2023 Frenship ISD Benefit Guide

Benefit Contact Information

FRENSHIP ISD BENEFITS

Frenship ISD Benefits Department (806) 866 9541 www.frenship.net

HOSPITIAL INDEMNITY

The Hartford Group # VHI 888093 (866) 547 4205 www.thehartford.com

MEDICAL BROKER MEDICAL

Marsh McLennan Acency (806) 798 9050 erin.e.dawson@marshmma.com

Scott and White Health Plan (800) 884 4901 https://www.swhp.org

HEALTH SAVINGS ACCOUNT (HSA) TELEHEALTH

HSA Bank (800) 357 6246 www.hsabank.com

DENTAL VISION

MGM Benefits Group (972) 608 7300 www.MGMBenefits.com

Superior Vision Group #31311 (800) 507 3800 www.superiorvision.com

CANCER LIFE AND AD&D

Loyal American Group #LG 6040 (800) 366 8354

EMERGENCY MEDICAL TRANSPORTATION

MASA (800) 643 9023 www.masamts.com

OneAmerica Group #00616354 (800) 553 3522 www.oneamerica.com

FLEXIBLE SPENDING ACCOUNT (FSA)

National Benefit Services (855) 399 3035 www.nbsbenefits.com

HealthiestYou (866) 703 1259 www.healthiestyou.com

DISABILITY

The Hartford Group #681131 (866) 547 9124 www.thehartford.com

ACCIDENT

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

Annual Benefit Enrollment

Annual Enrollment

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

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

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

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

New Hire Enrollment

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

Q&A

Who do I contact with Questions?

For supplemental benefit questions, you can contact your Benefits 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/ frenshipisd. 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 Frenship ISD benefit website: www.mybenefitshub.com/frenshipisd. 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

Section 125 Cafeteria Plan Guidelines

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

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

CHANGES IN STATUS (CIS):

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

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.

Eligibility for Government Programs

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

Helpful Definitions

Actively at Work

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

Annual Enrollment

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

Annual Deductible

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

Calendar Year

January 1st through December 31st

Co-insurance

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

Guaranteed Coverage

The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively at work and/or 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

January 1st through December 31st

Pre Existing Conditions

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

Annual Benefit Enrollment

Employee Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week. Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2023 benefits become effective on January 1, 2023, you must be actively at work on January 1, 2023 to be eligible for your new benefits.

Dependent Eligibility Requirements

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

AGE

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

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

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 Administrator to request a continuation of coverage.

Approved by Congress in 2003, HSAs are actual bank accounts in employee’s names that allow employees to save and pay for unreimbursed

free.

$1,500

(2023)

(2023)

(2023)

(2023)

expenses

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

Employees

N/A

$3,050 (2023)

Reimbursement

(as defined in Sec. 213(d) of IRC).

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

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

$404.44

$712.73

$617.94

$506.95

$858.55

$993.84

$728.99

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/frenshipisd

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).

Asked & Answered

Is

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.

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

hours per week on a regularly scheduled basis.

Hospital Indemnity The Hartford

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

BENEFITS

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 I no longer a member of this group?

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

1“Kaiser Family Foundation, November 2019. Adjusted expenses per inpatient day include expenses incurred for both inpatient and outpatient care; inpatient days are adjusted higher to reflect an estimate of the volume of outpatient services: https://www.kff.org/health costs/state indicator/expenses per inpatient day, viewed as of 4/16/2021.

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

3AbilityAssist® 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. Services may not be available in all states. Visit https://www.thehartford.com/employee benefits/value added services for more information.

4HealthChampionSM 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 is not responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue these services at any time. Services may not be available in all states. Visit https://www.thehartford.com/employee benefits/value added services for more information. HealthChampionSM 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.

Health Savings Account (HSA) HSA Bank

HSA

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

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

A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs it is also a tax exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs. A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax free and spends tax free if used to pay for qualified medical expenses. There is no “use it or lose it” rule you do not lose your money if you do not spend it in the calendar year and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.

HSA Eligibility

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

• Enrolled in an HSA eligible HDHP

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

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

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

• Not enrolled in Medicare or TRICARE

• Not receiving Veterans Administration benefits

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

Maximum Contributions

Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2023 is based on the coverage option you elect:

• Individual: $3,850

• Family (filing jointly): $7,700

• 55+ years: +$1,000

You decide whether to use the money in your account to pay for

qualified expenses or let it grow for future use. If you are 55 or older, you may make a yearly catch up contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch up contribution for the entire plan year.

Opening an HSA

If you meet the eligibility requirements, you may open an HSA administered by HSABank. 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 HSABank are eligible for automatic payroll deduction and company contributions.

How to Use your HSA

• HSA Bank Mobile App Download to check available balances, view HSA transaction details, save and store receipts, scan items in store to see if they’re qualified, and access customer service contact information.

• myHealth PortfolioSM Track your healthcare expenses, manage receipts and claims from multiple providers, and view expenses by provider, description, and more.

• Account preferences Designate a beneficiary, add an authorized signer, order additional debit cards, and keep important information up to date.

• Access online at: http://www.hsabank.com

Telehealth

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/frenshipisd

Alongside your medical coverage is access to quality telehealth services through HealthiestYou. Connect anytime day or night with a board certified doctor via your mobile device or computer. While HealthiestYou 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 HealthiestYou:

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

not use telemedicine for serious or life threatening emergencies.

HealthiestYou Confidential Counseling:

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

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

HealthiestYou Dermatology:

Upload photos of your condition to the app and get a treatment plan from a dermatologist within two business days.

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

Registration is Easy Register with HealthiestYou so you are ready to use this valuable service when and where you need it.

• Download the app. Search “HealthiestYou” in the app store or on Google Plan

• Set up your account. Once you’ve downloaded the app, select “Register” then choose “Employee” as your membership type.

• Enter basic contact information. Type in your last name, date of birth and ZIP code.

• Type in your security information. Enter a valid email address, password, the best number for our doctors to reach you, your preferred language, and accept terms and conditions.

For more information please Call: (866) 703 1259 or Visit: www.Healthiestyou.com

Telehealth Employee and Family $21.00

Dental Insurance MGM Benefits 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.mybenefitshub.com/frenshipisd

What will the plan reimburse?

You go to the dentist of your choice. You and your dentist determine the best method of treatment. Pre authorizations are never required and only cosmetic procedures (i.e. teeth whitening), implants and TMJ treatments are excluded.

Dental Reimbursement

Employee $23.00

Employee and Spouse $47.00

Employee and Child(ren) $50.00

Annual maximum benefit paid

is: $1,500.00. Child and Adult Orthodontia is limited to $1,500.00 lifetime maximum per insured. Exclusions include: cosmetic dentistry, implants, TMJ.

does this plan

(888)

Family $73.00

Vision Insurance

ABOUT VISION

Monthly Premiums

How to Print your Vision ID Card:

can request your vision id

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.

Discount Features

(range

as

10% 30%) prior to

30%

20% off retail

10% off retail

$39 maximum out of pocket

Vision has a nationwide network of independent

with leading LASIK networks

members a discount. These discounts range from 10% 50%, and are the best possible discounts available to Superior

Disability Insurance

The Hartford

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/frenshipisd

Educator Disability insurance combines the features of a short term and long term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need. You have the opportunity to purchase Disability Insurance through your employer. This highlight sheet is an overview of your Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.

Eligibility You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis.

Enrollment You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period.

Effective Date Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect

Actively at Work You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.

Benefit Amount You may purchase coverage that will pay you a monthly benefit of 30%, 40%, 50% or 60% of your monthly income, to a maximum of $7,500. Earnings are defined in The Hartford’s contract with your employer.

Elimination Period You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Disability benefit payment. The elimination

period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin.

Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the age at which disability occurs, the maximum duration may vary. Please see the applicable schedules below based on the Premium benefit option. Premium Option: For the Premium benefit option the table below applies to disabilities resulting from sickness or injury.

Age Disabled Maximum Benefit Duration

Prior to 63 To Normal Retirement Age or 48 mo. if greater Age 63 To Normal Retirement Age or 42 mo. if greater Age 64 36 months

Age 65 30 months

Age 66 27 months

Age 67 24 months Age 68 21 months Age 69+ 18 months

Pre Existing Condition Limitation Your policy limits the benefits you can receive for a disability caused by a pre existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have been insured under this policy for 12 months before your disability begins.

Benefit Integration Your benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as:

• Social Security Disability Insurance

• State Teacher Retirement Disability Plans

• Workers’ Compensation

Other employer based disability insurance coverage you may have

Disability Insurance

The

• Unemployment benefits

• Retirement benefits that your employer fully or partially pays for (such as a pension plan)

• Your plan includes a minimum benefit of 10% of your elected benefit.

Survivor Benefit If you die while receiving disability benefits, a benefit will be paid to your spouse or child under age 25, equal to three times your last monthly gross benefit.

The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services.

Travel Assistance Program Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre trip information, emergency medical assistance and emergency personal services.

Identity Theft Protection An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims.

Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full time employment.

per $100 in benefit

$2.17 $2.82 $3.69 $4.38

$1.74 $2.24 $2.94 $3.50

$1.44 $1.85 $2.43 $2.89

$0.98 $1.27 $1.66 $1.97

$0.85 $1.09 $1.44 $1.70

$0.66 $0.85 $1.10 $1.32

Cancer Insurance Loyal American

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.mybenefitshub.com/frenshipisd

ADDITIONAL BENEFIT AMOUNTS

ANNUAL CANCER SCREENING BENEFIT RIDER (form LG 6041)

A. Basic Benefit We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, once per calendar year per Insured Person for screening tests performed to determine whether Cancer exists in an Insured Person. Covered annual Cancer screening tests include but are not limited to: mammogram, pap smear, breast ultrasound, ThinPrep, biopsy, chest x ray, thermography, colonoscopy, flexible sigmoidoscopy, hemocult stool specimen, PSA (blood test for prostate cancer), CEA (blood tests for colon cancer), CA125 (blood test for ovarian cancer), CA15 3 (blood test for breast cancer), serum protein electrophesis (blood test for myeloma).

B. Additional Benefit We will pay the expense incurred, but not to exceed two times the maximum benefit amount per calendar year as shown on the Certificate Schedule, for one additional invasive diagnostic procedure required as the result of an abnormal cancer screening test for which benefits are

reduced

OCCURRENCE BENEFIT RIDER (form

DAILY RADIATION, CHEMOTHERAPY, IMMUNOTHERAPY and EXPERIMENTAL TREATMENT BENEFIT RIDER (form LG 6046)

will pay the expense incurred, but not to exceed the maximum

Schedule for each day

(1)

(3)

benefit amount for the initial

by a

amount shown on the

(2)

amount

implant, limited to the

and an equal amount for each refill; (4)

amount per prescription; (5) Radiation Treatment. Benefits payable for interstitial or intracavitary applications of Radiation Treatments are payable on the day of insertion only and not for each day the Radiation Treatment remains in the body; or (6) Experimental Treatment. The benefit amount shown on the Certificate Schedule is the maximum daily benefit available per Insured Person regardless of the number or types of Cancer

or Immunotherapy, limited to the

received on the same day.

Cancer Insurance Loyal American

SURGICAL BENEFIT RIDER (form LG 6048)

Surgical Expense We will pay the Surgical Expense benefit for a surgical procedure for the treatment of an Insured Person’s Cancer (except Skin Cancer) according to the Surgical Schedule shown in this rider. However, in no event will the amount payable exceed the maximum Surgical Expense benefit shown on the Certificate Schedule, nor will it exceed the expense incurred.

Anesthesia Expense We will pay the anesthesia expense incurred, not to exceed 25% of the covered Surgical Expense benefit for the operation performed. This includes the services of an anesthesiologist or of an anesthetist under supervision of a physician for the purpose of administering anesthesia.

Breast Reconstruction with transverse rectus adominis myocutaneous flap (TRAM), single pedicle, including closure of donor site, with microvascular anastomosis (supercharging) is one of the surgical procedures listed in the Surgical Schedule. If this procedure is performed on an Insured Person as the result of a mastectomy for which We paid a Surgical Expense benefit for the treatment of Breast Cancer, We will pay the expense incurred not to exceed $900 per $1,000 of the Surgical Benefit issued. Skin Cancer Surgery Expense We will pay the expense incurred, not to exceed the procedure amount listed in this rider ($125 to $750 depending on the procedure) when a surgical operation is performed on an Insured Person for treatment of a diagnosed Skin Cancer. This benefit is payable in lieu of any benefits for Surgical Expense and Anesthesia Expense which are not applicable to Skin Cancer.

DAILY HOSPITAL CONFINEMENT BENEFIT RIDER (form LG 6042)

Confinements of 30 Days or Less We will pay the Daily Hospital Confinement benefit amount shown on the Certificate Schedule for each of the first 30 days in each period of hospital confinement during which an Insured Person is confined to a hospital, including a government or charity hospital, for the treatment of Cancer.

Confinements of 31 Days or More If an Insured Person is continuously confined to a hospital, including a government or charity hospital, for longer than 30 consecutive days for the treatment of Cancer, We will pay two times the Daily Hospital Confinement benefit amount shown on the Certificate Schedule. This benefit payment will begin on the 31st continuous day of such confinement and continue for each day of confinement until the Insured Person is discharged from the Hospital. Benefits for an Insured Dependent Child under Age 21 The amount payable under this benefit will be double the Daily Hospital Confinement benefit shown on the Certificate Schedule if the Insured Person so confined is a dependent child under the age of 21.

OPTIONAL BENEFITS YOU MAY SELECT FOR ADDITIONAL PREMIUM HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER (form LG 6047)

Intensive Care Unit Benefit We will pay the daily Hospital Intensive Care Unit Benefit shown on the Certificate Schedule for an Insured Person’s confinement in an ICU for sickness or injury. Double Intensive Care Unit Benefit We will pay double the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person’s confinement in an ICU as a result of Cancer. We will also double this ICU benefit for only the initial ICU confinement resulting from an Insured Person’s travel related injury, provided that the ICU confinement begins within 24 hours of the accident causing the travel related injury. A travel related injury includes being struck by an automobile, bus, truck, van, motorcycle, train or airplane; or being involved in an accident where the Insured Person was the operator or passenger in or on such vehicle.

Step Down Unit Benefit We will pay one half of the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person’s confinement in a Step Down Unit for a sickness or injury.

$200/Day

$400/Day $400/$800/Day

$100/Day

$200/Day $200/$400/Day

Additional Limitations and Exclusions for the Hospital Intensive Care Unit Benefit Rider If the rider is issued and coverage is in force, it will provide benefits if an Insured Person goes into a hospital Intensive Care Unit (including a Cardiac Intensive Care Unit or Neonatal Intensive Care Unit). Benefits start the first day of confinement in an ICU for sickness or injury. Any combination of benefits payable under this rider is limited to a maximum of 45 days per each period of confinement.

ALL BENEFITS CONTAINED IN THIS HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER REDUCE BY ONE HALF AT AGE 75. Benefits are not payable for any ICU or Step Down Unit confinement that results from intentional self inflicted injury; or the Insured Person’s being intoxicated or under the influence of alcohol, drugs or any narcotics, unless administered on and according to the advice of a medical practitioner. THIS IS A LIMITED RIDER.

Emergency Medical Transport

ABOUT MEDICAL TRANSPORT

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

For full plan details, please visit your benefit website:

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*

Member is hereby entitled to Emergent Air Transportation services, if necessitated by a Serious Emergency, to be rendered by a duly licensed emergency transportation provider, subject to the terms, conditions and limitations herein. In the event that such services result in an outstanding balance due by the Member, MASA shall reimburse Member's reasonable and customary out of pocket expenses, equal to the lesser of (i) the outstanding balance, following any payment by Member's health and/or other insurance coverage(s) and/or membership(s) or (ii) three (3) times the applicable Medicare allowable rate for such transportation, less any payment by Member's health and/or other insurance coverage(s) and/ or membership(s). MASA shall attempt to fully resolve the outstanding balance, as described above, on behalf of the Member. However, in the event that such payment does not satisfy the outstanding balance, MASA shall make a payment directly to the Member in the amount of $20,000. Reimbursement for such services shall be limited to transportation to the nearest and most appropriate Medical Facility, readily capable of receiving Member and providing the necessary level of care, as may be required by the Serious Emergency. Transport must result from the request or recommendation of a first responder or treating/transferring physician, who deems Emergent Air Transportation medically necessary. Services must be provided by a medically equipped helicopter or fixed wing aircraft, subject to the limitations herein, that is provided by a common air ambulance carrier. Coverage for Emergent Air Transport by fixed wing aircraft shall only be covered, exclusively, in the event of (i) the unavailability and/or inefficiency of transport by rotary aircraft or ground transport and (ii) necessity of specialized, immediate, life and/or limb saving treatment not available locally. Transports covered under this Agreement must originate and end within the United States or Canada.

Emergent Ground Transportation*

Member is hereby entitled to Emergent Ground Transportation services, if necessitated by a Serious Emergency, to be rendered by a duly licensed emergency transportation provider, at no additional expense to the Member. Such transportation shall be to the nearest and most appropriate Medical Facility, readily capable of receiving Member and providing the necessary level of care, as may be required by the Serious Emergency. Transport must result from the request or recommendation by a first responder or transferring physician who deems Emergent Ground Transportation medically necessary. Emergent Ground Transportation shall also include any ground transportation associated with Emergent Air Transportation. Transports covered under this Agreement must originate and end within the United States or Canada.

* All coverage provided by this membership is limited to the continental United States, Alaska, Hawaii, and Canada, and must originate and conclude therein.

Emergency Medical Transportation

Accident Insurance

Daily

Accidental Dismemberment

Single finger or 1 toe

fingers or toes

Single hand, arm, foot or leg Multiple hands, arms, feet or legs

$2,500 $5,000

$300 per day

charges

to $2,500

$1,000 $1,000 $5,000 $10,000

charges up to $3,750 actual charges up to $5,000

$1,500 $1,500 $7,500 $15,000

$2,000 $2,000 $10,000 $20,000

Accidental Loss of Sight Benefit per unit Loss of Sight in one eye Loss of Sight in both eyes $2,500 $5,000 $5,000 $10,000 $7,500 $15,000 $10,000 $20,000

Eligibility This policy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.

Base Policy and Optional Benefits No benefits are payable for a pre existing condition. Pre existing condition means an Injury that pertains solely to an Accidental Bodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre Existing Conditions specifically named or described as permanently excluded in any part of this contract are never covered. A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the US Government for treatment of members or ex members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long term nursing unit or geriatrics ward.

Medical Expense Accidental Injury Benefit Expenses must commence within 60 days of the covered accident. The max benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.

Air and Ground Ambulance Benefit Emergency transportation must occur within 21 calendar days of the accident causing such Injury.

Daily Hospital Confinement Benefit The maximum benefit period for this benefit is 30 days per covered accident.

Accidental Death Accidental Death must result within 90 days of the covered accident causing the injury.

Accidental Dismemberment Benefit The total amount payable for all Losses resulting from the same accident will not exceed the Maximum Dismemberment Benefit of $5,000 cumulative per unit, per Accident. Loss must be within 90 days of the accident causing such Injury.

Exclusions See policy limits and exclusions on your benefit website, www.mybenefitshub.com/frenshipisd

Guaranteed Renewable You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correct premium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class.

OneAmerica

ABOUT LIFE AND AD&D

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

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

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

Basic Life and AD&D Coverage

$20,000 is provided by Frenship ISD to full time, benefits eligible employees.

Employee Voluntary Life Guaranteed Issue $200,000

Employee Voluntary Life Maximum $500,000 In increments of $10,000

Spouse Voluntary Life Guaranteed Issue $50,000

Spouse Voluntary Life Maximum $250,000 maximum in increments of $5,000 or 50% of employee’s election. Dependent Child(ren) Voluntary Life Guaranteed Issue 6 months 26 years $10,000

Employee Voluntary AD&D Coverage Amount Up to $500,000 in increments of $10,000

Spouse AD&D Coverage: 50% of the employee AD&D benefit, 40% if child included. Child AD&D Coverage: 15% of the employee AD&D benefit, 10% if child included

Guaranteed Life Insurance Coverage Amount: Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $200,000 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 $500,000 with evidence of insurability. See the Evidence of Insurability page for details. Your coverage amount will reduce by 65% of the original amount when you reach age 70; 45% of the original amount when

of the original amount when you reach age 80; 20% of the original amount when you reach age 85; and

Dependent

reach

of the original amount when

can

reach age 90.

for your

children when you choose coverage for yourself.

Flexible Spending Account (FSA)

plan

For

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 contribute the a Limited Health Care FSA if you enroll in a High Deductible Health Plan and contribute to a Health Savings Account (HSA). Limited purpose Health Care FSA funds may be used for Dental and Vision expenses only.

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.

Dependent Care FSA Guidelines

• Overnight camps are not eligible for reimbursement (only day camps can be considered).

• If your child turns 13 mid year, you may only request reimbursement for the part of the year when the child is under age 13.

• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your

Flexible Spending Account (FSA)

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 75 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.

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

Health Care FSA

Dependent Care FSA

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

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

$3,050

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

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

Reduces your taxable income

Account Type

Expenses

Contribution Limits

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 Frenship ISD Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice.

Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the Frenship ISD Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.