2016 Benefit Guide Humble ISD

HUMBLE ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2016 - 8/31/2017 www.mybenefitshub.com/humbleisd

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Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Health Savings Account (HSA) vs. Flexible Spending Account (FSA) TRS-ActiveCare Healthiestyou Telehealth Deer Oaks Employee Assistance Program (EAP) SISLink Medical Supplement Cigna Dental Superior Vision Aetna Long Term Disability Aetna Life and AD&D Loyal American Cancer Cigna Critical Illness NBS Health Savings Account (HSA) NBS Flexible Spending Account (FSA) NBS 403(b) Plan NBS 457(b) Plan Genworth Financial Long Term Care 2

3 4-5 6-11 6 7 8 9 10 11 12-15 16-17 18-19 20-23 24-29 30-31 32-35 36-37 38-45 46-49 50-51 52-55 56-57 58-59 60-63

FLIP TO...

PG. 4 HOW TO ENROLL

PG. 6 BENEFIT UPDATE— WHAT’S NEW

PG. 12 YOUR BENEFITS PACKAGE

Benefit Contact Information

Benefit Contact Information HUMBLE ISD BENEFITS

DENTAL

HEALTH SAVINGS ACCOUNT

Financial Benefit Services Jessica Thierry (800) 583-6908 www.mybenefitshub.com/humbleisd jessicat@fbsbenefits.com

Group # 3334708 Cigna (800) 244-6224 www.mycigna.com

National Benefit Services Stephen Smith (800) 274-0503 Opt. 2 www.nbsbenefits.com

HUMBLE ISD BENEFITS OFFICE

VISION

FLEXIBLE SPENDING ACCOUNT

Tammye Vaughn (281) 641-8042 tammye.vaughn@humble.k12.tx.us

Group # 326780 Superior Vision (800) 507-3800 www.superiorvision.com

National Benefit Services Stephen Smith (800) 274-0503 Opt. 2 www.nbsbenefits.com

MEDICAL

LONG TERM DISABILITY

403(b) PLAN

Aetna (800) 222-9205 www.trsactivecareaetna.com Aetna Teladoc: (855) 835-2362

Policy # 473323 Aetna (800) 583-6908 File a claim: (866) 326-1380 www.aetna.com

National Benefit Services Swayne Winterton ext. 685 (800) 274-0503 www.nbsbenefits.com

TELEHEALTH

LIFE AND AD&D

457(b) PLAN

Healthiestyou (866) 703-1259 https://member.healthiestyou.com

Policy # 473323 Aetna (800) 583-6908 www.aetna.com

National Benefit Services Swayne Winterton ext. 685 (800) 274-0503 www.nbsbenefits.com

EMPLOYEE ASSISTANT PROGRAM

CANCER

LONG TERM CARE

Deer Oaks (866) 327-2400 www.deeroaks.com

Group # 1441 Loyal American (800) 366-8354

Genworth Financial (866) 659-1970 www.genworth.com/trsactivemember

MEDICAL SUPPLEMENT

CRITICAL ILLNESS

COBRA - DENTAL AND VISION

Custom Link Special Insurance Services, Inc. (800) 767-6811 www.specialinc.com

Cigna (800) 583-6908 www.cigna.com

National Benefit Services (800) 274-0503 Opt. 4 www.nbsbenefits.com 3

How to Enroll On Your Device Enrolling in your benefits just got a lot easier! Text “humbleisd” to 313131 to receive everything you

TEXT

need to complete your enrollment.

“humbleisd”

Avoid typing long URLs and scan

TO

directly to your benefits website,

313131

to access plan information, benefit guide, benefit videos, and more!

TRY ME

SCAN:

On Your Computer Access the Humble ISD benefit

Our online benefit enrollment

website from your computer, tablet

platform provides a simple and

or smartphone!

easy to navigate process. Enroll at your own pace, whether at home or at work. www.mybenefitshub.com/ humbleisd delivers important benefit information with 24/7 access, as well as detailed plan information, rates and product videos.

!

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Open Enrollment Tip For your User ID: If you have less than six (6) characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.

Login Steps OR SCAN

1

Go to:

2

Click Login

3

Enter Username & Password

www.mybenefitshub.com/humbleisd

All login credentials have been RESET to the default described below:

Username:

GO

LOGIN

Sample Username for A. Lincoln

lincola1234 Sample Password

The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.

lincoln1234

If you have six (6) or less characters in your last name,

If you have trouble

use your full last name, followed by the first letter of

logging in, click on the

your first name, followed by the last four (4) digits of

“Login Help Video”

your Social Security Number.

for assistance.

Default Password: Last Name* (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.

Click on “Enrollment Instructions” for more information about how to enroll.

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Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New:  New benefits available beginning 09/01/2016! Humble

ISD has added 3 new benefits including a Medical Supplement Plan, Critical Illness Plan, and a CIGNA DHMO Plan!  Benefit elections will become effective 9/1/2016.

Elections requiring evidence of insurability, such as Life Insurance, may have a later effective date, if approved.

After annual enrollment, benefit changes can only be made if you experience a qualifying event. Changes must be made within 31 days of event. Contact the Benefits Department at 281-641-8042 for more information.  If you need assistance and choose to meet with a FBS

Enrollment Representative, it is necessary that you bring with you dependent information for spouse and children such as date of births, Social Security Numbers to add or update your dependents in the HUB before enrolling them in benefits or adding dependents to Beneficiary Information during your Annual Enrollment session.  Your current monthly HSA contribution will rollover to

next plan year unless you make a change to your election during the Annual Enrollment session.

 To ensure personalized customer service for Humble

ISD employees during the Annual Enrollment process beginning 07/18/2016 through 08/22/2016, in‐person assistance will be available by appointment only. Please contact Maria Saenz, our Benefits Specialist at (281) 641‐8118 to schedule an appointment to meet with Tammye Vaughn for assistance that could not be provided by the FBS Enrollment Representatives.  Employees requesting access to Pooling or the Split

Programs to share the medical costs or to discontinue the cost sharing between husband and wife for their family must schedule an appointment during the Annual Enrollment period to meet with Tammye Vaughn, in Humble ISD Benefits Department. FBS Enrollment Representatives will not assist with Pooling or Splitting enrollment or discontinuing the Split or Pooling Programs!  If you currently participate in a Healthcare or

Dependent Care Flexible Spending Account, you MUST re-elect a new contribution amount each year during the Annual Enrollment to participate. Current elections do not roll over!

Don’t Forget!     

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Login and complete your benefit enrollment from 07/18/2016 - 08/22/2016 The HUB is available 24 hours daily, 7 days a week to enroll or make changes to your benefits during the Annual Enrollment session!

Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202 to speak to a representative Monday—Friday between 8am – 5pm CST Update your profile information: home address, phone numbers, email, beneficiaries Update dependent social security numbers and student status for college aged children

SUMMARY PAGES

Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer.

Enrollment is automatic unless you decline this benefit.

Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.

CHANGES IN STATUS (CIS): Marital Status

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

QUALIFYING EVENTS A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).

A change in number of dependents includes the following: birth, adoption and placement for adoption.

Change in Number of Tax You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a Dependents result of a valid change in status event.

Change in Status of Employment Affecting Coverage Eligibility

Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.

An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements Gain/Loss of Dependents' under an employer's plan may include change in age, student, marital, employment or tax dependent Eligibility Status status.

If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.

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

Programs

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SUMMARY PAGES

Annual Enrollment During your annual enrollment period, you have the opportunity

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your school

Changes are not permitted during the plan year (outside of

district’s benefit website: www.mybenefitshub.com/

annual enrollment) unless a Section 125 qualifying event occurs.

humbleisd. Click on the benefit plan you need information on (i.e., Dental) and you can find the forms you need under the



Changes, additions or drops may be made only during the

Benefits and Forms section.

annual enrollment period without a qualifying event.

How can I find a Network Provider?

 Employees must review their personal information and verify that dependents they wish to provide coverage for are

district’s benefit website: www.mybenefitshub.com/

included in the dependent profile. Additionally, you must

humbleisd. Click on the benefit plan you need information on

notify your employer of any discrepancy in personal and/or

(i.e., Dental) and you can find provider search links under the

benefit information.



For benefit summaries and claim forms, go to your school

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

Quick Links section.

When will I receive ID cards?

If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and

New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card.

If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

Q&A Who do I contact with Questions?

For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services

at 866-914-5202 for assistance.

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SUMMARY PAGES

Employee Eligibility Requirements Supplemental Benefits: Eligible employees must work 20 or more

from their actively-at-work date (the date they start to work)

regularly scheduled hours each work week.

to enroll or decline coverage for themselves or their dependents. New hires may choose their actively-at-work

Eligible employees must be actively at work on the plan effective

date or the first of the month following their actively-at-work

date for new benefits to be effective, meaning you are physically

date as their effective date of coverage. Full monthly premium

capable of performing the functions of your job on the first day of

rate will apply when electing actively-at-work date!

work concurrent with the plan effective date. For example, if your 2016 benefits become effective on September 1, 2016, you

*If a TRS retiree has returned to work and has never been eligible for

must be actively-at-work on September 1, 2016 to be eligible for

TRS-Care, he or she would be eligible for TRSActiveCare coverage, as long as the retiree meets all the TRS-ActiveCare eligibility

your new benefits.

requirements.

Who is eligible for TRS-ActiveCare coverage?

Teachers, administrative personnel, substitutes, bus drivers,

Dependent Eligibility Requirements

librarians, crossing guards, cafeteria workers, and high school or

Dependent Eligibility: You can cover eligible dependent

college students are all eligible for coverage, provided no

children under a benefit that offers dependent coverage,

exception applies, if they are employees of the district/entity, not

provided you participate in the same benefit, through the

volunteers, and are either active contributing TRS members or

maximum age listed below. Dependents cannot be double

are employed by a participating district/entity for 10 or more

covered by married spouses within the Humble ISD or as both

regularly scheduled hours each week. New hires have 31 days

employees and dependents.

PLAN

CARRIER

MAXIMUM AGE

Medical

Aetna

25

Medical Supplement

SISLink

25

Dental

Cigna

25

Vision

Superior Vision

25

Cancer

Loyal American

Through age 24

Life

Aetna

Through age 25

Critical Illness

Cigna

25

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.

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SUMMARY PAGES

Helpful Definitions Actively at Work

In-Network

You are performing your regular occupation for the employer

Doctors, hospitals, optometrists, dentists and other providers

on a full-time basis, either at one of the employer’s usual

who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 9/1/2016 please notify your benefits administrator.

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

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

Out of Pocket Maximum The most an eligible or insured person can pay in co-insurance for covered expenses.

Plan Year September 1st through August 31st

Pre-Existing Conditions Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services

Calendar Year January 1st through December 31st

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

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

Actively-at-work and/or pre-existing condition exclusion

provisions do apply, as applicable by carrier.

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(including diagnostic and/or consultation services).

SUMMARY PAGES

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

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

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source Account Owner Underlying Insurance Requirement

Employee and/or employer Individual

Employee and/or employer Employer

High deductible health plan

None

Description

Minimum Deductible Maximum Contribution

$1,300 single (2016) $2,600 family (2016) $3,350 single (2016) $6,750 family (2016)

N/A Varies per employer

Permissible Use Of Funds

If used for non-qualified medical expenses, subject to current tax rate plus 20% penalty.

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

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

Permitted, but subject to current tax rate plus 20% penalty (penalty waived after age 65).

Not permitted

Year-to-year rollover of account balance?

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

No. Access to some funds can may be extended if your employer’s plan contains a 2 1/2 –month grace period or $500 rollover provision.

Does the account earn interest?

Yes

No

Portable?

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

No

FLIP TO… PG. 50

FLIP TO… PG. 52

FOR HSA INFORMATION

FOR FSA INFORMATION

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AETNA

Medical

YOUR BENEFITS PACKAGE

About this Benefit Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis.

DID YOU KNOW?

More than 70% of adults across the United States are already being diagnosed with a chronic disease.

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This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

Humble ISD 2016-17 Medical & Pharmacy Coverage Tiers and Premium Rates ActiveCare 1-HD Monthly Rate WITHOUT District Contribution*

Monthly Rate WITH District Contribution*

Semi-Monthly Rate WITH District Contribution

Pro-Rated SemiMonthly Rate WITH District Contribution

Employee Only

$341.00

$0.00

$0.00

$0.00

Employee & Spouse

$914.00

$538.00

$269.00

$358.66

Employee & Child(ren)

$615.00

$274.00

$137.00

$182.66

$1,231.00

$855.00

$427.50

$570.00

Coverage Tier

Employee & Family

ActiveCare Select

Coverage Tier

Employee Only Employee & Spouse Employee & Child(ren)

Employee & Family

Monthly Rate WITHOUT District Contribution*

Monthly Rate WITH District Contribution*

Semi-Monthly Rate WITH District Contribution

Pro-Rated SemiMonthly Rate WITH District Contribution

$484.00

$143.00

$71.50

$95.33

$1,147.00

$771.00

$385.50

$514.00

$779.00

$438.00

$219.00

$292.00

$1,361.00

$985.00

$492.50

$656.67

ActiveCare 2 Monthly Rate WITHOUT District Contribution*

Monthly Rate WITH District Contribution*

Semi-Monthly Rate WITH District Contribution

Pro-Rated SemiMonthly Rate WITH District Contribution

$645.00

$304.00

$152.00

$202.67

Employee & Spouse

$1,552.00

$1,176.00

$588.00

$784.00

Employee & Child(ren)

$1,042.00

$701.00

$350.50

$467.33

Employee & Family

$1,597.00

$1,221.00

$610.50

$814.00

Coverage Tier

Employee Only

Humble ISD contributes $341 per employee per month for the Employee Only and Employee & Children tiers of coverage; Humble ISD contributes $376 per employee per month for the Employee & Spouse and Employee & Family tiers of coverage. *Variable hour employees including Guest Teachers, AVID Tutors, and Part-Time Hourly Do Not qualify for the Humble ISD Contribution. *Employees that work in full time regularly scheduled positions Do qualify for the Humble ISD Contribution.

*Premiums are Pro-Rated and deducted for the entire year over an 18 month period (September - May) for Employees working in less than 260-day per year Auxillary positions.

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2016-2017 TRS-ActiveCare Plan Highlights Effective September 1, 2016 through August 31, 2017 | In-Network Level of Benefits* Type of Service

ActiveCare 1-HD

ActiveCare Select or ActiveCare Select Whole Health

ActiveCare 2

(Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Memorial Hermann Accountable Care Network; Seton Health Alliance) Deductible (per plan year)

$2,500 employee only $5,000 family

$1,200 individual $3,600 family

$1,000 individual $3,000 family

Out-of-Pocket Maximum (per plan year; does include medical deductible/ any medical copays/coinsurance/ any prescription drug deductible and applicable copays/coinsurance)

$6,550 individual $13,100 family (the individual out-of-pocket maximum only includes covered expenses incurred by that individual)

$6,850 individual $13,700 family

$6,850 individual $13,700 family

Coinsurance Plan pays (up to allowable amount) Participant pays (after deductible)

80% 20%

80% 20%

80% 20%

Office Visit Copay Participant pays

20% after deductible

$30 copay for primary $60 copay for specialist

$30 copay for primary $50 copay for specialist

Diagnostic Lab Participant pays

20% after deductible

Plan pays 100% (deductible waived) if performed at a Quest facility; 20% after deductible at other facility

Plan pays 100% (deductible waived) if performed at a Quest facility; 20% after deductible at other facility

Preventive Care See next page for a list of services

Plan pays 100%

Plan pays 100%

Plan pays 100%

Teladoc® Physician Services

$40 consultation fee (applies to deductible and out-of-pocket maximum)

Plan pays 100%

Plan pays 100%

High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays

20% after deductible

$100 copay plus 20% after deductible

$100 copay plus 20% after deductible

Inpatient Hospital (preauthorization required) (facility charges) Participant pays

20% after deductible

$150 copay per day plus 20% after deductible ($750 maximum copay per admission)

$150 copay per day plus 20% after deductible($750 maximum copay per admission; $2,250 maximum copay per plan year)

Emergency Room (true emergency use) Participant pays

20% after deductible

$150 copay plus 20% after deductible (copay waived if admitted)

$150 copay plus 20% after deductible (copay waived if admitted)

Outpatient Surgery Participant pays

20% after deductible

$150 copay per visit plus 20% after deductible

$150 copay per visit plus 20% after deductible

Bariatric Surgery Physician charges (only covered if performed at an IOQ facility) Participant pays

$5,000 copay plus 20% after deductible

Not covered

$5,000 copay (does not apply to out -of-pocket maximum) plus 20% after deductible

Prescription Drugs Drug deductible (per plan year)

Subject to plan year deductible

$0 for generic drugs $200 per person for brand-name drugs

$0 for generic drugs $200 per person for brand-name drugs

Retail Short-Term (up to a 31-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)

20% after deductible (Deductible and coinsurance waived for certain generic preventive drugs.

Go to www.trsactivecareaetna.com/ coverage to view the list.)

$20 $40** 50% coinsurance**

$20 $40** $65**

Retail Maintenance (after first fill; up to a 31-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)

20% after deductible $35 $60** 50% coinsurance**

$35 $60** $90**

Mail Order and Retail-Plus (up to a 90-day supply) Participant pays • Generic copay • Brand copay (preferred list) • Brand copay (non-preferred list)

20% after deductible $45 $105*** 50% coinsurance

$45 $105*** $180***

Specialty Drugs Participant pays

20% after deductible

20% coinsurance per fill

$200 per fill (up to 31-day supply) $450 per fill (32- to 90-day supply)

A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. **If the patient obtains a brand-name drug when a generic equivalent is available, the patient will be responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug.

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TRS-ActiveCare Plans—Preventive Care

Network Benefits When Using In-Network Providers

(Provider must bill services as “preventive care”)

ActiveCare 1-HD Preventive Care Services

ActiveCare Select or ActiveCare Select Whole Health

ActiveCare 2 Network

(Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Memorial Hermann Accountable Care Network; Seton Health Alliance) Evidence−based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (USPSTF) www.uspreventiveservicestaskforce.org/Page/Name/uspstf-aand-b-recommendations

Plan pays 100% (deductible waived)

Plan pays 100% (deductible waived; no copay required)

Plan pays 100% (deductible waived; no copay required)

Some examples of preventive care frequency and services:  Routine physicals – annually age 12 and over  Well-child care – unlimited up to age 12  Well woman exam & pap smear – annually age 18 and over  Mammograms – 1 every year age 35 and over  Colonoscopy – 1 every 10 years age 50 and over  Prostate cancer screening – 1 per year age 50 and over  Smoking cessation counseling – 8 visits per 12 months  Healthy diet/obesity counseling – unlimited to age 22; age 22 and over-26 visits per 12 months  Breastfeeding support – 6 lactation counseling visits per 12 months

Some examples of preventive care frequency and services:  Routine physicals – annually age 12 and over  Well-child care – unlimited up to age 12  Well woman exam & pap smear – annually age 18 and over  Mammograms – 1 every year age 35 and over  Colonoscopy – 1 every 10 years age 50 and over  Prostate cancer screening – 1 per year age 50 and over  Smoking cessation counseling – 8 visits per 12 months  Healthy diet/obesity counseling – unlimited to age 22; age 22 and over-26 visits per 12 months  Breastfeeding support – 6 lactation counseling visits per 12 months

Some examples of preventive care frequency and services:  Routine physicals – annually age 12 and over  Well-child care – unlimited up to age 12  Well woman exam & pap smear – annually age 18 and over  Mammograms – 1 every year age 35 and over  Colonoscopy – 1 every 10 years age 50 and over  Prostate cancer screening – 1 per year age 50 and over  Smoking cessation counseling –8 visits per 12 months  Healthy diet/obesity counseling – unlimited to age 22; age 22 and over-26 visits per 12 months  Breastfeeding support –6 lactation counseling visits per 12 months

Annual Vision Examination (one per plan year; performed by an opthalmologist or optometrist using calibrated instruments) Participant pays

After deductible, plan pays 80%; participant pays 20%

$60 copay for specialist

$50 copay for specialist

Annual Hearing Examination Participant pays

After deductible, plan pays 80%; participant pays 20%

$30 copay for primary $60 copay for specialist

$30 copay for primary $50 copay for specialist

Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved.

Evidence−informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children and adolescents. Additional preventive care and screenings for women, not described above, as provided for in comprehensive guidelines supported by the HRSA www.hhs.gov/healthcare/facts-and-features/fact-sheets/ preventive-services-covered-under-aca/#CoveredPreventive ServicesforAdults For purposes of this benefit, the current recommendations of the USPSTF regarding breast cancer screening and mammography and prevention will be considered the most current (other than those issued in or around November 2009).

The preventive care services described above may change as USPSTF, CDC and HRSA guidelines are modified.

(Examples of covered services included are: Routine annual physicals (one per year); immunizations; well-child care; breastfeeding support, services and supplies; cancer screening mammograms; bone density test; screening for prostate cancer and colorectal cancer (including routine colonoscopies); smoking cessation counseling services and healthy diet counseling; and obesity screening/counseling.

Examples of covered services for women with reproductive capacity are: Female sterilization procedures and specified FDA-approved contraception methods with a written prescription by a health care practitioner, including cervical caps, diaphragms, implantable contraceptives, intra-uterine devices, injectables, transdermal contraceptives and vaginal contraceptive devices.

Prescription contraceptives for women are covered under the pharmacy benefits administered by Caremark.

To determine if a specific contraceptive drug or device is included in this benefit, contact Customer Service at 1-800222-9205. The list may change as FDA guidelines are modified.

Note: Covered services under this benefit must be billed by the provider as “preventive care.” If you receive preventive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the ActiveCare 1-HD and ActiveCare 2. Non-network preventive care is not paid at 100%. There is no coverage for non-network services under the ActiveCare Select plan or ActiveCare Select Whole Health.

TRS-ActiveCare is administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims.

Prescription drug benefits are administered by Caremark.

15

HEALTHIESTYOU YOUR BENEFITS PACKAGE

Telehealth

About this Benefit Telehealth provides 24/7/365 access to boardcertified doctors via telephone consultations that can diagnose, recommend treatment and prescribe medication. Whether you are at home, traveling or at work, Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.

DID YOU KNOW?

75%

of all doctor, urgent care, and ER visits could be handled safely and effectively via telehealth.

16

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

Telehealth - EMPLOYER PAID NOTE: This employer paid benefit is only available if you are enrolled in ActiveCare 1-HD or if you waive the medical.

Personalized Wellness Program

Introducing Healthiestyou



Healthiestyou is the most innovative and comprehensive telehealth and wellness solution on the market, serving as an accessible complement to your company benefit plan. With access to a 24/7 physician network as well as a one-of-its-kind online wellness program, our services help you save money, reduce claims and increase productivity.

Physician Access Three easy steps to speak with a physician anytime and anywhere. Healthiestyou offers 24/7/365 licensed physician access via phone, email or video in all 50 states.   

Visit www.healthiestyou.com and log in to your account or call our toll free number.

A healthiestyou care coordinator will initiate your request.

You will be connected with a licensed physician in your state that can consult, diagnose and prescribe.

Top 9 Healthiestyou Physician Consults Include:         

Allergies Bronchitis Earache Sore Throat Sinusitis Pink Eye Strep Throat Upper Respiratory Infection Urinary Tract Infection

One-of-its-Kind Wellness Program A unique product developed and inspired by a Stanfordtrained physician, Kelly Traver, MD. Healthiestyou brings your employees the only smarter-with-use online health program available. This clinically validated program offers:  Online coaching  Personalized action plans  Multiple modalities for interaction (social, gaming, mobile, biosensors)  Cost effective wellness solutions

 

Visit www.healthiestyou.com to log in to your account, or simply download the healthiestyou iPhone app.

Launch your personalized wellness program by completing your health assessment.

Begin your path to feeling better!

Discount Prescriptions Stop paying too much for prescriptions! Go to www.healthiestyourx.com enter your medication and choose your location.

Compare drug prices at local and mail-order pharmacies and discover free coupons and savings tips. Find huge savings on drugs not covered by your insurance plan – you may even find savings versus your typical co-payment!

IT'S ALL ABOUT SATISFACTION...

97%

Members who will use healthiestyou again

93%

Patients with issues resolved by healthiestyou

95%

Members who would recommend healthiestyou

Healthiestyou is not health insurance and we encourage all members to maintain adequate insurance from a responsible provider. Heathiestyou is designed to complement, and not replace, the care you receive from your primary care physician. Healthiestyou physicians are an independent network of doctors who advise, diagnose, and prescribe at their own discretion. Healthiestyou physicians provide cross coverage and operate subject to state regulations. Physicians in the independent network do not prescribe DEA controlled substances, nontherapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Healthiestyou does not guarantee that a prescription will be written. No prescriptions available in Oklahoma.

17

DEER OAKS YOUR BENEFITS PACKAGE

EAP (Employee Assistance Program)

About this Benefit An Employee Assistance Plan (EAP) is an employee benefit program offered to help employees manage personal and professional problems that might adversely impact their work performance, health, and well-being. Employee Assistance Plans generally include short-term counseling and referral services for employees and their household members. Your Employee Assistance Program benefit is provided to you by your employer.

18

DID YOU KNOW?

38%

of employees have missed life events because of bad worklife balance.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

Employee Assistance Program (EAP) - EMPLOYER PAID The Deer Oaks Employee Assistance Program (EAP) is a free service provided for you and your dependents by your employer. This program offers a wide variety of counseling, referral, and consultation services, which are all designed to assist you and your family in resolving work/life issues in order to live happier, healthier, more balanced lives. These services are completely confidential and can be easily accessed by calling the toll-free Helpline.

Below is an overview of the services available through your EAP: Eligibility: All employees and their household members/ dependents are eligible to access the EAP. This includes retirees and employees who have recently separated from their employer.

Assessment & Counseling: A network of 54,000+ mental health providers throughout the United States is available to provide in-person assessment and counseling services to members wherever they may reside. Counselors may also conduct comprehensive assessments by phone and provide in-themoment telephonic support and crisis intervention.

Tele-Language Services: Deer Oaks has the ability to provide therapy in a language other than English if requested. Services are available for telephonic interpretation in over 190 of the most commonly spoken languages and dialects.

Referrals & Community Resources: Counselors provide referrals to community resources, member health plans, support groups, legal resources, and child/elder care services.

Advantage Legal Assist: Free 30-minute telephonic consultation with a plan attorney; free 30-minute in-person consultation; 25% discount on hourly attorney fees if representation is required; unlimited online access to a wealth of educational legal resources, links, tools and forms; interactive online Simple Will preparation; access to state agencies to obtain birth certificates and other records.

Advantage Financial Assist: Unlimited telephonic consultation with a financial counselor qualified to advise on a range of financial issues such as bankruptcy prevention, debt reduction and financial planning; supporting educational materials available; credit report review by a financial counselor and tips for improvement; objective, pressure-free advice; unlimited online access to a wealth of educational financial resources, links, tools and forms (i.e. tax guides, financial calculators, etc.).

Interactive Online Simple Will Preparation: Create a legallybinding simple state specific will at no cost through a step by step online "interview process." Access this service through www.deeroaks.com

Credit Monitoring: Free credit reports and credit monitoring available via the legal/financial center ID Recovery: Free 30-minute telephonic consultation with an Identity Recovery Professional; customized action plan and consultation; ongoing ID recovery guidance available as needed; free ID monitoring service.

Monthly Electronic Newsletters: Employees and supervisors receive monthly e-newsletters covering a variety of topics including health and wellness, work/life balance issues, conflict resolution, leadership, and more.

Online Tools & Resources: Log on to www.deeroaks.com to access an extensive topical library containing health and wellness articles, child and elder care resources, work/life balance resources and webinars. Contact (866)327-2400 / eap@deeroaks.com Work/Life Services: Work/Life Consultants are available to assist members with a wide range of daily living resources such as pet sitters, event planners, home repair, tutors and moving services. Simply call the Helpline for resource and referral information.

Find-Now Child & Elder Care Program: This program assists participants caring for children and/or aging parents with the search for licensed, regulated, and inspected child and elder care facilities in their area. Work/Life Consultants assess each member's needs, provide guidance, resources, and a list of up to three (3) referrals within 12 hours of the call. Searchable databases and other resources are also available on the Deer Oaks website.

Health & Wellbeing: Deer Oaks encourages not only the mental health, but also the physical health and wellbeing of our members. Work/Life Consultants are available to provide referrals to providers, specialists, and resources to meet specific needs such as safety programs, support groups, fitness centers and nutrition programs.

Critical Incident Stress Management: Traumatic events can be extremely disruptive to the well-being and productivity of employees. Deer Oaks will respond quickly when asked to provide Critical Incident Stress Management Services for any major company incident.

Take the High Road: Deer Oaks reimburses members for their cab fares in the event that they are incapacitated due to impairment by a substance or extreme emotional condition.

This service is available once per year per participant with a maximum reimbursement of $45.00 (excludes tips).

19

SISLINK YOUR BENEFITS PACKAGE

Medical Supplement

About this Benefit Medical supplement is designed to help supplement your Employer's major medical plan. This plan provides supplemental coverage to help offset outof-pocket costs that you may experience due to deductibles, co-payments and coinsurance of your medical plan.

DID YOU KNOW?

33% of total healthcare costs are paid out-of-pocket.

20

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

Medical Supplement - NEW BENEFIT This benefit provides coverage for medically necessary eligible out-of-pocket expenses related to the insured’s major medical plan’s co-insurance and deductibles up to the maximum benefit selected, provided such expenses are the result of treatment for a covered injury or sickness.

Inpatient Hospital Benefit The benefit options are: $1,500 or $2,500 In-Hospital benefit per covered person per calendar year. Note: This coverage may not cover 100% of out-of-pocket expenses.

BENEFITS INCLUDE:  Coverage for out-of-pocket expenses due to an inpatient hospital confinement  Inpatient surgeries and physician in-hospital charges  Emergency room treatment and ambulance for a covered injury or sickness when it results in hospital confinement within 24 hours  Routine newborn care  Durable medical equipment (DME) when provided while confined in a hospital

Outpatient Hospital Benefit The Outpatient Hospital benefit limit is 50% of the In-hospital benefit amount selected and two times the individual outpatient benefit for dependent coverage.

BENEFITS INCLUDE:  Emergency room treatment and ambulance as long as the person is NOT hospitalized within 24 hours of being transported to the hospital and ER treatment  Outpatient surgery in an outpatient surgical facility, emergency facility or physician’s office  Diagnostic testing, x-rays, labs, MRI’s, and CT scans  Outpatient radiation therapy or chemotherapy  Physical therapy or chiropractic care  Durable medical equipment (DME) The Outpatient Benefit does not cover a physician’s office visit charge.

Please note that in order for a service to be covered under the medical supplement plan, it needs to be covered under the major medical plan.

Traditional Plan Example of Medical Supplement Plan Payout Vs. No Medical Supplement Plan INPATIENT HOSPITAL CLAIM EXAMPLE Inpatient Hospital Bill Benefit Paid Patient Responsibility

How It Works WITHOUT MEDICAL SUPPLEMENT PLAN $5,000 N/A $5,000

WITH DEDUCTIBLE RELIEF MEDICAL SUPPLEMENT PLAN $5,000 $2,500 $2,500

HSA Compatible Plan Deductible - In order for your gap plan to be compatible with a Health Savings Account (HSA), it has a deductible amount of $1,300 that must be satisfied before any benefits are payable. When dependent coverage is elected, benefits are payable only after the entire family deductible has been satisfied by one or more insured persons.

Example of Medical Supplement Plan Payout Vs. No Medical Supplement Plan INPATIENT HOSPITAL CLAIM EXAMPLE Inpatient Hospital Bill Deductible-Paid by Insured Benefit Paid Patient Balance

How It Works WITHOUT MEDICAL SUPPLEMENT PLAN $5,000 N/A N/A $5,000

WITH DEDUCTIBLE RELIEF MEDICAL SUPPLEMENT PLAN $5,000 $1,300 $2,500 $1,200

21

Medical Supplement - NEW BENEFIT Traditional Plan Benefit Amount Under Age 40: Insured Only Insured & Spouse Insured & Child(ren) Insured & Family Ages 40—49: Insured Only Insured & Spouse Insured & Child(ren) Insured & Family Age 50 & Above: Insured Only Insured & Spouse Insured & Child(ren) Insured & Family

AGE BASED MONTHLY COST BY COVERAGE AMOUNT $1,500

$2,500

$24.54 $44.18 $54.25 $73.89

$36.09 $64.96 $79.76 $108.63

$34.04 $61.28 $62.64 $89.87

$50.04 $90.09 $92.09 $132.12

$54.96 $98.92 $89.03 $133.00

$80.80 $145.44 $130.90 $195.54

HSA Compatible Plan Benefit Amount Under Age 40: Insured Only Insured & Spouse Insured & Child(ren) Insured & Family Ages 40—49: Insured Only Insured & Spouse Insured & Child(ren) Insured & Family Age 50 & Above: Insured Only Insured & Spouse Insured & Child(ren) Insured & Family

22

AGE BASED MONTHLY COST BY COVERAGE AMOUNT $1,500

$2,500

$12.55 $22.59 $27.73 $37.78

$20.11 $36.19 $44.44 $60.53

$17.40 $31.33 $32.02 $45.95

$27.89 $50.19 $51.31 $73.62

$28.10 $50.58 $45.52 $68.00

$45.02 $81.03 $72.94 $108.95

Medical Supplement - NEW BENEFIT Plan Exclusions Benefits will not be paid for losses caused by or resulting from any one or more of the following: 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

any Expenses Incurred during any period the Insured Person does not have coverage under a Medical Plan; any expenses which are not Medically Necessary; war, declared or undeclared; suicide or any attempt thereat, while sane or insane (in Colorado, Missouri or Montana, while sane); any intentionally self-inflicted Injury or Sickness, while sane or insane (in Colorado, Missouri or Montana, while sane); any loss while the Insured Person is in the service of the Armed Forces of any country. Orders to active military service for training purposes of two months or less will not constitute service in the Armed Forces. Upon notice to the Company of entering the Armed Forces, the Company will return to the Insured Person pro rata any premium paid, less any benefits paid, for any period during which the Insured Person is in such service; any expense for which there is no legal obligation to pay, no charge is made or in the absence of coverage, no charge would be made; drugs or medicines, except medicines prescribed and taken while Hospital Confined; dental or vision services unless: a. resulting from an Injury occurring while the Insured Person’s coverage under the Policy is in force; or b. due to congenital disease or anomaly of a Dependent newborn child; mental illness or functional or organic nervous disorders, regardless of the cause; treatment of alcoholism, drug addiction or complications thereof; any Injury that occurs while an Insured Person has been determined to be intoxicated: a. by judicial or administrative judgment or order; b. by evidence of an alcohol concentration in the Insured Person’s blood, breath or urine which equals or exceeds the limits set by applicable motor vehicle laws; or c. by other evidence demonstrating the Insured Person was under the influence of any alcohol, narcotic, barbiturate or hallucinatory drug, unless the same was administered on the advice of a Physician and was taken according to the prescribed dosage; and the use of such substance was a proximate cause of the Injury; any treatment, services or supplies for Wellness Services. For this exclusion, “Wellness Services” means treatment, services or supplies provided for routine health care, including, but not limited to, routine health or check-up examinations, routine well child visits, mammograms and other charges incurred during the course of a routine physical examination or checkup; Injury or Sickness for which compensation is payable under any Workers’ Compensation Law, any Occupational Disease Law or similar legislation, or if the Policyholder opts out of such requirements, any similar coverage purchased or self-funded by the Policyholder to cover work-related Injuries or Sicknesses; any loss for which the Insured Person is not required to pay a Deductible, Copayment and/or Coinsurance under the Insured Person’s Medical Plan; any expense for which benefits are excluded under the Insured Person’s Medical Plan; or an Insured Person engaging in any act or occupation which is a violation of the law of the jurisdiction where the loss or cause of loss occurred. A violation of law includes both misdemeanor and felony violations.

Limitations Medical Plan. If the Insured Person did not have a Medical Plan on the Insured Person’s Effective Date under the Policy, the Company’s sole obligation will then be to refund all premiums paid for that Insured Person.

This plan is underwritten by Companion Life Insurance Company arranged through Special Insurance Services, Inc.

23

CIGNA

Dental

YOUR BENEFITS PACKAGE

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

DID YOU KNOW?

Good dental care may improve your overall health.

Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.

24

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

Dental PPO - High Plan Monthly PPO Premiums Tier

Rate

EE Only

$38.25

EE + Spouse

$75.21

EE + Child(ren)

$76.49

Family Coverage

$112.19

Receiving regular dental care can not only catch minor problems before they become major and expensive to treat - it may even help improve your overall health. Gum disease is increasingly being linked to complications for pre-term birth, heart disease, stroke, diabetes, osteoporosis and other health issues. That’s why this dental plan includes Cigna Dental WellnessPlusSM features.

When you or your family members receive any preventive care in one plan year, the annual dollar maximum will increase in the following plan year. When you or your family members remain enrolled in the plan and continue to receive preventive care, the annual dollar maximum will increase in the following plan year, until it reaches the level specified below. Please refer to your plan materials for additional information on this plan feature.

Benefits Network Plan Year Maximum (Class I, II, III and IX expenses)

Cigna Dental PPO In-Network Total Cigna DPPO Year 1: $1,000 Year 2: $1,150# Year 3: $1,300+ Year 4 and beyond: $1,450^

Annual Deductible Individual Family Reimbursement Levels** Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Full Mouth X-rays Bitewing X-rays Panoramic X-ray Periapical X-rays Fluoride Application Sealants Space Maintainers Emergency Care to Relieve Pain Histopathologic Exams Class II - Basic Restorative Care Fillings Root Canal Therapy/Endodontics Osseous Surgery Periodontal Scaling and Root Planing Denture Adjustments and Repairs Oral Surgery – Simple extractions Oral Surgery – All except simple extractions Anesthetics Surgical Extractions of Impacted Teeth Repairs to Bridges, Crowns and Inlays Class III - Major Restorative Care Crowns Dentures Bridges Inlays/Onlays Prosthesis Over Implant Class IV - Orthodontia Lifetime Maximum

$50 per person $150 per family

Out-of-Network Year 1: $1,000 Year 2: $1,150# Year 3: $1,300+ Year 4 and beyond: $1,450^ $50 per person $150 per family

Based on Reduced Contracted Fees

90th percentile of Reasonable and Customary Allowances Plan Pays You Pay

Plan Pays

You Pay

100%

No Charge

100%

No Charge

80%*

20%*

80%*

20%*

70%*

30%*

70%*

30%*

50%

50% $1,000 Covered for children & adults

50%

50% $1,000 Covered for children & adults

25

Dental PPO - Base Plan Monthly PPO Premiums Tier

Rate

EE Only

$30.90

EE + Spouse

$61.80

EE + Child(ren)

$60.77

Family Coverage

$90.64

Receiving regular dental care can not only catch minor problems before they become major and expensive to treat - it may even help improve your overall health. Gum disease is increasingly being linked to complications for pre-term birth, heart disease, stroke, diabetes, osteoporosis and other health issues. That’s why this dental plan includes Cigna Dental WellnessPlusSM features.

When you or your family members receive any preventive care in one plan year, the annual dollar maximum will increase in the following plan year. When you or your family members remain enrolled in the plan and continue to receive preventive care, the annual dollar maximum will increase in the following plan year, until it reaches the level specified below. Please refer to your plan materials for additional information on this plan feature.

Benefits Network Plan Year Maximum (Class I, II and III expenses)

Cigna Dental PPO In-Network Total Cigna DPPO Year 1: $1,000 Year 2: $1,150# Year 3: $1,300+ Year 4 and beyond: $1,450^

Annual Deductible Individual Family Reimbursement Levels** Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Full Mouth X-rays Bitewing X-rays Panoramic X-ray Periapical X-rays Fluoride Application Sealants Space Maintainers Emergency Care to Relieve Pain Histopathologic Exams Class II - Basic Restorative Care Fillings Root Canal Therapy/Endodontics Osseous Surgery Periodontal Scaling and Root Planing Denture Adjustments and Repairs Oral Surgery – Simple extractions Oral Surgery – All except simple extractions Anesthetics Surgical Extractions of Impacted Teeth Repairs to Bridges, Crowns and Inlays Class III - Major Restorative Care Crowns Dentures Bridges Inlays/Onlays Prosthesis Over Implant Class IV - Orthodontia Lifetime Maximum 26

$50 per person $150 per family

Out-of-Network Year 1: $1,000 Year 2: $1,150# Year 3: $1,300+ Year 4 and beyond: $1,450^ $50 per person $150 per family

Based on Reduced Contracted Fees

Based on Maximum Allowable Charge (In-network fee level) Plan Pays You Pay

Plan Pays

You Pay

100%

No Charge

100%

No Charge

80%*

20%*

80%*

20%*

50%*

50%*

50%*

50%*

50%

50% $1,000 Covered for children & adults

50%

50% $1,000 Covered for children & adults

Dental PPO - High and Base Plans Missing Tooth Limitation – The amount payable is 50% of the amount otherwise payable until insured for 24 months; thereafter, considered a Class III expense. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. * Subject to annual deductible Dental Oral Health Integration Program (OHIP) - All dental customers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP)® is designed to provide enhanced dental coverage for customers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides:  100% coverage for certain dental procedures  guidance on behavioral issues related to oral health  discounts on prescription and non-prescription dental products For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule.

For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees. #Increase contingent upon receiving Preventive Services in Plan Year 1 +Increase contingent upon receiving Preventive Services in Plan Years 1 and 2 ^Increase contingent upon receiving Preventive Services in Plan Years 1, 2 and 3

Procedure

Exclusions and Limitations

Late Entrants Limit Exams Prophylaxis (Cleanings) Fluoride Histopathologic Exams X-Rays (routine) X-Rays (non-routine) Model Minor Perio (non-surgical) Perio Surgery Crowns and Inlays Bridges Dentures and Partials Relines, Rebases Adjustments Repairs - Bridges Repairs - Dentures Sealants Space Maintainers Prosthesis Over Implant

50% coverage on Class III and IV for 24 months Two per Plan year Two per Plan year 1 per Plan year for people under 19 Various limits per Plan year depending on specific test Bitewings: 2 per Plan year Full mouth: 1 every 36 consecutive months., Panorex: 1 every 36 consecutive months Payable only when in conjunction with Ortho workup Various limitations depending on the service Various limitations depending on the service Replacement every 5 years Replacement every 5 years Replacement every 5 years Covered if more than 6 months after installation Covered if more than 6 months after installation Reviewed if more than once Reviewed if more than once Limited to posterior tooth. One treatment per tooth every three years up to age 14 Limited to non-Orthodontic treatment 1 per 60 consecutive months if unserviceable and cannot be repaired. Benefits are based on the amount payable for nonprecious metals. No porcelain or white/tooth colored material on molar crowns or bridges When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses

Alternate Benefit

Benefit Exclusions                         

Services performed primarily for cosmetic reasons Replacement of a lost or stolen appliance Replacement of a bridge or denture within five years following the date of its original installation Replacement of a bridge or denture which can be made useable according to accepted dental standards Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, diagnose or treat conditions of TMJ, stabilize periodontally involved teeth, or restore occlusion Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars Bite registrations; precision or semi-precision attachments; splinting A surgical implant of any type Instruction for plaque control, oral hygiene and diet Dental services that do not meet common dental standards Services that are deemed to be medical services Services and supplies received from a hospital Charges which the person is not legally required to pay Charges made by a hospital which performs services for the U.S. Government if the charges are directly related to a condition connected to a military service Experimental or investigational procedures and treatments Any injury resulting from, or in the course of, any employment for wage or profit Any sickness covered under any workers’ compensation or similar law Charges in excess of the reasonable and customary allowances To the extent that payment is unlawful where the person resides when the expenses are incurred; Procedures performed by a Dentist who is a member of the covered person’s family (covered person’s family is limited to a spouse, siblings, parents, children, grandparents, and the spouse’s siblings and parents); For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; To the extent that you or any of your Dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; To the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a “no fault” insurance law or an uninsured motorist insurance law. Cigna HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents.

In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer.

27

Dental DHMO - NEW BENEFIT 



This Patient Charge Schedule applies only when covered dental services are performed by your Network Dentist, unless otherwise authorized by Cigna Dental as described in your plan documents. Not all Network Dentists perform all listed services and it is suggested to check with your Network Dentist in advance of receiving services.

This Patient Charge Schedule applies to Specialty Care when an appropriate referral is made to a Network Specialty Periodontist or Oral Surgeon. You must verify with the Network Specialty Dentist that your treatment plan has been authorized for payment by Cigna Dental.

Prior authorization is not required for specialty referrals for Pediatric, Orthodontic and Endodontic services. You may select a Network Pediatric Dentist for your child under the age of 7 by calling Customer Service at 1.800.Cigna24 to get a list of Network Pediatric Dentists in your area. Coverage for treatment by a Pediatric Dentist ends on your child’s 7th birthday; however, exceptions for medical reasons may be considered on an individual basis. Your Network General Dentist will provide care upon your child’s 7th birthday.

Monthly DHMO Premiums

Tier

Rate

EE Only

$13.53

EE + Spouse

$27.06

EE + Child(ren)

$26.66

Family Coverage

$39.65



Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/certificate of coverage and/or group contract.



All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated.



The American Dental Association may periodically change CDT Codes or definitions. Different codes may be used to describe these covered procedures.



The administration of IV sedation, general anesthesia, and/or nitrous oxide is not covered except as specifically listed on this Patient Charge Schedule. The application of local anesthetic is covered as part of your dental treatment.



Cigna Dental considers infection control and/or sterilization to be incidental to and part of the charges for services provided and not separately chargeable.



This Patient Charge Schedule is subject to annual change in accordance with the terms of the group agreement.

After your enrollment is effective: Call the dental office identified in your Welcome Kit. If you wish to change dental offices, a transfer can be arranged at no charge by calling Cigna Dental at the toll free number listed on your ID card or plan materials. Multiple ways to locate a DHMO Network General Dentist:  Online provider directory at www.Cigna.com  Online provider directory on www.myCigna.com  Call the number located on your ID card to: - Use the Dental Office Locator via Speech Recognition - Speak to a Customer Service Representative For full Cigna DHMO Fee Schedule, go to www.mybenefitshub.com/humbleisd Code

Procedure Description

Member Pays

Office visit fee (per patient, per office visit in addition to any other applicable patient charges) Office visit fee

$ 5.00

Diagnostic/preventive – Oral evaluations are limited to a combined total of 4 of the following evaluations during a 12 consecutive month period: Periodic oral evaluations (D0120), comprehensive oral evaluations (D0150), comprehensive periodontal evaluations (D0180), and oral evaluations for patients under 3 years of age (D0145).

28

Code

Procedure Description

Member Pays

Diagnostic/preventive (cont.)

D0145

Oral evaluation for a patient under 3 years of age and counseling with primary caregiver

$0.00

D0150

Comprehensive oral evaluation – New or established patient

$0.00

D0210

X-rays intraoral – Complete series of radiographic images (limit 1 every 3 years)

$0.00

D0240

X-rays intraoral – Occlusal radiographic image

$0.00

D9310

Consultation (diagnostic service provided by dentist or physician other than requesting dentist or physician)

$11.00

D9430

Office visit for observation (During regularly scheduled hours) – No other services performed

$6.00

D0270

X-rays (bitewing) – Single radiographic image

$0.00

D0120

Periodic oral evaluation – Established patient

$0.00

D0330

X-rays (panoramic radiographic image) – (limit 1 every 3 years)

$0.00

D0140

Limited oral evaluation – Problem focused

$0.00

D0431

Oral cancer screening using a special light source

$50.00

Dental DHMO - NEW BENEFIT Code

Procedure Description

Member Pays

Diagnostic/preventive (cont.)

Procedure Description

Member Pays

Periodontics (cont.)

D1110

Prophylaxis (cleaning) – Adult (limit 2 per calendar year)

$0.00

D1120

Prophylaxis (cleaning) – Child (limit 2 per calendar year)

$0.00

D1206

Topical application of fluoride varnish (limit 2 per calendar year). There is a combined limit of a total of 2 D1206s and/or D1208s per calendar year.

$0.00

Sealant – Per tooth

$11.00

D1351

Code

D4341

Periodontal scaling and root planing – 4 or more teeth per quadrant (limit 4 quadrants per consecutive 12 months)

$45.00

D4342

Periodontal scaling and root planing – 1 to 3 teeth per quadrant (limit 4 quadrants per consecutive 12 months)

$35.00

D4910

Periodontal maintenance (limit 4 per calendar year) (only covered after active periodontal therapy)

$35.00

$65.00

Restorative (fillings, including polishing) D2140

Amalgam – 1 surface, primary or permanent

$0.00

Additional periodontal maintenance procedures (beyond 4 per calendar year)

D2330

Resin-based composite – 1 surface, anterior

$0.00

Periodontal charting for planning treatment of periodontal disease

$0.00

D2390

Resin-based composite crown, anterior

$40.00

Periodontal hygiene instruction

$0.00

Crown and bridge – All charges for crowns and bridges (fixed partial dentures) are per unit (each replacement or supporting tooth equals 1 unit). Coverage for replacement of crowns and bridges is limited to 1 every 5 years.

For single crowns, retainer (“abutment”) crowns, and pontics: The charges below include the cost of predominantly base metal alloy.

You may be charged up to these additional amounts, based on the type of material the dentist uses for your restoration.  No more than $150.00 per tooth for any noble metal alloys, high noble metal alloys, titanium or titanium alloys  No more than $75.00 per tooth for any porcelain fused to metal (only on molar teeth)  Porcelain/ceramic substrate crowns on molar teeth are not covered D2740

Crown – Porcelain/ceramic substrate

$255.00

D2792

Crown – Full cast noble metal

$220.00

D2722

Crown – Resin with noble metal

$220.00

D2950

Core buildup – Including any pins

$55.00

Endodontics (root canal treatment, excluding final restorations) D3310

Anterior root canal – Permanent tooth (excluding final restoration)

$90.00

D3330

Molar root canal – Permanent tooth (excluding final restoration)

$275.00

Periodontics (treatment of supporting tissues [gum and bone] of the teeth) periodontal regenerative procedures are limited to 1 regenerative procedure per site (or per tooth, if applicable), when covered on the patient charge schedule. The relevant procedure codes are D4263, D4264, D4266 and D4267. Localized delivery of antimicrobial agents is limited to 8 teeth (or 8 sites, if applicable) per 12 consecutive months, when covered on the patient charge schedule.

D4211

Gingivectomy or gingivoplasty – 1 to 3 teeth per quadrant

$90.00

D4240

Gingival flap (including root planing) – 4 or more teeth per quadrant

$165.00

Prosthetics (removable tooth replacement – dentures) includes up to 4 adjustments within first 6 months after insertion – Replacement limit 1 every 5 years. Characterization is considered an upgrade with maximum additional charge to the member of $200.00 per denture.

D5110

Full upper denture

$185.00

D5120

Full lower denture

$185.00

D5211

Upper partial denture – Resin base (including clasps, rests and teeth)

$185.00

D5212

Lower partial denture – Resin base (including clasps, rests and teeth)

$185.00

Oral surgery (includes routine postoperative treatment) Surgical removal of impacted tooth – Not covered for ages below 15 unless pathology (disease) exists.

D7111

Extraction of coronal remnants – Deciduous tooth

$6.00

D7140

Extraction, erupted tooth or exposed root – Elevation and/or forceps removal

$6.00

D7220

Removal of impacted tooth – Soft tissue

$55.00

D7240

Removal of impacted tooth – Completely bony

$100.00

Orthodontics (tooth movement) Orthodontic treatment (maximum benefit of 24 months of interceptive and/or comprehensive treatment. Atypical cases or cases beyond 24 months require an additional payment by the patient.)

D8670

Periodic orthodontic treatment visit – As part of contract Children – Up to 19th birthday: 24-month treatment fee Charge per month for 24 months

$1,464.00 $61.00

Adults: 24-month treatment fee Charge per month for 24 months

$2,160.00 $90.00

For full Cigna DHMO Fee Schedule, go to www.mybenefitshub.com/humbleisd

29

SUPERIOR VISION YOUR BENEFITS PACKAGE

Vision

About this Benefit Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan.

DID YOU KNOW?

75% of U.S. residents between age 25 and 64 require some sort of vision correction.

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This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

Vision Benefits Exam

In-Network

Out-of-Network

Covered in full*

Up to $40 retail*

Monthly Premiums Semi-Monthly Rates

Prorated SemiMonthly Rates

Frames

$130 retail allowance* Up to $45 retail*

EE Only

$3.70

$4.93

Contact Lenses

$150 retail allowance* Up to $150 retail*

EE + Spouse

$7.70

$10.27

EE + Child(ren)

$8.00

$10.67

EE + Family

$10.25

$13.67

Medically Necessary Contact Lenses Lasik Vision Correction

Covered in full*

Up to $210 retail*

$200 allowance1 (in or out of network)

Co-Pays

Lenses (standard) per pair

Exam

$10

Materials

$25

Contact Lens Fitting

$25

Single Vision

Covered in full*

Up to $40 retail*

Bifocal

Covered in full*

Up to $60 retail*

Trifocal

Covered in full*

Up to $80 retail*

Progressive

Covered in full*

Up to $75 retail*

Exam

12 months

Lenticular

Covered in full*

Up to $80 retail*

Frame

12 months

Scratch Coating

Covered in full*

Up to $25 retail*

Lenses

12 months

Polycarbonate

Covered in full*

Up to $20 retail*

Contact Lenses

12 months

1

Services/Frequency

(Based on date of service)

Lasik Vision Correction is in lieu of eyewear benefit, subject to routine regulatory filings and certain exclusions and limitations *After applicable copayments listed are above fulfilled.

**Contact lenses and related professional services (fitting, evaluation, and follow‐up) are covered in lieu of eyeglasses.

Coverage includes the complete contact lenses package. Coverage to include all contact lens types (ie. Standard daily wear, extended wear, disposable, toric, gas permeable, and bifocal.) Members receive a $150 retail allowance toward the purchase of contact lenses that retail for more than $150.

Platinum $130 Vision Plan Group #326780 If you choose a non‐participating provider, you may be expected to pay the doctor for services received. You then need to send the original receipt from your non‐participating doctor to Superior Vision for reimbursement. Superior Vision will review your eligibility and send the appropriate reimbursement.

31

AETNA YOUR BENEFITS PACKAGE

Long Term Disability

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

DID YOU KNOW?

Just over 1 in 4 of today's 20 year -olds will become disabled before they retire.

34.6 months is the duration of the average disability claim.

32

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

Long Term Disability Eligibility

Pre-Existing Exclusion

All active full time employees working 20 hours per week or more.

There is a 3/12 pre-existing conditions clause. This is a look back period to see if you were treatment-free for a 3-month period prior to the effective date of your coverage. If you weren’t treatment-free, the pre-existing condition is excluded from coverage if you’re disabled within 12-months of first becoming insured.

Purpose Long Term Disability insurance provides income replacement benefits for you and your family in the event you are unable to work due to an accident or sickness.

Maximizing Income Protection Long Term Disability (LTD) Insurance can offer an affordable way for educators and administrators to protect their lifestyles—and the people who depend upon them.

Employees can choose from a selection of LTD features they feel best match their financial needs.  

Employees can choose their Monthly Benefit Amount in $100 increments, from $200 to $8,000 (not to exceed 66 2/3% of monthly earnings).

Employees can choose from among six accident/sickness Benefit Waiting Periods. A benefit waiting period is the period of time in which an employee must be continuously disabled before you are eligible for benefits.

Accident 0 Days 14 Days 30 Days 60 Days 90 Days 180 Days

Sickness 7 Days 14 Days 30 Days 60 Days 90 Days 180 Days

Maximum Benefit Period Option A: To age 65 Option B: 2 Years

Own Occupation Period

Plan Features Maximum Benefit—This benefit allows employees to protect their income at higher maxes up to 66 2/3% of their income.

Definition of Disability—Covers total and partial disability.

1st Day Hospital Benefit—This feature waives the waiting period if an insured is hospitalized. This benefit is included in the 0/7, 14/14, and 30/30 waiting periods.

12 Month Return-to-Work Incentive—This benefit gives an employee the opportunity to return-to-work part time earning some income plus receive LTD benefits allowing them to receive up to 100% income replacement during the first 12 months.

Deductible Income—No offset for Summer Earnings during the first 12 months of Disability.

Approved Rehabilitation Program—This benefit allows Aetna to pay for an employer’s expenses toward work site modifications that result in a disabled employee’s return-to-work.

Survivor Benefit—Pays a lump sum equal to 3 times the nonintegrated LTD benefit.

Waiver of Premium—Payment of premium will be waived for LTD coverage while benefits are payable.

Rehabilitation Plan Benefit—Will pay for some or all of the expenses incurred by a disabled employee in connection with approved training and education, family care, and job-related and job search expenses.

24 Months Minimum Benefit—25% of gross maximum Monthly Benefit.

Any Occupation Period To age 65

Limitations & Exclusions Benefits for Mental/Nervous/Substance Abuse are limited to 2 years.

Cost—The cost for this benefit is paid by the Employee.

Filing Claims is Easy!

Call 866‐326‐1380 to file a claim telephonically.

Your Group Policy number is 473323

The information above highlights some of the features of the Group Policy, but it is not intended to be a detailed description of coverage. If you become insured, a Certificate of Coverage will be available on your benefits website that will contain more detailed information about the controlling terms and provisions of coverage.

33

Long Term Disability Option A: Maximum Benefit to Age 65

34

Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

3,600 5,400 7,200 9,000 10,800 12,600 14,400 16,200 18,000 19,800 21,600 23,400 25,200 27,000 28,800 30,600 32,400 34,200 36,000 37,800 39,600 41,400 43,200 45,000 46,800 48,600 50,400 52,200 54,000 55,800 57,600 59,400 61,200 63,000 64,800 66,600 68,400 70,200 72,000 73,800 75,600 77,400 79,200 81,000 82,800 84,600 86,400 88,200 90,000

300 450 600 750 900 1,050 1,200 1,350 1,500 1,650 1,800 1,950 2,100 2,250 2,400 2,550 2,700 2,850 3,000 3,150 3,300 3,450 3,600 3,750 3,900 4,050 4,200 4,350 4,500 4,650 4,800 4,950 5,100 5,250 5,400 5,550 5,700 5,850 6,000 6,150 6,300 6,450 6,600 6,750 6,900 7,050 7,200 7,350 7,500

200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500 1,600 1,700 1,800 1,900 2,000 2,100 2,200 2,300 2,400 2,500 2,600 2,700 2,800 2,900 3,000 3,100 3,200 3,300 3,400 3,500 3,600 3,700 3,800 3,900 4,000 4,100 4,200 4,300 4,400 4,500 4,600 4,700 4,800 4,900 5,000

* First Day Hospital is included in the 0/7, 14/14, and 30/30 only.

0/7* $7.66 $11.49 $15.32 $19.15 $22.98 $26.81 $30.64 $34.47 $38.30 $42.13 $45.96 $49.79 $53.62 $57.45 $61.28 $65.11 $68.94 $72.77 $76.60 $80.43 $84.26 $88.09 $91.92 $95.75 $99.58 $103.41 $107.24 $111.07 $114.90 $118.73 $122.56 $126.39 $130.22 $134.05 $137.88 $141.71 $145.54 $149.37 $153.20 $157.03 $160.86 $164.69 $168.52 $172.35 $176.18 $180.01 $183.84 $187.67 $191.50

Accident/Sickness Benefit Waiting Period Cost Per Month 14 /14* 30/30* 60/60 90/90 $6.12 $5.04 $3.46 $3.00 $9.18 $7.56 $5.19 $4.50 $12.24 $10.08 $6.92 $6.00 $15.30 $12.60 $8.65 $7.50 $18.36 $15.12 $10.38 $9.00 $21.42 $17.64 $12.11 $10.50 $24.48 $20.16 $13.84 $12.00 $27.54 $22.68 $15.57 $13.50 $30.60 $25.20 $17.30 $15.00 $33.66 $27.72 $19.03 $16.50 $36.72 $30.24 $20.76 $18.00 $39.78 $32.76 $22.49 $19.50 $42.84 $35.28 $24.22 $21.00 $45.90 $37.80 $25.95 $22.50 $48.96 $40.32 $27.68 $24.00 $52.02 $42.84 $29.41 $25.50 $55.08 $45.36 $31.14 $27.00 $58.14 $47.88 $32.87 $28.50 $61.20 $50.40 $34.60 $30.00 $64.26 $52.92 $36.33 $31.50 $67.32 $55.44 $38.06 $33.00 $70.38 $57.96 $39.79 $34.50 $73.44 $60.48 $41.52 $36.00 $76.50 $63.00 $43.25 $37.50 $79.56 $65.52 $44.98 $39.00 $82.62 $68.04 $46.71 $40.50 $85.68 $70.56 $48.44 $42.00 $88.74 $73.08 $50.17 $43.50 $91.80 $75.60 $51.90 $45.00 $94.86 $78.12 $53.63 $46.50 $97.92 $80.64 $55.36 $48.00 $100.98 $83.16 $57.09 $49.50 $104.04 $85.68 $58.82 $51.00 $107.10 $88.20 $60.55 $52.50 $110.16 $90.72 $62.28 $54.00 $113.22 $93.24 $64.01 $55.50 $116.28 $95.76 $65.74 $57.00 $119.34 $98.28 $67.47 $58.50 $122.40 $100.80 $69.20 $60.00 $125.46 $103.32 $70.93 $61.50 $128.52 $105.84 $72.66 $63.00 $131.58 $108.36 $74.39 $64.50 $134.64 $110.88 $76.12 $66.00 $137.70 $113.40 $77.85 $67.50 $140.76 $115.92 $79.58 $69.00 $143.82 $118.44 $81.31 $70.50 $146.88 $120.96 $83.04 $72.00 $149.94 $123.48 $84.77 $73.50 $153.00 $126.00 $86.50 $75.00

180/180 $2.32 $3.48 $4.64 $5.80 $6.96 $8.12 $9.28 $10.44 $11.60 $12.76 $13.92 $15.08 $16.24 $17.40 $18.56 $19.72 $20.88 $22.04 $23.20 $24.36 $25.52 $26.68 $27.84 $29.00 $30.16 $31.32 $32.48 $33.64 $34.80 $35.96 $37.12 $38.28 $39.44 $40.60 $41.76 $42.92 $44.08 $45.24 $46.40 $47.56 $48.72 $49.88 $51.04 $52.20 $53.36 $54.52 $55.68 $56.84 $58.00

Long Term Disability Option B: Maximum Benefit 2 Years Annual Earnings

Monthly Earnings

Maximum Monthly Benefit

3,600 5,400 7,200 9,000 10,800 12,600 14,400 16,200 18,000 19,800 21,600 23,400 25,200 27,000 28,800 30,600 32,400 34,200 36,000 37,800 39,600 41,400 43,200 45,000 46,800 48,600 50,400 52,200 54,000 55,800 57,600 59,400 61,200 63,000 64,800 66,600 68,400 70,200 72,000 73,800 75,600 77,400 79,200 81,000 82,800 84,600 86,400 88,200 90,000

300 450 600 750 900 1,050 1,200 1,350 1,500 1,650 1,800 1,950 2,100 2,250 2,400 2,550 2,700 2,850 3,000 3,150 3,300 3,450 3,600 3,750 3,900 4,050 4,200 4,350 4,500 4,650 4,800 4,950 5,100 5,250 5,400 5,550 5,700 5,850 6,000 6,150 6,300 6,450 6,600 6,750 6,900 7,050 7,200 7,350 7,500

200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500 1,600 1,700 1,800 1,900 2,000 2,100 2,200 2,300 2,400 2,500 2,600 2,700 2,800 2,900 3,000 3,100 3,200 3,300 3,400 3,500 3,600 3,700 3,800 3,900 4,000 4,100 4,200 4,300 4,400 4,500 4,600 4,700 4,800 4,900 5,000

* First Day Hospital is included in the 0/7, 14/14, and 30/30 only.

0/7* $6.10 $9.15 $12.20 $15.25 $18.30 $21.35 $24.40 $27.45 $30.50 $33.55 $36.60 $39.65 $42.70 $45.75 $48.80 $51.85 $54.90 $57.95 $61.00 $64.05 $67.10 $70.15 $73.20 $76.25 $79.30 $82.35 $85.40 $88.45 $91.50 $94.55 $97.60 $100.65 $103.70 $106.75 $109.80 $112.85 $115.90 $118.95 $122.00 $125.05 $128.10 $131.15 $134.20 $137.25 $140.30 $143.35 $146.40 $149.45 $152.50

Accident/Sickness Benefit Waiting Period Cost Per Month 14 /14* 30/30* 60/60 90/90 $4.68 $3.48 $1.78 $1.54 $7.02 $5.22 $2.67 $2.31 $9.36 $6.96 $3.56 $3.08 $11.70 $8.70 $4.45 $3.85 $14.04 $10.44 $5.34 $4.62 $16.38 $12.18 $6.23 $5.39 $18.72 $13.92 $7.12 $6.16 $21.06 $15.66 $8.01 $6.93 $23.40 $17.40 $8.90 $7.70 $25.74 $19.14 $9.79 $8.47 $28.08 $20.88 $10.68 $9.24 $30.42 $22.62 $11.57 $10.01 $32.76 $24.36 $12.46 $10.78 $35.10 $26.10 $13.35 $11.55 $37.44 $27.84 $14.24 $12.32 $39.78 $29.58 $15.13 $13.09 $42.12 $31.32 $16.02 $13.86 $44.46 $33.06 $16.91 $14.63 $46.80 $34.80 $17.80 $15.40 $49.14 $36.54 $18.69 $16.17 $51.48 $38.28 $19.58 $16.94 $53.82 $40.02 $20.47 $17.71 $56.16 $41.76 $21.36 $18.48 $58.50 $43.50 $22.25 $19.25 $60.84 $45.24 $23.14 $20.02 $63.18 $46.98 $24.03 $20.79 $65.52 $48.72 $24.92 $21.56 $67.86 $50.46 $25.81 $22.33 $70.20 $52.20 $26.70 $23.10 $72.54 $53.94 $27.59 $23.87 $74.88 $55.68 $28.48 $24.64 $77.22 $57.42 $29.37 $25.41 $79.56 $59.16 $30.26 $26.18 $81.90 $60.90 $31.15 $26.95 $84.24 $62.64 $32.04 $27.72 $86.58 $64.38 $32.93 $28.49 $88.92 $66.12 $33.82 $29.26 $91.26 $67.86 $34.71 $30.03 $93.60 $69.60 $35.60 $30.80 $95.94 $71.34 $36.49 $31.57 $98.28 $73.08 $37.38 $32.34 $100.62 $74.82 $38.27 $33.11 $102.96 $76.56 $39.16 $33.88 $105.30 $78.30 $40.05 $34.65 $107.64 $80.04 $40.94 $35.42 $109.98 $81.78 $41.83 $36.19 $112.32 $83.52 $42.72 $36.96 $114.66 $85.26 $43.61 $37.73 $117.00 $87.00 $44.50 $38.50

180/180 $1.20 $1.80 $2.40 $3.00 $3.60 $4.20 $4.80 $5.40 $6.00 $6.60 $7.20 $7.80 $8.40 $9.00 $9.60 $10.20 $10.80 $11.40 $12.00 $12.60 $13.20 $13.80 $14.40 $15.00 $15.60 $16.20 $16.80 $17.40 $18.00 $18.60 $19.20 $19.80 $20.40 $21.00 $21.60 $22.20 $22.80 $23.40 $24.00 $24.60 $25.20 $25.80 $26.40 $27.00 $27.60 $28.20 $28.80 $29.40 $30.00 35

AETNA YOUR BENEFITS PACKAGE

Life and AD&D

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

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

36

DID YOU KNOW? Motor vehicle crashes are the

#1

cause of accidental deaths in the US, followed by poisoning, falls, drowning, and choking.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

Life and AD&D Humble ISD provides you with Basic Term Life & Accidental Death & Dismemberment (AD&D) insurance coverage in the amount of $10,000 at no cost to you.

Employee Coverage Increments of $10,000 up to $750,000 (not to exceed 5 times your salary) Guarantee Issue: The lesser of 5 times salary or $200,000.

New Hires Enrollment in this Supplemental Term Life insurance plan is available without providing a Statement of Health for New Hires only as long as:  Your enrollment takes place within 31 days from the date you become eligible for benefits, and  You are enrolling for coverage equal to/less than 5 times your basic annual earnings or $200,000 If you do not meet all of the conditions stated above, you will need to provide additional medical information by completing a Statement of Health form.

Dependent Coverage Spouse– Increments of $5,000 up to $375,000 (not to exceed 50% of employee amount) Guarantee Issue: $30,000 Dependent Children* ‐ $5,000 or $10,000.

New Hires Your spouse and dependent children do not need to provide a Statement of Health If you are a new hire enrolling them in the benefit for the first time and as long as:  The enrollment takes place within 31 days from the date you become eligible for benefits, and  You are enrolling your spouse for coverage equal to/less than $30,000 and your child(ren) for coverage of $10,000.

If you do not meet all of the conditions stated above, you will need to provide additional medical information by completing a Statement of Health form. **Guaranteed Issue is only available to new hire employees.** Evidence of Insurability is required for all late entrants and amounts over the Guarantee Issue.

Employee must enroll in voluntary life benefits for spouse and/ or child(ren) to be eligible for voluntary life benefit.

Accelerated Benefits If you become terminally ill with a life expectancy of 24 months or less, you may receive up to 75% or your life benefit before you die.

Waiver of Premium Provision for Permanently and Totally Disabled Employees If you are unable to work at any reasonable job (any which you are suited to perform due to education, training or experience), you may be eligible to have your life insurance coverage extended at no cost.

Benefit Reductions Benefits Reduced By: 35% when you reach age 65 50% when you reach age 70

*Portability You may continue your Life Insurance at group rates if your employment terminates.

Voluntary Term Rates Age

Employee and Spouse Monthly Cost per $10,000

Under 30 30‐34 35‐39 40‐44 45‐49 50‐54 55‐59 60‐64 65‐69 70+ Cost for your Child(ren)

$0.40 $0.70 $0.80 $0.90 $1.50 $2.50 $3.60 $6.50 $13.00 $21.00 $0.80

*covers all eligible children

*Child(ren)’s Eligibility: Dependent children ages from live birth through 25 years old are eligible for coverage.

In addition to your Voluntary Term Life, you may choose to elect the same amount for Accidental Death and Dismemberment (AD&D) coverage. AD&D provides a covered amount should you or a dependent die from a covered accident, or pays a specified dollar amount for a bodily loss due to accidental injury.

Additional Employee/Spouse AD&D Coverage

Employee/Spouse Monthly Rates per $10,000

Employee Spouse

$0.30 $0.40

Additional Child AD&D Coverage Child Option 1 ‐$5,000 Child Option 2‐$10,000

$0.20 $0.40

*covers all eligible children

37

LOYAL AMERICAN

Cancer

YOUR BENEFITS PACKAGE

About this Benefit Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.

DID YOU KNOW? Breast Cancer is the most commonly diagnosed cancer in women.

If caught early, prostate cancer is one of the most treatable malignancies.

38

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

Cancer Cancer insurance is designed to be a supplement and pays for many costs not covered by your medical insurance. There are 4 plan options available, two with additional ICU benefits and two without. All new or increases in coverage are subject to a 12‐month pre‐existing condition exclusion.

Semi Monthly Rates Base Plan A

Base Plan A + ICU

Base Plan B

Base Plan B + ICU

Employee Only

$11.91

$13.07

$7.00

$8.16

Employee and Child(ren)

$14.39

$15.98

$8.76

$10.36

Employee and Family

$19.83

$22.03

$11.90

$14.11

Prorated Semi Monthly Rates Base Plan A

Base Plan A + ICU

Base Plan B

Base Plan B + ICU

Employee Only

$15.88

$17.43

$9.33

$10.88

Employee and Child(ren)

$19.19

$21.31

$11.68

$13.81

Employee and Family

$26.44

$29.37

$15.87

$18.81

BENEFIT PROVISIONS. Loyal American pays the benefits described in the Certificate for the treatment of an Insured Person’s Cancer, provided he or she is covered under an issued Certificate which remains in force. Payment will be made in accordance with all applicable policy provisions. Benefits are payable for a positive diagnosis that begins after the Effective Date. The positive diagnosis must be for Cancer as defined in the policy.

Positive Diagnosis Benefit ‐ We will pay the Actual Charge but not to exceed $300 per Calendar Year for one test that confirms the Positive Diagnosis of Cancer in an Insured Person. This benefit is not payable for multiple diagnoses of the same Cancer or for Cancer that metastasizes or for recurrence of the same Cancer.

National Cancer Institute Designated Comprehensive Cancer Treatment Center Evaluation/Consultation Benefit ‐ We will pay the Actual Charge, but not to exceed a lifetime maximum of $750, if an Insured Person is diagnosed with Internal Cancer and seeks evaluation or consultation from a National Cancer Institute designated Comprehensive Cancer Treatment Center. If the Comprehensive Cancer Treatment Center is located more than 30 miles from the Insured Person’s place of residence, We will also pay the transportation and lodging expenses incurred but not to exceed a lifetime maximum of $350. This benefit is not payable on the same day a Second or Third Surgical Opinion Benefit is payable and is in lieu of the Non‐Local Transportation and Lodging Expense Benefits of the Policy. This benefit is payable one time during the lifetime of the Insured Person.

Second and Third Surgical Opinion Expense Benefit ‐ We will pay the Actual Charge for a written second surgical opinion concerning the recommendation of Cancer surgery and if the second surgical opinion is in conflict with that of the Physician originally recommending the surgery and the Insured Person desires a third opinion, We will the Actual Charge for a written third surgical opinion. The Physician providing the second or third surgical opinion cannot be associated with the Physician who originally recommended the surgery. This benefit is not payable the same day the National Cancer Institute Evaluation/Consulting Benefit is payable.

Medical Imaging, Treatment Planning and Monitoring Expense Benefit ‐ We will pay the Actual Charge, but not to exceed $1,000 per Calendar Year, for laboratory tests, diagnostic X‐rays, medical images, when used in Cancer treatment plannings related to Radiation Treatment, Chemotherapy or Immunotherapy.

Anti‐Nausea Medication Expense Benefit - We will pay the Actual Charge for anti‐nausea medication, but not to exceed $150 per calendar month, when an Insured Person is prescribed such medication as the result of Radiation Treatment, Chemotherapy or Immunotherapy treatments for Cancer.

Colony Stimulating Factor or Immunoglobulin Expense Benefit - We will pay the Actual Charge but not to exceed $1,000 per Calendar Month for Colony Stimulating Factor Drugs or Immunoglobulins prescribed by a Physician or Oncologist during an Insured

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Cancer Person’s Cancer treatment regimen for which benefits are payable under the Radiation, Chemotherapy and Immunotherapy Benefit of this Policy or rider attached to it.

Outpatient Hospital or Ambulatory Surgical Center Expense Benefit ‐ We will pay the Actual Charge from an Ambulatory Surgical Center or Outpatient department of a Hospital for the use of its facilities for the performance of a surgical procedure covered under this Policy but not to exceed $350 per day.

Prosthesis Expense Benefit (A.) Surgically Implanted Breast Prosthesis - We will pay the Actual Charge for a surgically implanted prosthetic device required and prescribed to restore normal body contour lost as the direct result of an Insured Person’s breast removal for the treatment of Cancer. The Surgically Implanted Breast Prosthesis Benefit does not include coverage for breast reconstruction surgery which may be covered under the Surgical Schedule within the Surgical and Anesthesia Benefits Rider.

(B) Non‐Surgically Implanted Prosthesis - We will pay the Actual Charge incurred not to exceed $2,000 per amputation for an artificial or other non‐surgically implanted prosthetic device that is prescribed and required to restore normal body function lost as the direct result of amputation for the treatment of Cancer. We will pay a lifetime maximum of $2,000 per amputation. The cost of replacement of a prosthetic device is not covered. Hairpieces or wigs are not covered under this benefit.

Non‐Local Transportation Expense Benefit ‐ We will pay the Actual Charge, but not to exceed the coach fare on a Common Carrier for the Insured Person and one adult companion’s travel to a Hospital, Radiation Therapy Treatment Center, Chemotherapy Treatment Center, Oncology Clinic or any other specialized treatment center where the Insured Person receives treatment for Cancer. This benefit is payable only if the treatment is not available Locally but is available Non‐Locally. The adult companion may include the live donor of bone marrow or stem cells used in a bone marrow or stem cell transplant for the Insured Person. At the option of the Insured Person, We will pay a single private vehicle mileage allowance of $.50 per mile for Non‐Local transportation in lieu of the common carrier coach fare.

Lodging Expense Benefit ‐ We will pay the Actual Charge not to exceed $75 per day for a room in a motel, hotel or other appropriate lodging facility (other than a private residence), when an Insured Person receives treatment for Cancer at a Non‐Local Hospital, Radiation Therapy Treatment Center, Chemotherapy Treatment Center, Oncology Clinic or any other specialized treatment center. The room must be occupied by the Insured Person or an adult companion which may include the live donor of bone marrow or stem cells used in a bone marrow or stem cell transplant for the Insured Person. This benefit is not payable for lodging expense incurred more than 24 hours before the treatment nor for lodging expense incurred more than 24 hours following treatment. This benefit is limited to 100 days per Calendar Year.

Inpatient Blood, Plasma, and Platelets Expense Benefit - We will pay the Actual Charge not to exceed $300 per day for the procurement cost, administration, processing and cross matching of blood, plasma or platelets administered to an Insured Person in the treatment of Cancer while an Inpatient.

Outpatient Blood, Plasma, and Platelets Expense Benefit ‐ We will pay the Actual Charge not to exceed $300 per day for the procurement cost, administration, processing and cross matching of blood, plasma or platelets administered to an Insured Person in the treatment of Cancer while an Outpatient.

Bone Marrow Donor Expense Benefit - We will pay the Daily Hospital Confinement Benefit shown on the Certificate Schedule for each day a live donor, other than the Insured Person, is confined in a Hospital for the harvesting of bone marrow or stem cells used in a bone marrow or stem cell transplant for the treatment of an Insured Person’s Cancer.

Bone Marrow or Stem Cell Transplant Expense Benefit We will pay the Actual Charge not to exceed a lifetime maximum of $15,000 for surgical and anesthesia procedures (including the harvesting and subsequent re‐infusion of blood cells or peripheral stem cells) performed for a bone marrow transplant and/or a peripheral stem cell transplant for the treatment of an Insured Person’s Cancer.

This benefit will be paid in lieu of the Surgical Expense Benefit and the Anesthesia Expense Benefit which may be described in a rider attached to an issued Certificate.

Ambulance Expense Benefit ‐ We will pay the Actual Charge for ambulance service if an Insured Persons is transported to a Hospital where he or she is admitted as an inpatient for the treatment of Cancer . The ambulance service must be provided by a licensed professional ambulance company or an ambulance owned by the Hospital.

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Cancer Inpatient Oxygen Expense Benefit ‐ We will pay the Actual Charge not to exceed $300 per Hospital confinement for oxygen prescribed by a Physician and received by an Insured Person while confined in a Hospital for the treatment of Cancer.

Attending Physician Expense Benefit ‐ We will pay the Actual Charge not to exceed $40 per day for the professional services of a Physician or Oncologist rendered to an Insured Person while he or she is confined in a Hospital for the treatment of Cancer. This benefit is payable only if the Physician or Oncologist personally visits the Hospital room occupied by the Insured Person and the amount stated is the maximum amount that will be payable for each day of Hospital confinement regardless of the number of visits made by one or more Physicians or Oncologists.

Inpatient Private Duty Nursing Expense Benefit ‐ We will pay the Actual Charge not to exceed $150 per day for the full time service of a Nurse that is required and ordered by a Physician when an Insured Person is confined in a Hospital for the treatment of Cancer. The Nurse must provide services other than those normally provided by the Hospital and the Nurse may not be an employee of the Hospital or an Immediate Family Member of the Insured Person.

Outpatient Private Duty Nursing Expense Benefit ‐ We will pay the Actual Charge not to exceed $150 per day limited to the same number of days of the prior Hospital confinement for the full time service of a Nurse that is required and ordered by a Physician when an Insured Person is confined indoors at home as the result of Cancer . This benefit is not payable if the services of the Nurse are custodial in nature or to assist the Insured Person in the activities of daily living. This benefit is not payable when the Nurse is a member of the Insured Person’s Immediate Family. Charges must begin following a period of Hospital confinement for which benefits are payable under this Certificate.

Convalescent Care Facility Expense Benefit ‐ We will pay the Actual Charge not to exceed $100 per day for an Insured Person’s confinement in a Convalescent Care Facility. The maximum number of days for which this benefit is payable will be the number of days in the last Period of Hospital Confinement that immediately preceded admission to a Convalescent Care Facility. The Convalescent Care Facility Confinement must: be due to Cancer ; begin within 14 days after the Insured Person has been discharged from a Hospital for the treatment of Cancer ; be authorized by a Physician as being medically necessary for the treatment of Cancer.

Rental Purchase of Medical Equipment Expense Benefit ‐ We will pay the lesser of the Actual Charge not to exceed $1,500 per Calendar Year for either the rental or purchase of covered medical equipment designed for home use, required and ordered by the Insured Person’s attending Physician as the direct result of the treatment of Cancer. Covered medical equipment includes wheel chair, oxygen equipment, respirator, braces, crutches or hospital bed Home Health Care Expense Benefit ‐ We will pay benefits for the following Covered Charges when a Insured Person requires Home Health Care for the treatment of Cancer.

1. Home Health Care Visits ‐ We will pay the Actual Charge for Home Health Care Visits not to exceed $75 for each day on which one or more such visits occur. We will not pay this benefit for more than 60 days in any Calendar Year.

2. Medicine and Supplies ‐ We will pay the Actual Charge not to exceed $450 in any Calendar Year for drugs, medicine, and medical supplies provided by or on behalf of a Home Health Care Agency.

3. Services of a Nutritionist ‐ We will pay the Actual Charge not to exceed a lifetime maximum of $300 for the services of a nutritionist to set up programs for special dietary needs.

Hospice Care Expense Benefit ‐ We will pay the Actual Charge for Hospice Care not to exceed $100 per day, when such care is required because of Cancer. This benefit is payable whether confinement is required in a Hospice Center or services are provided in the Insured Person’s home by a Hospice Team. Eligibility for payments will be based on the following conditions being met:(1) the Insured Person has been given a prognosis as being Terminally Ill with an estimated life expectancy of 6 months or less; and (2) We have received a written summary of such prognosis from the attending Physician. We will not pay this benefit while the Insured Person is confined to a Hospital or Convalescent Care Facility. The lifetime maximum benefit is 365 days of Hospice Care.

Hairpiece Expense Benefit ‐ We will pay the Actual Charge not to exceed a lifetime maximum of $150 for the purchase of a wig or hairpiece that is required as the direct result of hair loss due to Cancer treatment.

Physical, Speech, Audio Therapy and Psychotherapy Expense Benefit We will pay the Actual Charge not to exceed $25 per therapy session for: 1. Physical therapy treatments given by a license Physical Therapist, or 41

Cancer 2.

3.

4.

Speech therapy given by a licensed Speech Pathologist/Therapist; or Audio therapy given by a licensed Audiologist; or Psychotherapy given by a licensed Psychologist. These sessions may be given at an institute of physical medicine and rehabilitation, a Hospital, or the Insured Person’s home. These treatments must be given on an Outpatient basis unless the primary purpose of a Hospital confinement is for treatment of Cancer other than with physical, speech or audio therapy or psychotherapy. Benefits may not exceed $1,000 per Calendar Year.

Waiver of Premium ‐ We will waive the premiums starting on the first premium due date following a 60 day period of Total Disability of the Named Insured due to Cancer. The Named Insured must: (a) be receiving treatment for such Cancer for which benefits are payable under this Certificate; and (b) remain disabled for 60 consecutive days. We will waive premiums for as long as the Named Insured remains Totally Disabled.

THIS IS A CANCER ONLY POLICY, which should be used to supplement your existing health care protection.

RENEWABILITY. Coverage will terminate when the Group Master Policy terminates or when required premium remains unpaid after expiration of the Grace Period.

PREMIUM RATES. We may change the premium rates for coverage only if we also change the rates for all other Certificates issued under the Group Master Policy.

EXCLUSIONS AND LIMITATIONS. No benefits will be paid under the Certificate or any attached riders for: 1. any loss due to any disease or illness other than Cancer, or a listed covered Specified Disease; 2. care and treatment received outside the territorial limits of the United States; 3. treatment by any program engaged in research that does not meet the criteria for Experimental Treatment as defined; 4. treatment that has not been approved by a Physician as being medically necessary; or 5. losses or medical expenses incurred prior to the Certificate Effective Date of an Insured Person’s coverage regardless of the Date of Positive Diagnosis.

PRE‐EXISTING CONDITIONS LIMITATION. Relative to any Insured Person, We will not pay benefits for expenses resulting from Pre‐ existing Conditions during the 12 months after coverage becomes effective.

“Pre‐existing Condition” means Cancer, or a listed Specified Disease if that optional rider is issued, which was diagnosed by a Physician or for which medical consultation, advice or treatment was recommended by or received from or sought from a Physician within 1 year prior to the effective date of coverage for each Insured Person.

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Cancer Additional Benefit Amounts

Plan A Maximum

Plan B Maximum

$100 Per $50 Per Calendar Year Calendar Year Basic Benefit– We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, once per calendar year per Insured Person for screening tests performed to determine whether Cancer exists in an Insured Person. Covered annual Cancer screening tests include but are not limited to: mammogram, pap smear, breast ultrasound, ThinPrep, biopsy, chest x‐ray, thermography, colonoscopy, flexible sigmoidoscopy, hemocult stool specimen, PSA (blood test for prostate cancer) CEA (blood tests for colon cancer), CA125 (blood test for ovarian cancer) CA15‐3 (blood test for breast cancer) serum protein electrophesis (blood test for myeloma) $200 Per $100 Per Additional Benefit Calendar Year Calendar Year We will pay the4 expense incurred, but not to exceed two times the maximum benefit amount per calendar year as shown on the Certificate Schedule, for one additional invasive diagnostic procedure for an Insured Person. This additional benefit is payable regardless of the results of the additional diagnostic procedure. However, the amount payable will be reduced dollar for any dollar payable under the Positive Diagnosis Benefit contained in the base Certificate First Occurrence Benefit Rider (Form LG‐6043) If the Insured Person received a positive diagnosis of internal Cancer, We will pay the $5,000 Once $2,500 Once First Occurrence benefit amount shown on the Certificate Schedule Per Lifetime Per Lifetime If the Insured Person receiving the positive diagnosis of Internal Cancer is a child under the age of 21, we will pay one and one‐half times the First Occurrence benefit amount $7,500 Once $3,750 Once shown on the Certificate Schedule Per Lifetime Per Lifetime Daily Radiation, Chemotherapy, Immunotherapy, and Experimental Treatment Benefit $300 Per Day $100 Per Day Rider (Form LG‐6046) We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule for each day that an Insured Person receives one or more of the following treatments for Cancer: (1) Chemotherapy (including Hormonal Therapy) or Immunotherapy; (2) Self‐injected Chemotherapy or Immunotherapy drugs, limited to the maximum daily benefit amount per treatment; (3) Chemotherapy or Immunotherapy drugs dispensed by a pump or implant, limited to the maximum daily benefit amount for the initial prescription and an equal amount for each refill; (4) Oral Chemotherapy or Immunotherapy, limited to the maximum daily benefit amount per prescription; (5) Radiation Treatment. Benefits payable for interstitial or intracavitary applications of Radiation Treatments are payable on the day of insertion only and not for each day the Radiation Treatment remains in the body; or (6) Experimental Treatment. The benefit amount shown on the Certificate Schedule is the maximum daily benefit available per Insured Person regardless of the number or types of Cancer treatments received on the same day.

Surgical Benefit Rider (Form LG 6048) Surgical Expense ‐ We will pay the Surgical Expense benefit for a surgical procedure for the treatment of an Insured Person’s Cancer (except Skin Cancer) according to the $3,500 $2,000 Surgical Schedule shown in this rider. However, in no event will the amount payable Procedure Procedure exceed the maximum Surgical Expense benefit shown on the Certificate Schedule, nor Maximum Maximum will it exceed the expense incurred Anesthesia Expense ‐ We will pay the anesthesia expense incurred, not to exceed 25% of $875 $500 the covered Surgical Expense benefit for the operation performed. This includes the Procedure Procedure services of an anesthesiologist or of an anesthetist under supervision of a physician for Maximum Maximum the purpose of administering anesthesia Breast Reconstruction ‐ with transverse rectus adominis myocutaneous flap (TRAM), single pedicle, including closure of donor site, with microvascular anastomosis $3,150 $1,800 (supercharging) is one of the surgical procedures listed in the Surgical Schedule. If this Procedure Procedure procedure is performed on an Insured Person as the result of a mastectomy for which Maximum Maximum We paid a Surgical Expense benefit for the treatment of Breast Cancer, We will pay the expense incurred not to exceed $900 per $1,000 of the Surgical Benefit Issued Skin Cancer Surgery Expense ‐ We will pay the expense incurred, not to exceed the procedure amount listed in this rider ($125 to $750 depending on the procedure) when a surgical operation is preformed on an Insured Person for treatment of a diagnosed Skin Per Procedure Per Procedure Cancer. This benefit is payable in lieu of any benefits for Surgical Expense and Aneshesia Expense which are not applicable to Skin Cancer.

Annual Cancer Screening Benefit Rider (Form LG‐6041)

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Cancer Additional Benefit Amounts Continued

Plan A Maximum

Plan B Maximum

Daily Hospital Confinement Benefit Rider (form LG‐6042) Confinements of 30 Days or Less ‐ We will pay the Daily Hospital Confinement benefit amount shown on the Cer ficate Schedule for each of the first 30 days in each period of $200 Per Day $100 Per Day hospital confinement during which an Insured Person is confined to a hospital, including a government or charity hospital, for the treatment of Cancer.

Confinement of 31 Days or More ‐ If an Insured Person is continuously confined to a hospital, including a government or charity hospital, for longer than 30 consecutive days for the treatment of Cancer, We will pay two times the Daily Hospital Confinement $400 Per Day $200 Per Day benefit amount shown on the Certificate Schedule. This benefit payment will begin on the 31st continuous day of such confinement and continue for each day of confinement until the Insured Person is discharged from the Hospital.

Benefits for an Insured Dependent under Age 21 - The amount payable under this $400/$800 $200/$400 benefit will be double the Daily Hospital Confinement benefit shown in the Certificate Per Day Per Day Schedule if the Insured Person so confined is a dependent Child under the age of 21.

Specified Disease Benefit Rider - If an Insured Person is first diagnosed with one or more covered Specified Diseases (for list of specific diseases please see detailed policy) and is hospitalized for the definitive treatment of any covered Specified Disease, We ill pay benefits according to the provisions of this rider. An applicant may select 1, 2, or 3 units of coverage.

Initial Hospitalization Benefit - We will pay a benefit of $1,500 per units of coverage selected when an Insured Person is confined to a hospital (for 12 or more hours, not applicable in SD) as a result of receiving treatment for a Specified Disease. This benefit is payable only once per period of confinement and once per calendar year for each Insured Person.

Hospital Confinement Benefit - We will pay a benefit of $300 per day per unit of coverage selected when an Insured Person is hospitalized during any continuous period of 30 days or less for the treatment of a covered Specified Disease. Benefits will double per day beginning the 31st day of continuous confinement. *If the hospital confinement follow a previously covered confinement, it will be deemed a continuation of the first confinement unless it is a result of an entirely different Specified Disease, or unless the confinements are separated by 30 days or more.

Optional Benefits You May Select for Additional Premium

Benefit Amount

Hospital Intensive Care Unit Benefit Rider (Form LG‐6047) Intensive Care Unit Benefit - We will pay the daily Hospital ICU Benefit shown on the Certificate Schedule for $500 Per Day an Insured Person’s confinement in an ICU for sickness or Injury.

Double Intensive Care Unit Benefit - We will pay double the daily Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for an Insured Person’s confinement in an ICU as a result of Cancer. We will also double this ICU benefit for only the initial ICU confinement resulting from an Insured Person’s travel related injury, provided that the ICU confinement begins within 24 hours of the accident $1,000 Per Day causing the travel related injury. A travel related injury includes being struck by an automobile, bus, truck, van, motorcycle, train or airplane; or being involved in an accident where the Insured Person was the operator or passenger in or on such vehicle.

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

Additional Limitations and Exclusions for the Hospital ICU Care Unit Benefit Rider - If the rider is issued and coverage is in force, it will provide benefits if an Insured Person goes into a hospital Intensive Care Unit (including a Cardiac Intensive Care Unit or Neonatal Intensive Care Unit). Benefits start the first day of confinement in an ICU for sickness or injury. Any combination of benefits payable under this rider is limited to a maximum of 45 days per each period of confinement. *ALL BENEFITS CONTAINED IN THIS HOSPITAL ICU BENEFIT RIDER REDUCE BY ONE‐HALF AT AGE 75 Benefits are not payable for any ICU or Step Down Unit confinement that results from intentional self‐inflicted injury; or the Insured Person’s being intoxicated or under the influence of alcohol, drugs or any narcotics, unless administered on and according to the advice of a medical practitioner.

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Cancer Additional Benefit Amounts Continued SPECIFIED DISEASE BENEFIT RIDER (FORM LG 60‐52) If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider.

COVERS THESE 38 SPECIFIED DISEASES Addison’s Disease Amyotrophic Lateral Sclerosis Botulism Bovine Spongiform Encephalopathy Budd‐Chiari Syndrome Cystic Fibrosis Diptheria Encephalitis Epilepsy Hansen’s Disease Histoplasmosis Legionnaire’s Disease Lyme Disease

Lupus Erythmatosus Malaria Meningitis Multiple Sclerosis Muscular Distrophy Myasthenia Gravis Neimann‐Pick Disease Osteomyelitis Poliomyelitis Q Fever Rabies Reye’s Syndrome Rheumatic Fever

Rocky Mountain Spotted Fever Sickle Cell Anemia Tay‐Sachs Disease Tetanus Toxic Epidermal Necrolysis Tuberculosis Tularemia Typhoid Fever Undulant Fever West Nile Virus Whipple’s Disease Whooping Cough

BENEFITS If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider. An applicant may select 1, 2, or 3, units of coverage.

Initial Hospitalization Benefit We will pay a benefit of $1,500 per unit of coverage selected when an Insured Person is confined to a hospital (for 12 or more hours, not applicable in SD) as a result of receiving treatment for a Specified Disease. This benefit is payable only once per period of confinement and once per calendar year for each Insured Person.

Hospital Confinement Benefit We will pay a benefit of $300 per unit of coverage selected when an Insured Person is hospitalized during any continuous period of 30 days or less for the treatment of a covered Specified Disease. Benefits will double per day beginning with the 31st day of continual confinement.

If the hospital confinement follows a previously covered confinement, it will be deemed a continuation of the first confinement unless it is the result of an entirely different Specified Disease, or unless the confinements are separated by 30 days or more.

All exclusions, limitations, definitions and terms of renewability of the Group Limited Benefit Cancer Policy (form LG-6040) apply to these riders. THESE ARE LIMITED RIDERS.

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CIGNA

Critical Illness

YOUR BENEFITS PACKAGE

About this Benefit Critical illness insurance is designed to supplement your medical and disability coverage easing the financial impacts by covering some of your additional expenses. It provides a benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke.

DID YOU KNOW?

$16,500 Is the aggregate cost of a hospital stay for a heart attack.

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This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

Critical Illness - NEW BENEFIT Eligibility

Portability

All active, full-time Employees of the Employer regularly working a minimum of 20 hours per week, who are United States citizens and permanent resident aliens, regularly working in the United States. Late applications require medical evidence of insurability. Excluding WA residents

Coverage may be continued upon employee’s termination of employment with employer.  Portable period is to age 100  Coverage(s) may be ported on employee, spouse/ domestic partner, and dependent child  Maximum port age is 70

Benefit Waiting Period 30 days following the effective date. Unless otherwise stated, no benefits will be paid for a covered loss which occurs during the Waiting Period

Employee Benefit Amount(s) 

Voluntary Benefits Amounts (options for employee selection): $5,000, $10,000, $15,000, $20,000, $30,000

Additional Benefit Provides an additional benefit amount equal to the plan benefit amount and percentage of the covered person for the diagnosis of a subsequent and different covered condition after a 6 month separation period.

Recurrence Benefit

(Spouse to age 70 is eligible for coverage if employee is enrolled)  100% of issued employee benefit amount (Guaranteed Issue)

Provides an additional benefit payout equal to the plan benefit amount and percentage of the covered person for each diagnosis of a subsequent and same covered condition that has received a benefit payout from a previous diagnosis, after a 12 month separation period from the previous diagnosis.

Dependent Child Benefit Amount(s)

Specific Benefit Exclusions and Limitations

Spouse/Domestic Partner Benefit Amount(s)

Child only eligible if Employee is enrolled Birth to 26  25% of issued employee benefit amount

Coverage Plan pays a lump sum cash benefit direct to the insured upon the first diagnosis, after the coverage effective date, of a covered condition from a single list of eligible conditions. Other enhancements will be defined in the policy.

   

Covered Conditions and Benefits Amount %

Stroke: Excludes: TIAs, brain injury from trauma/hypoxia/ anoxia or hypotension, or eye and ear diseases/disorders.

Major Organ Transplant: Limit: one benefit for multiorgan transplants Coronary Artery Disease (Surgery): Excludes: angioplasty, stent implants, or related procedures. Limit: paid once per lifetime per Covered Person.

Additional Critical Illness Benefit: Limit: No more than one Benefit Amount and one Additional Benefit Amount will ever be paid per Covered Person; benefits for Coronary Artery Disease is limited to once per lifetime per Covered Person. Unless otherwise stated, no benefits will be paid for a Covered Critical Illness that occurs during the Separation Period.

Recurrence Benefit Excludes: Coronary Artery Disease.

Recurrence is only payable if the insured person has not received treatment during the 12 month period between the two diagnoses. As used here, “treatment” does not include medications and follow-up visits to the insured person’s Physician.

Heart attack

100%

Stroke

100%

Renal (kidney) failure

100%

Major organ transplant

100%

Paralysis

100%

Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease)

100%

Blindness

100%

Benefit Reduction

Coronary Artery Disease (surgery)

25%

Benefits will be reduced by 50% at age 75



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Critical Illness - NEW BENEFIT Employee Paid Guaranteed Issue Level: $5,000 Uni-Tobacco Issue Age

Employee

Employee & Spouse

Employee & Child(ren)

Employee & Family

0-29

$1.20

$2.20

$1.35

$2.40

30-39

$2.55

$4.85

$2.75

$5.00

40-49

$5.00

$9.45

$5.15

$9.60

50-59

$8.70

$16.55

$8.85

$16.70

60-69

$14.10

$26.95

$14.30

$27.10

70-79

$16.20

$30.90

$16.35

$31.05

80+

$20.40

$38.95

$20.55

$39.10

Employee Paid Guaranteed Issue Level: $10,000 Uni-Tobacco 0-29

$2.40

$4.40

$2.70

$4.80

30-39

$5.10

$9.70

$5.50

$10.00

40-49

$10.00

$18.90

$10.30

$19.20

50-59

$17.40

$33.10

$17.70

$33.40

60-69

$28.20

$53.90

$28.60

$54.20

70-79

$32.40

$61.80

$32.70

$62.10

80+

$40.80

$77.90

$41.10

$78.20

Employee Paid Guaranteed Issue Level: $15,000 Uni-Tobacco 0-29

$3.60

$6.60

$4.05

$7.20

30-39

$7.65

$14.55

$8.25

$15.00

40-49

$15.00

$28.35

$15.45

$28.80

50-59

$26.10

$49.65

$26.55

$50.10

60-69

$42.30

$80.85

$42.90

$81.30

70-79

$48.60

$92.70

$49.05

$93.15

80+

$61.20

$116.85

$61.65

$117.30

Employee Paid Guaranteed Issue Level: $20,000 Uni-Tobacco

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0-29

$4.80

$8.80

$5.40

$9.60

30-39

$10.20

$19.40

$11.00

$20.00

40-49

$20.00

$37.80

$20.60

$38.40

50-59

$34.80

$66.20

$35.40

$66.80

60-69

$56.40

$107.80

$57.20

$108.40

70-79

$64.80

$123.60

$65.40

$124.20

80+

$81.60

$155.80

$82.20

$156.40

Critical Illness - NEW BENEFIT Employee Paid Guaranteed Issue Level: $30,000 Uni-Tobacco Issue Age

Employee

Employee & Spouse

Employee & Child(ren)

Employee & Family

0-29

$7.20

$13.20

$8.10

$14.40

30-39

$15.30

$29.10

$16.50

$30.00

40-49

$30.00

$56.70

$30.90

$57.60

50-59

$52.20

$99.30

$53.10

$100.20

60-69

$84.60

$161.70

$85.80

$162.60

70-79

$97.20

$185.40

$98.10

$186.30

80+

$122.40

$233.70

$123.30

$234.60

Active Service Definition An Employee will be considered in Active Service with the Employer on a day which is one of the Employer's scheduled work days if either of the following conditions are met. 



He or she is actively at work. This means the Employee is performing his or her regular occupation for the Employer on a Full-time basis, either at one of the Employer's usual places of business or at some location to which the Employer's business requires the Employee to travel.

Exclusions and Limitations In addition to any benefit-specific exclusions, benefits will not be paid for any Covered Loss which, directly or indirectly, in whole or in part, is caused by or results from any of the following unless coverage is specifically provided for by name in the Description of Benefits section: 

 The day is a scheduled holiday, vacation day or period of Employer approved paid leave of absence, other than disability or sick leave after 7 days*.

An Employee is considered in Active Service on a day which is not one of the Employer's scheduled work days only if he or she was in Active Service on the preceding scheduled work day. *7 days is variable and may be adjusted to align with sick leave/ disability policies

 





Intentionally self-inflicted Injury, suicide or any attempt thereat while sane or insane; Commission or attempt to commit a felony or an assault; Declared or undeclared war or act of war; A Covered Loss that results from active duty service in the military, naval or air force of any country or international organization. Upon Our receipt of proof of service, We will refund any premium paid for this time.

Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days; Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage; Operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant.

“Under the influence of alcohol”, for purposes of this exclusion, means intoxicated, as defined by the law of

49

NBS

HSA (Health Savings Account)

YOUR BENEFITS PACKAGE

About this Benefit A Health Savings Account is a tax-advantaged medical savings account available to employees who are enrolled in a high-deductible health plan. The funds contributed to the account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent.

DID YOU KNOW? The interest earned in an HSA is tax free.

Money withdrawn for medical spending never falls under taxable income.

50

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

HSA (Health Savings Account) You can use your Health Savings Account (HSA) to pay for a wide range of IRS-qualified medical expenses for yourself, your spouse or tax dependents. An IRS-qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medications. Funds used to pay for IRS-qualified medical expenses are always tax-free.

What is an HSA? 

 



A tax-advantaged savings account that you use to pay for eligible medical expenses as well as deductible, co-insurance, prescriptions, vision and dental care. Allows you to save while reducing your taxable income.

Unused funds that will roll over year to year. There’s no “use it or lose it” penalty.

Potential to build more savings through investing. If you maintain a minimum balance of $2,000, your additional funds may be invested in mutual funds yielding tax‐free earnings.

A way to accumulate additional retirement savings. After age 65, funds can be withdrawn for any purpose without penalty.

Participant Account Web Access www.nbsbenefits.com A Health Savings Account (HSA) works with a high deductible health plan (HDHP) and lets you set aside a portion of your paycheck ‐ before taxes– into an account to help you pay for medical expenses before you reach your deductible or that you aren’t covered by your plan. It can also help you pay for future medical expenses.

A Health Savings Account (HSA):  

Grows with you. If you maintain a balance of $2,000, your additional funds may be invested in mutual funds yielding tax‐free earnings.

Helps you plan for the future. Until you turn 65, withdrawals used for eligible expenses are tax free. After you turn 65, or if you become disabled, your HSA account becomes similar to a regular IRA. Withdrawals you use for non-eligible expenses will be taxed at your regular income tax rate but won’t incur additional penalties.

Using Funds

For a list of sample expenses, please refer to the Humble ISD benefit website at www.mybenefitshub.com/humbleisd

Pre-paid Debit Card: You may use the card to pay merchants or service providers that accept Master Card credit cards, so there is no need to pay cash up front and wait for reimbursements.

NBS Contact Information

2016 Annual HSA Contribution Limits Individual: $3,350 Family: $6,750 Catch-Up Contributions: Account holders over the age of 55 who have not yet enrolled in Medicare are eligible to make an additional $1,000 “catch‐up” contribution to their HSA.

P.O. Box 6980 West Jordan, UT 84084 Phone‐800‐274‐0503 Fax‐800‐478‐1528 Email: service@nbsbenefits.com

Will my HSA Funds be up fronted to me? Like a savings account, you can only withdrawal what you’ve contributed to the account.

Funds are not up fronted.

Are there any monthly fees? No, there are no monthly fees.

51

NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

About this Benefit A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a pre-established amount of money per plan year in a Healthcare Flexible Spending Account (FSA).

Funds allocated to a healthcare FSA must be used during the plan year or are forfeited unless your plan contains a $500 rollover or grace period provision.

Unlimited FSA (Non HSA Compatible) The funds in the unlimited healthcare FSA can be used to pay for eligible medical expenses like deductibles, co-payments, orthodontics, glasses and contacts.

FLIP TO‌ PG. 11 FOR HSA VS. FSA COMPARISON

52

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

FSA (Flexible Spending Account) NBS Flexcard

When Will I Receive My Flex Card?

You may use the card to pay merchants or service providers that accept MasterCard® credit cards, so there is no need to pay cash up front, then wait for reimbursement. If you are participating in the Dependent Care portion, the money isn’t loaded to the card.

You must file web or paper claims or enroll in continual reimbursement.

NBS Prepaid MasterCard® Debit Card

Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years. If you throw away your cards, there is a $5.00 fee to replace them.

Expect Flex Cards to be delivered to the address listed in THEbenefitsHUB near the end of September.

Don’t forget, Flex Cards Are Good For 3 Years!

For a list of sample expenses, please refer to the Humble ISD benefit website: www.mybenefitshub.com/humbleisd

NBS Contact Information: 8523 South Redwood Road West Jordan, UT 84088 Phone (800) 274‐0503 Fax (800) 478‐1528 Email: service@nbsbenefits.com

New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. Cards will be sent in unmarked envelopes so please watch for them as they should arrive within 21 business days of effective date. NBS debit cards are good for 3 years.

FSA Annual Contribution Max:

DID YOU KNOW? FSAs use tax-free funds to help pay for your Health Care Expenses.

$2,550

Dependent Care Annual Max: $5,000

Account Information: Participant Account Web Access: www.participant.nbsbenefits.com Participants may call NBS and talk to a representative during regular business hours, Monday-Friday, 8 am to 7 pm Central Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to the NBS website: www.NBSbenefits.com     

Detailed claim history and processing status Health Care and Dependent Care account balances Claim forms, Direct Deposit form, worksheets, etc.

Online claims FAQs 53

FSA Frequently Asked Questions What is a Flexible Spending Account?

A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend.

How does a Flexible Spending Account Benefit Me? A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. Your contributions are deducted from your pay before taxes are withheld. Because you are taxed on a lower amount of pay, you pay less in taxes and you have more to spend. Eligible expenses must be incurred within the plan year and contributions are useit-or- lose-it. Remember to retain all your receipts.

Health Care Expense Account Example Expenses:          

Acupuncture Body scans Breast pumps Chiropractor Co-payments Deductible Diabetes Maintenance Eye Exam & Glasses Fertility treatment First aid



       

Hearing aids & batteries Lab fees Laser Surgery Orthodontia Expenses Physical exams Pregnancy tests Prescription drugs Vaccinations Vaporizers or humidifiers

Dependent Care Expense Account Example Expenses:    

Before and After School and/or Extended Day Programs The actual care of the dependent in your home.

Preschool tuition.

The base costs for day camps or similar programs used as care for a qualifying individual.

What Can I Use My Flexible Spending Account On? For a full list of eligible expenses, please refer to www.mybenefitshub.com/humbleisd

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What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)?

Eligible expenses must be incurred within the plan year +75 day run-out period. Contributions are use-it-or- lose-it.

Remember to retain all your receipts (including receipts for card swipes).

How Do I File A Claim?

In most situations, you will be able to swipe your card however, in the event you lose your card or are waiting to receive one, you can visit www.mybenefitshub.com/ humbleisd and complete the “Claim Form” to send to NBS or use the web or phone app to file online.

How To Receive Your Dependent Care Reimbursement Faster.

A Direct Deposit form is available on the Benefits Website which will help you get reimbursed quicker!

How the FSA Plan Works You designate an annual election of pre-tax dollars to be deposited into your health and dependent-care spending accounts. Your total election is divided by the number of pay periods in the Plan year and deducted equally from each paycheck before taxes are calculated. By the end of the Plan year, your total election will be fully deposited.

However, you may make a claim for eligible health FSA expenses as soon as they are incurred during the Plan year. Eligible claims will be paid up to your total annual election even if you have not yet contributed that amount to your account.

Get Your Money 1.

2.

3.

4.

Complete and sign a claim form (available on our website) or an online claim.

Attach documentation; such as an itemized bill or an Explanation of Benefits (EOB) statement from a health insurance provider.

Fax or mail signed form and documentation to NBS. Receive your non-taxable reimbursement after your claim is processed either by check or direct deposit.

NBS Flexcard—FSA Pre-paid Benefit Card Your employer may sponsor the use of the NBS Flexcard, making access to your flex dollars easier than ever. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.

Account Information Participants may call NBS and talk to a representative during our regular business hours, Monday–Friday, 7am to 6pm Mountain Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at (801) 838-7324 or toll free (800) 274-0503. For immediate access to your account information at any time, log on to our website: www.NBSbenefits.com Information includes:  Detailed claim history and processing status  Health Care and Dependent Care account balances  Claim forms, worksheets, etc.  Online Claim Submission

Enrollment Considerations After the enrollment period ends, you may increase, decrease, or stop your contribution only when you experience a qualifying “change of status” (marriage status, employment change, dependent change). Be conservative in the total amount you elect to avoid forfeiting money that may be left in your account at the end of the year. Your employer may allow a short grace period after the Plan year ends for you to submit qualified claims for any unused funds.

55

NBS

403(b) Plan

YOUR BENEFITS PACKAGE

About this Benefit A 403(b) plan is a U.S. tax-advantaged retirement savings plan available for public education organizations.

DID YOU KNOW?

38% of Americans don’t actively save for retirement at all.

56

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

403(b) Plan What are the benefits of contributing to a 403(b) Plan?

LOWER TAXES The 403(b) contributions you make can be on a pre-tax basis. This means that the money used to invest in the 403(b) plan is not taxed until the funds are withdrawn. For example, if your federal marginal income tax rate is 25%, and you contribute $100 a month to a 403(b) plan, you have reduced your federal income taxes by nearly $25. In effect, your $100 contribution costs you only $75. The tax savings grow with the size of your 403(b) contribution.

How to Enroll in the Plan Your employer has provided investment option(s) for you. A list of approved vendor(s) and the Salary Reduction Agreement (“SRA”) can be found by visiting the (NBS) website at NBSbenefits.com/403b or by contacting NBS (contact information below).

Once you have chosen an approved vendor, please open a 403(b) account directly with them. To begin investing, send the completed SRA form to NBS who will work with your employer to begin contributions.

TAX-DEFERRED GROWTH In your 403(b) plan, interest and earnings grow tax-deferred. This means that your interest will grow tax-free until the time of your withdrawal. The compounding interest on your 403(b) plan allows your account to grow more quickly than money saved in a taxable account where interest and earnings are taxed each year.

Investment Choices

TAKING THE INITIATIVE Contributing to a 403(b) retirement plan helps you take control of your future retirement needs. Other sources of retirement income, including state pension plans and Social Security, often do not adequately replace a person’s salary upon retirement. A 403(b) plan can be a great way to supplement your income at retirement.

Transfers

POSSIBLE TAX CREDITS Pre-tax contributions may put you in a lower tax bracket reducing your overall tax rate.

ROTH You may also choose to invest part of your income on an aftertax (Roth) basis. Roth contributions are taxed at the time of the investment though contributions and earnings grow tax-free until withdrawn. Qualified distributions will allow you to withdraw your money tax-free.

HIGHER LIMITS Annual contribution limits are much higher than those of an IRA.

How much can you contribute to a 403(b) Plan?

You may elect to save:  100% of your income up to $18,000 (2016)  Extra $6,000 if age 50+ REQUIRED MINIMUM DISTRIBUTIONS (RMD) Distributions are required at age 70 ½. Exceptions may apply.

Annuity contracts made available through insurance companies or custodial accounts through a retirement account custodian are allowed in 403(b) plans. You will need to contact the vendor for a comprehensive listing and information regarding the available investment options.

As a participant in the 403(b) Plan, you have the option to move funds, or “transfer” tax-free between different vendors within the same plan.

Rollovers You also have the option of rolling retirement funds from previous employers to your current employer’s plan thus simplifying retirement management.

Distributions from the Plan You or your beneficiary will be able to withdraw your vested balance when one of the following occurs: 1. Retirement 2. Termination of Employment 3. Attainment of Age 59 ½ 4. Total Disability 5. Death *The vendors may require additional paperwork.

Loans You may borrow up to 50% of your vested balance up to $50,000 (whichever is less). Contact your current vendor about their specific loan provisions.

Hardship Distributions An in-service hardship distribution may be allowed if you satisfy certain criteria. Contact NBS for more information about the requirements. If you take a hardship distribution you are required to stop making contributions for 6 months.

57

NBS

457(b) Plan

YOUR BENEFITS PACKAGE

About this Benefit A 457(b) plan is a tax-deferred compensation plan provided for employees of certain tax-exempt, governmental organizations or public education institutions.

DID YOU KNOW?

Only 22% of workers are very confident they will have enough money in retirement.

58

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

457(b) Plan What are the benefits of contributing to a 457 Plan?

LOWER TAXES The 457 contributions you make can be on a pre-tax basis. This means that the money used to invest in the 457 plan is not taxed until the funds are withdrawn. For example, if your federal marginal income tax rate is 25%, and you contribute $100 a month to a 457 plan, you have reduced your federal income taxes by nearly $25. In effect, your $100 contribution costs you only $75. The tax savings grow with the size of your 457 contribution.

How to Enroll in the Plan Your employer has provided investment option(s) for you. A list of approved vendor(s) and the Salary Reduction Agreement (“SRA”) can be found by visiting the (NBS) website at NBSbenefits.com/403b or by contacting NBS (contact information below).

Once you have chosen an approved vendor, please open a 457 account directly with them. To begin investing, send the completed SRA form to NBS who will work with your employer to begin contributions.

TAX-DEFERRED GROWTH In your 457 plan, interest and earnings grow tax-deferred. This means that your interest will grow tax-free until the time of your withdrawal. The compounding interest on your 457 plan allows your account to grow more quickly than money saved in a taxable account where interest and earnings are taxed each year.

Investment Choices

TAKING THE INITIATIVE Contributing to a 457 plan helps you take control of your future retirement needs. Other sources of retirement income, including state pension plans and Social Security, often do not adequately replace a person’s salary upon retirement. A 457 plan can be a great way to supplement your income at retirement.

Transfers

POSSIBLE TAX CREDITS Pre-tax contributions may put you in a lower tax bracket reducing your overall tax rate.

You also have the option of rolling retirement funds from previous employers to your current employer’s plan thus simplifying retirement management.

ROTH You may also choose to invest part of your income on an aftertax (Roth) basis. Roth contributions are taxed at the time of the investment though contributions and earnings grow tax-free until withdrawn. Qualified distributions will allow you to withdraw your money tax-free.

Distributions from the Plan

Annuity contracts made available through insurance companies or custodial accounts through a retirement account custodian are allowed in 457 plans. You will need to contact the vendor for a comprehensive listing and information regarding the available investment options.

As a participant in the 457 Plan, you have the option to move funds, or “transfer” tax-free between different vendors within the same plan.

Rollovers

HIGHER LIMITS Annual contribution limits are much higher than those of an IRA.

You or your beneficiary will be able to withdraw your vested balance when one of the following occurs: 1. Retirement 2. Termination of Employment 3. Attainment of Age 70 ½ 4. Total Disability 5. Death *The vendors may require additional paperwork.

How much can you contribute to a 457 Plan?

Loans

You may elect to save:  100% of your income up to $18,000 (2016)  Extra $6,000 if age 50+  Limits are completely separate from those made to 403(b) or 401(k) accounts REQUIRED MINIMUM DISTRIBUTIONS (RMD) Distributions are required at age 70 ½. Exceptions may apply.

You may borrow up to 50% of your vested balance up to $50,000 (whichever is less). Contact your current vendor about their specific loan provisions.

Unforeseeable Emergency An unforeseeable emergency distribution may be allowed if you satisfy certain criteria. Contact NBS for more information about the requirements.

457 Special Catch-Up Provision This provision allows you to makeup, or “catchup” for prior years in which you may not have contributed the maximum amount to your employer’s plan. Contact National Benefit Services (NBS) for more information.

59

GENWORTH FINANCIAL

Long Term Care

YOUR BENEFITS PACKAGE

About this Benefit Long Term Care insurance is designed to help create a safety net if you are no longer able to care for yourself. If you suffer from an eligible prolonged illness, disability or cognitive disorder, long term care insurance will provide financial support.

DID YOU KNOW?

60% of Americans do not have a “rainy day� fund to cover three months of unanticipated financial emergencies.

60

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the Humble ISD Benefits Website: www.mybenefitshub.com/humbleisd

Long Term Care

Q. What is long term care?

A. Long term care is a variety of services and supports to meet health or personal care needs over an extended period of time.

Most long term care is non-skilled personal care assistance, such as helping perform everyday Activities of Daily Living (ADLs), which are: bathing, dressing, toileting, transferring, continence and eating.

Q. How does long term care insurance fit into my overall financial plan?

A. Neither health nor disability insurance are designed to cover long term care services. If it’s necessary to pay for care out of your pocket, you could quickly deplete the savings and retirement funds you’ve worked so hard to accumulate. Long term care insurance can help you protect your hard-earned money from the high cost of long term care.

Q. Is long term care insurance the same as long term disability insurance?

A. No. Disability insurance is designed to replace a portion of your income and is usually used to pay for basic living expenses. Long term care insurance is specifically designed to help pay for long term care services.

Q. Is home care covered?

A. Yes, this comprehensive group long term care insurance program will reimburse for covered care provided at home as well as in assisted living facilities, nursing homes and in the community. Coverage is subject to your daily or monthly maximum.

Q. Who should buy long term care insurance?

A. Regardless of age, anyone could suddenly be in a situation where long term care services are needed. A broken bone, chronic disease, or severe cognitive impairment, such as Alzheimer’s, could mean months or years of ongoing care. Long term care insurance is specifically designed to help pay for long term care.

Q. What is the Texas Partnership for Long Term Care Program?

A. Texas has elected to participate in a Long Term Care Partnership Program. The Program is authorized by federal legislation and is designed to help provide asset protection for those who own long term care insurance and seek to access to Medicaid benefits. Medicaid is a health plan funded by state and federal government that pays for certain long-term care costs for persons that meet certain income and resource minimums. With Partnership-qualified long term care insurance, the resource minimum can be disregarded to the extent that benefits under the coverage are paid. This means that the Partnership-qualified long term care insurance will protect a portion of your assets (to the extent that benefits are paid), enabling you to qualify for Medicaid without depleting all of your resources. For example, if you received $50,000 in benefits under Partnership-qualified insurance, you may receive $50,000 of asset protection in qualifying for Medicaid.

Without Partnership-qualified long term care insurance, the Texas Health and Human Services Commission may require you to spend the $50,000 for long term care services, along with other assets you may have, prior to becoming eligible for Medicaid. This is often referred to as “spending down”.

Frequently Asked Questions

Q. Shouldn’t members wait until they’re older?

A. Buying early offers several advantages. Premium rates are primarily based on age at the time of purchase. Typically, the older the age, the higher the premium rate. Another very good reason not to wait is that an accident or illness could happen at any time. If this occurs, it may not be possible to meet even modified underwriting requirements for coverage.

Q. What are the benefits of buying through a group long term care insurance program?

A. The group long term care insurance program offers several benefits:  Affordable group premiums.  Easier approval process than with most individual insurance policies.  Continue coverage if you leave the group.  Payroll deductions may be available.  Pre-selected coverage features tailored for the group.  Designed to make selecting plan options easy.

Q. Is long term care insurance affordable?

A. The cost of long term care insurance coverage varies depending on your age, the state where you live and the options chosen.

Many people find the premiums to be more affordable than they expect. Compare what you could pay for just one year in a nursing home to the total you might pay in premiums.

You can apply for coverage under the TRS Program that qualifies for the Texas Partnership for Long Term Care Program. In order to qualify, you must select an age qualifying benefit increase option for their plan. To learn which benefit increases options qualify, please go to the dedicated website, get a quote, benefit increase options section. Or, call customer service at 866-659-1970.

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Long Term Care Eligibility Eligible persons include Texas public school active Employees* who are contributing members of the Teacher Retirement System of Texas and Retirees,** their spouses, parents and parents-in-law, and grandparents and who are between the ages of 18 and 80.

Eligible persons must be U.S. residents. All applications are subject to the underwriting requirements of Genworth Life Insurance Company. (Genworth Life.)

Public School means a school district; another education district whose employees are members of the Teacher Retirement System of Texas; a regional education service center established under Chapter 8, Texas Education Code; and an open-enrollment charter school established under Subchapter D, Chapter 12, Texas Education Code * Employee: A contributing member of the Teacher Retirement System of Texas who is employed by a Public School and is not entitled to coverage in a group insurance program under the Texas Employees Group Benefits Act or the State University Employees Uniform Insurance Benefits Act. ** Retiree: A former contributing member of the Teacher Retirement System of Texas who has retired under the Teacher Retirement System of Texas, and who satisfies the age and service requirements determined by the Policyholder and is not entitled to coverage in a group insurance program under the Texas Employees Group Benefits Act or the State University Employees Uniform Insurance Benefits Act.

Underwriting  

  

Current, active TRS members and their spouses may apply for this coverage subject to Genworth Life’s underwriting requirements.

Employees in their first TRS-covered position have 90 days beginning on their employment date to apply for this coverage with no medical underwriting or streamlined underwriting, depending on their age and the plan they choose. Streamlined underwriting is a short form application. Based on the applicant’s answers medical records may be requested, and in some instances, a 20 or 30 minute telephone interview may also be required. Their spouses may apply with streamlined underwriting, depending on their age.

Retirees and their spouses may apply for this coverage subject to Genworth Life’s underwriting requirements.

Newly retired TRS members under the age of 60 may apply for this coverage with streamlined underwriting for the first 90 days following the effective date of their retirement.

Other eligible family members may also apply for this coverage, subject to Genworth Life’s underwriting requirements.

Resources for Members

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

Visit the website Active Members: www.genworth.com/trsactivemember Retirees: www.genworth.com/trsretiree



Request an Information Kit on the web or call 1-866-659-1970



Questions? Call Customer Service at 1-866-659-1970, M-F, 7am - 7pm (Central Time)

Long Term Care

PLAN OFFERING Monthly Benefit Options Total Coverage Options

Benefit Increase Options

Home Health Care Benefit

Elimination Period

 $3,000

 $4,500

Starting at: $108,000

Future Purchase Option

75% of selected Monthly Benefit Option

90 Calendar Day

 $6,000

 $7,500

Up to :

3% Compound for Life

$900,000

5% Compound for Life Plan premiums are based on the age of the applicant and his/her plan choices.

TEXAS COST OF CARE REFERENCE For the costs of care outside of Texas, visit www.genworth.com/trsactivemember

Home Health Aide Services

Assisted Living Facility

Nursing Home

(Non-Medicare Certified, Licensed) Average Monthly1 Rates

(Private One Bedroom) Average Monthly Rates

(Private Room) Average Monthly Rates

United States

$3,623

$3,261

$6,475

Texas

$3,423

$3,210

$5,019

Location

1

Based on 44 hours of home care per week. Source: Genworth 2011 Cost of Care Survey conducted by CareScout®, April 2011.

63

NOTES

64

NOTES

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www.mybenefitshub.com/humbleisd

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