobile accident; total and permanent loss of speech or hearing in both ears. Actual benefit amount paid depends on the type of Covered Loss. The Spouse and Child benefit is 50% and 50% respective of the benefit shown.

Wellness Treatment, Health Screening Test & Preventive Care Benefit

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

Loss of Life:

1

2

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

Employee’s Monthly Cost of Coverage: Costs are subject to change. Actual per pay period premiums may differ slightly due to rounding.

Important Definitions and Policy Provisions:

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

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

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

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

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

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

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

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

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

ABOUT CANCER

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

Surgical (not

site,

Patient Care Rider Benefits

Hospital Confinement:

Per day of Hospital Confinement (1 30 days)

Per day for Eligible Dependent Children (1 30 days) Per day of Hospital Confinement (31+ days)

Outpatient Facility Per day surgery

Attending Physician Per day of Hospital

Piece)

device

Cancer Insurance

APL

Patient Care Rider Benefits (cont’d)

Dread Disease Per day of Hospital Confinement (1 30 days / 31+ day)

Plan 1

BENEFITS

Plan 2

$200 / $400 $300 / $600

Extended Care Facility Up to the same number of Hospital Confinement Days $200 per day $300 per day

Donor

$200 per day $300 per day

Home Health Care Up to the same number of Hospital Confinement Days $200 per day $300 per day

Hospice Care Up to maximum of 365 days per lifetime

$200 $300 US Government, Charity Hospital or HMO Per day of Hospital Confinement (1 30 days/ 31+ days)

$200 / $400 $300 / $600

Miscellaneous Care Rider Benefits

Cancer Treatment Center Evaluation or Consultation 1 per lifetime $750 $750

Evaluation or Consultation Travel and Lodging 1 per lifetime $350 $350 Second / Third Surgical Opinion per diagnosis of cancer $300 / $300 $300 / $300

Drugs and Medicine Inpatient / Outpatient (maximum $150 per month)

$150 per confinement $50 per prescription $150 per confinement $50 per prescription

Hair Piece (Wig) 1 per lifetime $150 $150

Transportation Maximum 12 trips per calendar year for all modes of transportation combined

Travel by bus, plane or train

Travel by car

Lodging up to a maximum of 100 days per calendar year

Cancer Benefit Highlights

Family Transportation Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car

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

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

Family Lodging up to a maximum of 100 days per calendar year $100 per day $100 per day Blood, Plasma and Platelets $300 per day $300 per day Ambulance Ground/Air Maximum of 2 trips per Hospital Confinement for all modes of transportation combined $200 / $2,000 per trip $200 / $2,000 per trip

Inpatient Special Nursing Services per day of Hospital Confinement

$150 per day $150 per day Outpatient Special Nursing Services Up to same number of Hospital Confinement days $150 per day $150 per day

Medical Equipment Maximum of 1 benefit per calendar year $150 $150 Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year $25 per visit / $1,000 $25 per visit / $1,000 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

Hospital Intensive Care Unit Rider Benefits

Intensive Care Unit

$600 per day $600 per day

Step Down Unit Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit $300 per day $300 per day

Should you need to file a claim contact APL at (800) 256 8606 or online at www.ampublic.com

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.mybenefitshub.com/eoac

Critical Illness Benefits

Covered Conditions

Pays a percentage of face amount

ALS 100%

Alzheimer’s Disease 50%

Benign Brain Tumor 100%

Breast Cancer Carcinoma In Situ 100% Cancer (except skin cancer) 100%

Carcinoma In Situ 25% Coma 100%

Coronary Artery Obstruction 25%

End Stage Renal Failure 100%

Heart Attack 100% Loss of Sight, Speech or Hearing 100% Major Organ Failure 100%

Multiple Sclerosis 30% Paralysis or Dismemberment 100%

Parkinson’s Disease 25% Severe Burns 100%

Skin Cancer (payable once per insured per calendar year) $250 Stroke 100%

Sudden Cardiac Arrest 100%

Transient Ischemic Attack 10%

Childhood Conditions

Pays 100% of the face amount; Benefits payable for 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, Cancer, Coma, Coronary Artery Obstruction, Heart Attack, Major Organ Failure, Severe Burns, Stroke, or Sudden Cardiac Arrest. 50% Advocacy Package

Best Doctors Physician Referrals

Ask the Expert Hotline provides 24 hour advice from experts about a particular medical condition. In Depth Medical Review offers a full review of diagnosis and treatment plan.

Included Additional Benefit

Wellness Benefit (Per Covered Person, Per Calendar Year) $50

Critical Illness Insurance Chubb EMPLOYEE BENEFITS

Critical Illness

$5,000 Plan

Employee Only Employee and Spouse Employee and Children Employee and Family

18 29 $3.16 $6.30 $3.16 $6.30

39 $3.76 $7.50 $3.76 $7.50

49 $5.96 $11.90 $5.96 $11.90

59 $9.86 $19.70 $9.86 $19.70

69 $14.76 $29.50 $14.76 $29.50

$33.20 $66.40 $33.20 $66.40

$10,000 Plan

Employee Only Employee and Spouse Employee and Children Employee and Family

18 29 $4.50 $9.00 $4.50 $9.00

39 $5.70 $11.40 $5.70 $11.40

49 $10.10 $20.20 $10.10 $20.20

59 $17.90 $35.80 $17.00 $35.80

69 $27.70 $55.40 $27.70 $55.40

$64.60 $129.20 $64.60 $129.20 $15,000 Plan

Employee Only Employee and Spouse Employee and Children Employee and Family 18 29 $5.86 $11.70 $5.86 $11.70

39 $7.66 $15.30 $7.66 $15.30

49 $14.26 $28.50 $14.26 $28.50

59 $40.66 $81.30 $40.66 $81.30

69 $96.00 $192.00 $96.00 $192.00

Emergency Medical Transport MASA

ABOUT MEDICAL TRANSPORT

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

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

BENEFITS

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. After the group health plan pays its portion, MASA MTS works with providers to deliver our members’ $0 in out of pocket costs for emergency transport.

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.

Emergency Medical Transportation Employee and Family $14.00

Identity Theft Experian

ABOUT IDENTITY THEFT PROTECTION

Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.

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

BENEFITS

Identity Theft

Employee $8.50

Employee and Family $16.00

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Identity Restoration

Get back on track with support from an expert restoration agent that will walk you through the process of reclaiming what’s rightfully yours.

Dark Web Monitoring

If we detect any threats on the thousands of websites and millions of data points we scan, we’ll alert you so you can keep your family’s personal information safe.

Medical Identity Monitoring

If your insurance information is used to receive medical care or fill prescriptions, we’ll send you an alert to verify the service or act if you suspect identity theft.

Experian CreditLock™

Block fraudsters from using your information to get new credit and act quickly to help prevent identity theft. Unlock it when you want to apply for credit.

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 EOAC 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 EOAC 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.