2018 Benefit Guide Frenship ISD

FRENSHIP ISD

BENEFIT GUIDE EFFECTIVE: 01/01/2018 - 12/31/2018 WWW.MYBENEFITSHUB.COM/FRENSHIPISD

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Table of Contents

Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. HSA vs. FSA Comparison FirstCare Medical/IA Consulting/Marsh & McLennan HSA Bank Health Savings Account (HSA) Kemper Medical Supplement Healthiestyou Telehealth MGM Benefits Group Dental Superior Vision The Hartford Disability Loyal American Cancer APL Accident AUL a OneAmerica Company Life and AD&D 5Star Individual Life NBS Flexible Spending Account (FSA) MASA Emergency Transportation 2

3 4-5 6-11 6 7 8 9 10 11 12-13 14-17 18-21 22-23 24-25 26-27 28-31 32-35 36-39 40-45 46-49 50-53 54-55

FLIP TO...

PG. 4 HOW TO HOW TO ENROLL ENROLL

PG. 6 SUMMARY PAGES

PG. 12 YOUR BENEFITS

Benefit Contact Information FRENSHIP ISD BENEFITS

VISION

INDIVIDUAL LIFE

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

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

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

MEDICAL

DISABILITY

FLEXIBLE SPENDING ACCOUNT

FirstCare (800) 321-7947 www.firstcare.com

The Hartford (800) 523-2233 www.thehartford.com

National Benefit Services (855) 399-3035 www.nbsbenefits.com

IA Consulting/Marsh & McLennan Natalia Moore (806) 765-7264

CANCER

HEALTH SAVINGS ACCOUNT

Loyal American (800) 366-8354 www.mybenefitshub.com/frenshipisd

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

ACCIDENT

MEDICAL TRANSPORT

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

MASA U.S. (800) 423-3226 International (800) 643-9023 www.masamts.com

LIFE AND AD&D

EAP

AUL a OneAmerica Company (800) 583-6908 www.oneamerica.com

ComPsych Guide Resources (855) 387-9727 www.guidanceresources.com

Health Plan Call Center (800) 994-1231 IA Wellness (806) 765-7265

MEDICAL SUPPLEMENT Kemper (866) 860-9348 www.kemper.com

TELEHEALTH Healthiestyou (866) 703-1259 www.healthiestyou.com

DENTAL MGM Benefits Group (866) 881-2255 www.mgmbenefits.com

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MOBILE ENROLLMENT Enrollment made simple through your smartphone or tablet.

Text “FBS FRENSHIP” to 313131 and get access to

everything you need to complete your benefits enrollment: 

Benefit Information



Online Support



Interactive Tools



And more.

PLAY VIDEO

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Text “FBS FRENSHIP” to 313131 OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/frenshipisd

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:  Medical Plan by FirstCare

NEW PLANS AND CARRIER! Frenship ISD will offer three medical options through Firstcare. The three medical options include HSA HMO, HSA PPO and PPO. The in-network deductibles for each range from $3,750 to $4,000 per individual and $7,500 and $8,000 per family. The in-network Out-of-Pocket maximums for each range from $3,750 to $6,850 per individual and $7,500 to $13,700 per family.  Group Term Life and AD&D by One America

NEW CARRIER! New and existing employees of the district can purchase up to $200,000 group term life insurance on themselves, $50,000 on their spouse and $10,000 on their children on a Guarantee Issues Basis (No Health Questions Asked). Employees can also purchase up to $500,000 not to exceed 10 times annual salary of AD&D Life Insurance separate from their Group Term Life.  Individual Life with Quality of Life Rider by 5 Star

NEW CARRIER! Family Protection Plan-Terminal Illness Plan with Quality of Life Rider from 5Star is individual term life insurance protection that pays a monthly benefit if Long Term Care becomes necessary. The new benefit will be offered on a Guarantee Issue bases. Benefit can be purchased for employees, spouse, children and grandchildren prior age 23.

   

 Long Term Disability by The Hartford

NEW CARRIER AND RATES! Long Term Disability provides a monthly income to an individual that is disabled due to an accident or illness. This plan provides a 4 week benefit for pre-existing conditions for all new enrollees or increase in coverage. Benefit options are offered by percent of salary.  Dental Insurance by MGM Benefits Group

Frenship ISD offers a direct reimbursement dental plan.

You go to the dentist of your choice. You and your dentist determine the best method of treatment.

Pre-authorizations are never required and only cosmetic procedures (e.g., teeth whitening), implants and TMJ treatments are excluded. **Plan Year Maximum increased to $1,200!**  Limited FSA

Please remember, if you choose to elect a HSA you will be only eligible to choose the limited FSA. A limited FSA, allows you to use for your approved dental and vision expenses only.

Login and complete your benefit enrollment from 10/26/2017 - 11/16/2017 Enrollment assistance is available by calling Financial Benefit Services at (800) 583-6908 to speak to a representative Monday—Friday between 8am – 5pm CST Update your profile information: home address, phone numbers, email, beneficiaries REQUIRED: Provide correct dependent social security numbers 6

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 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.

CHANGES IN STATUS (CIS):

QUALIFYING EVENTS

Marital Status

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

Change in Number of Tax Dependents

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

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

Change in 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 Programs

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

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SUMMARY PAGES

Annual Enrollment



Wellness questions, you can contact IA Wellness 806-7657265.

During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each year.



Supplemental benefit questions, you can contact your

Changes are not permitted during the plan year (outside of

Benefits/HR department or you can call Financial Benefit

annual enrollment) unless a Section 125 qualifying event occurs.

Services at 800-583-6908 for assistance.



Changes, additions or drops may be made only during the

Where can I find forms?

annual enrollment period without a qualifying event.

For benefit summaries and claim forms, go to your school district’s benefit website: www.mybenefitshub.com/

 Employees must review their personal information and verify

frenshipisd. Click on the benefit plan you need information on

that dependents they wish to provide coverage for are

(i.e., Dental) and you can find the forms you need under the

included in the dependent profile. Additionally, you must

Benefits and Forms section.

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

How can I find a Network Provider?

For benefit summaries and claim forms, go to your school



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

district’s benefit website: www.mybenefitshub.com/ frenshipisd. Click on the benefit plan you need information on (i.e., Dental) and you can find provider search links under the Quick Links section.

When will I receive ID cards?

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.

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 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

Q&A Who do I contact with Questions? 

For Medical benefits questions, you can contact the Health Plan Call Center at 800-994-1231 or IA Consulting/Marsh & McLennan with Natalia Moore 806-994-1231.

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carrier’s customer service number to request another card.

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

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 30 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 Frenship 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 2018 benefits become effective on January 1, 2018, you must be actively-at-work on January 1, 2018 to be eligible for your new benefits.

PLAN

CARRIER

MAXIMUM AGE

Medical

FirstCare

Through age 25

HSA

HSA Bank

Through age 25

Medical Supplement

Kemper

Through age 25

Telehealth

Healthiestyou

Through age 25

Dental

MGM Benefits Group

Through age 25

Vision

Superior Vision

Through age 25

Cancer

Loyal American

Through age 24

Accident

American Public Life

Through age 25

Voluntary Life and AD&D

AUL a OneAmerica Company

Through age 25

Individual Life

5Star FPP

Through age 23

Medical Transportation

MASA

Through age 25

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

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SUMMARY PAGES

Helpful Definitions Actively at Work

In-Network

You are performing your regular occupation for the employer

Doctors, hospitals, optometrists, dentists and other providers

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

who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 1/1/2018 please notify your benefits administrator.

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

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

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

Plan Year January 1st through December 31st

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

Calendar Year January 1st through December 31st

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

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

Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.

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(including diagnostic and/or consultation services).

SUMMARY PAGES

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

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

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source Account Owner Underlying Insurance Requirement

Employee and/or employer Individual

Employee Employer

High deductible health plan

None

Description

Minimum Deductible Maximum Contribution

$1,300 single (2018) $2,600 family (2018) $3,450 single (2018) $6,900 family (2018)

$25.00 $2650 (2018)

Permissible Use Of Funds

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

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

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

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

Not permitted

Year-to-year rollover of account balance?

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

Access to funds is extended. Your employer's plan includes a 75 day grace period to use your funds, and a 90 day run out to file claims from the previous year.

Does the account earn interest?

Yes

No

Portable?

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

No

Funding

You will only have access to HSA funds that have been contributed up to that point. HSAs are not front loaded.

You will have access to the entire annual contribution amount on the effective date of your FSA. FSA balance is front loaded to provide access to the entire annual contribution.

FLIP TO FOR HSA INFORMATION

PG. 14

FLIP TO FOR FSA INFORMATION

PG. 50 11

FIRSTCARE/IA CONSULTING/MARSH & MCLENNAN

Medical

YOUR BENEFITS PACKAGE

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

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

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 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

Medical I.

Health Benefits

FirstCare HMO/PPO

HSA PPO

PPO

HSA HMO

HSA PPO

PPO

Deductible: (Single/ Family)

$6,550/$13,100

$4,000/$8,000

$3,750/$7,500

$4,000/$8,000

$4,000/$8,000

Plan Percentage (In/ Out)

100/0; 60/40

80/20; 60/40

100/0

100/0; 60/40

80/20; 60/40

$6,550/$13,100

$6,850/$13,700

$3,750/$7,500

$4,000/$8,000

$6,850/$13,700

Plan Type:

II.

Current BCBS

Out of Pocket Max: (Single/Family) Hospital Services: Dr. Office Vist CopPay: Prescription Drug Program Deductible:

100% after Ded 100% after Ded

80% after Ded $45/$90

100% after Ded 100% after Ded

100% after Ded 100% after Ded

80% after Ded $45/$90

Same as Medical

$300/$600

Same as Medical

Same as Medical

$300/$600

Generic:

100% after Ded

50% after Rx Ded

100% after Ded

100% after Ded

50% after Rx Ded

Preferred Brand Name:

100% after Ded

50% after Rx Ded

100% after Ded

100% after Ded

50% after Rx Ded

Non-Preferred Brand Name:

100% after Ded

50% after Rx Ded

100% after Ded

100% after Ded

50% after Rx Ded

Specialty

100% after Ded

50% after Rx Ded

100% after Ded

100% after Ded

50% after Rx Ded

Rates Employee Only Employee + Child(ren) Employee + Spouse Employee + Family

Current BCBS $45.00 $418.37 $598.08 $725.76

$137.43 $545.29 $756.73 $925.88

FirstCare HMO/PPO Wellness

Non-Wellness

$0.00 $325.05 $481.31 $592.34

$45.00 $370.05 $526.31 $637.34

Wellness

$25.00 $418.81 $598.52 $726.20

Non-Wellness

Wellness

Non-Wellness

$70.00 $463.81 $643.52 $771.20

$74.97 $424.24 $605.30 $750.15

$119.97 $469.24 $650.30 $795.15

*NOTE: The premiums illustrated in blue represent the Wellness premium and will require the employee to complete a wellness screening and one call to a Wellness Coach/Nurse, as directed by the District. On January 1, all FISD employees will be charged the Wellness premium and will have a 90 day period to complete the Wellness screening and coach call. Participation in the Wellness plan will save the employee $45 per month. If these requirements are not completed, the employee will revert to the higher premium. This information will be discussed at the campus insurance presentations.

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HSA BANK

HSA (Health Savings Account)

YOUR BENEFITS PACKAGE

PLAY VIDEO

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 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

HSA (Health Savings Account) HSA Bank has teamed up with your employer to create an affordable health coverage option that helps you save on healthcare expenses. This plan is only available for those who are participating in the Blue Cross Blue Shield HDHP medical plan.

You may not enroll in the Non-HSA Compatible Gap Plan if you participate in the HSA. You cannot participate in the HSA plan if you or your spouse participate in an FSA. 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.

Authorized Signers who are 55 or older must have their own HSA in order to make the catch-up contribution Monthly Fee: Your account will be charged a monthly fee of $1.75, waived with an average daily balance at or above $3,000.

Examples of Qualified Medical Expenses      

Surgery Braces Contact lenses Dentures Eyeglasses Vaccines

For a list of sample expenses, please refer to your school district’s benefits website at www.mybenefitshub.com/ frenshipisd

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

Using Funds 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.

2018 Annual HSA Contribution Limits Individual: $3,450 Family: $6,900 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)  Not enrolled in Medicare (if an accountholder enrolls in Medicare mid-year, catch-up contributions should be prorated) 15

How the HSA Plan Works A Health Savings Account (HSA) is an individually-owned, tax-advantaged 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 self-directed 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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2018 Annual HSA Contribution Limits Individual = $3,450 Family = $6,900

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 catch-up 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 tax-free.

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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KEMPER YOUR BENEFITS PACKAGE

Medical Supplement

PLAY VIDEO

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 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

Medical Supplement Signature Gap Insurance Plan

Plan Benefits Include:

The Kemper Benefits Signature Gap insurance plan is designed to be a secondary protection against the rising costs of healthcare in America.

In-Hospital Benefit: If you or your covered family member is hospital confined for at least 15 consecutive hours for a covered sickness or injury, the Kemper Benefits Signature Gap insurance plan will help pay out-of-pocket expenses such as your medical plan’s deductible, copayments or coinsurance. Expenses must be eligible under the insured person’s major medical plan in order to be covered.

The Signature Gap plan covers certain portions of the out-of-pocket expenses that employees and their families incur under their Medical Plan (coinsurance, copays, deductibles) up to the maximum benefit selected by the employer. It is designed to help fill gaps in primary coverage.

Benefit

Inpatient Hospital Benefit1

Outpatient Benefit Rider2

Traditional Benefit Period Deductible HSA Compatible Benefit Period Deductible Maximum4>

Benefit Option

Outpatient Hospital Benefit: The Kemper Benefits Signature Gap insurance plan pays benefits when you or your covered family member receives treatment as an outpatient due to an eligible sickness or injury. This benefit includes covered charges for treatment in a hospital emergency room and transportation by ambulance to a hospital due to sickness or injury if the insured person is not hospital confined within 24 hours of the treatment or transport.

Benefit Period Maximums Non-HSA Plan 1

Non-HSA Plan 2

HSA Plan 1

HSA Plan 2

Per Person

$2,000

$3,000

$3,000

$4,000

Per Person

$400

$600

$600

$800

Per Family

Up to 2 times the per-person outpatient benefit maximum

Up to 2 times the per-person outpatient benefit maximum

Up to 2 times the per-person outpatient benefit maximum

Up to 2 times the per-person outpatient benefit maximum

Per Insured Person

None

None

Individual Coverage

$1,300

$1,300

(Employee only) Family Coverage

$2,600

$2,600

19

Medical Supplement Exclusions The policy does not provide any benefits for the following: 1. any expenses incurred during any period the insured person does not have coverage under a medical plan; 2. any expenses which are not medically necessary; 3. war, declared or undeclared; 4. suicide or any attempt thereat, while sane or insane (in Colorado, Missouri or Montana, while sane); 5. any intentionally self-inflicted injury or sickness, while sane or insane (in Colorado, Missouri or Montana, while sane); 6. any loss while the insured person is in the service of the armed forces of any country. Orders to active military service for training purposes of two months or less will not constitute service in the armed forces. Upon notice to the Company of entering the armed forces, the Company will return to the insured person pro rata any premium paid, less any benefits paid, for any period during which the insured person is in such service; 7. any expense for which there is no legal obligation to pay, no charge is made or in the absence of coverage, no charge would be made; 8. drugs or medicines, except medicines prescribed and taken while hospital confined; 9. dental or vision services unless: a) resulting from an injury occurring while the insured person’s coverage under the policy is in force; or b ) due to congenital disease or anomaly of a dependent newborn child; 10. mental illness or functional or organic nervous disorders, regardless of the cause; 11. treatment of alcoholism, drug addiction or complications thereof; 12. any injury that occurs while an insured person has been determined to be intoxicated: a) by judicial or administrative judgment or order; b) by evidence of an alcohol concentration in the insured person’s blood, breath or urine which equals or exceeds the limits set by applicable motor vehicle laws; or c) by other evidence demonstrating the insured person was under the influence of any alcohol, narcotic, barbiturate or hallucinatory drug, unless the same was administered on the advice of a physician and was taken according to the prescribed dosage; and the use of such substance was a proximate cause of the injury; 13. any treatment, services or supplies for wellness services.

For this exclusion, “wellness services” means treatment, services or supplies provided for routine health care, including, but not limited to, routine health or check-up examinations, routine well child visits, mammograms and other charges incurred during the course of a routine physical examination or checkup; 20

14. injury or sickness for which compensation is payable under any Workers’ Compensation Law, any Occupational Disease Law or similar legislation, or if the policyholder opts out of such requirements, any similar coverage purchased or self-funded by the policyholder to cover work-related injuries or sicknesses; 15. any loss for which the Insured Person is not required to pay a deductible, copayment and/or coinsurance under the insured person’s medical plan; 16. any expense for which benefits are excluded under the insured person’s medical plan; or 17. an insured person engaging in any act or occupation which is a violation of the law of the jurisdiction where the loss or cause of loss occurred. A violation of law includes both misdemeanor and felony violations.

Limitations Medical Plan If an insured person did not have a medical plan on the insured person’s effective date under the policy, the company’s sole obligation will then be to refund all premiums paid for that insured person.

Pre-Existing Condition Limitation This product is not issued with a pre-existing condition limitation, however, a condition must be covered under the insured’s medical plan in order for benefits to be payable under this plan. Therefore, any pre-existing condition limitation applied to the medical plan would, in effect, limit coverage under this plan.

Subrogation There is no subrogation provision in the policy/certificate. Any settlement due an insured from a third party (from a motor vehicle accident for example) will not reduce the benefit payable. The intent of this product is to help pay for deductible and co-insurance amounts required by the insured’s underlying medical plan, regardless of any applicable third party settlements. *Not available in all states, some provisions, benefits or exclusions may vary by state.

Policy No. MG-158/MG-159/MG-160 Policy Form No. M-9134

Medical Supplement Monthly Rates Non-HSA Plan 1 Employee

Employee + Spouse

Employee + Children

Employee + Family

Age less than 40

$23.29

$41.12

$50.26

$68.09

Age 40-49

$31.91

$56.63

$57.87

$82.60

Age 50+

$50.90

$90.82

$81.84

$121.76

Employee

Employee + Spouse

Employee + Children

Employee + Family

Age less than 40

$31.04

$55.06

$67.38

$91.41

Age 40-49

$42.65

$75.98

$77.64

$110.97

Age 50+

$68.25

$122.05

$109.94

$163.74

Employee

Employee + Spouse

Employee + Children

Employee + Family

Age less than 40

$18.73

$32.90

$40.17

$54.35

Age 40-49

$25.58

$45.24

$46.22

$65.90

Age 50+

$40.68

$72.43

$65.29

$97.03

Employee

Employee + Spouse

Employee + Children

Employee + Family

Age less than 40

$23.72

$41.89

$51.21

$69.38

Age 40-49

$32.51

$57.72

$58.98

$84.18

Age 50+

$51.87

$92.56

$83.41

$124.09

Non-HSA Plan 2

HSA Plan 1

HSA Plan 2

21

HEALTHIESTYOU YOUR BENEFITS PACKAGE

Telehealth

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

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 22 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

Telehealth Introducing Healthiestyou

Personalized Wellness Program

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



Cost $12 per month

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

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

A healthiestyou care coordinator will initiate your request.

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

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

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

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

 

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

Launch your personalized wellness program by completing your health assessment.

Begin your path to feeling better!

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

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

IT'S ALL ABOUT SATISFACTION...

97%

Members who will use healthiestyou again

93%

Patients with issues resolved by healthiestyou

95%

Members who would recommend healthiestyou

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

23

MGM BENEFITS GROUP

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 24 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

Dental Direct Reimbursement Dental Plan

How does the plan work 1.

How does this plan benefit you?

You go to the dentist of your choice. You and your dentist determine the best method of treatment. Preauthorizations are never required and only cosmetic procedures (e.g., teeth whitening), implants and TMJ treatment are excluded.

2.

3.

Pay for your service (cash, check, credit card or other credit arrangement).

Obtain an invoice and a completed Standard Dental Claim form from your dental office.

Mail the completed forms to: MGM, 2121 N. Glenville Drive, Richardson, Texas 75082 or you may have the dental office mail them. For questions call 972.881.2255 or 866.881.2255

What will the plan reimburse?

Amount of Expense

Plan Share

Participant Share

Paid Benefit

First $100.00

100% ($100)

0% ($0)

$100.00

Next $250.00

80% ($200)

20% ($50)

$200.00

Next $1,800.00

50% ($700)

50% ($700)

$700.00

Annual Maximum Benefit Paid per Covered Person: $1,200.00 Child and Adult Orthodontia is limited to $1,000 lifetime maximum per insured.

Exclusions: cosmetic dentistry, implants, TMJ

Monthly Premiums Tier

Rate

Employee Only

$23.00

Employee + Spouse

$47.00

Employee + Child(ren)

$50.00

Employee + Family

$73.00

25

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 26 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

Vision Benefits

In-Network

Exam (ophthalmologist)

Out-of-Network

Covered in full

Up to $42 retail

Exam (optometrist) Frames

Covered in full $125 retail allowance

Up to $37 retail Up to $68 retail

Contact Lens Fitting (standard)

Covered in full

Not Covered

Contact Lens Fitting (specialty₂)

$50 retail allowance

Not Covered

Contact Lenses4

$150 retail allowance Up to $100 retail

Lenses (standard) per pair Single Vision Bifocal Trifocal Progressive lens upgrade

Covered in full Covered in full Covered in full

Up to $32 retail Up to $46 retail Up to $61 retail

See description3

Up to $61 retail

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

Monthly Premiums Emp. Only Emp. + Spouse Emp. + Child(ren) Emp. + Family

$7.28 $13.80 $13.98 $21.46

Co-Pays Exam Materials₁

$10 $20

Contact Lens Fitting (standard & specialty)

$25

Services/Frequency Exam Frame Contact Lens Fitting Lenses Contact Lenses

12 months 12 months 12 months 12 months 12 months

(Based on date of service)

₁ Materials co-pay applies to lenses & frames only, not contact lenses. ₂See your benefits materials for definitions of standard and specialty contact lens fittings. ₃Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay.

4Contact lenses are in lieu of eyeglass lenses and frames benefit.

Discount Features Look for providers in the Provider Directory who accept discounts, as some do not; please verify their services and discounts (range from 10%-30%) prior to service as they vary.

Discounts on Covered Materials5 Frames: Lens options: Progressives:

20% off amount over allowance 20% off retail 20% off amount over retail lined trifocal lens, including lens options

The following options have out-of-pocket maximums on standard (not premium, brand, or progressive) plastic lenses.

5Discounts

and maximums may vary by lens type. Please check with your

provider.

Maximum Member Out-of-Pocket Single Vision Bifocal & Trifocal Scratch coat $13 $13 Ultraviolet coat $15 $15 Tints, solid or gradients $25 $25 Anti-reflective coat $50 $50 Polycarbonate $40 20% off retail High index 1.6 $55 20% off retail Photochromics $80 20% off retail

Discounts on Non-Covered Exam and Materials5 Exams, frames, and prescription lenses: Lens options, contacts, other prescription materials: Disposable contact lenses: 5Discounts

30% off retail 20% off retail 10% off retail

and maximums may vary by lens type. Please check with your

provider.

Refractive Surgery Superior Vision has a nationwide network of refractive surgeons and leading LASIK networks who offer members a discount. These discounts range from 15%-50%, and are the best possible discounts available to Superior Vision.

The Plan discount features are not insurance. All allowances are retail; member is responsible for any amount over the allowance, minus available discounts.

Discounts are subject to change without notice.

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

27

THE HARTFORD YOUR BENEFITS PACKAGE

Long Term 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 28 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

Long Term Disability Disability is designed to provide a monthly income to an individual that is disabled due to an accident or illness. There are different plans available with benefits becoming available from the 1st day of disability to as late as the 180th day. For specific details on how benefits are paid, refer to carrier brochure. Your disability coverage amount and premium can be accessed during your enrollment.



Mental Illness, Alcoholism and Substance Abuse 

Pre-existing Conditions Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have not received treatment for the disabling condition within 3 months, while insured under this policy, before the disability begins, or You have been insured under this policy for 12 months before your disability begins. You may also be covered if you have already satisfied the pre-existing condition requirement of your previous insurer. If your disability is a result of a pre-existing condition we will pay benefits for a maximum of 4 weeks.











Your benefit payments will not be reduced by certain kinds of other income, such as:  Retirement benefits if you were already receiving them before you became disabled  Retirement benefits that are funded by your after-tax contributions  Your personal savings, investment, IRAs or Keoghs  Profit-sharing  Most personal disability policies  Social Security increases Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.

Exclusions You cannot receive Disability benefit payments for disabilities that are caused or contributed to by:  War or act of war (declared or not)  Military service for any country engaged in war or other armed conflict  The commission of, or attempt to commit a felony  An intentionally self-inflicted injury  Any case where your being engaged in an illegal occupation was a contributing cause to your disability

You can receive benefit payments for Long-Term Disabilities resulting from mental illness, alcoholism and substance abuse for a total of 24 months for all disability periods during your lifetime.

Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24 month lifetime limit.

What other benefits are included in my disability coverage?

Benefit Reductions Your benefit payments may be reduced by other income you receive or are eligible to receive due to your disability, such as:  Social Security Disability Insurance (please see www.mybenefitshub.com/frenshipisd for exceptions)  Workers' Compensation  Other employer-based Insurance coverage you may have  Unemployment benefits  Settlements or judgments for income loss  Retirement benefits that your employer fully or partially pays for (such as a pension plan.)

You must be under the regular care of a physician to receive benefits

 

Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full-time employment.

Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or in equal shares to your surviving children under the age of 25, equal to three times the last monthly gross benefit.

Travel Assistance Program – Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less.

Services include pre-trip information, emergency medical assistance and emergency personal services.

The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services.

Waiver of Premium – Once your disability claim is approved and you have satisfied your elimination period, your coverage premiums will be waived.

Identity Theft Protection – An array of identity fraud support services to help victims restore their identity.

Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims.

29

Long Term Disability Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from injury or sickness: Age Disabled Prior to Age 63 Age 63 Age 64 Age 65 Age 66 Age 67 Age 68 Age 69 and older

Benefits Payable To Normal Retirement Age or 48 months if greater To Normal Retirement Age or 42 months if greater 36 months 30 months 27 months 24 months 21 months 18 months

Premium Option – Monthly Premium Cost (based on 12 payments per year) Rates per $100 of Monthly Benefit 30% Benefit Elimination Period Rates

Option 1 Option 2 Option 3 0 days/7 days 14 days /14 days 30 days / 30 days

40% Benefit Elimination Period Rates

Option 1 Option 2 Option 3 0 days/7 days 14 days /14 days 30 days / 30 days

50% Benefit Elimination Period Rates

Option 1 Option 2 Option 3 0 days/7 days 14 days /14 days 30 days / 30 days

60% Benefit Elimination Period Rates

Option 1 Option 2 Option 3 0 days/7 days 14 days /14 days 30 days / 30 days

30

$1.89

$2.45

$3.21

$3.81

$1.51

$1.95

$2.56

$3.04

$1.25

$1.61

$2.11

$2.51

Option 4 Option 5 Option 6 60 days/60 days 90 days/90 days 90 days/90 days $0.85

$0.74

$0.57

Option 4 Option 5 Option 6 60 days/60 days 90 days/90 days 90 days/90 days $1.10

$0.95

$0.74

Option 4 Option 5 Option 6 60 days/60 days 90 days/90 days 90 days/90 days $1.44

$1.25

$0.96

Option 4 Option 5 Option 6 60 days/60 days 90 days/90 days 90 days/90 days $1.71

$1.48

$1.15

Long Term Disability- How To File A Claim THE HARTFORD MAKES IT EASY TO FILE A CLAIM. JUST FOLLOW THESE STEPS. STEP 1 Know when it’s time to file If you’re absent from work, we can advise you on when to file your claim. If your absence is scheduled, such as an upcoming hospital stay, call us 30 days prior to your last day of work. If unscheduled, please call us as soon as possible.

STEP 2 Have this information ready  Name, address, and other key identification information.  Name of your department and last day of active fulltime work. The nature of your claim.  Your treating physician’s name, address, and phone and fax numbers.

STEP 3 Make the call With your information handy, call The Hartford at 1-866-278-2655. You’ll be assisted by a caring professional who’ll take your information, answer your questions and file your claim.

1-866-278-2655 8:00am – 8:00pm CT, Monday – Friday Policy #681131 If you’re absent from work, we can advise you on when to file your claim. If your absence is scheduled, such as an upcoming hospital stay, call us 30 days prior to your last day of work. If unscheduled, please call us as soon as possible.

WHEN YOU CALL THE HARTFORD WILL ASK YOU TO PROVIDE:    

Name, address, and other key identification information.

Name of your department and last day of active fulltime work.

The nature of your claim.

Your treating physician’s name, address, and phone and fax numbers.

GET SUPPORTIVE ASSISTANCE Even after your claim has been filed, we may be in touch to check your progress, answer questions or obtain additional information from you. Our goal is to offer a smooth and hassle free experience until you return to work. Feel free to also call us with anything that’s on your mind. We’re here to help.

RELAX AND STAY POSITIVE You have the assurance of our knowledge, experience and understanding of what you are going through. We’re with you all the way, so you can receive the benefits you qualify for and get back to your life.

QUICK FACTS The Hartford’s goal is to help get you through your time away from work with dignity and assist you in any way we can. Keep the card below in a safe place for future use. We’ll be there when you need us.

31

LOYAL AMERICAN

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 32 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

Cancer ADDITIONAL BENEFIT AMOUNTS

PLAN A Maximum

PLAN B Maximum

ANNUAL CANCER SCREENING BENEFIT RIDER (form LG-6041) A.Basic Benefit We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, once per calendar year per Insured Person for screening tests performed to determine whether Cancer exists in an Insured Person. Covered annual Cancer screening tests include but are not limited to: mammogram, pap smear, breast ultrasound, ThinPrep, biopsy, chest x-ray, thermography, colonoscopy, flexible sigmoidoscopy, hemocult stool specimen, PSA (blood test for prostate cancer), CEA (blood tests for colon cancer), CA125 (blood test for ovarian cancer), CA15-3 (blood test for breast cancer), serum protein electrophesis (blood test for myeloma).

B.Additional Benefit We will pay the expense incurred, but not to exceed two times the maximum benefit amount per calendar year as shown on the Certificate Schedule, for one additional invasive diagnostic procedure required as the result of an abnormal cancer screening test for which benefits are payable under the Basic Benefit above for an Insured Person.

This additional benefit is payable regardless of the results of the additional diagnostic procedure. However, the amount payable will be reduced dollar for dollar for any amount payable under the Positive Diagnosis Benefit contained in the base Certificate.

FIRST OCCURRENCE BENEFIT RIDER (form LG-6043)

$50 $50 Per Calendar Year Per Calendar Year

$100 $100 Per Calendar Year Per Calendar Year

$2,000

$500

If an Insured Person receives a positive diagnosis of Internal Cancer, We will pay the First Occurrence benefit amount Once per Lifetime Once per Lifetime shown on the Certificate Schedule. $3,000 $750 If the Insured Person receiving the positive diagnosis of Internal Cancer is a child under the age of 21, we will pay one Once per Lifetime Once per Lifetime and one-half times the First Occurrence benefit amount shown on the Certificate Schedule.

DAILY RADIATION, CHEMOTHERAPY, IMMUNOTHERAPY and EXPERIMENTAL TREATMENT BENEFIT RIDER (form LG-6046) We will pay the Actual Charge, but not to exceed the maximum benefit amount shown on the Certificate Schedule for each day that an Insured Person receives one or more of the following treatments for Cancer: (1) Chemotherapy (including Hormonal Therapy) or Immunotherapy; (2) Self-injected Chemotherapy or Immunotherapy drugs, limited to the maximum daily benefit amount per treatment; (3) Chemotherapy or Immunotherapy drugs dispensed by a pump or implant, limited to the maximum daily benefit amount for the initial prescription and an equal amount for each refill; (4) Oral Chemotherapy or Immunotherapy, limited to the maximum daily benefit amount per prescription; (5) Radiation Treatment. Benefits payable for interstitial or intracavitary applications of Radiation Treatments are payable on the day of insertion only and not for each day the Radiation Treatment remains in the body; or (6) Experimental Treatment. The benefit amount shown on the Certificate Schedule is the maximum daily benefit available per Insured Person regardless of the number or types of Cancer treatments received on the same day.

SURGICAL BENEFIT RIDER (form LG-6048) Surgical Expense We will pay the Surgical Expense benefit for a surgical procedure for the treatment of an Insured Person’s Cancer (except Skin Cancer) according to the Surgical Schedule shown in this rider. However, in no event will the amount payable exceed the maximum Surgical Expense benefit shown on the Certificate Schedule, nor will it exceed the expense incurred.

Anesthesia Expense We will pay the anesthesia Actual Charge, not to exceed 25% of the covered Surgical Expense benefit for the operation performed. This includes the services of an anesthesiologist or of an anesthetist under supervision of a physician for the purpose of administering anesthesia.

$400 Per Day

$200 Per Day

$5,000 Procedure Maximum

$500 Procedure Maximum

$1,250 Procedure Maximum

$125 Procedure Maximum

$4,500 Procedure Maximum

$450 Procedure Maximum

Per Procedure

Per Procedure

$200 Per Day

$100 Per Day

$400 Per Day

$200 Per Day

$400/ $800 Per Day

$200/ $400 Per Day

Breast Reconstruction With transverse rectus adominis myocutaneous flap (TRAM), single pedicle, including closure of donor site, with microvascular anastomosis (supercharging) is one of the surgical procedures listed in the Surgical Schedule. If this procedure is performed on an Insured Person as the result of a mastectomy for which We paid a Surgical Expense benefit for the treatment of Breast Cancer, We will pay the Actual Charge incurred not to exceed $900 per $1,000 of the Surgical Benefit issued.

Skin Cancer Surgery Expense We will pay the Actual Charge, not to exceed the procedure amount listed in this rider ($125 to $750 depending on the procedure) when a surgical operation is performed on an Insured Person for treatment of a diagnosed Skin Cancer. This benefit is payable in lieu of any benefits for Surgical Expense and Anesthesia Expense which are not applicable to Skin Cancer.

DAILY HOSPITAL CONFINEMENT BENEFIT RIDER (form LG-6042) Confinements of 30 Days or Less We will pay the Daily Hospital Confinement benefit amount shown on the Certificate Schedule for each of the first 30 days in each period of hospital confinement during which an Insured Person is confined to a hospital, including a government or charity hospital, for the treatment of Cancer.

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

Benefits for an Insured Dependent Child under Age 21 The amount payable under this benefit will be double the Daily Hospital Confinement benefit shown on the Certificate Schedule if the Insured Person so confined is a dependent child under the age of 21.

33

Cancer Additional Benefits Amounts SPECIFIED DISEASE BENEFIT RIDER (form LG-6052) If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider.

Covers These 38 Specified Diseases Addison’s Disease Amyotrophic Lateral Sclerosis Botulism Bovine Spongiform Encephalopathy Budd-Chiari Syndrome Cystic Fibrosis Diptheria Encephalitis Epilepsy Hansen’s Disease Histoplasmosis Legionnaire’s Disease Lyme Disease

Lupus Erythematosus Malaria Meningitis Multiple Sclerosis Muscular Dystrophy Myasthenia Gravis Neimann-Pick Disease Osteomyelitis Poliomyelitis Q Fever Rabies Reye’s Syndrome Rheumatic Fever

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

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

Initial Hospitalization Benefit We will pay a benefit of $1,500 selected when an Insured Person is confined to a hospital (for 12 or more hours) as a result of receiving treatment for a Specified Disease. This benefit is payable only once per period of confinement and once per calendar year for each Insured Person.

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

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

Monthly Rates

Employee

Single Parent

Family

Plan A

$19.92

$22.56

$31.97

Plan A + ICU & Specified Disease

$25.06

$31.38

$43.26

Plan B

$11.56

$13.03

$18.36

Plan B + ICU & Specified Disease

$16.70

$21.85

$29.65

34

Cancer

OPTIONAL BENEFITS YOU MAY SELECT FOR ADDITIONAL PREMIUM

HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER (form LG-6047) Intensive Care Unit Benefit We will pay the daily Hospital Intensive Care Unit Benefit shown on the Certificate Schedule for an Insured Person’s confinement in an ICU for sickness or injury.

$1,000 Per Day

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

$2,000 Per Day

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

$500 Per Day

Additional Limitations and Exclusions for the Hospital Intensive Care Unit Benefit Rider If the rider is issued and while coverage is in force, it will provide benefits if an Insured Person goes into a hospital Intensive Care Unit (including a Cardiac Intensive Care Unit or Neonatal Intensive Care Unit). Benefits start the first day of confinement in an ICU for sickness or injury. Any combination of benefits payable under this rider is limited to a maximum of 45 days per each period of confinement.

ALL BENEFITS CONTAINED IN THIS HOSPITAL INTENSIVE CARE UNIT BENEFIT RIDER REDUCE BY ONE-HALF AT AGE 75.

Benefits are not payable for any ICU or Step Down Unit confinement that results from intentional self-inflicted injury; or the Insured Person’s being intoxicated or under the influence of alcohol, drugs or any narcotics, unless administered on and according to the advice of a medical practitioner.

THIS IS A LIMITED RIDER.

35

AMERICAN PUBLIC LIFE 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 36 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

A3 Supplemental Limited Benefit Accident Expense Insurance Frenship ISD

AMERICAN PUBLIC LIFE YOUR BENEFITS

Accident

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 NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

Summary of Benefits* Benefit Description Accidental Death - per unit Medical Expense Accidental Injury Benefit - per unit Daily Hospital Confinement Benefit Air and Ground Ambulance Benefit

DID YOU KNOW?

2/3 of disabling injuries suffered by American workers are not work American workers 36% ofreport they always or

Level 2 - 2 Units

Level 3 - 3 Units

Level 4 - 4 Units

$5,000

$10,000

$15,000

$20,000

actual charges up to actual charges up to actual charges up to actual charges up to $500 $1,000 $1,500 $2,000 $75 per day

$150 per day

$225 per day

$300 per day

actual charges up to actual charges up to actual charges up to actual charges up to $1,250 $2,500 $3,750 $5,000

Accidental Dismemberment Benefit Single finger or toe Multiple fingers or toes Single hand, arm, foot or leg Multiple hands, arms, feet or legs

$500 $500 $2,500 $5,000

$1,000 $1,000 $5,000 $10,000

$1,500 $1,500 $7,500 $15,000

$2,000 $2,000 $10,000 $20,000

Accidental Loss of Sight Benefit - per unit Loss of Sight in one eye Loss of Sight in both eyes

$2,500 $5,000

$5,000 $10,000

$7,500 $15,000

$10,000 $20,000

Individual

Individual & Spouse

1 Parent Family

2 Parent Family

$10.80 $17.10 $21.50 $24.50

$19.40

$21.20 $34.90 $45.20 $52.00

$29.80 $47.60 $62.60 $72.40

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

Level 1 - 1 Unit

Level 1 - 1 Unit Level 2 - 2 Units Level 3 - 3 Units Level 4 - 4 Units

$29.80 $38.90 $44.90

*Total premium includes the Plan selected and any applicable rider premium. The premium and amount of benefits vary dependent upon the Plan selected at time of application. Premiums are subject to increase with notice.

usually live paycheck to paycheck.

(03/16)

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

37

APSB-22329(TX)-MGM/FBS Frenship ISD

A3 Supplemental Limited Benefit Accident Expense Insurance Limitations and Exclusions Eligibility This policy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.

Base Policy and Optional Benefits

Exclusions Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with: (1) (2) (3)

No benefits are payable for a pre-existing condition. Preexisting condition means an Injury that pertains solely to an Accidental Bodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre-Existing Conditions specifically named or described as permanently excluded in any part of this contract are never covered.

(4)

A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex-members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward.

(7)

(5) (6)

(8)

(9) (10)

Medical Expense Accidental Injury Benefit Expenses must commence within 60 days of the covered accident. The maximum benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.

Air and Ground Ambulance Benefit Emergency transportation must occur within 21 calendar days of the accident causing such Injury.

Daily Hospital Confinement Benefit

(11)

(12) (13) (14)

The maximum benefit period for this benefit is 30 days per covered accident.

(15)

Accidental Death

(16)

Accidental Death must result within 90 days of the covered accident causing the injury.

sickness, illness or bodily infirmity; suicide, attempted suicide or intentional self-inflicted Injury, whether sane or insane; dental care or treatment unless due to accidental Injury to natural teeth; war or any act of war (whether declared or undeclared) or participating in a riot or felony; alcoholism or drug addiction; travel or flight in or descent from any aircraft or device which can fly above the earth’s surface in any capacity other than as a fare paying passenger on a regularly scheduled airline; Injury originating prior to the effective date of the Policy; Injury occurring while intoxicated (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss is incurred.); Voluntary inhalation of gas or fumes or taking of poison or asphyxiation; Voluntary ingestion or injection of any drug, narcotic or sedative, unless administered on the advice and taken in such doses as prescribed by a Physician; Injury sustained or sickness which first manifests itself while on full-time duty in the armed forces; (Upon notice, We will refund the proportion of unearned premium while in such forces.)

Injury incurred while engaging in an illegal occupation; Injury incurred while attempting to commit a felony or an assault; Injury to a covered person while practicing for or being a part of organized or competitive rodeo, sky diving, hang gliding, parachuting or scuba diving; driving in any race or speed test or while testing an automobile or any vehicle on any racetrack or speedway; hernia, carpal tunnel syndrome or any complication therefrom;

A3 Supplemental Limited Benefit Accident Expense Insurance If You are entitled to benefits under this Policy as a result of sprained or lame back, or any intervertebral disk conditions, such benefits shall be payable for a maximum period of time, not exceeding in the aggregate three (3) months for any Injury.

Guaranteed Renewable You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correct premium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class.

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

Accidental Dismemberment Benefit The total amount payable for all Losses resulting from the same accident will not exceed the Maximum Dismemberment Benefit of $5,000 cumulative per unit, per Accident. Loss must be within 90 days of the accident causing such Injury.

Underwritten by American Life Insurance Company. This is a brief description of the coverage. For actual benefits, limitations, exclusions and other provisions, please refer to the policy and riders. This coverage does not replace Workers’ Compensation Insurance. | This product is inappropriate for people who are eligible for Medicaid coverage. | Policy Form A3 Series | Texas | Supplemental Limited Benefit Accident Expense Insurance Policy | (10/14) | Frenship ISD

38

APSB-22329(TX)-MGM/FBS ESC Frenship ISD

APSB-22329(TX)-MGM/FBS ESC Frenship ISD

A3 Supplemental Limited Benefit Accident Expense Insurance Limitations and Exclusions Eligibility This policy will be issued to only those persons who meet American Public Life Insurance Company’s insurability requirements. Persons not meeting APL’s insurability requirements will be excluded from coverage by an endorsement attached to the policy.

Base Policy and Optional Benefits

Exclusions Benefits otherwise provided by this Policy will not be payable for services or expenses or any such Loss resulting from or in connection with: (1) (2) (3)

No benefits are payable for a pre-existing condition. Preexisting condition means an Injury that pertains solely to an Accidental Bodily Injury which resulted from an accident sustained before the Effective Date of coverage. Pre-Existing Conditions specifically named or described as permanently excluded in any part of this contract are never covered.

(4)

A Hospital is not an institution which is primarily a place for alcoholics or drug addicts; the aged; a nursing, rest or convalescent nursing home; a mental institution or sanitarium; a facility contracted for or operated by the United States Government for treatment of members or ex-members of the armed forces (unless You are legally required to pay for services rendered in the absence of insurance); or, a long-term nursing unit or geriatrics ward.

(7)

(5) (6)

(8)

(9) (10)

Medical Expense Accidental Injury Benefit Expenses must commence within 60 days of the covered accident. The maximum benefit amount payable for any one accident for the Insured Person shall not exceed the Medical Expense Benefit.

Air and Ground Ambulance Benefit Emergency transportation must occur within 21 calendar days of the accident causing such Injury.

Daily Hospital Confinement Benefit

(11)

(12) (13) (14)

The maximum benefit period for this benefit is 30 days per covered accident.

(15)

Accidental Death

(16)

Accidental Death must result within 90 days of the covered accident causing the injury.

sickness, illness or bodily infirmity; suicide, attempted suicide or intentional self-inflicted Injury, whether sane or insane; dental care or treatment unless due to accidental Injury to natural teeth; war or any act of war (whether declared or undeclared) or participating in a riot or felony; alcoholism or drug addiction; travel or flight in or descent from any aircraft or device which can fly above the earth’s surface in any capacity other than as a fare paying passenger on a regularly scheduled airline; Injury originating prior to the effective date of the Policy; Injury occurring while intoxicated (Intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss is incurred.); Voluntary inhalation of gas or fumes or taking of poison or asphyxiation; Voluntary ingestion or injection of any drug, narcotic or sedative, unless administered on the advice and taken in such doses as prescribed by a Physician; Injury sustained or sickness which first manifests itself while on full-time duty in the armed forces; (Upon notice, We will refund the proportion of unearned premium while in such forces.)

Injury incurred while engaging in an illegal occupation; Injury incurred while attempting to commit a felony or an assault; Injury to a covered person while practicing for or being a part of organized or competitive rodeo, sky diving, hang gliding, parachuting or scuba diving; driving in any race or speed test or while testing an automobile or any vehicle on any racetrack or speedway; hernia, carpal tunnel syndrome or any complication therefrom;

A3 Supplemental Limited Benefit Accident Expense Insurance If You are entitled to benefits under this Policy as a result of sprained or lame back, or any intervertebral disk conditions, such benefits shall be payable for a maximum period of time, not exceeding in the aggregate three (3) months for any Injury.

Guaranteed Renewable You have the right to renew this Policy until the first premium due date on or after Your 69th birthday, if you pay the correct premium when due or within the Grace Period. When an Insured’s coverage terminates at age 70, coverage for other Insured Persons, if any, shall continue under this Policy. We have the right to change premium rates by class.

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

Accidental Dismemberment Benefit The total amount payable for all Losses resulting from the same accident will not exceed the Maximum Dismemberment Benefit of $5,000 cumulative per unit, per Accident. Loss must be within 90 days of the accident causing such Injury.

Underwritten by American Life Insurance Company. This is a brief description of the coverage. For actual benefits, limitations, exclusions and other provisions, please refer to the policy and riders. This coverage does not replace Workers’ Compensation Insurance. | This product is inappropriate for people who are eligible for Medicaid coverage. | Policy Form A3 Series | Texas | Supplemental Limited Benefit Accident Expense Insurance Policy | (10/14) | Frenship ISD

39

APSB-22329(TX)-MGM/FBS ESC Frenship ISD

APSB-22329(TX)-MGM/FBS ESC Frenship ISD

AUL a ONE AMERICA 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 40 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

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

Frenship ISD provides all eligible employees with $20,000 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.

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

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)

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

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

$200,000 or max 5 times salary

Spouse Guaranteed Issue Amount

$50,000

Child Guaranteed Issue Amount

$10,000

Timely Enrollment

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

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.

Age:

70

75

80

85

90

Reduces To:

65%

45%

30%

20%

15%

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.

41

Voluntary Life Flexible Options:

Employee: $10,000 to $500,000, in $10,000 increments.

Spouse: $5,000 to $250,000, in $5,000 increments, not to exceed 50% of the employee’s amount Child: $10,000

Guaranteed Issue:

Employee: $200,000

Dependent Life Coverage:

Optional dependent life coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren).

Spouse: $50,000

Child: $10,000

If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.

You may be eligible to increase your coverage annually until you reach your maximum amount without providing evidence of insurability.

Accelerated Life Benefit: Annual Increase In Benefit:

Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent AD&D principal sum will reduce according to the employee's reduction schedule

Reductions:

EMPLOYEE ONLY OPTIONS (based on Employee's age as of 09/01) Life & AD&D

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

$10,000

$.50

$.50

$.50

$.70

$.90

$1.40

$2.00

$3.30

$4.10

$6.20

$10.50

$17.30

$25.60

$20,000

$1.00

$1.00

$1.00

$1.40

$1.80

$2.80

$4.00

$6.60

$8.20

$12.40

$21.00

$34.60

$51.20

$30,000

$1.50

$1.50

$1.50

$2.10

$2.70

$4.20

$6.00

$9.90

$12.30

$18.60

$31.50

$51.90

$76.80

$40,000

$2.00

$2.00

$2.00

$2.80

$3.60

$5.60

$8.00

$13.20

$16.40

$24.80

$42.00

$69.20

$102.40

$50,000

$2.50

$2.50

$2.50

$3.50

$4.50

$7.00

$10.00

$16.50

$20.50

$31.00

$52.50

$86.50

$128.00

$80,000

$4.00

$4.00

$4.00

$5.60

$7.20

$11.20

$16.00

$26.40

$32.80

$49.60

$84.00

$138.40 $204.80

$100,000

$5.00

$5.00

$5.00

$7.00

$9.00

$14.00

$20.00

$33.00

$41.00

$62.00

$105.00 $173.00 $256.00

$120,000

$6.00

$6.00

$6.00

$8.40

$10.80

$16.80

$24.00

$39.60

$49.20

$74.40

$126.00 $207.60 $307.20

$150,000

$7.50

$7.50

$7.50

$10.50

$13.50

$21.00

$30.00

$49.50

$61.50

$93.00

$157.50 $259.50 $384.00

$200,000

$10.00

$10.00

$10.00

$14.00

$18.00

$28.00

$40.00

$66.00

$82.00

$124.00 $210.00 $346.00 $512.00

SPOUSE ONLY OPTIONS (based on Spouse's Age as of 09/01) Life & AD&D

0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

$10,000

$.50

$.50

$.50

$.70

$.90

$1.40

$2.00

$3.30

$4.10

$6.20

$10.50

$17.30

$25.60

$20,000

$1.00

$1.00

$1.00

$1.40

$1.80

$2.80

$4.00

$6.60

$8.20

$12.40

$21.00

$34.60

$51.20

$30,000

$1.50

$1.50

$1.50

$2.10

$2.70

$4.20

$6.00

$9.90

$12.30

$18.60

$31.50

$51.90

$76.80

$40,000

$2.00

$2.00

$2.00

$2.80

$3.60

$5.60

$8.00

$13.20

$16.40

$24.80

$42.00

$69.20

$102.40

$50,000

$2.50

$2.50

$2.50

$3.50

$4.50

$7.00

$10.00

$16.50

$20.50

$31.00

$52.50

$86.50

$128.00

CHILD(REN) OPTIONS Life & AD&D Option 1:

Child(ren) 6 months to age 26 $10,000

Child(ren) live birth to 6 months $1,000

Deduction Amount Child(ren) $1.00

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 eligi42 ble children combined.

AD&D Flexible AD&D Options:

Employee: Up to $500,000, in $10,000 increments Spouse: 50% of the employee AD&D benefit, 40% if child included Child: 15% of the employee AD&D benefit, 10% if spouse included

AD&D Guaranteed Issue:

Employee: $500,000

Accidental Death and Dismemberment (AD&D):

If AD&D is selected, additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract.

Dependent AD&D Coverage:

Optional dependent AD&D coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren). If employee AD&D is declined, no dependent AD&D will be included

Reductions:

Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent AD&D principal sum will reduce according to the employee's reduction schedule

Age: Reduces To:

Spouse: $250,000 Child: $75,000

70 65%

75 45%

80 30%

85 20%

90 15%

Payroll Deduction Illustration: Monthly AD&D Options Employee AD&D

Employee Only

Employee + Family

Employee AD&D

Employee Only

Employee + Family

$10,000

$0.20

$0.38

$260,000

$5.20

$9.88

$20,000

$0.40

$0.76

$270,000

$5.40

$10.26

$30,000

$0.60

$1.14

$280,000

$5.60

$10.64

$40,000

$0.80

$1.52

$290,000

$5.80

$11.02

$50,000

$1.00

$1.90

$300,000

$6.00

$11.40

$60,000

$1.20

$2.28

$310,000

$6.20

$11.78

$70,000

$1.40

$2.66

$320,000

$6.40

$12.16

$80,000

$1.60

$3.04

$330,000

$6.60

$12.54

$90,000

$1.80

$3.42

$340,000

$6.80

$12.92

$100,000

$2.00

$3.80

$350,000

$7.00

$13.30

$110,000

$2.20

$4.18

$360,000

$7.20

$13.68

$120,000

$2.40

$4.56

$370,000

$7.40

$14.06

$130,000

$2.60

$4.94

$380,000

$7.60

$14.44

$140,000

$2.80

$5.32

$390,000

$7.80

$14.82

$150,000

$3.00

$5.70

$400,000

$8.00

$15.20

$160,000

$3.20

$6.08

$410,000

$8.20

$15.58

$170,000

$3.40

$6.46

$420,000

$8.40

$15.96

$180,000

$3.60

$6.84

$430,000

$8.60

$16.34

$190,000

$3.80

$7.22

$440,000

$8.80

$16.72

$200,000

$4.00

$7.60

$450,000

$9.00

$17.10

$210,000

$4.20

$7.98

$460,000

$9.20

$17.48

$220,000

$4.40

$8.36

$470,000

$9.40

$17.86

$230,000

$4.60

$8.74

$480,000

$9.60

$18.24

$240,000

$4.80

$9.12

$490,000

$9.80

$18.62

$250,000

$5.00

$9.50

$500,000

$10.00

$19.00

43

ComPsych GuidanceResources® Program “Employee Assistance Program" this benefit is provided by FISD and not additional charge to the employee.

Confidential Counseling

GuidanceResources® Online

This no-cost counseling service helps you address stress, relationship and other personal issues you and your family may face. It is staffed by GuidanceConsultantsSM—highly trained master’s and doctoral level clinicians who will listen to your concerns and quickly refer you to in-person counseling (up to 6 sessions per issue per year) and other resources for: › Stress, anxiety and depression › Job pressures › Relationship/marital conflicts › Grief and loss › Problems with children › Substance abuse

GuidanceResources Online is your one stop for expert information on the issues that matter most to you… relationships, work, school, children, wellness, legal, financial, free time and more. › Timely articles, HelpSheetsSM, tutorials, streaming videos and self-assessments › “Ask the Expert” personal responses to your questions › Child care, elder care, attorney and financial planner searches

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

Legal Support and Resources Talk to our attorneys by phone. If you require representation, we’ll refer you to a qualified attorney in your area for a free 30minute consultation with a 25% reduction in customary legal fees thereafter. Call about: › Divorce and family law › Real estate transactions › Debt and bankruptcy › Civil and criminal actions › Landlord/tenant issues › Contracts

Free Online Will Preparation EstateGuidance® lets you quickly and easily write a will on your computer. Just go to www.guidanceresources.com and click on the EstateGuidance link. Follow the prompts to create and download your will at no cost. Online support and instructions for executing and filing your will are included. You can: › Name an executor to manage your estate › Choose a guardian for your children › Specify your wishes for your property › Provide funeral and burial instructions

Call: 855.387.9727 TDD: 800.697.0353 Go online: guidanceresources.com Your company Web ID: ONEAMERICA3

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

OneAmerica is the marketing name for American United Life Insurance Company® (AUL). AUL markets ComPsych services. ComPsych Corporation is not an affiliate of AUL and is not a OneAmerica company.

44

Travel Assistance

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 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

Term Life with Terminal Illness and Quality of Life Rider The Family Protection Plan: Term Life Insurance with Terminal Illness Coverage to Age 100 Nearly 85% of Americans say most people need life insurance; unfortunately only 62% have coverage and a staggering 33% say they don’t have enough life insurance, including one-fourth who already have life insurance coverage.** Nobody wants to be a statistic - especially during a period of grief. That’s why 5Star Life Insurance Company developed its FPP policy - to ensure you and your loved ones are covered during a period of loss.

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.

DID YOU KNOW? Protecting your financial well being is easier than you think. It’s like trading in a daily latte for peace of mind.

$4.30 per day to start your morning with a $1.75

gourmet coffee OR per day to enrich your employee benefits package

It’s less expensive than you think.

Family Protection - Individual policies can be purchased on the employee, their spouse, children and grandchildren (ages newborn through 23).

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 favored basis for the following:  Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or  Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.

Convenience - Premiums are taken care of simply and easily through payroll deductions.

Protection You Can Count On - Within 24 hours after receiving notice of an insured’s death, an emergency death benefit of the lesser of 50% of the coverage amount, or $10,000, will be mailed to the insured’s beneficiary, unless the death is within the twoyear contestability period and/or under investigation. This product also contains no war or terrorism exclusions.

* 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 MONTHLY RATES GUARANTEED ISSUE RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT Employee Coverage Amounts

Spouse Coverage Amounts

Age on App. Date

$10,000

$25,000

$50,000

$75,000

$100,000

$125,000

$150,000

$10,000

$20,000

$30,000

18-25

$7.56

$12.40

$20.46

$28.52

$36.58

$44.65

$52.71

$7.56

$10.78

$14.01

26

$7.58

$12.46

$20.58

$28.71

$36.83

$44.96

$53.08

$7.58

$10.83

$14.08

27

$7.65

$12.63

$20.92

$29.21

$37.50

$45.79

$54.08

$7.65

$10.97

$14.28

28

$7.74

$12.85

$21.38

$29.90

$38.42

$46.94

$55.46

$7.74

$11.15

$14.56

29

$7.88

$13.21

$22.08

$30.96

$39.83

$48.71

$57.58

$7.88

$11.43

$14.98

30

$8.07

$13.67

$23.00

$32.33

$41.67

$51.00

$60.33

$8.07

$11.80

$15.53

31

$8.27

$14.17

$24.00

$33.83

$43.67

$53.50

$63.33

$8.27

$12.20

$16.13

32

$8.49

$14.73

$25.13

$35.52

$45.92

$56.31

$66.71

$8.49

$12.65

$16.81

33

$8.73

$15.31

$26.29

$37.27

$48.25

$59.23

$70.21

$8.73

$13.12

$17.51

34

$9.00

$16.00

$27.67

$39.33

$51.00

$62.67

$74.33

$9.00

$13.67

$18.33

35

$9.30

$16.75

$29.17

$41.58

$54.00

$66.42

$78.83

$9.30

$14.27

$19.23

36

$9.64

$17.60

$30.88

$44.15

$57.42

$70.69

$83.96

$9.64

$14.95

$20.26

37

$10.02

$18.54

$32.75

$46.96

$61.17

$75.38

$89.58

$10.02

$15.70

$21.38

38

$10.41

$19.52

$34.71

$49.90

$65.08

$80.27

$95.46

$10.41

$16.48

$22.56

39

$10.84

$20.60

$36.88

$53.15

$69.42

$85.69

$101.96

$10.84

$17.35

$23.86

40

$11.31

$21.77

$39.21

$56.65

$74.08

$91.52

$108.96

$11.31

$18.28

$25.26

41

$11.83

$23.08

$41.83

$60.58

$79.33

$98.08

$116.83

$11.83

$19.33

$26.83

42

$12.41

$24.52

$44.71

$64.90

$85.08

$105.27

$125.46

$12.41

$20.48

$28.56

43

$13.00

$26.00

$47.67

$69.33

$91.00

$112.67

$134.33

$13.00

$21.67

$30.33

44

$13.63

$27.56

$50.79

$74.02

$97.25

$120.48

$143.71

$13.63

$22.92

$32.21

45

$14.28

$29.19

$54.04

$78.90

$103.75

$128.60

$153.46

$14.28

$24.22

$34.16

46

$14.97

$30.92

$57.50

$84.08

$110.67

$137.25

$163.83

$14.97

$25.60

$36.23

47

$15.69

$32.73

$61.13

$89.52

$117.92

$146.31

$174.71

$15.69

$27.05

$38.41

48

$16.43

$34.56

$64.79

$95.02

$125.25

$155.48

$185.71

$16.43

$28.52

$40.61

49

$17.22

$36.54

$68.75

$100.96

$133.17

$165.38

$197.58

$17.22

$30.10

$42.98

50

$18.08

$38.69

$73.04

$107.40

$141.75

$176.10

$210.46

$18.08

$31.82

$45.56

51

$19.04

$41.10

$77.88

$114.65

$151.42

$188.19

$224.96

$19.04

$33.75

$48.46

52

$20.16

$43.90

$83.46

$123.02

$162.58

$202.15

$241.71

$20.16

$35.98

$51.81

53

$21.40

$47.00

$89.67

$132.33

$175.00

$217.67

$260.33

$21.40

$38.47

$55.53

54

$22.79

$50.48

$96.63

$142.77

$188.92

$235.06

$281.21

$22.79

$41.25

$59.71

55

$24.27

$54.17

$104.00

$153.83

$203.67

$253.50

$303.33

$24.27

$44.20

$64.13

56

$25.93

$58.33

$112.33

$166.33

$220.33

$274.33

$328.33

$25.93

$47.53

$69.13

57

$27.66

$62.65

$120.96

$179.27

$237.58

$295.90

$354.21

$27.66

$50.98

$74.31

58

$29.42

$67.04

$129.75

$192.46

$255.17

$317.88

$380.58

$29.42

$54.50

$79.58

48

Family Protection Plan - Terminal Illness MONTHLY RATES GUARANTEED ISSUE RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT Age on App. Date

Employee Coverage Amounts

Spouse Coverage Amounts

$10,000

$25,000

$50,000

$75,000

$100,000

$125,000

$150,000

$10,000

$20,000

$30,000

59

$31.23

$71.56

$138.79

$206.02

$273.25

$340.48

$407.71

$31.23

$58.12

$85.01

60

$33.12

$76.29

$148.25

$220.21

$292.17

$364.13

$436.08

$33.12

$61.90

$90.68

61

$35.08

$81.19

$158.04

$234.90

$311.75

$388.60

$465.46

$35.08

$65.82

$96.56

62

$37.13

$86.31

$168.29

$250.27

$332.25

$414.23

$496.21

$37.13

$69.92

$102.71

63

$39.31

$91.77

$179.21

$266.65

$354.08

$441.52

$528.96

$39.31

$74.28

$109.26

64

$41.68

$97.71

$191.08

$284.46

$377.83

$471.21

$564.58

$41.68

$79.03

$116.38

65

$44.33

$104.33

$204.33

$304.33

$404.33

$504.33

$604.33

$44.33

$84.33

$124.33

66*

$44.93

$105.81

$207.29

$308.77

$410.25

$511.73

$613.21

$44.93

$85.52

$126.11

67*

$48.25

$114.13

$223.92

$333.71

$443.50

$553.29

$663.08

$48.25

$92.17

$136.08

68*

$52.03

$123.58

$242.83

$362.08

$481.33

$600.58

$719.83

$52.03

$99.73

$147.43

69*

$56.33

$134.31

$264.29

$394.27

$524.25

$654.23

$784.21

$56.33

$108.32

$160.31

70*

$61.17

$146.42

$288.50

$430.58

$572.67

$714.75

$856.83

$61.17

$118.00

$174.83

Quality 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 effective date: age 14 days to 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.

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

FLIP TO‌ PG. 11 FOR HSA VS. FSA COMPARISON

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 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

FSA (Flexible Spending Account) NBS Flexcard

When Will I Receive My Flex Card?

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

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

NBS Prepaid MasterCard® Debit Card

Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years.

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

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

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

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

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

DID YOU KNOW?

FSA Annual Contribution Max:

FSAs use tax-free funds to help pay for your Health Care Expenses.

$2,650

Dependent Care Annual Max: $5,000

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

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

Online claims FAQs 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/frenshipisd

52

What Happens If I Don’t Use All of My Funds by The End of the Plan Year (December 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/ frenshipisd and complete the “Claim Form” to send to NBS or use the web or phone app to file online.

How To Receive Your Dependent Care Reimbursement Faster.

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

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

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

Get Your Money 1.

2.

3.

4.

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

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

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

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

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

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

53

MASA YOUR BENEFITS PACKAGE

Medical Transport

About this Benefit Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It includes emergency transportation via ground ambulance, air ambulance and helicopter.

A ground ambulance can cost up to

$2,400

and a helicopter transportation fee can cost

over $30,000

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 Frenship ISD Benefits Website: www.mybenefitshub.com/frenshipisd

Medical Transport MASA provides medical emergency transportation solutions and covers your out of pocket medical transport cost when your insurance falls short. MASA does not use a network, which means you are covered anywhere.

THE TRUTH...

Americans today suffer from a false sense of security that their medical coverage will pay for all costs associated with emergency or critical care transport. The reality is that a majority of Americans are only partially covered for these high costs.

Most healthcare policies will only pay based off of the “Usual and Customary Charges” while Medicare pays based off a set fee schedule, both leaving you with the remainder of the bill.

You face the possibility that your medical coverage will deny the claim leaving you responsible for the ENTIRE bill.

MASA provides medical emergency transportation solutions AND cover your out of pocket medical transport cost when your insurance falls short.

MASA MTS for Employees Ensures...      

NO health questions NO age limits NO claim forms NO deductibles NO provider network limitations NO dollar limits on emergency transport costs

What is Covered?  

Emergency Helicopter Transport Emergency Ground Ambulance Transport

How Much Does It Cost?

MASA Emergent rates are $9.00 per month, for employee only or family coverage.

Emergent Card Example:

“All I had to do was send the bill which was never paid by Medicare and TriCare for Life --- and the rest is history. When MASA received that bill, it was paid and all amounts owed satisfied.” --- MASA Member, 2015

55

NOTES

56

NOTES

57

WWW.MYBENEFITSHUB.COM/FRENSHIPISD 58