2024-25 CTXEBC Benefit Guide (TRS) by Higginbotham Public Sector

09/01/2024 - 08/31/2025

Benefit Contact Information

CTXEBC BENEFITS

Higginbotham Public Sector (800) 583-6908 www.ctxebc.com

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

Clever RX Group #1085 (800) 873-1195

https://cleverrx.com/

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

FCL Dental (877) 493-6282 www.fcldental.com

CHUBB (888) 499-0425 www.chubb.com MDLIVE (888) 365-1663 www.mdlive.com/fbs

Superior Vision (800) 507-3800 www.superiorvision.com

UNUM (800) 858-6843 www.unum.com LIFE AND AD&D

UNUM (800) 445-0402 www.unum.com

CHUBB (888) 499-0425 www.chubb.com

EMERGENCY MEDICAL TRANSPORTATION

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

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

CHUBB (888) 499-0425 www.chubb.com

ID Watchdog (800) 774-3772 www.idwatchdog.com

National Benefit Services (800) 274-0503 www.nbsbenefits.com

LegalShield (800) 654-7757 www.legalshield.com

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

How can I find a Network Provider?

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

When will I receive ID cards?

If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can log in 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 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 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.

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-at-work on September 1, 2024 to be eligible for your new benefits.

PLAN MAXIMUM AGE

Medical To age 26

Hospital Indemnity To age 26

Dental To age 26

Vision To age 26

Life To age 26

Cancer To age 26

Critical Illness To age 26

AD&D To age 26

Individual Life To age 26

Accident To age 26

Identity Theft To age 26

Emergency Transportation To age 26

Dependent Eligibility Requirements

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

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

Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact 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 Benefit Office to request a continuation of coverage.

Helpful Definitions

Actively-at-Work

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

Annual Enrollment

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

Annual Deductible

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

Calendar Year

January 1st through December 31st

Co-insurance

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

Guaranteed Coverage

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

In-Network

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

Out-of-Pocket Maximum

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

Plan Year

September 1st through August 31st

Pre-Existing Conditions

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

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

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.

Yes, portable year-to-year and between jobs. No

Major

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.

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Ov er 3 0 % of

Here’s How We Make Saving For Healthcare Expenses Easy, Convenient and Valuable

Making It Easy

Easy to Contribute

You can make pre-tax, current year contributions through your employer payroll deduction or make post-tax, current year contributions directly online, through a mailed deposit or at an EECU financial center.

Easy to Make Payments

EECU offers three easy ways. You can pay qualified medical expenses1 with your EECU HSA Debit Mastercard® through EECU’s free online banking and bill pay or by writing an HSA check (optional, fees apply2). You can also pay out-of-pocket for eligible medical expenses and then reimburse yourself from your HSA.

Easy to Manage Your Account

You can easily access your EECU HSA anytime, anywhere online or from your smartphone or tablet at eecu.org and manage your account on the go. Have a question or need help with a transaction, we’re here to help on the phone, online, chat or in person at a financial center.

Easy to Grow

Your EECU HSA is federally insured, pays a dividend rate based on balance amount and has no monthly fees, so you can maximize your savings.

HSA Overview

• Requires a qualifying high deductible health plan (HDHP)

• Used to pay for qualified medical expenses

• Funded by you, your employer or others

• Account funds belong to you

Qualified Medical Expenses

Use your HSA to pay for qualified medical expenses, as defined by the Internal Revenue Service, for yourself, your spouse or tax dependents1. Here are some examples:

• Acupuncture

• Ambulance Service

• Chiropractor

• Dental Care

• Doctor’s Fees

• Hearing Aids

• Laboratory Fees

• Prescription Drugs

• Surgery

• Vaccines

• Vision Care

• Wheel Chairs

• X-Rays

A list of Eligible Medical Expenses can be found in IRS Publication 502 - Medical and Dental Expenses.1

Save your receipts –for all qualified medical expenses. EECU does not verify eligibility. You are responsible for making sure payments are for qualified medical expenses.

Frequently Asked Questions

HSA Basics

Q What is a Health Savings Account (HSA)?

A A Health Savings Account allows you to save money, earn interest and spend money on a tax-free basis as long as the money being spent is on qualified medical expenses1. Unused HSA funds roll over from year to year, no “use it or lose it”. You own your HSA and can take it with you when you change medical plans, change jobs or retire.

To be eligible to set up an HSA and contribute to an HSA, you must be covered by a qualified High Deductible Health Plan, have no other coverage (e.g. Medicare) and cannot be claimed as a dependent on someone else’s taxes.

Q What is a High Deductible Health Plan (HDHP)?

A For 2023, a High Deductible Health Plan is a plan with an annual deductible of at least $1,500 for an Individual or $3,000 for Family coverage; and, the maximum out of pocket expenses must be no more than $7,500 for Individuals and no more than $15,000 for Family coverage. For 2024, a High Deductible Health Plan is a plan with an annual deductible of at least $1,600 for an Individual or $3,200 for Family coverage; and, the maximum out of pocket expenses must be no more than $8,050 for Individuals and no more than $16,100 for Family coverage.

Q Who is eligible to open an HSA?

A To be an eligible and qualify for an HSA, you must meet the following requirements.

• You are covered under a high deductible health plan (HDHP), described above.

• You have no other health coverage.

• You aren’t enrolled in Medicare.

• You can’t be claimed as a dependent on someone else’s tax return.

Q How does an HSA work?

A Health Savings Accounts work with high deductible health insurance plans. This enables consumers to save money on health insurance premiums, since HDHP’s typically cost less than traditional health insurance, while allowing account holders to contribute money to the account to pay out-of-pocket medical expenses up to the deductible.

• Contribute: you can make contributions (pre-tax and after-tax) to your HSA. Pre-tax contributions can reduce your taxable income and after-tax contributions are deductible. Contributions can be made by you, your employer or a third party via payroll deduction, online banking transfer or depositing a paper check. Contributions to your HSA as well as any earnings on those contributions grow tax deferred2

• Make Payments: you can pay for qualified medical expenses with your EECU HSA Mastercard® debit card, EECU Online Banking or HSA check (optional3). Payments or withdrawals from your HSA that are used for qualified medical expenses are tax-free. In addition, withdrawals can also be used for your deductible and co-pays.

EECU Health Savings Account

Frequently Asked Questions

HSA Maintenance (continued)

Q What happens to my EECU HSA if I switch jobs?

A All funds in your EECU HSA, including funds contributed by your employer, are yours to keep. If you leave your employer, you can keep your HSA at EECU or transfer your funds to another qualifying HSA

Can’t find the answers you need in our FAQs?

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

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

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

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

1 Contributions, investment earnings, and distributions are tax free for federal tax purposes if used to pay for qualified medical expenses, and may or may not be subject to state taxation. A list of Eligible Medical Expenses can be found in IRS Publication 502, http://www.irs.gov/pub/irs-pdf/p502.pdf As described in IRS publication 969, http://www.irs.gov/pub/irs-pdf/p969.pdf, over-the-counter medications (when prescribed by a doctor) are considered Eligible Medical Expenses for HSA purposes.

2 For more information consult a tax adviser or your state department of revenue.

3 Call (817) 882-0800 or stop by a financial center to order Standard checks at no charge, excludes shipping & handling or order custom checks, prices vary.

4 See Department of the Treasury, Internal Revenue Service Publication 969, “Health Savings Accounts and Other Tax-Favored Health Plans”

Federally insured by NCUA. National Credit Union Administration, a U.S. Government Agency – Member accounts are federally insured to at least $250,000 and backed by the full faith and credit of the United States Government.

EECU - November 2022 Get in touch with us your way.

Hospital Cash

It’s not easy to pay hospital bills, especially if you have a high deductible medical plan. Chubb Hospital Cash pays money directly to you if you are hospitalized so you can focus on your recovery. And since the cash goes directly to you, there are no restrictions on how you use your money. average three-day hospitalization cost.¹ average hospital stay.²

5.4 days

Choose from 1 of 2 plans

Hospital Admission Benefit

This benefit is for admission to a hospital or hospital sub-acute intensive care unit.

Hospital Admission ICU Benefit

This benefit is for admission to a hospital intensive care unit.

Hospital Confinement Benefit

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

Hospital Confinement ICU Benefit

The benefit for confinement in a hospital intensive care unit.

Newborn Nursery Benefit

This benefit is payable for an insured newborn baby receiving newborn nursery care and who is not confined for treatment of a physical illness, infirmity, disease or injury.

Observation Unit Benefit

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

Rehabilitation Unit Admission Benefit

This benefit is for admission to a rehabilitation unit as an inpatient.

• $1,500

• Maximum Benefit Per Calendar Year: 3

• $3,000

• Maximum Benefit Per Calendar Year: 3

• $200 Per Day

• Maximum Days Per Calendar Year: 30

• $400 Per Day

• Maximum Days Per Calendar Year: 30

• $500 Per Day

• Maximum Days per Confinement - Normal Delivery: 2

• Maximum Days per Confinement - Caesarean Section: 2

• $500

• Maximum Benefit Per Calendar Year: 2

• $200

$30,000 ¹

• Maximum Benefit Per Calendar Year: 3

• $3,000

• Maximum Benefit Per Calendar Year: 3

• $6,000

• Maximum Benefit Per Calendar Year: 3

• $200 Per Day

• Maximum Days Per Calendar Year: 30

• $400 Per Day

• Maximum Days Per Calendar Year: 30

• $500 Per Day

• Maximum Days per Confinement - Normal Delivery: 2

• Maximum Days per Confinement - Caesarean Section: 2

• $500

• Maximum Benefit Per Calendar Year: 2

• $500

• Maximum Benefit Per Calendar Year: 3

• Available anytime, day or night

• Consults by mobile app, video or phone

• Prescriptions can be sent to your nearest pharmac y if medically necessary

•Acne

•Allergies

•Cold/flu

•Constipation

•Cough

•Diarrhea

•Ear problems

•Insect bites

•Nausea/vomiting

•Pink eye

•Rash

•Respiratory problems

•Sore throats

•And more

Passive PPO Dental Plan (100/80/50)

Benefit - Per Person

$1,000 Percentage of Covered Benefits Per Policy Year

YEAR AND

*12-month waiting period

Calendar Year Deductible, Per Person$50/150 This deductible applies to Type II and III services Dependent Children Covered to Age 26

Payment is based upon allowable charges in the area in which service is rendered. Services provided at a non-contracting provider are paid at the 90th percentile.

TYPE I (PREVENTIVE SERVICES)

Including:

 No waiting period

 Routine Exams ( one per 6 months)

 Prophylaxis (cleanin gs-one per 6 months)

 Emergency exams for dental pain (minor procedures)

 Fluoride treatments for dependent children under age 19 (one per 12 months)

 Bitewing X-rays (once per 6 months)

TYPE II (BASIC SERVICES)

Including:

 No waiting period

 Periapical X-rays

 Simple restorative services (fillings)

 Simple extractions

 Palliative treatment for dental pain, local anesthesia

 Endodontics/root canal therapy

 Periodontics

 Oral Surgery

 Sealants for children ages 6-15 (one per tooth)

 Periapical X-rays

 Full mouth or panorex X-rays (one per 36 months)

TYPE III (MAJOR SERVICES)

Including:

 12 monthwaiting period

 Major restorative services (crowns and inlays)

 Prosthetics (bridges, dentures)

 Replacement of prosthodontics, dentures, crowns and inlays

 Denture relines

 General anesthesia (for services dentally necessary)

 Space Maintainers

ORTHODONTIC SERVICES

 12 month waiting period

 50% coverage – children under 19

 $1,000lifetime maximum benefit

Renewal Date: September 1, 2019

Limitations and Exclusions

Covered Expenses Will Not Include and No Benefits Will be Payable:

1. For any treatment which is for cosmetic purposes or to correct congenital malformations, except for medically necessary care and treatment of congenital cleft lip and palate.

2. To replace any prosthetic appliance, crown, inlay or onlay restoration, or fixed bridge within five years of the date of the last placement of these items, unless required because of an accidental bodily injury sustained while the Insured is covered. Replacement is not covered if the item can be repaired.

3. For initial placement of any prosthetic appliance or fixed bridge unless such placement is needed because of the extraction of natural teeth during the same period of cont inuous coverage. But the extraction of a third molar (wisdom tooth) will not qualify the item for payment. Any such appliance or fixed bridge must include the replacement of the extracted tooth or teeth. Coverage does not include the part of the cost th at aplies specifically to replacement of teeth extracted prior to the period of coverage.

4. For addition of teeth to an existing prosthetic appliance or fixed bridge unless for replacement of natural teeth extracted during the same period of continuous coverage.

5. For any expense incurred or procedure begun before the Insured’s current period of continuous coverage.

6. For any expense incurred or procedure begun after the Insured’s insurance under this section terminates, except for a prosthetic appliance, fixed bridge, crown, or inlay or onlay restoration for which both (a) the procedure begins before insurance ends and (b) the item’s final placement is within 90 days after insurance ends.

7. To duplicate appliances or replace lost or stolen appliances.

8. For appliances, restorations or procedures to:

a.alter vertical dimension;

b.restore or maintain occlusion;

c.splint or replace tooth structure lost as a result of abrasion or attrition; or

d.treat jaw fractures or disturbances of the temporomandibular joint.

9. For education or training in, and supplies used for, dietary or nutritional counseling, personal oral hygiene or dental plaque control.

10. For broken appointments or the completion of claim forms.

11. For orthodontia service or for any services associated with orthodontic therapy when this optional coverage is not elected and the premium is not paid.

12. For sealants which are:

a.not applied to a permanent molar;

b.applied before age 6 or after attaining age 16; or

c.reapplied to a molar within three years from the date of a previous sealant application.

13. For subgingival curettage or root planing (pr ocedure numbers 4220 and 4341) unless the presence of periodontal disease is confirmed by both x-rays and pocket depth summaries of each tooth involved.

14. Because of an Insured’s injury arising out of, or in the course of, work for wage or profit.

15. For an Insured’s sickness, injury or condition for which he or she is eligible for benefits under any Workers Compensation Act or similar laws.

16. For charges for which the Insured is not liable or which would not have been made had no insurance been in for ce.

17. For services which are not recommended by a dentist, not required for necessary care and treatment, or do not have a reasonably favorable prognosis.

18. Because of war or any act of war, declared or not, or while on full-time active duty in the armed forces of any country.

19. To an Insured if payment is not legal where the Insured is living when expenses are incurred.

20. For any services related to: equilibration, bite registration or bite analysis.

21. For crowns for the purpose of periodontal splinting.

22. For charges for: any implants; overdentures; precision or semi-precision attachments and associated endodontic treatment; other customized attachments; or specialized prosthodontic techniques or characterizations.

23. For charges for myofunctional therapy, orthognathic surgery or athletic mouthguards.

24. For procedures for which benefits are payable under the employer’s medical expense benefits plan for employees and their dependents.

25. Services or supplies provided by a family member or a member of the Insured’s household.

Note: This is a general outline of covered benefits and does not include all the benefits, limitations and exclusions of the policy. See your certificate for details.

Predetermination of Benefits: As a service to protect the Insured, First Continental Life & Accident Insurance Co. will provide predetermination of benefits for recommended treatment plans that exceed $300. This predetermination of benefits explains which of the recommended procedures will be covered and at what amount. This benefit helps Insured's better understand their coverage. The Insured should submit the treatment plan to First Continental Life & Accident Insurance Co. for review and predetermination of benefits before the service begins.

TAKEOVER BENEFITS

Takeover means that you are given credit for waiting periods for like coverage's accumulated under your existing plan. No credit is given for deductibles satisfied under your existing plan.

1. In order to provide Takeover Benefits your employer’s current dental plan must have beenin effect continuously for at least 12 months prior to the effective date of this plan.

2. All employees insured on the effective date with continuous coverage from the prior group dental contract are eligible for Takeover Benefits. Waiting periods will be reduced by the amount of time insured under the prior plan.

3. A minimum of three (3) enrolled members are needed for an employer to be eligible for Takeover Benefits.

4. Takeover Benefits must be requested and are subject to the approval of First Continental Life & Accident Insurance Co.

Submission of Claims:

Vision plan benefits for Central Texas Employee Benefits

Lenses (standard) per pair

vision

Contact lenses4

Medically necessary contact lenses

LASIK vision correction5

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements

1 Eye exam copay is a single payment due to the provider at the time of service

2 Eyewear copay applies to eyeglass lenses / frame and contact lenses. Eyewear copay is a single payment that applies to the en tire purchase of eyeglasses (frame and lenses)

3 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay

4 Contact lenses and related professional services (fitting, evaluation and follow -up) are covered in lieu of eyeglass lenses and frames benefit

5 Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limit ations

Discount features

Discounts on covered materials6

These discounts apply to the glasses and contacts that are covered under the vision benefits.

Frames: 20% off amount over allowance

Conventional contacts 20% off amount over allowance

Disposable contact 10% off amount over allowance

Lens type*

Scratch coat

Ultraviolet coat

Tints, solid

Tints, gradient

Polycarbonate

Blue light filtering

Digital single vision

Progressive lenses

Standard/Premium/Ultra/Ultimate

Anti-reflective coating

Standard/Premium/Ultra/Ultimate

Polarized lenses

Plastic photochromic lenses

High Index (1.67 / 1.74)

Member out-of-pocket6

$15

$12

$15

$18

$40

$15

$30

$55 / $110 / $150 / $225

$50 / $70 / $85 / $120

$75

$80

$80 / $120

* The above table highlights some of the most popular lens type and is not a complete listing. This table outlines member out-of-pocket costs5 and are not available for premium/upgraded options unless otherwise noted.

Discounts on non-covered exam, services and materials6

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

Contacts, miscellaneous options: 20% off retail

Disposable contact lenses: 10% off retail

Retinal imaging: $39 maximum out-of-pocket

Laser vision correction (LASIK)6

Laser vision correction (LASIK) is a procedure that can reduce or eliminate your dependency on glasses or contact lenses. This corrective service is available to you and your eligible dependents at a special discount (20-50%) with your Superior Vision plan. Contact QualSight LASIK at (877) 201-3602 for more information.

Hearing discounts6

A National Hearing Network of hearing care professionals, featuring Your Hearing Network, offers Superior Vision members discounts on services, hearing aids and accessories. These discounts should be verified prior to service.

All allowances are retail; the member is responsible for paying the provider directly for all non-covered items and/or any amount over the allowances, minus available discounts. These are not covered by the plan.

6Not all providers participate in Superior Vision Discounts, including the member out -of-pocket features. Call your provider prior to scheduling an appointment to confirm if he/she offers the discount and member out -of-pocket features. The discount and member out-of-pocket features are not insurance. Discounts and member out-of-pocket are subject to change without notice and do not apply if prohibited by the manufacturer. Lens options may not be available from all Superior Vision providers/all locations.

Disclaimer: All final determinations of benefits, administrative duties, and definitions are governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions.

Central Texas Employee Benefits Cooperative

Voluntary Disability Insurance Plan Highlights

Who is eligible? You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week.

What is my monthly benefit amount?

How long do I have to wait to receive benefits?

You can elect to purchase a benefit of 45%, 55% or 65% of your monthly earnings.

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

Elimination Period Options:

Option 1: 0 days/7 days first day hospital

Option 2: 14 days/14 days first day hospital

Option 2: 30 days/30 days first day hospital

Option 3: 90 days/90 days

Option 3: 180 days/180 days

During your elimination period, you will be considered disabled if you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury, you are under the regular care of a physician and you are unable to perform any of the material and substantial duties of your regular occupation due to the same sickness or injury.

If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.)

How long will my benefits last? Age at Disability

than age 62

Age 66

Age 67

Age 69 or older

Period of Payment

months Year of Birth

Security Normal Retirement Age (SSNRA)

When is my coverage effective?

Do I have to take a health exam to get coverage?

What if I am out of work when the coverage goes into effect?

What is my maximum monthly benefit amount?

What else is included with this policy?

Please see your plan administrator for your effective date.

You may receive coverage without answering any medical questions or providing evidence of insurability if you apply for coverage within 31 days after your eligibility date. If you apply more than 31 days after your eligibility date, your coverage will be subject to a 3/12 pre-existing condition exclusion.

Please see your plan administrator for your eligibility date.

Insurance will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

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

Worldwide emergency travel assistance is included with this long term disability plan. Emergency travel assistance is available to you, your spouse* and your dependent children when you travel to any foreign country, including Canada or Mexico. It is also available anywhere in the United States when you travel just 100 or more miles from home.

*A spouse traveling on business for his or her employer is not covered by the program.

Does this plan include help with work-life balance?

What is not covered?

Yes. Our work-life balance employee assistance program (EAP) provides professional advice for a wide range of personal and work-related issues. The service is available to you and your family members 24 hours a day, 365 days a year. It provides resources to help you find solutions to everyday issues — such as financing a car or selecting child care — as well as more serious problems, such as alcohol or drug addiction, divorce or relationship problems. There is no additional charge for using the program, and you do not have to have filed a disability claim or be receiving benefits to use the program.

Benefits would not be paid for disabilities caused by, contributed to by, or resulting from:

• Intentionally self-inflicted injuries;

• Active participation in a riot;

• War, declared or undeclared, or any act of war;

• Commission of a crime for which you have been convicted;

• Loss of professional license, occupational license or certification;

• Pre-existing conditions (see pre-existing condition section); or

• Any occupational injury or sickness for Short Term Disability coverage.

The loss of a professional or occupational license does not, in itself, constitute disability.

Unum will not pay a benefit for any period of disability during which you are incarcerated.

What is considered a pre-existing condition?

You have a pre-existing condition if:

•You received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and •The disability begins in the first 12 months after your effective date of coverage.

Benefits under this provision are payable for no more than 90 days of benefit from the date of disability. After 90 days, benefits are subject to a 3/12 preexisting condition exclusion. In no event will benefits be paid beyond the applicable benefit duration. This applies to new hires. Late entrants will be subject to a 3/12 pre-ex.

When does my coverage end?

How can I apply for coverage?

Your coverage under the policy ends on the earliest of the following:

• The date the policy or plan is cancelled;

• The date you no longer are in an eligible group;

• The date your eligible group is no longer covered;

• The last day of the period for which you made any required contributions;

• The last day you are in active employment except as provided under the covered layoff or leave of absence provision.

Please see your plan administrator for further information on these provisions.

Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

To apply for coverage, complete your enrollment online by the enrollment deadline.

Check with your plan administrator for your eligibility date, and complete your enrollment online within 31 days of that date.

You are considered in active employment, if on the day you apply for coverage, you are being paid regularly by your employer for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation.

The work-life balance employee assistance program, provided by LifeWorks, is available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.

Worldwide emergency travel assistance services, provided by Assist America, Inc., are available with select Unum insurance offerings. Terms and availability of service are subject to change and prior notification requirements. Services are not valid after coverage terminates. Please contact your Unum representative for details.

This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative. Underwritten by Unum Life Insurance Company of America, Portland, Maine

EN-1776 (1-17) FOR EMPLOYEES

Term Life and Accidental Death & Dismemberment (AD&D) Insurance

How does it work?

You choose the amount of coverage that’s right for you, and you keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.

AD&D Insurance is also available, which pays a benefit if you survive an accident but have certain serious injuries. It pays an additional amount if you die from a covered accident.

Why is this coverage so valuable?

If you previously purchased coverage, you can increase it up to $250,000 to meet your growing needs — with no medical underwriting.

What else is included?

A ‘Living’ Benefit — If you are diagnosed with a terminal illness with less than 12 months to live, you can request 75% of your life insurance benefit (up to $500,000) while you are still living. This amount will be taken out of the death benefit, and may be taxable. These benefit payments may adversely affect the recipient’s eligibility for Medicaid or other government benefits or entitlements, and may be taxable. Recipients should consult their tax attorney or advisor before utilizing living benefit payments.

Waiver of premium — Your cost may be waived if you are totally disabled for a period of time.

Portability — You may be able to keep coverage if you leave the company, retire or change the number of hours you work. Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.

Who can get Term Life coverage?

Who get Term Life coverage?

If you are actively at work at least 20 hours per week, you may apply for coverage for:

If you are actively at work at least 20 hours per week, you may apply for

Choose from $10,000 to $500,000 in $10,000 increments, up to 7 times your earnings. If you previously purchased coverage, you can increase it up to $250,000 with no medical underwriting. If you previously declined coverage, you may have to answer some health questions.

You: Choose from $10,000 to $500,000 in $10,000 increments, up to 7 times your earnings.

If you previously purchased coverage, you can increase it up to $250,000 with no medical underwriting. If you previously declined coverage, you may have to answer some health questions.

Your spouse: Get up to $500,000 of coverage in $5,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.

If you previously purchased coverage for your spouse, they can increase their coverage up to $50,000 with no medical underwriting, if eligible (see delayed effective date). If you previously declined spouse coverage, some health questions may be required.

Your children: Get up to $10,000 of coverage in $1,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 26th birthday.

The maximum benefit for children live birth to 6 months is $1,000.

Your children: Get up to $10,000 of coverage in $10,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 26th birthday.

Who can g verage? (AD&D) co

et Accidental Death & Dismemberment

The maximum benefit for children live birth to

Get up to $500,00 of AD&D coverage for yourself in $10,000 increments.

You: Your spouse: Your children: Get 50% of employee coverage amount up to $250,000 of AD&D coverage for your spouse in $5,000 increments if eligible (see delayed effective date).

Get 10% of employee coverage up to $50,000 of AD&D coverage for your children if eligible (see delayed effective date).

The maximum benefit for children live birth to 6 months is $1,000.

No medical underwriting is required for AD&D coverage.

Calculate your costs

1. Enter the coverage amount you want.

2. Divide by the amount shown.

3. Multiply by the rate. Use the rate table (at right) to find the rate based on age. (Choose the age you will be when your coverage becomes effective. See your plan administrator for your plan effective date. To determine your spouse rate, choose the age the employee will be when coverage becomes effective. See your plan administrator for your plan effective date.)

4. Enter your cost.

Exclusions and limitations

Actively at work

Eligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off.

An unmarried handicapped dependent child who becomes handicapped prior to the child’s attainment age of 26 may be eligible for benefits. Please see your plan administrator for details on eligibility. Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage. Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage.

Exclusions and limitations

Life insurance benefits will not be paid for deaths caused by suicide occurring within 24 months after the effective date of coverage. The same applies for increased or additional benefits.

AD&D specific exclusions and limitations:

Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:

• Disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)

• Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane

• War, declared or undeclared, or any act of war

• Active participation in a riot

• Committing or attempting to commit a crime under state or federal law

• The voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol.

• Intoxication – ‘Being intoxicated’ means your or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.

Delayed effective date of coverage

Insurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

Delayed Effective Date: if your spouse or child has a serious injury, sickness, or disorder, or is confined, their coverage may not take effect. Payment of premium does not guarantee coverage. Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan.

Age Reduction

Coverage amounts for Life and AD&D Insurance for you and your dependents will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction.

Termination of coverage

Your coverage and your dependents’ coverage under the policy ends on the earliest of:

• The date the policy or plan is cancelled

• The date you no longer are in an eligible group

• The date your eligible group is no longer covered

• The last day of the period for which you made any required contributions

• The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverage

In addition, coverage for any one dependent will end on the earliest of:

• The date your coverage under a plan ends

• The date your dependent ceases to be an eligible dependent

• For a spouse, the date of a divorce or annulment

• For dependents, the date of your death

Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.

Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.

Unum complies with state civil union and domestic partner laws when applicable.

Underwritten by:

Unum Life Insurance Company of America, Portland, Maine

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

Group 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.

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

First cancer benefit

Diagnosis of cancer

Hospital confinement

Hospital confinement ICU

Radiation therapy, chemotherapy, immunotherapy

Alternative care

Medical imaging

Skin cancer initial diagnosis

$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

$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

$200 per day – days 1 through 30

Additional days: $400

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:

$20,000

$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.)

Attending physician

Hospital confinement sub-acute ICU

Family care

Prescription drug in-patient

Private full-time nursing services

U.S. government or charity hospital

Specialty Care Benefits

Family member transportation and lodging

Home health care

Hospice care

Skilled nursing care facility

Air ambulance

Ambulance

Blood, plasma, and platelets

Bone marrow or stem cell donation

$30 per visit

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: $100

Additional days: $100

Maximum days per confinement: 15

Family transportation: $100 per trip

Maximum trips per calendar year: 12

Family lodging: $100 per day

Maximum days per calendar year: 100

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

Maximum days per calendar year: 30

$100 per day

Maximum days per calendar year: 30

$2,000 per trip

Maximum trips per confinement: 2

$200 per trip

Maximum trips per confinement: 2

$300 per transfusion

Maximum transfusions per calendar year: 2

$200 per confinement

Lifetime maximum donations: 2

$50 per visit

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: $200

Additional days: $400

Maximum days per confinement: 15

Plan

Family transportation: $100 per trip

Maximum trips per calendar year: 12

Family lodging: $100 per day

Maximum days per calendar year: 100

$200 per day not to exceed the number of days confined

Maximum days per calendar year: 30

$200 per day

Maximum days per calendar year: 30

$2,000 per trip

Maximum trips per confinement: 2

$200 per trip

Maximum trips per confinement: 2

$300 per transfusion

Maximum transfusions per calendar year: 2

$300 per confinement

Lifetime maximum donations: 2

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

Cancer Treatment Benefits Low Plan

Bone marrow or stem cell transplant

First bone marrow transplant: $6,000

Additional transplant: 50%

Lifetime maximum transplant(s): 2

First stem cell transplant: $600

Additional transplant: 50%

Lifetime maximum transplant(s): 2

Hormonal therapy

National Cancer Institute Designated

Comprehensive Cancer Treatment Center Evaluation/Consultation Benefit

Counseling

Hair piece

Medical equipment

Non-surgical prosthesis

Recovery at home

Therapy

Transportation and lodging

Genetic tumor testing

$50 per treatment

Maximum treatments per calendar year: 12

$750

Lifetime maximum consultation(s): 1

$75 per visit

Maximum visits per calendar year: 6

$150 per hair piece

Lifetime maximum: 1

$150 per piece of equipment

Maximum pieces per calendar year: 2

$100

Lifetime maximum number of devices: 1

$150 per day not to exceed the number of days confined

Maximum days per calendar year: 15

$25 per day of therapy

Maximum days per calendar year: 40

Transportation: $100 per trip

Maximum trips per calendar year: 12

Lodging: $100 per day

Maximum days per calendar year: 100

$50

Maximum days of service, per covered person per calendar year: 1 day(s)

Follow-up test benefit amount: $100

Waiting period: 0 days

$100 per test

Maximum tests per calendar year: 2

First bone marrow transplant: $9,000

Additional transplant: 50%

Lifetime maximum transplant(s): 2

First stem cell transplant: $900

Additional transplant: 50%

Lifetime maximum transplant(s): 2

$50 per treatment

Maximum treatments per calendar year: 12

$750

Lifetime maximum consultation(s): 1

$75 per visit

Maximum visits per calendar year: 6

$150 per hair piece

Lifetime maximum: 1

$150 per piece of equipment

Maximum pieces per calendar year: 2

$100

Lifetime maximum number of devices: 1

$150 per day not to exceed the number of days confined

Maximum days per calendar year: 15

$25 per day of therapy

Maximum days per calendar year: 40

Transportation: $100 per trip

Maximum trips per calendar year: 12

Lodging: $100 per day

Maximum days per calendar year: 100

$50

Maximum days of service, per covered person per calendar year: 1 day(s)

Follow-up test benefit amount: $100

Waiting period: 0 days

$100 per test

Maximum tests per calendar year: 2

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

Preventative and Wellness Benefits

Heritable cancer screening

Pharmacogenomic (PGX) screening test

Heart Attack or Stroke Benefit

Heart attack or stroke

Specified Disease Benefits

Hospital confinement for specified disease benefit

Surgical Treatment Benefits

Waiting period

Low Plan

$100

Maximum tests per calendar year: 1

$100 per test

Maximum tests per calendar year: 2

Low Plan

$5,000

Recurrence benefit: $2,500

Waiting period: 0 days

Benefit reduction: none

Low Plan

Waiting period: 0 days

Benefit reduction: None

$100 per day – days 1 through 30

Additional days: $100

Maximum days per confinement: 31

Low Plan

Waiting period: 0 days

High Plan

$100

Maximum tests per calendar year: 1

$100 per test

Maximum tests per calendar year: 2

High Plan

$10,000

Recurrence benefit: $5,000

Waiting period: 0 days

Benefit reduction: none

High Plan

Waiting period: 0 days

Benefit reduction: None

$200 per day – days 1 through 30

Additional days: $400

Maximum days per confinement: 31

High Plan

Waiting period: 0 days

Surgery Up to $3,000 Up to $3,000

Anesthesia

Outpatient surgery facility service

Preventative surgery

Reconstructive surgery

Second and third opinion

Skin cancer surgery

Surgical prosthesis

General anesthesia: 25% of surgery benefit

Maximum benefits per calendar year: 2

$200 per day

Maximum benefits per calendar year: 4

$250

Lifetime maximum: 1

Breast TRAM flap: $2,000

Breast reconstruction: $500

Breast symmetry: $500

Facial reconstruction: $500

$300

Maximum benefits per calendar year: 2

$100

Maximum benefits per calendar year: 2

$1,000 per device

Lifetime maximum benefit amount: $1,000

General anesthesia: 25% of surgery benefit

Maximum benefits per calendar year: 2

$400 per day

Maximum benefits per calendar year: 4

$250

Lifetime maximum: 1

Breast TRAM flap: $2,000

Breast reconstruction: $500

Breast symmetry: $500

Facial reconstruction: $500

$300

Maximum benefits per calendar year: 2

$100

Maximum benefits per calendar year: 2

$1,000 per device

Lifetime maximum benefit amount: $1,000

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

Accident and Sickness Benefits

Hospital intensive care for accident or sickness

Advocacy Package

Kindly HumanTM

Participants can talk for up to six hours total per year for pre-clinical peer-to-peer connections and navigation across real-life issues.

Additional plan benefits

Renewability

Portability

Low Plan

Hospital confinement ICU for accident or sickness benefit: $100

Maximum number of days per confinement: 30

Low Plan

Included

High Plan

Hospital confinement ICU for accident or sickness benefit: $200

Maximum number of days per confinement: 30

High Plan

Included

Conditionally Renewable Coverage is automatically renewed as long as the insured is an eligible employee, premiums are paid as due, and the policy is in force.

Portability Employees can keep their coverage if they change jobs or retire while the policy is in-force.

Continuity of coverage Included

Pre-existing conditions limitation

Waiver of premium

A condition for which a covered person received medical advice or treatment within the 12 months preceding the certificate effective date.

Included

Definitions and provisions

Continuity of coverage

Definition of cancer

If the certificate replaced another cancer indemnity certificate or individual policy, your coverage under the certificate shall not limit or exclude coverage for a preexisting condition or waiting period that would have been covered under the policy being replaced.

Benefits payable for a pre-existing condition or during the waiting period will be the lesser of the benefits that would have been payable under the terms of the prior coverage if it had remained in force; or the benefits payable under the certificate. Time periods applicable to pre-existing conditions and waiting periods will be waived to the extent that similar limitations or exclusions were satisfied under the coverage being replaced.

Continuity of coverage is only extended to the benefits provided under the certificate. The certificate may not include all the benefits provided under the prior coverage.

Cancer means carcinoma in situ, leukemia, or a malignant tumor characterized by uncontrolled cell growth and invasion or spread of malignant cells to distant tissue. Cancer is also defined as cancer which meets the diagnosis criteria of malignancy established by the American Board of Pathology after a study of the histocytologic architecture or pattern of the suspect tumor, tissue, or specimen.

Carcinoma in situ means a malignant tumor which is typically classified as Stage 0 cancer, where the tumor cells still lie within the tissue of the site of origin without having invaded neighboring tissue.

Definitions and provisions (cont.)

Definition of cancer

The following are not considered cancer: Pre-malignant conditions or conditions with malignant potential; non-invasive basal cell carcinoma of the skin; non-invasive squamous cell carcinoma of the skin; or melanoma diagnosed as Clark’s Level I or II or Breslow less than .75mm.

Plan descriptions Refer to the Certificate of Coverage for details specific to each plan.

Exclusions and limitations

No benefits will be paid for a date of diagnosis or treatment of cancer prior to the coverage effective date, except where continuity of coverage applies.

No benefits will be paid for services rendered by a member of the immediate family of a covered person.

We will not pay benefits for other conditions or diseases, except losses due directly from cancer or skin cancer.

We will not pay benefits for cancer or skin cancer if the diagnosis or treatment of cancer is received outside of the territorial limits of the United States and its possessions. Benefits will be payable if the covered person returns to the territorial limits of the United States and its possessions, and a physician confirms the diagnosis or receives treatment.

Rates

Questions?

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

*Please refer to your Certificate of Insurance at https://www.ctxebc.com for a complete listing of available benefits, limitations and exclusions. Underwritten by ACE Property & Casualty Company, a Chubb company. This information is a brief description of the important benefits and features of the insurance plan. It is not an insurance contract. This policy does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”) and does not satisfy a person’s individual obligation to secure the requirement of minimum essential coverage under the Affordable Care Act (ACA). For more information about the ACA, please refer to http://www.HealthCare.gov.

Accident

You do everything you can to stay active and healthy, but accidents happen every day. An injury that hurts an arm or a leg can hurt your finances too. Chubb Accident pays cash benefits directly to you regardless of any other coverage you have. Benefits can be used to help cover health plan gaps for out-of-pocket expenses like deductibles, copays, and coinsurance.

Accident Insurance

Eye Injury

Family Care (up to 30 days)

Follow-up Treatment (per visit)

Fractures (up to)

Herniated Disc Surgery

$500

$25 per day, per child in child care center

$100

$8,000

$1,200

Knee Cartilage - Torn $800

Lacerations

Lodging (per night, 100 or more miles)

Loss of Hands, Feet, Sight

Loss of Fingers or Toes

Major Diagnostic Exam (CT, MRI, etc.)

Paralysis

Two Limbs (paraplegia or hemiplegia)

Four Limbs (quadriplegia)

Prosthetics

Surgery - Abdominal, Cranial, or Thoracic

Hernia

Tendon, Ligament, Rotator Cuff

Therapy – Physical, Occupational, or Speech

Transportation (per trip, 100 or more miles)

Traumatic Brain Injury

X-Ray

$30-$500

$180

$50,000

$1,800

$300

$16,000

$24,000

$1,500

$3,000

$400

$825

$50

$750

$225

$100

Rates

Questions?

Critical Illness

Heart attacks, cancer and strokes happen every day and often unexpectedly. They don’t give you time to prepare and can take a serious toll on both your physical and financial well-being. Chubb Critical Illness pays cash benefits directly to you that you can use to help with your bills, your mortgage, your rent, your childcare— you name it—so you can focus on recovery.

Every 40 seconds

someone has a heart attack.¹

1 in 3

Americans don’t have enough money readily available to cover an unexpected $400 expense.²

Available coverage choices

Employee

Spouse

$10,000; $20,000; $30,000; or $40,000 face amounts

$5,000; $10,000; $15,000; or $20,000 face amounts

Child Included in the employee rate

No benefits will be paid for a date of diagnosis that occurs prior to the coverage effective date. Covered individuals must be treatment free from cancer for 12 months prior to diagnosis date and in complete remission. There is no pre-existing conditions limitation. All amounts are Guaranteed Issue — no medical questions are required for coverage to be issued.

Critical Illness Insurance

of sight, speech, or hearing

Skin Cancer Benefit - Payable once per insured per year

Occupational package

Pays 100% of the face amount; Benefits payable for HIV or hepatitis B, C, or D, MRSA, rabies, tetanus or tuberculosis contracted on the job.

Childhood conditions

Pays 100% of the dependent child face amount; Provides benefits for childhood conditions (autism spectrum disorder; cerebral palsy; congenital birth defects: heart, lung, cleft lip, palate, etc; cystic fibrosis; Down’s syndrome; Gaucher disease; muscular dystrophy; type 1 diabetes). Included

Miscellaneous Disease Rider + COVID-19

The Miscellaneous Disease Rider is payable once per covered condition.

Covered conditions include: Addison’s disease; cerebrospinal meningistis; diptheria; Hungtington’s chorea; Legionnaire’s disease; malaria; myasthenia gravis; meningitis; necrotizing fasciitis; osteomyelitis; polio; rabies; sclerodema; systematic lupus; tetanus; tuberculosis.

COVID-19 means a disease resulting in a positive COVID-19 diagnostic screening and 5 consecutive days of hospital confinement.

Recurrence Benefit

Benefits are payable for a subsequent diagnosis of benign brain tumor; cancer; coma; coronary artery obstruction; heart attack; major organ failure; stroke; or sudden cardiac arrest.

Advocacy package

Diabetes Benefit

Diabetes Diagnosis Benefit

100% misc. diseases excluding Covid-19

50% Covid- 19

Pays a benefit once for covered person’s diabetes diagnosis. $500

Additional benefits

Waiver of Premium

Waives premium while the insured is totally disabled.

Wellness Benefit - Payable once per insured per year $50

Questions?

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

No one is immune to identity theft.

Better Protect What Matters Most.

Identity theft can affect anyone—from infants to seniors. Each generation has habits that savvy criminals know how to exploit—resulting in over $50 billion lost in the US to identity fraud in 2021.1 Take action with award-winning ID Watchdog identity theft protection.

Greater Peace of Mind

With ID Watchdog® as an employee benefit, you have a more convenient and affordable way to help better protect and monitor your identity. You’ll be alerted to potentially suspicious activity and enjoy greater peace of mind knowing you don't have to face identity theft alone.

Why Choose ID Watchdog?

We scour billions of data points— public records, transaction records, social media and more—to search for signs of potential identity theft.

We've got you covered with lock features for added control over your credit report(s) to help keep identity thieves from opening new accounts in your name.

Extensive Family Coverage

Awarded Best in Class Identity Protection Service Provider for Consumers

If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored.

Our family plan helps you better protect your loved ones 2 with personalized accounts for adult family members, family alert sharing, and exclusive features for children.

Our US-based, customer care team is here for you 24/7/365 at 866.513.1518 .

1 Javelin Strategy & Research, 2022 Identity Fraud Study: The Virtual Battleground, Mar 2022.

2 Refer to your employer or ID Watchdog for family plan eligibility.

Powerful Features Included in Both ID Watchdog Plans

Control & Manage Monitor & Detect Support & Restore

•Financial Accounts Monitoring

•Social Account Monitoring

•Registered Sex Offender Reporting

•Customizable Alert Options

• Equifax Blocked Inquiry Alerts

•National Provider ID Alerts

•Dark Web Monitoring1

• Data Breach Notifications

• • • •

Subprime Loan Monitoring2

• High-Risk Transactions Monitoring2

Public Records Monitoring

USPS Change of Address Monitoring

Identity Profile Report

• Credit Score Tracker

•Fully Managed Resolution Services including Pre-Existing Conditions

•Online Resolution Tracker

•Lost Wallet Vault & Assistance

•Deceased Family Member Fraud Remediation3 (Family Plan only)

•Credit Freeze Assistance

Help better protect children with Equifax Child Credit Lock & Equifax Child Credit Monitoring PLUS features with this icon

Plan-Specific Features

• Up to $1M Stolen Funds Reimbursement

- Checking and savings accounts

- 401k/HSA/ESOP accounts

• Home Title Fraud

• Cyber Extortion

Subprime Loan Block2 within the monitored lending network

Telecom & Utility Alerts | 1 Bureau NEW

Integrated Fraud Alerts8

With a fraud alert, potential lenders are encouraged to take extra steps to verify your identity before extending credit.

=Targeted to be available9 by Jan 2023

What You Need to Know

The credit scores provided are based on the VantageScore 3.0 model. For three-bureau VantageScore credit scores, data from Equifax, Experian, and TransUnion are used respectively. Any one-bureau VantageScore uses Equifax data. Third parties use many different types of credit scores and are likely to use a different type of credit score to assess your creditworthiness.

(1)Dark Web Monitoring scans thousands of internet sites where consumers’ personal information is suspected of being bought and sold, and is constantly adding new sites to those it searches. However, the internet addresses of these suspected internet trading sites are not published and frequently change, so there is no guarantee that ID Watchdog is able to locate and search every possible internet site where consumers’ personal information is at risk of being traded. (2)The monitored network does not cover all businesses or transactions. (3)Applicable for enrolled family members only. (4)Monitoring from TransUnion and Experian will take several days to begin. (5)Under certain circumstances, access to your Equifax Credit Report may not be available as certain consumer credit files maintained by Equifax contain credit histories, multiple trade accounts, and/or an extraordinary number of inquiries of a nature that prevents or delays the delivery of your Equifax Credit Report. If a remedy for the failure is not available, the product subscription will be cancelled and a full refund will be made. (6)Locking your Equifax or TransUnion credit report will prevent access to it by certain third parties. Locking your Equifax or TransUnion credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax or TransUnion credit report include: companies like ID Watchdog and TransUnion Interactive, Inc. which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state, and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make pre-approved offers of credit or insurance to you. To opt out of preapproved offers, visit www.optoutprescreen.com. (7)The Identity Theft Insurance is underwritten and administered by American Bankers Insurance Company of Florida, an Assurant company. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions. Review the Summary of Benefits (www.idwatchdog.com/terms/insurance). (8)The Integrated Fraud Alert feature is made available to consumers by Equifax Information Services LLC and fulfilled on its behalf by Identity Rehab Corporation. (9)May be subject to delay or change.

Insurance companies may not cover all air and ground ambulance expenses which can result in max in-network out-of-pocket** costs of: DID YOU KNOW?

are sent to the emergency room through ground or air ambulance every year * .

$8,700 Individual

$17,400 Family

Ground ambulance out-of-network transportation costs may be even higher than in-network since the No Surprises Act does not apply to ground ambulance at this time.

EMERGENT PLUS MEMBERSHIPBENEFITS

A MASA MTS Membership provides the ultimate peace of mind at an aﬀ ordable rate for emergency ground and air transportation assistance expenses within the continental United States, Alaska, Hawaii, and while traveling in Canada, regardless of whether the provider is in or out of your group healthcare bene ts network. After the group health plan pays its portion, MASA works with providers to make certain our Members have no out-of-pocket expenses~ for emergency ambulance transportation assistance and other related services.

Emergency Air Ambulance Coverage1

MASA MTS covers out-of-pocket expenses associated with emergency air transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.

Emergency Ground Ambulance Coverage1

MASA MTS covers out-of-pocket expenses associated with emergency ground transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.

Hospital to Hospital Ambulance Coverage1

MASA MTS covers out-of-pocket expenses that you or a dependent family member may incur for hospital transfers, due to a serious emergency, to the nearest and most appropriate medical facility when the current medical facility cannot provide the required level of specialized care by air ambulance to include medically equipped helicopter or xed-wing aircraft.

Repatriation to Hospital Near Home Coverage1

MASA MTS provides services and covers out-of-pocket expenses for the coordination of a Member’s nonemergency transportation by a medically equipped, air or ground ambulance in the event of hospitalization more than one hundred (100) miles from the Member’s home if the treating physician and MASA MTS’ Medical Director says it’s medically appropriate and possible to transfer the Member to a hospital nearer to home for continued care and recuperation.

Contact Your Representative, to learn more:

The information provided in this product information sheet is for informational purposes only. The benets listed and the descriptions thereof do not represent the full terms and conditions applicable for usage and may only be oﬀered in some memberships. Premiums and benets vary depending on the benets selected. Commercial air and Worldwide coverage are not available in all territories. For a complete list of benets, premiums, and full terms, conditions, and restrictions, please refer to the applicable member services agreement for your territory. MASA MTS products and services are not available in AK, NY, WA, ND, and NJ. MASA MTS utilizes third-party transportation service providers for all transportation services. MASA Global, MASA MTS and MASA TRS are registered service marks of MASA Holdings, Inc., a Delaware corporation. Void where prohibited by law.

~If a member has a high deductible health plan that is compatible with a health savings account, benets will become available under the MASA membership for expenses incurred for medical care (as dened under Internal Revenue Code (“IRC”) section 213 (d)) once a member satises the applicable statutory minimum deductible under IRC section 223(c) for high-deductible health plan coverage that is compatible with a health savings account.

COVERAGE TERRITORIES:

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

SOURCES:

*ACEP NOW 2014

** Patient Protection and Aﬀordable Care Act; HHS Notice of Benet and Payment Parameters for 2022 and Pharmacy Benet Manager Standards. May 5, 2021.

Flexible Spending Plans

Policies other than company sponsored policies (i.e. spouse’s or dependents’ individual policies) may not be paid through the �e�ible bene�ts plan. �urthermore� �uali�ed long�term care insurance plans may not be paid through the �e�ible bene�ts plan. What Can I Save with an FSA?

NBS

Mobile App

Mobile app features

Sample Expenses

Medical Expenses

•Acupuncture

• Addiction programs

• Adoption (medical expenses for baby birth)

•Alternative healer fees

•Ambulance

•Body scans

•Breast pumps

•Care for mentally handicapped

•Chiropractor

•Copayments

•Crutches

•Diabetes (insulin, glucose monitor)

•Eye patches

Dental Expenses

• Artificial teeth

• Copayments

•Deductible

•Dental work

•Dentures

•Fertility treatment

•First aid (e.g., bandages, gauze)

•Hearing aids & batteries

•Hypnosis (for treatment of illness)

• Incontinence products (e.g., Depends, Serene)

•Joint support bandages and hosiery

•Lab fees

•Menstrual Products*

• Monitoring device (blood pressure, cholesterol)

•Non-prescription medicines or drugs (vitamins/supplements without a prescription are not eligible)*

• Orthodontia expenses

• Preventative care at dentist office

•Bridges, crown, etc.

•Physical exams

•Pregnancy tests

•Prescription medicines or drugs

•Psychiatrist/psychologist (for mental illness)

•Physical therapy

•Speech therapy

•Vaccinations

• Vaporizers or humidifiers

•Weight loss program fees (if prescribed by physician)

•Wheelchair

Vision Expenses

•Braille - books & magazines

• Contact lenses

•Contact lens solutions

•Eye exams

Items that generally do not qualify for reimbursement

•Personal hygiene (e.g., deodorant, soap, body powder, sanitary products. Does not include menstrual products)

•Addiction products**

•Cosmetic surgery**

•Cosmetics (e.g., makeup, lipstick, cotton swabs, cotton balls, baby oil)

•Counseling (e.g., marriage/family)

•Dental care - routine (e.g., toothpaste, toothbrushes, dental floss, antibacterial mouthwashes, fluoride rinses, teeth whitening/bleaching)**

•Exercise equipment**

• Haircare (e.g., hair color, shampoo, conditioner, brushes, hair loss products)

• Health club or fitness program fees**

•Homeopathic supplement or herbs**

•Household or domestic help

•Laser hair removal

•Massage therapy**

•Eyeglasses

*After January 1, 2020

•Laser surgery

• Office fees

•Guide dog and upkeep/ other animal aid

•Nutritional and dietary supplements (e.g., bars, milkshakes, power drinks, Pedialyte)**

• Skin care

(e.g., moisturizing lotion, lip balm)

•Sleep aids (e.g., snoring strips)**

•Vitamins**

•Weight reduction aids

(e.g., Slimfast, appetite suppressant)**

**Portions of these expenses may be eligible for reimbursement if they are recommended by a licensed medical professional as medically necessary for treatment of a specific medical condition.

Save with these incredible MEMBERPERKS

Your LegalShield and IDShield memberships are simply amazing. And in addition to the privileges that are already yours, we have added these MEMBERPERKS with hundreds of merchants and thousands of discounts. Members can access savings at both national and local companies on everyday purchases such as tickets, electronics, apparel, travel and more. Members have the opportunity to save, on average, over $2,000 per year. MEMBERPERKS can save you enough to pay for your membership for years to come!

RECEIVE EXCLUSIVE DISCOUNTS

Access your members-only discounts in categories such as:

WHAT MEMBERS ARE SAYING:

“MEMBERPerks pays for my membership!”

— Martha S.

“I saved 20% at Advance Auto and I also saved 30% on movie tickets on date night with my wife. This membership is it!”

— Andre E.

“I am receiving 8% off my Verizon cell phone monthly charge!”

— Paulette M.

Getting Started

AND MANY MORE!

To sign up, simply login at legalshield.com, click on the Resources tab, then click on MEMBERPERKS. If you don’t already have an account, follow the simple on-screen instructions to make an account with your personal or work email and LegalShield membership number.

These benefits are for LegalShield and IDShield members. All

or promotions are subject to change without notice.

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 CTXEBC 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 CTXEBC 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.