2024-25 Andrews ISD Benefit Guide by Higginbotham Public Sector

Benefit Contact Information

Higginbotham Public Sector (800) 583-6908 www.mybenefitshub.com/andrewsisd

Chubb Policy# 100000215 (888) 499-0425 www.chubb.com

The Hartford Group #395333 www.thehartford.com

The Hartford Group #VCI-888093 (866) 547-4205 www.TheHartford.com

FLEXIBLE SPENDING ACCOUNTS (FSA AND DCFSA)

Higginbotham (866) 419-3519 http://www.higginbotham.net/

HEALTH SAVINGS ACCOUNT (HSA)

EECU

817-882-0800 https://www.eecu.org/

Lincoln Financial Group

Group #00001D039766 (800) 423-2765 www.lfg.com

Mutual of Omaha Group #GPS3466429 (800) 775-8805 www.mutualofomaha.com

Chubb Policy# 100000215 (800) 499-0425 www.chubb.com

MASA (800) 423-3226 Group # B2BASD www.masamts.com

The Standard Policy# 763263 (800) 877-7195 www.standard.com

Experian (855) 797-0052 www.experian.com

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

MDLive Policy # FBS (888) 365-1663 https://mdlive.com/fbs/

Clever RX (800) 873-1195 https://partner.cleverrx.com/ andrewsisd

5Star Life Insurance Company

Group #2269 (866) 863-9753 http://5starlifeinsurance.com

www.mybenefitshub.com/andrewsisd

CLICK LOGIN

Enter your Information

• Last Name

• Date of Birth

• Last Four (4) of Social Security Number

NOTE: THEbenefitsHUB uses this information to check behind the scenes to confirm your employment status.

Once confirmed, the Additional Security Verification page will list the contact options from your profile. Select either Text, Email, Call, or Ask Admin options to receive a code to complete the final verification step.

Enter the code that you receive and click Verify. You can now complete your benefits enrollment!

Annual Benefit Enrollment

Annual Enrollment

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

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

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

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

New Hire Enrollment

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

Q&A

Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits department or you can call Higginbotham Public Sector 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/andrewsisd.

How can I find a Network Provider? For benefit summaries and claim forms, go to the Andrews ISD benefit website: www.mybenefitshub.com/andrewsisd. 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.

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

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

Annual Benefit Enrollment

Section 125 Cafeteria Plan Guidelines

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

CHANGES IN STATUS (CIS):

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

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 Benefits 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.

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

Employee Eligibility Requirements

Medical and 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 2024 benefits become effective on September 1, 2024, you must be actively-atwork on September 1, 2024 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.

Actively-at-Work

You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel If you will not be actively at work beginning 9/1/2024 please notify your benefits administrator.

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 Higginbotham Public Sector, or contact the insurance carrier for additional information on spouse eligibility.

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

Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Higginbotham Public Sector, 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 Higginbotham Public Sector 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 Benefits Administrator to request a continuation of coverage.

Description

Health Savings Account (HSA)

(IRC Sec. 223)

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

Flexible Spending Account (FSA)

(IRC Sec. 125)

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

Employer Eligibility A qualified high deductible health plan. All employers

Contribution Source Employee and/or employer

Account Owner Individual

Underlying Insurance Requirement High deductible health plan

Minimum Deductible

Maximum Contribution

Permissible Use Of Funds

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

Year-to-year rollover of account balance?

Does the account earn interest?

Portable?

$1,600 single (2024)

$3,200 family (2024)

$4,150 single (2024)

$8,300 family (2024)

55+ catch up +$1,000

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

Employee and/or employer

Employer

None

N/A

$3,200 (2024)

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

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

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

Yes

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

No. Access to some funds may be extended if your employer’s plan contains a 2 1/2 –month grace period or $550 rollover provision.

Medical Insurance

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/andrewsisd

Learn the Terms.

• Premium: The monthly amount you pay for health care coverage.

• Deductible: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay.

• Copay: The set amount you pay for a covered service at the time you receive it. The amount can vary based on the service.

• Coinsurance: The portion you’re required to pay for services after you meet your deductible. It’s often a specified percentage of the costs; e.g., you pay 20% while the health care plan pays 80%.

• Out-of-Pocket Maximum: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket maximum, the plan pays 100% of allowable charges for covered services.

Compare Prices for Common Medical Services

TRS contracts with HMOs in certain regions to bring participants in those areas additional options. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.

Blue Essentials - South Texas HMOSM Brought to you by TRS-ActiveCare

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

Blue Essentials - West Texas HMOSM Brought to you by TRS-ActiveCare

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

Dental Insurance Lincoln Financial Group

ABOUT DENTAL

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

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

Routine oral exams

Bitewing X-rays

Full-mouth or panoramic X-rays

Other dental X-rays (including periapical films)

Routine cleanings

Fluoride treatments

Space maintainers for children

Sealants

Problem focused exams

Dental Insurance Lincoln Financial Group

Consultations

Palliative treatment (including emergency relief of dental pain)

Injections of antibiotics and other therapeutic medications Fillings

Prefabricated stainless steel and resin crowns

Simple extractions

Biopsy and examination of oral tissue - including brush biopsy

General anesthesia and I.V.

sedation(High Plan Only)

Oral surgery (High Plan Only)

Surgical Extractions

Bridges

Full and partial dentures

Denture reline and rebase services

Crowns, inlays, onlays, and related services

Implant & implant related services (High Plan Only)

General anesthesia and I.V. sedation(Low Plan Only)

Oral surgery (Low Plan Only)

Study models

Appliances

Contracting Dentists/Non-Contracting Dentists: Visit www.LincolnFinancial.com/FindADentist 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. For example, if you need a crown…

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

Non-Contracting Dentists: 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 allowance and the dentist’s billed charge.

USUAL AND CUSTOMARY (U&C): the maximum expense covered by the Policy. U&C allowances are based on dental charge information collected by nationally recognized industry databases. U&C allowances are reviewed and updated periodically. If Covered Expenses are Incurred outside the United States, the U&C allowance will be the amount that would be allowed for that procedure if it had been performed at the Company’s Group Insurance Service Office in Omaha, Nebraska. U&C allowances may be higher or lower than the fees charged by a Dentist. U&C is not an indication of the appropriateness of the Dentist’s fee. Instead, U&C is a variable plan provision used to determine the extent of coverage provided by the Policy.

Andrews Independent School District

Group Vision Insurance

Help protect your eye health with coverage for exams, glasses and contacts.

This summary of benefits and coverage shows how you and The Standard would share the cost for covered vision care services.

NOTE: This is only a summary; for detailed information on coverage, please consult your certificate of coverage.

Plan 1: Balanced Care Vision I Plan Summary Effective Date: 9/1/2024 VSP

Deductibles

$10 Exam

$25 Eye Glass Lenses or Frames*

Annual Eye Exam Covered in full

$10 Exam

$25 Eye Glass Lenses or Frames

to $45 Lenses (per pair)

Single Vision Covered in full

Bifocal Covered in full

Trifocal Covered in full

Lenticular Covered in full

Progressive See lens options NA Contacts

Fit & Follow Up Exams

to $30

to $50

to $65

to $100

Participant cost up to $60 Not covered

Elective Up to $150

Medically Necessary Covered in full

Frame Allowance $150**

to $70 Frequencies (months)

Exam/Lens/Frame 12/12/12 12/12/12

Based on date of service

*Deductible applies to a complete pair of glasses or to frames, whichever is selected.

**The Costco and Walmart allowance will be the wholesale equivalent.

Lens Options (participant cost)*

Progressive Lenses

Std. Polycarbonate

Solid Plastic Dye

Based on date of service

VSP Choice Network + Affiliates Out of

(Other than Costco)

Up to provider’s contracted fee for Lined Bifocal Lenses. The patient is responsible for the difference between the base lens and the Progressive Lens charge. Up to Lined Bifocal allowance.

Covered in full for dependent children

$33 adults Not covered

$15 (except Pink I & II)

Plastic Gradient Dye $17

Photochromatic Lenses

(Glass & Plastic)

Scratch Resistant Coating

Anti-Reflective Coating

Ultraviolet Coating

$31-$82

$17-$33

$43-$85

*Lens Option participant costs vary by prescription, option chosen and retail locations.

Andrews Independent School District

Rates

Additional Balanced Care Vision I Choice Network Features

Contact Lenses Elective

Additional Glasses

Frame Discount

Laser VisionCare

Low Vision

Allowance can be applied to disposables, but the dollar amount must be used all at once (provider will order 3 or 6 month supply). Applies when contacts are chosen in lieu of glasses. For plans without a separate contact fitting & evaluation (which includes follow up contact lens exams), the cost of the fitting and evaluation is deducted from the allowance.

20% off additional complete pairs of prescription glasses and/or prescription sunglasses.*

VSP offers 20% off any amount above the retail allowance.*

VSP offers an average discount of 15% off or 5% off a promotional offer for LASIK Custom LASIK and PRK. The maximum out-of-pocket per eye for participants is $1,800 for LASIK and $2,300 for custom LASIK using Wavefront technology, and $1,500 for PRK. In order to receive the benefit, a VSP provider must coordinate the procedure.

With prior authorization, 75% of approved amount (up to $1,000 is covered every two years).

Based on applicable laws, reduced costs may vary by doctor location.

Section 125

This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligibl e, he/she may elect to participate at the Policyholder's next Annual Election Period.

Vision Plan Participant Service

Balanced Care Vision I from The Standard features the money -saving eye care network of VSP. Customer service is available to plan participants through VSP's well -trained and helpful service representatives. Call or go online to locate the nearest VSP network provider, view plan benefit information and more.

VSP Call Center: 800.877.7195

⚫ Service representative hours: 5 a.m. to 7 p.m. Pacific Monday through Friday, 6 a.m. to 2:30 p.m. Pacific Saturday

⚫ Interactive Voice Response available 24/7

Locate a VSP provider at: www.standard.com/services

Cash benefits when you need them most — Cancer Insurance from Chubb

A cancer diagnosis and treatment can be an emotionally and physically difficult time. Chubb is there to help support you by providing cash benefits paid directly to you. Benefits are paid if you are diagnosed with cancer, but also help cover many other cancer-related services such as doctor’s visits, treatments, specialty care, and recovery. However, there are no restrictions on how to use these cash benefits—so you can use them as you see fit.

Choose the right level of coverage during the enrollment period to better protect your family.

Cash benefits for every step of the way

Cancer Insurance Benefits

First cancer benefit

Diagnosis of cancer

Low Plan High Plan

$100 paid upon receipt of first covered claim for cancer; only one payment per covered person per certificate per calendar year

$5,000 employee or spouse

$7,500 child(ren)

Waiting period: 0 days

Benefit reduction: none

Hospital confinement

Hospital confinement ICU

Radiation therapy, chemotherapy, immunotherapy

Alternative care

Medical imaging

Skin cancer initial diagnosis

$100 per day – days 1 through 30

Additional days: $200

Maximum days per confinement: 31

$600 per day – days 1 through 30

Additional days: $600

Maximum days per confinement: 31

Maximum per covered person per calendar year per 12-month period:

$10,000

$75 per visit

Maximum visits per calendar year: 4

$500 per imaging study

Maximum studies per calendar year: 2

$100 per diagnosis

Lifetime maximum: 1

$100 paid upon receipt of first covered claim for cancer; only one payment per covered person per certificate per calendar year

$10,000 employee or spouse

$15,000 child(ren)

Waiting period: 0 days

Benefit reduction: none

$300 per day – days 1 through 30

Additional days: $600

Maximum days per confinement: 31

$600 per day – days 1 through 30

Additional days: $600

Maximum days per confinement: 31

Maximum per covered person per calendar year per 12-month period:

$15,000

$75 per visit

Maximum visits per calendar year: 4

$500 per imaging study

Maximum studies per calendar year: 2

$100 per diagnosis

Lifetime maximum: 1

Cash benefits for every step of the way (cont.)

Cancer Insurance Benefits

Attending physician

Hospital confinement sub-acute ICU

Low Plan High Plan

$50 per visit

Maximum visits per confinement: 2

Maximum visits per calendar year: 4

$300 per day – days 1 through 30

Additional days: $300

Maximum days per confinement: 31

Family care

Prescription drug in-patient

Private full-time nursing services

U.S. government or charity hospital

Care Benefits

Family

plasma, and platelets

Childcare: $100 per day per child

Maximum days per calendar year: 30

Adult day care or home healthcare:

$100 per day

Maximum days per calendar year: 30

Per confinement: $150

Maximum confinements per calendar year: 6

$150 per day

Maximum days per confinement: 5

Days 1 through 30: $100

Additional days: $200

Maximum days per confinement: 15

Plan

$100 per day not to exceed the number of days confined

Maximum days per calendar year: 30

$50 per visit

Maximum visits per confinement: 2

Maximum visits per calendar year: 4

$300 per day – days 1 through 30

Additional days: $300

Maximum days per confinement: 31

Childcare: $100 per day per child

Maximum days per calendar year: 30

Adult day care or home healthcare:

$100 per day

Maximum days per calendar year: 30

Per confinement: $150

Maximum confinements per calendar year: 6

$150 per day

Maximum days per confinement: 5

Days 1 through 30: $300

Additional days: $600

Maximum days per confinement: 15

Plan

transportation: $100 per trip

trips per calendar year: 12

lodging: $100 per day Maximum days per calendar year: 100

$300 per day not to exceed the number of days confined

Maximum days per calendar year: 30

$300 per transfusion

Maximum transfusions per calendar year: 2

$300 per transfusion

Maximum transfusions per calendar year: 2

Accident Insurance Mutual of Omaha

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/andrewsisd

Eligibility Requirement You must be actively working a minimum of 30 hours per week to be eligible for coverage.

Dependent Eligibility Requirement

To be eligible for coverage, your dependents must be able to perform normal activities, and not be confined (at home, in a hospital, or in any other care facility), and any child(ren) must be under age 26. In order for your spouse and/or children to be eligible for coverage, you must elect coverage for yourself. Premium

The premiums for this insurance are paid in full by you.

Accident Insurance Mutual of Omaha

Follow-Up Care1 – Treatment / service required within 365 days of accident; Medical device is once per accident per insured person

Physician Follow-Up Office Visit

Therapy Services

Medical Device

Prosthetic Device(s)

$100; Up to 2 per accident

$50; Up to 6 per accident

$200

$1,000; Up to 2 per accident

Additional Benefits1 – Benefits are payable within 365 days of accident

Transportation (Up to 3 trips per accident)

Lodging (Up to 30 nights per accident)

Childcare (Up to 30 days per accident)

$450 Per trip

$150 Per night

$30 Per day

$50; Up to 2 per accident

$25; Up to 6 per accident

$50

$500; Up to 2 per accident

$150 Per trip

$100 Per night

$20 Per day

Catastrophic Benefits1,4 – Benefits are payable within 365 days of accident; Once per accident per insured person

Principal Sum (PS)

Common Carrier Accidental Death

Transportation of Remains

Dismemberment & Paralysis

Reasonable Modifications

Coma

SERVICES

Hearing Discount Program

1Additional limitations apply as described in the certificate.

You: $50,000

Spouse: $25,000 Child(ren): $10,000

300% of PS

Up to $5,000

Up to 100% of PS

Up to 10% of PS 25% of PS

You: $10,000

Spouse: $5,000 Child(ren): $5,000

300% of PS

Up to $5,000

Up to 100% of PS

Up to 10% of PS

50% of PS

The Hearing Discount program provides you and your family discounted hearing products, including hearing aids and batteries. Call (888) 534-1747 or visit www.amplifonusa.com/mutualofomaha to learn more.

2Fractures and dislocations require treatment within 90 days of accident, burns and lacerations within 72 hours of an accident, and dental care within 30 days. If an insured person sustains both a fracture and dislocation as the result of the same accident, the maximum amount payable is up to 200% of the amount payable for the injury with the highest applicable benefit amount.

3Daily confinement must begin with 90 days of accident and ICU confinement within 30 days. Surgical treatment timeframes vary. If applicable, diagnostic services must be received within 90 days of accident. Except for confinement benefits, most benefits are payable once per accident per insured person. If any surgery occurs concurrently with an open reduction for a fracture or dislocation of the same bone or joint as a result of the same accident, only the highest applicable benefit is payable.

4The principal sum for you and your spouse reduces by 50% when you reach the age of 70.

Who is eligible for this insurance? You must be actively working (performing all normal duties of your job) at least 30 hours per week and be under age 80. Your dependent(s) must be performing normal activities and not be confined (at home or in a hospital / care facility) and any child(ren) must be under age 26.

What is the “Express Benefit”? This benefit is payable upon notification of an accident in which an insured person is injured. It can be paid in a short time frame with minimal information (compared to a typical claim).

Can I take this insurance with me if I change jobs / am no longer a member of this group? In the event this insurance ends due to a change in your employment / membership status with the group, or for certain other reasons, you or your insured spouse have the right to continue this insurance under the Portability provision, subject to certain conditions.

When does this insurance end? Insurance will end on the last day of the month in which an insured person no longer satisfies the applicable eligibility conditions, or when you reach the age of 80. Additional circumstances under which insurance will end are described in the certificate.

Are there any exclusions or limitations? The benefits payable are based on the insurance in effect on the date of the covered accident, subject to the definitions, limitations, exclusions and other provisions of the policy. The exclusions and limitations are summarized in the outline of coverage and detailed in the certificate. Please contact your benefits administrator for a copy of the outline of coverage or if you have questions prior to enrolling.

Identity Theft + Financial Wellness

Experian

About Identity Theft

As identity theft and fraud continue to increase, an evolving suite of products helps you monitor any potential threats to your identity and alerts you if there are any areas of concern. You will also have access to a full financial wellness platform and proactive digital privacy tools that can help you keep passwords and other personal information private and secure while surfing the web.

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

Disability Insurance

ABOUT DISABILITY

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

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

What is Educator Disability Income Insurance? 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 can 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 on your employers benefits website.

Why do I need Disability Insurance? Coverage? More than half of all personal bankruptcies and mortgage foreclosures are a consequence of disability1

1 Facts from LIMRA, 2016 Disability Insurance Awareness Month

The average worker faces a 1 in 3 chance of suffering a job loss lasting 90 days or more due to a disability2

2Facts from LIMRA, 2016 Disability Insurance Awareness Month

Only 50% of American adults indicate they have enough savings to cover three months of living expenses in the event they’re not earning any income3

3Federal Reserve, Report on the Economic Well-Being of U.S. Households in 2018

ELIGIBILITY AND ENROLLMENT

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

Actively at Work

FEATURES OF THE PLAN

Benefit Amount

Elimination Period

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.

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 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 the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.

You may purchase coverage that will pay you a monthly benefit of 65%, 55%, 45% or 35% of your monthly income, to a maximum of $7,500. Earnings are defined in The Hartford’s contract with your employer.

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. For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.

Maximum Benefit Duration

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: Table below shows Max Benefit resulting from sickness or injury.

Disability Insurance

The Hartford

Mental Illness, Alcoholism and Substance Abuse, Self- Reported or Subjective Illness

You can receive benefit payments for Long-Term Disabilities resulting from mental illness, alcoholism, and substance abuse for a total of 24 months for all disability periods during your lifetime.

Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24-month lifetime limit.

Partial Disability Partial Disability is covered provided you have at least a 20% loss of earnings and duties.

Other Important Benefits

Survivor Benefit

If you die while receiving disability benefits, a benefit will be paid to your spouse or child under age 26, 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 helps 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.

PROVISIONS OF THE PLAN

Definition of Disability

Pre-Existing Condition Limitation

Continuity of Coverage

Recurrent Disability

Disability is defined as The Hartford’s contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy, or other medical conditions covered by the insurance, and as a result, your current monthly earnings are 80% or less of your pre-disability earnings.

One you have been disabled for 24 months, you must be prevented from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 66 2/3% or less of your pre-disability earnings.

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.

If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 1 month of disability.

If you were insured under your district’s prior plan and not receiving benefits the day before this policy is effective, there will not be a loss in coverage, and you will get credit for your prior carrier’s coverage.

What happens if I Recover but become Disabled again?

Periods of Recovery during the Elimination Period will not interrupt the Elimination

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

Benefit Integration

General Exclusions

• Other employer-based disability insurance coverage you may have:

• Unemployment benefits

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

Your plan includes a minimum benefit the greater of 10% of elected benefit or $100.

You cannot receive Disability benefit payments for disabilities that are caused or contributed to by:

• War or act of war (declared or not)

• Military service for any country engaged in war or other armed conflict

• The commission of or attempt to commit a felony.

• An intentionally self-inflicted injury

• Any case where Your being engaged in an illegal occupation was a contributing cause to your disability.

• You must be under the regular care of a physician to receive benefits.

Educator Group Term Life Insurance

Benefit Summary

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

Voluntary Term Life and AD&D Insurance is made available for purchase by you and your family. Employees must be actively at work for at least 20 hours per week.

Life Insurance/AD&D

For You

$10,000 increments up to a maximum of $500,000

For Your Spouse

$5,000 to $500,000 in $5,000 increments not to exceed 100% of employee benefit amount

For Your Dependent Children

Live birth to 6 months: $1,000 6 months to age 26: $10,000

Reduction Schedule

50% at age 70

Additional Plan Benefits

Death

Guaranteed Issue

Employee: $300,000 Spouse: $100,000 Child: $10,000

Newly eligible employees and dependents: You and your eligible dependents may elect coverage up to the guaranteed issue amounts without answering health questions. Elections over the guaranteed issue amounts will require medical underwriting.

Current employees: At subsequent annual enrollments if you or your eligible dependents are currently enrolled in the plan, you may increase your coverage up to the guaranteed issue amounts without answering health questions. All amounts over the guaranteed issue will require medical underwriting.

*Please note that if you or your dependents did not elect coverage when first eligible, then you are considered a late entrant. Late entrants will be medically underwritten and will have to answer health questions for any amount of coverage elected.

for Long Term Care 4% of Death Benefit per month up to 75% of Death Benefit, not to exceed $200,000 Accelerated Death Benefit for Terminal Illness

of Death Benefit, not to exceed $500,000

AD&D Covered Losses and Benefits

The AD&D plan provides additional protection for you and your dependents in the event of an accidental bodily injury resulting in death or dismemberment. In addition to standard dismemberment coverage, the following benefit provisions are included:

• Air Bag Benefit – The lesser of 5% of AD&D benefit or $5,000

• Child Care Expense Benefit – 5% of employee’s AD&D benefit up to $12,000 per year for 4 years

• Child Education Expense Benefit – 6% of AD&D benefit up to $6,000 for 6 years; maximum benefit of $24,000

• Common Carrier Benefit – Included

• Elder Care Expense Benefit – The lesser of 1% of AD&D benefit or $500

• Exposure and Disappearance Benefit– Included

• Repatriation Expense Benefit – The lesser of $1,000 or the actual expense incurred

• Seatbelt Benefit – The lesser of 10% of AD&D benefit or $25,000

• Spouse Education Benefit – The lesser of 1% of AD&D benefit, $1,000, or the actual tuition expenses incurred

• Workplace Felonious Assault Benefit – 5% of AD&D benefit up to $10,000

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

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

Monthly Costs for Voluntary Term Life/AD&D Insurance

You have the option to purchase Supplemental Term life Insurance. Listed below are the monthly rates.

Child Life/AD&D monthly rate is $2.30 per $10,000. One premium covers all children.

Term Life Exclusions*

No benefits will be paid for losses that are caused by, contributed to, or result from: 1) suicide, while sane or insane, occurring within 24 months after a Covered Person’s initial effective date of coverage; and 2) suicide, while sane or insane, occurring within two years after the date any increases in or additional coverage applied for becomes effective for a Covered Person.

Accidental Death And Dismemberment Benefit Exclusions*

The Policy does not cover: 1) an infection not occurring as a direct result or consequence of Accidental Bodily Injury; 2) loss caused or contributed to by attempted suicide, while sane or insane; 3) loss caused or contributed to by intentionally self-inflicted harm, while sane or insane; 4) loss caused or contributed to by war or act of war; 5) loss caused or contributed to by active participation in a riot, insurrection; or terrorist activity; 6) loss caused or contributed to by committing or attempting to commit a felony; 7) loss caused or materially contributed to by voluntary intake or use by any means of any drug, unless: a. prescribed or administered by a Physician and taken in accordance with the Physician’s instructions; or b. an over the counter drug, taken in accordance with the instructions; 8) loss caused or contributed to being intoxicated as defined by the jurisdiction where the Accident occurred; and 9) loss caused or materially contributed to by participation in an illegal occupation or activity.

Contact the FBS Benefits CareLine via the QR code or (833) 453-1680

*Please refer to your Certificate of Insurance at https://www.mybenefitshub.com/andrewsisd for a complete listing of available benefits, limitations and exclusions. Underwritten by ACE Property & Casualty Company, a Chubb company.

Family Protection Plan

Group Term Life Insurance to age 121 with Quality of Life

Make a smart choice to help protect your loved ones and your future.

Life doesn’t come with a lesson plan

Help protect your family with the Family Protection Plan Group Level Term Life Insurance to age 121. You can get coverage for your spouse even if you don’t elect coverage on yourself. And you can cover your ﬁnancially dependent children and grandchildren (14 days to 26 years old). The coverage lasts until age 121 for all insured,* so no matter what the future brings, your family is protected.

Why buy life insurance when you’re young?

Buying life insurance when you’re younger allows you to take advantage of lower premium rates while you’re generally healthy, which allows you to purchase more insurance coverage for the future. This is especially important if you have dependents who rely on your income, or you have debt that would need to be paid off.

Portable

Coverage continues with no loss of beneﬁts or increase in cost if you terminate employment after the ﬁrst premium is paid. We simply bill you directly.

Why is portability important?

Life moves fast so having a portable life insurance allows you to keep your coverage if you leave your school district. Keeping the coverage helps you ensure your family is protected even into your retirement years.

44% of American households would encounter significant financial difficulties within six months if they lost the primary family wage earner.

28% would reach this point in one month or less.

Family Protection Plan

Term

Terminal illness acceleration of beneﬁts

Coverage pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL).

Protection you can count on

Within one business day of notiﬁcation, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneﬁciary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions.

Convenient

Easy payment through payroll deduction.

Quality of Life beneﬁt

Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis* for the following:

•Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or

•Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.

How does Quality of Life help?

Many individuals who can’t take care of themselves require special accommodations to perform ADLs and would need to make modifications to continue to live at home with physical limitation. The proceeds from the Quality of Life benefit can be used for any purpose, including costs for infacility care, home healthcare professionals, home modifications, and more.

2024 Enrollment Plan Year

Guaranteed Issue is offered to all eligible applicants regardless of health status. No Doctor exams or physicals.

Employee: $100,000 | Spouse: $30,000 | Child: $10,000

Enroll to provide peace of mind for your family

To do an initial enrollment or if you have questions please call our customer service at 866-914-5202. Monday - Friday | 8:00 am-6:00 pm CST

About the coverage

The Family Protection Plan offers a lump-sum cash benefit if you die before age 121. The initial death benefit is guaranteed to be level for at least the first ten policy years. Afterward, the company intends to provide a nonguaranteed death benefit enhancement which will maintain the initial death benefit level until age 121. The company has the right to discontinue this enhancement. The death benefit enhancement cannot be discontinued on a particular insured due to a change in age, health, or employment status.

Flexible Spending Account (FSA) Higginbotham

ABOUT FSA

A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year.

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

Health Care FSA

The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $3,200 annually to a Health Care FSA and you are entitled to the full election from day one of your plan year. Eligible expenses include:

• Dental and vision expenses

• Medical deductibles and coinsurance

• Prescription copays

• Hearing aids and batteries

You may not contribute to a Health Care FSA if you contribute to a Health Savings Account (HSA)

Higginbotham Benefits Debit Card

The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB).

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 Depend ent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled or a full-time student.

Things to Consider Regarding the Dependent Care FSA

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

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

• You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.

• The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.

Flexible Spending Accounts

Higginbotham

Important FSA Rules

• The maximum per plan year you can contribute to a Health Care FSA is $3,200. 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.

• In most cases, you can continue to file claims incurred during the plan year for another 90 days after the plan year ends.

• Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.

• Review your employer's Summary Plan Document for full details. FSA rules vary by employer.

Over-the-Counter Item Rule Reminder

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.

Higginbotham Portal

The Higginbotham Portal provides information and resources to help you manage your FSAs.

• Access plan documents, letters and notices, forms, account balances, contributions and other plan information

• Update your personal information

• Utilize Section 125 tax calculators

• Look up qualified expenses

• Submit claims

• Request a new or replacement Benefits Debit Card

Visit https://flexservices.higginbotham.net and click Register. Follow the instructions and scroll down to enter your information.

• Enter your Employee ID, which is your Social Security number with no dashes or spaces.

• Follow the prompts to navigate the site.

• If you have any questions or concerns, contact Higginbotham:

∗ Phone – 866-419-3519

∗ Questions – flexsupport@higginbotham.net

∗ Fax – 866-419-3516

∗ Claims- flexclaims@higginbotham.net

Health Savings Account (HSA)

ABOUT HSA

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

www.mybenefitshub.com/andrewsisd

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 (High Deductible Health Plan) Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan

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

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

• Not enrolled in Medicare or TRICARE

• Not receiving Veterans Administration benefits

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

Maximum Contributions

Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum for 2024 is based on the coverage option you elect:

• Individual – $4,150

• Family (filing jointly) – $8,300

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 EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.

Important HSA Information

• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.

• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.

• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.

How To Use Your HSA

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

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

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

• Stop by a local EECU financial center: www.eecu.org/ locations.

Hospital Indemnity

The Hartford

ABOUT HOSPITAL INDEMNITY

This is an affordable supplemental plan that pays you should you be inpatient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance. For full plan details, please visit your benefit website: www.mybenefitshub.com/andrewsisd

Hospital Indemnity The Hartford

IS THIS COVERAGE HSA COMPATIBLE? 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 30 hours per week on a regularly scheduled basis.

Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26.

CAN I INSURE MY DOMESTIC OR CIVIL UNION PARTNER? Yes. Any reference to “spouse” includes your domestic partner, civil union partner or equivalent, as recognized and allowed by applicable law.

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

HOW DO I PAY FOR THIS INSURANCE? 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, within 31 days of the date you have a change in family status, or within 31 days of the completion of any eligibility waiting period established by your employer.

WHEN DOES THIS INSURANCE BEGIN? The initial effective date of this coverage is September 1, 2019. Subject to any eligibility waiting period established by your employer, if you enroll for coverage prior to this date, insurance will become effective on this date. If you enroll for coverage after this date, 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 dependent(s) no longer satisfy the applicable eligibility conditions, premium is unpaid, you are no longer actively working, you leave your employer, or the coverage is no longer offered.

CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP? Yes, you can take this coverage with you. Coverage may be continued for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances. This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this insurance coverage. A copy of the certificate can be obtained from your employer.

Critical Illness Insurance The

ABOUT CRITICAL ILLNESS

Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non-medical costs related to the illness, including transportation, child care, etc.

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

Facing a serious illness can be devastating both emotionally and financially. Major medical insurance may pick up most of the tab but can still leave out-of-pocket expenses that add up quickly. Critical Illness insurance can provide a lump-sum benefit upon diagnosis that can be used however you choose - from expenses related to treatment, to deductibles or day-to-day costs of living such as the mortgage or your utility bills.

Critical Illness

Critical Illness Insurance The Hartford

of diagnosis.

WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full-time employee who works at least 30 hours per week on a regularly scheduled basis and are less than age 80. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26.

WHEN DOES THIS INSURANCE END? This insurance will end when you or your dependent(s) no longer satisfy the applicable eligibility conditions, or when you reach the age of 80, premium is unpaid, you are no longer actively working, you leave your employer, or the coverage is no longer offered.

CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO

LONGER A MEMBER OF THIS GROUP? Yes, you can take this coverage

with you.

Coverage may be continued for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances.

GROUP CRITICAL ILLNESS INSURANCE LIMITATIONS AND EXCLUSIONS

The benefits payable are based on the insurance in effect on the date of the diagnosis of a covered illness, subject to the definitions, limitations, exclusions and other provisions of the policy.

You and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates.

Exclusions. This insurance does not provide benefits for any loss that results from or is caused by:

• Suicide, attempted suicide, or intentionally self-inflicted injury, whether sane or insane

• War or act of war, declared or undeclared

• A covered person’s participation in a felony, riot or insurrection

• A covered person’s engaging in any illegal occupation

• A covered person’s service in the armed forces or units auxiliary to them

General Limitations. Benefits under the policy are not payable for any covered illness:

• Diagnosed prior to the effective date of insurance for a covered person (except for newborn children)

• Diagnosed during an applicable benefit separation period

• For which a covered person has already received a benefit payment under the policy, unless the covered illness is included in a recurrence provision

• For which a covered person has already received a benefit payment under the recurrence provision In addition, benefits are not payable for any critical illness not included as a covered illness in your certificate.

Stay prepared with MASA® Access

Comprehensive coverage and care for emergency transport.

Our Emergent Plus membership plan includes:

Emergency Ground Ambulance Coverage1

Your out-of-pocket expenses for your emergency ground transportation to a medical facility are covered with MASA.

Emergency Air Ambulance Coverage1

Your out-of-pocket expenses for your emergency air transportation to a medical facility are covered with MASA.

Hospital to Hospital Ambulance Coverage1

When specialized care is required but not available at the initial emergency facility, your out-of-pocket expenses for the ground or air ambulance transfer to the nearest appropriate medical facility are covered with MASA.

Repatriation Near Home Coverage1

Should you need continued care and your care provider has approved moving you to a hospital nearer to your home, MASA coordinates and covers the expense for ambulance transportation to the approved medical facility.

Did you know?

51.3 million emergency responses occur each year

MASA protects families against uncovered costs for emergency transportation and provides connections with care services.

Source: NEMSIS, National EMS Data Report, 2023

About MASA

MASA is coverage and care you can count on to protect you from the unexpected. With us, there is no “out-of-network” ambulance. Just send us the bill when it arrives and we’ll work to ensure charges are covered. Plus, we’ll be there for you beyond your initial ride, with expert coordination services on call to manage complex transport needs during or after your emergency — such as transferring you and your loved ones home safely.

Protect yourself, your family, and your family’s financial future with MASA.

Stay prepared with MASA®

protects families against out-of-pocket costs for emergency transportation and provides connections with care. Gain peace of mind and shield your finances knowing there’s a MASA plan best suited for your needs.

On-demand care for illness and injuries is part

of your health plan.

MDLIVE. Anytime. Anywhere.

Getting sick is always a hassle. When you need care fast, talk to a board-certified MDLIVE doctor in minutes. Get reliable care from the comfort of home instead of an urgent care clinic or crowded ER. MDLIVE is open nights, weekends, and holidays. No surprise costs.

Convenient and reliable care.

MDLIVE doctors have an average of 15 years of experience and can be reached 24/7 by phone or video.

Affordable alternative to urgent care clinics and the ER. MDLIVE treats 80+ common conditions like flu, sinus infections, pink eye, ear pain, and UTIs (Females, 18+). By talking to a doctor at home, you can avoid long waits and exposure to other sick people. Prescriptions.

Your MDLIVE doctor can order prescriptions1 to the pharmacy of your choice. MDLIVE can also share notes with your local doctor upon request.

MDLIVE cares for more than 80 common, non-emergency conditions, including: • Cough

• Sore Throat

Ear Pain

Headache • Prescriptions • Pink Eye • Sinus Problems

• UTI (Females, 18+)

• Yeast Infections

• And more

1Prescriptions are available at the physician’s discretion when medically necessary. A renewal of an existing prescription can also be provided when your regular physician is unavailable, depending on the type of medication.

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Unlock discounts on thousands of medications

Save up to 80% off prescription drugs – often beats the average copay

Download your Clever RX card or Clever RX App to unlock exclusive savings.

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Download the FREE Clever RX App From your App Store search for "Clever RX" and hit download. Make sure you enter in Group ID and in Member ID during the on-boarding process. This will unlock exclusive savings for you and your family!

70%

ST EP 2 :

Find where you can save on your medication. Using your zip code, when you search for your medication Clever RX checks which pharmacies near you offer the lowest price. Savings can be up to 80% compared to what you're currently paying.

Present your Clever RX App or Clever RX card to your pharmacist. DID Y OU KNOW?

FREE to use. Save up to 80% off prescription drugs and beat copay prices.

Accepted at most pharmacies nationwide

ST EP 3 :

Click the voucher with the lowest price, closest location, and/or at your preferred pharmacy. Click "share" to text yourself the voucher for easy access when you are ready to use it. Show the voucher on your screen to the pharmacist when you pick up your medication.

ST EP 4:

Share the Clever RX App. Click "Share" on the bottom of the Clever RX App to send your friends, family, and anyone else you want to help receive instant discounts on their prescription medication. Over 70% of people can benefit from a prescription savings card.

NOW TH A T IS N O T ONLY CL EVER, I T IS CL EVE R RX

Over 7 0% of peopl e c an benefi t fro m a pre sc rip ti on sav ing s c ard due t o high dedu ct ible heal t h plan s, high c opa ys , and being unde r in s ured or u ni ns ur ed

Ov er 3 0 % of pre sc rip t ion s ne ver ge t filled due t o high co sts 30%

4 0% of t he t op t en most prescribed d rugs ha v e in cr ea s ed in cost b y o v e r 1 00 %

2024 - 2025 Plan Year

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