Jefferson County BOE - Benefit Guide - 2026 VIEW ONLY

Benefits Guide

2026 Effective July 1st, 2026 Summary for Review Purposes Only

Table of Contents

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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.

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Eligibility & Important Notes

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Qualified Life Events & Preventive Care

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Health Insurance 101

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Service Hub/Support Center

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Enrollment in Benefits - Take Action

9-10

Medical Plan (State Health Benefit Plan)

11

Employee Assistance Program

12

Disability Plans

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Basic and Voluntary Life and AD&D Plans

Need help? Start Here:

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Get the most out of your Dental and Vision Plans

mybenefits@campusbenefits.com 866.433.7661, opt. 5

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Dental Plans

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Vision Plan

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Hospital Indemnity Plan

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Accident Plan

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Critical Illness w/Cancer Plan

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Wellness Incentives

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Legal Plan with Identity Theft

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MedCareComplete

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

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.

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 your last month of employment coinciding with 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.

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.

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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 July 1st to December 31st.

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: 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

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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

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.

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 paid 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.

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.

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Service Hub/Support Center Campus Benefits is your dedicated advocate for all your voluntary benefits.

What We Can Help You With: Portability/Conversion Benefits Education Evidence of Insurability Qualified Life Event Changes Claims Card Requests Benefit Questions COBRA Information

How to File a Claim: Contact Campus Benefits via phone or email Work with Campus Benefits’ claims specialist to complete the necessary paperwork Submit the necessary paperwork to Campus Benefits via the secure upload Secure upload located at: www.jeffersonbenefits.com

Other 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

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

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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.

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)

Start with Campus Benefits Enrollment 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 7/1 - 12/31 Annual open enrollment occurs in the spring (April/May) After the 2026 enrollment, annual enrollment will occur each fall

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 you have changed it.

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.

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.

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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)

Finish Enrollment with State Health Benefit Plan 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:

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

Health Maintenance Organization (HMO)

Health Reimbursement Account (HRA)

In-network providers only (except for emergency care).

Preventive care covered at 100%.

Co-pays for certain services.

Some services subject to deductible and co-insurance.

Verify your provider is innetwork before enrolling.

First-dollar coverage for eligible medical and pharmacy expenses and is funded by SHBP. No co-pay. You pay deductible and co-insurance.

Preventive care covered at 100% with in-network providers.

You must meet separate innetwork and out-of-network deductibles and out-of-pocket maximums.

High Deductible Health Plan (HDHP) Large in-network and out-ofnetwork coverage statewide and nationwide.

Lower monthly premium.

Includes HSA to save money tax deferred and help offset plan costs.

Preventive care covered at 100% with in-network providers.

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.

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.

SHBP Phone Number: 1.800.610.1863 Wellness Credits

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

Up to 480 Credits

$500*

Up to 480 Credits

Spouse

Up to 480 Credits

Up to 480 Credits

$500*

Up to 480 Credits

Reward Card credits for member/spouse

N/A

N/A

N/A

$250 Reward Card (covered member & spouse)

Potential Total credits/dollars

960 credits

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 a 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 rollover each plan year.

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.

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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

In

Out

In

Out

In

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

In

In

In

Out

In

$2,500

$5,000

$1,300

$1,300

$3,500

$7,000

$0

$6,000

$3,750

$7,500

$1,950

$1,950

$7,000

$14,000

$0

$3,000

$6,000

$3,750

$7,500

$1,950

$1,950

$7,000

$14,000

$0

$4,000

$8,000

$5,000

$10,000

$2,600

$2,600

$7,000

$14,000

$0

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

$4,000

$6,450

$12,900

$6,350

You + Spouse

$6,000

$12,000

$7,500

$15,000

$9,000

$18,000

$6,500

$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

$6,500

$12,900

$25,800

$12,700

You + Family

$8,000

$16,000

$10,000

$20,000

$12,000

$24,000

$9,000

$9,000

$12,900

$25,800

$12,700

Coinsurance (Plan pays.

Some out-ofnetwork services not covered)

85%

60%

80%

60%

75%

60%

80%

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

ER

$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

$35 Copay

$45 Copay

$45 Copay

100%

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

$213.71

EE + CH

$390.68

EE + SP Family

$50 Copay

Coinsurance after deductible

$125 Copay

UHC HDHP

Kaiser HMO*

$200 Copay

Anthem HRA Bronze Plan

Anthem HMO

UHC HMO

$146.11

$92.12

$177.21

$217.19

$81.11

$177.21

$275.76

$183.97

$328.63

$396.59

$165.26

$328.63

$531.82

$389.86

$276.48

$455.17

$539.13

$253.36

$455.17

$708.79

$519.51

$368.33

$606.59

$718.53

$337.51

$606.59

Kaiser Permanente* is available in the Metro Atlanta Service Area and Athens-Clarke, in-network only.

There is an $80 tabacco surcharge added to all rates.

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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)

Confidential Counseling Helps employees address stress, relationship and other personal issues for you and your family An in-house team of master’s level EAP professionals who are available 24/7/365 to provide individual assessments Three sessions per year (per household) conducted by face-to-face* counseling or telehealth (text, chat, phone or video) via a secure, HIPAA compliant portal Sessions with highly trained master’s and doctoral level clinicians about the following topics: Stress anxiety and depression Relationship/marital conflicts Problems with children Job pressures Grief and loss Substance abuse

Financial Information and Resources Speak by phone with a Certified Public Accountant and Certified Financial Planner on a wide range of financial issues, including: Getting out of debt Credit card or loan problems Tax questions Retirement planning Estate planning Saving for college

Work-Life Solutions Work-Life Specialists will do the research for you, providing qualified referrals and customized resources for: Child and elder care Moving and relocation Making major purchases College planning Pet care Home repair

GuidanceResources Online One stop for expert information on relationships, work, school, children, wellness, financial, and more Timely articles, HelpSheets, tutorials, streaming videos and self-assessments “Ask the Expert” personal responses to your questions Child care, elder care, attorney and financial planner searches

Free Online Will Preparation EstateGuidance lets you quickly and easily write a will on your computer Go to www.guidanceresources.com and click on EstateGuidance link Follow the prompts to create and download your will at no COST Name an executor to manage your estate Choose a guardian for your children Specify your wishes for your property Provide funeral and burial instructions

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

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.

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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. Does not offset for sick leave, will offset for Paid Parental Leave, workers compensation, or any other outside income.

Long-Term Disability: Employer paid benefit, all employees are automatically enrolled. Benefit is offset by any outside income (Social Security, sick leave, retirement, etc.)

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.

Short-Term Disability Quick Summary Elimination Period

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

Benefit Duration

Covers accidents and illnesses up to 11 weeks

Benefit Percentage (weekly)

40% or 60% of your gross weekly salary

Maximum Benefit Amount

$1,200 (weekly benefit)

Pre-existing Condition Limitation

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 Quick Summary Elimination Period

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

Benefit Duration

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 (monthly)

60% of your gross monthly salary

Maximum Benefit Amount

$5,000 (monthly benefit)

Pre-existing Condition Limitation

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.

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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.

Basic and Voluntary Term Life and AD&D Plans

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 Voluntary Term Life only: Only covered employees may elect dependent coverage; Dependent coverage may not exceed employee coverage amounts.

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.

Basic Life and AD&D Plan Rates

Basic Life and Accidental Death & Dismemberment (AD&D) Quick Summary

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

Employee Benefit Amount

$15,000

AD&D Amount

Match Life Amount

Voluntary Life and AD&D Plan Rates

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.

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.

Voluntary Term Life and Accidental Death & Dismemberment (AD&D) Quick Summary 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 (Future Enrollments)

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

Additional Features

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

If employee and spouse are both employed by Jefferson County, they cannot cover each other or double cover their dependents.

Please contact Campus Benefits if you have questions regarding coverage.

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.

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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 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. Take your prescription user name and password. providers 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.

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.

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.

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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.

Dental Benefits Quick Summary Coinsurance

Low Plan

High Plan

Class I: Preventive

100%

100%

Class II: Basic

80%

80%

Class III: Major

50%

50%

Orthodontia

Not Covered

50% (Children up to age 26)

Plan Benefits 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)

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.

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Dental Plan Have major dental work coming up? Avoid a surprise bill by exploring costs of dental services in your Guardian dental account. Submit a pre-treatment estimate to stay ahead of your expenses.

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)

Dental Services Quick Summary (see certificate for full list of services and frequencies) Low Plan

High Plan Preventive (100%)

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) Basic (80%) 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 Major (50%) Bridges & Dentures, Single Crowns, Repair & Maintenance Bridges & Dentures, Single Crowns, Repair & Maintenance of Crowns, Inlays, Onlays & Veneers, TMJ of Crowns, Inlays, Onlays & Veneers, TMJ, Implants

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.

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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 Plans 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 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.

Vision In-Network Benefits Quick Summary (see certificate for full list of services and frequencies) 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

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)

Contact Lenses Elective Contacts

$150 allowance plus 15% off balance

Medically Necessary

Covered in full after eyewear copay 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

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.

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Hospital Indemnity Plan What is Hospital Indemnity Insurance? 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 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.

Hospital Indemnity Benefits Quick Summary (see certificate for full list of services and frequencies) Plan Details Coverage

24-Hour (On and Off the Job)

Pre-existing condition limitation

None

Age Reduction

None

Portability

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

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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

Health Screening Benefit

$50 per person per calendar year

Hospital Indemnity Plan Rates Employee

$12.52

Employee + Spouse

$22.00

Employee + Child(ren)

$18.34

Employee + Family

$28.82

Why Hospital Indemnity Insurance Matters?

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 Helping cover deductibles, copays, and other out-of-pocket medical costs Giving you flexibility to use funds for everyday expenses like housing, childcare, and transportation

Claims must be filed with the carrier for reimbursement.

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.

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!

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.

Accident Quick Summary (see benefits highlight sheet and plan certificate for full list of benefits and frequencies) Plan Details Coverage

24-Hour Coverage (On and Off the Job)

Age Reduction

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

Pre-Existing Condition Limitation/Waiting Period

None

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)

Health Screening Benefit

$50 per covered person

Accidents can happen anytime, Accident Insurance helps provide financial protection by: Paying benefits directly to you for covered accidents Helping offset out-of-pocket costs like deductibles, co-pays, and out-of-network care Giving you flexibility to use funds for everyday needs such as childcare, transportation, or other unexpected expenses Accident Plan Rates Employee

$6.67

Employee + Spouse

$13.13

Employee + Child(ren)

$15.79

Employee + Family

$18.63

Visit the benefits website for a full list of covered items and instructions on how to file a claim.

Claims must be filed with the carrier for reimbursment.

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.

19

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.

Critical Illness Quick Summary (see certificate for full list of benefits and frequencies) Plan Details

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.

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.

Health Screening Benefit

$50 (1 per covered person, per calendar year)

Plan Benefits

CI w/Cancer (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)

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

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.

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Claims must be filed with the carrier for reimbursement.

Why should I consider it?

Critical illness insurance is an affordable way to supplement and pay for additional expenses that your health insurance may not cover. The policy typically provides payments for the first and second time you’re diagnosed with a covered illness. Plus, critical illness insurance is portable and payments are made directly to you.

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.

Wellness Incentives What are Wellness incentives? An annual reimbursement for covered members who complete one of the eligible screening procedures on an elected Accident, Critical Illness or Hospital Indemnity plan.

Available Wellness Incentives Mutual of Omaha - Accident, Critical Illness & Hospital Indemnity

$50/per covered person per year

What Qualifies as Wellness?

Accident, Critical Illness & Hospital Indemnity - Mutual of Omaha* Adult Immunization Bone marrow testing CA 15-3 (blood test for breast cancer) Carotid ultrasound Colonoscopy CT angiography EKG (electrocardiogram) Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Polysomnogram (Sleep Study) Vascular Ultrasound Abdominal aortic aneurysm ultrasound Angiogram Basic or Comprehensive Metabolic Screening Blood test for triglycerides Body Mass Index (BMI Assessment) Bone density screening Breast ultrasound CA 125 (blood test for ovarian cancer) Cancer Testing/Screening/Biopsy CEA (blood test for colon cancer) Chest X-ray Child/Adolescent Exams or Sports Physicals Child/Adolescent Vaccines

Dental/Hearing/Physician Annual Exam Diabetes Health Screening Domestic Violence Screening Double contrast barium enema Echocardiogram (ECHO) Genetic Testing Hepatitis B/C Screening Lower Extremity Ultrasound Mammography Mental Health Evaluation Neurological Health Studies Neurological Imaging Studies Pap smear Prenatal/Perinatal Care PSA (blood test for prostate cancer) Serum cholesterol test (HDL & LDL) SPEP (blood test for myeloma) Stress test (on a bicycle or treadmill) Substance Abuse Screening Thermography Transmitted Diseases/Blood Borne Infection Screening Vascular Ultrasound

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 *Some of these benefits are only available on select accident plans. Please refer to your certificate of coverage for benefits covered under your policy.

Visit www.jeffersonbenefits.com for claim forms and additional information.

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.

21

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) 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.

Legal experts on your side, whenever you need them Quality legal assistance can be pricey. And it can be hard to know where to turn to find an attorney to trust. For a monthly cost, you can have a team of top attorneys ready to help take care of life’s planned and unplanned legal events.

MetLife Legal Plans gives you access to the expert guidance and tools needed to handle the broad range of personal legal needs you might face throughout your life. This could be when you’re buying or selling a home, starting a family, dealing with identity theft or caring for aging parents.

Why MetLife Legal Plans Matter MetLife Legal Plans make getting legal help simple by: Offering flexible access to attorneys in person, by phone, email, or online Giving you the freedom to choose a network attorney or use one outside the network with reimbursement Providing unlimited access to legal support for covered matters, with affordable payroll-deducted premiums Legal Plan Rates

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Employee

$8.00

Employee + Family

$19.50

Helping you to navigate the most frequently needed personal legal matters: Money Matters Home & Real Estate Estate Planning Family & Personal Civil Lawsuits Elder-Care Issues (extends to parents/inlaws) Traffic & Other Matters High Plan covers the following additional benefits: Tax Preparation Services: MetLife has partnered with TurboTax to offer tax preparation and filing services. See the Tax Prep flyer on the benefits website for more details.

Caregiving Support: MetLife has partnered with Family First to provide customized caregiving solutions. Receive unlimited access to a confidential team of experts who will examine your unique situation and create a holistic care plan for your loved one. See flyer on the benefits website for more details.

Visit the Jefferson Benefits Portal for a detailed list of covered services.

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.

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.

Telemedicine Get 24/7/365 on-demand telephone access to Board-Certified physicians for diagnosis and prescriptions for common or acute illnesses. There are no copays and no limit to how many times you can utilize this feature.

Acute illnesses include but are not limited to the following: Asthma Fever Headache Infections Sore Throat

Migraines Rashes Bacterial Infections Diarrhea/Constipation Cold & Flu

Heartburn Sinus Conditions Urinary Tract Infections Gout Nausea & Vomiting

Medical Bill Negotiator Identifies errors and overcharges on your medical bills. 80% of medical bills submitted achieve 40% savings on average.

Medication Management For members and their families who suffer from chronic or poly-chronic conditions. The home delivery service is available for those who take more than four maintenance medications per day.

Restoration Expert A theft risk management specialist can assess your identity theft situation, and move forward with a fully managed resolution.

Expense Reimbursement This service provides you with a $25,000 insurance policy to reimburse expenses caused by identity theft.

Individual Monthly Rate

Family Monthly Rate

$10.50

$12.50

Bronchitis Ear Infections Joint Aches Pink Eye Insect Bites

Medical & ID Theft Monitoring High-risk transaction alerts can help maintain awareness when someone has breached your information online.

Compare & Save Networks A free health and wellness discount program with a national network of over 59,000 pharmacies to help save on prescriptions. Members also gain access to discounts on a wide variety of health products and services such as dental, vision, hearing, and more!

Social Media Tracking Receive instant notifications of potential reputation damaging items directed at you or a family member, including cyber bullying, cyber predators, and more.

Sex Offender Alerts Register for alerts to notify you of move in/outs of registered sex offenders within 5 miles of an identified address

NO COPAY 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.

23

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 2026 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 866-433-7661, opt. 5.