2017 Fall Benefit Guide Hillsboro ISD

HILLSBORO ISD

BENEFIT GUIDE EFFECTIVE:

09/01/2017 - 08/31/2018 WWW.MYBENEFITSHUB.COM/ HILLSBOROISD

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Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. What’s New 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements TRS ActiveCare Aetna MDLIVE Telehealth HSA Bank Health Savings Account (HSA) Companion Special Insurance Services (SIS) Cigna Dental Superior Vision AUL a OneAmerica Company Disability APL Cancer AUL a OneAmerica Compant Life and AD&D Voya Accident Voya Critical Illness Permanent Life 5Star NBS Flexible Spending Accounts (FSAs) ID Theft Protection Legal Shield 403(b) Retirement Plan 457 Retirement Plan

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3 4-5 6-8 6 7 8 9 10 12-13 14-17 18-19 20-23 24-25 26-29 30-35 36-39 40-43 44-45 46-49 50-53 54-55 56-57 58-59

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PG. 4 HOW TO HOW TO ENROLL ENROLL

PG. 6 SUMMARY PAGES

PG. 10 YOUR BENEFITS

Benefit Contact Information

Benefit Contact Information HILLSBORO BENEFITS

DISABILITY

LEGAL SERVICES

Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/hillsboroisd

AUL a OneAmerica Company (800) 537-6442 https://www.oneamerica.com

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

MEDICAL

CANCER

403(B) RETIREMENT PLAN

TRS Active Care - Aetna (800) 222-9205 www.trsactivecareaetna.com

American Public Life (800) 256-8606 www.ampublic.com

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

PHARMACY

CRITICAL ILLNESS

457 RETIREMENT PLAN

Caremark (800) 222-9205/Option 2 www.caremark.com/trsactivecare

Voya (972) 225-1524 www.voya.com

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

MEDICAL GAP

ACCIDENT

3121 FICA ALTERNATIVE PLAN

Companion Life/Benefit Connection (972) 788-0699 www.benefitconnect.com

Voya (972) 225-1524 www.voya.com

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

DENTAL

BASIC AND VOLUNTARY LIFE

FLEXIBLE SPENDING ACCOUNTS (FSAs )

Cigna (800) 244-6224 www.mycigna.com

AUL a OneAmerica Company (800) 537-6442 https://www.oneamerica.com

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

VISION

PERMANENT LIFE

COBRA (DENTAL AND VISION)

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

5Star Life Insurance Company (866) 863-9753 http://5starlifeinsurance.com

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

HEALTH SAVINGS ACCOUNT (HSA)

ID THEFT

HSA Bank (800) 357-6246 www.hsabank.com

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

FBS is the new Third Party Administrator for the Hillsboro ISD benefit package. Please call 469-385-4640 if you have any questions.

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MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet.

Text “FBS HILSB” to 313131 and get access to everything you need to complete your benefits enrollment: 

Benefit Information



Online Support



Interactive Tools



And more.

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Text “FBS HILSB” to 313131 OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/ hillsboroisd

CLICK LOGIN

ENTER USERNAME & PASSWORD All login credentials have been RESET to the default described below:

Username: 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.

ONLIINE SUPPORT

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.

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

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Annual Benefit Enrollment

SUMMARY PAGES

Benefit Updates - What’s New: 

Financial Benefit Services (FBS) is the new Third Party Administrator for Hillsboro ISD. FBS will conduct the annual enrollment and provide benefit support for Hillsboro ISD employees. New benefits and insurance providers have been selected by the district to provide  the best in insurance coverage at affordable rates for you as an employee of Hillsboro ISD.



Benefit elections will become effective 9/1/2017.

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

After annual enrollment closes, benefit changes can only be made if you experience a qualifying event (and changes must be made within 31 days of event.)

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Aetna remains the carrier for TRS Medical Plans: ActiveCare 1 HD, ActiveCare 2 and ActiveCare Select.

Scott and White Health Plan and First Care remain as the HMO medical plan options. All eligible employees, including active, contributing TRS members and employees regularly working 10 hours per week MUST either enroll for coverage or decline coverage in the Benefits HUB. For comprehensive TRS medical information, visit the website, www.trs.texas.gov

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A Health Savings Account with HSA Bank is a tax-free savings account available for those employees enrolled in ActiveCare 1 HD. These funds can be used to pay for medical, dental, vision or prescription expenses. The

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2017 HSA annual contribution maximum is $3,400 for individuals and $6,750 for your family. For individuals who are between 55-65, there is an additional catch-up provision of $1,000 that can be contributed annually.

NEW FSA ADMINISTRATOR! National Benefit Services is the new FSA Administrator for Hillsboro ISD. The 2017 FSA contribution limit is $2600. If you currently participate or are enrolling for the first time in a FSA or a Dependent Care FSA with Hillsboro ISD, you will receive NEW debit cards with the new provider, National Benefit Services by the end of September.

Remember, you must re-elect a new contribution amount every year to continue to participate. You can manually submit claims prior to receiving your cards.

Find the claim form on the benefits website at www.mybenefitshub.com/hillsboroisd.

NEW Benefit Offering! MDLive is the new provider for Telehealth. Enjoy unlimited phone consultations with a licensed physician for you and your household at no costs to you! A Welcome Kit and ID card can be printed from the benefit website at www.mybenefitshub.com/ hillsboro.com. This benefit is available to you even if you are not enrolled on the medical plan with the district. This benefit is not to be confused with the Telehealth benefit included in the ActiveCare plans.

Annual Benefit Enrollment

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 30 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 the Hillsboro

Changes are not permitted during the plan year (outside of

ISD benefit website: www.mybenefitshub.com/hillsboroisd.

annual enrollment) unless a Section 125 qualifying event occurs.

Click on your school district, then click on the benefit plan you need information on (i.e., Dental) and you can find the forms

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Changes, additions or drops may be made only during the

you need under 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

ISD benefit website: www.mybenefitshub.com/hillsboroisd.

included in the dependent profile. Additionally, you must

Click on your school district, then click on the benefit plan you

notify your employer of any discrepancy in personal and/or benefit information.



For benefit summaries and claim forms, go to the Hillsboro

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.

need information on (i.e., Dental) and you can find provider search links under the Quick Links section.

When will I receive ID cards?

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

dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and

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.

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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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.

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more

Dependent Eligibility: You can cover eligible dependent

regularly scheduled hours each work week.

children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the

Eligible employees must be actively at work on the plan effective

maximum age listed below. Dependents cannot be double

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

covered by married spouses within Hillsboro ISD or as both

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

employees and dependents.

work concurrent with the plan effective date. For example, if your 2017 benefits become effective on September 1, 2017, you must be actively-at-work on September 1, 2017 to be eligible for your new benefits.

PLAN

CARRIER

MAXIMUM AGE

Accident

Voya

To Age 26

Cancer

APL

To Age 26

Critical Illness

Voya

To Age 26

Dental

Cigna

To Age 26

Identity Theft

Legal Shield

To Age 25

Individual Life

5Star

To Age 24

Medical Supplement Plan

SIS Companion

To Age 26

Vision

Superior Vision

To Age 26

Voluntary Life and AD&D

AUL a OneAmerica Company

To Age 26

If your dependent is disabled, coverage can 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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2017-2018 TRS-ActiveCare Plan Highlights Hillsboro ISD offers Medical Coverage to all eligible employees and their eligible dependents. Employees who have questions about the medical insurance options should contact TRS/Aetna directly at 800.222.9205 or go to the TRS/Aetna website located at www.trsactivecareaetna.com. Premiums for the 2017-2018 Plan Year are shown in the chart below.

TRS-ActiveCare 1-HD Employee & Spouse Employee & Child(ren) Employee & Family Deductible: Employee Only $2500 & Employee Family $5000 Max Out of Pocket: Employee Only $6550 & Employee Family $13100

TRS-ActiveCare Select- Exclusive Provider Organization Employee & Spouse Employee & Child(ren) Employee & Family Deductible: Employee Only $1200 Ded. & Employee Family $3600 Ded. Max Out of Pocket: Employee Only $7150 & Employee Family $14300

TRS-ActiveCare 2

Total Monthly Hillsboro ISD Premium Contribution

Employee Monthly Deduction

$351.00

$235.00

$116.00

$991.00

$235.00

$756.00

$671.00

$235.00

$436.00

$1,316.00

$235.00

$1,081.00

Total Monthly Hillsboro ISD Premium Contribution

Employee Monthly Deduction

$514.00

$235.00

$279.00

$1,264.00

$235.00

$1,029.00

$834.00

$235.00

$599.00

$1,589.00

$235.00

$1,354.00

Total Monthly Hillsboro ISD Premium Contribution

Employee Monthly Deduction

$714.00

$235.00

$479.00

Employee & Spouse

$1,694.00

$235.00

$1,459.00

Employee & Child(ren)

$1,062.00

$235.00

$827.00

Employee & Family Deductible: Employee Only $1000 & Employee Family $3000 Max Out of Pocket: Employee Only $7150 & Employee Family $14300

$2,004.00

$235.00

$1,769.00

Scott and White HMO Employee only Employee & Spouse Employee & Child(ren) Employee & Family

Total Monthly Hillsboro ISD Premium Contribution

Employee Monthly Deduction

$561.04

$235.00

$326.04

$1,263.08

$235.00

$1,028.08

$888.42

$235.00

$653.42

$1,400.98

$235.00

$1,165.98

Deductible: Employee Only $1000 Ded & Employee Family $3000 Max Out of Pocket: Employee Only $6550 & Employee Family $13,100

First Care Employee only Employee & Spouse Employee & Child(ren) Employee & Family Deductible: Employee Only $750 Ded & Employee Family $2250 10

District Total Monthly Contribution Premium Per Month

Employee Monthly Deduction

$514.82

$235.00

$279.82

$1,287.60

$235.00

$1,052.60

$816.07

$235.00

$581.07

$1,298.52

$235.00

$1,063.52

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MDLIVE YOUR BENEFITS PACKAGE

Telehealth

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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.

75%

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

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 12 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

Telehealth When should I use MDLIVE?  If you’re considering the ER or urgent care for a nonemergency medical issue  Your primary care physician is not available  At home, traveling, or at work  24/7/365, even holidays!

What can be treated?         

Allergies Asthma Bronchitis Cold and Flu Ear Infections Joint Aches and Pain Respiratory Infection Sinus Problems And More!

Pediatric Care related to:       

Cold & Flu Constipation Ear Infection Fever Nausea & Vomiting Pink Eye And More!

Are children eligible?

Yes. MDLIVE has local pediatricians on-call 24/7/365. Please note, a parent or guardian must be present during any interactions involving minors. We ask parents to establish a child record under their account. Parents must be present on each call for children 18 or younger.

How much does it cost? $0.

One cost covers entire family with unlimited phone consultations.

Download the App Doctor visits are easier and more convenient with the MDLIVE App. Be prepared. Download today. www.mdlive.com/getapp 

   

Access to a doctor anywhere: at home, at work, or on the go Choose doctors from one of the nation's largest telehealth networks Available 24/7 by video or phone Private, secure and confidential visits Connect instantly with MDLIVE Assist

Who are our doctors?

MDLIVE has the nation’s largest network of telehealth doctors.

On average, our doctors have 15 years of experience practicing medicine and are licensed in the state where patients are located. Their specialties include primary care, pediatrics, emergency medicine and family medicine. Our doctors are committed to providing convenient, quality care and are always ready to take your call.

Scan with your smartphone to get the app.

Call us at (888) 365-1663 or visit us at www.consultmdlive.com

Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for 13 abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. For complete terms of use visit www.mdlive.com/pages/terms.html 010113

HSA BANK

HSA (Health Savings Account)

YOUR BENEFITS PACKAGE

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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.

The interest earned in an HSA is tax free.

Money withdrawn for medical spending never falls under taxable income.

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 14 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

HSA (Health Savings Account) HSA Bank has teamed up with your employer to create an  Not enrolled in Medicare (if an accountholder enrolls in affordable health coverage option that helps you save on Medicare mid-year, catch-up contributions should be healthcare expenses. This plan is only available for those who are prorated) participating in the Active Care 1-HD medical plan. You may not Authorized Signers who are 55 or older must have their own enroll in the MEDlink® plan if you participate in the HSA. HSA in order to make the catch-up contribution Depending on your district, you may or may not be able to participate in the FSA plan if you participate in HSA. Medicare, Monthly Fee: Your account will be charged a monthly fee of Medicaid, and Tricare participants are not eligible to participate $1.75, waived with an average daily balance at or above in an HSA. $3,000.

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.

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

Using Funds

Examples of Qualified Medical Expenses      

Surgery Braces Contact lenses Dentures Eyeglasses Vaccines

For a list of sample expenses, please refer to the CBEBC website at www.cbebc.com

HSA Bank Contact Information 605 N. 8th Street, Ste 320 Sheboygan, WI 53081 Phone: 800-357-6246 www.hsabank.com

Debit Card  You may use the card to pay merchants or service providers that accept VISA credit cards, so there is no need to pay cash up front and wait for reimbursements.  You can make a withdrawal at any time. Reimbursements for qualified medical expenses are tax free. If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distributions as taxable income. You may also use your funds for a spouse or tax dependent not covered by your HDHP.

2017 Annual HSA Contribution Limits Individual: $3,400 Family: $6,750 Catch-Up Contributions: Accountholders who meet the qualifications noted below are eligible to make an HSA catch-up contribution of an additional $1,000.  Health Savings accountholder  Age 55 or older (regardless of when in the year an accountholder turns 55)

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How the HSA Plan Works A Health Savings Account (HSA) is an individually-owned, taxadvantaged account that you can use to pay for current or future IRS-qualified medical expenses. With an HSA, you’ll have the potential to build more savings for healthcare expenses or additional retirement savings through selfdirected investment options1.

How an HSA works: 







You can contribute to your HSA via payroll deduction, online banking transfer, or by sending a personal check to HSA Bank. Your employer or third parties, such as a spouse or parent, may contribute to your account as well.

You can pay for qualified medical expenses with your HSA Bank Debit Card directly to your medical provider or pay out-of-pocket. You can either choose to reimburse yourself or keep the funds in your HSA to grow your savings.

Unused funds will roll over year to year. After age 65, funds can be withdrawn for any purpose without penalty (subject to ordinary income taxes).

Check balances and account information via HSA Bank’s Internet Banking 24/7.

Are you eligible for an HSA? If you have a qualified High Deductible Health Plan (HDHP) either through your employer, through your spouse, or one you’ve purchased on your own - chances are you can open an HSA. Additionally:  You cannot be covered by any other non-HSA-compatible health plan, including Medicare Parts A and B.  You cannot be covered by TriCare.  You cannot have accessed your VA medical benefits in the past 90 days (to contribute to an HSA).  You cannot be claimed as a dependent on another person’s tax return (unless it’s your spouse).  You must be covered by the qualified HDHP on the first day of the month.

When you open an account, HSA Bank will request certain information to verify your identity and to process your application.

What are the annual IRS contribution limits?

Contributions made by all parties to an HSA cannot exceed the annual HSA limit set by the Internal Revenue Service (IRS).

Anyone can contribute to your HSA, but only the accountholder and employer can receive tax deductions on those contributions. Combined annual contributions for the accountholder, employer, and third parties (i.e., parent, spouse, or anyone else) must not exceed these limits2.

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2017 Annual HSA Contribution Limits Individual = $3,400 Family = $6,750

Catch-up Contributions Accountholders who meet these qualifications are eligible to make an HSA catch-up contribution of $1,000: Health Savings accountholder; age 55 or older (regardless of when in the year an accountholder turns 55); not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated). Authorized signers who are 55 or older must have their own HSA in order to make the catchup contribution.

According to IRS guidelines, each year you have until the tax filing deadline to contribute to your HSA (typically April 15 of the following year). Online contributions must be submitted by 2:00 p.m., Central Time, the business day before the tax filing deadline. Wire contributions must be received by noon, Central Time, on the tax filing deadline, and contribution forms with checks must be received by the tax filing deadline.

How can you benefit from tax savings?

An HSA provides triple tax savings3. Here’s how:  Contributions to your HSA can be made with pre-tax dollars and any after-tax contributions that you make to your HSA are tax deductible.  HSA funds earn interest and investment earnings are tax free.  When used for IRS-qualified medical expenses, distributions are free from tax.

IRS-Qualified Medical Expenses You can use your 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 taxfree.

HSA funds can be used to reimburse yourself for past medical expenses if the expense was incurred after your HSA was established. While you do not need to submit any receipts to HSA Bank, you must save your bills and receipts for tax purposes.

How the HSA Plan Works Examples of IRS-Qualified Medical Expenses4: Acupuncture Alcoholism treatment Ambulance services Annual physical examination Artificial limb or prosthesis Birth control pills (by prescription) Chiropractor Childbirth/delivery Convalescent home (for medical treatment only) Crutches Doctor’s fees Dental treatments (including x-rays, braces, dentures, fillings, oral surgery) Dermatologist Diagnostic services Disabled dependent care Drug addiction therapy Fertility enhancement (including in-vitro fertilization) Guide dog (or other service animal)

Gynecologist Hearing aids and batteries Hospital bills Insurance premiums5 Laboratory fees Lactation expenses Lodging (away from home for outpatient care) Nursing home Nursing services Obstetrician Osteopath Oxygen Pregnancy test kit Podiatrist Prescription drugs and medicines (over-the-counter drugs are not IRSqualified medical expenses unless prescribed by a doctor) Prenatal care & postnatal treatments Psychiatrist Psychologist Smoking cessation programs

Special education tutoring Surgery Telephone or TV equipment to assist the hearing or vision impaired Therapy or counseling Medical transportation expenses Transplants Vaccines Vasectomy Vision care (including eyeglasses, contact lenses, lasik surgery) Weight loss programs (for a specific disease diagnosed by a physician – such as obesity, hypertension, or heart disease) Wheelchairs X-rays

For assistance, please contact the Client Assistance Center 800-357-6246 Monday – Friday, 7 a.m. – 9 p.m., and Saturday, 9 a.m. - 1 p.m., CT www.hsabank.com | 605 N. 8th Street, Ste. 320, Sheboygan, WI 53081

1 Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank. Investment losses which are replaced are subject to the annual contribution limits of the HSA. 2 HSA funds contributed in excess of these limits are subject to penalty and tax unless the excess and earnings are withdrawn prior to the due date, including any extensions for filing Federal Tax returns. Accountholders should consult with a qualified tax advisor in connection with excess contribution removal. The Internal Revenue Service requires HSA Bank to report withdrawals that are considered refunds of excess contributions. In order for the withdrawal to be accurately reported, accountholders may not withdraw the excess directly. Instead, an excess contribution refund must be requested from HSA Bank and an Excess Contribution Removal Form completed.

3 Federal Tax savings are available no matter where you live and HSAs are taxable in AL, CA, and NJ. HSA Bank does not provide tax advice. Consult your tax professional for tax‐related questions.

4 This list is not comprehensive. It is provided to you with the understanding that HSA Bank is not engaged in rendering tax advice. The information provided is not intended to be used to avoid Federal tax penalties. For more detailed information, please refer to IRS Publication 502 titled, “Medical and Dental Expenses”.

Publications can be ordered directly from the IRS by calling 1-800-TAXFORM. If tax advice is required, you should seek the services of a professional.

5 Insurance premiums only qualify as an IRS-qualified medical expense: while continuing coverage under COBRA; for qualified long-term care coverage; coverage while receiving unemployment compensation; for any healthcare coverage for those over age 65 including Medicare (except Medicare supplemental coverage).

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COMPANION (SIS)

YOUR BENEFITS PACKAGE

Medical Gap Insurance

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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.

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

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 18 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

Medical Gap Insurance Basic Plan Benefits offered to employees of Hillsboro ISD

Hospital Confinement Benefit* - This benefit is designed to offset the cost you incur as an in-patient in the hospital when your primary comprehensive major medical policy applies such expenses to your deductible or coinsurance maximum, up to the $1,500 plan year maximum per insured person.

Out-Patient Benefit* - This benefit offsets the cost you incur for out-patient treatment when your primary major medical policy applies such expenses to your deductible or coinsurance maximum, up to the $750 benefit limit, and up to a maximum of three outpatient occurrences per family per calendar year. An “occurrence” is the treatment, or the series of treatments, for a specific injury or illness within a plan year. Expenses related to physician office visits are not included in this benefit. Covered expenses include:   

Surgery in an Out-Patient Facility or a Physician’s Office Emergency Room visits Diagnostic testing, MRI’s, CT scans, Lab & X-ray at a diagnostic or hospital out-patient facility or at a Physician’s office if the cost is not included in the global office visit fee and is not part of wellness/preventive care

*For expenses to be eligible under this plan they must be medically necessary for the treatment of an injury or illness. Expenses not covered by your group major medical plan are not covered.

How to File a Claim When you enroll in the Benefit Connection plan, you will receive an ID card, along with specific instructions on how to file a claim.

This form outlines the procedures you should follow to obtain a claim form, what you need to file a claim, and where you should send your claim. Simply stated, you will need to submit a completed claim form, itemized bills (NOT balance due statements), and EOB’s that correspond to the itemized bills.

Claims may be filed at any time, but must be filed no longer than 12 months from the date of service in order to be eligible for coverage.

Ages 39 & Under

Ages 40 - 49

Ages 50 & Above

Monthly

Monthly

Monthly

Employee Only

$22.20

$29.35

$61.60

Employee & Spouse

$40.75

$53.88

$113.15

Employee & Child(ren)

$54.26

$58.36

$107.25

Employee & Family

$72.31

$82.26

$157.48

This information sheet highlights the important features of the product. The policy has limitations and exclusions. The exact provisions governing the insurance are contained in the master policy issued to each group on form number GAPP-4200, policy series G4200. Your carrier representative can supply you with costs and complete details of coverage.

19

CIGNA

Dental

YOUR BENEFITS PACKAGE

PLAY VIDEO

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.

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.

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 20 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

Dental PPO - High Option Cigna Dental Choice Plan Network Options

Reimbursement Levels Calendar Year Benefits Maximum Applies to: Class II & III expenses Calendar Year Deductible

In-Network: Total Cigna DPPO Network

Out-of-Network: See Non-Network Reimbursement

Based on Contracted Fees

Maximum Reimbursable Charge

$1,000

$1,000

$50 $150

$50 $150

Individual Family

Benefit Highlights Class I: Diagnostic & Preventive

Monthly PPO Premiums

Plan Pays

You Pay

Plan Pays

You Pay

100% No Deductible

No Charge

100% No Deductible

No Charge

Class II: Basic Restorative Restorative: fillings Oral Surgery: Simple Extractions Brush Biopsy

80% After Deductible

20% After Deductible

80% After Deductible

20% After Deductible

Class III: Major Restorative

50% After Deductible

50% After Deductible

50% After Deductible

50% After Deductible

Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain

Endodontics: minor and major Periodontics: minor and major Oral Surgery: All Except Simple Extractions Surgical Extractions of Impacted Teeth Anesthesia: general and IV sedation Repairs: Bridges, Crowns and Inlays Repairs: Dentures Denture Relines, Rebases and Adjustments Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures

Class IV: Orthodontia Coverage for Adults and Dependents Lifetime Benefits Maximum: $1,000

50% 50% No Deductible No Deductible

Tier

Rate

EE Only

$27.96

EE + Spouse

$70.94

EE + Children

$78.08

EE + Family

$99.98

50% 50% No Deductible No Deductible

This material is for informational purposes only and is designed to highlight some of the benefits available under this plan. Consult the plan documents to determine specific terms of coverage relating to your plan. Terms include covered procedures, applicable waiting periods, exclusions and limitations.

21

Dental PPO - Low Option Benefit Plan Provisions: In-Network Reimbursement Non-Network Reimbursement Cross Accumulation Calendar Year Benefits Maximum Calendar Year Deductible Late Entrant Limitation Provision Pretreatment Review Alternate Benefit Provision Oral Health Integration Program (OHIP)

Timely Filing Benefit Limitations: Missing Tooth Limitation Oral Evaluations X-rays (routine) X-rays (non-routine) Diagnostic Casts Cleanings Fluoride Application Sealants (per tooth) Space Maintainers Periodontal Scaling and Root Planing Inlays, Crowns, Bridges, Dentures and Partials Denture and Bridge Repairs Denture Adjustments, Rebases and Relines

Benefit Plan Provisions: For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Fee Schedule or Discount Schedule.

For services provided by a non-network dentist, Cigna Dental will reimburse according to the Maximum Reimbursable Charge. The MRC is calculated at the 90th percentile of all provider charges in the geographic area. The dentist may balance bill up to their usual fees.

All deductibles, plan maximums, and service specific maximums cross accumulate between in and out of network. Benefit frequency limitations are based on the date of service and cross accumulate between in and out of network.

The plan will only pay for covered charges up to the yearly Benefits Maximum, when applicable. Benefitspecific Maximums may also apply.

This is the amount you must pay before the plan begins to pay for covered charges, when applicable. Benefitspecific deductibles may also apply.

Payment will be reduced by 50% for Class III and IV services for 12 months for eligible members that are allowed to enroll in this plan outside of the designated open enrollment period. This provision does not apply to new hires.

Pretreatment review is available on a voluntary basis when dental work in excess of $200 is proposed.

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.

Cigna Dental Oral Health Integration Program offers enhanced dental coverage for customers with the following medical conditions: diabetes, heart disease, stroke, maternity, head and neck cancer radiation, organ transplants and chronic kidney disease. There’s no additional charge for the program, those who qualify get reimbursed 100% of coinsurance for certain related dental procedures. Eligible customers can also receive guidance on behavioral issues related to oral health and discounts on prescription and non-prescription dental products. Reimbursements under this program are not subject to the plan deductible, but will be applied to and are subject to the plan annual maximum. Discounts on certain prescription and non-prescription dental products are available through Cigna Home Delivery Pharmacy only, and you are required to pay the entire discounted charge. For more information including how to enroll in this program and a complete list of program terms and eligible medical conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24.

Out of network claims submitted to Cigna after 365 days from date of service will be denied.

For teeth missing prior to coverage with Cigna, the amount payable is 50% of the amount otherwise payable until covered for 12 months; thereafter, considered a Class III expense.

2 per calendar year Bitewings: 2 per calendar year Complete series of radiographic images and panoramic radiographic images: Limited to a combined total of 1 per 36 months Payable only in conjunction with orthodontic workup 1 routine cleaning per 6-month consecutive period, including periodontal maintenance procedures following active therapy 1 per calendar year for children under age 19 Limited to posterior tooth. 1 treatment per tooth every 36 months for children under age 14 Limited to non-orthodontic treatment for children under age 19 Limited to 1 per 24 months per quadrant Replacement every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth-colored material on molar crowns or bridges.

Reviewed if more than once Covered if more than 6 months after installation 1 every 60 months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth colored material on molar crowns or bridges.

Prosthesis Over Implant Benefit Exclusions: Covered Expenses will not include, and no payment will be made for the following:

Procedures and services not listed under Benefit Highlights; Diagnostic: cone beam imaging; Preventive Services: instruction for plaque control, oral hygiene and diet; Restorative: Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and/or third molars; Periodontic: bite registrations; splinting; Prosthodontic: precision or semi-precision attachments; Implants: implants or implant related services; Procedures, appliances or restorations, except full dentures, whose main purpose is to: change vertical dimension; diagnose or treat conditions or dysfunction of the temporomandibular joint (TMJ); stabilize periodontally involved teeth; or restore occlusion; Athletic mouth guards; Replacement of a lost or stolen appliance; Services performed primarily for cosmetic reasons; Personalization; Services that are deemed to be medical in nature; Services and supplies received from a hospital; Drugs: prescription drugs Charges in excess of the Maximum Reimbursable Charge.

Contracted 22 providers are not obligated to provide discounts on non-covered services and may charge their usual fees.

23

SUPERIOR VISION YOUR BENEFITS PACKAGE

Vision

PLAY VIDEO

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.

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

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 24 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

Vision Benefits

In-Network

Out-of-Network

Covered in full

Up to $35 retail

Frames

$125 retail allowance

Up to $70 retail

Contact Lenses4

$150 retail allowance

Up to $80 retail

Covered in full

Up to $150 retail

Exam

Medically Necessary Contact Lenses

Laser Vision Correction

$200 retail allowance3

Single Vision

Covered in full

Up to $25 retail

Bifocal

Covered in full

Up to $40 retail

Trifocal

Covered in full

Up to $45 retail Up to $45 retail

Progressive Lenticular

EE Only

$8.52

EE + Spouse

$14.48

EE + Child(ren)

$15.34

EE + Family

$23.00

Co-Pays 1

Exam

Eyewear

Lenses (standard) per pair

3

Monthly Premiums

See description Covered in full

1

$10 2

$25

Services/Frequency Exam

12 months

Frame

12 months

Lenses

12 months

Contact Lenses

12 months

Up to $80 retail

Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1 Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 2 Contact lenses and related professional services (fitting, evaluation and followup) are covered in lieu of eyeglass lenses and frames benefit

Discount Features  

Rates are guaranteed for 3 years.

Minimum requirements:  Minimum 2 enrolled employees.  The employer pays 0% of the employee premium and 0% of the dependent premium.

This quote is valid for effective dates within 90 days of the proposed effective date noted above. The proposed rates are based on the information provided to prepare this quote and the parameters outlined in this quote. This quote is subject to adjustment if actual information is materially different than that provided, or if there are changes from the parameters outlined in this quote.

Co-pays are due in full to in-network providers at the time of service. Co-pays associated with services provided by out-of-network providers will be deducted from member reimbursements.

All allowances are at a retail value; the member is responsible for any charges in excess of this retail allowance.

SuperiorVision.com Customer Service 800.507.3800    

1 Eye exam co-pay is a single payment due to the provider at the time of service.

2 Eyewear co-pay applies to eyeglass lenses / frame and contact lenses. Eyewear co-pay is a single payment that applies to the entire purchase of eyeglasses (frame and lenses) or contacts in lieu of glasses. Services and eyewear obtained through out-of-network providers are subject to the same co-payment and limitations as services through participating providers.

3 If progressives are purchased, Member receives an allowance equal to the in-network provider's usual and customary retail charge for standard trifocal lenses.

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

25

AUL a ONEAMERICA COMPANY YOUR BENEFITS PACKAGE

Disability

PLAY VIDEO

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.

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.

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 26 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

Disability Eligible Employees

Pre-Existing Condition Period

This benefit is available for employees who are actively-at-work on the effective date and working a minimum of 20 hours per week.

Certain disabilities are not covered if the cause of the disability is traceable to a condition existing prior to your effective date of coverage.

Pre-Existing Condition Period

Flexible Choices

3 months / 12 months

Since everyone's needs are different, these plans offer flexibility for you to choose a benefit option that fits your income replacement needs and budget.

Elimination Period Timely Enrollment Enrolling timely means you have enrolled during the initial enrollment period when benefits were first offered by AUL or as a newly hired employee within 31 days following completion of any applicable waiting period.

This is a period of consecutive days of disability before benefits may become payable under the contract.

Age When Total Disability Begins Option 1

0 Days / 7 Days

Portability

Option 2

14 Days / 14 Days

Should your coverage terminate, you may be eligible to take this disability insurance with you without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible.

Option 3

30 Days / 30 Days

Option 4

60 Days / 60 Days

Option 5

90 Days / 90 Days

Option 6

180 Days /180 Days

Waiver of Premium If approved, this benefit waives your Disability insurance premium in case you become disabled and are unable to collect a paycheck.

Elimination Period This is a period of consecutive days of disability before benefits may become payable under the contract.

Maximum Benefit Duration This is the length of time that you may be paid benefits if continuously disabled as outlined in the contract.

Age When Total Disability Begins

Maximum Duration

Total Disability You are considered disabled if, because of injury or sickness, you cannot perform the material and substantial duties of your regular occupation, you are not working in any occupation and are under the regular attendance of a physician for that injury or sickness.

Partial Disability You may be paid a partial disability benefit, if because of injury or sickness, you are unable to perform every material and substantial duty of your regular occupation on a full-time basis, are performing at least one of the material and substantial duties of your regular occupation, or another occupation on a full or part-time basis and are earning less than 80% of your predisability earnings due to the same injury or sickness.

Less than age 60

Greater of Social Security Full Retirement Age or: To age 65

60

5 years

Residual

61

4 years

62

3.5 years

The elimination period can be satisfied by total disability, partial disability or a combination of both.

63

3 years

64

2.5 years

65

2 years

66

21 months

67

18 months

68

15 months

69 and over

12 months

Return to Work You may be able to return to work for a specified time period without having your partial disability benefits reduced according to the contract. The Return to Work Benefit is offered up to a maximum of 12 months.

Integration 27

Disability The method by which your benefit may be reduced by Other Income Benefits.

Pre-Existing Condition Limitations The pre-existing period is 3/12. Certain disabilities are not covered if the cause of the disability is traceable to a condition existing prior to your effective date of coverage. A pre-existing condition is any condition for which a person has received medical treatment or consultation, taken or were prescribed drugs or medicine or received care or services, including diagnostic measures, within a time-frame specified in the contract.

You must also be treatment-free for a time-frame specified in some contracts following your individual effective date of coverage.

Benefit Percentage

28

Elimination Period

Rate per $100 of Monthly Benefit

40%

0/7 14/14 30/30 60/60 90/90 180/180

$2.50 $2.20 $1.87 $1.21 $1.05 $0.77

50%

0/7 14/14 30/30 60/60 90/90 180/180

$2.77 $2.44 $2.07 $1.34 $1.16 $0.85

60%

0/7 14/14 30/30 60/60 90/90 180/180

$3.26 $2.87 $2.44 $1.58 $1.37 $1.00

Disability

29

APL

Cancer

YOUR BENEFITS PACKAGE

PLAY VIDEO

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.

Breast Cancer is the most commonly diagnosed cancer in women.

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

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 30 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

GC14 Limited Benefit Group Cancer Indemnity Insurance Hillsboro ISD THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NONSUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

SUMMARY OF BENEFITS

Plan 1

Plan 2

Cancer Treatment Policy Benefits

Level 1

Level 4

Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12-month period

$10,000

$20,000

Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment Cancer Screening Rider Benefits Diagnostic Testing - 1 test per calendar year Follow-Up Diagnostic Testing - 1 test per calendar year Medical Imaging - per calendar year Surgical Rider Benefits Surgical Anesthesia Bone Marrow Transplant - Maximum per lifetime Stem Cell Transplant - Maximum per lifetime Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime

$50 per treatment

$50 per treatment

paid in same manner and under the same maximums as any other benefit Level 1

Not Available

$50per test

Not Available

$100 per test

Not Available

$500 per test / 1 per calendar year Level 1

Not Available

$30 unit dollar amount Max $3,000 per operation 25% of amount paid for covered surgery $6,000

Not Available

$600

Not Available

$1,000 / $100

Not Available

Not Available Not Available

Patient Care Rider Benefits

Level 2

Hospital Confinement Per day of Hospital Confinement (1-30 days) Per day for Eligible Dependent Children (1-30 days) Per day of Hospital Confinement (31+ days) Per day for Eligible Dependent Children (31+ days) Outpatient Facility - Per day surgery is performed

$100 $200 $200 $400 $200

Not Available

Attending Physician - Per day of Hospital Confinement

$30

Not Available

Dread Disease - Per day of Hospital Confinement (1-30 days / 31+ days)

$100 / $200

Not Available

Extended Care Facility - Up to the same number of Hospital Confinement Days

$100 per day

Not Available

Not Available

Donor

$100 per day

Not Available

Home Health Care - Up to the same number of Hospital Confinement Days

$100 per day

Not Available

Hospice Care - Up to maximum of 365 days per lifetime

$100 per day

Not Available

US Government, Charity Hospital or HMO Per day of Hospital Confinement (1-30 days / 31+ days) Miscellaneous Care Rider Benefits

$100 / $200 Level 1

Not Available

Cancer Treatment Center Evaluation or Consultation - 1 per lifetime

Not Included

Not Available

Evaluation or Consultation Travel and Lodging - 1 per lifetime

Not Included

Not Available

Second / Third Surgical Opinion - per diagnosis of cancer

$300 / $300

Not Available

$150 per confinement $50 per prescription $150

Not Available

Drugs and Medicine - Inpatient / Outpatient (maximum $150 per month) Hair Piece (Wig) - 1 per lifetime Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Lodging - up to a maximum of 100 days per calendar year Family Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Family Lodging - up to a maximum of 100 days per calendar year

actual coach fare or $0.40 per mile $0.40 per mile $50 per day actual coach fare or $0.40 per mile $0.40 per mile $50 per day

Not Available Not Available

Not Available

31

APSB-22339(TX)-0615 MGM/FBS Hillsboro ISD

GC14 Limited Benefit Group Cancer Indemnity Insurance Level 1

Miscellaneous Care Rider Benefits Con’t.

Blood, Plasma and Platelets

$300 per day

Not Available

$200 / $2,000 per trip $150 per day

Not Available Not Available

Outpatient Special Nursing Services - Up to same number of Hospital Confinement days

$150 per day

Not Available

Medical Equipment - Maximum of 1 benefit per calendar year

Not Included

Not Available

$25 per visit / $1,000

Not Available

Waive Premium

Not Available

Ambulance - Ground/Air - Maximum of 2 trips per Hospital Confinement for all modes of transportation combined Inpatient Special Nursing Services - per day of Hospital Confinement

Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year Waiver of Premium Internal Cancer First Occurrence Rider Benefits

Level 1

Level 4

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

$2,500

$10,000

Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime

$3,750

$15,000

Heart Attack/Stroke First Occurrence Rider Benefits

Level 4

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

Not Available

$10,000

Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime

Not Available

$15,000

Intensive Care Unit

$600 per day

$600 per day

Step Down Unit - Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit

$300 per day

$300 per day

Hospital Intensive Care Unit Rider Benefits

TOTAL MONTHLY PREMIUMS BY PLAN** Issue Ages 18 +

Individual

Individual & Spouse

1 Parent Family

2 Parent Family

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

$19.90

$24.80

$41.96

$53.70

$25.96

$30.40

$47.96

$59.34

**Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice.

The premium and amount of benefits vary dependent upon the Plan selected at time of application.

Benefits are only payable following a diagnosis of cancer for a loss incurred for the treatment of cancer while covered under the policy. A charge must be incurred for benefits to be payable. When coverage terminates for loss incurred after the coverage termination date, our obligation to pay benefits also terminates for a specified disease that manifested itself while the person was covered under the policy. All benefits are subject to the benefit maximums.

Pre-Existing Condition Exclusion

Cancer Treatment Benefits

No benefits are payable for any loss incurred during the pre-existing condition exclusion period, following the covered person’s effective date as the result of a pre-existing condition. Pre-existing conditions specifically named or described as excluded in any part of the policy are never covered.

If any change to coverage after the certificate effective date results in an increase or addition to coverage, the time limit on certain defenses and pre-existing condition exclusion for such increase will be based on the effective date of such increase.

Eligibility

Waiting Period

You and your eligible dependents are eligible to be insured under this certificate if you and your eligible dependents meet our underwriting rules and you are actively at work with the policyholder and qualify for coverage as defined in the master application.

Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date regardless of when specified disease was diagnosed.

Only Loss for Cancer

The policy pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The policy also covers other conditions or diseases directly caused by cancer or the treatment of cancer. The policy does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer.

32

APSB-22339(TX)-0615 MGM/FBS Hillsboro ISD

The policy and any attached riders contain a waiting period during which no benefits will be paid. If any covered person has a specified disease diagnosed before the end of the waiting period immediately following the covered person’s effective date, coverage for that person will apply only to loss that is incurred after one year from the covered person’s effective date. If any covered person is diagnosed as having a specified disease during the waiting period immediately following the covered person’s effective date, you may elect to void the certificate from the beginning and receive a full refund of premium.

If the policy replaced group specified disease cancer coverage from any company that terminated within 30 days of the certificate effective date, the waiting period will be waived for those covered persons that were covered under the prior coverage. However, the pre-existing condition exclusion provision will still apply.

GC14 Limited Benefit Group Cancer Indemnity Insurance Termination of Certificate

Insurance coverage under the certificate and any attached riders will end on the earliest of these dates: the date the policy terminates; the end of the grace period if the premium remains unpaid; the date insurance has ceased on all persons covered under this certificate; the end of the certificate month in which the policyholder requests to terminate this coverage; the date you no longer qualify as an insured; or the date of your death.

Termination of Coverage

Insurance coverage for a covered person under the certificate and any attached riders for a covered person will end as follows: the date the policy terminates; the date the certificate terminates; the end of the grace period if the premium remains unpaid; the end of the certificate month in which the policyholder requests to terminate the coverage for an eligible dependent; the date a covered person no longer qualifies as an insured or eligible dependent; or the date of the covered person’s death.

We may end the coverage of any Covered Person who submits a fraudulent claim.

Cancer Screening Benefits Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Surgical Benefits Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Patient Care Benefits

You must remain disabled for 60 continuous days before this benefit will begin. The waiver of premium will begin on the next premium due date following the 60 consecutive days of disability. This benefit will continue for as long as you remain disabled until the earliest of either of the following: the date you are no longer disabled; the date coverage ends according to the termination provisions in the certificate; or the date coverage ends according to the termination provisions in this rider. Proof of disability must be provided for each new period of disability before a new waiver of premium benefit is payable.

Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Termination of Cancer Screening, Surgical, Patient Care & Miscellaneous Benefit Rider(s) The above listed rider(s) will terminate and coverage will end for all covered persons on the earliest of: the end of the grace period if the premium for the rider remains unpaid; the date the policy or certificate to which the rider is attached terminates; the end of the certificate month in which APL receives a request from the policyholder to terminate the rider; or the date of your death. Coverage on an eligible dependent terminates under the rider when such person ceases to meet the definition of eligible dependent.

Internal Cancer First Occurrence Benefits Pays a lump sum benefit amount when a covered person receives a first diagnosis of internal cancer and the date of diagnosis occurs after the waiting period. Only one benefit per covered person, per lifetime is payable under this benefit and the lump sum benefit amount will reduce by 50% at age 70.

Limitations and Exclusions

We will not pay benefits for a diagnosis of internal cancer received outside the territorial limits of the United States or a metastasis to a new site of any cancer diagnosed prior to the covered person’s effective date, as this is not considered a first diagnosis of an internal cancer.

A hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended-care facility; or a facility primarily affording custodial, educational care, or care of treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.

Pre-Existing Condition Exclusion

Limitations and Exclusions

This rider contains a 30-day waiting period during which no benefits will be paid. If any internal cancer is diagnosed before the end of the waiting period immediately following the covered person’s effective date of this rider, coverage will apply only to loss that is incurred after one year from the covered person’s effective date of this rider.

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Only Loss for Cancer or Dread Disease

Pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. This rider also covers other conditions or diseases directly caused by cancer or the treatment of cancer. This rider does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer except for conditions specifically provided in the dread disease benefit.

Miscellaneous Benefits Waiver of Premium

When the certificate is in force and you become disabled, we will waive all premiums due including premiums for any riders attached to the certificate.

Disability must be due to cancer and occur while receiving treatment for such cancer.

APSB-22339(TX)-0615 MGM/FBS Hillsboro ISD

No benefits are payable for any loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as the result of a pre-existing condition.

Waiting Period

Termination

This rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider; the date of covered person’s death or the date the lump sum benefit amount for internal cancer has been paid for all covered persons under this rider. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent.

Heart Attack/Stroke First Occurrence Benefits Pays a lump sum benefit amount when a covered person receives a first diagnosis of heart attack or stroke and the date of diagnosis occurs after the waiting period. Only one benefit per covered person per lifetime is payable under this benefit and the lump sum benefit amount will reduce by 50% at age 70.

33

GC14 Limited Benefit Group Cancer Indemnity Insurance Limitations and Exclusions

We will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war [(if coverage is suspended for any covered person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request)]; participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; or participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).

Pre-Existing Condition Exclusion

No benefits are payable for any loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as the result of a Pre-Existing Condition.

Waiting Period

This rider contains a 30-day waiting period during which no benefits will be paid. If any heart attack or stroke is diagnosed before the end of the waiting period immediately following the covered person’s effective date of this rider, coverage will apply only to loss that is incurred after one year from the covered person’s effective date.

Termination

This rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider; the date of a covered person’s death or the date the lump sum benefit amount for heart attack or stroke has been paid for all covered persons under this rider.

Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent, as defined in the policy.

Hospital Intensive Care Unit Benefits Pays a daily benefit amount, up to the maximum number of days for any combination of confinement, for each day charges are incurred for room and board in an intensive care unit (ICU) or step-down unit due to an accident or sickness. Benefits will be paid beginning on the first day a covered person is confined in an ICU or step-down unit due to an accident or sickness that begins after the effective date of this rider. This benefit will reduce by 50% at age 70.

Termination

This rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider or the date of the covered person’s death. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent.

Optionally Renewable This policy/riders are optionally renewable. The policyholder or we have the right to terminate the policy/riders on any premium due date after the first anniversary following the policy/riders effective date. We must give at least 60 days written notice to the policyholder prior to cancellation.

Portability (Voluntary Plans Only) When you no longer meet the definition of Insured, you will have the option to continue this coverage, including any attached riders. No Evidence of Insurability will be required. Portability must meet all of the following conditions: the certificate has been continuously in force for the last 12 months; we receive a request and payment of the first premium for the portability coverage no later than 30 days after the date you no longer qualify as an eligible insured; and the policy, under which this certificate was issued, continues to be in force on the date you cease to qualify for coverage. All future premiums due will be billed directly to you. You are responsible for payment of all premiums for the portability coverage.

The benefits, terms and condition of the portability coverage will be the same as those elected under the certificate immediately prior to the date you exercised portability. Portability coverage may include any eligible dependents who were covered under the certificate at the time you ceased to qualify as an eligible insured. No new eligible dependents may be added to the portability coverage except as provided in the New Born and Adopted Children provision. No increases in coverage will be allowed while you are exercising your rights under this rider. The premium for the portability coverage will be based on the premium tables used for such coverage at the time of the portability request.

Coverage under this rider will terminate in accordance with the provisions of the Termination of Coverage in the certificate. If the policy is no longer in force, then portability coverage is not available.

Limitations and Exclusions

For a newborn child born within the 10-month period following the effective date, no benefits under this rider will be provided for confinements that begin within the first 30 days following the birth of such child. No benefits under this rider will be provided during the first two years following the effective date for confinements caused by any heart condition when any heart condition was diagnosed or treated prior to the end of the 30-day period following the covered person’s effective date. The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date.

We will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war [(if coverage is suspended for any covered person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request)]; participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606

Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For detailed benefits, limitations, exclusions and other provisions, please refer to the policy/certificate/riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered

by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC14 Series | TX | Limited Benefit Group Cancer Indemnity Insurance | (10/14) | MGM/FBS | Hillsboro ISD 34

APSB-22339(TX)-0615 MGM/FBS Hillsboro ISD

GC14 Limited Benefit Group Cancer Indemnity Insurance

35

AUL a ONEAMERICA COMPANY YOUR BENEFITS PACKAGE

Life and AD&D

PLAY VIDEO

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.

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 36 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

Life and AD&D Group Term Life Including matching AD&D Coverage     

Hillsboro ISD provides all eligible employees with $10,000 Basic Life with AD&D. Waiver of premium benefit Accelerated life benefit Additional AD&D Benefits: Seat Belt, Air Bag, Repatriation, Child Higher Education, Child Care, Paralysis/Loss of Use, Severe Burns Optional Guaranteed issue amounts of dependent coverage as follows:

Eligible Employees This benefit is available for employees who are actively at work on the effective date and working a minimum of 15 hours per week.

Flexible Choices Since everyone's needs are different, this plan offers flexibility for you to choose a benefit amount that fits your needs and budget.

Accidental Death & Dismemberment (AD&D)

Evidence of Insurability If you elect a benefit amount over the Guaranteed Issue Amount shown above, or you do not enroll timely, you will need to submit a Statement of Insurability form for review. Based on health history, you will be approved or declined for insurance coverage by AUL.

Continuation of Coverage Options Portability Should your coverage terminate for any reason, you may be eligible to take this term life insurance with you without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible. The Portability option is available until you reach age 70.

OR Conversion Should your life insurance coverage, or a portion of it, cease for any reason, you may be eligible to convert your Group Term Coverage to Individual Coverage without providing Evidence of Insurability. You must apply within 31 days from the last day you are eligible.

Additional life insurance benefits may be payable in the event of Accelerated Life Benefit an accident which results in death or dismemberment as defined If diagnosed with a terminal illness and have less than 12 in the contract. Additional AD&D benefits include seat belt, air months to live, you may apply to receive 25%, 50% or 75% of bag, repatriation, child higher education, child care, paralysis/ your life insurance benefit to use for whatever you choose. loss of use, severe burns, disappearance, and exposure.

Waiver of Premium

Guaranteed Issue Amounts This is the most coverage you can purchase without having to answer any health questions. If you decline insurance coverage now and decide to enroll later, you will need to provide Evidence of Insurability. If you have existing coverage, you may increase your election amount by 2 increments without answering health questions (not to exceed the maximum the Guarantee Issue).

Employee Guaranteed Issue Amount

$150,000

Spouse Guaranteed Issue Amount

$50,000

Child Guaranteed Issue Amount

$10,000

If approved, this benefit waives your insurance premium in case you become totally disabled and are unable to collect a paycheck.

Age:

65

70

Reduces To:

65%

50%

Reductions Upon reaching certain ages, your original benefit amount will reduce to a percentage as shown in the following schedule. The amounts of Dependent Life Insurance and Dependent AD&D Principal Sum will reduce according to the Employee's reduction schedule.

Timely Enrollment Enrolling timely means you have enrolled during the initial enrollment period when benefits were first offered by AUL, or as a newly hired employee within 31 days following completion of any applicable waiting period.

37

Life and AD&D Voluntary Term Life Coverage including matching AD&D coverage Monthly Payroll Deduction Illustration About your benefit options:    

You may select a minimum Life benefit of $10,000 up to a maximum amount of $500,000, in increments of $10,000.

Life amounts requested above $250,000 for an Employee, $50,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability. Employees with existing coverage may increase 2 increments of coverage during open enrollment up to Guarantee Issue amount.

Employee must select coverage to select any Dependent coverage.

Spouse coverage cannot exceed 50% of the Voluntary Term Life amount selected by the Employee.

Age Category

Monthly Premium Rates Per $1,000 of Coverage

Age Category

Monthly Premium Rates Per $1,000 of Coverage

0-24

$0.050

55-59

$0.670

25-29

$0.060

60-64

$0.840

30-34

$0.080

65-69

$1.460

35-39

$0.100

70-74

$2.370

40-44

$0.150

75+

$3.640

45-49

$0.250

50-54

$0.410

Voluntary AD&D for all ages

$0.030

0-24

$0.050

50-54

Monthly Premium Rates per $1,000 of Coverage $0.410

25-29

$0.060

55-59

$0.670

30-34

$0.080

60-64

$0.840

35-39

$0.100

65-69

$1.460

40-44

$0.150

70-74

$2.370

45-49

$0.250

75+

$3.640

Age Category

Monthly Premium Rates per $1,000 of Coverage

Age Category

$0.030

Voluntary AD&D for all ages

CHILD(REN) OPTIONS Life & AD&D

Voluntary Dependent Life Monthly Premium Rate Per Unit of Coverage

Voluntary Dependent AD&D Monthly Premium Rate Per Unit of Coverage

Option 1:

$1.700

$0.300

Employee premiums are based on your age as of 09/01. Spouse premiums are based on your spouse's age as of 09/01. Child premiums are for all eligible children combined.

38

39

VOYA YOUR BENEFITS PACKAGE

Accident

PLAY VIDEO

About this Benefit

2/3

Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-soserious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.

of disabling injuries suffered by American workers are not work related.

American workers 36% ofreport they always or

usually live paycheck to paycheck.

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 40 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

Accident What accident benefits are available?

The following list is a summary of the benefits provided by Accident Insurance. You may be required to seek care for your injury within a set amount of time.

EVENT

Note that there may be some variations by state. For a list of standard exclusions and limitations, go to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any benefits.

BENEFIT

Accident Hospital Care Surgery Open abdominal, thoracic Surgery exploratory or without repair Blood, plasma, platelets Hospital admission Hospital confinement Per day up to 365 Critical care unit confinement per day, up to 15 days Rehabilitation facility confinement per day for 90 days Coma Duration of 14 or more days Transportation per trip, up to 3 per accident Lodging Per day, up to 30 days Family care per child, up to 45 days

$800 $125 $400 $1,000 $300 $475 $125 $11,500 $500 $120 $15

Accident Care Initial doctor visit Urgent care facility treatment Emergency room treatment Ground ambulance Air ambulance Follow-up doctor treatment Chiropractic treatment up to 6 per accident Medical equipment Physical or occupational therapy up to six per accident Speech therapy up to 6 per accident Prosthetic device (one) Prosthetic device (two or more) Major diagnostic exam

60 150 150 240 1,000 60 30 $40 $30 $30 $500 $800 $80

Outpatient surgery (one per accident)

$150

X-ray

$30

Common Injuries Burns second degree, at least 36% of the body Burns 3rd degree, at least 9 but less than 35 square inches of the body Burns 3rd degree, 35 or more square inches of the body Skin Grafts Emergency dental work Eye Injury removal of foreign object Eye Injury surgery Torn Knee Cartilage surgery with no repair or if cartilage is shaved Torn Knee Cartilage surgical repair Laceration1 treated no sutures Laceration1 sutures up to 2” Laceration1 sutures 2” – 6” Laceration1 sutures over 6” Ruptured Disk surgical repair

$1,000 $4,500 $10,000 25% of the burn benefit $250 crown, $60 extraction $60 $225 $150 $500 $20 $40 $160 $320 41 $500

Accident EVENT Tendon/Ligament/Rotator Cuff One, surgical repair Tendon/Ligament/Rotator Cuff Two or more, surgical repair Tendon/Ligament/Rotator Cuff Exploratory Arthroscopic Surgery with no repair Concussion Paralysis paraplegia Paralysis quadriplegia Dislocations Hip joint Knee Ankle or foot bone (s) Other than toes Shoulder Elbow Wrist Finger/toe Hand bone(s) Other than fingers Lower jaw Collarbone Partial dislocations Fractures Hip Leg Ankle Kneecap Foot Excluding toes, heel Upper arm Forearm, Hand, Wrist Except fingers Finger, Toe Vertebral body Vertebral processes Pelvis Except coccyx Coccyx Bones of face Except nose Nose Upper jaw Lower jaw Collarbone Rib or ribs Skull – simple Except bones of face Skull – depressed Except bones of face Sternum Shoulder blade Chip fractures

1

BENEFIT $275 $550 $800 $150 $10,750 $16,000 Closed/open reduction2 $2,550/$5,100 $1,600/$3,200 $1,000/$2,000 $1,000/$2,000 $750/$1,500 $750/$1,500 $175/$350 $750/$1,500 $750/$1,500 $750/$1,500 25% of the closed reduction amount Closed/open reduction3 $2,000/$4,000 $1,500/$3,000 $1,200/$2,400 $1,200/$2,400 $1,200/$2,400 $1,400/$2,800 $1,200/$2,400 $160/$320 $2,240/$4,480 $960/$1,920 $2,250/$4,500 $200/$400 $800/$1,600 $400/$800 $1,000/$2,000 $960/$1,920 $960/$1,920 $300/$600 $1,000/$2,000 $2,000/$4,000 $240/$480 $1,200/$2,400 25% of the closed reduction amount

Laceration benefits are a total of all lacerations per accident.

Closed Reduction of Dislocation = Non-surgical reduction of a completely separated joint. Open Reduction of Dislocation = Surgical reduction of a completely separated joint.

3 Closed Reduction of Fracture = Non-surgical. Open Reduction of Fracture = Surgical.

42 2

Accident Common Carrier: If the death occurs as a result of a covered accident on a common carrier, a higher benefit will be payable.

Common carrier means any commercial transportation that operates on a regularly scheduled basis between predetermined points or cities.

Accidental Death Benefits Employee Spouse Children Other Accident Employee Spouse Children Accidental Dismemberment Benefits Loss of both hand or both feet or sight in both eyes Loss of one hand or one foot AND the sight of one eye Loss of one hand AND one foot Loss of one hand OR one foot

Benefit $65,000 $30,000 $15,000

Loss of Two or more fingers or toes

$1,200

Loss of one finger or one toe

$30,000 $12,500 $6,000 Benefit $20,000 $14,000 $14,000 $7,500 $750

Monthly Rates (12 Pay Periods) Employee

Employee and Spouse

Employee and Children

Family

$10.41

$17.43

$20.15

$27.17

What does my Accident Insurance include?

The benefits listed below are included with your Accident Insurance coverage. For a list of standard exclusions and limitations, please refer to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any benefits.  Wellness Benefit: This provides an annual benefit payment if you complete a health screening test. You may only receive a benefit payment once per year, even if you complete multiple health screening tests.  Examples of health screening tests include but are not limited to: Pap test, serum cholesterol test for HDL and LDL levels, mammography, colonoscopy, and stress test on bicycle or treadmill.  The annual benefit amount is $50 for completing a health screening test.  If your spouse and/or children are covered for Accident Insurance, they are also covered for the Wellness Benefit. Your spouse’s benefit amount is also $50. The benefit for child coverage is 50% of your benefit amount per child with an annual maximum of $100 for all children  Sports Accident Benefit: If your accident occurs while participating in an organized sporting activity as defined in



the certificate; the accident hospital care, accident care or common injuries benefit will be increased by 25%; to a maximum additional benefit of $1000.

Accidental Death and Dismemberment (AD&D) coverage: If you are severely injured or die as a result of a covered accident, an AD&D benefit may be payable to you or your beneficiary.  Common carrier: If the death occurs as a result of a covered accident on a common carrier, a higher benefit will be payable. Common carrier means any commercial transportation that operates on a regularly scheduled basis between predetermined points or cities.

Exclusions and limitations Exclusions for the Certificate, Spouse Accident Insurance, and Children’s Accident Insurance and AD&D are listed below.

(These may vary by state.) Benefits are not payable for any loss caused in whole or directly by any of the following*:  Participation or attempt to participate in a felony or illegal activity.  An accident while the covered person is operating a motorized vehicle while intoxicated. Intoxication means the covered person’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred.  Suicide, attempted suicide or any intentionally selfinflicted injury, while sane or insane.  War or any act of war, whether declared or undeclared, other than acts of terrorism.  Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.  Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor.  Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.  Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded. Performing these acts as part of your employment with the employer is not excluded.  Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities.  Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received.  Any sickness or declining process caused by a sickness.  Work for pay, profit or gain. *See the certificate of insurance and riders for a complete list of available benefits, exclusions and limitations.

43

VOYA

Critical Illness

YOUR BENEFITS PACKAGE

PLAY VIDEO

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.

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

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 44 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

Critical Illness What is Cri cal Illness Insurance?

Cri cal Illness Insurance pays a lump‐sum benefit if you are diagnosed a er your effec ve date of coverage with a covered illness or condi on listed below. Please review cer ficates of coverage for any limita ons that may apply.

Cri cal Illness Insurance is a limited benefit policy. It is not health insurance and does not sa sfy the requirement of minimum essen al coverage under the Affordable Care Act.

For what cri cal illnesses and condi ons are benefits available?

Base Module  Heart aƩack  Stroke  Coronary artery by-

  

pass (25%)



Major organ failure

Cancer Module  Cancer  Skin cancer (10%)



Non‐Tobacco User Issue Age

$5,000

Under 30

$4.80

$7.00

$9.20

$11.40

$13.60

$15.80

30-39

$5.40

$8.20

$11.00

$13.80

$16.60

$19.40

End stage renal (kidney) failure

40-49

$8.40

$14.20

$20.00

$25.80

$31.60

$37.40

50-59

$14.45

$26.30

$38.15

$50.00

$61.85

$73.70

60-64

$20.15

$37.70

$55.25

$72.80

$90.35

$107.90

65-69

$25.15

$47.70

$70.25

$92.80

$115.35

$137.90

70+

$32.95

$63.30

$93.65

$124.00

$154.35

$184.70

Tobacco User Issue Age

$5,000

Under 30

$5.80

$9.00

$12.20

$15.40

$18.60

$21.80

OccupaƟonal HIV

30-39

$7.05

$11.50

$15.95

$20.40

$24.85

$29.30

Blindness

40-49

$12.00

$21.40

$30.80

$40.20

$49.60

$59.00

50-59

$22.10

$41.60

$61.10

$80.60

$100.10

$119.60

60-64

$32.35

$62.10

$91.85

$121.60

$151.35

$181.10

Carcinoma in situ (25%)

How much does Cri cal Illness Insurance cost?

$37.30

$72.00

$106.70

$141.40

$176.10

$210.80

70+

$48.75

$94.90

$141.05

$187.20

$233.35

$279.50

Spouse Coverage* Monthly Rates Includes Wellness Benefit Rider

Exclusions and Limita ons Benefits are not payable for any cri cal illness caused in whole or directly by any of the following*:

  



Par cipa on or a empt to par cipate in a felony or illegal ac vity.

Suicide, a empted suicide or any inten onally self‐ inflicted injury, while sane or insane.

War or any act of war, whether declared or undeclared, other than acts of terrorism.

Loss that occurs while on full‐ me ac ve duty as a member of the armed forces of any na on. We will refund, upon wri en no ce of such service, any premium which has been accepted for any period not covered as a result of this exclusion.

Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direc on of a doctor.

Benefits may reduce 50% for the employee and/or covered spouse on the policy anniversary following the 70th birthday, however, premiums do not reduce as a result of this benefit change. *See the cer ficate of insurance and any riders for a complete list of available benefits, along with applicable provisions, exclusions and limita ons.

$10,000 $15,000 $20,000 $25,000 $30,000

65-69

See chart for the premium amounts.



$10,000 $15,000 $20,000 $25,000 $30,000

Permanent paralysis

Coma

Module A  Benign brain tumor   Deafness 

Employee Coverage Monthly Rates

Tobacco User

Non‐Tobacco User

Issue Issue $5,000 $10,000 $15,000 $5,000 $10,000 $15,000 Age Age Under 30 $5.40 $8.20 $11.00 Under 30 $6.65 $10.70 $14.75 30-39

$6.00

$9.40

$12.80

30-39

40-49

$9.40

$16.20

$23.00

50-59

$17.50 $32.40

$47.30

60-64

$25.65 $48.70

65-69 70+

$7.85

$13.10

$18.35

40-49

$13.40 $24.20

$35.00

50-59

$27.00 $51.40

$75.80

$71.75

60-64

$41.85 $81.10 $120.35

$31.80 $61.00 $90.20 $41.85 $81.10 $120.35

65-69

$48.15 $93.70 $139.25

70+

$63.00 $123.40 $183.80

Children Coverage Monthly Rates Includes Wellness Benefit Rider Coverage Amount

Rate

$1,000

$0.64

$2,500

$1.60

$5,000

$3.20

$10,000

$6.40

45

5STAR

Individual Life

YOUR BENEFITS PACKAGE

PLAY VIDEO

About this Benefit Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death.

The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.

Experts recommend at least

x 10 your gross annual income in coverage when purchasing life insurance.

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 46 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

Individual Life with Terminal Illness and Quality of Life Rider The Family Protection Plan: Individual Life Insurance with Terminal Illness Coverage to Age 100 With the Family Protection Plan (FPP), you can provide financial stability for your loved ones should something happen to you.

You have peace of mind that you are covered up to age 100.* No matter what the future brings, you and your family will be protected.

If faced with a chronic medical condition that required continuous care, would you be able to protect yourself?

Traditionally, expenses associated with treatment and care necessitated by a chronic injury or illness have accounted for 86% of all health care spending and can place strain on your assets when you need them most. To provide protection during this time of need, 5Star Life Insurance Company (5Star Life) is pleased to offer the Quality of Life Rider, which is included with your FPP life insurance coverage.

Affordability—With several options to choose from, select the coverage that best meets the needs of your family.

Terminal Illness—This plan pays the insured 30% (25% in Connecticut and Michigan) of the policy coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months.

Portability—You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid. If this happens, we can simply bill you directly. Coverage can never be cancelled by the insurance company or your employer unless you stop paying premiums.

Family Protection—Individual policies can be purchased on the employee, their spouse, children and grandchildren.

Quality of Life Benefit - Following a diagnosis of either a chronic illness or cognitive impairment, this rider accelerates a portion of the death benefit on a monthly basis – 4%; up to 75% of your benefit, and payable directly to you on a tax This rider accelerates a portion of the death benefit on a monthly favored basis for the following: basis—4% each month as scheduled by your employer at the  Permanent inability to perform at least two of the six group level, and payable directly to you on a tax favored basis.

Activities of Daily Living (ADLs) without substantial You can receive up to 75% of the current face amount of the life assistance; or benefit, following a diagnosis of either a chronic illness or  Permanent severe cognitive impairment, such as dementia, cognitive impairment that requires substantial assistance.

Alzheimer’s disease and other forms of senility, requiring substantial supervision.

Benefits are paid for the following:  Permanent inability to perform at least two of the six Children & Grandchildren Plan—Policies can be purchased for Activities of Daily Living (ADLs) without substantial children and grandchildren ages (14 days through 23 years). assistance, or  A permanent severe cognitive impairment, such as Convenience—Premiums are taken care of simply and easily dementia, Alzheimer’s disease and other forms of senility through payroll deductions. requiring substantial supervision.

Protection You Can Count On—Within 24 hours after receiving Weekly Death Accelerated notice of an insured’s death, an emergency death benefit of Example Premium Benefit Benefit the lesser of 50% of the coverage amount, or $10,000, will be mailed to the insured’s beneficiary, unless the death is within 4% Your age at the two-year contestability period and/or under investigation. $10.00 $89,655 $3,586.20 issue: 35 This product also contains no war or terrorism exclusions. a month For example, in case of chronic illness, you would receive $3,586 each month up to $67,241.25.

The remainder death benefit of $22,413.75 would be made payable to your beneficiary.

* Life insurance product underwritten by 5Star Life Insurance Company (a Baton Rouge, Louisiana company). Product may not be available in all states or territories. Request FPP insurance from Dell Perot, Post Office Box 83043, Lincoln, Nebraska 68501, (866) 863-9753.

47

Family Protection Plan - Terminal Illness Age on Eff. Date

Employee Coverage Amounts

Spouse Coverage Amounts

$10,000

$25,000

$50,000

$75,000

$100,000

$10,000

$20,000

$30,000

18-25

$7.56

$12.40

$20.46

$28.52

$36.58

$7.56

$10.78

$14.01

26

$7.58

$12.46

$20.58

$28.71

$36.83

$7.58

$10.83

$14.08

27

$7.65

$12.63

$20.92

$29.21

$37.50

$7.65

$10.97

$14.28

28

$7.74

$12.85

$21.38

$29.90

$38.42

$7.74

$11.15

$14.56

29

$7.88

$13.21

$22.08

$30.96

$39.83

$7.88

$11.43

$14.98

30

$8.07

$13.67

$23.00

$32.33

$41.67

$8.07

$11.80

$15.53

31

$8.27

$14.17

$24.00

$33.83

$43.67

$8.27

$12.20

$16.13

32

$8.49

$14.73

$25.13

$35.52

$45.92

$8.49

$12.65

$16.81

33

$8.73

$15.31

$26.29

$37.27

$48.25

$8.73

$13.12

$17.51

34

$9.00

$16.00

$27.67

$39.33

$51.00

$9.00

$13.67

$18.33

35

$9.30

$16.75

$29.17

$41.58

$54.00

$9.30

$14.27

$19.23

36

$9.64

$17.60

$30.88

$44.15

$57.42

$9.64

$14.95

$20.26

37

$10.02

$18.54

$32.75

$46.96

$61.17

$10.02

$15.70

$21.38

38

$10.41

$19.52

$34.71

$49.90

$65.08

$10.41

$16.48

$22.56

39

$10.84

$20.60

$36.88

$53.15

$69.42

$10.84

$17.35

$23.86

40

$11.31

$21.77

$39.21

$56.65

$74.08

$11.31

$18.28

$25.26

41

$11.83

$23.08

$41.83

$60.58

$79.33

$11.83

$19.33

$26.83

42

$12.41

$24.52

$44.71

$64.90

$85.08

$12.41

$20.48

$28.56

43

$13.00

$26.00

$47.67

$69.33

$91.00

$13.00

$21.67

$30.33

44

$13.63

$27.56

$50.79

$74.02

$97.25

$13.63

$22.92

$32.21

45

$14.28

$29.19

$54.04

$78.90

$103.75

$14.28

$24.22

$34.16

46

$14.97

$30.92

$57.50

$84.08

$110.67

$14.97

$25.60

$36.23

47

$15.69

$32.73

$61.13

$89.52

$117.92

$15.69

$27.05

$38.41

48

$16.43

$34.56

$64.79

$95.02

$125.25

$16.43

$28.52

$40.61

49

$17.22

$36.54

$68.75

$100.96

$133.17

$17.22

$30.10

$42.98

50

$18.08

$38.69

$73.04

$107.40

$141.75

$18.08

$31.82

$45.56

51

$19.04

$41.10

$77.88

$114.65

$151.42

$19.04

$33.75

$48.46

52

$20.16

$43.90

$83.46

$123.02

$162.58

$20.16

$35.98

$51.81

53

$21.40

$47.00

$89.67

$132.33

$175.00

$21.40

$38.47

$55.53

54

$22.79

$50.48

$96.63

$142.77

$188.92

$22.79

$41.25

$59.71

55

$24.27

$54.17

$104.00

$153.83

$203.67

$24.27

$44.20

$64.13

56

$25.93

$58.33

$112.33

$166.33

$220.33

$25.93

$47.53

$69.13

57

$27.66

$62.65

$120.96

$179.27

$237.58

$27.66

$50.98

$74.31

58

$29.42

$67.04

$129.75

$192.46

$255.17

$29.42

$54.50

$79.58

59

$31.23

$71.56

$138.79

$206.02

$273.25

$31.23

$58.12

$85.01

60

$33.12

$76.29

$148.25

$220.21

$292.17

$33.12

$61.90

$90.68

61

$35.08

$81.19

$158.04

$234.90

$311.75

$35.08

$65.82

$96.56

62

$37.13

$86.31

$168.29

$250.27

$332.25

$37.13

$69.92

$102.71

63

$39.31

$91.77

$179.21

$266.65

$354.08

$39.31

$74.28

$109.26

64

$41.68

$97.71

$191.08

$284.46

$377.83

$41.68

$79.03

$116.38

65

$44.33

$104.33

$204.33

$304.33

$404.33

$44.33

$84.33

$124.33

66*

$44.93

$105.81

$207.29

$308.77

$410.25

$44.93

$85.52

$126.11

67*

$48.25

$114.13

$223.92

$333.71

$443.50

$48.25

$92.17

$136.08

68*

$52.03

$123.58

$242.83

$362.08

$481.33

$52.03

$99.73

$147.43

69*

$56.33

$134.31

$264.29

$394.27

$524.25

$56.33

$108.32

$160.31

70*

$61.17

$146.42

$288.50

$430.58

$572.67

$61.17

$118.00

$174.83

48

Family Protection Plan - Terminal Illness *Qualify of Life not available ages 66-70. Quality of Life benefits not available for children.

Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years). $4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 coverage.

49

NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

PLAY VIDEO

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.

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 50 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

FSA (Flexible Spending Account) NBS Flexcard

When Will I Receive My Flex Card?

You may use the card to pay merchants or service providers who accept MasterCard® credit cards, so there is no need to pay cash up-front and 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 mid-September.

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

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

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

New Plan Participants NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in unmarked envelopes, so please watch for them, as they should arrive within 21 business days of the 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?

$2,600

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 onto 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 claim FAQs 51

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. You may save as much as 35 percent on the cost of each benefit option!

Eligible expenses must be incurred within the plan year and contributions are use-it-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/hillsboroisd

52

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 grace 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/hillsboroisd 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 who accept credit cards, so there is no need to pay cash up-front and 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, in order for you to submit qualified claims for any unused funds.

53

LEGAL SHIELD

Identity Theft

YOUR BENEFITS PACKAGE

About this Benefit Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.

An identity is stolen every 2 seconds, and takes over

300 hours

to resolve, causing an average loss of $9,650.

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 54 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

Identity Theft Have you ever?      

Needed your Will prepared or updated Been overcharged for a repair or paid an unfair bill Had trouble with a warranty or defective product Signed a contract Received a moving traffic violation Had concerns regarding child support

     

Worried about being a victim of Identity theft Been concerned about your child’s identity Lost your wallet Worried about entering personal information on-line Feared the security of your medical information Been pursued by a collection agency

What is LegalShield?

LegalShield was founded in 1972, with the mission to make equal justice under law a reality for all North Americans. The 3.5 million individuals enrolled as LegalShield members throughout the United States and Canada can talk to a lawyer on any personal legal matter, no matter how trivial or traumatic, all without worrying about high hourly costs. LegalShield has provided identity theft protection since 2003 with Kroll Advisory Solutions, the world’s leading company in ID Theft consulting and restoration. We have safeguarded over 1 million members, provided more than 200,000 identity consultations, and helped restore nearly 10,000 individual identities.

The LegalShield® Membership Includes:

          

Personal Legal advice on unlimited issues Letters/calls made on your behalf Contracts & documents reviewed (up to 15 pages) Residential Loan Document Assistance Lawyers prepare your Will, your Living Will and your Health Care Power of Attorney Moving Traffic Violations (available 15 days after enrollment) IRS Audit Assistance Trial Defense (if named defendant/respondent in a covered civil action suit) Uncontested Divorce, Separation, Adoption and/or Name Change Representation (available 90 days after enrollment) 25% Preferred Member Discount (Bankruptcy, Criminal Charges, DUI, Other Matters, etc.)

24/7 Emergency Access for covered situations

LegalShield legal plans cover the member; member’s spouse; never married dependent children under 26 living at home; dependent children under age 18 for whom the member is legal guardian; never married, dependent children up to age 26 if a full-time college student; and physically or mentally disabled dependent children. An individual rate is available for those enrollees who are not married, do not have a domestic partner and do not have minor children or dependents. No family benefits are available to individual plan members. Ask your Independent Associate for details.

Monthly Premiums Individual

Family

LegalShield

$14.95

$15.95

IDShield

$8.45

$15.95

Combined

$23.40

$28.90

The IDShieldSM Membership Includes:









Privacy Monitoring Monitoring your name, SSN, date of birth, email address (up to 10), phone numbers (up to 10), driver license & passport numbers, and medical ID numbers (up to 10) provides you with comprehensive identity protection service that leaves nothing to chance.

Security Monitoring SSN, credit cards (up to 10), and bank account (up to 10) monitoring, sex offender search, financial activity alerts and quarterly credit score tracking keep you secure from every angle. With the family plan, Minor Identity Protection is included and provides monitoring for up to 8 children under the age of 18.

Consultation Your identity protection plan includes 24/7/365 live support for covered emergencies, unlimited counseling, identity alerts, data breach notifications and lost wallet protection.

Full Service Restoration Complete identity recovery services by Kroll Licensed Private Investigators and our $5 million service guarantee ensure that if your identity is stolen, it will be restored to its pretheft status.

IDShield plans are available at individual or family rates. A family rate covers the member; member’s spouse and up to 8 dependents up to the age of 18.

For more information, please call your independent associate: Financial Benefit Services This is a general overview and is for illustrative purposes only. Plans and services vary from state to state. See a plan contract for your state of residence for complete terms, coverage, amounts, conditions and exclusions.

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.

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

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 56 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

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 (2017)   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.

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

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 58 Hillsboro ISD Benefits Website: www.mybenefitshub.com/hillsboroisd

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 (2017)  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.

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