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TYLER ISD

BENEFIT GUIDE EFFECTIVE: 01/01/2019 - 09/30/2019 (short plan year) WWW.MYBENEFITSHUB.COM/TYLERISD

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Table of Contents Benefit Contact Information 1. How to Enroll Through TEAMS 2. Benefit Updates 3. Section 125 Cafeteria Plan Guidelines 4. Annual Enrollment 5. Eligibility Requirements 6. Helpful Definitions 7. HSA vs. FSA Comparison NBS Health Savings Account (HSA) MDLIVE Telehealth Delta Dental UnitedHealthCare Vision Cigna Long Term Disability Loyal American Cancer Cigna Accident Cigna Critical Illness AUL a OneAmerica Company Life and AD&D 5Star Family Protection Plan Term Life Insurance with Quality of Life Rider MASA Medical Transport NBS Flexible Spending Account (FSA)

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3 4 4 5 6 7 8 9 10-11 12-13 14-15 16-17 18-21 22-29 30-33 34-37 38-41 42-45 46-49 50-53

FLIP TO... PG. 4 SUMMARY PAGES

PG. 10 YOUR BENEFITS


Benefit Contact Information TYLER ISD BENEFITS

VISION

LIFE AND AD&D

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

Policy #915446 UnitedHealthCare (800) 638-3120 www.myuhcvision.com

Policy #615228 AUL a OneAmerica Company (800) 583-6908 www.oneamerica.com

BENEFIT REPRESENTATIVE

DISABILITY

FAMILY PROTECTION PLAN

Makenzie Fontenot 214-490-7668 makenzief@fbsbenefits.com

Policy # SLH-100002 Cigna (800) 244-6244 www.mycigna.com

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

HEALTH SAVINGS ACCOUNT

CANCER

MEDICAL TRANSPORT

National Benefit Services (800) 274-0503 http://nbs.lh1ondemand.com

Policy # 1562 Loyal American (800) 366-8354

MASA (800) 423-3226 www.masamts.com

TELEHEALTH

ACCIDENT

FLEXIBLE SPENDING ACCOUNT

MDLIVE (888) 365-1663 www.consultmdlive.com

Policy #AI960493 Cigna (800) 244-6244 www.mycigna.com

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

DENTAL

CRITICAL ILLNESS

COBRA

Policy # 16076 Delta Dental (800) 521-2651 www.deltadentalins.com

Policy #CI960493 Cigna (800) 244-6244 www.mycigna.com

WebTPA (800) 930-5123 www.webtpa.com

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Annual Benefit Enrollment How To View Your Benefits

SUMMARY PAGES

Login Support: TISD Help Desk (903) 262‐3000

Benefit Updates ‐ What’s New:  VISION‐ Your vision plan is now with UnitedHealthcare

Vision effec ve January 1, 2019. Under your UHC Vision plan, you are eligible for a covered exam, covered frames (up to $150), and covered lenses! Exam co‐pay is $5 , and the material co‐pay is $5. Covered lenses include Standard Scratch‐resistant Coa ng, Polycarbonate Lenses‐ covered in full.

Don’t Forget!    

 Flexible Spending Accounts‐ Annual maximum

contribu on is currently $2,650 for 2019. Your flexible spending plan will only be available for 9 months from 01/01/2019 to 09/30/2019. Please elect your maximum contribu on wisely for this short plan year. For new par cipant, your Visa Flex card will arrive in your mailbox around the middle of January with your en re 2019 annual contribu on balance. Tyler ISD offers all ac ve employees a 90‐day grace period in which services can s ll be incurred a er the 09/30/19 plan year ends up to 90 days from 10/1.

Login and complete your benefit enrollment from 09/01/2018 ‐ 11/16/2018 Update your profile informa on: home address, phone numbers, email, beneficiaries REQUIRED: Provide correct dependent social security numbers Tyler ISD will have a SHORT PLAN YEAR. This means your supplemental benefits will be effec ve from 01/01/2019 through 09/30/2019.

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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 During your annual enrollment period, you have the opportunity

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your school

Changes are not permitted during the plan year (outside of

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

annual enrollment) unless a Section 125 qualifying event occurs.

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

Changes, additions or drops may be made only during the

Benefits and Forms section.

annual enrollment period without a qualifying event. How can I find a Network Provider?

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

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

included in the dependent profile. Additionally, you must

Click on the benefit plan you need information on (i.e.,

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

For benefit summaries and claim forms, go to your school

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

Dental) and you can find provider search links under the Quick Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and

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

verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits/HR department or you can call Financial Benefit Services at 800-583-6908 for assistance.

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SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more

Dependent Eligibility: You can cover eligible dependent

regularly scheduled hours each work week.

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

Eligible employees must be actively at work on the plan effective

maximum age listed below. Dependents cannot be double

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

covered by married spouses within the Tyler 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 2019 benefits become effective on January 1, 2019, you must be actively-at-work on January 1, 2019 to be eligible for your new benefits. PLAN

CARRIER

MAXIMUM AGE

Telehealth

MDLIVE

To age 26

Dental

Delta Dental

To age 26

Vision

UHCVision

To age 26

Cancer

Loyal American

To age 25

Accident

Cigna

To age 25

Critical Illness

Cigna

To age 25

Voluntary Life

AUL a OneAmerica Company

To age 26

Family Protection Plan

5Star

To age 24

Medical Transport

MASA

To age 26

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 01/01/2019 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 Short plan year: January 1st through September 30th

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

Calendar Year January 1st through December 31st

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

Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.

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(including diagnostic and/or consultation services).


SUMMARY PAGES

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

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

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

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

Employer Eligibility

A qualified high deductible health plan.

All employers

Contribution Source Account Owner Underlying Insurance Requirement

Employee and/or employer Individual

Employee and/or employer Employer

High deductible health plan

None

Description

Minimum Deductible Maximum Contribution

$1,300 single (2019) $2,600 family (2019) $3,500 single (2019) $7,000 family (2019)

N/A $2,650

Permissible Use Of Funds

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

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

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

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

Not permitted

Year-to-year rollover of account balance?

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

No. Tyler ISD gives active employees a grace period to use leftover funds.

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. 10

FLIP TO FOR FSA INFORMATION

PG. 50 9


NBS

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 10 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


HSA (Health Savings Account) You can use your Health Savings Account (HSA) to pay for a wide range of IRS‐qualified medical expenses for yourself, your spouse or tax dependents. An IRS‐qualified medical expense is defined as an expense that pays for healthcare services, equipment, or medica ons. 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 deduc ble, co‐insurance, prescrip ons, 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. Poten al to build more savings through inves ng. If you maintain a minimum balance of $2,000, your addi onal funds may be invested in mutual funds yielding tax‐free earnings. A way to accumulate addi onal re rement savings. A er age 65, funds can be withdrawn for any purpose without penalty.

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

A Health Savings Account (HSA):  

Grows with you. If you maintain a balance of $2,000, your addi onal funds may be invested in mutual funds yielding tax‐free earnings. Helps you plan for the future. Un l you turn 65, withdrawals used for eligible expenses are tax free. A er you turn 65, or if you become disabled, your HSA account becomes similar to a regular IRA. Withdrawals you use for non‐eligible expenses will be taxed at your regular income tax rate but won’t incur addi onal penal es.

Using Funds

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

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

NBS Contact Informa on

2019 Annual HSA Contribu on Limits Individual: $3,500 Family: $7,000 Catch‐Up Contribu ons: Account holders over the age of 55 who have not yet enrolled in Medicare are eligible to make an addi onal $1,000 “catch‐up” contribu on to their HSA.

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

Will my HSA Funds be up fronted to me? Like a savings account, you can only withdrawal what you’ve contributed to the account. Funds are not up fronted. Are there any monthly fees? There is a $2.00 monthly fee.

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MDLIVE YOUR BENEFITS PACKAGE

Telehealth

PLAY VIDEO

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

75%

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 12 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


Telehealth When should I use MDLIVE?

 If you’re considering the ER or urgent care for a non‐emergency medical issue  Your primary care physician is not available  At home, traveling, or at work  24/7/365, even holidays!

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

Allergies Asthma Bronchi s Cold and Flu Ear Infec ons Joint Aches and Pain Respiratory Infec on Sinus Problems And More!

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

Cold & Flu Cons pa on Ear Infec on Fever Nausea & Vomi ng Pink Eye And More!

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

How much does it cost? $7.00 If you are enrolled in the Tyler ISD Medical Benefits Plan, this benefit is provided to you and your family at no cost. If you are not enrolled in medical, $7.00 covers you, your spouse, and your children up to age 26 with unlimited phone consulta ons.

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

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

Who are our doctors? MDLIVE has the na on’s largest network of telehealth doctors. On average, our doctors have 15 years of experience prac cing medicine and are licensed in the state where pa ents are located. Their special es include primary care, pediatrics, emergency medicine and family medicine. Our doctors are commi ed to providing convenient, quality care and are always ready to take your call.

Scan with your smartphone to get the app.

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

Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regula on and may not be available in certain states. MDLIVE does not guarantee that a prescrip on will be wri en. MDLIVE does not prescribe DEA controlled substances, non‐therapeu c drugs and certain other drugs which may be harmful because of their poten al for 13 abuse. MDLIVE physicians reserve the right to deny care for poten al misuse of services. For complete terms of use visit www.mdlive.com/terms‐of‐use/ 010113


DELTA DENTAL

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 14 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


Dental PPO Plan Benefit Highlights for: Group No: Effective Date:

Monthly Premiums

Tyler ISD 16076 01/01/2018

EE Only EE + 1 EE + 2 or more

$32.67 $67.96 $98.98

Eligibility

Primary enrollee, spouse and eligible dependent children to age 26.

Deductibles

$50 per person / $150 per family each calendar year. Yes.

Deductibles waived for D & P?

Maximums D & P counts toward maximum?

Waiting Period(s) Benefits and Covered Services* Diagnostic & Preventive Services (D & P)

$1,000 per person each calendar year. Yes. Basic Benefits—0 Months Major Benefits—0 Months Orthodontics—0 Months

Delta Dental PPO Dentists**

Non-Delta Dental Dentists**

100%

100%

80%

80%

80%

80%

80%

80%

80%

80%

50%

50%

50%

50%

50%

50%

$1,000 Lifetime

$1,000 Lifetime

Exams, cleanings, x-rays, sealants

Basic Services Fillings, simple tooth extractions

Endodontics (root canals) Covered under Basic Services

Periodontics (gum treatment) Covered under Basic Services

Oral Surgery Covered under Basic Services

Implants Major Services Crowns, inlays, onlays and cast restorations, bridges and dentures

Orthodontic Benefits Adults and dependent children

Orthodontic Maximums

* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s submitted fees. ** Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and 90th percentile for nonDelta Dental dentists.

Delta Dental Insurance Company 1130 Sanctuary Parkway, Suite 600 Alpharetta, GA 30009

Customer Service 800-521-2651

www.deltadentalins.com

Claims Address P.O. Box 1809 Alpharetta, GA 30023-1809 15


UHCVISION 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 16 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


Vision Benefit Frequency

Exam with Materials

Comprehensive Exam(s)

Once every 12 months

Spectacle Lenses

Once every 12 months

Frames

Once every 12 months

Contact Lenses in Lieu of Once every 12 months Eyeglasses In-Network Services Copays Exam(s)

$ 5.00

Materials

$ 5.00

Frame Benefit (for frames that exceed the allowance, an additional 30% discount may be applied to the overage)¹ Private Practice Provider $150.00 retail frame allowance Retail Chain Provider

$150.00 retail frame allowance

Lens Options Standard Scratch-resistant Coating, Polycarbonate Lenses for Dependent Children (up to age 19) covered in full. Other optional lens upgrades may be offered at a discount (discount varies by provider). The Lens Options list can be found at myuhcvision.com. Contact Lens Benefit² (Selection contact lenses refers to our formulary contact list. Contact lenses not listed on the formulary are referred to as non-selection. A copy of the list can be found at myuhcvision.com). Selection contact lenses If you choose disposable The fitting/evaluation fees, contacts, up to 6 boxes are contact lenses, and up to two included when obtained from an follow-up visits are covered in in-network provider. full after copay (if applicable). Non-selection contact lenses An allowance is applied toward the purchase of contact lenses $150.00 outside the selection. Materials copay (if applicable) is waived. Necessary contact lenses3 Covered in full after copay (if applicable). Out-of-Network Reimbursements (Copays do not apply) Exam(s) Up to $40.00 Frames

Up to $45.00

Single Vision Lenses

Up to $40.00

Lined Bifocal Lenses

Up to $60.00

Lined Trifocal Lenses

Up to $80.00

Lenticular Lenses

Up to $80.00

Elective Contacts in Lieu of Eyeglasses² Necessary Contacts in Lieu of Eyeglasses3

Up to $150.00 Up to $210.00

Monthly Premiums EE Only

$8.05

EE + 1

$13.71

EE + 2 or more

$20.13

Discounts Laser vision UnitedHealthcare has partnered with the Laser Vision Network of America (LVNA) to provide our members with access to discounted laser vision correction providers. Members receive 15% off standard or 5% off promotional pricing at more than 550 network provider locations and even greater discounts through set pricing at LasikPlus® locations. For more information, call 1-888-563-4497 or visit us at www.uhclasik.com. Additional Material At a participating in-network provider you will receive up to a 20% discount on an additional pair of eyeglasses or contact lenses. This program is available after your vision benefits have been exhausted. Please note that this discount shall not be considered insurance, and that UnitedHealthcare shall neither pay nor reimburse the provider or member for any funds owed or spent. Additional materials do not have to be purchased at the time of initial material purchase. Hearing Aids As a UnitedHealthcare vision plan member, you can save on high-quality hearing aids when you buy them from hi HealthInnovations™. To find out more go to hiHealthInnovations.com. When placing your order use promo code myVision to get the special price discount.

¹30% discount available at most participating in-network provider locations. May exclude certain frame manufacturers. Please verify all discounts with your provider. ²Contact lenses are in lieu of eyeglass lenses and/or eyeglass frames. Coverage for Selection contact lenses does not apply at Costco, Walmart or Sam's Club locations. The allowance for Non-selection contact lenses applies to materials. No portion will be exclusively applied to the fitting and evaluation. ³Necessary contact lenses are determined at the provider's discretion for one or more of the following conditions: Following cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be corrected with eyeglass lenses and/or frames; with certain conditions such as anisometropia, keratoconus, irregular corneal/astigmatism, aphakia, facial deformity; or corneal deformity. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare vision confirming the reimbursement that UnitedHealthcare will make before you purchase such contacts.

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CIGNA YOUR BENEFITS PACKAGE

Disability

PLAY VIDEO

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

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

34.6 months is the duration of the average disability claim.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 18 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


Long Term Disability Long Term Disability (LTD) Insurance Coverage Eligibility

If you are an active employee who works at least 20 hours per week, you are eligible on the first of the month following Actively at Work date. Benefit Amount

Flat dollar benefit in $100 increments between $200 and $7,500 that cannot exceed 66 2/3% of your current monthly earnings.

Maximum

$7,500 per month

Monthly Benefit

Elimination Period

Benefit Duration

Select from Six Options: Accident/Sickness * For any selected Elimination Period 0 days/7 days of 30 days or less, the Elimination 14 days/14 days Period will be waived if the 30 days/30 days Employee is hospital confined as 60 days/60 days an inpatient. 90 days/90 days 180 days/180 days Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit or until you no longer qualify for benefits, whichever occurs first. Should you remain Disabled, your benefits continue according to one of the following schedules, depending on your age at the time you become Disabled and the plan you select.

Definition of Disability

When Coverage Takes Effect

“Disability” or “Disabled” means that, solely because of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to earn 80% or more of your indexed earnings from working in your regular occupation. After benefits have been payable for 24 months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 80% or more of your indexed earnings. We will require proof of earnings and continued disability.

Your coverage takes effect on the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date you return to work. If you have to submit evidence of good health, your coverage takes effect on the date we agree, in writing, to cover you.

Covered Earnings “Covered Earnings” means your wages or salary, not including bonuses, commissions, and other extra compensation.

Termination of Disability Benefits Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, or on the following events: (1) the date you earn from any occupation more than 80% of your Covered Earnings, or the date you fail to cooperate with us in a rehabilitation plan, or transitional work arrangement, or the administration of the claim.

When Benefits Begin You must be continuously Disabled for your elected benefit waiting period before benefits will be payable for a covered Disability.

Effects of Other Income Benefits This plan is structured to prevent your total benefits and postdisability earnings from equaling or exceeding pre-disability earnings. Therefore, we reduce this plan’s benefits by Other Income Benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Note: Some Other Income Benefits, as defined in the insurance contract, will not be considered until after benefits are payable for one year. Disability benefits will be reduced by amounts received through Social Security disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will also be reduced by amounts received through other government programs, employer’s sabbatical leave, employer’s assault leave plan, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto nofault, and damages for wage loss. For details, see your outline of coverage, policy certificate, or your employer’s summary plan description. 19


Long Term Disability Select Plan B—Maximum Benefit Period Schedule Age at Disability

Prior to age 63

63

64

65

66

67

68

69+

Duration of Payments (Accident)

To age SSNRA or the date the 48th monthly benefit is payable, if later

To age SSNRA or the date the 42nd monthly benefit is payable, if later

36

30

27

24

21

18

To Age 70, but not less than 12 months

12

Duration of Payments (Sickness)

60 months

Premium Plan A—Maximum Benefit Period Schedule Age at Disability

Prior to age 63

63

64

65

66

67

68

69+

Duration of Payments (Accident and Sickness)

To age SSNRA or the date the 48th monthly benefit is payable, if later

To age SSNRA or the date the 42nd monthly benefit is payable, if later

36

30

27

24

21

18

Earnings While Disabled During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of pre-disability Covered Earnings. After that, benefits will be reduced by 50% of earnings from employment.

Limited Benefit Period Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months for outpatient treatment: Anxietydisorders, delusional (paranoid) or depressive disorders, eating disorders, mental illness, somatoform disorders (including psychosomatic illnesses) ,alcoholism, drug addiction or abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 24-month lifetime outpatient limit is exhausted.

Pre-existing Condition Waiver The Insurance Company will waive the Pre-Existing Condition Limitation for the first 4 weeks of Disability even if the Insured has a Pre-Existing Condition. The Disability Benefits as shown in the Schedule of Benefits will continue beyond 4 weeks only if the Pre-Existing Condition Limitation does not apply.

Pre-existing Condition Limitation The Insurance Company will not pay benefits for any period of Disability caused or contributed to by, or resulting from, a Pre-existing Condition. A "Pre-existing Condition" means any Injury or Sickness for which {the Employee} received medical 20

treatment, care or services including diagnostic measures, took prescribed drugs or medicines within {12 months}#3 before his or her effective date of insurance. The Pre-existing Condition Limitation will apply to any added benefits or increases in benefits. This limitation will not apply to a period of Disability that begins on the earlier of: 3 months beginning on or after the Employee’s effective date of insurance during which the Employee has received no medical treatment, care or services in connection with the pre-existing conditions or is covered for at least 12 months after his or her effective date of insurance, or the effective date of any added or increased benefits. Except for any amount of benefit in excess of a Prior Plan’s benefits, it will not apply to an Insured covered under a Prior Plan who satisfied the Pre-existing Condition Limitation, if any, under that plan. If an Insured, covered under a Prior Plan, did not fully satisfy the Pre-existing Condition Limitation of that plan, credit will be given for any time he did satisfy. Time will not be credited for any day an Insured is not in Active Service or is not actively at work due to Sickness. This limitation will be extended by the number of days the Insured is not in Active Service or not actively at work due to Sickness.

Termination of Disability Benefits Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, or on the following events: (1) the date you earn from any occupation more than 80% of your Covered Earnings, or the date you fail to cooperate with us in a rehabilitation plan, or transitional work arrangement, or the administration of the claim.


Long Term Disability Rehabilitation Requirement To be eligible for Disability benefits under this plan, you may be required to participate in a rehabilitation plan at the sole discretion and expense of the insurance company or company administering benefits under this plan. If you fail to fully cooperate with the rehabilitation plan, no Disability benefits will be paid, and coverage will end. For details, see your Certificate of Insurance.

Exclusions This plan does not pay benefits for a Disability which results, directly or indirectly, from any of the following:     

  

Suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane. War or any act of war, whether or not declared. Active participation in a riot; Commission of a felony; The revocation, restriction or non-renewal of an Employee’s license, permit or certification necessary to perform the duties of his or her occupation unless due solely to Injury or Sickness otherwise covered by the Policy. Any cosmetic surgery or surgical procedure that is not Medically Necessary. An Injury or Sickness for which the Employee is entitled to benefits from Workers’ Compensation or occupational disease law. An Injury or Sickness that is work related.

In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution.

21


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 22 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


Cancer BASE PLAN ONLY MONTHLY RATES

EMPLOYEE

SINGLE PARENT

FAMILY

BASE PLAN A

$17.98

$22.19

$30.42

BASE PLAN B

$24.70

$29.86

$41.26

BASE PLAN C

$34.59

$41.29

$57.41

OPTIONAL ADDITIONAL BENEFIT AMOUNTS BASE PLAN + INTENSIVE CARE UNITE BENEFIT $500 MONTHLY RATES

EMPLOYEE

SINGLE PARENT

FAMILY

BASE PLAN A + ICU 500

$20.30

$25.38

$34.82

BASE PLAN B + ICU 500

$27.03

$33.06

$45.66

BASE PLAN C + ICU 500

$36.92

$44.49

$61.81

BASE PLAN + INTENSIVE CARE UNITE BENEFIT $1,000 MONTHLY RATES

EMPLOYEE

SINGLE PARENT

FAMILY

BASE PLAN A + ICU 1,000

$22.63

$28.58

$39.22

BASE PLAN B + ICU 1,000

$29.35

$36.25

$50.06

BASE PLAN C + ICU 1,000

$39.24

$47.69

$66.21

BENEFIT PROVISIONS. Loyal American pays the benefits described in the Certificate for the treatment of an Insured Person’s Cancer, provided he or she is covered under an issued Certificate which remains in force. Payment will be made in accordance with all applicable policy provisions. Benefits are payable for a positive diagnosis that begins after the Effective Date. The positive diagnosis must be for Cancer as defined in the policy. Positive Diagnosis Benefit ‐ We will pay the Actual Charge but not to exceed $300 per Calendar Year for one test that confirms the Positive Diagnosis of Cancer in an Insured Person. This benefit is not payable for multiple diagnoses of the same Cancer or for Cancer that metastasizes or for recurrence of the same Cancer. National Cancer Institute Designated Comprehensive Cancer Treatment Center Evaluation/Consultation Benefit ‐ We will pay the Actual Charge, but not to exceed a lifetime maximum of $750, if an Insured Person is diagnosed with Internal Cancer and seeks evaluation or consultation from a National Cancer Institute designated Comprehensive Cancer Treatment Center. If the Comprehensive Cancer Treatment Center is located more than 30 miles from the Insured Person’s place of residence, We will also pay the transportation and lodging expenses incurred but not to exceed a lifetime maximum of $350. This benefit is not payable on the same day a Second or Third Surgical Opinion Benefit is payable and is in lieu of the Non‐Local Transportation and Lodging Expense Benefits of the Policy. This benefit is payable one time during the lifetime of the Insured Person. Second and Third Surgical Opinion Expense Benefit ‐ We will pay the Actual Charge for a written second surgical opinion concerning the recommendation of Cancer surgery and if the second surgical opinion is in conflict with that of the Physician originally recommending the surgery and the Insured Person desires a third opinion, We will the Actual Charge for a written third surgical opinion. The Physician providing the second or third surgical opinion cannot be associated with the Physician who originally recommended the surgery. This benefit is not payable the same day the National Cancer Institute Evaluation/Consulting Benefit is payable. Medical Imaging, Treatment Planning and Monitoring Expense Benefit ‐ We will pay the Actual Charge, but not to exceed $1,000 per Calendar Year, for laboratory tests, diagnostic X‐rays, medical images, when used in Cancer treatment plannings related to Radiation Treatment, Chemotherapy or Immunotherapy. 23


Cancer Anti‐Nausea Medication Expense Benefit - We will pay the Actual Charge for anti‐nausea medication, but not to exceed $150 per calendar month, when an Insured Person is prescribed such medication as the result of Radiation Treatment, Chemotherapy or Immunotherapy treatments for Cancer. Colony Stimulating Factor or Immunoglobulin Expense Benefit - We will pay the Actual Charge but not to exceed $1,000 per Calendar Month for Colony Stimulating Factor Drugs or Immunoglobulins prescribed by a Physician or Oncologist during an Insured Person’s Cancer treatment regimen for which benefits are payable under the Radiation, Chemotherapy and Immunotherapy Benefit of this Policy or rider attached to it. Outpatient Hospital or Ambulatory Surgical Center Expense Benefit ‐ We will pay the Actual Charge from an Ambulatory Surgical Center or Outpatient department of a Hospital for the use of its facilities for the performance of a surgical procedure covered under this Policy but not to exceed $350 per day. Prosthesis Expense Benefit (A.) Surgically Implanted Breast Prosthesis - We will pay the Actual Charge for a surgically implanted prosthetic device required and prescribed to restore normal body contour lost as the direct result of an Insured Person’s breast removal for the treatment of Cancer. The Surgically Implanted Breast Prosthesis Benefit does not include coverage for breast reconstruction surgery which may be covered under the Surgical Schedule within the Surgical and Anesthesia Benefits Rider. (B) Non‐Surgically Implanted Prosthesis - We will pay the Actual Charge incurred not to exceed $2,000 per amputation for an artificial or other non‐surgically implanted prosthetic device that is prescribed and required to restore normal body function lost as the direct result of amputation for the treatment of Cancer. We will pay a lifetime maximum of $2,000 per amputation. The cost of replacement of a prosthetic device is not covered. Hairpieces or wigs are not covered under this benefit. Non‐Local Transportation Expense Benefit ‐ We will pay the Actual Charge, but not to exceed the coach fare on a Common Carrier for the Insured Person and one adult companion’s travel to a Hospital, Radiation Therapy Treatment Center, Chemotherapy Treatment Center, Oncology Clinic or any other specialized treatment center where the Insured Person receives treatment for Cancer. This benefit is payable only if the treatment is not available Locally but is available Non‐Locally. The adult companion may include the live donor of bone marrow or stem cells used in a bone marrow or stem cell transplant for the Insured Person. At the option of the Insured Person, We will pay a single private vehicle mileage allowance of $.50 per mile for Non‐Local transportation in lieu of the common carrier coach fare. Lodging Expense Benefit ‐ We will pay the Actual Charge not to exceed $75 per day for a room in a motel, hotel or other appropriate lodging facility (other than a private residence), when an Insured Person receives treatment for Cancer at a Non‐Local Hospital, Radiation Therapy Treatment Center, Chemotherapy Treatment Center, Oncology Clinic or any other specialized treatment center. The room must be occupied by the Insured Person or an adult companion which may include the live donor of bone marrow or stem cells used in a bone marrow or stem cell transplant for the Insured Person. This benefit is not payable for lodging expense incurred more than 24 hours before the treatment nor for lodging expense incurred more than 24 hours following treatment. This benefit is limited to 100 days per Calendar Year. Inpatient Blood, Plasma, and Platelets Expense Benefit - We will pay the Actual Charge not to exceed $300 per day for the procurement cost, administration, processing and cross matching of blood, plasma or platelets administered to an Insured Person in the treatment of Cancer while an Inpatient. Outpatient Blood, Plasma, and Platelets Expense Benefit ‐ We will pay the Actual Charge not to exceed $300 per day for the procurement cost, administration, processing and cross matching of blood, plasma or platelets administered to an Insured Person in the treatment of Cancer while an Outpatient. Bone Marrow Donor Expense Benefit - We will pay the Daily Hospital Confinement Benefit shown on the Certificate Schedule for each day a live donor, other than the Insured Person, is confined in a Hospital for the harvesting of bone marrow or stem cells used in a bone marrow or stem cell transplant for the treatment of an Insured Person’s Cancer.

24


Cancer Bone Marrow or Stem Cell Transplant Expense Benefit We will pay the Actual Charge not to exceed a lifetime maximum of $15,000 for surgical and anesthesia procedures (including the harvesting and subsequent re‐infusion of blood cells or peripheral stem cells) performed for a bone marrow transplant and/or a peripheral stem cell transplant for the treatment of an Insured Person’s Cancer. This benefit will be paid in lieu of the Surgical Expense Benefit and the Anesthesia Expense Benefit which may be described in a rider attached to an issued Certificate. Ambulance Expense Benefit ‐ We will pay the Actual Charge for ambulance service if an Insured Persons is transported to a Hospital where he or she is admitted as an inpatient for the treatment of Cancer . The ambulance service must be provided by a licensed professional ambulance company or an ambulance owned by the Hospital. Inpatient Oxygen Expense Benefit ‐ We will pay the Actual Charge not to exceed $300 per Hospital confinement for oxygen prescribed by a Physician and received by an Insured Person while confined in a Hospital for the treatment of Cancer. Attending Physician Expense Benefit ‐ We will pay the Actual Charge not to exceed $40 per day for the professional services of a Physician or Oncologist rendered to an Insured Person while he or she is confined in a Hospital for the treatment of Cancer. This benefit is payable only if the Physician or Oncologist personally visits the Hospital room occupied by the Insured Person and the amount stated is the maximum amount that will be payable for each day of Hospital confinement regardless of the number of visits made by one or more Physicians or Oncologists. Inpatient Private Duty Nursing Expense Benefit ‐ We will pay the Actual Charge not to exceed $150 per day for the full time service of a Nurse that is required and ordered by a Physician when an Insured Person is confined in a Hospital for the treatment of Cancer. The Nurse must provide services other than those normally provided by the Hospital and the Nurse may not be an employee of the Hospital or an Immediate Family Member of the Insured Person. Outpatient Private Duty Nursing Expense Benefit ‐ We will pay the Actual Charge not to exceed $150 per day limited to the same number of days of the prior Hospital confinement for the full time service of a Nurse that is required and ordered by a Physician when an Insured Person is confined indoors at home as the result of Cancer . This benefit is not payable if the services of the Nurse are custodial in nature or to assist the Insured Person in the activities of daily living. This benefit is not payable when the Nurse is a member of the Insured Person’s Immediate Family. Charges must begin following a period of Hospital confinement for which benefits are payable under this Certificate. Convalescent Care Facility Expense Benefit ‐ We will pay the Actual Charge not to exceed $100 per day for an Insured Person’s confinement in a Convalescent Care Facility. The maximum number of days for which this benefit is payable will be the number of days in the last Period of Hospital Confinement that immediately preceded admission to a Convalescent Care Facility. The Convalescent Care Facility Confinement must: be due to Cancer ; begin within 14 days after the Insured Person has been discharged from a Hospital for the treatment of Cancer ; be authorized by a Physician as being medically necessary for the treatment of Cancer. Rental Purchase of Medical Equipment Expense Benefit ‐ We will pay the lesser of the Actual Charge not to exceed $1,500 per Calendar Year for either the rental or purchase of covered medical equipment designed for home use, required and ordered by the Insured Person’s attending Physician as the direct result of the treatment of Cancer. Covered medical equipment includes wheel chair, oxygen equipment, respirator, braces, crutches or hospital bed Home Health Care Expense Benefit ‐ We will pay benefits for the following Covered Charges when a Insured Person requires Home Health Care for the treatment of Cancer. 1. Home Health Care Visits ‐ We will pay the Actual Charge for Home Health Care Visits not to exceed $75 for each day on which one or more such visits occur. We will not pay this benefit for more than 60 days in any Calendar Year. 2. Medicine and Supplies ‐ We will pay the Actual Charge not to exceed $450 in any Calendar Year for drugs, medicine, and medical supplies provided by or on behalf of a Home Health Care Agency. 3. Services of a Nutritionist ‐ We will pay the Actual Charge not to exceed a lifetime maximum of $300 for the services of a nutritionist to set up programs for special dietary needs.

25


Cancer Hospice Care Expense Benefit ‐ We will pay the Actual Charge for Hospice Care not to exceed $100 per day, when such care is required because of Cancer. This benefit is payable whether confinement is required in a Hospice Center or services are provided in the Insured Person’s home by a Hospice Team. Eligibility for payments will be based on the following conditions being met:(1) the Insured Person has been given a prognosis as being Terminally Ill with an estimated life expectancy of 6 months or less; and (2) We have received a written summary of such prognosis from the attending Physician. We will not pay this benefit while the Insured Person is confined to a Hospital or Convalescent Care Facility. The lifetime maximum benefit is 365 days of Hospice Care. Hairpiece Expense Benefit ‐ We will pay the Actual Charge not to exceed a lifetime maximum of $150 for the purchase of a wig or hairpiece that is required as the direct result of hair loss due to Cancer treatment. Physical, Speech, Audio Therapy and Psychotherapy Expense Benefit We will pay the Actual Charge not to exceed $25 per therapy session for: 1. Physical therapy treatments given by a license Physical Therapist, or 2. Speech therapy given by a licensed Speech Pathologist/Therapist; or 3. Audio therapy given by a licensed Audiologist; or 4. Psychotherapy given by a licensed Psychologist. These sessions may be given at an institute of physical medicine and rehabilitation, a Hospital, or the Insured Person’s home. These treatments must be given on an Outpatient basis unless the primary purpose of a Hospital confinement is for treatment of Cancer other than with physical, speech or audio therapy or psychotherapy. Benefits may not exceed $1,000 per Calendar Year. Waiver of Premium ‐ We will waive the premiums starting on the first premium due date following a 60 day period of Total Disability of the Named Insured due to Cancer. The Named Insured must: (a) be receiving treatment for such Cancer for which benefits are payable under this Certificate; and (b) remain disabled for 60 consecutive days. We will waive premiums for as long as the Named Insured remains Totally Disabled. THIS IS A CANCER ONLY POLICY, which should be used to supplement your existing health care protection. RENEWABILITY. Coverage will terminate when the Group Master Policy terminates or when required premium remains unpaid after expiration of the Grace Period. PREMIUM RATES. We may change the premium rates for coverage only if we also change the rates for all other Certificates issued under the Group Master Policy. EXCLUSIONS AND LIMITATIONS. No benefits will be paid under the Certificate or any attached riders for: 1. any loss due to any disease or illness other than Cancer, or a listed covered Specified Disease; 2. care and treatment received outside the territorial limits of the United States; 3. treatment by any program engaged in research that does not meet the criteria for Experimental Treatment as defined; 4. treatment that has not been approved by a Physician as being medically necessary; or 5. losses or medical expenses incurred prior to the Certificate Effective Date of an Insured Person’s coverage regardless of the Date of Positive Diagnosis. PRE‐EXISTING CONDITIONS LIMITATION. Relative to any Insured Person, We will not pay benefits for expenses resulting from Pre‐ existing Conditions during the 12 months after coverage becomes effective. “Pre‐existing Condition” means Cancer, or a listed Specified Disease if that optional rider is issued, which was diagnosed by a Physician or for which medical consultation, advice or treatment was recommended by or received from or sought from a Physician within 1 year prior to the effective date of coverage for each Insured Person.

26


Cancer Additional Benefit Amounts

Plan A Plan B Plan C Maximum Maximum Maximum

$50 Per $50 Per $100 Per Calendar Calendar Calendar Year Year Year Basic Benefit– We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, once per calendar year per Insured Person for screening tests performed to determine whether Cancer exists in an Insured Person. Covered annual Cancer screening tests include but are not limited to: mammogram, pap smear, breast ultrasound, ThinPrep, biopsy, chest x‐ray, thermography, colonoscopy, flexible sigmoidoscopy, hemocult stool specimen, PSA (blood test for prostate cancer) CEA (blood tests for colon cancer), CA125 (blood test for ovarian cancer) CA15‐3 (blood test for breast cancer) serum protein electrophesis (blood test for myeloma) $100 Per $100 Per $200 Per Additional Benefit Calendar Calendar Calendar Year Year Year 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 for an Insured Person. This additional benefit is payable regardless of the results of the additional diagnostic procedure. However, the amount payable will be reduced dollar for any dollar payable under the Positive Diagnosis Benefit contained in the base Certificate First Occurrence Benefit Rider (Form LG‐6043) If the Insured Person received a positive diagnosis of internal Cancer, We will pay the $2,000 Once $4,000 Once $5,000 Once First Occurrence benefit amount shown on the Certificate Schedule Per Lifetime Per Lifetime Per Lifetime If the Insured Person receiving the positive diagnosis of Internal Cancer is a child under the age of 21, we will pay one and one‐half times the First Occurrence benefit $3,000 Once $6,000 Once $7,500 Once amount shown on the Certificate Schedule Per Lifetime Per Lifetime Per Lifetime $7,500 Per $10,000 Per $15,000 Per Annual Radiation, Chemotherapy, Immunotherapy, and Experimental Treatment Calendar Calendar Calendar Benefit Rider (Form LG‐6045) Year Year Year We will pay the expense incurred, but not to exceed the maximum benefit amount shown on the Certificate Schedule, per calendar year per Insured Person for Radiation Treatment, Chemotherapy, Hormonal Therapy, Immunotherapy or Experimental Treatment. The Radiation Treatment, Chemotherapy, Hormonal Therapy, Immunotherapy or Experimental Treatment must be for the treatment of an Insured Person’s Cancer. The benefit amount shown on the Certificate Schedule is the maximum calendar year benefit available per Insured Person regardless of the number or types of Cancer treatments received in the same year. 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 $2,000 $4,000 $6,000 Surgical Schedule shown in this rider. However, in no event will the amount payable Procedure Procedure Procedure exceed the maximum Surgical Expense benefit shown on the Certificate Schedule, nor Maximum Maximum Maximum will it exceed the expense incurred Anesthesia Expense ‐ We will pay the anesthesia expense incurred, not to exceed $500 $1,000 $1,500 25% of the covered Surgical Expense benefit for the operation performed. This Procedure Procedure Procedure includes the services of an anesthesiologist or of an anesthetist under supervision of a Maximum Maximum Maximum physician for the purpose of administering anesthesia Breast Reconstruction ‐ with transverse rectus adominis myocutaneous flap (TRAM), single pedicle, including closure of donor site, with microvascular anastomosis $1,800 $3,600 $5,400 (supercharging) is one of the surgical procedures listed in the Surgical Schedule. If Procedure Procedure Procedure this procedure is performed on an Insured Person as the result of a mastectomy for Maximum Maximum Maximum which We paid a Surgical Expense benefit for the treatment of Breast Cancer, We will pay the expense incurred not to exceed $900 per $1,000 of the Surgical Benefit Issued Skin Cancer Surgery Expense ‐ We will pay the expense incurred, not to exceed the procedure amount listed in this rider ($125 to $750 depending on the procedure) Per Per Per when a surgical operation is preformed on an Insured Person for treatment of a Procedure Procedure Procedure 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. Annual Cancer Screening Benefit Rider (Form LG‐6041)

27


Cancer Additional Benefit Amounts Continued 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. Confinement of 31 Days or More ‐ If an Insured Person is continuously confined to a hospital, including a government or charity hospital, for longer than 30 consecutive days for the treatment of Cancer, We will pay two times the Daily Hospital Confinement benefit amount shown on the Certificate Schedule. This benefit payment will begin on the 31st continuous day of such confinement and continue for each day of confinement until the Insured Person is discharged from the Hospital. Benefits for an Insured Dependent under Age 21 - The amount payable under this benefit will be double the Daily Hospital Confinement benefit shown in the Certificate Schedule if the Insured Person so confined is a dependent Child under the age of 21.

Plan A Plan B Plan C Maximum Maximum Maximum $100 Per Day

$200 Per Day

$300 Per Day

$200 Per Day

$400 Per Day

$600 Per Day

$200/$400 Per Day

$400/$800 Per Day

$300/$600 Per Day

Additional Benefit Amounts Continued SPECIFIED DISEASE BENEFIT RIDER (FORM LG 60‐52) If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider. COVERS THESE 38 SPECIFIED DISEASES Addison’s Disease Lupus Erythmatosus Rocky Mountain Spotted Fever Amyotrophic Lateral Sclerosis Malaria Sickle Cell Anemia Botulism Meningitis Tay‐Sachs Disease Bovine Spongiform Encephalopathy Multiple Sclerosis Tetanus Budd‐Chiari Syndrome Muscular Distrophy Toxic Epidermal Necrolysis Cystic Fibrosis Myasthenia Gravis Tuberculosis Diptheria Neimann‐Pick Disease Tularemia Encephalitis Osteomyelitis Typhoid Fever Epilepsy Poliomyelitis Undulant Fever Hansen’s Disease Q Fever West Nile Virus Histoplasmosis Rabies Whipple’s Disease Legionnaire’s Disease Reye’s Syndrome Whooping Cough Lyme Disease Rheumatic Fever BENEFITS If an Insured Person is first diagnosed with one or more covered Specified Diseases and is hospitalized for the definitive treatment of any covered Specified Disease, We will pay benefits according to the provisions of this rider. An applicant may select 1, 2, or 3, units of coverage. Initial Hospitalization Benefit We will pay a benefit of $1,500 per unit of coverage selected when an Insured Person is confined to a hospital (for 12 or more hours, not applicable in SD) as a result of receiving treatment for a Specified Disease. This benefit is payable only once per period of confinement and once per calendar year for each Insured Person. Hospital Confinement Benefit We will pay a benefit of $300 per unit of coverage selected when an Insured Person is hospitalized during any continuous period of 30 days or less for the treatment of a covered Specified Disease. Benefits will double per day beginning with the 31st day of continual confinement. If the hospital confinement follows a previously covered confinement, it will be deemed a continuation of the first confinement unless it is the result of an entirely different Specified Disease, or unless the confinements are separated by 30 days or more. *SPECIFIED DISEASE BENEFIT RIDER IS NOT INCLUDED IN PLAN A This page is an Insert to be used ONLY with Brochure Form LG-6040. If you do not have this Brochure, ask that your agent provide one for you. All exclusions, limitations, definitions and terms of renewability of the Group Limited Benefit Cancer Certificate (form LG-6040) apply to these riders. THESE ARE LIMITED RIDERS. 28


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 ICU Benefit shown on the Certificate Schedule for an Insured Person’s confinement in an ICU for sickness or Injury.

$500 Per Day

$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.

$1,000 Per Day

$2,000 Per Day

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

$250 Per Day

$500 Per Day

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

29


CIGNA 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 30 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


Accident Who Can Elect Coverage?: You: All active, Full-time Employees of the Employer who are United States citizens or permanent resident aliens regularly working a minimum of 15 hours per week in the United States. You will be eligible for coverage the first of the month on or after 30 days of active service. Your Spouse: Up to age 70, as long as you apply for and are approved for coverage yourself. Your Child(ren): Birth to 26, as long as you apply for and are approved for coverage yourself.

Available Coverage: This Accidental Injury plan provides 24 hour coverage. The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred. Benefits are only payable when all policy terms and conditions are met. Please read all the information in this summary to understand terms, conditions, exclusions and limitations applicable to these benefits. See your Certificate of Insurance for more information.

Spouse definition includes civil union for employees residing in Vermont and includes registered domestic partners for employees residing in California & Oregon.

Initial & Emergency Care

Low Plan

High Plan

$300/$1,200

$400/$1,600

Emergency Care Treatment

$100

$200

Diagnostic Exam (x-ray or lab)

$10

$50

Physician Office Visit

$50

$100

Low Plan

High Plan

$1,000

$1,300

Hospital Stay (per day)

$200

$250

Intensive Care Unit Stay (per day)

$400

$600

Ground Ambulance/Air Ambulance

Hospitalization Benefits Hospital Admission

Fractures and Dislocations

Low Plan

High Plan

Per covered surgically-repaired fracture

$100-$4,000

$200-$8,000

Per covered non-surgically-repaired fracture

$50-$2,000

$100-$4,000

Chip Fracture (percent of fracture benefit)

25%

25%

Per covered surgically-repaired dislocation

$100-$4,000

$200-$6,000

Per covered non-surgically-repaired dislocation

$50-$2,000

$100-$3,000

Follow-Up Care

Low Plan

High Plan

Follow-up visit to the doctor

$50

$75

Follow-up physical therapy visits

$25

$50

Enhanced Accident Benefits

Low Plan

High Plan

Examples: Small Lacerations (Less than or equal to 6 inches long and requires 2 or more sutures) Large Lacerations (more than 6 inches long and requires 2 or more sutures) Coma (lasting 7 days with no response) Concussion Plus 22 other benefits - See certificate for details, including limitations and exclusions.

31


Accident Available Coverage — continued Accidental Death and Dismemberment Rider: Pays benefits for Accidental Death and Dismemberment. Examples of benefits include (but are not limited to) payment for death from Automobile accident or total and permanent loss of speech or hearing in both ears. Actual benefit amount paid depends on the type of Covered Loss. To receive benefits, the death or loss must occur within 365 days of the covered accident. Benefit – Specific Conditions, Exclusions, Limitations & Reductions The exclusions that apply to this benefit are in the Common Exclusions Section. If a Covered Person dies as a result of an automobile accident other loss of life benefits will not be paid. If the driver, he/she must hold a current and valid driver’s license. If total and permanent loss of speech or hearing in both ears is payable, no benefits will be paid under the dismemberment benefit and total benefits will not exceed the loss of life death benefit. Benefit Amounts for the Covered Person’s will reduce to 50% at age 70, but child benefits if applicable, will not reduce. This is not a complete list. See certificate for complete details, including limitations and exclusions that apply to this benefit. Portability Feature: You, your spouse, and child(ren) can continue

Important Definitions and Policy Provisions: Coverage Type: Benefits are paid when a covered injury results, directly and independently of all other causes, from a Covered Accident. Covered Accident: A sudden, unforeseeable, external event that results, directly and independently of all other causes, from a Covered Injury or Covered Loss and occurs while the Covered Person is insured under this Policy; is not contributed to by disease, sickness, mental or bodily infirmity; and is not otherwise excluded under the terms of this Policy. Covered Injury: Any bodily harm that results directly and independently of all other causes from a Covered Accident. Covered Person: An eligible person who is enrolled for coverage under this Policy. Covered Loss: A loss that is from a Covered Accident suffered by the Covered Person within the applicable time period described in the Policy. Hospital: an institution that is licensed as a hospital pursuant to applicable law; primarily and continuously engaged in providing medical care and treatment to sick and injured persons; managed under the supervision of a staff of medical doctors; provides 24-hour nursing services by or under the supervision of a graduate registered Nurse (R.N.); and has medical, diagnostic and treatment facilities with major surgical facilities on its premises, or available to it on a prearranged basis, and charges for its services. The term Hospital does not include a clinic, facility, or unit of a Hospital for: rehabilitation, convalescent, 32

100% of your coverage at the time your coverage ends. You must be under the age of 70 in order to continue your coverage. Rates may change and all coverage ends at age 100.

Integration Services Clinical Program Referrals – leveraging authorized medical information to make referrals to suitable wellness programs. Proactive Coverage Review – automatic review and reminder of accidental injury coverage if a claim is filed for other Cigna coverages. Automatic Claim Approach – automatic submission of an accidental injury claim if a qualifying Cigna Short-Term-Disability accident claim has been filed.

Monthly Cost of Coverage Tier Employee Employee and spouse Employee and child(ren) Family

Low Plan $8.40 $14.30 $14.54 $19.62

High Plan $14.55 $24.81 $25.25 $34.07

Costs are subject to change, and may be different if certain benefits or riders are not available in certain resident states. Actual per pay period premiums may differ slightly due to rounding.

custodial, educational, or nursing care; or the aged, drug addicts or alcoholics. When your coverage begins: Coverage begins on the later of the program’s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. Your coverage will not begin unless you are actively at work on the effective date. Dependent coverage will not begin for any dependent who on the effective date is hospital, home, or facility confined under the care of a physician for sickness or injury; receiving disability benefits; or unable to perform any activities of daily living without assistance. When your coverage ends: Coverage ends on the earliest of the date you and your dependents are no longer eligible, the date the group policy is no longer in force, or the date for the last period for which required premiums are paid. (Under certain circumstances, your coverage may be continued if you stop working. Be sure to read the Continuation of Insurance provisions in your Certificate.)

Benefit Reductions, Exclusions and Limitations: This document provides only the highlights. All claims for a covered loss must meet specific Benefit Conditions and Limitations and are otherwise subject to all other terms set forth in the group policy. Common Exclusions: In addition to any benefit specific exclusions, no payments will be made for losses caused directly or indirectly, in whole or in part, by: • intentionally self-inflicted


Accident injury, including suicide or any attempted suicide; • committing an assault or felony; • bungee jumping; parachuting; skydiving; parasailing; hang-gliding; • declared or undeclared war or act of war; • Aircraft or air travel, except as a commercial passenger or Aircraft used by the Air Mobility Command (unless owned, leased or controlled by Subscriber); • sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment, except bacterial infection from an accidental external cut or wound or accidental ingestion of contaminated food; • activities of active military duty, except Reserve or National Guard active duty training lasting 31 days or less; • operating any vehicle under the influence of alcohol or any drug, narcotic or other intoxicant; • voluntary use of drugs, unless taken as prescribed and under direction of a physician; • services or treatment rendered by a Physician, Nurse or any other person who is: employed by the Subscriber, living with or immediate family of the Covered Person, or providing alternative medical treatments; and • injuries that occur during the course of any employment for pay, benefit or profit. Actual policy terms may vary depending on your plan design and location. Specific Benefit Exclusions & Limitations: Ground Ambulance/Air Ambulance: Services must be provided from the scene of the Covered Accident or within 90 days of Covered Accident. Limits: payable once per Covered Accident, per Covered Person; limit 1 benefits per month; only one benefit will be paid ground/air, whichever is greater. Emergency Care Treatment: Treatment must occur within 30 days of the Covered Accident. Limits: payable once per Covered Accident, per Covered Person; limit 1 Covered Accidents per month. Excludes: treatment provided by an Immediate family member, clinic, or doctor’s office. Diagnostic Exam: payable once per Covered Accident, per Covered Person; Treatment must occur within 90 days of the Covered Accident. Physician Office Visit: Must be diagnosed and treated by a Physician within 90 days of the Covered Accident. Limits: payable once per Covered Accident, per Covered Person; not payable if a Covered Person is eligible to receive a benefit under Emergency Treatment. Excludes: routine health examinations or immunizations for Covered Persons Age 60 and older, visits for Mental or Nervous Disorders, and visits by a surgeon while Confined to a Hospital. • Hospital Admission: Inpatient admission must occur within 90 days of the Covered Accident due to such accident; Limits: payable once per Covered Accident; limit 1 benefit per month. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re-admission for the same Covered Accident. Hospital Stay per day: Must be admitted for at least 23 hours or admitted inpatient and confined within 90 days of the Covered Accident. Limits: 365 days per Covered Accident; 1 benefit per month; not payable for hospital re-admission for same Covered Accident; if eligible for Hospital Stay Benefit and Initial Intensive Care Unit Benefit, only 1 benefits will be paid for the same

Covered Accident, whichever is greater; Stays within 90 days for the same or a related Covered Accident are considered one Stay. • Intensive Care Unit Stay per day: Must be admitted for at least 23 hours or admitted inpatient and confined within 90 days of the Covered Accident. Limits: 365 days per Covered Accident, 1 benefits per month; not payable for hospital re-admission for same Covered Accident; if eligible for Hospital Stay Benefit and Initial Intensive Care Unit Benefit, only 1 benefits will be paid for the same Covered Accident, whichever is greater; Stays within 90 days for the same or a related Covered Accident are considered one Stay. Fracture/Dislocation: If more than one fracture, only one benefit will be paid, whichever is the greater amount. Chip fracture not paid in addition to closed fracture. Limits: Both fractures and dislocations are limited to 1 per accident. Must be diagnosed and treated by a physician within 90 days of the Covered Accident. Follow-up visit to the doctor/Follow-up physical therapy visits: Limits: 10 benefits for each Covered Person per Covered Accident for both visits to the doctor and also physical therapy visits; limit 1 Covered Accident per month for a Covered Person. Must be examined, treated or prescribed by physician. Examination or treatment must be provided within 90 days and treatment must be completed within 365 days of the Covered Accident. Large Lacerations: Treatment by physician must be received within 90 days of the Covered Accident. Limits: payable 1 time per Covered Person, Per Covered Accident; Multiple lacerations pay a maximum of 2 times the benefit. • Coma: Limits: payable 1 times per Covered Accident. Must be unconscious for 7 days or more with no response to external stimuli and requiring artificial respiratory or life support. Excludes: medically induced coma. Concussion: Must be diagnosed by a physician within 90 days of the Covered Accident. Limits: payable 1 times per Covered Accident.

33


CIGNA

Critical Illness

YOUR BENEFITS PACKAGE

PLAY VIDEO

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

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 34 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


Critical Illness Who Can Elect Coverage?:

Available Coverage:

You: All active, Full-time Employees of the Employer who are United States citizens or permanent resident aliens regularly working a minimum of 15 hours per week in the United States. You will be eligible for coverage on the first of the month following your date of hire. Your Spouse: Up to age 70, as long as you apply for and are approved for coverage yourself. Your Child(ren): Up to age 26, as long as you apply for and are approved for coverage yourself.

The benefit amounts shown will be paid regardless of the actual expenses incurred. The benefit descriptions are a summary only. There are terms, conditions, exclusions and limitations applicable to these benefits. Please read all of the information in this Summary and your Certificate of Insurance for more information. All Covered Critical Illness Conditions must be due to disease or sickness.

Spouse definition includes civil union for employees residing in Vermont and includes registered domestic partners for employees residing in California & Oregon.

Benefit Amount

Guaranteed Issue Amount

$5,000, $10,000, $15,000, $20,000, $30,000

Up to $30,000

Spouse

$5,000, $10,000, $15,000

Up to $15,000

Children

$1,250, $2,500, $3,750, $5,000

All guaranteed issue

Employee

See “Guaranteed Issue� section below for more information.

Initial Benefit Amount %

Recurrence % of Initial Benefit Amount

Heart Attack

100%

100%

Stroke

100%

100%

Coronary Artery Disease

25%

25%

Advanced Alzheimer's Disease

25%

Not Available

Amyotrophic Later Sclerosis (ALS)

25%

Not Available

Parkinson's Disease

25%

Not Available

Multiple Sclerosis

25%

Not Available

Benign Brain Tumor

100%

100%

Blindness

100%

Not Available

Coma

25%

25%

End-Stage Renal (Kidney) Disease

100%

100%

Major Organ Failure

100%

100%

Paralysis

100%

100%

Loss of Hearing

100%

Not Available

Loss of Speech

100%

Not Available

Systemic Lupus

25%

25%

Systemic Sclerosis

25%

25%

Covered Conditions

Nervous System Conditions

Other Specified Conditions

35


Critical Illness Health Screening Test Benefit

Employee + Family (EE+F)

Examples includes (but are not limited to) mammography, and certain blood tests. A 30 day benefit waiting period applies, during which benefits will not be paid.

$50 per day, limited to 1 per year

Benefits Initial Critical Illness Benefit Benefit for a diagnosis made after the effective date of coverage for each Covered Condition shown above. The amount payable per Covered Condition is the Initial Benefit Amount multiplied by the applicable percentage shown. Each Covered Condition will be payable one time per Covered Person, subject to the Maximum Lifetime Limit. A 90 days separation period between the dates of diagnosis is required. Recurrence Benefit Benefit for the diagnosis of a subsequent and same Covered Condition for which an Initial Critical Illness Benefit has been paid, payable after a 6 month separation period from diagnosis of a previous Covered Condition, subject to the Maximum Lifetime Limit. Maximum Lifetime Limit

The maximum benefit payable per Covered Person is the lesser of 5 times the elected Benefit Amount or $150,000. The following benefits are not subject to this limit: Additional Benefits.

A 30 days benefit waiting period applies during which benefits will not be paid.

Additional Benefits Portability Feature: You can continue 100% of coverage for all Covered Persons at the time Your coverage ends. You must be covered under the policy and be under the age of 70 in order to continue your coverage. Rates may change and all coverage ends at age 100. *excludes residents of Vermont. Integration Services Clinical Program Referrals – leveraging authorized medical information to make referrals to suitable wellness programs. Proactive Coverage Review – automatic review and reminder of critical illness coverage if a claim is filed for other Cigna coverages. Automatic Claim Approach – automatic submission of a critical illness claim if a qualifying Cigna Short-Term-Disability accident claim has been filed.

Employee’s Monthly Cost of Coverage: Employee Rates Age Band <29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80 to 89 90+

$5,000 $2.73 $3.10 $3.96 $5.79 $8.30 $14.99 $33.15 $33.15

$10,000 $3.47 $4.21 $5.92 $9.58 $14.61 $28.00 $64.32 $64.32

$15,000 $4.20 $5.32 $7.89 $13.38 $20.92 $41.01 $95.48 $95.48

$20,000 $4.94 $6.43 $9.86 $17.18 $27.24 $54.01 $126.65 $126.65

$30,000 $6.42 $8.65 $13.81 $24.77 $39.86 $80.03 $188.97 $188.97

Spouse Rates Age <29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80 to 89 90+

$5,000 $2.30 $2.88 $4.16 $7.02 $10.21 $16.86 $41.49 $41.49

$10,000 $3.11 $4.27 $6.83 $12.55 $18.93 $32.29 $81.50 $81.50

$15,000 $3.91 $5.66 $9.50 $18.08 $27.65 $47.69 $121.50 $121.50

Children (CH) $1,250 $2,500 $3,750 $5,000 $1.52 $1.73 $1.93 $2.14 Costs are subject to change, and may be different if certain benefits or riders are not available in certain resident states. Actual per pay period premiums may differ slightly due to rounding. The policy’s rate structure is based on attained age, which means the premium can increase due to the increase in your age. 36


Critical Illness Important Policy Provisions and Definitions: Eligibility: Part-time employees working 15 hours or more residing in Vermont are eligible for coverage. Benefit Waiting Period: The period of time following the effective date of coverage, including any increase in coverage, during which no benefits will be paid for any loss or benefit otherwise due under the policy. The Benefit Waiting Period may differ in certain resident states. Be sure to read your Certificate. Covered Person: An eligible person who is enrolled for coverage under the Policy. Covered Loss: A loss that is specified in the Policy in the Schedule of Benefits section and suffered by the Covered Person within the applicable time period described in the Policy. When your coverage begins: Coverage begins on the later of the program’s effective date, the date you become eligible, the date we or your employer receive your completed enrollment form, the date you authorize any necessary payroll deductions, or if evidence of insurability is required, after we have approved you (or your dependent) for coverage in writing. Your coverage will not begin unless you are actively at work on the effective date. Coverage for all Covered Persons will not begin on the effective date if the Covered Person is confined to a hospital, facility or at home, disabled or receiving disability benefits or unable to perform activities of daily living. When your coverage ends: Coverage ends on the earliest of the date you and your dependents are no longer eligible, the date the group policy is no longer in force, or the date for the last period for which required premiums are paid. For your dependent, coverage also ends when your coverage ends, when their premiums are not paid or when they are no longer eligible. (Under certain circumstances, your coverage may be continued. Be sure to read the provisions in your Certificate about when coverage may continue.) 30 Day Right To Examine Certificate: If a Covered Person is not satisfied with the Certificate of Insurance for any reason, it may be returned to us within 30 days after receipt. We will return any premium that has been paid and the Certificate will be void as if it had never been issued.

Benefit Reductions, Exclusions and Limitations: Exclusions: In addition to any benefit-specific exclusions, benefits will not be paid for any Covered Loss that is caused directly or indirectly, in whole or in part by any of the following: • intentionally self-inflicted injury, suicide or any attempt thereat while sane or insane; • commission or attempt to commit a felony or an assault; • declared or undeclared war or act of war; • a Covered Loss that results from active duty service in the military, naval or air force of any country or international organization (upon our receipt of proof of service, we will refund any premium paid for this time; Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days); • voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage; • operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant (‘’Under the influence of alcohol’’, for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Covered Loss occurred) • a diagnosis not in accordance with generally accepted medical principles prevailing in the United States at the time of the diagnosis.

Advanced Alzheimer’s Disease, progressive degenerative disorder that attacks the brain’s nerve cells resulting in the inability to perform 3 or more of the Activities of Daily Living. Amyotrophic Lateral Sclerosis (ALS aka Lou Gehrig’s Disease), motor neuron disease resulting in muscular weakness and atrophy. Parkinson’s Disease, progressive, degenerative neurologic disease with indicated signs of the disease. Multiple Sclerosis, disease involving damage to brain and spinal cord cells with signs of motor or sensory deficits confirmed by MRI. Benign Brain Tumor, non-cancerous abnormal cells in the brain. Blindness, irreversible sight reduction in both eyes; Best corrected single eye visual acuity less than 20/200 (E-Chart) or 6/60 (Metric) or with visual field reduction (both eyes) to 20 degrees or less. Coma, unconscious state lasting at least 96 continuous hours. Excludes any state of unconsciousness intentionally or medically induced from unconsciousness intentionally which the Covered Person is able to be aroused. End-Stage Renal (Kidney) Disease, chronic, irreversible function of both kidneys. Requires hemo or peritoneal dialysis. Major Organ Failure, includes: liver, lung, pancreas, kidney, heart or bone marrow. Happens when transplant is prescribed or recommended and placed on UNOS registry. If the Covered Person has a combination transplant (i.e. heart and lung), a single benefit amount will be payable. Recurrence Benefit not payable for same organ for which a benefit was previously paid. Paralysis, complete, permanent loss of use of two or more limbs due to a disease. Excludes loss due to Stroke, Multiple Sclerosis and Cerebral Palsy. Loss of Hearing, permanent hearing loss in both ears; loss greater than 90dB HL. Loss of Speech, permanent loss of speech which is irrecoverable by other means excludes loss due to Invasive Cancer, Stroke or Alzheimer’s. Systemic Lupus, chronic, inflammatory, auto-immune disease with indicated signs of the disease. Systemic Sclerosis, chronic, degenerative, auto-immune disease with indicated signs of the disease.

Guaranteed Issue: If you are a new hire you are not required to provide evidence of good health if you enroll during your employer’s eligibility waiting period and you choose an amount of coverage up to and including the Guaranteed Issue Amount. If you apply for an amount of coverage greater than the Guaranteed Issue Amount, coverage in excess of the Guaranteed Issue Amount will not be issued until the insurance company approves acceptable evidence of good health. Guaranteed Issue coverage may be available at other specified periods of time. Your employer will notify you when these periods of time are available. Pre-existing condition limitations may apply. Your Spouse must be age 18 or older to apply if evidence of insurability is required. THIS POLICY PAYS LIMITED BENEFITS ONLY. IT DOES NOT CONSTITUTE COMPREHENSIVE HEALTH INSURANCE COVERAGE AND IS NOT INTENDED TO COVER ALL MEDICAL EXPENSES. THIS COVERAGE DOES NOT SATISFY THE “MINIMUM ESSENTIAL COVERAGE” OR INDIVIDUAL MANDATE REQUIREMENTS OF THE AFFORDABLE CARE ACT (ACA). THIS COVERAGE IS NOT A MEDICAID OR MEDICARE SUPPLEMENT POLICY.

Specific Benefit Exclusions and Limitations: The date of diagnosis must occur while coverage is in force and the condition definition must be satisfied. Only one Initial Benefit will be paid for each Covered Condition per person and benefits will be subject to separation periods and Maximum Lifetime Limits. Heart Attack, includes the following that confirms permanent loss of heart muscle function: 1) EKG changes; 2) elevation of cardia enzyme. Stroke, cerebrovascular event–for instance, cerebral hemorrhage–confirmed by neuroimaging studies or with neurological deficits lasting 96 hours or more. Excludes transient ischemic attack (TIAs), brain injury related to trauma or infection, brain injury associated with hypoxia or anoxia, vascular disease affecting eye or optic nerve or ischemic disorders of the vestibular system. Coronary Artery Disease, heart disease/angina requiring coronary artery bypass surgery, as prescribed by a Physician. Excludes angioplasty (percutaneous coronary intervention) and stent implantation. 37


AUL a ONEAMERICA COMPANY YOUR BENEFITS PACKAGE

Life and AD&D

PLAY VIDEO

About this Benefit Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

Motor vehicle crashes are the

#1

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

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included in the summary plan description located on the 38 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


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

Life and AD&D insurance coverage amount of $5,000 or $15,000 (depending on your medical election) at no cost to you 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

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

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

Accidental Death & Dismemberment (AD&D) If approved for this benefit, additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract.

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. Employee Guaranteed Issue Amount: Life $250,000 AD&D $500,000 Spouse Guaranteed Issue Amount: Life $100,000 AD&D $250,000 Child Guaranteed Issue Amount: Life and AD&D $10,000

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

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

Accelerated Life Benefit 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.

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 Reduces to: 50%

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

39


Life and AD&D Voluntary Term Life with optional non-matching AD&D Coverage Monthly Payroll Deduction Illustration About your benefit options:  

You may select a minimum benefit of $10,000 up to a maximum amount of $500,000, in increments of $10,000. Amounts requested above $250,000 for an Employee, $100,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability. All AD&D amounts are Guaranteed Issue.

EMPLOYEE ONLY OPTIONS (based on Employee's age as of 01/01) 0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

AD&D

$10,000

$0.50

$0.50

$0.50

$0.60

$0.80

$1.00

$1.50

$2.50

$4.70

$7.20

$13.50

$20.00

$0.30

$20,000

$1.00

$1.00

$1.00

$1.20

$1.60

$2.00

$3.00

$5.00

$9.40

$14.40

$27.00

$40.00

$0.60

$30,000

$1.50

$1.50

$1.50

$1.80

$2.40

$3.00

$4.50

$7.50

$14.10

$21.60

$40.50

$60.00

$0.90

$40,000

$2.00

$2.00

$2.00

$2.40

$3.20

$4.00

$6.00

$10.00

$18.80

$28.80

$54.00

$80.00

$1.20

$50,000

$2.50

$2.50

$2.50

$3.00

$4.00

$5.00

$7.50

$12.50

$23.50

$36.00

$67.50

$100.00

$1.50

$80,000

$4.00

$4.00

$4.00

$4.80

$6.40

$8.00

$12.00

$20.00

$37.60

$57.60

$108.00 $160.00

$2.40

$100,000

$5.00

$5.00

$5.00

$6.00

$8.00

$10.00

$15.00

$25.00

$47.00

$72.00

$135.00 $200.00

$3.00

$130,000

$6.50

$6.50

$6.50

$7.80

$10.40

$13.00

$19.50

$32.50

$61.10

$93.60

$175.50 $260.00

$3.90

$150,000

$7.50

$7.50

$7.50

$9.00

$12.00

$15.00

$22.50

$37.50

$70.50

$108.00 $202.50 $300.00

$4.50

$180,000

$9.00

$9.00

$9.00

$10.80

$14.40

$18.00

$27.00

$45.00

$84.60

$129.60 $243.00 $360.00

$5.40

$200,000 $10.00

$10.00

$10.00

$12.00

$16.00

$20.00

$30.00

$50.00

$94.00

$144.00 $270.00 $400.00

$6.00

$230,000 $11.50

$11.50

$11.50

$13.80

$18.40

$23.00

$34.50

$57.50

$108.10 $165.60 $310.50 $460.00

$6.90

$250,000 $12.50

$12.50

$12.50

$15.00

$20.00

$25.00

$37.50

$62.50

$117.50 $180.00 $337.50 $500.00

$7.50

The Voluntary Life amounts over $250,000 require Statement of Insurability form. $260,000 $13.00

$13.00

$13.00

$15.60

$20.80

$26.00

$39.00

$65.00

$122.20 $187.20 $351.00 $520.00

$7.80

$280,000 $14.00

$14.00

$14.00

$16.80

$22.40

$28.00

$42.00

$70.00

$131.60 $201.60 $378.00 $560.00

$8.40

$300,000 $15.00

$15.00

$15.00

$18.00

$24.00

$30.00

$45.00

$75.00

$141.00 $216.00 $405.00 $600.00

$9.00

$330,000 $16.50

$16.50

$16.50

$19.80

$26.40

$33.00

$49.50

$82.50

$155.10 $237.60 $445.50 $660.00

$9.90

$350,000 $17.50

$17.50

$17.50

$21.00

$28.00

$35.00

$52.50

$87.50

$164.50 $252.00 $472.50 $700.00

$10.50

$380,000 $19.00

$19.00

$19.00

$22.80

$30.40

$38.00

$57.00

$95.00

$178.60 $273.60 $513.00 $760.00

$11.40

$400,000 $20.00

$20.00

$20.00

$24.00

$32.00

$40.00

$60.00

$100.00 $188.00 $288.00 $540.00 $800.00

$12.00

$430,000 $21.50

$21.50

$21.50

$25.80

$34.40

$43.00

$64.50

$107.50 $202.10 $309.60 $580.50 $860.00

$12.90

$450,000 $22.50

$22.50

$22.50

$27.00

$36.00

$45.00

$67.50

$112.50 $211.50 $324.00 $607.50 $900.00

$13.50

$480,000 $24.00

$24.00

$24.00

$28.80

$38.40

$48.00

$72.00

$120.00 $225.60 $345.60 $648.00 $960.00

$14.40

$500,000 $25.00

$25.00

$25.00

$30.00

$40.00

$50.00

$75.00

$125.00 $235.00 $360.00 $675.00 $1,000.00 $15.00

40


Life and AD&D Voluntary Term Life with optional non-matching AD&D Coverage Monthly Payroll Deduction Illustration About your benefit options:     

You may select a minimum Spouse benefit of $10,000 up to a maximum amount of $250,000, in increments of $10,000, not exceed 100% of the Voluntary Term Life amount selected by the Employee. Amounts requested above $100,000 for a Spouse, or any amount not requested timely will require Evidence of Insurability. All amounts of AD&D coverage are Guaranteed Issue. Employee must select Life coverage to select any Dependent Life coverage. Employee must select AD&D coverage to select Dependent AD&D coverage.

SPOUSE ONLY OPTIONS (based on Employee's age as of 01/01 and amount of coverage chosen) 0-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

AD&D

$10,000

$0.50

$0.50

$0.50

$0.60

$0.80

$1.00

$1.50

$2.50

$4.70

$7.20

$13.50

$20.00

$0.30

$20,000

$1.00

$1.00

$1.00

$1.20

$1.60

$2.00

$3.00

$5.00

$9.40

$14.40

$27.00

$40.00

$0.60

$30,000

$1.50

$1.50

$1.50

$1.80

$2.40

$3.00

$4.50

$7.50

$14.10

$21.60

$40.50

$60.00

$0.90

$40,000

$2.00

$2.00

$2.00

$2.40

$3.20

$4.00

$6.00

$10.00

$18.80

$28.80

$54.00

$80.00

$1.20

$50,000

$2.50

$2.50

$2.50

$3.00

$4.00

$5.00

$7.50

$12.50

$23.50

$36.00

$67.50

$100.00

$1.50

$80,000

$4.00

$4.00

$4.00

$4.80

$6.40

$8.00

$12.00

$20.00

$37.60

$57.60

$108.00 $160.00

$2.40

$100,000

$5.00

$5.00

$5.00

$6.00

$8.00

$10.00

$15.00

$25.00

$47.00

$72.00

$135.00 $200.00

$3.00

The Voluntary Life amounts over $100,000 require Statement of Insurability form. $260,000 $13.00

$13.00

$13.00

$15.60

$20.80

$26.00

$39.00

$65.00

$122.20 $187.20 $351.00 $520.00

$7.80

$280,000 $14.00

$14.00

$14.00

$16.80

$22.40

$28.00

$42.00

$70.00

$131.60 $201.60 $378.00 $560.00

$8.40

$300,000 $15.00

$15.00

$15.00

$18.00

$24.00

$30.00

$45.00

$75.00

$141.00 $216.00 $405.00 $600.00

$9.00

$330,000 $16.50

$16.50

$16.50

$19.80

$26.40

$33.00

$49.50

$82.50

$155.10 $237.60 $445.50 $660.00

$9.90

$350,000 $17.50

$17.50

$17.50

$21.00

$28.00

$35.00

$52.50

$87.50

$164.50 $252.00 $472.50 $700.00

$10.50

$380,000 $19.00

$19.00

$19.00

$22.80

$30.40

$38.00

$57.00

$95.00

$178.60 $273.60 $513.00 $760.00

$11.40

$400,000 $20.00

$20.00

$20.00

$24.00

$32.00

$40.00

$60.00

$100.00 $188.00 $288.00 $540.00 $800.00

$12.00

CHILD(REN) OPTIONS Child(ren) 6 months to age 26

Child(ren) live birth to 6 months

Life Monthly Payroll Deduction Amount

AD&D Monthly Payroll Deduction Amount

Option 1:

$5,000

$1,000

$0.90

$0.20

Option 2:

$10,000

$1,000

$1.80

$0.40

41


5 STAR

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 42 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


Term Life with Terminal Illness and Quality of Life Rider The Family Protection Plan: Individual Life Insurance with Terminal Illness Coverage to Age 100 With the Family Protection Plan (FPP), you can provide financial stability for your loved ones should something happen to you. You have peace of mind that you are covered up to age 100.* No matter what the future brings, you and your family will be protected. If faced with a chronic medical condition that required continuous care, would you be able to protect yourself? Traditionally, expenses associated with treatment and care necessitated by a chronic injury or illness have accounted for 86% of all health care spending and can place strain on your assets when you need them most. To provide protection during this time of need, 5Star Life Insurance Company (5Star Life) is pleased to offer the Quality of Life Rider, which is included with your FPP life insurance coverage. This rider accelerates a portion of the death benefit on a monthly basis—4% each month as scheduled by your employer at the group level, and payable directly to you on a tax favored basis. You can receive up to 75% of the current face amount of the life benefit, following a diagnosis of either a chronic illness or cognitive impairment that requires substantial assistance. Benefits are paid for the following:  Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance, or  A permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility requiring substantial supervision. Example

Weekly Premium

Death Benefit

Accelerated Benefit

Your age at issue: 35

$10.00

$89,655

4% $3,586.20 a month

Affordability—With several options to choose from, select the coverage that best meets the needs of your family. Terminal Illness—This plan pays the insured 30% (25% in Connecticut and Michigan) of the policy coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months. Portability—You and your family continue coverage with no loss of benefits or increase in cost should you terminate employment after the first premium is paid. If this happens, we can simply bill you directly. Coverage can never be cancelled by the insurance company or your employer unless you stop paying premiums. Family Protection—Individual policies can be purchased on the employee, their spouse, children and grandchildren. Children & Grandchildren Plan—Policies can be purchased for children and grandchildren ages 15 days to age 23. 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 two-year contestability period and/or under investigation. This product also contains no war or terrorism exclusions.

For example, in case of chronic illness, you would receive $3,586 each month up to $67,241.25. The remainder death benefit of $22,413.75 would be made payable to your beneficiary.

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

43


Term Life with Terminal Illness and Quality of Life Rider

Age on App. Date 18-25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 44

$10,000 $7.56 $7.58 $7.65 $7.74 $7.88 $8.07 $8.27 $8.49 $8.73 $9.00 $9.30 $9.64 $10.02 $10.41 $10.84 $11.31 $11.83 $12.41 $13.00 $13.63 $14.28 $14.97 $15.69 $16.43 $17.22 $18.08 $19.04 $20.16 $21.40 $22.79 $24.27 $25.93 $27.66 $29.42 $31.23 $33.12 $35.08 $37.13 $39.31 $41.68 $44.33

MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT Employee Coverage Amounts Spouse Coverage Amounts $25,000 $50,000 $75,000 $100,000 $10,000 $20,000 $30,000 $12.40 $20.46 $28.52 $36.58 $7.56 $10.78 $14.01 $12.46 $20.58 $28.71 $36.83 $7.58 $10.83 $14.08 $12.63 $20.92 $29.21 $37.50 $7.65 $10.97 $14.28 $12.85 $21.38 $29.90 $38.42 $7.74 $11.15 $14.56 $13.21 $22.08 $30.96 $39.83 $7.88 $11.43 $14.98 $13.67 $23.00 $32.33 $41.67 $8.07 $11.80 $15.53 $14.17 $24.00 $33.83 $43.67 $8.27 $12.20 $16.13 $14.73 $25.13 $35.52 $45.92 $8.49 $12.65 $16.81 $15.31 $26.29 $37.27 $48.25 $8.73 $13.12 $17.51 $16.00 $27.67 $39.33 $51.00 $9.00 $13.67 $18.33 $16.75 $29.17 $41.58 $54.00 $9.30 $14.27 $19.23 $17.60 $30.88 $44.15 $57.42 $9.64 $14.95 $20.26 $18.54 $32.75 $46.96 $61.17 $10.02 $15.70 $21.38 $19.52 $34.71 $49.90 $65.08 $10.41 $16.48 $22.56 $20.60 $36.88 $53.15 $69.42 $10.84 $17.35 $23.86 $21.77 $39.21 $56.65 $74.08 $11.31 $18.28 $25.26 $23.08 $41.83 $60.58 $79.33 $11.83 $19.33 $26.83 $24.52 $44.71 $64.90 $85.08 $12.41 $20.48 $28.56 $26.00 $47.67 $69.33 $91.00 $13.00 $21.67 $30.33 $27.56 $50.79 $74.02 $97.25 $13.63 $22.92 $32.21 $29.19 $54.04 $78.90 $103.75 $14.28 $24.22 $34.16 $30.92 $57.50 $84.08 $110.67 $14.97 $25.60 $36.23 $32.73 $61.13 $89.52 $117.92 $15.69 $27.05 $38.41 $34.56 $64.79 $95.02 $125.25 $16.43 $28.52 $40.61 $36.54 $68.75 $100.96 $133.17 $17.22 $30.10 $42.98 $38.69 $73.04 $107.40 $141.75 $18.08 $31.82 $45.56 $41.10 $77.88 $114.65 $151.42 $19.04 $33.75 $48.46 $43.90 $83.46 $123.02 $162.58 $20.16 $35.98 $51.81 $47.00 $89.67 $132.33 $175.00 $21.40 $38.47 $55.53 $50.48 $96.63 $142.77 $188.92 $22.79 $41.25 $59.71 $54.17 $104.00 $153.83 $203.67 $24.27 $44.20 $64.13 $58.33 $112.33 $166.33 $220.33 $25.93 $47.53 $69.13 $62.65 $120.96 $179.27 $237.58 $27.66 $50.98 $74.31 $67.04 $129.75 $192.46 $255.17 $29.42 $54.50 $79.58 $71.56 $138.79 $206.02 $273.25 $31.23 $58.12 $85.01 $76.29 $148.25 $220.21 $292.17 $33.12 $61.90 $90.68 $81.19 $158.04 $234.90 $311.75 $35.08 $65.82 $96.56 $86.31 $168.29 $250.27 $332.25 $37.13 $69.92 $102.71 $91.77 $179.21 $266.65 $354.08 $39.31 $74.28 $109.26 $97.71 $191.08 $284.46 $377.83 $41.68 $79.03 $116.38 $104.33 $204.33 $304.33 $404.33 $44.33 $84.33 $124.33


Term Life with Terminal Illness and Quality of Life Rider

Age on App. Date 66* 67* 68* 69* 70*

$10,000 $44.93 $48.25 $52.03 $56.33 $61.17

MONTHLY RATES WITH QUALITY OF LIFE RIDER DEFINED BENEFIT Employee Coverage Amounts Spouse Coverage Amounts $25,000 $50,000 $75,000 $100,000 $10,000 $20,000 $30,000 $105.81 $207.29 $308.77 $410.25 $44.93 $85.52 $126.11 $114.13 $223.92 $333.71 $443.50 $48.25 $92.17 $136.08 $123.58 $242.83 $362.08 $481.33 $52.03 $99.73 $147.43 $134.31 $264.29 $394.27 $524.25 $56.33 $108.32 $160.31 $146.42 $288.50 $430.58 $572.67 $61.17 $118.00 $174.83

*Qualify of Life not available ages 66-70. Quality of Life benefits not available for children. Child life coverage available only on children and grandchildren of employee (age on application date: 14 days through 23 years). $4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 coverage.

45


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 46 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


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.

Emergent Card Example:

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. BENEFIT We provide medical emergency transportation solutions AND cover your out of pocket medical transport cost when your insurance falls short. “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

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?

EMERGENT PLATINUM

Emergency Helicopter Transport

Emergency Ground Ambulance Transport

Fixed Wing (Airplane) Transport

Minor Child/Grandchild Return

Organ Recipient Transport

Organ Retrieval

Repatriation/Recuperation with worldwide coverage

Non-injury Transport

Pet Return

Vehicle Return

Return Transportation

Escort Transportation

Mortal Remains Transport

MASA Emergent rates are $9 a month, per employee only/ family coverage. MASA Platinum is $24.50/employee per month and $32.50/family per month.

47


Medical Transport

PLATINUM MEMBERSHIP BENEFITS

Emergency Air Medical Transportation

Should a member suffer serious life or limb threatening emergency that requires immediate transport by fixed wing or helicopter air ambulance of that member to the nearest most appropriate medical facility capable of providing required emergency medical treatments, also referred to as “golden hour transports”, MASA MTS will cover the out-of-pocket expenses resulting from that transport. (U.S. and Canada only)

Emergency Ground Transportation

Should a member suffer a life or limb emergency requiring emergent ground transport from the site of serious illness or injury, or from a transferring medical facility that is unable to provide services required, to the nearest most appropriate medical facility capable of attending to the member’s medical needs MASA MTS will cover the out-of-pocket expenses resulting from that transport. (U.S. and Canada only)

Air Transportation – Hospital to Hospital

Should a member suffer a serious illness or injury resulting in hospitalization and if the member is in need of specialized treatment not available locally, then MASA MTS will fly him/her to the nearest appropriate medical facility capable of providing such specialized treatment (Worldwide coverage)

Organ Retrieval**

MASA MTS will provide air transportation of an organ to be used in an organ transplant. (U.S. only)

Organ Recipient Transportation**

MASA MTS will fly a member to the commercial airport nearest the medical facility where an organ transplant is scheduled to happen. (U.S. only)

Recuperation / Repatriation

If a member is hospitalized while away from home, MASA MTS will fly them home to recuperate in familiar surroundings. (Worldwide coverage)

Escort Transportation

If a member requires emergency air transport, MASA MTS will fly the member's spouse, family member or friend to accompany them in the air. (Worldwide coverage)

Non-injury Transportation

If a member is hospitalized while away from his/her home for more than 7 days, the member may select a family member to visit them during confinement. MASA MTS will provide round trip, common carrier air transportation for the person selected. (Basic coverage area only*)

Minor Children / Grandchildren Return

When minor children or grandchildren are left unattended as a result of a member using MASA MTS air ambulance service, MASA MTS will provide one-way common carrier air transport for return of the children to the commercial airport nearest the place of residence of the children. (Basic coverage only*)

*Basic Coverage Area includes U.S., Canada, Mexico, and Caribbean (excluding Cuba). **One (1) year waiting period if pre-existing condition requiring transplant. There is a 90 day waiting period on pre-existing conditions. This clause is WAIVED for emergent ground and air transports.

48


Medical Transport

PLATINUM MEMBERSHIP BENEFITS

Vehicle Return

MASA MTS will return vehicles such as cars, vans, RVs or trucks owned or rented by the member when illness, injury or death requires use of the air ambulance services provided by MASA MTS. The vehicle will be carried to the member's place of residence or rental vehicles will be returned to the nearest rental company office or agent. (Basic coverage area only*)

Mortal Remains Transport

In the event a member dies while away from his/her place of residence, MASA Assist will return his/her remains to the commercial airport nearest his/her residence. (Worldwide coverage)

Pet Return

MASA MTS will return the Memberâ&#x20AC;&#x2122;s dog, cat or smaller animal, should the Member be flown to a hospital near their residence on an air ambulance arranged by the MASA MTS. (Basic coverage area only*)

*Basic Coverage Area includes U.S., Canada, Mexico, and Caribbean (excluding Cuba). There is a 90 day waiting period on pre-existing conditions. This clause is WAIVED for emergent ground and air transports.

49


NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

PLAY VIDEO

About this Benefit A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a pre-established amount of money per plan year in a Healthcare Flexible Spending Account (FSA). Funds allocated to a healthcare FSA must be used during the plan year or are forfeited unless your plan contains a $500 rollover or grace period provision.

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

FLIP TOâ&#x20AC;Ś PG. 9 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 Tyler ISD Benefits Website: www.mybenefitshub.com/tylerisd


FSA (Flexible Spending Account) NBS Flexcard

When Will I Receive My Flex Card?

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

NBS Prepaid MasterCard® Debit Card

Current plan participants: KEEP YOUR CARDS! NBS debit cards are good for 3 years. If you need a replacement card please contact NBS directly at (800) 274-0503.

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.

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 Tyler ISD benefit website: www.mybenefitshub.com/tylerisd

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

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

FSA Annual Contribution Max: $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 claim FAQs

51


FSA Frequently Asked Questions What is a Flexible Spending Account? A Flexible Spending Account allows you to save money by paying out‐of‐pocket health and/or dependent care related expenses with pre‐tax dollars. Your contribu ons 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 op on! Eligible expenses must be incurred within the plan year and have a 90 day run out period. Remember to retain all your receipts.

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

Acupuncture Body scans Breast pumps Chiropractor Co‐payments Deduc ble Diabetes Maintenance Eye Exam & Glasses Fer lity treatment First aid

        

Hearing aids & ba eries Lab fees Laser Surgery Orthodon a Expenses Physical exams Pregnancy tests Prescrip on drugs Vaccina ons Vaporizers or humidifiers

Dependent Care Expense Account Example Expenses:    

Before and A er School and/or Extended Day Programs The actual care of the dependent in your home. Preschool tui on. The base costs for day camps or similar programs used as care for a qualifying individual. Spouse or other individual who is physically or mentally incapable of self‐care may be a qualifying individual

-Spouse or Other Individual Who Is Phy sically or Mentally Incapable of Self -Care May Be a Qualifying Individual



52

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

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 +90 day grace period. Remember to retain all your receipts (including receipts for card swipes).

How Do I File A Claim? In most situa ons, you will be able to swipe your card however, in the event you lose your card or are wai ng to receive one, you can visit www.mybenefitshub.com/tylerisd and complete the “Claim Form” to send to NBS or use the web or phone app to file online.

Can Elderly Day‐Care Payments Qualify as Dependent Care Expenses? Yes, provided that the person receiving the elderly day care is a qualifying individual.* All of the other criteria for claiming expenses must also be met (e.g., the individual must regularly spend at least eight hours per day in the employee's household in order for care provided outside the employee's household to qualify for reimbursement under a DCAP).

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 or rollover after the Plan year ends for you to submit qualified claims for any unused funds. If you choose to enroll in the HSA you are not eligible to enroll in the FSA.

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WWW.MYBENEFITSHUB.COM/TYLERISD 56

2019 Benefit Guide Tyler ISD  
2019 Benefit Guide Tyler ISD