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Jefferson County Board of Education Benefits Guide

2027 Effective January 1st, 2027 Summary for Review Purposes Only

Table of Contents 3

Prepare for Enrollment

Eligibility & Important Notes

Qualified Life Events & Preventive Care

Service Hub/Support Center Claims Instructions

Voluntary Benefits Claims Instructions

Employee Assistance Program (EAP)

9-10

Enrollment in Benefits - Take Action

Health Insurance 101

12-13

Medical Plan (State Health Benefit Plan)

14-15

Dental Plan

Vision Plan

Get the most out of your Dental and Vision Plans

Disability Plans

Life Insurance 101

Basic Life AD&D Plan

Voluntary Life and AD&D Plan

Permanent Life Insurance

Hospital Indemnity Plan

Accident Plan

Critical Illness w/Cancer Plan

Cancer Plan

Wellness Incentives

Legal Plan

MedCareComplete

30-31

Jefferson County Board of Education offers a comprehensive and valuable benefits program to all eligible employees. Our benefits package is designed to provide security and assistance during a time of need. Please become familiar with the various options and select the best coverage for the upcoming plan year.

Need help? Start Here: mybenefits@campusbenefits.com 866.433.7661, opt. 5

Jefferson County Board of Education Contact: Gre’Shun Nicholson Director of Human Resources nicholsong@jefferson.k12.ga.us Melisa Partridge Payroll partridgem@jefferson.k12.ga.us

Notes

Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Prepare for Enrollment Prepare for your New Hire Enrollment or Open Enrollment by asking yourself the following questions: How did my benefits work for me this year? What plans will meet my needs? Do I have any health changes that need to be addressed? Do I have any family health history that I should be considering? Any family changes on the horizon? Are there any questions I have on what is offered or how to use the benefits offered?

Keeping P.A.C.E. with Your Benefits

P A C E

Participate Attend a benefits meeting Assess Review plan options and evaluate family needs Complete Submit benefit elections on time Embrace Document your choices, share important plan information with family and keep benefit details for future reference.

Eligibility Waiving Coverage

Benefits Eligible Employees:

Full-time employees working 20 or more hours a week and bus drivers working 15 or more hours a week. Eligible family members may be enrolled under certain plans when elected by the employee.

Eligible family members include:

Your legally married spouse Your unmarried children who are your natural children, stepchildren, adopted children, or children for whom you have legal custody (age restrictions may apply) up to the age of 26. Disabled children age 26 or older who meet certain criteria may continue on your health coverage.

Employees who choose to waive/decline any benefits for themselves or their dependents will not be eligible to enroll until open enrollment for each plan without a Qualifying Life Event.

Additional Rules:

Specific employee and dependent eligibility rules are governed by each plan’s policy document/certificate; available on the employee benefits website, or by contacting Campus Benefits.

When Do Benefits Begin? The effective date of coverage for benefits depends on your hire date. Typically, benefits will begin the first of the month following 30 days of employment. For all benefits, employees must be actively at work on the effective date of coverage. New hires must complete enrollment within 30 days of hire date, prior to effective date of coverage. Supporting documentation is required to be submitted to process qualifying life events.

When Do Benefits End? Upon termination of employment, the benefits end date may vary by benefit, but typically end at the end of the month after your last payroll deduction. Please consult with a Campus Benefits advisor on your specific end date and portability options for any current coverages.

Important Notes: This guide is presented for illustrative purposes only and is not intended to offer insurance advice. It is important to review each benefit’s summary plan description (SPD) and other carrier materials before making any selections. Remember: Review the plan options and/or update beneficiaries annually for all benefits including Basic Life and Voluntary Term Life & AD&D. Carefully review your plan options and consider which ones best meet your needs. Make elections during the assigned enrollment period to receive coverage for the coming year. Enrollment requires dependent information, including Social Security Numbers and dates of birth.

When can I change my benefits? Employee benefit elections are allowed as a new hire and during the annual open enrollment period. The selected benefits will remain in effect throughout the plan year. Plan year is from January 1st to December 31st. Qualifying Life Events: Each year during open enrollment, you will have the opportunity to make changes to your benefit elections for yourself and your covered dependents. Outside of open enrollment, you must experience a qualifying event that satisfies federal regulations outlined below: Marriage, legal separation or divorce Birth or adoption of a child Death of a covered dependent Loss or gain of other coverage (e.g. spouse loses job-based coverage) Change in employment status (e.g. full-time to part-time or vice versa) Change in dependent eligibility (e.g. child turns 26 and ages out of coverage) Relocation that affects coverage options (e.g. moving out of a plan’s service area) Court order requiring coverage for a dependent (e.g. through legal guardianship or custody) Entitlement to Medicare IMPORTANT NOTE: Campus Benefits must be notified of any qualifying life events within 30 days. You will need to submit supporting documentation to process your life event. Please keep any records of the above occurrences.

Wellness and Health Management: Preventive Care Understanding the full value of covered benefits allows you to maintain good health and build healthy habits. Through State Health Benefit Plan (SHBP), preventive services recommended by the U.S. Preventive Services Task Force are covered at 100% under the Affordable Care Act (i.e. Health Care Reform) when using in-network providers.

Which Preventive Care Services are Covered? Routine Physical Exam Well Woman Visits Routine Bone Density Test Routine Gynecological Exam Obesity Screening and Counseling Routine Prostate Test Routine Mammograms Smoking Cessation Health Counseling for STDs and HIV Screening and Counseling for Domestic Violence

Well Baby and Child Care Immunizations Routine Breast Exam Screening for Gestational Diabetes Routine Colonoscopy Routine Lab Procedures Routine Pap Smear Health Education/Counseling Services Testing for HPV and HIV See SHBP page for additional details

Service Hub/Support Center Claim Instructions What can Campus Benefits help you with? Portability/Conversion Benefits Education Evidence of Insurability Qualified Life Event Changes

Claims Card Requests Benefit Questions COBRA Information

Campus Benefits is your dedicated advocate for all your voluntary benefits. Common Questions Am I required to contact Campus Benefits to file a claim? No. However, in our experience, the number one reason for claim denial or delay is due to incomplete or inaccurate paperwork. By working with a Campus Benefits’ claim specialist, we can advocate on your behalf. How can I access my dental card or vision card quickly? Your group dental and vision information is available at www.jeffersonbenefits.com.

Voluntary Term Life Part 1: Employer Completes Part 2: Employee Completes Sign authorization to release personal information Supply death certificate (employees can submit claim form before obtaining death certificate to get the process started)

Disability Section 1: Employee Completes Sign authorization to release personal information Sign authorization to release personal information to employer For direct deposit, complete electronic transfer form Provide voided check copy Section 2: Employer Completes Section 3: Physician Completes

The Campus Benefits team understands the claims process and leverages the necessary carrier relationships to expedite the paperwork efficiently to ensure claims are not delayed due to improper paperwork completion. Phone: 866.433.7661, Opt 5 Email: mybenefits@campusbenefits.com Website: www.jeffersonbenefits.com REMINDER: Make sure your physician completes their portion if needed.

Voluntary Benefits Claim Instructions Required for all voluntary benefits claims: UB-04 form for Hospital Visits: Request a UB-04 (CMS-1450) from the hospital billing department. This provides details of hospital services and charges and can help ensure all eligible benefits are considered. Explanation of Benefits (EOBs) from your health insurance

Hospital Indemnity Admission & discharge dates, including room type (ICU and/or Non-ICU) Diagnosis, treatment details/records and discharge papers Auto-accident claims: Police report and if applicable, toxicology or blood-screening results.

Critical Illness Medical records supporting the condition, such as doctors’ notes, test results, and other relevant treatment records Proof of diagnosis, such as a pathology report or other supporting medical evidence Applicable hospital records, such as admission and discharge summaries Any additional documentation supporting the diagnosis or condition

Accident Medical documentation showing the patient’s name, dates of service, diagnosis, and treatment or procedure Itemized medical bills and ER discharge papers If hospitalized, include admission/discharge dates and room type (ICU or non-ICU). Auto-accident claims: Police report and, if applicable, toxicology or blood-screening results

Cancer Proof of diagnosis, such as a pathology report. If the diagnosis was based on clinical information rather than pathology, provide the medical evidence supporting the diagnosis. Medical and treatment records, such as test results, progress notes, discharge summaries, operative reports, or consultation reports Applicable bills or receipts for hospital care, chemotherapy, radiation, anesthesia, ambulance, transportation, or lodging

How to Submit Your Claim: Step 1 - Request claim forms from Campus Benefits or pull from benefits website Step 2 - Collect all applicable documentation (see above) Step 3 - Upload securely through the benefits portal: (www.jeffersonbenefits.com/contact-campus) Step 4 - Campus Benefits will review, confirm and submit to the carriers REMINDER: Make sure your physician completes their portion if needed. Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Employee Assistance Program (EAP)

What is an EAP? This is a program offered to Jefferson County Board of Education employees to provide guidance with personal issues, planning for life events or simply managing daily life which can affect your work, health and family. Coverage through OneAmerica Available for all Jefferson County employees, their household members and unmarried children up to age 26 Provides support, resources, and information for personal and work-life challenges Visit the Employee Assistance Program website to view timely articles and resources on a variety of financial, well-being, behavioral and mental health topics CALL 1.855.387.9727 or visit Guidanceresources.com (Web ID: ONEAMERICA3)

EAP Benefits 24/7 Access Reach an EAP professional anytime, day or night.

3 face-to-face sessions* Up to three sessions per issue, per calendar year with a counselor.

GuidanceResources Online Find articles, videos and self-assessments Additional information on EAP services

EAP can help with: Financial resources Debt management Credit card and loan problems Tax questions Retirement and estate planning Saving for college

Emotional well-being Stress, anxiety and depression Grief and loss Family and relationships Relationship/marital conflicts Parenting challenges Job pressures Work changes and challenges Substance abuse support Assesment for substance abuse and addiction

Work-life solutions Child and elder care Moving and relocation Making major purchases College planning Pet and home care

EAP Plan Rates Coverage paid for by Jefferson County Board of Education at no cost to you.

Enrollment in Benefits - Take Action There are two separate benefit enrollments: 1. Campus Benefits (Dental, Vision, Life, Disability etc.) 2. State Health Benefit Plan (Medical)

Campus Benefits Enrollment

Step 1: Visit www.jeffersonbenefits.com Step 2: Click Enroll/Login tab and complete your enrollment Need help? Click Campus Connect tab to send in questions OR call 1.866.433.7661, opt. 5

New User Registration 1. Register as a new user and enter: First Name Last Name Company Identifier: JCS2025 PIN: Last 4 Digits of SSN Birthdate 2.Click Next 3. Create login credentials (see FAQ) 4. Click Register then Login 5. Enter Username and Password 6. Click Start Benefits to begin enrollment

Important Notes: Plan Year is 1/1 - 12/31 Annual open enrollment occurs in the fall (October/November)

Still Need Help? Contact Campus Benefits Email: mybenefits@campusbenefits.com Call: 1.866.433.7661, opt. 5

Frequently Asked Questions What is my username?

The default username is your work email or the email on file with HR, unless it has changed.

What is my password?

Create or reset your password on the login page. It must be at least 6 characters and include a number and symbol. Using uppercase, numbers, and symbols greatly improves security.

Enrollment in Benefits - Take Action There are two separate benefit enrollments: 1. Campus Benefits (Dental, Vision, Life, Disability etc.) 2. State Health Benefit Plan (Medical)

State Health Enrollment

Step 1: Visit www.jeffersonbenefits.com Step 2: Click State Health Benefit Plan Step 3: Click SHBP Enrollment Link

Need help? Refer to the SHBP section of the guide for additional details OR call SHBP at 1.800.610.1863.

Compare Plan Options: Health Maintenance Organization (HMO) Allows you to receive covered medical services from in-network providers only (except for emergency care). It is important to verify your current provider is in-network when selecting an HMO Plan Option. Plan pays 100% of covered services provided by in-network providers that are properly coded as “preventive care.” There are co-pays with this plan for certain services and certain services are subject to a deductible and coinsurance.

Health Reimbursement Account (HRA) The HRA provides first-dollar coverage for eligible medical and pharmacy expenses and is funded by SHBP. When going to the doctor, you will not pay a co-pay. Instead, you pay the applicable deductible and coinsurance. Plan pays 100% of covered services provided by in-network providers that are properly coded as “preventive care”. You must meet separate in-network and out-of-network deductibles and out-of-pocket maximums.

High Deductible Health Plan (HDHP) The HDHP offers in-network and out-of-network benefits and provides access to one of the largest network of providers statewide and on a national basis across the United States. In addition to a lower monthly premium, you can open a Health Savings Account (HSA) that allows you to save money tax deferred to help offset your plan costs. Plan pays 100% of covered services provided by in-network providers that are properly coded as “preventive care.”

The Georgia State Health Benefit Plan (SHBP) provides annual legal and prescription drug coverage disclosure notices, as well as forms for disclosing or authorizing the release of protected health information. Visit https://shbp.georgia.gov/legal-notices to review the following notices. Please review these notices in their entirety.

Federal Patient Protection and Affordable Care Act Notices HIPAA Special Enrollment Notice Women’s Health and Cancer Rights Act of 1998 Newborns’ and Mothers’ Health Protection Act of 1996 Health Insurance Portability and Accountability Act Notice of Information Privacy Practices

Centers for Medicare & Medicaid Services Medicare Part D Credible Coverage Notice Summaries of Benefits and Coverage Georgia Law Section 33-30-13 Notice

Health Insurance 101 Before enrolling, take a moment to review these key terms to better understand and navigate the benefits options with confidence. See your specific plan summary for additional details.

In-Network vs. Out-of-Network In-Network providers have contracts with health plans to offer services at discounted rates. Out-of-Network providers are not contracted and rates are higher. Explanation of Benefits (EOB) A statement from the insurance provider showing what was billed, what the plan paid, and what you may still owe. An EOB is not a bill. Summary of Benefits and Coverage (SBC) A standardized overview of what the plan covers, costs, and examples of how the plan would pay for common medical situations. Qualifying Life Event (QLE) Qualified life change that allows midyear benefit changes. Reasonable & Customary Typical cost for services in your area.

Premium Amount you pay for coverage, which is separate from the deductible and out-of-pocket maximum. Copayment A fixed amount you pay for services that counts towards your out-ofpocket maximum, not the deductible. Deductible Amount paid for covered services before your insurance plan starts to pay on your behalf. Coinsurance The percentage you pay for covered costs after meeting the deductible. Out-of-Pocket Maximum (OOPM) The highest amount paid annually for covered services. Afterwards, the plan pays 100% (with minimal exceptions). Preventive Care Routine services like check-ups, immunizations, and screenings for adults and children.

Medical Plan (State Health Benefit Plans) Jefferson County Board of Education offers all eligible employees health insurance through the Georgia State Health Benefit Plan. During the annual open enrollment, employees have the opportunity to review all available options and make elections for the upcoming plan year. Coverage through Anthem/BCBS of GA, United Healthcare, or Kaiser Permanente* All qualifying life events must be submitted directly to State Health Benefit Plan via the SHBP Portal Kaiser Permanente* is available in the Metro Atlanta Service Area and Athens-Clarke, in-network only Transferring from another school district: You will not be able to make changes until the next open enrollment period, unless it is a qualifying life event The information provided is an overview; please see the SHBP summary plan descriptions on the benefits website for detailed listing of services in their entirety.

SHBP Enrollment Portal:

SHBP Wellness Portal:

How to Enroll:

SHBP Decision Guide:

www.shbp.georgia.gov/enrollment-portal

www.bewellshbp.com

Go to website above Enter your Username and Password and click Login. If you need assistance, click on “Forgot User ID?” or “Forgot Your Password?”. If you have not registered, click “Register Here”. Your registration code is SHBP-GA.

This Guide provides a brief explanation about each health benefit option, a benefit comparison guide, and a list of things to consider before making plan decisions. Access the decision guide at www.shbp.georgia.gov/enrollment/decision-guides

SHBP Phone Number: 1.800.610.1863 Wellness Credits (Due by November 30th)

Anthem HMO MyIncentive Account (MIA)

Anthem Health Reimbursement Arrangement (HRA)

Kaiser Permanente (KP) Regional HMO

UHC HMO & HDHP Health Incentive Account (HIA)

Member

Up to 480 Credits

$500*

Up to 480 Credits

Spouse

Up to 480 Credits

$500*

Up to 480 Credits

Reward Card credits for member/spouse

N/A

$250 Reward Card (covered member & spouse)

Potential Total credits/dollars

960 credits

$1,000*

1,460 credits

Please review the Active Decision Guide for full incentive program details and requirements. Anthem: members enrolled in an Anthem HRA Plan Option will receive SHBP-funded base credits at the beginning of the Plan Year. The amount funded will be based on your elected coverage tier. If you enroll in an HRA during the Plan Year, these credits will be prorated based on the elected coverage tier and the months remaining in the current Plan Year. *KP: members enrolled in the KP Regional HMO Plan Option and their covered spouses will each receive a $500 Mastercard reward card after they each satisfy KP’s Wellness Program requirements. **UnitedHealthcare: Spouses enrolled in an UnitedHealthcare Plan Option can now earn a 240 well-being incentive credit match. This means members and their covered spouses enrolled in an UnitedHealthcare Plan Option can each earn a 240 well-being incentive credit match with a maximum combined up to 480 well-being incentive credits matched by UnitedHealthcare for completing wellness requirements under the plan. After credits are added to your HIA, any remaining credits will roll over each plan year.

Medical Plan (State Health Benefit Plans) The table below is a high level overview, for official details and plan information please review the SHBP Decision Guide. Anthem HRA Gold Plan

Anthem HRA Silver Plan

Anthem HRA Bronze Plan

Out

You

$1,500

$3,000

$2,000

$4,000

You + Spouse

$2,250

$4,500

$3,000

You + Child(ren)

$2,250

$4,500

You + Family

$3,000

$6,000

Plan

Anthem HMO

UHC HMO

Out

$2,500

$5,000

$1,300

$3,500

$7,000

$6,000

$3,750

$7,500

$1,950

$7,000

$14,000

$3,000

$6,000

$3,750

$7,500

$1,950

$7,000

$14,000

$4,000

$8,000

$5,000

$10,000

$2,600

$7,000

$14,000

UHC HDHP

Kaiser HMO*

Deductible

Medical Out of Pocket Maximum (OOPM) You

$4,000

$8,000

$5,000

$10,000

$6,000

$12,000

$4,000

$6,450

$12,900

$6,350

You + Spouse

$6,000

$12,000

$7,500

$15,000

$9,000

$18,000

$6,500

$12,900

$25,800

$12,700

You + Child(ren)

$6,000

$12,000

$7,500

$15,000

$9,000

$18,000

$6,500

$12,900

$25,800

$12,700

You + Family

$8,000

$16,000

$10,000

$20,000

$12,000

$24,000

$9,000

$12,900

$25,800

$12,700

Coinsurance (Plan pays. Some out-ofnetwork services not covered)

85%

60%

80%

60%

75%

60%

80%

70%

50%

100%

Health Reimbursement Arrangement Credits (HRA) You

$400

$200

$100

You + Spouse

$600

$300

$150

You + Child(ren)

$600

$300

$150

You + Family

$800

$400

$200

N/A

$200 Copay $200 Copay

Urgent Care and PCP Visit

Coinsurance after deductible

Specialist Visit Preventive

100%

N/A

100%

N/A

100%

N/A

$35 Copay

$45 Copay

100%

$200 Copay Coinsurance after deductible

$35 Copay $45 Copay

100%

N/A

100%

Retail Rx (Not subject to deductible on HRA Plans) Tier 1

15%, Min $5, Max $10

$5 Copay

Tier 2

25%, Min $55, Max $85

$55 Copay

Tier 3

25%, Min $85, Max $130

$95 Copay

Coinsurance after deductible

$20 Copay $50 Copay $80 Copay

Mail Order Rx Tier 1

15%, min $12.50, Max $25

$12.50 Copay

Tier 2

25%, Min $137.50, max $212.50

$137.50 Copay

Tier 3

25%, Min $212.50, max $325

$237.50 Copay

Monthly Premiums

Anthem HRA Gold Plan

Anthem HRA Silver Plan

Employee

$227.19

EE + CH

$415.51

EE + SP Family

$50 Copay

Coinsurance after deductible

$125 Copay

UHC HDHP

Kaiser HMO*

$200 Copay

Anthem HRA Bronze Plan

Anthem HMO

UHC HMO

$153.17

$94.16

$189.29

$232.70

$83.76

$189.29

$289.67

$189.35

$351.08

$424.87

$171.67

$351.08

$565.89

$410.44

$286.52

$486.30

$577.46

$264.68

$486.30

$754.21

$546.94

$381.71

$648.09

$769.63

$352.59

$648.09

Kaiser Permanente* is available in the Metro Atlanta Service Area and Athens-Clarke, in-network only. There is an $80 tobacco surcharge added to all rates. Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Dental Plan What is Dental Insurance? This is a health and wellness plan designed to pay a portion of dental costs associated with preventive, basic, some major dental care, as well as orthodontia. Coverage through Guardian Provider directory: www.guardianlife.com/find-a-provider (Network: Dental Guard Preferred) Claims must be submitted within 90 days of date of service Orthodontics available only for children up to age 26 (subject to takeover provision/lifetime max) The chart below is a sample of covered services. Please see the Plan Certificate on your Employee Benefits Website for a detailed listing of services in their entirety. Quick Summary

Low Plan

High Plan

Class I: Preventive

100%

Class II: Basic

80%

Class III: Major

50%

Orthodontia

Not Covered

50% (Children up to age 26)

Plan Benefits

Low Plan

High Plan

Orthodontia Lifetime Maximum (Per covered person)

Not Covered

$1,000

Calendar Year Maximum (Per covered person)

$750

$1,200

Preventive Advantage included where preventive services do not apply to calendar year maximum. Calendar Year Deductible

$50 / $150 Family Max (Does not apply to Preventive Services)

Out-of-Network Coverage

90th UCR

Waiting Period

None

Additional Benefits

Early Smiles Program - 100% coverage for children up to age 12 for Preventive, Basic, & Major Services (does not include orthodontia)

Dental Premium Plan Rates Jefferson County pays for 100% of Employee Low Premium (applied to all other tiers) Plan

Low Plan

High Plan

Employee

$0.00

$6.66

Employee + Spouse

$54.78

$72.91

Employee + Child(ren)

$54.78

$72.91

Employee + Family

$54.78

$72.91

*Click here for more information and printable version of the ID Card (electronic guide)

Dental Plan

TIP: Submit a pre-treatment estimate to stay ahead of your expenses.

Have major dental work coming up? Avoid a surprise bill by exploring costs of dental services in your dental account.

Unlock your dental benefits with the Guardian dental app On the app, you can: First Time using the App? Check claims, deductibles, and coverage Create an account at login.guardianlife.com Find in-network dentists Download the App on the Apple App Store or See your digital ID card Google Play See your Explanation of Benefits (EOBs) Quick Summary

Preventive

Basic

Major

Low Plan

High Plan

Exams (2/calendar year) Cleanings (2/calendar year) Bitewing X-Rays (1/calendar year) Full Mouth X-Rays (1/60 months) Fluoride for children up to age 14 (2/calendar year) Sealants for children up to age 16 (1/36 months) Fillings Perio Maintenance Procedure (2/calendar year) Periodontal Services (Scaling and Root Planing) Periodontal Surgery Simple Extractions Complex Extractions Endodontic Services (Root Canal) General Anesthesia Space Maintainers/Harmful Habit Appliances Bridges & Dentures Single Crowns Repair & Maintenance of Crowns Inlays, Onlays & Veneers TMJ

Bridges & Dentures Single Crowns Repair & Maintenance of Crowns Inlays, Onlays & Veneers TMJ Implants

The chart above is a sample of covered services. Please see the Plan Certificate on your Employee Benefits Website for a detailed listing of services in their entirety.

Preventive Advantage Members have an unlimited preventive care maximum (frequency/age limitations still apply). Members obtain preventive care, including exams, cleanings, x-rays and fluoride treatments, without having the benefit deducted from their annual maximum. The entire annual maximum amount is preserved for basic and major services. Preventive care will continue to be covered even after the annual maximum is met. Preventive Advantage promotes preventive care to help keep members healthy and productive while extending the value of their annual maximum. Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Vision Plan What is Vision Insurance? A health and wellness plan designed to reduce your costs for routine preventive eye care including eye exams and prescription eyewear (eyeglasses and contact lenses). Coverage through MetLife Provider directory: www.metlife.com/insurance/vision-insurance (Network: Davis Vision) Claims must be submitted within 90 days of date of service No waiting periods The chart below is a sample of covered services. Please see the Plan Certificate on your Employee Benefits Website for a detailed listing of services in their entirety. Quick Summary

One Plan

Exam

$10 Copay

Contact Lens Fit & Follow-Up

15% Discount

Frames (See highlight sheet for details on the Exclusive Collection)

$150 allowance plus 20% off balance (Discount on balance does not apply to Costco, Walmart, & Sam's Club)

Single Vision, Lined Bifocal & Trifocal, Lenticular Lenses

$20 Copay

Standard Progressive Lenses

Up to $55 Copay

Vision Plan Rates Employee

$9.48

Employee + Spouse

$18.97

Employee + Child(ren)

$19.92

Employee + Family

$27.74

Network: Davis Vision

Additional Lens Options Standard UV Coating

$12 Copay

Standard Scratch Resistant

$15 - $30 Copay

Standard Polycarbonate

Children: Covered in Full (Up to age 18) Adults: $40 Copay

Tints (plastic lenses)

Up to $15 Copay

Anti-Reflective Coating

$50 - $120 Copay

Blue Light Filtering

Up to $15 Copay

Photochromic

Up to $80 Copay Contact Lenses

Elective Contacts

$150 allowance plus 15% off balance

Medically Necessary

Covered in full after eyewear copay

Employee Name Jefferson County Board of Education Group Name

5958875 Group #:

To confirm eligibility with participating providers, mention the network above and provide your name and date of birth.

*Click here for more information and printable version ID card (electronic guide)

Frequencies

Exams, Lenses, Contact Lenses and Frames

Every 12 Months

2nd Pair Benefit (Advise provider to submit two pair of glasses on separate invoices)

Each covered person can get one of the options below: Two pairs of prescription eyeglasses OR one pair of prescription eyeglasses and an allowance toward contacts OR double the contact lens allowance

Get the most out of your Dental and Vision Plans Dental and vision plans help pay a portion of costs associated with care and provide options to get the most out of these benefits. Tips for utilizing your Dental Benefits Look for participating dentist online Go to www.guardianlife.com or at www.guardianlife. com/find-adownload the Guardian Dental & provider Vision Mobile App. Find providers, *Your plan allows you to visit any view claims and more. general dentist or specialist. Group name: Jefferson County Board However, you usually save more with of Education a participating dentist.

Your dentist can request a pretreatment estimate for any service that is more the $300 to help you manage your cost and care

*In-Network discounts apply even after you reach your plan’s annual maximum, reducing your out-of-pocket expense. Tips for utilizing your Vision Benefits Track your claims and plan usage by registering for a MetLife My Benefit Account (if enrolled in both dental You can price shop your lens & frame and vision, you will utilize the same Look for participating vision providers providers. Take your prescription user name and password. online at www.metlife.com from your out-of-network provider to Visit www.metlife.com, scroll down Network: Davis Vision an in-network provider to receive the and select MyBenefits portal. most benefit from your vision plan. Enter Jefferson County Board of Education as your employer/organization. *While your plan allows you to visit any licensed vision provider, remember your benefits go further when you go in-network.

Dental - Early Smiles Program Early Smiles program is available on both the Dental High and Low plans. From the time that first tooth comes in, dental care can critically impact a child’s overall health and well-being. In fact, it’s recommended that kids go in for their first oral health checkup when their baby teeth first begin to emerge or by the time of their first birthday. That’s why Guardian includes the Early Smiles benefit to help you save on dental care for your children while taking care of their health. How does Early Smiles work? All Preventive, Basic and Major dental services are covered at 100% for children ages 12 and under. Does not include orthodontia. No deductible will apply; benefits can be used right away. No waiting periods. Can go to any dental provider in or out-of-network. Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Disability Plans What is Disability Insurance? Disability insurance replaces a portion of your income if injury or illness prevents you from working, providing financial security for you and your dependents. Coverage through OneAmerica (Employee must be actively at work on the effective date.) Short-Term Disability: Annual enrollment, no health questions every year Long-Term Disability: Employer paid benefit, all employees are automatically enrolled The chart below is a sample of covered services. Please see the Plan Certificate on your Employee Benefits Website for a detailed listing of services in their entirety. Quick Summary

Short-Term Disability

Long-Term Disability

Elimination Period

Benefits begin after being out of work due to an injury or illness for 14 days.

Benefits begin after you have been out of work due to an injury or illness for 90 calendar days

Benefit Duration

Covers accidents and illnesses up to 11 weeks

Covers accidents and sicknesses up to Social Security Normal Age of Retirement (Please note exclusions or limitations may apply; see plan certificate for details)

Benefit Percentage (weekly)

40% or 60% of your gross weekly salary

60% of your gross monthly salary

Maximum Benefit Amount

$1,200 (weekly benefit)

$5,000 (monthly benefit)

Leave Offset Rules

Does not offset for Sick Leave but will Will offset with Sick Leave and any outside offset for Paid Parental Leave (will offset income (Social Security, Military pension, for any other outside income) retirement, etc.)

Pre-Existing Condition Limitation

Short-Term Disability: 3/6 - Any sickness or injury for which you received medical treatment, consultation, care, or services during the specified months (3 months) prior to your coverage effective date. A disability arising from any such sickness or injury will be covered only if it begins after you have performed your regular occupation on a full-time basis for the specified months (6 months) following the coverage effective date. (Applies to new enrollees only and if moving from the 40% benefit to the 60% benefit)

Long-Term Disability: 3/6/12 - Any sickness or injury for which you received medical treatment, consultation, care, or services during the specified months (3 months) prior to your coverage effective date. A disability arising from any such sickness or injury will be covered only if it begins after you have performed your regular occupation on a full-time basis for the specified months (12 months) following the coverage effective date, unless you go treatment free for 6 months. (Applies to new enrollees only)

Disability Plan Rates Cost of coverage is based on your age and salary. Please consult with a Campus Benefits Counselor or log into the enrollment system for rate details. Long-Term Disability premiums are paid by Jefferson County Board of Education.

Life Insurance 101 Term Life and Permanent Life work best used in conjunction with one another. Term Life can protect your family in your younger working years and Permanent Life can protect your family in your retirement years. The need for life insurance depends on each individual life situation. If loved ones are financially dependent on you, then buying life insurance coverage can absolutely be worth it. Even if you don’t have financial dependents yet, life insurance can be a valuable solution for making loss easier financially for a family. There are two voluntary life insurance options offered through your employer: Term Life Insurance and Permanent Life Insurance.

Quick Reference

Term Life Insurance

Permanent Life Insurance

Available Plans

Employer Paid Basic Life and AD&D Voluntary Life and AD&D

Whole Life

Coverage Duration

Protection during your working years

Lifelong protection as long as premiums are paid

Initial Cost

Lower initial cost, premium increases as you age.

Higher initial cost, premiums stay the same for the life of the policy

Benefit Flexibility

Highly flexible, benefit amounts can be changed annually based on life changes (e.g. marriage, children, nearing retirement)

Benefit amount is typically fixed at issue. Add additional plans to increase coverage

Purpose

For the unexpected death during your working years to protect your family

Long-term security, intended to take into retirement and provide foundational coverage

Cash Value

No cash value accumulation

Builds cash value, see policy for details

Portability

Portable at retirement or leaving employer, but Fully portable at the same cost at retirement or premiums will increase leaving employer

Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents 19 posted on your employer’s benefits website or request documents before electing coverage.

Basic Life and AD&D Plan

What is Basic Life and AD&D Insurance? A financial protection which provides a lump-sum payment, known as a death benefit, to a beneficiary upon the death of employee. Coverage through OneAmerica Premiums paid by Jefferson County Board of Education Upon termination or retirement, continuation of coverage may apply The chart below is a sample of covered services. Please see the Plan Certificate on your Employee Benefits Website for a detailed listing of services in their entirety. Quick Summary

Basic Life and AD&D

Benefit Amounts

Employee: $15,000 (AD&D matches Life amounts)

Additional AD&D Benefits

Seat Belt, Airbag, Repatriation, Education Benefit (See certificate for details)

Age Reduction

None

Conversion

Included

Accelerated Life Benefit

If diagnosed with a terminal illness with less than 12 months to live, you can request your benefit while still living.

Employee Assistance Program (EAP)

Included, please see EAP page for more information

Portability

Portable at retirement or leaving employer, paid by employee

Keep your beneficiary information up to date Review your beneficiaries regularly. Life changes such as marriage, divorce, the birth or adoption of a child, or the death of a loved one may mean your current beneficiary designations no longer reflect your wishes. Don't forget your other accounts. In addition to your employerprovided Basic Life and AD&D coverage, review the beneficiaries on other life insurance policies, retirement accounts, HSAs, and other financial accounts. A will may not override a beneficiary designation. Benefits and account balances are generally paid according to the beneficiary information on file, making it important to keep your designations current. Take a few minutes to review your information. Keeping your beneficiary designations up to date can help ensure your benefits are distributed according to your wishes and make things easier for those you leave behind.

Basic Life and AD&D Plan Rates Coverage is provided by Jefferson County Board of Education at no cost to you.

Voluntary Life and AD&D Plan What is Term Life Insurance? A life and AD&D insurance plan provides financial protection by paying a lump-sum benefit to your beneficiary in the event of your death or accidental dismemberment, helping replace lost income and support your family’s financial goals. Coverage through OneAmerica Evidence of Insurability (EOI) may be required if electing outside of initial enrollment or above guaranteed issue amounts The chart below is a sample of covered services. Please see the Plan Certificate on your Employee Benefits Website for a detailed listing of services in their entirety.

Quick Summary

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

Employee Benefit

Increments of $10,000 up to the lesser of $500,000 or 5 times annual salary Guaranteed Issue: $300,000

Spouse Benefit

Increments of $5,000 up to $500,000 (100% of Employee Election) Guaranteed Issue: $50,000

Child(ren) Benefit

$5,000 or $10,000 Benefit $1,000 for children Live Birth to 6 months Guaranteed Issue: $10,000

AD&D Amount

Match Life Amount

Age Reduction

Benefit reduces to 65% at age 70 and 45% at age 75 Reduction is based on employee age

Portability & Conversion

Included

Accelerated Life Benefit

If diagnosed with a terminal illness with less than 12 months to live, you can request 75% of your benefit while still living.

Guaranteed Increase in Benefit for future enrollments

Employee and Spouse: If currently enrolled: Increase by $10,000 without an Evidence of Insurability; can go over guaranteed issue amounts.

Additional Benefits

Seat Belt, Airbag, Repatriation, Education Benefit (See certificate for details)

Dual Coverage (if both employee and spouse work at Jefferson County Board of Education)

If you and your spouse both work for Jefferson County Board of Education, you can each purchase life insurance for your spouse, and you can both enroll eligible dependents in coverage.

Voluntary Life and AD&D Plan Rates Cost of coverage is based on the level of benefit you choose and your age. Spouse rate based on employee’s age. Please consult with a Campus Benefits Counselor or log into the enrollment system for rate details. Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Permanent Life Insurance What is Permanent Life Insurance? Coverage that provides lifelong protection, and the ability to maintain level premium, while allowing employees the choice of benefit and premium amounts to fit family needs.

Coverage through UNUM Underwriting may be required. Coverage is not guranteed until approved by the carrier Upon termination or retirement, continuation of coverage is available at the same cost

Quick Summary Plan Maximums

Whole Life Employee Up to $35,000 (age 15-50) Up to $25,000 (age 51-80)

Spouse Up to $10,000 (age 15-50) Up to $10,000 (age 51-80)

Child Up to $25,000 (age 14 days-26)

Guaranteed Issue (New Hire or First Time Eligible)

Employee: Guaranteed issue amounts are available for new hires and first time eligible. Spouse: One qualifying health question is always required. This amount is based on your age and the weekly premium amount. Please log into the enrollment platform for specific rate details.

Additional Features

Guaranteed Interest rate of 4.5% Build Cash Value Level Premiums deducted from your paycheck Level Death Benefit - Coverage does not decrease with age “Living” Benefit - Early death benefit payout for qualifying terminal illness; reduces the benefit paid to beneficiaries

Portability

Employees can port the coverage at the same cost.

Permanent Life Rates Cost of coverage is based on the level of benefit you choose and your age. Please consult with a Campus Benefits Counselor or log into the enrollment system for rate details.

Hospital Indemnity Plan

What is Hospital Indemnity Insurance? This is supplemental coverage that helps offset costs associated with hospital stays, whether for planned or unplanned reasons. Payments are made directly to you and benefits do not offset with medical insurance. Coverage through Mutual of Omaha Employee must be actively at work on the effective date. Dependent children are covered up to age 26. Routine childbirth and complications from pregnancy are covered No pre-existing condition limitations or waiting periods No Health Questions Every Year! The chart below is a sample of covered services. Please see the Plan Certificate on your Employee Benefits Website for a detailed listing of services in their entirety. Quick Summary

Plan Details

Coverage

24-Hour (On and Off the Job)

Age Reduction

None

Portability

Included, Prior to age 70 (employee and depemdents must be covered for at least 6 months) Plan Benefits

Hospital and ICU Admission Combined total of 4 admissions per policy year, separated by 30 days

Hospital - $500/admission ICU - $1,000/admission

Hospital Confinement 60 days per calendar year (Combined Hospital and ICU)

Hospital - $100/Day ICU - $100/Day

Daily Newborn Nursery Care Confinement

$75/day (max 2/policy year)

Daily Rehabilitation Facility Confinement

$50/day (max 30/policy year)

Mental/Nervous Facility Admission

$500/admission (1/policy year)

Substance Abuse Facility Admission

$500/admission (1/policy year)

Mental/Nervous Facility Confinement

$100/day (max 30/policy year; 180/lifetime max)

Substance Abuse Confinement

$100/day (max 30/policy year; 180/lifetime max)

Express Benefit (equal to 1 daily hospital confinement benefit)

$100/hospital admission

Wellness Incentives

$50 per person per calendar year (See Wellness Incentives Page)

Please see plan hightlight sheets for additional details, located on your benefits website. Hospital Indemnity Plan Rates Employee

$12.52

Employee + Spouse

$22.00

Employee + Child(ren)

$18.34

Employee + Family

$28.82

Why Does Hospital Indemnity Insurance Matter? If you’re admitted to the hospital for a planned or unexpected stay, Hospital Indemnity Insurance helps provide financial support by paying a lump-sum benefit directly to you, not providers, to help cover your expenses. Claims must be filed with the carrier for reimbursement.

Accident Plan What is Accident Insurance? Accident insurance provides direct payments to help cover medical and out-ofpocket costs from unexpected accidents, without offsetting your medical insurance. Coverage through Mutual of Omaha Employee must be actively at work on the effective date No health questions - Every Year! No pre-existing condition limitation or waiting periods Payments made directly to you and benefits do not offset with medical coverage The chart below is a sample of covered services. Please see the Plan Certificate on your Employee Benefits Website for a detailed listing of services in their entirety. Quick Summary

Plan Details

Coverage

24-Hour Coverage (On and Off the Job)

Age Reduction

Only on Catestrophic Benefits (reduces to 50% at age 70)

Portability

Included, Prior to age 70 Plan Benefits

Emergency Room

$300

Urgent Care Center

$225

Hospital Admission

$1,500

Hospital Stay

$300/day (Max 365 days)

ICU Stay

$600/day (Max 30 days)

Fractures, Dislocations, Burns, and Lacerations

Up to $20,000 (Amounts vary according to type of injury and severity)

Wellness Incentives

$50 per covered person (See Wellness Incentives Page)

Please see plan highlight sheets for additional details, located on your benefits website.

Accident Plan Rates

Employee

$6.67

Employee + Spouse

$13.13

Employee + Child(ren)

$15.79

Employee + Family

$18.63

Accidents can happen anytime, Accident Insurance helps provide financial protection by: Helping offset out-of-pocket costs like deductibles, copays, and out-of-network care Giving you flexibility to use funds for everyday needs such as childcare, transportation, or other unexpected expenses

Critical Illness w/Cancer Plan What is Critical Illness Insurance? A health and wellness plan in which you receive a lump sum cash payment if diagnosed with one of the specific illnesses on the predetermined list of critical illnesses. Coverage through Mutual of Omaha Employee must be actively at work on the effective date. Dependent children are covered up to age 26. No health questions - Every Year! Attained Rates - rates increase as you age and are based on your age at the time of renewal Payments made directly to you and benefits do not offset with medical coverage The chart below is a sample of covered services. Please see the Plan Certificate on your Employee Benefits Website for a detailed listing of services in their entirety. Quick Summary

Critical Illness w/Cancer No Age Reduction/Pre-Existing Condition Limitation/Waiting Period

Portability

Included, Prior to age 70

Subsequent Benefit

No Separation Period Required

Reoccurrence Benefit

90 days – Once an Initial Benefit has been paid for a Critical Illness for an Insured Person, a benefit for a reoccurrence of the same diagnosis is payable if the dates of diagnosis are separated by 90 days or more. Plan Benefits (All amounts are Guaranteed Issue)

Employee

$5,000 increments up to $30,000

Spouse

$5,000 increments up to $30,000 (100% of Employee Amount)

Children

Up to $15,000 (50% of Employee Amount)

Policy Benefit Maximum

1000% – The total amount of benefits payable for each insured person is subject to a benefit maximum of 1000% of the Critical Illness Principal Sum in effect for the insured person.

Wellness Incentives

$50 (1 per covered person, per calendar year) (See Wellness Incentives Page)

Please see benefit highlight sheet or plan certificate for specific coverage percentages for each covered illness. Must be diagnosed after your effective date of coverage.

What does it cover? Critical illnesses includes coverage for many illness and disorders. See your plan highlight sheets and policy documents for details. Autoimmune Disorders Cancers & Benign Tumors Childhood Conditions Vascular & Pulmonary Conditions Functional Loss

Neurological Brain & Skull Conditions Organ Conditions Infectious Diseases Neurological Movement Disorders

Why should I consider it? Critical illness insurance is an affordable way to supplement and pay for additional expenses that you may incur when diagnosed with an illness. The policy provides lump-sum payments when you are diagnosed with one of the covered illnesses (must be diagnosed after your effective date). You decide how to use the money.

Critical Illness w/Cancer Plan Rates Cost of coverage is based on the level of benefit you choose and your age. Spouse rate based on employee’s age. Children are automatically included in employee premium, no additional cost. Please consult with a Campus Benefits Counselor or log into the enrollment system for rate details. Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Cancer Plan What is Cancer Insurance? Cancer insurance is a form of supplemental insurance meant to offset cancerrelated expenses so you can focus on recovery. Coverage through Guardian No health questions - Every Year! Must be diagnosed after effective date of the plan Payments made directly to you and benefits do not offset with medical coverage Coverage amounts apply to employee, spouse and child (if covered) The chart below is a sample of covered services. Please see the Plan Certificate on your Employee Benefits Website for a detailed listing of services in their entirety. Quick Summary

Advantage Plan (Low)

Premier Plan (High)

Portability

Included, Prior to age 70

Pre-existing Condition Limitation

12 months/12 Months (Applies to new enrollees only)

Age Reduction

None

Waiting Period

30 Days for initial Diagnosis only

Plan Benefits

Advantage Plan (Low)

Premier Plan (High)

Initial Diagnosis Benefit (must be first time diagnosis)

$2,500

$5,000

Hospital Confinement

$300/day for first 30 days; $600/day for 31st day thereafter per confinement

$400/day for first 30 days; $800/day for 31st day thereafter per confinement

ICU Confinement

$400/day for first 30 days; $600/day for 31st day thereafter per confinement

$600/day for first 30 days; $800/day for 31st day thereafter per confinement

Blood/Plasma/Platlets

$100/day up to $5,000 per year

$200/day up to $10,000 per year

Radiation/Chemotherapy (Actual Cost)

Up to $10,000 per calendar year

Up to $15,000 per calendar year

Skin Cancer

Benefits vary from $100 - $600 (see policy for details)

Surgical Benefit

Schedule amount up to $4,125

Schedule amount up to $5,500

Experimental Treatment

$100/day up to $1,000/month

$200/day up to $2,400/month

$50; $50 for Follow-Up screening (See Wellness Incentive Page)

Wellness Incentive

Please see benefit highlight sheet or plan certificate for specific coverage amounts or frequencies. Cancer Monthly Plan Rates Plan

Advantage Premier Plan (Low) Plan (High)

Employee

$20.58

$32.09

Employee + Spouse

$39.86

$62.19

Employee + Child(ren)

$23.19

$35.42

Employee + Family

$42.47

$65.52

How is Cancer Insurance Different from Critical Illness Insurance? Cancer insurance is designed to provide benefits for a covered cancer diagnosis and related treatment, while critical illness insurance provides a lump-sum benefit for a range of covered conditions, which may include cancer. Cancer plans will pay out benefits annually as you receive treatment. Critical Illness plans are a one-time lump sum benefit.

Wellness Incentives What are Wellness Incentives? An annual reimbursement for covered members who complete one of the eligible screening procedures on an elected plan. Available Wellness Incentives

Low Plan

High Plan

Guardian - Cancer

$50; $50 for Follow-Up screening

Mutual of Omaha - Accident, Critical Illness & Hospital Indemnity

$50/year

State Health Benefit Plan

See SHBP page of the benefits guide for details

Examples of Eligible Screenings: Guardian Cancer (Policy #00098001)

Mutual of Omaha Accident, Critical Illness & Hospital Indemnity (Policy #G000C3S7)

Bone marrow testing BRCA testing Breast MRI Breast ultrasound Chest x-ray Colonoscopy/Virtual Colonoscopy CT scans/MRI scans Mammography Pap Smear/ThinPrep pap test PSA (blood test for prostate cancer) Testicular ultrasound

Blood test for triglycerides Bone marrow testing Breast ultrasound CA 15-3 (blood test for breast cancer) Chest X-ray Colonoscopy EKG (electrocardiogram) Fasting blood glucose test Mammography Pap smear Serum cholesterol test (HDL & LDL)

How to submit a claim: Visit www.guardianlife.com and select “My Account/Login” to register or access your account.

How to submit a claim: Call 800.775.8805 Fax completed documents to 404.997.1898 Email completed documents to submitgrpacc@mutualofomaha.com Mail completed documents to: 3300 Mutual of Omaha Plaza Omaha, NE 68175 Visit: www.mutualofomaha.com/support/forms

IMPORTANT NOTE: This is not a complete list. Visit your employee benefits website at www.jeffersonbenefits.com or review the carrier documents for all eligible screenings. Disclaimer: The Benefits Guide is provided for illustrative purposes only and actual benefits and/or premiums may change after printing. Eligibility, benefits, limitations, services, premiums, claims processes and all other features & plan designs are offered and governed exclusively by the insurance provider or vendor contract and associated Summary Plan Description (SPD). All employees should review carrier documents posted on your employer’s benefits website or request documents before electing coverage.

Legal Plan What is a Legal Plan? A plan which provides valuable legal and financial educational resources for a variety of life events and needs. Coverage through MetLife Visit www.legalplans.com/why-enroll or call 800.821.6400 for additional information Non-Members & Members create an account and select Employer for plan information (creating an account doesn’t enroll you in plans) Elder care extends to parents and in-laws Additional plan information available on your Employee Benefits Website (www.jeffersonbenefits.com) The chart below is a sample of covered services. Please see the Plan Certificate on your Employee Benefits Website for a detailed listing of services in their entirety.

Plan Highlights

Consult with attorneys in person, by phone, email or online

Choose a network attorney or request reimbursement for an out-of-network attorney

Examples of Covered Legal Services: Money Matters Identity theft and tax collection defense Home & Real Estate Deeds, foreclosure, mortgages, tenant matters Estate Planning Wills, living wills, powers of attorney Family & Personal Guardianship and name changes Civil Lawsuits Small claims and consumer disputes Elder-Care Issues Consultations and document review for parents Traffic Matters Defense of traffic ticket (DUI not covered) IIMPORTANT NOTE: This is not a complete list. Visit your employee benefits website at www.jeffersonbenefits.com or review the carrier documents.

Unlimited legal assistance for covered matters

No waiting periods, copays, deductible or claim forms for network services

Additional High Plan Benefits 4 hours of attorney time for non-covered items Bankruptcy and tax-audit representation Home purchases, refinancing and property-tax matters Trusts, adoption, immigration and prenuptial agreements Tax Preparation and Caregiving Support 1. Find an attorney Visit members.legalplans.com, or call 800-821-6400 to get matched with the right attorney and receive the case number. 2. Make an appointment Call the attorney you select, provide the case number and schdule a time to talk or meet. 3. Easy from start to finish No copays, deductible, claim forms with an in-network attorney for a covered matter.

Legal Monthly Plan Rates Low Plan

$8.00

High Plan

$19.50

MedCareComplete What is MedCareComplete? A bundle of services constructed to save you time, money, and hassle while simplifying your life. This is a supplemental benefit and does not replace health insurance Register at MCC: Medcarecomplete.com/members to access the full range of benefits Phone number: 1-866-610-3619 Register at 1800MD: 1800md.com or 800.388.8785 to access telemedicine benefits This is supplemental coverage and does not replace health insurance The information below is a sample of covered services. Please see the plan documents on your Employee Benefits Website for a detailed listing of services in their entirety.

24/7/365 Telemedicine Speak with a Board-certified physician by phone for help with common and acute illnesses. No copay or usage limits. Asthma Fever/Cold & Flu Headache/Migraines Infections/Rashes Sore Throat/Sinus Conditions

Heartburn/Gout Bacterial Infections Urinary Tract Infections Pink Eye Nausea & Vomiting

Legal Plan Monthly Rates Individual

Family

$10.50

$12.50 NO COPAY

IMPORTANT NOTE: This is not a complete list. Visit your employee benefits website at www.jeffersonbenefits.com or review the carrier documents.

Additional Services: Medical Bill Negotiator Identifies errors and overcharges on medical bills. Of submitted bills, 80% achieve an average savings of 40%.

Medical & ID Theft Monitoring Provides high-risk transaction alerts when personal information may have been compromised online.

Medication Management Home delivery is available for members and their families managing chronic conditions and taking more than four maintenance medications daily.

Compare & Save Networks Offers access to a nationwide network of more than 59,000 pharmacies, along with discounts on prescriptions, dental, vision, hearing and other wellness services.

Restoration Expert An identity-theft specialist assesses the situation and helps manage the resolution process.

Social Media Tracking Sends alerts about potential damaging online content directed towards you or a family member, includes cyberbullying and predators.

Expense Reimbursement Provides a $25,000 insurance policy for eligible expenses from identity theft.

Sex Offender Alerts Get notified when a registered sex offender moves within five miles of an identified address.

Notes

The Service Hub Helps With: Portability/Conversion Benefits Education Evidence of Insurability Qualified Life Event Changes

Claims Card Requests Benefit Questions COBRA Information

Phone: 866-433-7661, opt. 5 Email: mybenefits@campusbenefits.com Benefit Website: www.jeffersonbenefits.com

The 2027 Benefits Guide is provided for illustrative purposes only. Actual benefits, services, premiums, claims processes and all other features and plan designs for coverage offered is governed exclusively by the insurance contract and associated Summary Plan Description (SPD). In case of discrepancies between this document and the insurance contract and SPD, the contract and SPD will prevail. We reserve the right to change, modify, revise, amend or terminate these plan offerings at any time. Updates, changes, and notices are available for review at www.jeffersonbenefits.com or by contacting HR or the email above. These should be reviewed fully prior to electing any benefits. Disclosures: All required SPD, legal and plan Disclosures are posted on the Benefit Website. For a written copy please contact Campus Benefits at 866433-7661, opt. 5.